Phenomenological – hermeneutic approach

4 Methodological framework

4.1 Phenomenological – hermeneutic approach

The overall aim of this study was to explore PIRs’ potential to promote quality improvement in terms of human care values such as participation, influence and collaboration, according to the body of scientific knowledge and experiences from care receivers and care providers.

To achieve the goal of the study, the research questions seek

descriptions, insight and understanding, therefore, a phenomenological and hermeneutic scientific philosophy was relevant (Dahlberg et al., 2008; Gadamer et al., 2010). While phenomenology is a philosophical approach to the study of lived experiences (Dahlberg et al., 2008), hermeneutics is the philosophy of understanding gained through interpretation (Dahlberg et al., 2008; Gadamer et al., 2010).

As PIRs were conducted in a context, in this thesis mental health services after a prevailing restraint event, an interpretation of the experiences applying a hermeneutical approach contributed to an extended understanding of the explored phenomena, the PIR (Gadamer et al., 2010). According Hans Georg Gadamer (2010), understanding, that is more than an explanation, may be achieved through entering the hermeneutic circle, a dialectic movement between proximity and distance, parts and the whole, self and others and present and past.

the patient’s experienced knowledge by requesting and recognising the knowledge may thus increase the patients’ power.

4 Methodological framework

The following section describes the methodological framework applied in this thesis. The phenomenological-hermeneutical approach is described, as are further methods with descriptions of data collecting methods, participants, data analyses and ethical and methodological considerations.

4.1 Phenomenological – hermeneutic approach

To achieve the goal of the study, the research questions seek

the patient’s experienced knowledge by requesting and recognising the knowledge may thus increase the patients’ power.

in 2015 where the risk of bias in my research became a conversation topic.

During the interviews with patients and care providers, I experienced gradually expressed attitudes and utterances that stimulated reflections regarding PIRs. ‘To be aware of my bias,’ (Gadamer et al., 2010, p.241) was than a primary hermeneutic task. The interviews and reflections with my supervisors and the advisory group contributed thus to extending my previous understanding of PIRs. As an example, I became during these processes gradually aware of the PIR context as critical for the patients’

experiences of the encounter.

The phenomenological-hermeneutic interpretation process

A scoping review and two empirical studies were conducted to achieve the overall aim and the study’s research questions. The three sub-studies were interpreted inductively.

Understanding, or as Gadamer (2010) puts it, a fusion of horizons, was in this thesis developed as the dialogs, transcribed to written text, and me a researcher dialectically moved between the empirical findings and theory and further between the parts and the whole in a hermeneutic circle. Each sub-study was both a part and a whole, so the movement took place both within the parts and the whole of each sub-study and later each sub-study was integrated into synthesis to develop new understanding (Gadamer et al., 2010; Graneheim et al., 2017; Graneheim

& Lundman, 2004).

Gadamer (2010) emphasises bringing one’s own preunderstanding into play in the interpretation process. This implies the challenge to meet the data with openness and reflexivity. New expanded understanding derived from my pre-understanding arose in the interviews with patients and care providers as well as discussions with supervisors, research fellows and an advisory group that had experience (Greenhalgh et al., 2004).

The researcher’s pre-understanding

A basic assumption in hermeneutics is that one never meets the world without prejudice. Gadamer et al. (2010) emphasize that our prejudice is a necessary condition for understanding what is possible. Therefore, to clarify my pre-understanding is of importance from the philosophical and methodological perspective of this thesis.

At the beginning start of my work with this project, my pre-understanding was highly influenced by my 20 years of care experiences with people with mental health problems. In the period 1992–2002, I worked as a lead nurse in a ward unit that frequently used mechanical and physical restraint. I did sometimes participate in restraint events where I later identified my emotional reactions as ‘moral uneasiness’

(Norvoll et al., 2017). In the actual ward unit, we had to a small extent organised systematic reflection regarding moral views on our practice.

The turning point was in the early 2000s when I joined the board of The Mental Health Nursing Group in Norwegian Nurses Association.

Through this work I met previous patients and fellows that presented other perspectives and solutions that challenged my previous attitudes and practices. Consequently, my master thesis in 2009 dealt with service users’ (ex-patients’) experiences with restraint measures in mental health services. What affected me most through this work, was services users who told about being re-traumatised by being restrained after previous physical and sexual abuse and further the participants’ statements that they were never offered PIRs afterwards. PIRs were at the time only routinely offered to care providers (Hammervold, 2009).

My pre-understanding with respect to PIRs was initially characterized by a predominant positive attitude, where I claimed to have no professional or ethical objections regarding conducting PIRs after use of coercion.

This attitude was even commented on after a presentation of the project