Hermeneutics In Health Care and Nursing

Afza.Malik GDA

Health Care and Nursing and Hermeneutics

Hermeneutics In Health Care and Nursing

Hermeneutics, Importance of Hermeneutics, Heidegger's fore structure,Interpretive Phenomenon,Nature of Hermeneutical Scholarship,Analysis of Hermeneutical Researchers,Understanding Interpretation and Critique and Benner Study

What is Hermeneutics

    Historically, hermeneutics described the art or theory of interpretation (predominantly that of texts) and was prevalent in disciplines such as theology and law. 

    German philosopher Wilhelm Dilthey's (1833-1911) redefined hermeneutics as a science of historical understanding and sought a method for deriving objectively valid interpretations. 

    Martin Hei degger (1889-1976) recast hermeneutics from being based on the interpretation of historical consciousness to revealing the temporality of self-understandings (Palmer, R., 1969).

Importance of Hermeneutics

    Hermeneutics is an approach to scholarship that acknowledges the temporal situatedness of both the researcher and the participants. Time as it advances, or time as lived, is central to the work of hermeneutics. 

    The centrality of time is what differentiates hermeneutics from traditional forms of Henselian phenomenology. The hermeneutic scholar works to uncover how humans are "always already" given as time. 

    Hermeneutics has no beginning or end that can be concretely defined but is a continuing experience for all who participate.

Heidegger's fore structure

    Interpretation presupposes a threefold structure of understanding, which Heidegger called the fore structure. The premise of the fore structure is that all interpretations are based on background practices that grant us practical familiarity with phenomena. Heidegger called this sense of phenomena fore-having. 

    Our background practices also form the perspective from which we approach understanding. Our interpretive lens, termed fore-sight, is constituted by background practices. Fore-conception describes our anticipated sense of what our interpreting will reveal. This too is shaped and framed by our background practices. 

    Understanding is circular, and humans as self-interpreting being share always already within this interpretive (hermeneutic) circle of understanding. Thus, "interpretation is never a presuppositionless grasping of something previously given" (Heidegger, 1927/1996, p. 141). 

    Hermeneutic researchers do not attempt to isolate or "bracket" their presuppositions, but rather to make them explicit. Hans Georg Gadamer (1989), a student of Heidegger's, has extended hermeneutical research in this area. 

    The essence of hermeneutics lies not in some kind of mystic relativism but in an attitude of respect for the impossibility of bringing the understanding of "Being" to some kind of final or ultimate closure. The way of hermeneutics is to allow oneself to be drawn into the complexity of the simple and overlooked (Heidegger, 1977/1993).

Interpretive Phenomenon

    The work of interpretive phenomenologists moves beyond traditional logical structures to reveal and explicate otherwise hidden relationships. Calling attention to human practices and experiences, hermeneutics is closely related to critical social theory, feminism, and postmodernism. 

    Unlike them, however, hermeneutics does not posit politically or psychologically determined frameworks as the modus operandi of the method, nor does the interpretive phenomenologist attempt to posit, explain, or reconcile an underlying cause of a particular experience. 

    Rather, the description of the common practices and shared meanings is intended to reveal, enhance, or extend understandings of the human situation as it is lived.

Nature of Hermeneutical Scholarship

    The thinking that accompanies hermeneutical scholarship is reflective, reflexive, and circular in nature. However, describing the process of hermeneutical research may suggest a linearity and structure that believed the seamless, fluid nature of this approach to inquiry. 

    On the other hand, not describing the process implies a thoughtless or haphazard approach that does not reflect the scholarliness of hermeneutical research. Therefore, al- though a brief summary of hermeneutical analysis is given here, the reader is referred to several authors (Benner, 1994; Gadamer, 1960, 1989; Grondin, 1995; Palmer, 1969) who discuss hermeneutical methodology in more detail.

Analysis of Hermeneutical Researchers

    Commonly, hermeneutical researchers work in teams and study areas of personal interest and expertise. Each interview, as text analogue, is read by team members to obtain an overall understanding. 

    Members of the research team identify common themes within each interview and share their written interpretations, including excerpts from each interview, with the team. 

    Dialogue among team members clarifies the analyses. As the team analyzes subsequent interviews, they read each text against those that preceded it. This enables new themes to emerge and previous themes to be continuously refined, expanded, or overcome. Team members clarify any discrepancies in their interpretations by referring to the interview text or reinterviewing participants. 

    This is not to say that hermeneutic researchers reduce phenomena to differences or similarities. Rather, through dialogue, the team members explicate the practices of identifying the seemingly simple and overlooked.

    Team members identify and explore themes that cut across interview texts. They reread and study interpretations generated previously to see if similar or contradictory interpretations are present in the various interviews. 

    Though an underlying assumption of hermeneutical analysis is that no single correct interpretation exists, the team's continuous examination of the whole and the parts of the texts with constant reference to the participants ensures that interpretations are focused and reflected in the text. 

    Whenever conflicts arise among the various interpretations of the interviews, team members provide extensive documentation to support their interpretations.

Understanding Interpretation and Critique and Benner Study

    Reading across post positivist, feminist, critical, and postmodern texts, team members hold open and problematic the identification and interpretation of common practices. Team members read across all texts and write critiques of the interpretations.     

    The purpose is to conduct critical scholarship using other interpretive approaches to extend, support, or overcome the themes and patterns identified by hermeneutics. In this way analysis proceeds in "cycles of understanding, interpretation, and critique" (Benner, 1994, p. 116). 

    Like the hermeneutic circle, interpretations are complete but never ending. During the interpretive sessions, patterns may emerge. A pattern is constitutive, present in all the interviews, and expresses the relationships of the themes. 

    Patterns are the highest level of hermeneutical analysis. The hermeneutic approach provides an opportunity for team members and researchers not on the team to review the entire analysis for plausibility, coherence, and comprehensiveness. 

    In addition, participants in the study may be asked to read interpretations of their interviews as well as the interviews of other participants to confirm, extend, or challenge the analysis. 

    Others, not included in the analysis but likely to be readers of this study, may review the written interpretations. This review process exposes unsubstantiated and unwarranted interpretations that are not supported by the texts. The purpose of the research report is to provide a wide range of explicated text so that the reader can recognize common practices and shared experiences. 

    The researcher writes the final report using sufficient excerpts from the interviews to allow the reader to participate in the analysis. Hermeneutical research that draws on interpretive phenomenology was introduced to nursing by Patricia Benner in Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics.     

This study revealed nursing as an interpretive practice with skills, expertise, and practical knowledge (Benner, Panner, & Chesla, 1996). Viewing nursing as a practice rather than as an applied science presents a new approach to understanding that has implications for practice, research, and education.     

Hermeneutics deconstructs the corresponding relationship between theory and practice and reveals the practical knowledge and expertise that evolves over time.

     Following the Benner study, hermeneutics emerged as a significant area of scholarship in nursing. Christine Tanner, through hermeneutical analyzes of the narratives of nurses, has recast clinical judgment making and clinical thinking as interpretive practices.     

Nancy Dickel man is utilizing hermeneutics to describe the concertful practices of teaching and learning. These shared practices of students, teachers, and clinicians offer a view of schooling, teaching, and learning as interpretive practices to transform conventional nursing education.


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