The hermeneutic nature of process in nursing : a grounded theory approach.
This thesis is an enquiry into the nature of process in nursing. The study was initiated
by the experience of the researcher as a nurse attempting to utilise the Nursing Process
in clinical practice. From the outset however, the focus of the study shifted from the
utility of the Nursing Process to the nature of process in nursing. The data were
collected by in depth, unstructured interviews with twenty staff nurses from general
medical and surgical wards in five district general hospitals in the South of England. The
interviews were transcribed, and analysed following grounded theory methods.
The analysis produced a number of categories related to nursing practice and the context
in which it occurs. The major finding of the study is represented as the core category
and is labelled Nursing carea s clinicalh ermeneuticIsn. identifying this category the researcher
considers nursing to be essentially a process of interpretation of clinical situations, that is
to say that process in nursing is essentially hermeneutic in nature. Other categories were
identified relating to the strategies used by nurses and the context of nursing practice.
These were labelled as; latching over,T hinking about,B eingt here,D oing to,f orand with, Letting
go, Climate of Constantc hangeL, andscapeo f predictabilitya nd Landscapeo f perfect expectation.
These categories were linked to each other and to the core category forming an
illumination of the core category. The categories of SufferingC' omfortinga nd Healing were
identified as providing the impetus for nursing care.
The categories have been linked together in a statement of substantive theory which
describes nursing care as clinical hermeneutics in the following way:
A process, which is the resultant of a complex, dynamic interplay between
knowing, thinking, feeling, doing and context, in which the nurse seeks to
prevent and relieve suffering, to promote comfort and facilitate healing. This
interpretative process is achieved by helping the patient to understand the illness
process, by reducing the alienating effects of illness and by facilitating a return to
a taken-for-granted state of wholeness of mind and body. It is achieved through
the nursing strategies of watching over, thinking about, being there, doing to, for
and with and lettinggo and shaped by the context in which it occurs.
In using grounded theory to achieve this theoretical stance, the thesis makes and seeks
to justify four important claims about nursing. These are firstly, that nursing is more
than simply a collection of tasks, but rather is a process of interpretation involving
certain kinds of tasks. Secondly that apparently simple (or indeed complex) tasks
involved in nursing are themselves an integral part of the process of interpretation.
Thirdly that as a hermeneutic process, nursing may claim to have a philosophical basis.
And finally that as a hermeneutic process, nursing is supported by and requires many
forms of knowing, none of which are privileged but all of which are legitimate.