"Caring for Insiderness": Phenomenologically informed insights that can guide practice.

Understanding the ‘‘insider’’ perspective has been a pivotal strength of qualitative research. Further than this, within the more applied fields in which the human activity of ‘‘caring’’ takes place, such understanding of ‘‘what it is like’’ for people from within their lifeworlds has also been acknowledged as the foundational starting point in order for ‘‘care’’ to be caring. But we believe that more attention needs to be paid to this foundational generic phenomenon: what it means to understand the ‘‘insiderness’’ of another, but more importantly, how to act on this in caring ways. We call this human phenomenon ‘‘caring for insiderness.’’ Drawing on existing phenomenological studies of marginal caring situations at the limits of caring capability, and through a process of phenomenologically oriented reflection, we interrogated some existential themes implicit in these publications that could lead to deeper insights for both theoretical and applied purposes. The paper provides direction for practices of caring by highlighting some dangers as well as some remedies along this path

The articulation of enkinaesthetic entanglement

In this article I present an argument for the necessary co-articulation of meaning within our felt enkinaesthetic engagement with our world. The argument will be developed through a series of stages, the first of which will be an elaboration of the notion of articulation of and through the body. This will be followed by an examination of enkinaesthetic experiential entanglement and the role it plays in rendering our world meaningful and our actions values-realising. At this stage I will begin to extend Husserl’s notion of intentional transgression to the enkinaesthetic sphere of lived experience, and in support of this claim I will examine the theoretical and practical work of osteopathic manual listening [Gens & Roche 2014] and the ‘felt sense’ in focusing [Gendlin] which makes possible a shift from a somatic articulation to a semantic, and potentially conceptual, one. Throughout, my position will be compatible with Merleau-Ponty’s claim that “Whenever I try to understand myself, the whole fabric of the perceptible world comes too, and with it comes the others who are caught in it.” [Merleau-Ponty 1964a, p.15]

Doing it differently: Engaging interview participants with imaginative variation

Imaginative variation was identified by Husserl (1936/1970) as a phenomenological technique for the purpose of elucidating the manner in which phenomena appear to consciousness. Briefly, by engaging in the phenomenological reduction and using imaginative variation, phenomenologists are able to describe the experience of consciousness, having stepped outside of the natural attitude through the epochē. Imaginative variation is a stage aimed at explicating the structures of experience, and is best described as a mental experiment. Features of the experience are imaginatively altered in order to view the phenomenon under investigation from varying perspectives. Husserl argued that this process will reveal the essences of an experience, as only those aspects that are invariant to the experience of the phenomenon will not be able to change through the variation. Often in qualitative research interviews, participants struggle to articulate or verbalise their experiences. The purpose of this article is to detail a radical and novel way of using imaginative variation with interview participants, by asking the participants to engage with imaginative variation, in order to produce a rich and insightful experiential account of a phenomenon. We will discuss how the first author successfully used imaginative variation in this way in her study of the erotic experience of bondage, discipline, dominance & submission, and sadism & masochism (BDSM), before considering the usefulness of this technique when applied to areas of study beyond sexuality

Manifestations of cardiotoxicity in patients after radiation therapy

Cardiotoxic effects of antitumor treatment are diverse and develop both after chemotherapeutic treatment and after the application of radiation therapy. In recent decades, the problem of heart lesions due to the use of radiotherapy has acquired new significance, primarily due to a significant increase in the number of patients exposed to radiation in the modern world. The frequency of radiation damage to the cardiovascular system is quite high and, according to various data, can reach 54%. The structure of radiation-induced disease describes the development of pericarditis, cardiomyopathy, coronary and valvular pathology, rhythm and conduction disorders, post-radiation heart disease is one of the most difficult in treatment and early diagnosis is the most important task of the modern trend - cardiooncology. The need for long-term follow-up of patients after antitumor treatment with radiation therapy is one of the topical issues of practical public health.Кардиотоксические эффекты противоопухолевого лечения разнообразны и развиваются как после химиотерапевтического лечения, так и после применения лучевой терапии. В последние десятилетия проблема поражений сердца вследствие применения лучевой терапии приобрела новое значение, прежде всего в связи с существенным увеличением в современном мире числа пациентов, подвергшихся лучевому воздействию. Частота развития лучевых повреждений сердечно-сосудистой системы достаточно высока и, по различным данным, может достигать 54%. В структуре радиационно-индуцированной болезни описаны развитие перикардитов, кардиомиопатии, коронарная и клапанная патологии, нарушения ритма и проводимости, постлучевое поражение сердца является одним из самых трудных в вопросах лечения и ранняя диагностика является важнейшей задачей современного направления - кардиоонкологии. Необходимость длительного наблюдения пациентов после противоопухолевого лечения с использованием лучевой терапии является одним из актуальных вопросов практического здравоохранения

The composite first person narrative: Texture, structure, and meaning in writing phenomenological descriptions

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method's applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or “contextual” human qualities of the phenomena are often not visible. The “what is it like” or the “unsaid” aspects of such human phenomena are not clear to the reader when proxies are used to “account for” a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the “we” among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry

The narrative model of therapeutic change: an exploratory study tracking innovative moments and protonarratives using state space grids

Despite the popularity of narrative approaches to the change in psychotherapy, a better understanding of how narrative transformation facilitates therapeutic change is needed. Research on innovative moments (IMs) has explored how IMs in psychotherapy evolve over time. We expand on past studies by exploring how IMs become aggregated in narrative threads, termed protonarratives, which come to constitute an alternative self-narrative at the conclusion of therapy. The results suggest that the good outcome case had a different pattern of IM integration within protonarratives, revealing greater flexibility than the poor outcome case. These results support the heuristic value of the concept of the protonarrative

Cardiovascular complications of immune checkpoint inhibitors

Cardiovascular toxicity of cancer therapies remains an urgent problem today. The creation of highly effect antitumor drugs also means the appearance of new adverse effects. Immune checkpoint inhibitors (ICI) is a new class of antitumor drugs that is different from traditional chemotherapeutic and targeted drugs. Immunotherapy with ICI (monoclonal antibodies targeting the cytotoxic T-lymphocyte associated antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or its ligand (PD-L1)) significantly improved the results of treatment of cancer therapy. These drugs regulate antitumor immunity and promote cancer regression and improve survival, but can also cause a wide range of immunity-related adverse events (AEs). Although cardiotoxicity associated with ICI is rare, it is important because of its high mortality rates. In recent years, cases of myocarditis and fatal heart failure have been recorded more often in patients receiving ICI. This review focuses on the mechanisms of cardiotoxicity, methods for the prevention and treatment of these adverse events. Severe cardiovascular consequences associated with the use of ICI are important issues for oncologists, cardiologists and immunologists