Chapter 22. Phenomenology
Tanya McCance and Sonja Mcilfatrick
▪ Introduction
▪ What is phenomenology?
▪ Phenomenology and nursing
▪ Types of phenomenology
▪ Criticisms of phenomenological nursing research
▪ Phenomenology and the research process
▪ Conclusion
Introduction
One of the main reasons for the increased popularity of phenomenology in nursing research is that it provides a research approach that is consistent with the art, philosophy and practice of nursing: ‘understanding unique individuals and their meanings and interactions with others and the environment’ (Lopez & Willis 2006, p.726). However, there is much debate about adopting this approach within nursing, particularly without an adequate grasp of the underlying philosophy (Barkway 2001, Crotty 1996 and Paley 1998). Lopez and Willis (2006) argued that a failure to examine the philosophical basis of a research method can result in research that is ambiguous in its purpose, structure and findings. Furthermore, there has also been a failure of nurse researchers to acknowledge the conflicting perspectives within phenomenology (descriptive versus interpretive). This chapter will seek to address this by providing an overview of phenomenology within nursing research and an analysis of the strengths and weaknesses associated with its use. The main types of phenomenology (descriptive and interpretive) will be examined alongside a consideration of how the philosophical underpinnings have informed the research process. Finally, some practical examples will help to elucidate how this approach has been used to explore phenomena that are central to nursing and health care.
What is phenomenology?
In its simplest form phenomenology can be described as ‘the study of phenomena, the appearance of things’ (Cohen 1987, p. 31). This is reflective of the fundamental principle of phenomenology articulated by Husserl – ‘back to the things themselves’ (Swanson-Kauffman & Schonwald 1988). This is illustrated by Van Manen (1990, p. 10) who stated ‘phenomenology asks for the very nature of a phenomenon, for what makes a ‘some-thing’ what it is – and without which it could not be what it is’. Husserl emphasised the importance of returning to the everyday world where people are living through various phenomena in actual situations (Giorgi 1985). Hence, phenomenology focuses on a person’s lived experience as a means of uncovering meaning and generating understanding about certain ‘things’. When we talk about lived experience we are referring to the events that individuals live through. By recalling the detail of these events we transform them into objects of consciousness (Kleinman 2004) that can then be re-examined. For example, in Field’s (1981) phenomenological study focusing on the nurses’ experience of giving an injection he identified the ‘phenomenon particular’ (the injection) as well as ‘phenomenon perceived’ (the lived experience of giving an injection).
It has been noted that nurse researchers have difficulty in understanding phenomenological language and its underpinning philosophy (Corben 1999). This has been attributed to the fact that phenomenology is described as both a philosophy and a research method (Cohen 1987). In the philosophical sense, phenomenology refers to ‘a particular way of approaching the world: it implies apprehending experience as it is lived’ (Parse 1995, p. 12). As a research method, phenomenology is ‘governed by rigorous processes in data gathering and data analysis’ (Parse 1995, p. 13). Both perspectives should not be viewed separately because the philosophical understanding of phenomenology has important implications in relation to how we use it as a research method.
Phenomenology and nursing
The use of phenomenology within nursing research has been a direct consequence of the ability of this approach to answer questions of particular relevance to nursing practice (Lawler 1998 and Taylor 1993). It has been advocated that phenomenology is congruent with nursing, where humanistic knowledge is valued (Rose et al 1995). As noted by Beck (1994, p. 499), ‘phenomenology affords nursing new ways to interpret the nature of consciousness in the world’. Many nurse researchers regard phenomenology as a research method that could provide understanding of the person’s reality and experience, one that values individuals and the nurse–patient relationship, and one which embraces a holistic approach to the person (Benner 1994 and Holmes 1990). In commenting on the use of phenomenology as a research method for nurses, Lawler (1998) suggested that:
Unless nurses know what meanings people attach to events that disrupt their lives, nurses – as practitioners and people – have a restricted capacity to help their patients or find ways to deal with their own experiences as practitioners’ (p. 106)
Some examples of phenomena that have been explored using phenomenology have included:
▪ women’s experience of acute myocardial infarction (Svedlund et al 1994);
▪ registered nurses’ perspective of caring for adolescent females with anorexia nervosa (King & Turner 2000);
▪ patients’ and nurses’ experience of caring in nursing (McCance 2003);
▪ providing information to patients receiving radiation therapy (Long 2001);
▪ patient’s experience of an intensive care unit following a liver transplant (Del Barrio et al 2004);
▪ nurses’ experience of day hospital chemotherapy (McIlfatrick et al 2006).
In examining the implications of phenomenology for nursing knowledge development and the use of knowledge in practice, Van der Zalm and Bergum (2000) suggested that phenomenology contributes to Carper’s (1978) ways of knowing, i.e. empirical, moral, aesthetic and personal knowledge development. Thus, its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. In the phenomenological sense, knowledge does not inform practice, rather reflection on practice (life) results in knowledge (understanding) that in turn enlightens practice (Van Manen 1990).
Types of phenomenology
Descriptive or Husserlian phenomenology was developed by Husserl (1859–1938), and is aimed at ‘uncovering and describing the essence of the phenomena of interest’ (Priest 2004, p. 6). Interpretive or Heideggerian phenomenology was developed by Heidegger (1889–1976), and is aimed at ‘the interpretation of phenomena to uncover hidden meanings’ (Priest 2004, p. 6). These two traditions have distinct differences in relation to their philosophical underpinnings, which influence how these approaches are used as a research method. Whilst there are many phenomenological philosophers, Walters (1995) acknowledges that the phenomenological traditions drawn from the work of Heidegger and Husserl are most prominent in phenomenological nursing research. Within this section these two traditions will be described and their philosophical basis discussed, with the intention of trying to elucidate the distinct differences between these two approaches, which are summarised in Table 22.1.
| Descriptive phenomenology | Interpretive phenomenology |
|---|---|
| Husserlian | Heideggerian |
| Epistemology (questions of knowing) | Ontology (questions of experiencing and understanding) |
| Person considered as a separate mind–body person living in a world of objects | Person exists as a ‘being’ in and of the world |
| Data speaks for itself | Interpreters participate in making data |
| Techniques and procedures to aid rigour (adoption of analysis structures) | Own criteria for trustworthiness |
| Bracketing defending objectivity | Hermeneutic circle (background, pre-understanding) |
| Useful in uncovering the ‘essence’ of a phenomena | Useful in examining the contextual features of experience – values uniqueness and diversity |
Descriptive phenomenology
Husserl is considered the ‘father’ of the phenomenological movement. Central to his ideas was the ‘fundamental recognition of experience as the ultimate ground and meaning of knowledge’ (Koch 1995, p. 828). Husserl’s method focused on description and explanation (Ray 1985), with the prime aim of uncovering the ultimate structures of the consciousness (essences) (Koch 1995). According to Kleinman (2004, p. 10), essence refers to ‘the most essential meaning for a particular context’. It is the essence that forms the consciousness and perception of the world. Whilst Husserl did not claim himself to be a positivist, Koch (1995) argues that his emphasis on description as that which elucidates the nature of reality appeals to an empiricist’s view of knowledge. Annells (1999) similarly presents a case for placing Husserlian phenomenology within a positivist paradigm, identifying the following assumptions:
▪ A phenomenon is believed to be a reality, a truth that exists as an essence (of the phenomenon), and which can be disclosed – a ‘realist’ belief.
▪ This essence of the phenomenon exists independently from the researcher – an ‘objectivist’ opinion.
▪ The phenomenologist can, and should, seek to disclose the essence of the phenomenon in its purity, untainted by the phenomenologist’s preconceptions of the phenomenon – objectivity is essential (p. 14).
Phenomenological reduction is central to Husserl’s approach and is associated with the idea of bracketing. Walters (1995) described phenomenological reduction as that which ‘involves reducing a complex problem into its basic components by eliminating one’s own prejudices about the world’ (p.792). Researchers as human beings will bring their own personal experiences, preconceptions, beliefs and attitudes to the research situation, which Husserl refers to as the ‘natural attitude’ (Paley 1997). It is these aspects that a researcher attempts to bracket by putting aside all preconceptions. This enables the researcher to present the phenomenon exactly as the participant experiences it (Wall 2004 and Ray 1985 describes bracketing in a nursing context, giving the example of the experience of pain. Using Husserl’s approach, the clinical nurse or researcher must not impose their knowledge of pain on the client, but allow them to express their own experience of pain as lived by them.
The ability of researchers to hold in abeyance their beliefs about a phenomenon under study is a major criticism of Husserlian phenomenology (Kvale 1983 and Parse 1995). Beck (1994), however, would argue that whilst ‘it is impossible for a researcher to be completely free from bias in reflection of the experience being studied … it is possible to control it’ (p. 500). The processes that can be used for bracketing are not always clearly described in the literature. Wall et al (2004), in attempting to provide a guide to the novice researcher, place this process within a continuous activity of reflection, and caution that there is no standard method for undertaking bracketing. They describe the process as more of ‘a psychological orientation towards oneself rather than an observable set of procedures to be adopted by a researcher’ (p. 22). The critical analysis of the use of Husserlian phenomenology within nursing conducted by Paley (1997) not only questioned the idea of bracketing, but also the accurate use of this method within nursing research. He argued that nurse researchers largely misunderstand the concepts of phenomenological reduction, phenomena and essence. It is important, however, to acknowledge the value and potential contribution that descriptive phenomenology can make to uncovering the essence of phenomena important to nursing practice.
Interpretive phenomenology
Although it is recognised that interpretive phenomenology has been informed by various philosophers, such as Gadamer 1989, Habermas 1990, Heidegger 1962 and Ricoeur 1981, this discussion will focus on the approach developed by Heidegger. Parse (1995) suggested that Heideggerian phenomenology could be viewed as an extension of Husserl’s original ideas, adding meaning and interpretation to descriptions without the notion of bracketing. Heidegger did not believe that getting to know and describe the experience of individuals was enough. Instead, he stressed the importance of knowing how respondents come to experience phenomena in the way they do (Parahoo 2006). Heidegger considered that the primary focus of philosophy was on the nature of existence (ontology), while Husserl focused on the nature of knowledge (epistemology). According to Koch (1995), Heidegger focused on the ‘experience of understanding’, while Husserl focused on the ‘experience itself’. As Moules (2002) suggested, Heidegger brought the ‘something’ (self/being, tradition, history, and experience) back into the ‘experience of something’.
This understanding can be linked to Heidegger’s emphasis on hermeneutics. Hermeneutics has been defined as the ‘science of interpretation’ (Allen & Jensen 1990). Hermeneutics originates from the seventeenth century and is derived from the Greek word hermenia, which relates to the Greek god Hermes who interpreted and conveyed messages from the gods to mortals (Mavrotataki 1997). Therefore, hermeneutic phenomenology is concerned with illuminating details of experience with the goal of creating meaning and achieving a sense of understanding (Wilson & Hutchinson 1991). An important distinction between the two types of phenomenology concerns the notion of ‘letting the facts speak for themselves’ or of knowledge independent of interpretation. Sandelowski (2000) argues that all enquiry entails description and all description entails interpretation.
Heidegger referred to human existence as ‘Dasein’, or being-there, which emphasises the ‘situatedness’ of human reality (Walters 1995). This indicates the need to view individuals’ experience in the context in which they experience it. Munhall and Oiler (1986) noted that ‘people are tied to their worlds and comprehensible only in their contexts’ (p. 58). The dominant themes in interpretive phenomenology are the hermeneutic circle and the historicality of understanding (Koch 1995 and Heidegger 1962 described understanding in terms of a three-fold structure consisting of:
▪ fore-having – something we have in advance;
▪ fore-sight – something we see in advance;
▪ fore-conception – something we grasp in advance (p. 191).
Thus, the central distinction between Husserlian and Heideggerian approaches is that presuppositions are not to be eliminated or suspended (Ray 1994). Rather, researchers acknowledge that they cannot be extracted from being-in-the-world and reject the notion of bracketing, recognising the important contribution of the researcher’s experiences in the interpretive process. The researcher is, therefore, considered inseparable from assumptions and preconceptions about the phenomena under investigation, and instead of bracketing these preconceptions, they are explicated and integrated into the research findings (Lopez & Willis 2006). Linked to the fore structure of understanding is the hermeneutic circle or circle of understanding, which places us in the world in a way that presupposes understanding, enabling us to make sense of the world. The interpretive process is achieved through a hermeneutic circle, which moves from the parts of experience, to the whole of experience, and back and forth again and again to increase the depth of engagement with, and the understanding of, words or texts (Annells 1996 and Koch 1996).
Criticisms of phenomenological nursing research
The use of phenomenology within nursing research has become increasingly popular (McVicar & Caan 2005). It has, however, been noted that in the nursing literature there is misuse of the term phenomenology, with no clear distinction between the use of interpretive phenomenology and descriptive phenomenology (Koch 1995, Parse 1995 and Walters 1995). The main criticism centres around the detachment of key philosophical notions from the phenomenological method used in nursing research (Yegdich 2000). Misunderstandings by researchers of the philosophical issues underpinning phenomenology have led to confusion about the use and application of the method (Paley 1997). Therefore, it is important for nurse researchers to ‘explore, justify and articulate the philosophical underpinnings of their selected phenomenological approach’ (Priest 2004, p. 4). It is suggested that such appraisal of the philosophical underpinnings increases one’s appreciation of the validity of the method and provides soundness (rigour) to the method (Corben 1999 and Koch 1995). Furthermore, Lowes and Prowes (2001) state that:
The omission of a clear statement about the philosophical underpinnings of phenomenological research results in methodological confusion that may impact on the overall quality and rigour of the research endeavour. (p. 472)
Streubert and Carpenter (1999) suggested that making explicit the school of thought that guides an inquiry will help researchers to conduct a credible study and help those who use the findings apply the results within the appropriate context.
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