Pollio’s Approach to Existential Phenomenology: A Brief Synopsis

Pollio’s Approach to Existential Phenomenology: A Brief Synopsis

ARTICLE COMMENTARY Pollio’s Approach to Existential Phenomenology: A Brief Synopsis Janet A. Secrest, PhD, RN THERE IS A GROWING demand for evidence ...

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ARTICLE COMMENTARY

Pollio’s Approach to Existential Phenomenology: A Brief Synopsis Janet A. Secrest, PhD, RN THERE IS A GROWING demand for evidence to support our nursing practice. Although much of the research evidence has been quantitatively derived, not all research questions relevant to nursing can be reduced to statistical analysis. Take, for example, questions of an ethical or philosophical nature. Similarly, questions that involve experience and the meanings they have for people require a different approach, namely qualitative. Qualitative and quantitative methodologies can be complementary to give nursing a more complete picture. An example contrasting the two complementary research methodologies involves time. The length of stay in the PACU is a common outcome measure in research and quality assurance. In this instance, time is measured precisely by the clock to see if a particular “best practice” will reduce the number of minutes patients spend in the PACU. But this says nothing of how people experience time, which is another matter altogether. Time can be agonizingly slow for the mother waiting for her child undergoing surgery. On the other hand, it can be agonizingly fast to the nurse who is desperately working with that newly extubated child with an airway crisis. Of the many qualitative methodologies, existential-phenomenology is the one that strives to uncover meaning in experience. Even within existential-phenomenology, there are several approaches! One such approach, Pollio’s,1,2 has had particular relevance and utility for nursing. Howard Pollio, a psychologist at the University of Tennessee, has led a multidisciplinary interJournal of PeriAnesthesia Nursing, Vol 22, No 1 (February), 2007: pp 5-9

pretive group that has been a working laboratory for the refinement and application of this methodology. This interdisciplinary collaboration has proven productive, resulting in successful dissertations and published papers3–14 and books.1,2 To understand what Pollio’s approach brings to existential-phenomenology, some grounding in the overarching methodology is important. Existential-phenomenology arose from a union of two philosophies, both concerned with human existence. Existentialism can be traced to the 19th century works of Kierkegaard, Dostoyevsky, and Nietzsche, for whom the personal meaning of man’s everyday, concrete existence was important.15 Edmund Husserl (1859-1938), the German philosopher, is considered founder of phenomenology. His emphasis was on a rigorous scientific method to uncover answers to “what do we know as persons?”16 Thus, existentialism is a philosophy concerned with questions of human existence, and phenomenology with the methods needed to study existence. Their union, first by Heidegger, then Merleau-Ponty, opened a path for “a rigorous description of

Janet A. Secrest, PhD, RN, is a UC Foundation Associate Professor, University of Tennessee at Chattanooga, Chattanooga, TN. Address correspondence to Janet A. Secrest, PhD, RN, University of Tennessee at Chattanooga, School of Nursing, Dept. 1051, 615 McCallie Ave, Chattanooga, TN 37403; e-mail address: [email protected]. © 2007 by American Society of PeriAnesthesia Nurses. 1089-9472/07/2201-0002$35.00/0 doi:10.1016/j.jopan.2006.11.008 5

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human life as it is lived and reflected upon in all of its first-person concreteness, urgency, and ambiguity.”1 This approach seeks to understand a phenomenon in the everyday world, investigating people’s experiences and the meanings these experiences have to them. Intentionality and figure/ground are two important aspects of human existence (or consciousness) to understand from an existential-phenomenological perspective. Intentionality is the fundamental relatedness of humans and the world. Existence is always contextual and situated: “There is no inner man, man is in the world, and only in the world does he know himself.”17 In other words, there is no “I” separate from the world. From a research perspective, this means that the person cannot be taken out of the context of the situation; variables about the person cannot be separated from the person. An example would be measuring pain numerically without addressing the context in which the pain is occurring. Investigating experiences in isolation from the world, as many studies do, violates this methodological understanding of human experience. Figure/ground is another important aspect of human experience. Existence, which means literally “to stand out,” emerges as a figure against a ground. Figural experiences are those that stand out. The figure/ground concept is readily understood when viewing reversible pictures of, for example, the vase and faces. In viewing these types of pictures, it becomes obvious that only one aspect of the picture is clearly in focus at a time; the other way of seeing the picture becomes the background: one does not exist without the other. We have all had the experience of not noticing something in our environment until we have direct experience with it, and then we begin to see that “something” everywhere! It is not that the “something” has become more in number or frequency; it has just become more figural for us. We are just noticing it more—it has become more meaningful. Figure/ground is not a static concept, as

figural experiences recede into ground and ground becomes figural. Importantly, what stands out for someone provides significant glimpses into what is meaningful to that person. Figure and ground are different aspects of the same experience, providing a way of describing and contextualizing human experience. Qualitative research has been called “soft science” by some who doubt this branch of research can have rigor. To those conducting qualitative research true to its philosophical underpinnings, we resoundly reject that notion! Pollio’s approach has procedures that enhance the rigor of its studies: (1) an interpretive research group, (2) a bracketing interview, (3) themes stated in words of the participants, and (4) a thematic structure. The significance of each of these will be discussed as they arise in the following chronology.

The Process The process in Pollio’s approach (Fig 1) provides a path to understanding. This is not meant to be rigidly prescriptive, but rather to be mindful of different foci as the research progresses. The process is facilitated by an interpretive research group. Pollio’s original group was in-

Fig 1. Steps in Pollio’s approach to existential-phenomenology. Modified and reprinted with the permission of Cambridge University Press from Pollio et al.1

POLLIO’S APPROACH TO EXISTENTIAL PHENOMENOLOGY

terdisciplinary, composed of faculty, graduate, and doctoral students, clinicians, and researchers. The nature of the group was stable, yet dynamic, supportive, yet challenging. Several members provided the core, with many others entering the group for varying periods of time. Group members differed in education, experience, and discipline, but each person’s interpretation or contribution was valued equally. Pollio emphasizes that the group’s purpose is to look at all possible interpretations of the text, to provide banter of opinion, to hold other members to instances in the text to support their interpretations. The interpretive research group plays a pivotal role in this approach. Cornerstones of a successful interpretive group are mutual respect and an openness to explore one’s own and others’ perspectives. Focus: Self

Initially, the focus is on self, meaning the researcher. Phenomenological reduction, also called bracketing, is frequently referred to as the process of suspending assumptions or presuppositions about the phenomenon under study (eg, the perianesthesia experience). This seems not only a formidable task, but in fact, an impossible one! How can we not know what we know? In Pollio’s approach, we aim to more fully know what we know—make clearer our perhaps unconscious biases through an interview of the researcher on the phenomenon by a member of the interpretive group. The group and researcher participate in the analysis of the transcribed interview in the same manner the participants’ transcripts are analyzed; this way the researcher’s perspective is laid bare! The researcher is clear about what his/her biases are and must try to hold those in check; the interpretive group is there along the way to be certain this is so. Bracketing as a solitary endeavor is very difficult to do. Even with a supportive group, this is difficult. The purpose of Pollio’s interpretive group is to offer competing explanations and to be mindful of that bracketing interview. In this way, bracketing continues throughout the study.

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Focus: Participants

The focus shifts to the participants, who are then interviewed. The interview is a dialogue between researcher and participant as meaning unfolds in the context of the interview. Kvale18 writes the word as Inter View to emphasize its dialogic nature and the interconnectedness between the researcher and participant, also known as the co-researcher. Both of those involved in the interview have an interest in the phenomenon under study. The interview questions are designed to evoke descriptions of direct experiences as they are lived. The descriptions are thus of unreflected experience. In other words, not of what the participant thought about the experience, but instead of what the participant describes of the experience, of specific details. It is the interviewer’s challenge to return to the details of the phenomenon, to keep the focus on the unreflected descriptions. This is an important distinction from experience that has been reflected on and/or explained. In examining questions of existence or meaning, as mentioned above, “to stand out,” a typical opening question in Pollio’s approach may be: “Please describe specific experiences of . . . that stand out for you.” Describing specific experiences grounds the participant in experience rather than reflection or explanation, and those that stand out are those that are meaningful. The participant, therefore—not the interviewer— chooses the experiences that relate to the phenomenon under study. Nurses make good phenomenological interviewers because the dialogue is not unlike therapeutic communication, with the difference being that this is not therapeutic, but rather focused on the phenomenon under study. Focus: Text

The interviews are transcribed verbatim and the participants are given a pseudonym. Participants in qualitative research are not referred to as “subjects,” and in this approach, keeping track of the transcripts in their wholeness is easier when there is a name association.

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The purpose of interpretation in Pollio’s approach is to recognize patterns or themes, and to describe relationships in the themes in a thematic structure. The hermeneutic circle is a way of interpreting texts through a part-towhole process. This approach offers a contextual basis for all interpretations through an understanding of the relation between a passage (part) of an individual transcript and the entire (whole) transcript; and an individual transcript (part) in relation to all of the transcripts (whole); the “wholes” are in turn understood in relation to the “parts.” Although the process seems circular, and at times a back-and-forth movement between part and whole, the understanding is more a spiral. With each return to the part or whole, a deeper understanding is attained. The interpretive group is an important aspect in implementing the hermeneutic circle. Analysis begins with an individual transcript, which is read aloud within the group. Any group member is free to interrupt the reading to discuss, question, or offer an interpretation of a passage. Discrete passages are understood in the context of the whole transcript and vice versa. Through immersion in the data, patterns and themes emerge within and across transcripts. Pollio1 makes a clear distinction between the words infer and interpret. Infer means “to bring in,” such as to bring in or overlay a theoretical understanding. To infer means “to add a layer of abstraction to the interpretation,” placing the relationships into a theoretical framework. The central theme for the perianesthesia experience was “control.” An example of inference would be to place this theme in the context of Neuman’s Model as within the client’s normal line of defense; loss of control would threaten that line. Interpret, on the other hand, means to carry between. An interpretation is a bridge to understanding without adding a level of abstraction. Pollio uses interpretation, not inference, as a path to understanding. Because the approach seeks an interpretation rather than an inference,

theoretical or abstract conjectures are avoided. Instead, the actual words of participants are used, avoiding a misinterpretation. In a sense, this is also a bracketing technique because in grounding the interpretation in the text, an overlay of the researcher’s perspective is avoided. Thus, the focus remains close to the text, and hence, with the participant. Most researchers using this approach develop a thematic structure, which is a diagrammatic representation demonstrating the interrelationship of the themes. This provides a view of the whole experience and the relationship among themes. In the process of diagramming the relationships among themes, the researcher is better able to discern among themes and categories. This avoids a laundry list of unrelated “themes” seen in some studies that fail to capture the essence of the experience. Focus: Participants

When the researcher and the interpretive group are satisfied the thematic structure is representative of the experience, it may then be shared with participants. Does the interpretation bridge a new understanding? Is it plausible? Illuminating? In our experience, the thematic structure has been so for the participants. Most participants in phenomenological studies express gratitude for the opportunity to speak about something important to them; indeed, conducting this type of research is also a profound experience for the researcher. Focus: Research/Practice Community

Finally, the focus turns to the research and practice community as the findings are disseminated. Most who have conducted this research have found that each time it has been presented, a deeper understanding of the phenomenon is found. Understanding meaning of experience is important so nurses at the bedside can be authentically present to their patients. While the approaches and procedures are very different from quantitative methodologies, the evidence

POLLIO’S APPROACH TO EXISTENTIAL PHENOMENOLOGY

we demand for this research methodology should be every bit as rigorous as we demand for quantitative methodologies. Pollio’s approach to existential-phenomenology builds in

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rigor through its use of an interpretive research group, bracketing interview of the researcher, use of participants’ words, and a thematic structure representing the whole experience.

References 1. Pollio HR, Thompson CB, Henley T. The Phenomenology of Everyday Life. Cambridge, UK: Cambridge University Press; 1997. 2. Thomas SP, Pollio HR. Listening to Patients: A Phenomenological Approach to Nursing Research and Practice. New York: Springer Publishing Co; 2002. 3. Brooks A, Thomas SP, Droppleman PG. From frustration to red fury: A description of work-related anger in male registered nurses. Part II. Nurs Forum. 1996;31:22-33. 4. Fields B, Reesman K, Robinson C, et al. Anger of AfricanAmerican women in the South. Issues Mental Health Nurs. 1998;19:353-373. 5. Meighan M, Davis MW, Thomas SP, et al. Living with postpartum depression: The father’s experience. Am J Matern Child Nurs. 1999;24:202-208. 6. McCurry AH, Thomas SP. Spouses’ experiences in heart transplantation. Western J Nurs Res. 2002;24:180-194. 7. Mozingo JN, Davis MW, Droppleman PG, et al. “It wasn’t working”: Women’s experiences with short-term breastfeeding. AJNIT. 2000;25:120-126. 8. Secrest J, Norwood B, Keatley V. The meaning of professionalism for Baccalaureate nursing students. J Nurs Educat. 2003;42:77-82. 9. Secrest J, Thomas SP. Continuity and discontinuity: The experience of life following stroke. Rehabil Nurs. 1999;24: 240-266,270.

10. Smith M, Droppleman PG, Thomas SP. Under assault: The experience of work-related anger in female registered nurses . . . part I. Nurs Forum. 1996;31:22-33. 11. Smucker C. A phenomenological description of the experience of spiritual distress. Nurs Diagn. 1996;7:81-91. 12. Thomas SP. A phenomenological study of chronic pain. Western J Nurs Res. 2000;22:683-705. 13. Thomas SP, Smucker C, Droppleman PG. It hurts most around the heart: A phenomenological exploration of women’s anger. J Adv Nurs. 1998;28:311-322. 14. Tuck I, du Mont P, Evans G, et al. The experience of caring for an adult child with schizophrenia. Arch Psychiatr Nurs. 1997;11:118-125. 15. Stewart D, Mickunas A. Exploring phenomenology. A guide to the field and its literature. Chicago, IL: American Library Association; 1974. 16. Cohen MZ, Omery A. Schools of phenomenology: Implications for research. In: Morse J, ed. Critical issues in qualitative research methods. Thousand Oaks, CA: Sage Publications; 1994. 17. Merleau-Ponty M. Phenomenology of perception. London: Routledge & Kegan Paul; 1945/1962. 18. Kvale S. Interviews. An introduction to qualitative research interviewing. Newbury Park, CA: Sage Publications; 1996.