In,.

J Nun

Pergamon 0020-7489(94)00025-5

Srud., Vol. 31, No. 6, pp. 499 510. 1994 Copyrght 1994 Elsevier Saence Ltd c) Prmted m Great Britam All nghts reserved 0020 7489194 $7.00+0 00

Phenomenology: its use in nursing research

CHERYL TATANO BECK, D.N.Sc., C.N.M., F.A.A.N.
Visi/ing Associute PrqfessorUniwrsity , RI 02X81-0814. U.S.A. qf Rhode Island, College c~f Nursing, Kingston.

nurses begin to recognize the incongruities between their philosophy of nursing and their research methods, growing acceptance of phenomenology as an alternative research method is occurring. This trend is evidenced by the increase in publications of phenomenological research studies in nursing literature. The purpose of this article is to review (a) some philosophical and methodological issues of phenomenology and (b) the use of phenomenology in nursing research. The studies reviewed in this article illustrate the breadth of applicability of this qualitative method for nursing. Phenomenological research has been conducted with persons ranging from adolescents to the oldest old. Diverse clinical specialties of nursing have already proven fertile areas for phenomenological research such as medical-surgical, maternal-child, gerontological, and emergency room nursing.
Abstract-As

Phenomenology: its use in nursing research

Phenomenology provides a closer fit conceptually with clinical nursing and with the types of research questions that emerge from clinical practice than quantitative research (Davis, 1978). The emphasis in phenomenological research is on the meaning of lived experience. Other people experiences and reflections on their experiences are borrowed so that the s researcher will be better able to understand the deeper meaning or significance of an aspect of human experience (van Manen, 1984). For decades logical positivism has dominated scientific inquiry in nursing. The logical positivists view of science is not congruent with the discipline of nursing which describes its philosophy as holistic and interactive and its epistemology as knowledge based on experiencing human persons (Ray, 1990). Phenomenology affords nursing a new way to interpret the nature of consciousness and of an individual involvement in the world. s In this article, phenomenology as both a philosophy and as a method is addressed, along
499

500

C T. BPC . K

with some of the difficulties involved in researching subjectively, such as bracketing. The latter half of this article focuses on the use of phenomenology in nursing research. The results of a computer search of CINAHL database (1983-l 993) to retrieve these phenomenological studies are shared. The goal of phenomenology is to describe human experience as it is lived (MerleauPonty, 1964). Phenomena are described as they are consciously experienced without theories about their cause and as free as possible from unexamined preconceptions and presuppositions (Spiegelberg, 1975). Critical to the success of phenomenological research is this heightened awareness of the researcher consciousness. In order to accomplish this, s the process of reduction is necessary which involves recovering our original awareness of a lived experience through bracketing (Merleau-Ponty, 1956). Bracketing involves a researcher exposing his/her presuppositions about the phenomenon under study, making them appear so that the researcher can deliberately abstain from them. In order to describe lived experience the researcher needs to be astonished before the world (Merleau-Ponty, 1956). Through this astonishment, the layers of meaning provided by a researcher knows ledge and interpretation are preserved and set aside. Complete reduction, however, is not possible since a researcher consciousness is engagement in the world (Merleau-Ponty, s 1964). One can never completely accomplish the task of reduction because one never gets beyond time (p. 49). It is impossible for a researcher to be completely free of bias in reflection on the experience being studied but it is possible to control it. In phenomenology the researcher self is the major instrument for collecting data. It is s through the developing relationships that occur in the in-depth interviewing process that essential descriptions of a lived human experience are obtained. Bergum (1991) views phenomenological research as an interactive involvement of both the researcher and the researched. A problematic area phenomenologists grapple with, however, is when to use self and when to use bracketing. Lipson (1991) views this as a paradoxical struggle to both keep yourself as the researcher in there and out at the same time. Bracketing can be viewed as the tool a researcher uses to meet the ethical dictum of phenomenology (Swanson-Kauffman and Schonwald, 1988). This ethical component of phenomenology centers on accurately portraying the reality of the phenomenon under study as it is lived and described by the researcher participants. s How can researchers best suspend or bracket their beliefs about the phenomenon being studied so as to control their bias? van Manen (1984) warns that if you just try to ignore what you already know, your presuppositions may persistently creep back into your reflections. Instead he suggests that researchers make explicit their beliefs, bias, and assumptions so that they do not just try to forget them but rather turn this preconceived knowledge against itself so that the shallow or concealing character can be exposed (p. 46). Schutz (1973) acknowledges that bracketing is not a simple task but that it is within human capability. Lengthy periods of undisturbed time are needed to strip away the layers of meaning. Boyd (1993) suggests that reduction as a technique can be used in degrees. Separate layers of our interpretations or experience can be painstakingly peeled away one at a time. To facilitate bracketing Paterson and Zderad (1988) suggest some approaches for opening up one own perspective in order to break through one tunnel vision of routine. Through s s deliberate practice an individual can develop the habit of identifying and exposing one s own biases by putting beliefs and notions out on the table. By repeatedly asking, What am I taking for granted?, a person can be helped in reflecting on and articulating experi-

PHENO MENOLOG

Y: ITS USE

501

ences with the phenomenon under study. Other approaches for increasing openness to one s own perspective include noting whether the phenomenon is being experienced actively or passively and whether it is being viewed objectively or subjectively. A considerable amount of self-knowledge is required for a researcher to identify and suspend personal bias in regards to the phenomenon of study. A journal in which a researcher can reflect on personal feelings and self-questioning can help to maintain a heightened level of awareness throughout a research project (Drew, 1989). Such attentiveness permits new understandings of the phenomenon being studied that can go beyond the reality of the researcher presuppositions. s In phenomenology, experience is not limited to sensory awareness as it is in traditional science. Instead, experience incorporates multiple modes of awareness known as integral evidence which, Husserl(l962), refers to as the principle of intentionality. The observer is not separate from the observed. Subject and object are united in being in the world. A basic philosophical assumption of phenomenology is that one can only know what one experiences by attending to perceptions and meanings that awaken conscious awareness. The philosophy of phenomenology presents a dramatic difference from the logical positivist tradition in which the observer is separate from the observed and phenomena are described without any subjective interpretation (Reeder, 1984). In attempting to ensure their research is objective, logical positivists screen out certain aspects of life such as feelings and intuition which are vitally important to nursing. Even the most rigorously designed quantitative study, though, can still be subjective in relation to the researcher theoretical stance. s questions asked, and interpretation of findings (Lipson, 199 1). Phenomenological assumpi:ons in comparison to those of logical positivism have important implications for how the production of knowledge is viewed. In phenomenology meaning is constructed as an intersubjective phenomenon (Schutz, 1967). Through interactions between people, such as between researcher and informant, meaning is created. In direct contrast to this perspective is that of the natural sciences which see social facts as located in the social structure, independent of the interpretive schemes of societal members (Anderson, 1991, p. 29). In logical positivism a reductionist approach is espoused in which data are reduced or broken down into parts in order that these units be examined individually. Phenomenology and clinical nursing practice parallel each other in a number of ways. Both emphasize observing, interviewing, and interacting with clients so that a deeper understanding of the client experience can be grasped. The use of self as a data collection s instrument in phenomenological research is similar to nurses therapeutic use of self in clinical practice. Some of the activities that are an intrinsic part of nursing practice, such as striving to understand the meaning of individual experiences with illness, are an excellent fit with the phenomenological approach. Also, in phenomenology the social nature of the research act is realized. No longer is the view of subject as object meaningful, just as in nursing practice the view of client as object is not meaningful. Nurse researchers are realizing that the perspective of humans espoused by the quantitative methods is not comprehensive. Its reductionist perspective does not allow for researching human phenomena as holistic. The phenomenological approach offers nurse researchers lens for viewing rather than hammers (Psathas, 1973). As nurses begin to recognize the incongruities between their philosophy of nursing and their research methods, there is a growing acceptance of phenomenology as an alternative research method. The trend is evidenced by an increase in publications of phenomenological research studies in

502

C.T BECK

nursing literature. In the 1970s a trickle of phenomenological research studies were published in nursing journals. An upsurge of phenomenological studies appearing in the nursing literature occurred in the latter 1980s and this trend is continuing into the 1990s.
Phenomenological studies in nursing

A computer search of the CINAHL database for the years 1983-l 993 was conducted to retrieve these phenomenological studies. In reviewing the literature, three variations of the phenomenological method used most often by nurse researchers were Colaizzi (1978) Giorgi (198.5) and VanKaam (1966). During this review of published nursing literature additional phenomenological studies were found in which nurse researchers utilized more general steps of phenomenological analysis and did not use a specific modification. This review focuses on the nursing studies in which the phenomenological methodologies of Colaizzi, Giorgi, and VanKaam had been used. Thirteen nursing research studies using Colaizzi method, nine studies employing Giorgi method, and five studies utilizing Vans s Kaam modification were located. A comparison of these three phenomenological methods s can be found in Table 1 (Beck, 1994). The last column in Table 1 focuses on the credibility of the studies. Lincoln and Guba (1985) proposed that credibility is the qualitative researcher s substitute for quantitative research internal validity. This criterion addresses whether s researchers carried out their inquiry in such a way that their results will be found credible, that is, that they have represented the phenomena under study adequately. Steps that the researchers had taken to ensure that their findings were credible are identified in Tables 2-4.
Colaizzi

Search of the computerized CINAHL database revealed 13 studies in which Colaizzi s method had been used (Table 2). In four of those phenomenological studies caring was investigated. The essential structures of caring and noncaring nurse-client interactions were the focus of a study by Riemen (1986). Three themes emerged when Riemen clustered the significant statements: the nurse presence, the client response, and consequences. Forrest s s (1989) explored the lived experience of caring as perceived by 17 nurses. In a phenomenological study involving 47 undergraduate nursing students, Beck (1991a) sought to answer the question, What is the essential structure of a caring nursing student-faculty interaction? Three clusters of themes emerged: attentive presence, sharing of selves, and consequences. The meaning of caring in nursing practice for six registered nurses was highlighted in a study by Clarke and Wheeler (1992). Being supportive, communicating, pressure, and caring ability were the four caring categories that were uncovered. Colaizzi (1978) method has also been used by nurse researchers to study the meaning s of varied lived experiences of persons across the age continuum from adolescents to the elderly. Haase (1987) investigated the components of courage in nine chronically ill adolescents who described their experiences of courage during an interview. Sowell et al. (1991) interviewed eight men concerning their lived experience of survival and bereavement following the death of a lover from AIDS. Following analysis of themes and clusters of these themes, three categories evolved: isolation/disconnectedness, emotional confusion, and acceptance/denial. Rose (1990) conducted a phenomenological study of women inner strength while s Coward (1990) investigated self-transcendence in five women with advanced breast cancer.

PHENOMENOLOG Table I. Comparison Colaizzi I Read all of the subjects descriptions in order to acquire a feeling for them. Giorgi

Y: ITS USE methods Vankaam

503

of three phenomenological

1. One reads the entire description in order to get a sense of the whole.

2. Return to each protocol extract significant statements.

and

3. Spell out the meaning of each significant statement, known as formulating meanings.

2. Researcher discriminates units from the participants description of the phenomenon being studied. Researcher does this from within a psychological perspective and with a focus on the phenomenon under study. 3. Researcher expresses the psychological insight contained in each of the meaning units more directly.

4. Organize the formulated meanings into clusters of themes. a. Refer these clusters of themes back to the original protocols in order to validate them. b. At this point discrepancies may be noted among and/or between the various clusters. Researchers must refuse temptation of ignoring data or themes which do not fit. 5. Results so far are integrated into an exhaustive description of phenomenon under study.

4. Researcher synthesizes all of the transformed meaning units into a consistent statement regarding the participant s experiences. This is referred to as the structure of the experience and can be expressed on a specific or a general level.

I. Listing and preliminary grouping of descriptive expressions which must be agreed upon by expert judges. Final listing presents percentages of these categories in that particular sample. 2. In reduction the researcher reduces the concrete, vague, and overlapping expressions of the participants to more precisely descriptive terms. There again intersubjective agreement among judges is necessary. 3. Elimination of these elements that are not inherent in the phenomenon being studied or which represent a blending of this phenomenon with other phenomena that most frequently accompany it is done. 4. A hypothetical identification and description of the phenomenon being studied is written.

6. Formulate the exhaustive description of the investigated phenomenon in as unequivocal a statement of identification as possible

5. The hypothetical description is applied to randomly selected cases of the sample. If necessary, the hypothesized description is revised. This revised description must be tested again on a new random sample of cases. 6. When operations described in previous steps have been carried out successfully, the formerly hypoidentification of thetical the phenomenon under study may be considered to be a valid identification and description.

7. A final validating step can be achieved by returning to each subject asking about the findings so far. Reprinted with permission: Beck, C. T. Reliability Nursing Research. 16, 254-267 (1994). and validity issues in phenomenology. Wesfrrn Journal of

Thirteen theme clusters evolved. An example of one of these theme clusters is: selftranscendence is associated with increased appreciation of things dear and with the environment (p. 166). Through interviewing seven mothers, Beck (1992a) explored the lived experience of postpartum depression. Eleven theme clusters emerged and were integrated into an essential

504 Table 2. Nursing Authors/year published Riemen/ 1986 research

C. T. BECK studies using Colaizzi s phenomenological method

Topic Nurses noncaring and caring in the clinical setting Components of courage in chronically ill adolescents Experience of caring

Sample 10 nonhospitalized adults over 18 years of age 9 chronically ill adolescents

Data sources Interview

Credibility 8 of the nurses validated exhaustive description the

Haase/l987

Interview

Forrest/l989

17 hospital nurses

staff

Interview

Coward/l

990

Rose/l990

Self-transcendence in women with advanced breast cancer Women inner s strength Meaningful experiences the elderly life to

5 women with stage IV breast cancer 9 women who experienced inner strength 11 elderly persons ranging in age from 65 to 87 years 47 undergraduate nursing students 8 men who have lost a loved one from AIDS

Written description interview Interview

and

Trite/ 1990

Interview

Beck/ 199 1

Nursing studentfaculty caring

Written description

Sowell et al./ 1991

Wolf/ 199 1

Beck/ 1992

Survival and bereavement following the death of a lover from AIDS Nurses experiences giving postmortem care to patients who have donated organs Postpartum depression

Interview

2 doctorally prepared judges validated formulated meanings and 3 of the adolescents confirmed exhaustive descriptions Validation sought from participants to compare descriptive results 3 of the women validated the exhaustive description and so did the expert in phenomenological analysis 8 of the women clarified meanings of significant statements and validated themes 4 of 11 participants validated formulated meanings and 2 other phenomenological researchers Master prepared nurse followed s audit trail and all 47 nursing students validated exhaustive description 5 member research team analyzed transcripts

8 nurses who had given postmortem care to organ donors 7 mothers with postpartum depression 6 staff nurses

Interview

Interview

Clarke and Wheeler/l992 Phipps/l993

Caring in nursing practice Couples infertility

2 interviews

8 infertile
couples

Interview

Price/l 993

Body listening

9 healthy adults and 9 chronically ill adults

Interview and a 6-week diary

All 8 nurses received exhaustive descriptions in the mail and returned them with written comments 3 of the 7 mothers confirmed exhaustive description and master prepared nurse followed s audit trail All 6 nurses validated the exhaustive description during second interviews All couples reviewed the exhaustive description without any revisions; consultant with expertise in phenomenology reviewed audit trail Partially met during interview to review diary data; format validation of the exhaustive description was not done

PHENOMENOLOGY:

ITS USE

505

structure of postpartum depression which reflected that this phenomenon was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing. The purpose of Phipps (1993) study was to describe the lived experience of infertility for eight couples. Examples of some common categories of both male and female experiences with infertility included: evaluation of the meaning of childlessness, coping, investment, and perseverance. Price (1993) explored body listening; that is, how adults understand their internal body experience. Nine healthy adults and nine adults with either asthma or multiple sclerosis kept a &week diary and were also interviewed. Perception of energy patterns was central to both the healthy and chronically ill adults. Trite (1990) investigated meaningful life experiences for 11 elderly individuals. A meaningful life experience for the elderly involved a concern for others and a perception by the elderly that they were helpful to those other persons. Three of the phenomenological studies using Colaizzi (1978) method focused on the s lived experience of nurses themselves rather than the patients. Two of these studies involved caring research described earlier (Clarke and Wheeler, 1992; Forrest, 1989). The third study examined nurses experiences giving postmortem care to patients who have donated organs (Wolf, 1991). Examples of some clusters of themes that evolved are: dual responsibilities of nurses to donor and recipient families, the family extraordinary gift of life from death. s and the emotional difficulty for nurses at the donor death. s

Nine nursing studies which had employed Giorgi (1985) phenomenological method s were retrieved from the CINAHL database (Table 3). In some of the studies listed in Table 3 the researchers included additional steps of validation that Giorgi (1989) did not purport such as validating the emerging themes with the participants (Dobbie, 1991) or with another researcher (Porter and Clinton, 1992). These credibility steps that are not consistent with Giorgi method are not included in this table. s The relentless drive to be ever thinner was examined in Santopinto (1989) phenomenological study. From the written descriptions of this phenomenon by two women, the central finding discovered was that the relentless drive to be ever thinner is a persistent struggle toward an imaged self lived through withdrawing-engaging (p. 29). Banonis ( 1989) explored recovering from addiction of three participants. Data analysis revealed that this phenomenon involved struggling to pull oneself out of the depths of darkness into the comfort of light. Family members views of relationships between health care providers and recipients with chronic illness were examined by Thorne and Robinson (1988). This phenomenological study combined data from two separate qualitative investigations using Giorgi meths odology. Analysis of the transcriptions of the interviews from both studies yielded a conceptualization of these relationships as an evolving process which includes three stages: naive trusting, disenchantment, and guarded alliance. Giorgi (1985) phenomenological method was used to describe the lived experience of s 20 emergency department nurses encounters with patients who attempted suicide (Pallik-

506 Table 3. Authors/year published Thorne and Robinson/l988 Banonis/ 1989 Nursing research

C. T. BECK studies using Giorgi s phenomenological modification

Topic Health care relationships in chronic illness Recovering from addiction Relentless drive to be ever thinner

Sample 26 family members 3 nurses

Data sources Interviews

Credibility Bracketing

Santopintoll989

2 women

Adolescent girls experience of witnessing marital violence Henderson and Experiences of new Brouse/l991 fathers during the first 3 weeks of life Dobbie/l991 Women midlife s experience Palhkkothayil Emergency and department nurses Morgan/l991 encounters with patients who attempted suicide Porter and Adjusting to the Clinton/l992 nursing home Witnessing family Ericksen and Henderson/ 1992 violence Receiving Samarel/ 1992 therapeutic touch

Bennett/l991

5 adolescent

girls

Written descriptions interviews Written descriptions interviews Interviews

and Bracketing and returned to participants to clarify areas of ambiguity in descriptions

and

22 fathers

Interviews

10 women 20 nurses

Interviews Interviews

Follow-up telephone to clarify handwritten Bracketing

interview description

243 nursing home residents 13 children 20 adults

Interview 1-2 interviews 2 interviews Bracketing; second interview to clarify information shared in the first interview

kathayil and Morgan, 1991). Findings revealed that both the nurse and the suicide attempter brought a set of characteristics to the situation. The nurse and the suicide attempter came together in a system having its own unique characteristics. In two of the studies employing Giorgi (1985) method of phenomenological analysis, s the meaning of children witnessing family violence was explored. Adolescent girls experis ence of witnessing marital violence was investigated in the study by Bennett (1991). The following seven core themes emerged: remembering, living from day to day, feeling the impact, escaping, understanding, coping, and resolving or settling. Ericksen and Henderson (1992) conducted a phenomenological study to describe the experience of 13 children, ages 4-12 years, who witnessed family violence. Giorgi (1985) process of analysis was followed s and revealed three components of the children experience: living with violence, living in s transition, and living with mom. Henderson and Brouse (199 1) examined the experiences of 22 new fathers during the first 3 weeks of their infants lives. The fathers described their experience as a three-stage process: (a) coming to the experience of fatherhood with preconceptions about how it would be, (b) the uncomfortable reality, and (c) a conscious decision to take control and work at gaining the skills required for their view of fathering. A phenomenological study by Dobbie (1991) examined the midlife spiritual experience

PHENOMENOLOGY:ITSUSE

507

of 10 women who were members of the United Church of Canada. Data analysis of their interviews revealed that the women spiritual experience in midlife transition was organized s within two simultaneous and inter-related experiences: an evolving consciousness of self and children, and an evolving consciousness of God. The purpose of research by Samarel (1992) was to describe the patient experience of s receiving therapeutic touch (TT) treatments. Giorgi (1985) operations of phenoms enological analysis revealed that the experience of a TT treatment was one of developing physiological and mental/emotional self-awareness in addition to developing awareness of others roles and relationships with the participants. Porter and Clinton (1992) used the following research question to guide their phenomenological study: How do older adults experience the changes associated with living in a nursing home? Giorgi (1985) method was used to analyze the responses of 243 persons s and yielded two meaning units: adjustment approach and adjustment influences.
Van Kaam

Five nursing research studies were retrieved from the CINAHL database in which VanKaam (1966) method had been used (Table 4). Carter (1989) studied themes associated s with bereavement in narrative accounts of 30 adults who had experienced the death of a loved one. Five core themes of bereavement emerged: being stopped, hurting, missing, holding, and seeking. The lived experience of health was explored in two phenomenological studies: one with the oldest old (Wondolowski and Davis, 1991) and one with nursing students (Beck, 1991b). By means of VanKaam analysis, three common elements of the meaning of health for the s oldest old emerged: abiding vitality, generating fulfillment, and rhapsodic reverie (Won-

Table 4. Nursing Authors/year published Carter! 1989

research

studies using Vankaam s

phenomenological

method

Topic Themes of grief

Sample 30 adults who experienced death of a loved one 108 men and women ages 80 to lOOf

Data sources Interview

Credibility

Wondolowski and Davis/l990

Health old

in the oldest

Beck/ 199 I

Nursing students experience of health Caring between nursing students and physically/mentally handicapped children Caring among nursing students

Beck! 1992

56 undergraduate nursing students 31 senior nursing students

Second reader agreement with researcher on themes ranged from 62 to 88%. Feedback from 5 of the participants. Written All data analysis activities were descriptions and verified by a known researcher in interview if phenomenological method difficulty writing Written Master prepared nurse verified s descriptions every step of data analysis Written descriptions Master prepared nurse verified s each step of data analysis

Beck/l992

53 undergraduate nursing students

Written descriptions

Master prepared nurse verified s all steps in data analysis

508

C. T. BECK

dolowski and Davis, 1991). Beck (199lb) also explored the meaning of health but this phenomenological study focused on its meaning for 56 undergraduate nursing students. Three necessary constituents of health were identified: optimal unfolding, peaceful contentedness, and perpetual vigilance. The remaining two studies located which used VanKaam (1966) phenomenological s methodology explored the meaning of caring. The essence of a caring experience 36 nursing students had with an exceptional child was examined by Beck (1992b). Six necessary constituents of caring evolved: authentic presenting, physical connectedness, reciprocal sharing, delightful merriment, bolstered self-esteem, and an unanticipated self-transformation. Beck (1993) also investigated caring among 53 nursing students. Four necessary constituents emerged related to caring among nursing students: authentic presenting, selfless sharing, fortifying support, and enriching effects. From this review of the use of phenomenology in nursing research, the richness of the data that can emerge from this qualitative method is evident. Through phenomenological research, a deeper understanding of the essence of the phenomenon under study is discovered. The studies reviewed in this article illustrate the breadth of applicability of this qualitative method for nursing. Phenomenological research has been conducted with persons ranging from as young as 4 years old to as old as 102 years. Diverse clinical specialties of nursing have already proven fertile areas for phenomenological research such as medicalsurgical, maternal-child, gerontological, and emergency room nursing. Through phenomenological research a baseline could be provided encompassing a thorough and accurate description of nursing phenomena which would help clarify nursing concepts (Boyd, 1993). Nursing theories incorporating these clarified concepts and research studies deduced from these theories would be more relevant to nursing because they could be closely based to nursing lived world. s Because nursing is primarily a social act between nurse and client, phenomenological perspective can help increase nurses understanding of their clients by entering into their lifeworld. Conducting phenomenological research will also help nurses to learn the art of unknowing which Munhall(l993) has identified as the fifth pattern of knowing. Unknowing is similar to bracketing in phenomenology and also calls for a great amount of introspection. In order for a nurse to engage in an authentic encounter with patients, the art of unknowing s must be practiced wherein the nurse situates knowingly in one own life and interacts with full unknowingness about the other life (Munhall, 1993, p. 125). This fifth pattern s of knowing, just as phenomenological research, enables nurses to understand the essential meaning that patients experiences hold for them.

References Anderson, J. (1991). The phenomenological perspective. In Qualitative Nursing Research: a Contemporary Dialogue (Morse, J., Ed.), pp. 25-38. Sage Publications, Newbury Park, CA. Banonis, B. (1989). The lived experience of recovering from addiction: a phenomenological study. Nurs. Sci. Quart. 2, 37-43. Beck, C. T. (1991a). How students perceive faculty caring: a phenomenological study. Nurse Educator 16, 18-22. Beck, C. T. (1991 b). Undergraduate nursing students lived experience of health: a phenomenological study. J. Nurs. Educ. 30,371-374. Beck, C. T. (1992a). The lived experience of postpartum depression: a phenomenological study. Nurs. Res. 41, 166-l 70. Beck, C. T. (1992b). Caring between nursing students and physically/mentally handicapped children: a phenomenological study. J. Nurs. Educ. 31, 361-366.

PHENOMENOLOGY:

ITS USE

509

Beck, C. T. (1993). Caring among nursing students. Nurse Educaror 17,22227. Beck, C. T. (1994). Reliability and validity issues in phenomenology. Wesf. J. nurs. Res. l&254267. Bennett, L. (1991). Adolescent girls experience of witnessing marital violence: a phenomenological study. J. A&. Nurs. 16,431438. Bergum, V. (1991). Being a phenomenologicdl researcher. In QualitutiPe Nursing Research: a Contemporar> Dialogue (Morse, J., Ed.). pp. 55-71. Sage Publications, Newbury Park, CA. Boyd, C. 0. (1993). Phenomenology: the method. In Nursing Research: a Qualirath?e Perspective. 2nd ed. (Munhall. P. and Boyd, C. O., Eds), pp. 999132. National League for Nursing Press, New York. Boyd. C. 0. (1993). Philosophical foundations of qualitative research. In Nursing Research: u Qualitutice Pwspw tire, 2nd ed. (Munhall. P. and Boyd. C. O., Eds), pp. 66-93. National League for Nursing Press. New York Carter, S. (1989). Themes of grief. Nurs. Res. 38, 354358. Clarke, J. and Wheeler, S. (1992) A view of the phenomenon of caring in nursing practice. J. Adr. Nurv. 17, 1283 1290. Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In E.uistentiul Phmomenoloyic,trl Alrernariwfor Psychology (Valle, R. and King, M., Eds), pp. 48-71. Oxford University Press, New York. Coward, D. (1990). The lived experience of self-transcendence in women with advanced breast cancer. Nurs. Sci. Quarz. 3, 162-169. Davis, A. (1978). The phenomenological approach in nursing research. In The Nursing Profession: Views through New York. the Mist (Chaska, N., Ed.). McGraw-Hill, Dobbie, 9. (1991). Women mid-life experience: an evolving consciousness s of self and children. J. A&. Nur.~. 16, 825-831. Drew, N. (1989). The interviewer experience as data in phenomenological s research. Wes/. J. Nurs. REX. 11.43 I 439. Ericksen, J. and Henderson, A. (1992). Witnessing family violence: the children experience. J. A&. Nurs. 17, s 1200-1209. Forrest, D. (1989). The experience of caring. J. Adr. Nurs. 14, 815-823. Giorgi. A. (1985). Phenomenology and Psychological Research. Duquesne University Press, Pittsburgh. PA. Giorgi. A. (1989). Some theoretical and practical issues regarding the psychological phenomenological method. Soybrook Rec. 7, 71-85. Haase. J. (1987). Components of courage in chronically ill adolescents: a phenomenological study. Ah.. Nurv. SC;. 9, 64480. Henderson, A. and Brouse. A. (1991). The experience of new fathers during the Hurst 3 weeks of life. .I. Adr. Nws. 16,293-298. Husserl. E. (1962). Ideas: General Introduction to Pure Phenomenology. Macmillan. New York. Lincoln, Y. and Cuba, E. (1985). Naturalistic Inquiry. Sage Publications. Newbury Park, CA. Lipson, J. (1991). On bracketing. In Qualitative Nursing Research: u Contemporary, Dialogue (Morse. J.. Ed.). pp. 23. 24. Sage Publications, Newbury Park, CA. Merleau-Ponty, M. (1956). What is phenomenology? Cross Currenfs 6, 59-70. Merleau-Ponty. M. (1964). The Primacy ofPerception. Northwestern University Press, Evanston, IL. Munhall, P. (1993). Unknowing: toward another pattern of knowing in nursing. Nurs. Outlook 41, 125- 128. Pallikkathayil. L. and Morgan. S. (1991). Phenomenology as a method for conducting clinical research. Appl. Nur.v. Res. 4, 195-200. New York. Paterson, J. and Zderad, L. (1988). Humanistic Nursing. NLP Publication. Phipps, S. (1993). A phenomenological study of couples infertility: gender influence. HOI. Nurs. Pracr. 7,44 56. Porter, E. and Clinton, J. (1992). Adjusting to the nursing home. Wesr. /. Nurs. Rrs. 14,464481. Price, M. (1993). Exploration of body listening: health and physical self-awareness in chronic illness. Adr.. Nurs. SC;. 15, 37 ~52. Psathas, G. (1973). Phenomenological Sociology: Issues and Applications. John Wiley and Sons, New York. Ray, M. (1990). Phenomenological method for nursing research. In Nursing Prqftission: Turning Points (Chaska. H., Ed.). C. V. Mosby, St. Louis. Reeder. F. (1984). Philosophical issues in the Rogerian science of unitary human being. Adv. Nurs. Sci. 8, 14 23. Riemen, D. (1986). Noncaring and caring in the clinical setting: patients descriptions, Topics C Nurs. 8, 30 kn. 36. Rose. J. (1990). Psychologic health of women: a phenomenologic study of women inner strength. AdI>. Nur.v. Sci. s 12, 5670. Samarel. N. (1992). The experience of receiving therapeutic touch. J. Adr. Nurs. 17, 651657. Santopinto, M. (1989). The relentless drive to be ever thinner: a study using the phenomenological method. Nurs. Sci. Quurt. 2, 29-36. Schutz. A. (1967). The Phenomenology of the Social World. Northwestern University Press, Evanston. IL. Schutz. A. (1973). Collected Papers I: The Problem of Social Realitv. Martinus Nijhoff, The Hague. Sowell, R.. Bramlett, M., Gueldner, S., Gritzmacher, D. and Martin, G. (1991). The lived experience of survival and bereavement following the death of a lover from AIDS. Image 23, 89-94.

510

C. T. BECK

Spiegelberg, H. (1975). Doing Phenomenology: Essays on and in Phenomenolog~. Martinus Nijhoff, The Hague. Swanson-Kauffman, K. and Schonwald, E. (1988). Phenomenology. In Paths to Knowledge: Innovative Research Methods for Nursing (Sarter, B., Ed.), pp. 97-105. National League for Nursing, New York. Thome, S. and Robinson, C. (1988). Health care relationships: the chronic illness perspective. Res. Nurs. Hlth 11. 293-300. Trite, L. (1990). Meaningful life experience to the elderly. Image 22, 248-251. VanKaam, A. (1966). Existential Foundations of Psychology. Duquesne University Press, Pittsburgh, PA. van Manen, M. (1984). Practicing phenomenological writing. Phenomenol. Pedag. 2, 3669. Wolf, Z. (1991). Nurses experiences giving postmortem care to patients who have donated organs: a phenomenological study. Schol. Inq. Nurs. Pratt. 5, 73-87. Wondolowski, C. and Davis, D. (1991) The lived experience of health in the oldest old: a phenomenological study. Nurs. Sci. Quart. 4, 113-l 18. (Received 2 December 1993; infinalform 17 March 1994; acceptedfor publication 28 April 1994)