Using Qualitative Research in a Clinical Setting

Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting Using the following articles as a guide, discuss when you would use qualitative research in your clinical practice and why. .11.pdf .12.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Using Qualitative Research in a Clinical Setting. The Humbled Expert: An Exploration of Spiritual Care Expertise Nick Sinclair / Alamy By Gail E. Pittroff Gail E. Pittroff, PhD, RN, is an Assistant Professor at St. Louis University in St. Louis, Missouri, and a Commissioned Lay Minister in the United Church of Christ. She has experience in ICU, maternal newborn, hospital administration, hospice, and inpatient palliative care. The author declares no conflict of interest. ABSTRACT: This interpretive phenomenological study explored how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Humbled experts describes the nurses’ personhood and spiritual care practices, offering insight for skilled spiritual care in any setting. Accepted by peer review 1/9/13 DOI:10.1097/CNJ.0b013e318294e8d3 164 JCN/Volume 30, Number 3 KEY WORDS: chaplaincy, end-of-life, nursing, palliative care, spiritual care journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Lord, make me an instrument of your peace. Where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; and where there is sadness, joy. O Divine Master, grant that I may not so much seek to be consoled as to console; to be ­understood as to understand; to be loved as to love. For it is in giving that we receive; it is in pardoning that we are pardoned; and it is in dying that we are born to eternal life. Amen Saint Francis of Assisi EXPLORING SPIRITUAL CARE EXPERTISE predicated on being humble; humility is essential for providing care and comaint Francis of Assisi, medieval, fort. “Humbled experts” represents the personhood and spiritual care practices mystic, and monastic, comof the palliative care nurse consultants posed this famous prayer of interviewed for the study. Although poetic paradox (Tyson, 1999). this study focused on inpatient palliaThe word paradox literally means something contradictory or opposite of tive care, nurses in any setting can learn what makes sense, yet represents truth. much about spiritual care from the Humbled experts is a paradoxical theme nurse participants. Inpatient palliative care is a rapidly that emerged through a study of palliative care nurse consultants and their exploding field of study. Caregivers in spiritual care expertise (Pittroff, 2010). palliative care seek to understand the problems and challenges of end of life Expertise in professional healthcare through research, which provides often is in contradiction with humilevidence for the best care of patients ity.Yet, in the context of spiritual care and their families. Spiritual care is a key at the end of life, nursing expertise is S journalofchristiannursing.com component of quality end-of-life care, yet there is a paucity of research on spiritual care in the inpatient setting at the end of life.The purpose of this study was to better understand how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Additional aims included discovering the personhood of nurses providing spiritual care for dying patients. A purposeful sample of 10 experienced palliative care nurse consultants working in inpatient palliative care in the Midwestern United States were recruited for two recorded semi­structured interviews to produce 20 transcripts. Institutional review board approval was obtained from the author’s institution, and informed consent was obtained from all participants. A historical self-awareness, nursing process, and expertise in practice interview guide were utilized to obtain narrative data (Benner, Tanner, & Chesla, 2009). Transcripts were decoded, checked for accuracy, and analyzed by the primary investigator (PI). Using Qualitative Research in a Clinical Setting Themes were identified by the PI and verified by a team of experienced interpretive phenomenological researchers as well as validated by participants. Interpretive phenomenology, which seeks holistic understanding and illumination of phenomena, was the methodology used for this study. This is an appropriate research method for examining the everyday practice and skill of providing spiritual care. As nurses presented narratives about caring for patients and families at end of life, they described the lived experience of providing spiritual care in concrete situations where meaning and shared experiences were uncovered and skills and practices explicated. A CHORUS OF HUMBLED ­EXPERTS Ten female nurses actively employed as inpatient palliative nurse consultants participated in this study. They had a median age of 54.5, with 31 median years in nursing and 6.5 median years of palliative care experience. Two of the nurses worked in urban settings, four in suburban, and four in rural settings. JCN/July-September 2013 165 Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Their educational levels included two associate, five bachelors, and three masters degreed nurses. Every nurse reported active participation in a faith tradition; nine Christian and one Unitarian Universalist were represented. Pseudo names were assigned to the nurses to protect anonymity. None of the participants reported receiving education in spiritual care in their basic nursing education, especially at the end of life. What little knowledge they did receive was just the “tip of the iceberg.” Bev, when asked if she had received spiritual care training in nursing school, said, “No absolutely not, oh wait I take that back, we had a lecture on the five stages of grief, one lecture, that was it.” Melissa saw spiritual care as part of the holistic model of caring in all settings and said: Nurses provide spiritual care all the time, but not formalized like a chaplain would, but they do and sometimes we don’t even realize that were doing it. It’s part of our overall nursing care that isn’t defined as spiritual but it is. All participants had continuing education in spiritual care through conferences or personal study. However, it was largely through their personal life experience, participation in a faith community, and evolving nursing practice that they learned to recognize and offer an alternative to spiritual suffering. All had experienced loss, some through personal illness and many through family illness and death. The following excerpts represent the notion of humbled experts.The opportunity to provide care at end of life was described as a “gift” and the role of providing presence, support, and spiritual advocacy as “honor and privilege.”The capacity to provide care of this nature is related to the nurses’ own experience of suffering and loss, growing spiritual awareness, and learned ability not to judge others.The experience of being with people undergoing loss and death creates a context of hospitality, invitation, and mutuality of care.These experiences also have enlarged the nurses’ own perspectives on life: 166 JCN/Volume 30, Number 3 Jane: People very much invite you into their lives… As I arrived she took her last breaths…this was the end of an ongoing relationship with many difficult decisions being made… I looked upon this as a gift… Her death was very peaceful and I was able to be present…It’s an honor to be part of that. Melissa: The patient had just died…the daughter was screaming on the floor, so I got on the floor with her and tried to support her. I spent a lot of time with her, not always saying anything, just being present with her, holding her hand. One of the physicians said to me, ‘That’s not your job…’ I’m thinking, it is my job, that’s part of palliative care, to support the family, that’s really what the nurse does, you know, and it is spiritual. Vicki: I have learned not to be judgmental of people and to accept people for who they are. Before this, I took care of patients in their homes…I saw people with nothing, dirty homes, very sad situations, high illiteracy rates… Gosh, when you started talking to some people, victims of sexual abuse and incest, I wasn’t even aware of that… I was really sheltered. Working in hospice and palliative care was eye-opening for me, because you go home humbled every day from that.You think I’m so grateful for my family and what I have. Lucy: Looking back on my hospice experiences made me realize that you can’t be judgmental. Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting. Every family is very different, there isn’t a right way and a wrong way, it’s just their way.The biggest piece is trying to put yourself in their shoes…and saying to yourself, if this was me, and I were in this situation, what would I want to hear? Invitation, hospitality, support, presence, nonjudgment, and the recognition of gift and grace represent the etiquette these nurses embody while providing spiritual care. Benner et al. (2009) call this “ethical comportment,” an attribute of agency in expert nursing practice. The manners and humbled relational stances of the nurses engage and permit actualization of spiritual and transcendent meanings and concerns. Through the practice of ordinary acts of nursing care, clients can experience, in their last moments on this earth, the very mystery of our existence. Religious parlance would speak of this as participation with an “experience of the redemptive activity of the Mystery at the heart of things” (Dykstra, 1999, p. xi). Many of the nurses testified with conviction about a reinforcement of their spirituality, mutuality of care, and mystery of human existence they experience while attending to the spiritual needs of others. Cindy had direct personal and professional experience with loss and the redemptive nature of spiritual care inclusive of God, self, and others. She highlighted the void that exits when spiritual concerns are dismissed and death is denied: PI: You mentioned feeling excluded from your grandmother’s funeral when you were young. What other experiences had an impact on you? Cindy: I’m a cancer survivor myself. We’ve had a lot of cancer in our family, so I’ve experienced a lot of death as an adult in our family. I think that’s why I initially was asked to participate in putting our palliative team together here at the hospital. People knew my experiences… they thought I’d be good at it, and my past experiences have helped a bunch. PI: How would you say it’s helped? Cindy: Well, I’ve had surgery, chemotherapy, radiation. I understand the side effects, the feelings, the anxieties, and the fears. I think that just helps me relate to patients and the families… My illness also strengthened my faith, because I had a lot of prayer at that time, I was baptized at that time. So I think I kind of went through a transformation during my cancer treatment that increased my faith and strengthened it. PI: So you relied on your religious beliefs and the rituals that you’ve learned as a Christian? journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Cindy: I think for self-support as well as trying to help support others. Certainly I think faith is really important. It’s important to help get you through crisis, and no matter what the outcome, you need that. beliefs… the power the human spirit has amazes and humbles me a lot. I feel very fortunate… it puts the rest of my life into perspective too. The chorus of the nurses’ voices revealed that through a humbled relational stance, the client and family Cindy’s dialog highlights the intersecting relationship inclusive of God, self, experience support, presence, nonjudgand others that is articulated in spiritual ment, and empathy. The nurses describe care literature (Guido, 2010; Kelly, 2004; the opportunity to provide spiritual care Taylor, 2002) and the things that matter as one of gift, privilege, and honor, taking a relational stance when providing care. to her in terms of spiritual care and practice. Dunne (1997) discusses how “I AND THOU” RELATIONSHIP practices rely on socially embedded Years of experience and learning practical knowledge; certainly both engendered responsiveness and shared and tacit background meanings enter into the world of nursing practice empathy from the nurses when dealing with people undergoing, tragedy, loss, in this setting and others. Cindy’s experiences of being excluded from her and fear of the unknown. They nurses in this study intentionally work to create and embody a subject-tosubject stance rather than the subjectto-­object distancing so prevalent in healthcare. Within this relational stance, study participants described feelings of hospitality, privilege, honor, and mutuality. Bev illuminates the personal understandings and professional experiences that engender this stance: I discharged a patient to hospice today and I thanked him for allowing me to care for him…To be able to help people at this time of life, their most difficult, to take that last step with them is truly an honor…v as you become older I think your spirituality develops more, because as you mature, you recognize the meaning of life. Expertise in professional healthcare often is in contradiction with humility. grandmother’s funeral, personal illness, and multiple losses of loved ones combine to inform her practice. Her “Being” represents, as Gadamer (1975) described, a “fusion of horizons” (p. 304) with those she cares for. This, simply put, is a shared social reality or understanding of and participation with others who face similar exclusion, dislocation, illness, fear, anxiety, and death. Cindy’s very “Being” and capacity to respond to suffering is grounded by her personal and professional experience. This “fusion” is affirmed by those who knew and recruited her to start a palliative care program. The following excerpt from ­Donna summarizes the honor and mystery of life revealed to her while providing care: To me it is really an honor to be able to assist people on this journey…People are very honest at the end of their life and you get a glimpse to see into their soul… I see souls, I see spirits, they’re incredible beings, and I know they’re going to go on. It reaffirms my spiritual journalofchristiannursing.com provide for their clients what theologian Craig Dykstra (1999) metaphorically calls “bread instead of stones” (p. 13). They accomplish this largely through a relational stance they maintain with their clients, which Martin Buber (1958) named an “I and Thou” relationship. This is a subjectto-subject rather than a subject-toobject way of relating. It necessitates a humbling of self and reverence to another for full engagement. Pohlman’s (2009) research on fathers of critically ill preterm infants discussed the technological gaze that persons fall victim to in the healthcare setting, and the objectifying stance this creates in modern institutional care. Jesus, in the hours before his arrest and crucifixion, taught the disciples the gift of servanthood through the act of washing their feet (John 13:1-17). Jesus embodied through ritual a humbling of self and reverence to another. He honors the disciples and ultimately, through an “I and Thou” relational stance, honors God. The Bev describes herself as a “cradle Catholic” (Catholic from birth). She holds firm to her belief and faith conviction that as she stated, “I was born to love and serve God and others.” Bev also articulated her journey into palliative care as being influenced by her father’s death and the positive connection and experiences her father and entire family encountered with the hospice team prior to his death. Bev highlighted how personal experience with loss, in addition to providing insight and help for others, also has the potential for interfering with spiritual caring. This occurs when personal self-disclosure supersedes the awareness of client needs. Bev is clear about the importance of humility and this assists her in maintaining an “I and thou” or humbled relational stance: I see this at times when not so much patients, but families are struggling to do the right thing for their loved one. Someone on the healthcare team, when JCN/July-September 2013 167 Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. we’re having meetings, will all of a sudden start talking about something in their personal life involving a crisis…. It doesn’t help, it’s irrelevant… If the family wants to know more they will ask you about your personal life, but for the most part families don’t…Later families will say to me oh, “I felt so sorry for him [the team member]” and I’m thinking wait a minute, it’s not a about him, it’s about you. Self-disclosure regarding personal experience and/or beliefs can be beneficial and may enhance the involvement of care. But central to spiritual care is a client-centered therapeutic relationship. Caregivers must continue to examine if their motivation for self-disclosure is meeting their own needs or the needs of their clients. Taylor (2002), when entire palliative team. She views spiritual care as inclusive of all that gives meaning and value to life, including the religious aspect that, for many patients, articulates the essence of spirituality. She considers the focus of palliative care one in which you utilize the entire team to holistically meet client needs. Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting. This team approach highlights what Benner et al. (2009) called expert agency, the ability to work in and through others to meet client needs: Bev: I always, well I won’t say 100% of the time, but for the most part I have the chaplains come in and discern spiritual needs. They are the experts in that field; they are equipped to respond to patients from an active religious standpoint as well as general support and spiritual Sophia: You know it’s interesting because people come with a lot of hope, and we talked about hope in the meeting.The chaplain said sometimes hope changes and goes from hope for a cure, to hope for time, and then a hope for peace. I think because those words came from a chaplain, it was more comforting to the family. Chaplains are faith-driven and there may be a mistrust of the medical at this point… But when the family acknowledges peace, something that people get spiritually from God, I think it opens up a dialogue for me as a nurse practitioner, where I can say, ‘Well, we are not able to cure this, but we can provide comfort…’.The chaplain also promised the wife that someone from their department would see her husband each shift for prayer and support. Nothing can be more valuable to Personal experience with loss…has the potential for interfering… when personal self-disclosure supersedes the awareness of client needs. discussing spiritual self-awareness, suggests nurses ask themselves, “What is the purpose of my self-revelation? For whom is this disclosure? Will my disclosure enhance the therapeutic relationship?” (p. 71). This holds true for the disclosure of personal life experience as well as personal beliefs and values. Bev views her relationship with clients as “invitation” and responds to their hospitality to cojourney with them at the most difficult moments as one of “honor and privilege.” She is aware of the difference between self-serving commentary and communication that meets client needs. Through this awareness she is able to embody a humbled expert relational stance, which includes her ability to enlist other experts. “ENLISTING OTHER EXPERTS” Bev’s humility assists her in careful discernment of not only her nursing role but also the expertise of the 168 JCN/Volume 30, Number 3 guidance… Enlisting all the experts in the care of patie …Using Qualitative Research in a Clinical Setting Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Using Qualitative Research in a Clinical Setting

Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting Using the following articles as a guide, discuss when you would use qualitative research in your clinical practice and why. .11.pdf .12.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Using Qualitative Research in a Clinical Setting. The Humbled Expert: An Exploration of Spiritual Care Expertise Nick Sinclair / Alamy By Gail E. Pittroff Gail E. Pittroff, PhD, RN, is an Assistant Professor at St. Louis University in St. Louis, Missouri, and a Commissioned Lay Minister in the United Church of Christ. She has experience in ICU, maternal newborn, hospital administration, hospice, and inpatient palliative care. The author declares no conflict of interest. ABSTRACT: This interpretive phenomenological study explored how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Humbled experts describes the nurses’ personhood and spiritual care practices, offering insight for skilled spiritual care in any setting. Accepted by peer review 1/9/13 DOI:10.1097/CNJ.0b013e318294e8d3 164 JCN/Volume 30, Number 3 KEY WORDS: chaplaincy, end-of-life, nursing, palliative care, spiritual care journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Lord, make me an instrument of your peace. Where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; and where there is sadness, joy. O Divine Master, grant that I may not so much seek to be consoled as to console; to be ­understood as to understand; to be loved as to love. For it is in giving that we receive; it is in pardoning that we are pardoned; and it is in dying that we are born to eternal life. Amen Saint Francis of Assisi EXPLORING SPIRITUAL CARE EXPERTISE predicated on being humble; humility is essential for providing care and comaint Francis of Assisi, medieval, fort. “Humbled experts” represents the personhood and spiritual care practices mystic, and monastic, comof the palliative care nurse consultants posed this famous prayer of interviewed for the study. Although poetic paradox (Tyson, 1999). this study focused on inpatient palliaThe word paradox literally means something contradictory or opposite of tive care, nurses in any setting can learn what makes sense, yet represents truth. much about spiritual care from the Humbled experts is a paradoxical theme nurse participants. Inpatient palliative care is a rapidly that emerged through a study of palliative care nurse consultants and their exploding field of study. Caregivers in spiritual care expertise (Pittroff, 2010). palliative care seek to understand the problems and challenges of end of life Expertise in professional healthcare through research, which provides often is in contradiction with humilevidence for the best care of patients ity.Yet, in the context of spiritual care and their families. Spiritual care is a key at the end of life, nursing expertise is S journalofchristiannursing.com component of quality end-of-life care, yet there is a paucity of research on spiritual care in the inpatient setting at the end of life.The purpose of this study was to better understand how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Additional aims included discovering the personhood of nurses providing spiritual care for dying patients. A purposeful sample of 10 experienced palliative care nurse consultants working in inpatient palliative care in the Midwestern United States were recruited for two recorded semi­structured interviews to produce 20 transcripts. Institutional review board approval was obtained from the author’s institution, and informed consent was obtained from all participants. A historical self-awareness, nursing process, and expertise in practice interview guide were utilized to obtain narrative data (Benner, Tanner, & Chesla, 2009). Transcripts were decoded, checked for accuracy, and analyzed by the primary investigator (PI). Using Qualitative Research in a Clinical Setting Themes were identified by the PI and verified by a team of experienced interpretive phenomenological researchers as well as validated by participants. Interpretive phenomenology, which seeks holistic understanding and illumination of phenomena, was the methodology used for this study. This is an appropriate research method for examining the everyday practice and skill of providing spiritual care. As nurses presented narratives about caring for patients and families at end of life, they described the lived experience of providing spiritual care in concrete situations where meaning and shared experiences were uncovered and skills and practices explicated. A CHORUS OF HUMBLED ­EXPERTS Ten female nurses actively employed as inpatient palliative nurse consultants participated in this study. They had a median age of 54.5, with 31 median years in nursing and 6.5 median years of palliative care experience. Two of the nurses worked in urban settings, four in suburban, and four in rural settings. JCN/July-September 2013 165 Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Their educational levels included two associate, five bachelors, and three masters degreed nurses. Every nurse reported active participation in a faith tradition; nine Christian and one Unitarian Universalist were represented. Pseudo names were assigned to the nurses to protect anonymity. None of the participants reported receiving education in spiritual care in their basic nursing education, especially at the end of life. What little knowledge they did receive was just the “tip of the iceberg.” Bev, when asked if she had received spiritual care training in nursing school, said, “No absolutely not, oh wait I take that back, we had a lecture on the five stages of grief, one lecture, that was it.” Melissa saw spiritual care as part of the holistic model of caring in all settings and said: Nurses provide spiritual care all the time, but not formalized like a chaplain would, but they do and sometimes we don’t even realize that were doing it. It’s part of our overall nursing care that isn’t defined as spiritual but it is. All participants had continuing education in spiritual care through conferences or personal study. However, it was largely through their personal life experience, participation in a faith community, and evolving nursing practice that they learned to recognize and offer an alternative to spiritual suffering. All had experienced loss, some through personal illness and many through family illness and death. The following excerpts represent the notion of humbled experts.The opportunity to provide care at end of life was described as a “gift” and the role of providing presence, support, and spiritual advocacy as “honor and privilege.”The capacity to provide care of this nature is related to the nurses’ own experience of suffering and loss, growing spiritual awareness, and learned ability not to judge others.The experience of being with people undergoing loss and death creates a context of hospitality, invitation, and mutuality of care.These experiences also have enlarged the nurses’ own perspectives on life: 166 JCN/Volume 30, Number 3 Jane: People very much invite you into their lives… As I arrived she took her last breaths…this was the end of an ongoing relationship with many difficult decisions being made… I looked upon this as a gift… Her death was very peaceful and I was able to be present…It’s an honor to be part of that. Melissa: The patient had just died…the daughter was screaming on the floor, so I got on the floor with her and tried to support her. I spent a lot of time with her, not always saying anything, just being present with her, holding her hand. One of the physicians said to me, ‘That’s not your job…’ I’m thinking, it is my job, that’s part of palliative care, to support the family, that’s really what the nurse does, you know, and it is spiritual. Vicki: I have learned not to be judgmental of people and to accept people for who they are. Before this, I took care of patients in their homes…I saw people with nothing, dirty homes, very sad situations, high illiteracy rates… Gosh, when you started talking to some people, victims of sexual abuse and incest, I wasn’t even aware of that… I was really sheltered. Working in hospice and palliative care was eye-opening for me, because you go home humbled every day from that.You think I’m so grateful for my family and what I have. Lucy: Looking back on my hospice experiences made me realize that you can’t be judgmental. Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting. Every family is very different, there isn’t a right way and a wrong way, it’s just their way.The biggest piece is trying to put yourself in their shoes…and saying to yourself, if this was me, and I were in this situation, what would I want to hear? Invitation, hospitality, support, presence, nonjudgment, and the recognition of gift and grace represent the etiquette these nurses embody while providing spiritual care. Benner et al. (2009) call this “ethical comportment,” an attribute of agency in expert nursing practice. The manners and humbled relational stances of the nurses engage and permit actualization of spiritual and transcendent meanings and concerns. Through the practice of ordinary acts of nursing care, clients can experience, in their last moments on this earth, the very mystery of our existence. Religious parlance would speak of this as participation with an “experience of the redemptive activity of the Mystery at the heart of things” (Dykstra, 1999, p. xi). Many of the nurses testified with conviction about a reinforcement of their spirituality, mutuality of care, and mystery of human existence they experience while attending to the spiritual needs of others. Cindy had direct personal and professional experience with loss and the redemptive nature of spiritual care inclusive of God, self, and others. She highlighted the void that exits when spiritual concerns are dismissed and death is denied: PI: You mentioned feeling excluded from your grandmother’s funeral when you were young. What other experiences had an impact on you? Cindy: I’m a cancer survivor myself. We’ve had a lot of cancer in our family, so I’ve experienced a lot of death as an adult in our family. I think that’s why I initially was asked to participate in putting our palliative team together here at the hospital. People knew my experiences… they thought I’d be good at it, and my past experiences have helped a bunch. PI: How would you say it’s helped? Cindy: Well, I’ve had surgery, chemotherapy, radiation. I understand the side effects, the feelings, the anxieties, and the fears. I think that just helps me relate to patients and the families… My illness also strengthened my faith, because I had a lot of prayer at that time, I was baptized at that time. So I think I kind of went through a transformation during my cancer treatment that increased my faith and strengthened it. PI: So you relied on your religious beliefs and the rituals that you’ve learned as a Christian? journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Cindy: I think for self-support as well as trying to help support others. Certainly I think faith is really important. It’s important to help get you through crisis, and no matter what the outcome, you need that. beliefs… the power the human spirit has amazes and humbles me a lot. I feel very fortunate… it puts the rest of my life into perspective too. The chorus of the nurses’ voices revealed that through a humbled relational stance, the client and family Cindy’s dialog highlights the intersecting relationship inclusive of God, self, experience support, presence, nonjudgand others that is articulated in spiritual ment, and empathy. The nurses describe care literature (Guido, 2010; Kelly, 2004; the opportunity to provide spiritual care Taylor, 2002) and the things that matter as one of gift, privilege, and honor, taking a relational stance when providing care. to her in terms of spiritual care and practice. Dunne (1997) discusses how “I AND THOU” RELATIONSHIP practices rely on socially embedded Years of experience and learning practical knowledge; certainly both engendered responsiveness and shared and tacit background meanings enter into the world of nursing practice empathy from the nurses when dealing with people undergoing, tragedy, loss, in this setting and others. Cindy’s experiences of being excluded from her and fear of the unknown. They nurses in this study intentionally work to create and embody a subject-tosubject stance rather than the subjectto-­object distancing so prevalent in healthcare. Within this relational stance, study participants described feelings of hospitality, privilege, honor, and mutuality. Bev illuminates the personal understandings and professional experiences that engender this stance: I discharged a patient to hospice today and I thanked him for allowing me to care for him…To be able to help people at this time of life, their most difficult, to take that last step with them is truly an honor…v as you become older I think your spirituality develops more, because as you mature, you recognize the meaning of life. Expertise in professional healthcare often is in contradiction with humility. grandmother’s funeral, personal illness, and multiple losses of loved ones combine to inform her practice. Her “Being” represents, as Gadamer (1975) described, a “fusion of horizons” (p. 304) with those she cares for. This, simply put, is a shared social reality or understanding of and participation with others who face similar exclusion, dislocation, illness, fear, anxiety, and death. Cindy’s very “Being” and capacity to respond to suffering is grounded by her personal and professional experience. This “fusion” is affirmed by those who knew and recruited her to start a palliative care program. The following excerpt from ­Donna summarizes the honor and mystery of life revealed to her while providing care: To me it is really an honor to be able to assist people on this journey…People are very honest at the end of their life and you get a glimpse to see into their soul… I see souls, I see spirits, they’re incredible beings, and I know they’re going to go on. It reaffirms my spiritual journalofchristiannursing.com provide for their clients what theologian Craig Dykstra (1999) metaphorically calls “bread instead of stones” (p. 13). They accomplish this largely through a relational stance they maintain with their clients, which Martin Buber (1958) named an “I and Thou” relationship. This is a subjectto-subject rather than a subject-toobject way of relating. It necessitates a humbling of self and reverence to another for full engagement. Pohlman’s (2009) research on fathers of critically ill preterm infants discussed the technological gaze that persons fall victim to in the healthcare setting, and the objectifying stance this creates in modern institutional care. Jesus, in the hours before his arrest and crucifixion, taught the disciples the gift of servanthood through the act of washing their feet (John 13:1-17). Jesus embodied through ritual a humbling of self and reverence to another. He honors the disciples and ultimately, through an “I and Thou” relational stance, honors God. The Bev describes herself as a “cradle Catholic” (Catholic from birth). She holds firm to her belief and faith conviction that as she stated, “I was born to love and serve God and others.” Bev also articulated her journey into palliative care as being influenced by her father’s death and the positive connection and experiences her father and entire family encountered with the hospice team prior to his death. Bev highlighted how personal experience with loss, in addition to providing insight and help for others, also has the potential for interfering with spiritual caring. This occurs when personal self-disclosure supersedes the awareness of client needs. Bev is clear about the importance of humility and this assists her in maintaining an “I and thou” or humbled relational stance: I see this at times when not so much patients, but families are struggling to do the right thing for their loved one. Someone on the healthcare team, when JCN/July-September 2013 167 Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. we’re having meetings, will all of a sudden start talking about something in their personal life involving a crisis…. It doesn’t help, it’s irrelevant… If the family wants to know more they will ask you about your personal life, but for the most part families don’t…Later families will say to me oh, “I felt so sorry for him [the team member]” and I’m thinking wait a minute, it’s not a about him, it’s about you. Self-disclosure regarding personal experience and/or beliefs can be beneficial and may enhance the involvement of care. But central to spiritual care is a client-centered therapeutic relationship. Caregivers must continue to examine if their motivation for self-disclosure is meeting their own needs or the needs of their clients. Taylor (2002), when entire palliative team. She views spiritual care as inclusive of all that gives meaning and value to life, including the religious aspect that, for many patients, articulates the essence of spirituality. She considers the focus of palliative care one in which you utilize the entire team to holistically meet client needs. Using Qualitative Research in a Clinical Setting Using Qualitative Research in a Clinical Setting. This team approach highlights what Benner et al. (2009) called expert agency, the ability to work in and through others to meet client needs: Bev: I always, well I won’t say 100% of the time, but for the most part I have the chaplains come in and discern spiritual needs. They are the experts in that field; they are equipped to respond to patients from an active religious standpoint as well as general support and spiritual Sophia: You know it’s interesting because people come with a lot of hope, and we talked about hope in the meeting.The chaplain said sometimes hope changes and goes from hope for a cure, to hope for time, and then a hope for peace. I think because those words came from a chaplain, it was more comforting to the family. Chaplains are faith-driven and there may be a mistrust of the medical at this point… But when the family acknowledges peace, something that people get spiritually from God, I think it opens up a dialogue for me as a nurse practitioner, where I can say, ‘Well, we are not able to cure this, but we can provide comfort…’.The chaplain also promised the wife that someone from their department would see her husband each shift for prayer and support. Nothing can be more valuable to Personal experience with loss…has the potential for interfering… when personal self-disclosure supersedes the awareness of client needs. discussing spiritual self-awareness, suggests nurses ask themselves, “What is the purpose of my self-revelation? For whom is this disclosure? Will my disclosure enhance the therapeutic relationship?” (p. 71). This holds true for the disclosure of personal life experience as well as personal beliefs and values. Bev views her relationship with clients as “invitation” and responds to their hospitality to cojourney with them at the most difficult moments as one of “honor and privilege.” She is aware of the difference between self-serving commentary and communication that meets client needs. Through this awareness she is able to embody a humbled expert relational stance, which includes her ability to enlist other experts. “ENLISTING OTHER EXPERTS” Bev’s humility assists her in careful discernment of not only her nursing role but also the expertise of the 168 JCN/Volume 30, Number 3 guidance… Enlisting all the experts in the care of patie …Using Qualitative Research in a Clinical Setting Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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