Kathleen Galvin

Background Health ministries in Europe are investing increasingly in innovative digital technologies. Older adults, who have not grown up with digital innovation, are expected to keep up with technological shifts as much as other age groups. This is ethically challenging, as it may threaten a sense of dignity and well-being in older adults. Research objective To clarify the phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met within the context of digitally led healthcare in Norway. Research design A Reflective Lifeworld Research design was chosen, and purposive, in-depth interviews were conducted. Participants and research context The participants were 13 adults 75 years and older from Northern Norway, living at home and not receiving consistent assistance. Ethical considerations Followed the principles of the Helsinki Declaration. This study was approved by the Social Science Data Services in Norway (project number 916119). Interviews were conducted carefully within a safe environment chosen by the participants. Findings Older adults experience that using new digital systems in healthcare makes them become dependent with experiences of helplessness. They feel an increased sense of dependency on other people, and that recognition can assail their experience of personal dignity. Older adults not only expect digitally led healthcare to give them a feeling of safety but also experience feeling insecure concerning privacy and loss of possibilities for dialogue with healthcare providers. They are met by demands from society, which they often struggle to achieve. Conclusion The phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met within digitally led healthcare, indicates a sense of feeling lost in the digital world. Further, innovative healthcare lacks focus on ethical performance. This impacts their perception of dignity, as loss of dignity is noticed especially in its rupture.

Something is missing in contemporary health and social care. Health and illness is often measured in policy documents in economic terms, and clinical outcomes are enmeshed in statistical data, with the patient's experience left to one side. This stimulating book is concerned with how to humanise health and social care and keep the person at the centre of practice. Caring and Well-Being opens by articulating Galvin and Todres' innovative framework for humanising health care and closes with a synthesis of their argument and a discussion of how this can be applied in healthcare policy and practice. It: presents an innovative lifeworld-led approach to the humanisation of care; explores the concept of well-being and its relationship to suffering and outlines the rationale for a focus on them within this approach; discusses how the framework can be applied and how health and social practitioners can draw on aesthetic and empathic avenues to help develop their capacity for care; provides direction for policy, practice and education. Investigating what it means to be human in a health and social care context and what the things that make us feel more human are, this book presents new perspectives about how professionals can enhance their capacity for humanly sensitive care. It is a valuable work for all those interested in ideas about care and caring in a health and social context, including psychologists, doctors and nurses.

ABSTRACT The aim of this article is to bring philosophical thinking closer to practice-based empirical work. Using Martin Heidegger’s philosophy, it offers a bridge between these two worlds, attempting to provide philosophical depth to the findings of a hermeneutic phenomenological study. This process unfolded through the appearance of three intertwined, potential, meaningful modes of being in the lifeworld: space as a condition for being and being for worlding the world; temporal and spatial self-being, the existence of multiple selves in time and space; and suffering and thriving as modes of being. The article extends the dialogue and concludes with key reflections and insight for research practice.

The poet speaks in a particular way that can “bring things to nearness”. This particular way of bringing things to nearness may have some useful implications for understanding human well-being. Sometimes I have noticed that, when I read a poem that really “speaks to me”, the poetic language puts me in touch with well-being in a very palpable way, and this has brought me to wonder about this question: What is it that is taking place in a much loved poem that can bring me close to a felt sense of well-being? This paper will draw upon some philosophical insights from the writings of Heidegger and Gendlin to explore what poetry opens up and holds in order to speak of well-being. What is it about poetry that is adequate to hold the deepest roots of hearing with the fullness of what is speaking? Heidegger’s later ideas about the essence of language and its non-representational power held within the unity of “the fourfold” may be helpful here. And what is it about poetry that can open up worlds, open us to sensation, and carry us beyond the literal words into the experience of well-being? Gendlin’s ideas concerning “thinking beyond patterns” and “carrying forward” may illuminate how poetry holds open what other language cuts off for us. The paper will conclude by pointing to poetry as a crucial form of adequate human discourse that is up to the task of understanding well-being and is therefore highly relevant to health and social care.

Our general purpose is to show how a philosophically oriented theoretical foundation, drawn from a lifeworld perspective can serve as a coherent direction for caring practices in education. We argue that both caring and learning share the same ontological foundation and point to this intertwining from a philosophical perspective. We proceed by illustrating shared epistemological ground through some novel educational practices in the professional preparation of carers. Beginning in a phenomenologically oriented philosophical foundation, we will first unfold what this means in the practice of caring, and secondly what it means for education and learning to care in humanly sensitive ways. We then share some ways that may be valuable in supporting learning and health that provides a basis for an existential understanding. We argue that existential understanding may offer a way to bridge the categorisations in contemporary health care that flow from problematic dualisms such as mind and body, illness and well-being, theory and practice, caring and learning. Ways of overcoming such dualistic splits and new existential understandings are needed to pave the way for a care that is up to the task of responding to both human possibilities and vulnerabilities, within the complexity of existence. As such, we argue that caring and learning are to be understood as an intertwined phenomenon of pivotal importance in education of both sensible and sensitive carers. Lifeworld led didactics and reflection, which are seen as the core of learning, constitute an important educational strategy here.

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life‐world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care feel humanly focused. An action research group process in 2014–2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third‐year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care.

Understanding people's experience of skin ageing as it is lived can enable sensitive approaches to promoting healthy skin and to care in general. By understanding the insider perspective, what it is like for individuals, a way to sensitise practice for more humanly sensitive care is offered. Through interviews with seventeen community‐dwelling older people, the essential meaning of living within ageing skin was illuminated as a state of managed inevitability. The skin is inevitably changing, and ageing skin is a marker of change over time but the person within remains. Constituents of the phenomenon comprise the experience of unfamiliar sights and sensations given by ageing skin; facing and accepting bodily changes and seeing this back and forth in family connections; taking care of the skin “to face” the world; and to present oneself to others and a different place in the world, same person, changed body. Findings point to why and how nurses can treat older people as persons by not over emphasising a view on ageing bodies or bodies with aged skin alone, but in tempering this view with deeper existential insights, meeting the older person with a skin care need as a person and not just as a physical entity.

In bringing together this special edition we wish to contribute to a conversation concerning the meaning of 'evidence-based practice'. We are nurses and phenomenological researchers interested in lifeworld approaches and in the many ways of knowing that are relevant to everyday caring practice. In the context of the ever-increasing specialisation of knowledge, we wish to widen the embrace of current notions of evidence and point to ways of knowing that are inclusive of the 'head, hand and heart'. This wider embrace of evidence does not excessively exclude kinds of knowledge that include the aesthetic, empathic, embodied and relational dimensions of understanding.

Nel corso degli ultimi 20 anni c’è stata una espansione globale in materia di istruzione dottorale e in particolare di ‘dottorati professionali’. Difficoltà nell’avanzamento e nel completamento diventano sempre più il centro dell’attenzione per tutti i tipi di dottorato. È stato riconosciuto che una serie di fattori al di là di quelli prettamente demografici potrebbe influire sulla possibilità di completare gli studi. C’è ancora molto da imparare sul motivo per cui l’avanzamento e il completamento del dottorato sono così impegnativi. In questo articolo vorremmo mettere in evidenza un settore che sembra trascurato dalla ricerca: l’esperienza emotivamente complessa del percorso di dottorato.Offriamo un contributo al dibattito su ciò che è necessario per facilitare il successo e intrinsecamente un soddisfacente avanzamento all’interno di un programma di dottorato professionale. Noi sosteniamo che una maggiore attenzione debba essere prestata al cammino esperienziale di studenti di dottorato dal momento che essi hanno il difficile compito di integrare la loro vita personale, professionale e accademica. Il nostro interesse per le risorse emotive di cui gli studenti possono avvalersi durante il loro percorso di dottorato è iniziato con la progettazione e lo sviluppo del nostro primo dottorato professionale in materia di sanità e cura. Attraverso la nostra iniziale esperienza con due gruppi di studenti, abbiamo riflettuto sullo sviluppo del dottorato professionale, in generale, e trasversalmente a diverse altre discipline, per comprendere meglio come facilitare una buona esperienza di dottorato e una conclusione nei tempi.L’importanza di partecipare all’esperienza emotiva all’interno del complesso percorso di dottorato professionale ci ha portato al concetto di ‘nourished scholarship’. Si definisce la nozione di ‘nourished scholarship’ come un percorso di apprendimento che lega i valori personali, significativi e attuali, allo sviluppo e al contributo professionale. Tale nutrimento emotivo è caratterizzato da una soddisfacente esperienza di scambio tra il sé, l’apprendimento e la comunità di pratica/studio. La nostra opinione è che tale nutrimento emotivo sia una risorsa fondamentale da cui gli studenti attingono al momento di negoziare le sfide complesse del percorso professionale di dottorato. Al fine di illustrare il significato di ‘nourished scholarship’ descriviamo alcune delle sue dimensioni emotive chiave. Queste dimensioni possono essere agevolate in vari modi, ma qui ne segnaliamo uno in particolare: il sostegno reciproco e la supervisione di gruppo facilitata. Al fine di illustrare le dimensioni della ‘nourished scholarship’ quindi noi riflettiamo su un caso specifico, quello di una coorte di studenti di dottorato professionale. Sono state estratte alcune loro esperienze per illustrare sette dimensioni che sono importanti per contribuire all’esperienza di ‘nourished scholarship’ come una risorsa di sostegno:- Sperimentare i benefici di appartenenza- Aiutarsi vicendevolmente a contenere l’ansia- Vivere la crescente fiducia- Accettare comunanza e unicità- Miglioramento personale, identità professionale e accademica attraverso la chiarificazione dei valori- Sperimentare i benefici di relazionarsi ad una più ampia comunità scientifica- Accettare i ritmi dei tempi in cui ricevere dei tempi attivi.Inoltre, in questo articolo si riflette su come la particolare struttura del programma di dottorato è stata in grado di sostenere lo sviluppo di queste risorse. Ci sono state tre caratteristiche chiave che crediamo siano state fondamentali nel modo in cui il programma è stato progettato e realizzato:a) ‘Cohortness’ in cui gli studenti si impegnano con il programma come un gruppo in viaggio.b) Supervisione di coorte: anche se tutti studiavano diversi argomenti, si è formato un gruppo insieme a due facilitatori accademici per discutere il processo, l’esperienza del percorso e il loro apprendimento.c) Una strategia di valutazione flessibile che permette agli studenti di progredire in modo personale e non lineare.Il valore potenziale di questo articolo per i programmi educativi è che fornisce un quadro per focalizzare l’attenzione sull’importanza del percorso emotivo e sui modi per sostenere la motivazione degli studenti e la resilienza. Noi crediamo che questo quadro abbia un potenziale trasferibile ad altre situazioni in cui tali risorse emotive possono essere importanti.During the past 20 years there has been a global expansion in doctoral education and in particular professional doctorates. Difficulties with progression and completion have increasingly become the focus of attention within both academic and professional contexts. It has been acknowledged that a range of factors, beyond demographics, could be influential in whether students are able to sustain their studies to completion. In this paper we stress the importance of conceptualising professional doctoral studies as a personal, professional and academic journey that is sustained by emotional factors that may need more explicit attention. As such, our contribution is the delineation of a phenomenon that we call ‘nourished scholarship’. We wish to illustrate how such ‘nourished scholarship’ functions as a resource for sustaining motivation and integration through the doctoral journey. We offer seven dimensions that a doctoral programme needs to embody in order to facilitate ‘nourished scholarship’: belonging, containing anxiety, growing confidence, commonality and uniqueness, values clarification, scholarly community, and negotiating the rhythms of receptive and active times. We illustrate these dimensions in the context of a professional doctorate programme that emphasises ‘cohort supervision’ as the primary resource for facilitating such nourished scholarship. We believe that this notion has transferable potential to other provisions where such emotional resources may be important.

Nel corso degli ultimi 20 anni c’è stata una espansione globale in materia di istruzione dottorale e in particolare di ‘dottorati professionali’. Difficoltà nell’avanzamento e nel completamento diventano sempre più il centro dell’attenzione per tutti i tipi di dottorato. È stato riconosciuto che una serie di fattori al di là di quelli prettamente demografici potrebbe influire sulla possibilità di completare gli studi. C’è ancora molto da imparare sul motivo per cui l’avanzamento e il completamento del dottorato sono così impegnativi. In questo articolo vorremmo mettere in evidenza un settore che sembra trascurato dalla ricerca: l’esperienza emotivamente complessa del percorso di dottorato.Offriamo un contributo al dibattito su ciò che è necessario per facilitare il successo e intrinsecamente un soddisfacente avanzamento all’interno di un programma di dottorato professionale. Noi sosteniamo che una maggiore attenzione debba essere prestata al cammino esperienziale di studenti di dottorato dal momento che essi hanno il difficile compito di integrare la loro vita personale, professionale e accademica. Il nostro interesse per le risorse emotive di cui gli studenti possono avvalersi durante il loro percorso di dottorato è iniziato con la progettazione e lo sviluppo del nostro primo dottorato professionale in materia di sanità e cura. Attraverso la nostra iniziale esperienza con due gruppi di studenti, abbiamo riflettuto sullo sviluppo del dottorato professionale, in generale, e trasversalmente a diverse altre discipline, per comprendere meglio come facilitare una buona esperienza di dottorato e una conclusione nei tempi.L’importanza di partecipare all’esperienza emotiva all’interno del complesso percorso di dottorato professionale ci ha portato al concetto di ‘nourished scholarship’ . Si definisce la nozione di ‘nourished scholarship’ come un percorso di apprendimento che lega i valori personali, significativi e attuali, allo sviluppo e al contributo professionale. Tale nutrimento emotivo è caratterizzato da una soddisfacente esperienza di scambio tra il sé, l’apprendimento e la comunità di pratica/studio. La nostra opinione è che tale nutrimento emotivo sia una risorsa fondamentale da cui gli studenti attingono al momento di negoziare le sfide complesse del percorso professionale di dottorato. Al fine di illustrare il significato di ‘nourished scholarship’ descriviamo alcune delle sue dimensioni emotive chiave. Queste dimensioni possono essere agevolate in vari modi, ma qui ne segnaliamo uno in particolare: il sostegno reciproco e la supervisione di gruppo facilitata. Al fine di illustrare le dimensioni della ‘nourished scholarship’ quindi noi riflettiamo su un caso specifico, quello di una coorte di studenti di dottorato professionale. Sono state estratte alcune loro esperienze per illustrare sette dimensioni che sono importanti per contribuire all’esperienza di ‘nourished scholarship’ come una risorsa di sostegno:- Sperimentare i benefici di appartenenza- Aiutarsi vicendevolmente a contenere l’ansia- Vivere la crescente fiducia- Accettare comunanza e unicità- Miglioramento personale, identità professionale e accademica attraverso la chiarificazione dei valori- Sperimentare i benefici di relazionarsi ad una più ampia comunità scientifica- Accettare i ritmi dei tempi in cui ricevere dei tempi attivi.Inoltre, in questo articolo si riflette su come la particolare struttura del programma di dottorato è stata in grado di sostenere lo sviluppo di queste risorse. Ci sono state tre caratteristiche chiave che crediamo siano state fondamentali nel modo in cui il programma è stato progettato e realizzato:a) ‘Cohortness’ in cui gli studenti si impegnano con il programma come un gruppo in viaggio.b) Supervisione di coorte: anche se tutti studiavano diversi argomenti, si è formato un gruppo insieme a due facilitatori accademici per discutere il processo, l’esperienza del percorso e il loro apprendimento.c) Una strategia di valutazione flessibile che permette agli studenti di progredire in modo personale e non lineare.Il valore potenziale di questo articolo per i programmi educativi è che fornisce un quadro per focalizzare l’attenzione sull’importanza del percorso emotivo e sui modi per sostenere la motivazione degli studenti e la resilienza. Noi crediamo che questo quadro abbia un potenziale trasferibile ad altre situazioni in cui tali risorse emotive possono essere importanti.During the past 20 years there has been a global expansion in doctoral education and in particular professional doctorates. Difficulties with progression and completion have increasingly become the focus of attention within both academic and professional contexts. It has been acknowledged that a range of factors, beyond demographics, could be influential in whether students are able to sustain their studies to completion. In this paper we stress the importance of conceptualising professional doctoral studies as a personal, professional and academic journey that is sustained by emotional factors that may need more explicit attention. As such, our contribution is the delineation of a phenomenon that we call ‘nourished scholarship’. We wish to illustrate how such ‘nourished scholarship’ functions as a resource for sustaining motivation and integration through the doctoral journey. We offer seven dimensions that a doctoral programme needs to embody in order to facilitate ‘nourished scholarship’: belonging, containing anxiety, growing confidence, commonality and uniqueness, values clarification, scholarly community, and negotiating the rhythms of receptive and active times. We illustrate these dimensions in the context of a professional doctorate programme that emphasises ‘cohort supervision’ as the primary resource for facilitating such nourished scholarship. We believe that this notion has transferable potential to other provisions where such emotional resources may be important

We are particularly interested in how poetry and phenomenological research come together to increase understanding of human phenomena. We are further interested in how these more aesthetic possibilities of understanding can occur within a community context, that is the possibility of a process in which understanding is shared through an ongoing process of participation. In this way phenomenologically-oriented understandings may meaningfully speak of that which is common between us as well as that which may be uniquely lived for each of us in terms of its individual context and nuance. In this paper we reflect on a process by which we engaged with participants to poetically re-present a description of an experiential phenomenon. As part of this process we offered an evocative description of a health care scenario, and facilitated collectively created ‘embodied responses’ inspired by the interactive form of Japanese Renga. We ask the question: “What kind of phenomenology is this?” Through so doing we attempt to address the theme of this special issue, namely, a focus on a wide embrace of the notion of evidence. We do this by drawing out the epistemological implications of a phenomenological approach that attends to the ‘awakening of presences’ in embodied and linguistic ways. In this pursuit we are assisted by the writings of Gendlin, Gadamer, Levinas and Shotter. Indo-Pacific Journal of Phenomenology , Volume 12, Special Edition July 2012

Within the context of health and social care education, attempts to define ‘scholarship’ have increasingly transcended traditional academic conceptions of the term. While acknowledging that many applied disciplines call for a kind of ‘actionable knowledge’ that is also not separate from its ethical dimensions, engagement in the caring professions in particular provides an interesting exemplar that raises questions about the nature and practice of ‘actionable knowledge’: how is such knowledge from different domains integrated and sustained? This paper is theoretical and wishes to outline some philosophical ideas that may be important when considering the characteristics of the kind of scholarship for caring practices that draw on deep resources for creativity and integration. Firstly, there is an attempt to clarify the nature of scholarly practice by drawing on Aristotle’s notion of ‘phronesis’ . Secondly, a more meditative approach to the integration of knowledge, action and ethics is highlighted. Finally, its implications for scholarship are introduced, in which scholarly integration may best be served by more contemplative ways of being and thinking. Drawing on Heidegger and Gendlin, we consider the challenges of contemplative thinking for pursuing scholarly practice. We articulate contemplative thinking as an unspecialized mode of being that is given to human beings as an intimate source of creativity. The sense in which unspecialization can be cultivated and practised is discussed

This study aimed to investigate the phenomenon of the meaning of mobility for elders living in rural areas. A phenomenological study was undertaken with older people living in rural South West England and Wales. Ten interviews were undertaken in peoples’ homes and focused on the spatial dimensions of what it was like to live in the rural area and the everyday experiences of traversing rural space. Spatial mobility was experienced by our sample as any of the possible ways that achieved personal life activities where the traverse of space was normally relevant. We describe the meaning of mobility sensitised by the terms used in the “continuum of mobilities” : “literal mobility,” “virtual mobility,” “potential mobility,” and “imaginative mobility.” Our phenomenological findings revealed that the transport and mobility needs of older people living in rural areas could not be meaningfully understood without understanding their well-being priorities, the kinds of movement that constituted well-being, and how this related to the phenomenon of “dwelling,” which included their feeling of “at-homeness” in their rural environment. But also what emerged was a second phenomenon that we have called rural living as a portal to well-being in older people. The connection between well-being and rural place was constituted by two interrelated experiences: the importance of dwelling and slowing down in older age, and the importance of a “rich textured locale” for the well-being of rural older people. We conclude by considering how the elders in our study may have something important to remind us: that mobility and sense of place are mutually implicated and that our present culture places an over emphasis on mobility, which may obscure the value of dwelling.

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense

In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus revisit the potential of Husserl’s notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl’s interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices