Richard Hovey, PhD - St. Mary's Hospital · 2013-04-12 · Richard Hovey, PhD Division of Oral...
Transcript of Richard Hovey, PhD - St. Mary's Hospital · 2013-04-12 · Richard Hovey, PhD Division of Oral...
St. Mary’s Hospital
Montreal Quebec
St. Mary's Research Seminar Series
February 19th 2013
Richard Hovey, PhD Division of Oral Health and Society
McGill University
Researching patient experience: an
interpretation of an interpretation
Language and narrative constitute the fabric of everyday
life because we live our lives though narratives and
stories.
Research / Scholarship
Conversation
Interviews
Data collection
Interpretation
Rigor and Transferability
Transformational Learning
Philosophical hermeneutics
Philosophy is NOT, as one often hears,
the professional art of splitting hairs, the
search for artificial precise
definition’s—one who attempts to
philosophize must first of all have an
attentive ear for the language in which
the thinking experiences of many
generations has been sedimented, long
before we begin to attempt our own
thinking. (Gadamer,1989, p.181)
Experience, Research and Writing
“Experience is initially always the
experience of negation: something
is not what we supposed it to
be”(Gadamer 1989, p. 354).
“Clean and reasonable
scholarship about messy,
unreasonable experiences [is] an
exercise in alienation” (Tamas, 2009, p.16)
“Language and thinking about
experience are bound together.”
(Gadamer, 1989, p. 417)
“Experiences of exceptional joy or of
grief share intricacies that evade easy
linguistic expression but are not
beyond words. Profound experiences
only assumes significance once
brought into language spoken or
thought (Davey, 2006, p.49).”
Researching human experience
interpretation of interpretation
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Hermeneutics, is an activity
carried out in the name of its founding
spirit, Hermes: Messenger of gods,
guardian of thresholds, and carrier of
cryptic codes.
Different meanings
Tricksters and messengers
All / most cultures
Philosophical Hermeneutic…
…inquiry is the tradition, theory and practice of interpretation
it is a reflective, dialogic inquiry, concerned with understanding the lifeworld and the various forms in which understanding is manifested.
Gadamer’s dialogical philosophical
hermeneutics
… unite the experience of
one subject with that of the
others.
The researcher is working
toward understanding the
experience of the individual
within the context of a
community of experiences.
The meaning of living with chronic illness
“Richard, in the five years that I had osteoporosis,
experienced fractures, many-many trips to
doctors, hospitals and at last here at the Grace
Osteoporosis Centre, you are the first person who
has asked me how it feels to have osteoporosis.”
Hermeneutic research…
“… understanding is not
something that takes place at
the end of humanistic
research about an object, it
stands at the beginning and
governs the whole
process of questioning,
step by step”.
(Gadamer, 2001, p. 50)
Annie…
My three-year-old looked at
me one day, about four
months after my daughter
died.
He said, mommy, did the
doctors hurt Annie?
You think about what was
going on in his mind.
And I said, Well, it’s more
like she was falling and
nobody tried to catch her.
Hermeneutics…
…allows us, with the help of
others, to make sense of the
particulars of these contexts and
arrive at deeper understandings
and the meaning of health /
illness, medical-patient education
/ practice within a certain context.
Humanizing medical error
Yes, I’ll tell you about it [a patient
experience], but I have to tell you
that whenever I discuss this…
...the way my son explained it to me
was that it is very much like putting
your hand into a pocket full of razor
blades.
It is very painful and people don’t
necessarily see the little small cuts.
But I feel it’s very important that I
speak out about my experience. My
mother died as a result of medical
error, and actually a series of
medical errors.
Articulating a new experience
Experience itself seeks and finds
words to express it. We seek the
right word—i.e. the word that
really belongs to the thing (or
experience) so that the thing
comes into language. (Gadamer, 1989, p. 417)
Trauma and Metaphor
“Yes, you know
undoubtedly when you are
first diagnosed it is
traumatic. Have you ever
seen the movie Snow
White and the Seven
Dwarves? Remember
when the Queen diverted
into the witch, she looked
exactly how it feels.”
Philosophical Hermeneutics…
… offers the opportunity
to conduct thoughtful,
effective, skillful and
humane practice in
contexts where
prescription and assumed
practices do not
adequately satisfy the
complexity of such
practices.
Conversation…
“One of my first experiences, we always wore
these little Topees (sun hats) in India for the sun.
And when you go through the Red Sea on your last
trip home from India, it is chucked over into the
water. I was just devastated because I had never
ever been allowed anywhere without it. My Mother
chucked it overboard as that is what you did on
your last return trip from India to England.
The topi continued
Of course my topi was my friend so that was
adaptation for you as a child. And of course I did not
have my parents for a year when I was with my
grandparents. I think people have very restricted
stable lives in one place and not much change and
they do not have to deal with change. But you look
at my life and it is constant change.
I guess I have just had to adapt to it and I don’t
know how you teach that, because some people
find change very threatening.”
Loss
“Loss is a cavernous, empty place,
filled with pain and longing for
something that can’t be restored. It
defines you in particular ways that
nothing else does. You begin to
know the journey, dreaded and
unannounced, sometimes too well,
the sickening sense of being
abandoned, the dread when you
remember after you have briefly
forgotten, the sense of something
missing that never really leaves, and
the sadness, and the waste of
someone’s life unlived.”
References
Davey, N. (2006). Unquiet understanding: Gadamer’s philosophical hermeneutics. Al- bany, NY: State University of New York Press.
Dreyfus, H. L. (1991). Being-in-the-world: A commentary on Heidegger’s being and time. Cambridge, MA: Division I. MIT Press.
Frank, A. W. (2009). Tricksters and truth tellers: Narrating illness in an age of authenticity and
appropriation. Literature and Medicine, 28(2), 185-199.
Gadamer, H. G. (2001). Gadamer in Conversation: Reflections and commentary. (R. E. Palmer,
Ed. & Trans. New Haven: Yale University Press.
Gadamer, HG (1992). HGG- on Education, poetry and history: applied hermeneutics. State Univ
of New York Pr.
Gadamer, H. G. (1989). Truth and method (2nd rev. ed.). (J. Weinsheimer & D. G. Mar- shal,
Trans.). New York: Continuum. (Origi- nal work published 1975).
Gadamer, H. G. (1996). The enigma of health: The art of healing in a scientific Age. (J. Gaiger &
N. Walker, Trans.). Palo Alto, CA: Stanford University Press.
Hovey, R., & Craig, R. (2011). Understanding the relational aspects of learning with, from, and about the other. Nursing Philosophy, 12(4), 262-270.
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References
Hovey, R., & Massfeller, H. (2012- In press). Exploring the relational aspects of patient and
doctor communication. Journal of Medicine and the Person.
Hovey, R., Cuthbertson, K., Birnie K., Thomas, B. C., Robinson, J., Massfeller, H.,
Ruether, J. D., & Scott, C. (2012). The Influence of Distress on Knowledge Transfer for
Men Newly Diagnosed with Prostate Cancer. Journal of Cancer Education. (DOI)
10.1007/s13187-012-0343-2.
Hovey, R., & Craig, R. (2012). Learning to live with osteoporosis: a metaphoric narrative.
Journal of Applied Hermeneutics. Article 3.
Hovey, R., Dvorak, M., Hatlie, M., Burton, T., Padilla, J., Worsham, S., & Morck, A. (2011) Patient safety: A consumer's perspective. Qualitative Health Research, 21(5), 662-672.
Kearney, R. (2011). What is diacritical her-meneutics? Journal of Applied Hermeneutics. Article 1.
Ricoeur, P. (1998). Hermeneutics and the human sciences: Essays on language, actions and interpretation (J.B. Thompson, Trans.). Cambridge: Cambridge University Press
Tamas, S. (2009). Writing and righting trauma: Troubling the autoethnographic voice. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 10(1) Article 22.
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