Phenomenology of Professional Practices in Education and Health Care: An Empirical Investigation

In this article a group of professionals working in education and health care explore professional practices and interactions from a phenomenological perspective, drawing on Max van Manen’s conceptualization of the phenomenology of practice and his knowledge interest in understanding and furthering sensitive, caring professional practice. Posing the question what is the meaning of interaction in encounters within education and health care, we look at practice experiences drawn from close observations and interviews during research concerning special needs education, physiotherapy and weight loss programs. Three anecdotes are offered as a way to ‘show,’ rather than interpret, the processes involved. Each anecdote is followed by reflections in which we draw on van Manen’s notion of pathic knowledge and Nancy’s ideas about co-existence to develop phenomenological insights about temporal, embodied and relational qualities of the phenomenon of interaction in professional practice. Such interaction seems to involve continuous negotiation. It emerges as a process of exchange, a movement back and forth between supporting and letting oneself be supported; between confronting and being confronted; between pushing and being pushed. Moments of active engagement give way to periods of waiting for the other to act. The experience is one of continuous back and forth movement in the relational space in-between.Phenomenology of Professional Practices in Education and Health Care: An Empirical InvestigationpublishedVersio

The ambiguity of preparing and being prepared for a patient consultation

This paper presents findings from a study on the ways in which counsellors working at national centres for rare disorders in Norway experience preparing, and being prepared for, a face-to-face patient consultation. The research involved semi-structured interviews with five experienced counsellors from different health professional backgrounds working at two separate centres. These interviews were then analysed with reference to the theoretical insights of phenomenologists. The excerpts chosen for this paper shed particular light on the process of preparing for a face-to-face patient consultation. Our findings underline the significance of preparing and being prepared while also drawing attention to the multifaceted, complex and ambiguous nature of the processes involved. Preparing for face-to-face consultations with patients is revealed to require approaches that are thoughtful, flexible and empathic. To be prepared for something one does not yet know is about being open to the unexpected and the unpredictable

Physiotherapy at the intersection between standardization and individual adaptation

Drawing on the phenomenological tradition, contemporary physiotherapy practice may be understood as an embodied experience; one that requires standardized approaches to evidence-based examination, treatment, and evaluation while simultaneously requiring adaptation of each of these elements of practice to individual patients. Drawing on material from a study of encounters between physiotherapists and patients, this chapter addresses how the work of reconciling the needs for standardization and adaptation is accomplished in physiotherapy practice. The research approach and analysis of the material draws on a number of scholars in the phenomenological tradition, beginning with Maurice Merleau-Ponty. The study illuminated the ways in which both explicit and tacit forms of knowing are brought together in the physiotherapy encounter. Physiotherapists use explicit knowledge primarily as a framework for thinking about assessment and intervention; however, it is the inter-subjective, communicative practice of being-with-another from which the therapeutic encounter draws its power. It is this being-withanother that enables the physiotherapist to adapt abstract, explicit knowledge for the individual with whom they co-construct physiotherapy care. The study revealed how the knowledge put into play in physiotherapy depends on the sensitivity and reflective embodied knowledge of the physiotherapist, and their bodily style and developed professional skills. This is the bodily style that in some way transforms the therapist’s relation to the world, and especially to various and creative ways of knowledge translation at different moments in the process of practicing physiotherapy

Clinical reasoning - embodied meaning-making in physiotherapy

This article examines physiotherapists’ lived experience of practicing physiotherapy in primary care, focusing on clinical reasoning and decision-making in the case of a patient we call Eva. The material presented derives from a larger study involving two women participants, both with a protracted history of neck and shoulder pain. A total of eight sessions, all of them conducted by the first author, a professional physiotherapist, in his own practice room, were videotaped, after which the first author transcribed the sessions and added reflective notes. One session emerged as particularly stressful for both parties and is explored in detail in this article. In our analysis, we seek to be attentive to the experiences of physiotherapy displayed and to explore their meaning, significance and uniqueness from a phenomenological perspective. Our research reveals the complexity of integrating multiple theoretical perspectives of practice in clinical decision-making and suggests that a phenomenological perspective can provide insights into clinical encounters through its recognition of embodied knowledge. We argue that good physiotherapy practice demands tactfulness, sensitivity, and the desire to build a cooperative patient–therapist relationship. Informed by theoretical and practical knowledge from multiple disciplines, patient management can evolve and unfold beyond rehearsed routines and theoretical principles

Naked in the eyes of the public: A phenomenological study of the lived experience of suffering from burnout while waiting for recognition to be ill

Although there has been a focus on problematic issues related to health care services and complaints made by patients, individuals who suffer from medically unexplained syndromes continue to report being epistemically marginalized or excluded by health professionals. The aim of this article is to uncover a deeper understanding of the what‐ness of experiencing being naked in the eyes of the public while waiting to be recognized as ill. Therefore, a phenomenological approach was chosen to inductively and holistically understand the human experience in this context‐specific setting. Semi‐structured interviews were conducted with two men and six women between 25 and 65 years of age, who had been on sick leave for more than 52 weeks. Their symptoms were consistent with Exhaustion Disorder (ICD‐10, F43.8A). The meaning of the interviewees' lived experience was explored using a life‐world approach to phenomenological reflection and writing. The participants described their experience of encountering the general practitioner as taking part in a battle. Feeling distrusted by others seemed to result in disconnection from their habitual lifeworld, which in turn triggered a shame reaction. Additionally, the study showed a possible distrust related to several communication levels within the health care system, which influenced the recovery process negatively. Lack of experienced support can lead to exacerbated feelings of distress. Accordingly, the psychosocial experience of being ill might be as important as its unknown aetiology. Therefore, in the context of these interpersonal relations, both norms, values, and attitudes, and issues of power need to be considered and addressed properly

Naked in the eyes of the public: A phenomenological study of the lived experience of suffering from burnout while waiting for recognition to be ill

Although there has been a focus on problematic issues related to health care services and complaints made by patients, individuals who suffer from medically unexplained syndromes continue to report being epistemically marginalized or excluded by health professionals. The aim of this article is to uncover a deeper understanding of the what‐ness of experiencing being naked in the eyes of the public while waiting to be recognized as ill. Therefore, a phenomenological approach was chosen to inductively and holistically understand the human experience in this context‐specific setting. Semi‐structured interviews were conducted with two men and six women between 25 and 65 years of age, who had been on sick leave for more than 52 weeks. Their symptoms were consistent with Exhaustion Disorder (ICD‐10, F43.8A). The meaning of the interviewees' lived experience was explored using a life‐world approach to phenomenological reflection and writing. The participants described their experience of encountering the general practitioner as taking part in a battle. Feeling distrusted by others seemed to result in disconnection from their habitual life world, which in turn triggered a shame reaction. Additionally, the study showed a possible distrust related to several communication levels within the health care system, which influenced the recovery process negatively. Lack of experienced support can lead to exacerbated feelings of distress. Accordingly, the psychosocial experience of being ill might be as important as its unknown aetiology. Therefore, in the context of these interpersonal relations, both norms, values, and attitudes, and issues of power need to be considered and addressed properly

Burned out or "just" depressed? An existential phenomenological exploration of burnout

Rationale, aim, and objective An increasing number of patients are on sick leave from work due to fatigue‐ and pain‐related symptoms that could indicate burnout. The aetiology is unknown, and recently, it has been considered whether burnout should be a distinct medical diagnosis or “just” a form of depression. Little attention has been given to these individuals' experiences. Therefore, we conducted a phenomenological study to explore burnout from a first person perspective. The aim of the study was to obtain a deeper understanding of burnout as phenomenon. Theoretical perspective and method We are inspired by Merleau‐Ponty's phenomenological approach and gestalt theory. The phenomenological focus is to attend to the embodied consciousness of the lived experience of being human. An interpretative phenomenological analysis (IPA) was chosen to uncover how the interviewees made meaning of their situation. Six individuals who had been on sick leave at 50% to 100% for at least 3 months due to fatigue‐ and pain‐related symptoms were interviewed. Results Four narrative phases mirroring burnout as a temporal sequence stood out: achievement, pressure, psychosomatic collapse, and personal meaning and reorientation. We identified several interruptions to contact, which seemed to boost the interviewees' ability to continue striving beyond their limits. The results of this study contribute to a deeper understanding of how complex factors might influence individual vulnerability and lead to a fatigue reaction. Conclusion The findings indicate that lack of recognition of the interviewees' illness may have affected the healing process. When understanding burnout as an intersubjective, lived, contextual, and temporal experience, it is important to take the implications of such factors into consideration for both medical theory and clinical practice. On the basis of our findings, we argue that reducing burnout to a form of depression will neither solve the problem of its unknown aetiology nor provide for meaningful individual health care

Out of Chaos—Meaning Arises: The Lived Experience of Re-Habituating the Habitual Body When Suffering From Burnout

Sufferers from burnout might experience a sincere bonding to their lost lifeworld, which can result in their holding on to their previous worlds while simultaneously trying to unleash themselves. In this article, four experiential dimensions are presented in discussion with the phenomenological insights provided by Merleau-Ponty. These dimensions are “Trapped in the present body,” “the balancing act,” “precious moments of joy,” and “this is my Lifeworld now.” In the rehabilitation process, the participants demonstrated deliberate choices and reflective self-cultivation to adjust to their present situation. The illness seemed to promote a search for meaning—and out of the existential chaos, a “new” habitual body might appear. The study provides invaluable information about the rehabilitation process and the need for humanistic interventions

Burned out or "just" depressed? An existential phenomenological exploration of burnout

Rationale, aim, and objective: An increasing number of patients are on sick leave from work due to fatigue‐ and pain‐related symptoms that could indicate burnout. The aetiology is unknown, and recently, it has been considered whether burnout should be a distinct medical diagnosis or “just” a form of depression. Little attention has been given to these individuals' experiences. Therefore, we conducted a phenomenological study to explore burnout from a first person perspective. The aim of the study was to obtain a deeper understanding of burnout as phenomenon. Theoretical perspective and method: We are inspired by Merleau‐Ponty's phenomenological approach and gestalt theory. The phenomenological focus is to attend to the embodied consciousness of the lived experience of being human. An interpretative phenomenological analysis (IPA) was chosen to uncover how the interviewees made meaning of their situation. Six individuals who had been on sick leave at 50% to 100% for at least 3 months due to fatigue‐ and pain‐related symptoms were interviewed. Results:Four narrative phases mirroring burnout as a temporal sequence stood out: achievement, pressure, psychosomatic collapse, and personal meaning and reorientation. We identified several interruptions to contact, which seemed to boost the interviewees' ability to continue striving beyond their limits. The results of this study contribute to a deeper understanding of how complex factors might influence individual vulnerability and lead to a fatigue reaction. Conclusion: The findings indicate that lack of recognition of the interviewees' illness may have affected the healing process. When understanding burnout as an intersubjective, lived, contextual, and temporal experience, it is important to take the implications of such factors into consideration for both medical theory and clinical practice. On the basis of our findings, we argue that reducing burnout to a form of depression will neither solve the problem of its unknown aetiology nor provide for meaningful individual health care