role of literature review in phenomenological research

An overview of interpretive phenomenology as a research methodology

Affiliation.

• 1 National University of Ireland, Galway. [email protected]
• PMID: 23909107
• DOI: 10.7748/nr2013.07.20.6.17.e315

Aim: To provide an overview of interpretive phenomenology.

Background: Phenomenology is a philosophy and a research approach. As a research approach, it is used extensively in nursing and 'interpretive' phenomenology is becoming increasingly popular.

Data sources: Online and manual searches of relevant books and electronic databases were undertaken.

Review methods: Literature review on papers on phenomenology, research and nursing (written in English) was undertaken.

Discussion: A brief outline of the origins of the concept, and the influence of 'descriptive' phenomenology on the development of interpretive phenomenology is provided. Its aim, origins and philosophical basis, including the core concepts of dasein, fore-structure/pre-understanding, world view existential themes and the hermeneutic circle, are described and the influence of these concepts in phenomenological nursing research is illustrated.

Conclusion: This paper will assist readers when deciding whether interpretive phenomenology is appropriate for their research projects.

Implications for research/practice: This paper adds to the discussion on interpretive phenomenology and helps inform readers of its use as a research methodology.

Publication types

• Nursing Methodology Research / methods*
• Philosophy, Nursing*
• Qualitative Research*

Phenomenology

Phenomenology has been applied extensively in a range of diverse disciplines (Friesen et al., 2012). In educational science, phenomenological descriptions are used to articulate the interests, aims, approaches, cultures, interactions, structures and reflections of educators and/or learners in a particular context.

Phenomenology: GO-GN Insights

Sarah Hutton conducted in-depth interviews with students and content analysis to connect shared internal goals supported by participation in an open publishing model where students are provided the opportunity to self-publish openly online or contribute to OER materials for the course.

“A phenomenological case study provides the opportunity for creating a rich narrative surrounding a shared experience. This method can help researchers establish a better understanding of individual meanings, and how subjects uniquely comprehend the world around them. Phenomenology and grounded theory pair well together for data collection and analysis, allowing for a more natural emergence of new ideas and thematic elements across a shared experience. “A disadvantage to this type of approach is the sheer volume of data that must be collected and sorted through to create that narrative. While recommendations on numbers of study participants may vary slightly between researchers, the more data that is collected over a longitudinal period, the stronger a pattern can be indicated as interviews are analyzed. In depth interviews produce a large amount of data for analysis, and for a course case study, 3 interviews should be completed (beginning, middle, end) to complete a longitudinal thread of student experience and development throughout the course. Another disadvantage is that, similar to other qualitative data methods, phenomenology may be taken less seriously by policy makers than other larger-scale quantitative studies.”

Michael Paskevicius used a phenomenological approach with self-identifying open education practitioners. This explores how OEPs are being actualised in formal higher education and impacting learning design, and describes the ways educators are bringing elements of openness into their everyday teaching and learning practice through educational technologies.

“I employed an empirical phenomenological approach in my PhD study to investigate the personal social construction and ‘lifeworld’ human experience of individuals engaging with OEP (Giorgi, 1997; Gray, 2013). At the core of phenomenological research is a pursuit of understanding mental directedness or consciousness by investigating individuals’ explanations grounded in their subjective experiences (Aspers, 2009). Empirical phenomenological research seeks to portray the essence of the conscious experience of others, essentially how they perceive the world, exploring what their experiences means to them, and provide a comprehensive description while recognizing the importance of social structure and context (Moustakas, 1994). Social structures are represented through the individual’s interpretation and construction of meaning in the world, and this social meaning construction can be studied empirically by the researcher (Aspers, 2009). The phenomenological approach aims to understand the general or typical essential structures of individual experience, based on the descriptions of those experiences. In doing so, I seek to understand not what ‘is’ in the world but to understand why conscious individuals say that something ‘is’ (Giorgi, 1997). “Trialing research questions can strengthen a phenomenological study as it allows one to engage with and become familiar with the research space, learn about the context in which individuals of interest work, and gather feedback from potential participants or those operating in similar situations (Aspers, 2009). The interview questions, conducted using the Zoom synchronous meeting service, were trialed first with my supervisor, who uses open educational practices in her undergraduate and graduate teaching. My supervisor was able to provide some feedback on the questions from her perspective as a faculty member. As a result of this process, we adjusted some of the language and sequencing of the questions.”

Jessica O’Reilly includes an interpretivist phenomenological analysis (IPA) methodology in her study of OER enabled pedagogy.

“The idiographic focus of the IPA approach fits very well with my research question, which is interpretivist, emergent, and very focused on contextualized individual experience and sensemaking. One clear advantage that I see is the combination of psychological, interpretive, and idiographic “lenses” within the approach. IPA is well-suited, I think, to questions concerned with the experiences of a fairly concentrated and homogenous participant sample. A potential disadvantage to my IPA study will be the reliance upon interview data and the huge amount of work involved with transcription and analysis.”

Useful references for Phenomenology: Clandinin & Connelly (2004); Friesen, Henriksson & Saevi (2012); Giorgi (1997); Gray (2014); Manen (2018); Maxwell 2013); Smith, Flowers & Larkin (2009)

Research Methods Handbook Copyright © 2020 by Rob Farrow; Francisco Iniesto; Martin Weller; and Rebecca Pitt is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Phenomenology: A Review of the Literature

This article is a review of relevant literature on the use of phenomenology as a research methodology in education research, with a focus on music education research. The review is organized as follows: (a) general education, (b) music research, (c) music education research, (d) dissertations, (e) important figures, (f) themes, and (g) the future. The article concludes with a synthesis of the existing research that attempts to provide suggestions for applying the results to current research practice.The purpose of this literature review is to examine recent scholarship that uses phenomenology and to make recommendations for which areas of the teaching and learning of music might benefit most from this methodology in the future.

Related Papers

Update: Applications of Research in Music Education

Clint Randles

This article is a review of relevant literature on the use of phenomenology as a research methodology in education research, with a focus on music education research. The review is organized as follows: (a) general education, (b) music research, (c) music education research, (d) dissertations, (e) important figures, (f) themes, and (g) the future. The article concludes with a synthesis of the existing research that attempts to provide suggestions for applying the results to current research practice. The purpose of this literature review is to examine recent scholarship that uses phenomenology and to make recommendations for which areas of the teaching and learning of music might benefit most from this methodology in the future.

International Journal of Music Education

renee crawford

Interpretative Phenomenological Analysis (IPA) is an experiential research methodology that aims to rigorously investigate personal meaning and lived experience. Informed by phenomenological philosophy, hermeneutics and idiography, IPA allows researchers to conduct a detailed exploration of how participants construct meaning from their personal and social contexts. The method has been applied further afield in social science disciplines such as education. This article provides insight into the process of conducting IPA in music education research, which is illustrated by material taken from studies conducted by the author who began using the analysis system in 2005. In this context IPA is regarded as an authentic approach situated in constructivism for exploring and interpreting authentic learning and teaching practice. It is proposed that such an approach can be used in music education qualitative research studies to provide an evidence-base for practice.

Dylan van der Schyff

Abstract: This thesis consists of an introduction and seven essays that develop possibilities for philosophy of music and music education through the lenses of phenomenology and the ‘enactive’ approach to mind. The phenomenological-enactive perspective presents a compelling alternative to dominant information-processing or so-called ‘cognitivist’ models by embracing an embodied and relational understanding of perception and cognition. It therefore offers new opportunities for exploring the nature and meaning of music and education that have both ethical and practical implications. While the essays may be read as stand-alone pieces, they also share a number of concepts and concerns. Because of this, they are organized into four parts according to the general themes they develop. Part I provides a general introduction to the basic ontological questions that motivate the essays. Here I discuss my path as a scholar, introduce the phenomenological and enactive perspectives, and briefly consider how they align with pedagogical theory. Building on these concerns, the following essay adopts a ‘critically ontological’ orientation. It draws out a number of reductive assumptions over the nature of music, education and what human being and knowing entails. In response, it posits a general framework for a music pedagogy based in enactive bio-ethical principles. Part II explores the nature of musical experience in more detail. Here knowledge in embodied cognitive science is developed towards an enactive approach to musical emotions, and to reconsider the problematic notion of (musical) ‘qualia’. Part III discusses practical applications of phenomenology for music and arts education––first in the context of private music instruction (drumming pedagogy), and then through the development of multimedia arts- inquiry projects. Part IV draws on enactivism to explore the deep continuity between music, improvisation, and the fundamental movements of life. The first paper suggests possibilities for curriculum development and self-assessment in improvisation pedagogy. The concluding essay brings together many of the insights discussed in the previous papers––recasting them in light of Eastern philosophy to reassert the relational, holistic, and “life based” understanding of mind, music and education that lies at the heart of an enactive music pedagogy.

Philip Boast

Music Listening, Music Therapy, Phenomenology and Neuroscience

Erik Christensen

Nuova Secondaria - n. 6, febbraio 2021 - Anno XXXVIII - ISSN 1828-4582

Emanuele Raganato

Although in an educator's life the time devoted to reflection is on average marginal, a balance between a reflective and active dimension, between theory and practice, can provide the teacher with a sense of coherence needed in his or her activity. Reflecting on one's own educational practice can in fact favour or radically change certain positions and beliefs and improve the relationship between the educator and the educational system. The fundamental question for an educational process to be effective is in fact that the teachers involved are fully aware and compatible with the premises of the system itself. A conceptual framework in which the functions and relationships in the educational process are highlighted is an important aid to reflection, to establish who we are, what we do where we want to go and how. In this process a prominent role is certainly that of culture, of which music is an essential part. In socio-cultural relations there is space for conflicts, ideologies and theories of all kinds that can be applied to the concept of what we usually call music education.

Arnold Berleant

Understanding performance can not only increase our theoretical grasp of music but reveal something of the general character of human experience. Performance evokes a condition that affects the fundamental aspects of experience: the perception of time and space, of the body and sensation, and of personal and social experience. A phenomenological description of performance from within the situation reveals a transformation of ordinary experience. Time and space are transfigured, body awareness and the sensory system are intensified, the dynamic character of musical experience is heightened, and its personal character is enlarged to encompass both audience and tradition, as the listener becomes an active participant in this process.

Vita Venslovaite

Małgorzata A. Szyszkowska

The work begins by asking the questions of how contemporary phenomenology is concerned with music, and how phenomenological descriptions of music and musical experiences are helpful in grasping the concreteness of these experiences. I then proceed with minor findings from phenomenological authorities, who seem to somehow need music to explain their phenomenology. From Maurice Merleau-Ponty to Jean-Luc Nancy and back to Edmund Husserl and Martin Heidegger, there are musical findings to be asserted. I propose to look at phenomenological studies of the musical aspects of existence as they appear in various philosophical works bringing together different accounts of music and aesthetics and pointing towards phenomenological study as a methodology for everyday aesthetics. While there are many different areas of music phenomenology such as studies of sound and listening, studies in perception of musical works, in experience of artistic creation, in singing and playing musical instruments, and phenomenology of transcendent or religious horizons of the experience of music, it is most promising-I suggest-to look at phenom-enological studies of music from the perspective of everyday happenings and discoveries of musical aspects of life. Thus, I attempt to display the uses of phenomenology in finding musical aspects of everyday existence as well as in describing and illuminating the art of music. A look at Roman Ingarden's and Mikel Dufrenne's most intuitive and promising ideas will be broadened with a perspective from Don Ihde and Arnold Berleant.

Phenomenology is explored as a way of helping students and educators open up to music as a creative and transformative experience. I begin by introducing a simple exercise in experimental phenomenology involving multi-stable visual phenomena that can be explored without the use of complex terminology. Here, I discuss how the ‘phenomenological attitude’ may foster a deeper appreciation of the structure consciousness, as well as the central role the body plays in how we experience and form understandings the worlds we inhabit. I then explore how the phenomenological attitude may serve as a starting point for students and teachers as they begin to reflect on their involvement with music as co-investigators. Here I draw on my teaching practice as a percussion and drum kit instructor, with a special focus on multi-stable musical phenomena. To conclude, I briefly consider how the phenomenological approach might be developed beyond the practice room to examine music’s relationship to the experience of culture, imagination and ‘self’.

RELATED PAPERS

Harmony Musiyarira

Journal of Proteome Research

Ashley Cowie

IEEE Transactions on Antennas and Propagation

christian mazzucco

Questionner l’effondrement

Jean Chamel

Mineralogical Magazine

jose maldonado

Jean-Paul BENTZ

Symposium on Interactive 3D Graphics and Games

Daniel Aliaga

Rak Bunga Besi

Produsen Rak Bunga Besi

Journal of Biological Chemistry

Waseem Sajid

Abentak Malika

Unidad de Geodetección - Universidad de Cádiz , Lázaro Lagóstena , Francisco Javier Catalán González , Isabel Rondán-Sevilla , Manuel Ruiz Barroso , Álvaro Fonteseca Torralvo

Clinical cancer research : an official journal of the American Association for Cancer Research

Ian Zlotolow

Journal of Chromatography A

Dominique Van Der Straeten

Forest Research: Open Access

L. Portoghesi

Separation & Purification Reviews

Raquel Mesquita

Steven Wojcikiewicz

Veterinary Parasitology

Francisco Rojo-Vázquez

ERKEN TÜRKLERİN SKANDİNAVYA YAZITLARI

KAZIM MİRŞAN

Amy Bleakley

Elena Tuchina

Journal of Ayub Medical College, Abbottabad : JAMC

Muhammad Bilal

Social Science Research Network

Iris BenDavid-Hadar

claisse.info

Marta Castellote

See More Documents Like This

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• Open access
• Published: 01 April 2024

Exploring the psychological experience of novice nurses in stomatological hospitals in China: a phenomenological study

• Jian Liu 1 ,
• Tiantian Lu 1 ,
• Hongyuan Dai 1 &

BMC Nursing volume  23 , Article number:  223 ( 2024 ) Cite this article

Metrics details

At the onset of their professional journey, novice nurses often undergo a multifaceted psychological experience as they transition from theoretical knowledge to clinical practice, potentially impacting their development of professional identity. However, limited research has been conducted on the psychological aspects pertaining to newly graduated nurses in stomatological hospitals in our country.

The phenomenological method and semi-structured interviews were used in this study, and the sample size of the interview was purposive sampling method. A semi-structured virtual interview was conducted with 21 new nurses in the department of stomatology. Colaizzi’s analysis method was used to analyse the interview data.

Based on Kramer’s reality shock theoretical framework and analyzing interview data, this study extracted the psychological experiences of novice nurses during their first year of employment across four distinct stages. The four stages include: cheerful period, frustration period, adjustment period and competency period. Six themes and nine sub-themes were derived from the four period.

Due to the lack of professional knowledge, novice oral nurses will experience a series of complex positive and negative emotions at the beginning of their career. Through the research, the training of oral specialty theory, good psychological counseling and peer support can improve their participation in oral outpatient nursing. At the same time, the establishment of oral care quality assurance system and the improvement of oral care higher education in our country will become the focus of future research.

Peer Review reports

According to statistics, there has been a recent increase in the number of patients with oral diseases in China, resulting in a total of 703 million cases of dental caries [ 1 ], malocclusion, pulpitis, and other oral conditions [ 2 ]. The work of oral nurses is not limited to daily oral treatment assistance, but also involves oral health education, preventive health care, oral imaging technology, instrument disinfection and sterilization, four-hand operation cooperation, and oral disease management and research. With the increasing public awareness of oral health and the growing demand for oral medical services, the demand for oral nurses continues to increase. Dental nurses play a crucial role as integral members of the medical service team in the field of oral health care. However, studies [ 3 ] have indicated that most dental clinic nurses receive training primarily focused on general nursing rather than specialized oral care. In clinical practice, these student nurses typically undergo rotations lasting over eight months at grade-A tertiary general hospitals [ 4 ]. Novice oral nurses lack systematic basic knowledge of oral nursing specialty and related practical courses before entering the oral outpatient nursing work. At the beginning of the work, the new nurse is enthusiastic about the work. After entering the workplace for some time, they feel anxious and helpless, and crave help from colleagues and care managers. At the same time, due to the increase in work intensity and responsibility, the novice nurses will become less confident and even increase the turnover rate [ 5 , 6 ]. Therefore, adopting a phenomenological perspective for this study involved conducting in-depth interviews with newly employed nurses who did not specialize in oral nursing but had recently joined stomatological hospitals. The aim was to extract their psychological experiences during the transitional stage [ 7 ], identify strategies for stress relief and coping mechanisms while providing valuable insights for enhancing professional development and management practices among nurses within stomatological hospitals.

Objective of the study

The purpose of this study was to explore the psychological experience of novice nurses in different stages of early work in stomatological hospitals, and to provide evidence for future training of stomatological nurses.

Participants

Purposive sampling method was used to select 21 newly recruited nurses from different regions and different grades of stomatology hospitals for interview. They are going through the early stages of their career development,with less than one year of work experience. The inclusion criteria were as follows: (I) Graduation with a nursing major and possession of a valid nurse practicing certificate; (II) Engagement in dental specialist outpatient nursing duties; (III) Less than one year of working experience; (IV) Provision of informed consent and voluntary participation in this study. Exclusion criteria included: (I) Taking sick leave or being on sick leave for more than three months; (II) Transferring to non-oral outpatient nursing positions. The sample size was determined based on information saturation, ensuring no new topics emerged.

Data collection

A semi-structured interview guide (Table  1 ) was used to collect information through face-to-face interviews. This interview guide was based on a thorough literature review [ 8 ] and extensive discussions within the research group. The interview guide was then refined through consultations with two dental specialists, two dental outpatient nursing managers, one dental nurse, and pre-interviews with five novice nurses. All the interviews were conducted by a postgraduate nursing student who was trained in qualitative research. A research assistant played an auxiliary role which included recording the interviews. The interview took place in the nurses’ lounge and lasted 30 to 40 min.The interviews were recorded by a whole process of synchronous recording, notes, and timely reminiscence during the interview, and participants’ views were clarified and confirmed to ensure accuracy. The interview times ranged from 30 to 40 min. The interviews were conducted in the participant’s language (Chinese). At the end of each interview, two Doctor of Nursing who are familiar with the disciplinary background and professional terms were invited to translate the interview content into English to ensure the accuracy of the translation.We stopped when the analysis reached data saturation: the interview has not added any new information to the data collection process. The sample size was saturated when the information appeared repeatedly and there was no new content or topic. The study did not repeat the interviews.

Data analysis

Throughout the analysis, two researchers independently reviewed and coded the interview transcripts, identifying initial themes and subthemes. This study adopts the Colaizzi descriptive analysis framework [ 9 ] divided into seven analytical steps. (1) Reading of interviews by two researchers who reread transcripts several times to become immersed in the data. (2) Identification and coding of significant statements related to psychological concerns in novice nurses.(3) Extracting meaningful fragments through team discussions. (4) Organizing each significant statement into meaningful units and subthemes into major themes. (5) Linking themes closely to research phenomena and detailing them. (6) Identifying similar ideas and deleting them. (7) Providing feedback on the results to participants to ensure the authenticity of the content. To enhance reliability and agreement, a third researcher was involved in developing credibility around the themes and addressing any discrepancies between the initial coders.

Ethical considerations

The Ethics Committee of the Stomatology Hospital Affiliated to the School of Medicine of Nanjing University provided an ethical review. All participants signed an informed consent document before the interview. Additionally, participants were informed that their participation in the study was voluntary and the information gathered from the interviews would be recorded and used only for scientific purposes. To protect the privacy of interviewees, the interviews were presented anonymously, and names were replaced with numerical identifiers.

Rigour was ensured by following the criteria for trustworthiness: credibility, confirmability, dependability and transferability. During the interview, the researcher asked questions according to the interview outline, listened carefully, asked questions, retold and summarized in a timely manner, and kept an objective attitude without inducing, evaluating or easily interrupting the interviewees’ statements,and and this methodology strengthened the overall credibility of the study. All of the participants confirmed that the results resonated with their experiences, and no new feedback had developed in their practice since the initial interviews. All authors took part in all analytical stages. The condensed text was discussed until consensus was reached on the analysis and the formulated themes. This strengthens the dependability of the study, together with a clear description of the research process. The results are presented with participants’ quotes to facilitate external judgement and to consider transferability of results to other nursing contexts.

A total of 21 novice nurses participated in the interview and their demographic information is shown in Table  2 . There were 18 female nurses and 3 male nurses, ranging in age from 20 to 23 years. The themes in the interviews are presented in Table  3 .

The cheerful period: enter the new work environment feel temporary pleasant and relaxation

Theme 1: pleasant and relaxation, keeping a positive attitude towards learning.

All interviewees reported that oral outpatient nursing was less physically demanding than clinical nursing for the same amount of time. At the same time, because the night shift in the oral clinic decreased or even some of them did not have night shift, they all indicated that the daily self-management time increased, and they were more willing to accept nursing work without night shift. They are eager to learn new things.The participants provided the following accounts of their experiences:

“Before that, I worked as an intern in the intensive care unit of a Grade III general hospital, where I had to turn over for patients every two hours. I was very nervous and tired every day, because I did not want to continue working night shifts, so I want to learn about oral care”. (N5)

“I am very interested in every nursing operation, hope to master as soon as possible, and want to learn new knowledge every day”.(N6).

Avoiding nurse-patient conflict

The working environment of stomatology hospital is different from that of general hospital, the oral clinic is relatively clean and quiet, and doctors are responsible for the main treatment and communication work. Nurses need to cooperate with doctors in the process of diagnosis and treatment to prepare materials before diagnosis and treatment, four-hand operation, delivery of goods, mixing materials, disposal of materials, and health education for patients, etc., which avoids long-term direct contact between nurses and patients and reduces nurse-patient conflicts. The working environment of general hospital is noisy and busy, which is easy to cause the contradiction between nurse and patient. Participants shared their experiences in this regard:

“There is no need to directly face the patient, there is no need to explain to the patient before doing the operation, only cooperate with the doctor to pass the instrument, do their own work, and never conflict with the patient”.(N18).

“I am very friendly to every patient, working in the dental clinic smile is essential”.(N4).

The frustration period: the expectation of the new role is very different from the daily work and lack of security

Theme 2: self-doubt, peer support.

With the passage of time, their own high demands on the work and often frustrated in the outpatient nursing work, the new nurses have become less and less confident. They crave understanding and support. Participants shared their experiences as follows:

“When mixing materials, I did not have a good grasp of the nature of the materials, and each doctor had different preferences. Sometimes I would confuse their preferences, which made them dissatisfied, and I became less and less confident. After the work, I will talk to my good friends, they show understanding and will give me support”.(N7).

“My friends tell me you’ll do a lot of operations. For example, intravenous infusion, enema, sputum aspiration and other operations. It’s just not useful in your current field of work”.(N8).

Theme 3: helpless

Professional support.

Novice nurses encounter setbacks in the workplace, feeling helpless and eager to seek professional help. At the same time, they tend to have low career achievements due to lack of professional guidance and work mistakes. However, compared with the new nurses who entered the general hospital, they have been more competent because of the systematic training of clinical nursing professional knowledge.

“I want to learn some professional knowledge about oral care, which will improve my confidence. So I hope that nursing managers can increase their training in oral knowledge and oral nursing practice skills”.(N18).

“I was nervous at work, afraid of doing it wrong, and I wanted someone (nursing managers) to guide me in oral care. If I master the professional knowledge, I may not be nervous in the future work”.(N7).

Theme 4: frustration

Need to maintain self-esteem.

After the short enthusiasm for the new environment, with the increase of work intensity and the requirements of job duties, novice nurses who have just entered the hospitals will often feel uneasy and even fall into frustration due to their lack of oral care expertise and weak practical operation. Participants shared their experiences as follows:

“Sometimes I am nervous and afraid of making mistakes in my work, A few times I’ve seen doctors shake their heads disdainfully at me because I’ve made a mistake in my work”.(N14).

“I felt that it was too different from the clinical, I felt that I was out of place, and the operational skills I knew before were less useful here”.(N15).

The adjustment period: the career development transitioned from a state of confusion to gradually adapting

Theme 5: relieved, managing negative emotions.

At this stage, nursing students realize their negative emotions in the work, begin to adjust their mentality.

“When I’m feeling down, I take a deep breath and whisper to myself to be confident”.(N1).

“I will think of something pleasant and try not to bring negativity into my work”.(N6).

Making up for the shortcomings

Novice nurses begin to accept their shortcomings in ability and strive to enrich themselves, and gradually adapt to the nursing work in the oral clinic. Participants shared their experiences as follows:

“Like the previous internship, I will prepare a small book, and record in time what I don’t understand in my usual work. After work, I will consult the information or consult my colleagues and head nurses”.(N19).

“When I get home from work, I start reading oral care books, sometimes studying until the wee hours of the morning. I don’t want to fall behin’’.(N3).

The competency period: be able to put your role in perspective and be competent in clinical work

Theme 6: self-affirmation, cognitive reappraisal.

Novice nurses with improved abilities in all aspects can independently carry out nursing operations, and when they encounter problems, they are no longer afraid and uneasy, and begin to think about how to use existing resources to change the status quo. They are eager for long-term development, and strive to become a dental specialist nurse in order to better show their value in work. Participants shared their experiences as follows:

“At work, I have a cooperative relationship with doctors, but we have different division of labor. Whether it is clinical work or oral clinic work, it is a process of continuous learning and accumulation of knowledge. I believe that I can become a qualified and competent nurse in any field”. (N21)

Transform knowledge

By strengthening the learning of oral nursing professional knowledge and professional skills, new nurses will combine the previous knowledge with the new knowledge and apply it to the field of work.

“After all, I was in clinical practicum, and the doctor praised me for my strong aseptic concept when I assisted the doctor with the surgery. I found that clinical and oral outpatient work have many similarities, but we need to transform and accurately apply it to the usual outpatient work”.(N11).

This study found that after the newly graduated nurses worked in the stomatological hospitals, the outpatient work mode reduced the damage to their body caused by high-intensity night shift, and the change of working environment reduced the nurse-patient conflict, both of which alleviated the physical and mental pressure of such nurses. It shows that improving the working environment can relieve the working pressure of nurses. However, in terms of work content, they are prone to frustration due to their proficiency in oral nursing when they first enter the job due to their weak knowledge base in oral nursing. At this time, nurses will have negative emotions, which requires them to be good at regulating their emotions.Secondly, the nurses in the dental clinic are mainly engaged in nursing cooperation beside the chair, and the relationship between nurses and doctors has changed from cooperation to subordination, and the sense of professional achievement has decreased. Therefore, it is suggested that nursing managers should strengthen the training of the basic knowledge and practical ability of the new oral nurses after they enter the clinical work. Make practical learning plans and training plans to guide the career planning of nurses. At the same time, in terms of psychology, psychological experts should be used to guide the psychology of novice nurses, which should be different from person to person. To help and support novice nurses in work and life, improve the status and importance of nurses in oral diagnosis and treatment, and finally realize the high-quality development of oral care.

Improving the working environment

Studies have shown that [ 10 ] poor working environment, uncooperative service objects and overloaded workload tend to cause nurses to be in a state of long-term high pressure. Long-term high pressure can lead to anxiety, empathy fatigue, headache and other sub-health [ 11 ], which also enhances nurses’ turnover intention. In addition, greater work pressure will not only affect the physical and mental health of nurses [ 12 ], but also pose a threat to the life safety of patients. This study shows that the working environment in the dental clinic is more conducive to nurses’ physical and mental relaxation than the clinical working environment. The most direct and obvious impact is to protect nurses’ sleep and reduce nurse-patient conflicts. Among them, all interviewees mentioned that within the same working hours, oral outpatient nursing work consumes less physical energy, and self-perception of oral outpatient working environment is better. This is consistent with the survey results of Wang Qian [ 5 ] et al. Therefore, working environment, work load and good nurse-patient relationship are more conducive to nurses’ involvement in work, and are also one of the factors for nurses to choose jobs. The stomatological hospitals should pay attention to the working environment and workload of nurses, conduct on-the-job skills and theoretical knowledge training for nurses, and take corresponding measures to improve the working environment and timely adjust the allocation of human resources, so as to alleviate the physical and mental fatigue of nurses and reduce the turnover rate of nurses.

Regulating your emotions

According to the emotional regulation process model of Campos [ 13 ], the purpose of individual emotional regulation is to choose socially acceptable responses to coordinate inconsistent conflicts in daily interactions. If not solved in time, the negative psychology in interpersonal communication is likely to cause individuals to have distress and avoidance behaviors in social activities [ 14 , 15 ]. In this study, with the increase of work intensity over time, nurses in the transition period felt more conflict between ideal and reality. On the one hand, due to the lack of theoretical knowledge and practical skills in stomatology, novice nurses often frustrated in nursing work, which leads to the reduction of professional achievement; On the other hand, there are studies [ 16 ] showing that nurses will take doctors as the reference objects for social comparison in terms of career promotion, social status and treatment. The more unfairness they feel, the more negative emotions they will have. Therefore, for the psychological conditions faced by novice nurses, medical institutions should invite psychological experts to psychological counseling them to help them get out of negative emotions as soon as possible. Help them re-examine their role and correctly understand their responsibilities and importance in the work [ 17 ]. It is understood that although the working environment and nursing operation of the dental clinic are different from the clinical clinic, the essence of nursing work is patient-centered, rather than focusing on a certain specialty. Different professional and technical personnel need to collaborate with each other to provide better service to patients.

Positive learning attitude

In traditional Chinese ethics, people attach great importance to the cultivation of learning attitude. Some studies [ 18 , 19 ] show that positive learning attitude helps cross-professional nursing students master professional knowledge, integrate into team work more quickly and improve critical thinking of nursing students. In this study, some of the nurses in the dental clinic during the transition period had clinical work experience, or even had rich work experience and status. However, due to the change of the working environment, the weak theoretical knowledge and practical operation ability of stomatology will make them feel uncomfortable. However, after self-emotional management and psychological construction, they have given up the praise of the past honor, maintain a positive learning attitude in daily work, and strive to enrich themselves to fill the vacancy in oral oral care specialist theoretical knowledge. Therefore, it is suggested that nurses should maintain a positive learning attitude at any stage of their work to enrich their professional knowledge. At the same time, nursing managers should also pay attention to the cultivation of nurses’ learning attitude.

Improving the ability of knowledge transfer

The ability to acquire and transform knowledge [ 20 ] is more important than knowledge itself, and to achieve the integration of knowledge and action requires improving one’s own knowledge transformation ability. SECI [ 21 ], a knowledge transformation model proposed by Ikujiro Nonaka, holds that tacit knowledge and explicit knowledge can transform each other. In this study, clinical nurses based on clinical nursing knowledge applied strong aseptic concept to oral outpatient nursing work, and also learned oral medicine knowledge in the work. As a branch of nursing, oral nursing adds the basic course of oral medicine on the basis of nursing, which is the cross specialty of nursing and oral medicine. Therefore, it is suggested that nurses should quickly transform the relevant theoretical knowledge and practical experience in nursing, oral care and oral medicine into their work field, and treat their work and patients with a proactive attitude [ 22 ]. Learn to use their own knowledge, experience, communication and other advantages combined with the existing environment, strengthen the ability of knowledge transformation, so that no matter how the working environment changes, as a nurse can quickly qualified for new posts. Just as scholar Han Bin [ 23 ] said, “Only by targeting the needs of patients and providing professional guidance can the nursing specialty outpatient clinics have vitality”.

Study limitations

The study was limited by its use of a single data source, as participants were recruited from only two dental specialty hospitals and were not generalized nationwide. So it may not be generalizable to other nurses.

Implications for practice

The study provides evidence for improving the adaptability of new graduates to work more quickly.Nursing managers should strengthen the training of the newly graduated nurses on the theoretical knowledge of the specialty, and at the same time, they should also provide psychological counseling to such nurses to help them face the work more actively and grow into an excellent nurse quickly.

Through in-depth interviews with 21 novice dental nurses, the objective of this qualitative study was to gain insight into the psychological experience of novice nurses in the stomatological hospitals and to extract their psychological experiences during the transitional stage, identify strategies for stress relief and coping mechanisms while providing valuable insights for enhancing professional development and management practices among nurses within stomatological hospitals. Through the research, it is found that the dental hospital has some deficiencies in the training of the theoretical knowledge and practical operation ability of the dental novice nurses. In the future, it is suggested that scholars and dental hospitals develop feasible training programs for new dental nurses. In the aspect of psychological counseling, establish a professional organization to carry out psychological counseling for novice nurses. It is suggested that China should improve the specialized education of oral nursing, and form a specialized nursing education system with higher nursing education as the mainstream.

Data availability

The datasets generated and/or analysed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

Consumer Healthcare Industry Depth. Industry Atlas– 220901 (58 pages).

Xia YA, Cao YX, Yu XY. A case report and literature review of implant repair of severe class III alveolar bone [J/OL]. Journal of Ji Nan university (natural science and medicine edition),2023,09(02):1–6.

Yin YL, Han JN, Fu L. Current situation and enlightenment of training oral nursing professionals in China [J]. Chin J Nurs Educ. 2022;19(02):182–7.

Google Scholar  

Wang Q, Mandew, Shi Yue Xian. Investigation on job involvement and influencing factors of outpatient nurses in Stomatology hospital [J]. J Nurs. 2022;37(05):38–41.

Zhu YQ, Zhang YY, Zhang YQ. Research progress of transition impact of newly graduated nurses [J]. China Nurs Adm. 2023;23(06):882–6.

Huang YX. Study on the impact Degree of nursing undergraduates’ transformation and its influencing factors [D]. Chongqing Medical University; 2022.

Mo YY, Su ZQ, Li YF. Factors influencing the working mental state of dental nurses [J]. Nurs Pract Res. 2022;19(11):1590–3.

Han YT, Wu YF, Hou LL. Application of psychological course based on reality impact theory in the training of new nurses [J]. Shanghai Nurs. 2023;23(03):27–30.

Webb C. Information point: Colaizzi’s framework for analysing qualitative data[J].Clin Nurs,1999, 8(5):576.

Maher L, Dertadian G. Qualitative research. Addiction. 2018;113(1):167–72.

Article   PubMed   Google Scholar  

Peng J, Li D, Zhang Z. How can core self-evaluations influence job burnout? The key roles of organizational commitment and job satisfaction [J]. J Health Psychol. 2016;21(1):50–9.

Wei LW, He QH, Wang MM. The relationship between work time stress and mental health of graduate students: the mediating effect of sleep quality and the moderating effect of mental flexibility [J]. Chin J Health Psychol. 2022;30(09):1375–80.

Zhang HL, Huo XN, Zhao ZY. The mediating effect of health promoting lifestyle on job stress and sleep quality in nurses [J]. Chin J Health Psychol. 2022;30(03):401–5.

Campos JJ, Mumme DL, Kermoian R. A functionalist perspective on the nature of emotion [J]. Monogr Soc Res Child Dev. 1994;59(2–3):284–303.

Article   CAS   PubMed   Google Scholar  

Xue J, Hong JW. Withdrawal self-rescue under burden: An Analysis of Young users’ social media burnout Behavior based on Rooted theory [J]. News Writ, 2022, (08): 70–83.

Zhang GJ, Liu HL. Expression of loneliness in social media: an analysis of the advantages and disadvantages of revealing negative emotions and seeking support [J]. Friends Editor, 2022, (09): 77–81.

Dai JH. Investigation and analysis of professional identity of college nursing students [J]. Nurs Pract Res. 2014;11(08):100–2.

Gross JJ. Emotion regulation: affective, cognitive, and social consequences [J]. Psychophysiology. 2002;39(3):281–91.

Lau PS, Wu FK. Emotional competence as a positive youth development construct: a conceptual review [J]. Scientific World Journal, 2012, 2012: 975189.

Lundell Rudberg S, Lachmann H, Sormunen T. The impact of learning styles on attitudes to interprofessional learning among nursing students: a longitudinal mixed methods study [J]. BMC Nurs. 2023;22(1):68.

Article   PubMed   PubMed Central   Google Scholar  

Jiang YC. Dynamic demand and capability generation of knowledge construction growth [J]. Inform Theory Pract. 2014;37(04):19–23.

CAS   Google Scholar  

Farnese ML, Barbieri B, Chirumbolo A. Managing knowledge in Organizations: a Nonaka’s SECI Model operationalization [J]. Front Psychol. 2019;10:2730.

Dai P, Zhang JM. Factors influencing the quality of humanistic care in dental outpatient nurses [J]. Nurs Pract Res. 2021;18(09):1283–6.

Download references

Acknowledgements

We would like to thank the 21 participants who shared their feelings about entering a new field of work.

No founding was obtained for this study.

Author information

Authors and affiliations.

Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China

Jian Liu, Tiantian Lu, Yan Li, Hongyuan Dai & Li Li

You can also search for this author in PubMed   Google Scholar

Contributions

J.L: Conceptualization, methodology, data collection, formal analysis, project administration, writing-original draft, writing-review & editing. T.T.L: Data collection, formal analysis. Y.L and H.Y.D: Methodology, writing-review & editing. L.L: Conceptualization, methodology, supervision, project administration, writing-review & editing.

Corresponding author

Correspondence to Li Li .

Ethics declarations

Ethics approval and consent to participate.

Before filling in the questionnaire, all participants obtained informed consent to the content and significance of this study, and then filled in anonymously. All procedures were carried out in accordance with the 1964 Helsinki declaration, and the research proposal was approved by the Ethics Committee of the Stomatology Hospital Affiliated to the School of Medicine of Nanjing University.(KY-2023NL-081).

Consent for publication

Not applicable.

Competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Liu, J., Lu, T., Li, Y. et al. Exploring the psychological experience of novice nurses in stomatological hospitals in China: a phenomenological study. BMC Nurs 23 , 223 (2024). https://doi.org/10.1186/s12912-024-01879-z

Download citation

Received : 02 September 2023

Accepted : 17 March 2024

Published : 01 April 2024

DOI : https://doi.org/10.1186/s12912-024-01879-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Novice nurse
• Stomatological hospital
• Qualitative study
• Phenomenological research

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

How phenomenology can help us learn from the experiences of others

• A Qualitative Space
• Open access
• Published: 05 April 2019
• Volume 8 , pages 90–97, ( 2019 )

Cite this article

You have full access to this open access article

• Brian E. Neubauer 1 , 2 ,
• Catherine T. Witkop 3 &
• Lara Varpio 1  

505k Accesses

439 Citations

44 Altmetric

Explore all metrics

Introduction

As a research methodology, phenomenology is uniquely positioned to help health professions education (HPE) scholars learn from the experiences of others. Phenomenology is a form of qualitative research that focuses on the study of an individual’s lived experiences within the world. Although it is a powerful approach for inquiry, the nature of this methodology is often intimidating to HPE researchers. This article aims to explain phenomenology by reviewing the key philosophical and methodological differences between two of the major approaches to phenomenology: transcendental and hermeneutic. Understanding the ontological and epistemological assumptions underpinning these approaches is essential for successfully conducting phenomenological research.

This review provides an introduction to phenomenology and demonstrates how it can be applied to HPE research. We illustrate the two main sub-types of phenomenology and detail their ontological, epistemological, and methodological differences.

Conclusions

Phenomenology is a powerful research strategy that is well suited for exploring challenging problems in HPE. By building a better understanding of the nature of phenomenology and working to ensure proper alignment between the specific research question and the researcher’s underlying philosophy, we hope to encourage HPE scholars to consider its utility when addressing their research questions.

Similar content being viewed by others

A worked example of Braun and Clarke’s approach to reflexive thematic analysis

David Byrne

Focus group methodology: some ethical challenges

Julius Sim & Jackie Waterfield

Doing Reflexive Thematic Analysis

Avoid common mistakes on your manuscript.

A Qualitative Space highlights research approaches that push readers and scholars deeper into qualitative methods and methodologies. Contributors to A Qualitative Space may: advance new ideas about qualitative methodologies, methods, and/or techniques; debate current and historical trends in qualitative research; craft and share nuanced reflections on how data collection methods should be revised or modified; reflect on the epistemological bases of qualitative research; or argue that some qualitative practices should end. Share your thoughts on Twitter using the hashtag: #aqualspace

Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so.—Douglas Adams

Despite the fact that humans are one of few animals who can learn from the experiences of others, we are often loath to do so. Perhaps this is because we assume that similar circumstances could never befall us. Perhaps this is because we assume that, if placed in the same situation, we would make wiser decisions. Perhaps it is because we assume the subjective experience of an individual is not as reliably informative as objective data collected from external reality. Regardless of the assumptions grounding this apprehension, it is essential for scholars to learn from the experiences of others. In fact, it is a foundational premise of research. Research involves the detailed study of a subject (i. e., an individual, groups of individuals, societies, or objects) to discover information or to achieve a new understanding of the subject [ 1 ]. Such detailed study often requires understanding the experiences of others so that we can glean new insights about a particular phenomenon. Scholars in health professions education (HPE) are savvy to the need to learn from the experiences of others. To maximize the effectiveness of feedback, of workplace-based learning, of clinical reasoning, or of any other of a myriad of phenomena, HPE researchers need to be able to carefully explore and learn from the experiences of others. What often curtails these efforts is a lack of methodology. In other words: HPE researchers need to know how to learn from the experiences of others.

Phenomenology is a qualitative research approach that is uniquely positioned to support this inquiry. However, as an approach for engaging in HPE research, phenomenology does not have a strong following. It is easy to see why: To truly understand phenomenology requires developing an appreciation for the philosophies that underpin it. Those philosophies theorize the meaning of human experience. In other words, engaging in phenomenological research requires the scholar to become familiar with the philosophical moorings of our interpretations of human experience. This may be a daunting task, but Douglas Adams never said learning from the experiences of others would be easy.

The questions that phenomenology can answer, and the insights this kind of research can provide, are of foundational importance to HPE: What is the experience of shame and the impact of that experience for medical learners [ 2 ]? What does it mean to be an empathetic clinician [ 3 ]? What is the medical learner’s experience of failure on high stakes exams [ 4 ]? How do experienced clinicians learn to communicate their clinical reasoning in professional practice [ 5 ]? Answers to such questions constitute the underpinnings of our field. To answer such questions, we can use phenomenology to learn from the experiences of others.

In this manuscript, we delve into the philosophies and methodologies of two varieties of phenomenology: hermeneutic and transcendental. Our goal is not to simplify the complexities of phenomenology, nor to argue that all HPE researchers should use phenomenology. Instead, we suggest that phenomenology is a valuable approach to research that needs to have a place in HPE’s body of research. We will place these two approaches in the context of their philosophical roots to illustrate the similarities and differences between these ways of engaging in phenomenological research. In so doing, we hope to encourage HPE researchers to thoughtfully engage in phenomenology when their research questions necessitate this research approach.

What is phenomenology?

In simple terms, phenomenology can be defined as an approach to research that seeks to describe the essence of a phenomenon by exploring it from the perspective of those who have experienced it [ 6 ]. The goal of phenomenology is to describe the meaning of this experience—both in terms of what was experienced and how it was experienced [ 6 ]. There are different kinds of phenomenology, each rooted in different ways of conceiving of the what and how of human experience. In other words, each approach of phenomenology is rooted in a different school of philosophy. To choose a phenomenological research methodology requires the scholar to reflect on the philosophy they embrace. Given that there are many different philosophies that a scientist can embrace, it is not surprising that there is broad set of phenomenological traditions that a researcher can draw from. In this manuscript, we highlight the transcendental and the hermeneutic approaches to phenomenology, but a broader phenomenological landscape exists. For instance, the Encyclopedia of Phenomenology, published in 1997, features articles on seven different types of phenomenology [ 7 ]. More contemporary traditions have also been developed that bridge the transcendental/hermeneutic divide. Several of these traditions are detailed in Tab.  1 [ 8 , 9 , 10 ].

To understand any of these approaches to phenomenology, it is useful to remember that most approaches hold a similar definition of phenomenology’s object of study. Phenomenology is commonly described as the study of phenomena as they manifest in our experience, of the way we perceive and understand phenomena, and of the meaning phenomena have in our subjective experience [ 11 ]. More simply stated, phenomenology is the study of an individual’s lived experience of the world [ 12 ]. By examining an experience as it is subjectively lived, new meanings and appreciations can be developed to inform, or even re-orient, how we understand that experience [ 13 ].

From this shared understanding, we now address how transcendental (descriptive) phenomenology and hermeneutic (interpretive) phenomenology approach this study in different ways. These approaches are summarized in Tab.  2 .

• Transcendental phenomenology

Phenomenology originates in philosophical traditions that evolved over centuries; however, most historians credit Edmund Husserl for defining phenomenology in the early 20th century [ 14 ]. Understanding some of Husserl’s academic history can provide insight into his transcendental approach to phenomenology. Husserl’s initial work focused on mathematics as the object of study [ 15 ], but then moved to examine other phenomena. Husserl’s approach to philosophy sought to equally value both objective and subjective experiences, with his body of work ‘culminating in his interest in “pure phenomenology” or working to find a universal foundation of philosophy and science [ 13 ].’ Husserl rejected positivism’s absolute focus on objective observations of external reality, and instead argued that phenomena as perceived by the individual’s consciousness should be the object of scientific study. Thus, Husserl contended that no assumptions should inform phenomenology’s inquiry; no philosophical or scientific theory, no deductive logic procedures, and no other empirical science or psychological speculations should inform the inquiry. Instead, the focus should be on what is given directly to an individual’s intuition [ 16 ]. As Staiti recently argued, this attitude towards phenomenology is akin to that of ‘a natural scientist who has just discovered a previously unknown dimension of reality [ 17 ].’ This shift in focus requires the researcher to return ‘to the self to discover the nature and meaning of things [ 18 ].’ As Husserl asserted: ‘Ultimately, all genuine and, in particular, all scientific knowledge, rests on inner evidence [ 19 ].’ Inner evidence—that is, what appears in consciousness—is where a phenomenon is to be studied. What this means for Husserl is that subjective and objective knowledge are intimately intertwined. To understand the reality of a phenomenon is to understand the phenomenon as it is lived by a person. This lived experience is, for Husserl, a dimension of being that had yet to be discovered [ 17 ]. For Husserl, phenomenology was rooted in an epistemological attitude; for him, the critical question of a phenomenological investigation was ‘What is it for an individual to know or to be conscious of a phenomenon [ 20 ]?’ In Husserl’s conception of phenomenology, any experienced phenomenon could be the object of study thereby pushing analysis beyond mere sensory perception (i. e. what I see, hear, touch) to experiences of thought, memory, imagination, or emotion [ 21 ].

Husserl contended that a lived experience of a phenomenon had features that were commonly perceived by individuals who had experienced the phenomenon. These commonly perceived features—or universal essences—can be identified to develop a generalizable description. The essences of a phenomenon, according to Husserl, represented the true nature of that phenomenon. The challenge facing the researcher engaging in Husserl’s phenomenology, then, is:

To describe things in themselves, to permit what is before one to enter consciousness and be understood in its meanings and essences in the light of intuition and self-reflection. The process involves a blending of what is really present with what is imagined as present from the vantage point of possible meanings; thus, a unity of the real and the ideal [ 18 ] .

In other words, the challenge is to engage in the study of a person’s lived experience of a phenomenon that highlights the universal essences of that phenomenon [ 22 ]. This requires the researcher to suspend his/her own attitudes, beliefs, and suppositions in order to focus on the participants’ experience of the phenomenon and identify the essences of the phenomenon. One of Husserl’s great contributions to philosophy and science is the method he developed that enables researchers ‘to suspend the natural attitude as well as the naïve understanding of what we call the human mind and to disclose the realm of transcendental subjectivity as a new field of inquiry [ 17 ].’

In Husserl’s’ transcendental phenomenology (also sometimes referred to as the descriptive approach), the researcher’s goal is to achieve transcendental subjectivity —a state wherein ‘the impact of the researcher on the inquiry is constantly assessed and biases and preconceptions neutralized, so that they do not influence the object of study [ 22 ].’ The researcher is to stand apart, and not allow his/her subjectivity to inform the descriptions offered by the participants. This lived dimension of experience is best approached by the researcher who can achieve the state of the transcendental I —a state wherein the objective researcher moves from the participants’ descriptions of facts of the lived experience, to universal essences of the phenomenon at which point consciousness itself could be grasped [ 23 ]. In the state of the transcendental I , the researcher is able to access the participants’ experience of the phenomenon pre-reflectively—that is ‘without resorting to categorization on conceptualization, and quite often includes what is taken for granted or those things that are common sense [ 13 ].’ The transcendental I brings no definitions, expectations, assumption or hypotheses to the study; instead, in this state, the researcher assumes the position of a  tabula rasa, a blank slate, that uses participants’ experiences to develop an understanding of the essence of a phenomenon.

This state is achieved via a series of reductions. The first reduction, referred to as the transcendental stage , requires transcendence from the natural attitude of everyday life through epoche , also called the process of bracketing . This is the process through which the researchers set aside—or bracket off as one would in a mathematical equation—previous understandings, past knowledge, and assumptions about the phenomenon of interest. The previous understandings that must be set aside include a wide range of sources including: scientific theories, knowledge, or explanation; truth or falsity of claims made by participants; and personal views and experiences of the researcher [ 24 ]. In the second phase, transcendental-phenomenological reduction , each participant’s experience is considered individually and a complete description of the phenomenon’s meanings and essences is constructed [ 18 ]. Next is reduction via imaginative variation wherein all the participants’ descriptions of conscious experience are distilled to a unified synthesis of essences through the process of free variation [ 25 ]. This process relies on intuition and requires imagining multiple variations of the phenomenon in order to arrive at the essences of the phenomenon [ 25 ]. These essences become the foundation for all knowledge about the phenomenon.

The specific processes followed to realize these reductions vary across researchers engaging in transcendental phenomenology. One commonly used transcendental phenomenological method is that of psychologist Clark Moustakas, and other approaches include the works of: Colaizzi [ 26 ], Giorgi [ 27 ], and Polkinghorne [ 28 ]. Regardless of the approach used, to engage rigorously in transcendental phenomenology, the researcher must be vigilant in his/her bracketing work so that the researcher’s individual subjectivity does not bias data analysis and interpretations. This is the challenge of reaching the state of the transcendental I where the researcher’s own interpretations, perceptions, categories, etc. do not influence the processes of reduction. It is important to note that modern philosophers continue to wrestle with Husserl’s notions of bracketing. If bracketing is successfully achieved, the researcher sets aside the world and the entirety of its content—including the researcher’s physical body [ 17 ]. While dedication to this bracketing is challenging to maintain, Husserl asserts that it is necessary. Suspending reliance on and foundations in physical reality is the only way to abandon our human experiences in such a way as to find the transcendent I. Researchers might borrow [ 29 ] practices from other qualitative research methods to achieve this goal. For instance, a study could be designed to have multiple researchers triangulate [ 30 ] their reductions to confirm appropriate bracketing was maintained. Alternatively, a study could involve validation of data [ 18 ] via member checking [ 31 ] to ensure that the identified essences resonated with the participants’ experiences.

Husserl’s transcendental phenomenology has been employed by HPE researchers. For example, in 2012, Tavakol et al. studied medical students’ understanding of empathy by engaging in transcendental phenomenological research [ 32 ]. The authors note that medial students’ loss of empathy as they transition from pre-clinical to clinical training is well documented in the medical literature [ 33 ], and has been found to negatively impact patients and the quality of healthcare provided [ 34 ]. Tavakol et al. [ 32 ] used a descriptive phenomenological approach (i. e. using the methodology of Colaizzi and Giorgi) to report on the phenomenon of empathy as experienced by medical students during the course of their training. The authors identified two key factors impacting empathic ability: innate capacity for empathy and barriers to displaying empathy [ 32 ].

• Hermeneutic phenomenology

Hermeneutic phenomenology, also known as interpretive phenomenology, originates from the work of Martin Heidegger. Heidegger began his career in theology, but then moved into academia as a student of philosophy. While Heidegger’s philosophical inquiry began in alignment with Husserl’s work, he later challenged several key aspects of Husserl’s transcendental phenomenology. A foundational break from his predecessor was the focus of phenomenological inquiry. While Husserl was interested in the nature of knowledge (i. e., an epistemological focus), Heidegger was interested in the nature of being and temporality (i. e., an ontological focus) [ 21 ]. With this focus on human experience and how it is lived, hermeneutic phenomenology moves away from Husserl’s focus on ‘acts of attending, perceiving, recalling and thinking about the world [ 13 ]’ and on human beings as knowers of phenomenon. In contrast, Heidegger is interested in human beings as actors in the world and so focuses on the relationship between an individual and his/her lifeworld. Heidegger’s term lifeworld referred to the idea that ‘individuals’ realities are invariably influenced by the world in which they live [ 22 ].’ Given this orientation, individuals are understood as always already having an understanding of themselves within the world, even if they are not constantly, explicitly and/or consciously aware of that understanding [ 17 ]. For Heidegger, an individual’s conscious experience of a phenomenon is not separate from the world, nor from the individual’s personal history. Consciousness is, instead, a formation of historically lived experiences including a person’s individual history and the culture in which he/she was raised [ 22 ]. An individual cannot step out of his/her lifeworld. Humans cannot experience a phenomenon without referring back to his/her background understandings. Hermeneutic phenomenology, then, seeks ‘to understand the deeper layers of human experience that lay obscured beneath surface awareness and how the individual’s lifeworld, or the world as he or she pre-reflectively experiences it, influences this experience [ 35 ].’ Hermeneutic phenomenology studies individuals’ narratives to understand what those individuals experience in their daily lives, in their lifeworlds.

But the hermeneutic tradition pushes beyond a descriptive understanding. Hermeneutic phenomenology is rooted in interpretation—interpreting experiences and phenomena via the individual’s lifeworld. Here, Heidegger’s background in theology can be seen as influencing his approach to phenomenology. Hermeneutics refers to the interpretation of texts, to theories developed from the need to translate literature from different languages and where access to the original text (e. g., the Bible) was problematic [ 36 ]. If all human experience is informed by the individual’s lifeworld, and if all experiences must be interpreted through that background, hermeneutic phenomenology must go beyond description of the phenomenon, to the interpretation of the phenomenon. The researcher must be aware of the influence of the individual’s background and account for the influences they exert on the individual’s experience of being.

This is not to say that the individual’s subjective experience—which is inextricably linked with social, cultural, and political contexts—is pre-determined. Heidegger argued that individuals have situated freedom. Situated freedom is a concept that asserts that ‘individuals are free to make choices, but their freedom is not absolute; it is circumscribed by the specific conditions of their daily lives [ 22 ].’ Hermeneutic phenomenology studies the meanings of an individual’s being in the world, as their experience is interpreted through his/her lifeworld, and how these meanings and interpretations influence the choices that the individual makes [ 13 ]. This focus requires the hermeneutic phenomenologist to interpret the narratives provided by research participants in relation to their individual contexts in order to illuminate the fundamental structures of participants’ understanding of being and how that shaped the decisions made by the individual [ 37 ].

Another key aspect that distinguishes hermeneutic phenomenology is the role of the researcher in the inquiry. Instead of bracketing off the researcher’s subjective perspective, hermeneutic phenomenology recognizes that the researcher, like the research subject, cannot be rid of his/her lifeworld. Instead, the researcher’s past experiences and knowledge are valuable guides to the inquiry. It is the researcher’s education and knowledge base that lead him/her to consider a phenomenon or experience worthy of investigation. To ask the research to take an unbiased approach to the data is inconsistent with hermeneutic phenomenology’s philosophical roots. Instead, researchers working from this tradition should openly acknowledge their preconceptions, and reflect on how their subjectivity is part of the analysis process [ 16 ].

The interpretive work of hermeneutic phenomenology is not bound to a single set of rule-bound analytical techniques; instead, it is an interpretive process involving the interplay of multiple analysis activities [ 35 ]. In general, this process:

Starts with identifying an interesting phenomenon that directs our attention towards lived experience. Members of the research team then investigate experience as it is lived, rather than as it is conceptualized, and reflect on the essential [phenomenological] themes that characterize the participant’s experience with the phenomenon, simultaneously reflecting on their own experiences. Researchers capture their reflections in writing and then reflect and write again, creating continuous, iterative cycles to develop increasingly robust and nuanced analyses. Throughout the analysis, researchers must maintain a strong orientation to the phenomenon under study (i.   e., avoid distractions) and attend to the interactions between the parts and the whole. This last step, also described as the hermeneutic circle, emphasizes the practice of deliberately considering how the data (the parts) contribute to the evolving understanding of the phenomena (the whole) and how each enhances the meaning of the other [ 35 ] .

In the hermeneutic approach to phenomenology, theories can help to focus inquiry, to make decisions about research participants, and the way research questions can be addressed [ 22 ]. Theories can also be used to help understand the findings of the study. One scholar whose engagement with hermeneutic phenomenology is widely respected is Max van Manen [ 38 ]. Van Manen acknowledges that hermeneutic phenomenology ‘does not let itself be deceptively reduced to a methodical schema or an interpretative set of procedures [ 39 ].’ Instead, this kind of phenomenology requires the researcher to read deeply into the philosophies of this tradition to grasp the project of hermeneutic phenomenological thinking, reading, and writing.

A recent study published by Bynum et al. illustrates how hermeneutic phenomenology may be employed in HPE [ 2 ]. In this paper, Bynum et al. explored the phenomenon of shame as an emotion experienced by medical residents and offer insights into the effects of shame experiences on learners. As a means in scholarly inquiry, this study demonstrates how hermeneutic phenomenology can provide insight into complex phenomena that are inextricably entwined in HPE.

Incorporating phenomenological research methodologies into HPE scholarship creates opportunities to learn from the experiences of others. Phenomenological research can broaden our understanding of the complex phenomena involved in learning, behaviour, and communication that are germane to our field. But success in these efforts is dependent upon both improved awareness of the potential value of these approaches, and enhanced familiarization with the underlying philosophical orientation and methodological approaches of phenomenology. Perhaps most critically, HPE scholars must construct research processes that align with the tenets of the methodology chosen and the philosophical roots that underlie it. This alignment is the cornerstone for establishing research rigour and trustworthiness.

Following a specific checklist of verification activities or mandatory processes cannot buoy the quality and rigour of a particular phenomenological study. Instead, beyond maintaining fidelity between research question, paradigm, and selected methodology, robust phenomenological research involves deep engagement with the data via reading, reflective writing, re-reading and re-writing. In Moustakas’s approach to transcendental phenomenology, the researcher reads the data, reduces the data to meaning units, re-reads those reductions to then engage in thematic clustering, compares the data, writes descriptions, and so on in an ongoing process of continually engaging with the data and writing reflections and summaries until the researcher can describe the essence of the lived experience [ 18 ]. In hermeneutic phenomenology, scholars describe engaging in a hermeneutic circle wherein the researcher reads the data, constructs a vague understanding, engages in reflective writing, then re-engages with the text with revised understandings [ 40 ]. In cycles of reading and writing, of attending to the whole of the text and the parts, the hermeneutic researcher constructs an understanding of the lived experience. In both traditions, deep engagement with the data via reading, writing, re-reading and re-writing is foundational. While this engagement work is not standardized, Polkinghorne suggests that rich descriptions of phenomenological research might be characterized by qualities such as vividness, richness, accuracy, and elegance [ 41 ]. While we question how these qualities might be evaluated in a qualitative study, they confirm that attention to the depth of engagement in reading and writing of the phenomenological data is a necessary condition for rigour.

Phenomenology is a valuable tool and research strategy. For those who are not familiar with its philosophical underpinnings or methodological application, it can seem challenging to apply to HPE scholarship. We hope this manuscript will serve to relieve some of the apprehension in considering the use of phenomenology in future work. We believe that the appropriate application of phenomenology to HPE’s research questions will help us to advance our understanding by learning from the experiences of others.

The views expressed herein are those of the authors and do not necessarily reflect those of the Uniformed Services University of the Health Sciences, the United States Department of Defense or other federal agencies.

Cambridge Online Dictionary. 2019. https://dictionary.cambridge.org/us/dictionary/english/research . Accessed 24 Feb 2019, Research.

Bynum W, Artino A, Uijtdehaage S, Webb A, Varpio L. Sentinel emotional events. The nature, triggers, and effects of shame experiences in medical residents. Acad Med. 2018; https://doi.org/10.1097/ACM.0000000000002479 . Oct 1 [cited 2018 Oct 10] Epub ahead of print.

Article   Google Scholar  

Hooker C. Understanding empathy: why phenomenology and hermeneutics can help medical education and practice. Med Health Care Philos. 2015;2015(18):541–52.

Patel RS, Tarrant C, Bonas S, Shaw RL. Medical students’ personal experience of high-stakes failure: case studies using interpretative phenomenological analysis. Bmc Med Educ. 2015;15:1–9.

Ajjawi R, Higgs J. Using hermeneutic phenomenology to investigate how experienced practitioners learn to communicate clinical reasoning. Qual Rep. 2007;12:612:38.

Google Scholar  

Teherani A, Martimianakis T, Stenfors-Hayes T, Wadhwa A, Varpio L. Choosing a qualitative research approach. J Grad Med Educ. 2015;7:669–70.

Contributions to phenomenology. In: Embree L, editor. Encyclopedia of phenomenology. Vol. 18. Netherlands: Springer; 1997.

Ashworth P. An approach to phenomenological psychology: the contingencies of the lifeworld. J Phenom Psychol. 2003;34:145–56.

Vagle M. Crafting phenomenological research. London and New York: Routledge Taylor and Francis Group; 2018.

Book   Google Scholar  

Tuffour I. A critical overview of interpretative phenomenological analysis: a contemporary qualitative research approach. J Healthc Commun. 2017;2(4:52):1–5.

Smith, David Woodruff. Phenomenology. Stanford encyclopedia of philosophy. https://plato.stanford.edu/entries/phenomenology/ . Accessed 9 Oct 2018.

Manen MV. Researching lived experience: human science for an action sensitive pedagogy. London and New York: Routledge Taylor and Francis Group; 1997.

Laverty SM. Hermeneutic phenomenology and phenomenology: a comparison of historical and methodological considerations. Int J Qual Methods. 2003;2:1–29.

Kafle NP. Hermeneutic phenomenological research method simplified. Bodhi: Interdiscip J. 2011;5:181–2.

Jones WT. The twentieth century to Wittgenstein and Sartre. San Francisco, CA: Harcourt Brace Jovanovich; 1975.

Moran D. Introduction to phenomenology. Milton Park: Routledge; 2000.

Staiti A. The pedagogic impulse of Husserl’s ways into transcendental phenomenology: an alternative reading of the Erste Philosophie lecture. Grad Fac Philos J. 2012;33:39–56.

Moustakas CE. Phenomenological research methods. 1st ed. Thousand Oaks: SAGE; 1994.

Husserl E. The crisis of European sciences and transcendental phenomenology. 1st ed. Evanston: Northwestern University Press; 1970.

Barua A. Husserl, Heidegger, and the transcendental dimension of phenomenology. Indo-Pacific J Phenomenol. 2015;7:1–10.

Reiners GM. Understanding the differences between Husserl’s (descriptive) and Heidegger’s (interpretive) phenomenological research. J Nurs Care. 2012;1:1–3.

Lopez KA, Willis DG. Descriptive versus interpretive phenomenology: their contributions to nursing knowledge. Qual Health Res. 2004;14:726–35.

Davidsen AS. Phenomenological approaches in psychology and health sciences. Qual Res Psychol. 2013;10:318–39.

Presuppose Nothing AP. The suspension of assumptions in phenomenological psychological methodology. J Phenomenol Psychol. 1996;27:1–25.

Gill MJ. The possibilities of phenomenology for organizational research. Organ Res Methods. 2014;17:118–37.

Colaizzi P. Psychological research as a phenomenologist views it. In: Valle RS, King M, editors. Existential-phenomenological alternatives for psychology. Oxford, UK: Oxford University Press; 1978.

Giorgi A. Phenomenology and psychological research. Pittsburgh, PA: Duquesne University Press; 1985.

Polkinghorne DE. Phenomenological research methods. In: Valle RS, Halling S, editors. Existential-phenomenological perspectives in psychology: exploring the breadth of human experience. New York: Springer; 1989. pp. 41–60.

Chapter   Google Scholar  

Varpio L, Martimianakis T, Mylopoulos M. Qualitative research methodologies: embracing methodological borrowing, shifting, and importing. In: Durning SJ, Cleland J, editors. Researching medical education. 1st ed. West Sussex: Wiley-Blackwell; 2015. pp. 245–55.

Arksey H, Knight PT. Interviewing for social scientists. London: SAGE; 1999.

Birt L, Scott S, Cavers D, Campbell C, Walter F. Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qual Health Res. 2016;26:1802–11.

Tavakol S, Dennick R, Tavakol M. Medical students’ understanding of empathy: a phenomenological study. Med Educ. 2012;46:306–16.

Neumann M, Edelhauser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86:996–1009.

Del Canale S, Louis DZ, Maio V, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87:1243–9.

Bynum W, Varpio L. When I say … hermeneutic phenomenology. Med Educ. 2018;52:252–3.

Enos T, editor. Encyclopedia of rhetoric and composition. New York: Routledge; 2010.

Heidegger M. Being and time. Blackwell: Oxford UK and Cambridge USA; 1867.

Van Manen M. Researching lived experience: human science for an action sensitive pedagogy. Albany, NY: SUNY; 1990.

Van Manen M. Phenomenology of practice. Walnut Creek: Left Coast Press, Inc; 2014.

Grondin J. Gadamer’s basic understanding of understanding. In: Dostal RJ, editor. The cambridge companion to Gadamer. Cambridge: Cambridge University Press; 2002. pp. 36–51.

Polkinghorne D. Methodology for the human sciences. Albany: SUNY; 1983.

Download references

Intramural Grant, Uniformed Services University

Author information

Authors and affiliations.

Department of Medicine, Uniformed Services University, Bethesda, MD, USA

Brian E. Neubauer & Lara Varpio

General Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

Brian E. Neubauer

Department of Preventative Medicine and Biostatistics, Uniformed Services Medical Center, Bethesda, MD, USA

Catherine T. Witkop

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Brian E. Neubauer .

Additional information

The views expressed are those of the authors and do not necessarily reflect the official policy or position of the US Air Force, Department of Defense, or the US Government.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Neubauer, B.E., Witkop, C.T. & Varpio, L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ 8 , 90–97 (2019). https://doi.org/10.1007/s40037-019-0509-2

Download citation

Published : 05 April 2019

Issue Date : April 2019

DOI : https://doi.org/10.1007/s40037-019-0509-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Qualitative
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Experience of Nurses in Hemodialysis Care: A Phenomenological Study

This study aimed to describe the experiences of nurses in hemodialysis care. In this phenomenological study, purposive sampling began and continued until data saturation. The research environment was the Hemodialysis unit. Data was collected through semi-structured interviews. Finally, two main classes and four sub-classes were identified, including factors effective on care (inhibitors and facilitators) and care outcomes (the negative effects of care on the nurse and the positive effects of care on the patient), and “challenging care” as the main theme. As the results show, nurses suffer from several physical and mental harm, and this harm even extends to their family environment, and their families are indirectly affected by the negative effects of this care. Therefore, strengthening management approaches to eliminate the inhibitor factors is essential in order to prevent nurses’ burnout or quitting while improving the quality of care provided by them.

1. Introduction

Chronic kidney disease (CKD) includes a spectrum of various pathologic processes that can lead to irreversible reduction of renal function [ 1 ]. The prevalence of chronic kidney disease is increasing in the world [ 2 ]; the average global growth rate of this disease was 8% per year in the past five years. In Iran, this growth is higher than the global average and is about 12% [ 3 ]. Many patients with end-stage kidney disease (ESKD) cannot get kidney transplants and undergo hemodialysis for many years [ 4 ]. Since the first hemodialysis in humans by Hess in 1924, it is still considered the most important treatment for these patients [ 5 ]. In 2009, 92.9% of patients in the United States underwent hemodialysis [ 6 ]. In Iran, hemodialysis is the most common treatment for renal failure, and 50% of patients are treated with this method [ 7 ]. Although, hemodialysis reduces the disease symptoms and improves patients’ lifestyle, their quality of life is affected by the disease and its complications that lead to disability [ 8 ]. Meanwhile, hemodialysis imposes great stress on the patient, and patients undergoing it usually experience higher levels of psychological than physical stress [ 9 ]. Hemodialysis, therefore, requires specialized nursing care, including establishment of a therapeutic and interpersonal relationship, treatment of physical symptoms, and attention to the functional limitations, mental disorders, and educational needs of these patients [ 5 ]. Basically, nurses are the main people who provide care for these patients, and their most important responsibility is to identify the essential care of these patients [ 10 ]. Hemodialysis patients need mental support to adapt to their current status, and nurses can help them become accustomed to their problems and fears of the disease by reducing anxiety, enhancing adaptability, supporting decision making, and providing emotional support and education [ 11 ]. Therefore, nurses’ awareness of high quality of care can affect the care of these patients and increase patients’ satisfaction; notably, the quality of the provided nursing care is an important indicator of nurses’ involvement in the care program [ 9 ]. Shafipour reported in their qualitative study that patients receive comfort from humans more than environment and modern facilities [ 12 ]. This issue reflects the important role of nursing and human nursing in contrast to the need for technical nursing and modern specialized facilities [ 8 ]. Sometimes, however, nursing care lacks the necessary adequacy and safety of patients. Future studies should therefore aim to clarify the dimensions of nursing care plan and place the nursing care structure into standard care [ 13 ]. This, of course, requires identification of barriers to nursing care, as working in hemodialysis unit makes many nurses exhausted due to factors such as heavy workload and lack of resources [ 5 ]. Although nephrology nurses play an important role in determining the adequacy and quality of care in hemodialysis patients, few studies in Asia have examined the quality of nursing care. Meanwhile, adequacy of the provided care is assessed by quantitative measures rather than qualitative ones, while qualitative studies provide the best tool for understanding human experiences and is more appropriate for assessing the experiences and views of a group of people on a particular topic [ 9 ]. Qualitative research is based on the hypothesis that there is a dynamic truth and proposes a perspective for searching and understanding human elements that cannot be measured through quantitative research methods [ 14 ]. Therefore, considering the importance of the quality of nursing care and understanding deep experiences of nurses, as well as the literature review that indicated few studies on experiences of hemodialysis patients, this study aimed to describe the living experiences of nurses in hemodialysis care.

2. Experimental Section

This study was reported according to COREQ guideline [ 15 ]. This qualitative research used descriptive phenomenology with a Colaizzi approach. Descriptive phenomenology is a method for analyzing and describing specific phenomena free of any pre-judgment that shapes an understanding of living experiences at the time of attention and focuses on the richness, breadth, and depth of these experiences [ 16 ].

In this study, the research environment is the Hemodialysis Department of Amiralmomenin Hospital in Zabol, which was selected due to the cooperation of the relevant authorities and easier access to the research units. To select participants, purposive sampling began and continued until data saturation. In qualitative research, data saturation determines the sample size in phenomenology research [ 17 ]. The criterion for selecting nurses that participated in this study was having a bachelor’s degree and at least one year of work experience in hemodialysis department. The main data collection method in this study was semi-structured interviews. Open questions such as “Please describe the care you provide for hemodialysis patient during your work?” and “Define the memories you remember about this?” were used as interview guide question that were earlier tested on two persons as pilot. Interview is considered as the main method of data collection in phenomenological research and provides a situation for participants to describe their views on the world as they have experienced in their own language and vocabulary [ 17 ]. The interviewers (H.S. and M.R) had a lot of experience in qualitative research on spiritual care and conducted face to face interviews individually in one of the rooms of the hemodialysis units in a quiet environment. The duration of each interview was 45 min to 1 h in one or two sessions depending on the free time and the patience of the nurse, using audio recorder device. In total, until data saturation, nine participants were interviewed. The interviews were conducted in January 2017. All the selected nurses participated in interviews. The authors tried to maximize the diversity of participants (in terms of work history, age, gender, and marital status). All interviews were recorded and then handwritten immediately for analysis. Usually, those who work with descriptive phenomenological methods use Colaizzi technique for data analysis [ 16 ]. The seven-step Colaizzi technique involves studying participants’ descriptions in order to understand them, extracting the important sentences, formulating known meanings, categorizing the data, compiling results in the form of a comprehensive description, a clear statement of the basic structure of the studied phenomenon, and a final validation of the findings [ 14 ]. The same approach was used to analyze the data in this study. During this study, methods used to ensure the accuracy and robustness of data, including credibility, transferability, dependability, and confirmability, were considered as scientific accuracy criteria in qualitative research [ 14 ]. In order to confirm the findings’ acceptability, the researcher involved the research subject extensively, and the research findings were reviewed by the participants and other colleagues for approval. To confirm the transferability of the findings, the authors tried to use nurses with different demographic characteristics and different experiences. To confirm the coherence, the research findings were provided to another researcher who was not involved in this research, and his conclusions were compared with that of the study researcher. For confirmability, the findings were commonly evaluated by three faculty members and the researcher tried not to interfere with the assumptions in the process of data collection and analysis, as much as possible.

This study was approved by the University’s Ethics Committee (code: Zbmu.1.REC.1396.209). Before beginning the study, the consent of relevant authorities was obtained. At the beginning of the interview, the research objectives and the interview method were explained to the participants, and they were ensured about the confidentiality of their information and their choice to participate in the study. Then, informed consent was obtained from them. The interview time was adjusted based on the coordination and willingness of the participant so that it would not interfere with their daily schedules. MAXQDA 12 (VERBI Software Sozialforschung GmbH, Berlin, Germany) was used for data management.

The demographic characteristics of the participants are presented in Table 1 . Analysis of the data obtained from nurses regarding hemodialysis patient care led to the extraction of two main categories and four sub-class, including mutual factors effective on care (care inhibitors and facilitators) and care outcomes (negative effects of care on the nurse and positive effects of care on the patient), and “challenging care” was identified as the main theme ( Table 2 ).

Demographic characteristics of participants (nurses in hemodialysis department).

Main theme, main classes, and subclasses derived from data.

3.1. Mutual Factors Affecting Care

Nurses encounter two factors when caring for hemodialysis patients, which includes “care inhibitors” and “care facilitators”.

3.2. Care Inhibitors

Nurses’ experience in the hemodialysis department showed that they had many inhibitory factors in the process of providing care to patients. Some of them were related to nurses (shortage of nurses, nurses’ financial and family problems, inexperienced nurses, nurses’ fatigue and mental stresses, and heavy work shifts), while some factors were related to patients (patient’s emotional sensitivity and difficulty in attracting patients’ trust), and some factors were due to poor management (inadequate ventilation of the department, lack of equipment technician, shortage of devices and equipment, and weak cooperation of head nurse with nurses).

“If the number of devices and nurses increase proportional to the number of patients, it can greatly affect the quality of care” (A 38-year-old woman with 10 years of work experience).

“When I first came to hemodialysis department, early in my career, the patients did not accept me and did not trust me, so they did not let me do my job” (A 29-year-old woman with 2.5 years of work experience).

“The nurse’s experience has a positive effect on dialysis patients. For example, once an inexperienced nurse enters, she wants to detach the patient from the machine, and the patient needs resuscitation” (A 40-year-old woman with 18.5 years of work experience).

3.3. Care Facilitators

“Assessing nurses’ experience revealed that some factors can help in care of hemodialysis patients, including nurse’s experience, the emotional relationship between the nurse and patient, nurse’s high educational level, and a safe environment” (A 35-year-old woman with 10 years of work experience).

“I can gain my patient’s satisfaction by creating a safe and secure environment, and a close relationship with the patient” (A 38-years-old man with eight years of work experience).

“We need to raise our literacy level, provide training and retraining courses for care of dialysis patients, which has a great influence on perfect and high-quality care of these patients” (A 38-year-old man with eight years of work experience).

3.4. Mutual Care Outcomes

Nurses’ experience in hemodialysis department showed that there were pleasant and unpleasant outcomes, including “negative effects of care on the nurse” and “positive effects of care on the patient”.

3.5. The Negative Effects of Care on the Nurse

The experiences expressed by nurses suggest that taking care of hemodialysis patients is associated with negative personal effects (facing physical damages), mental effect (misconduct, bad temper), feelings of burnout, obsessive thoughts regarding health, feelings of depression and anxiety, tendency to leave the department, and negative family effects (neglecting children, inability to meet spouse’s needs, inability to perform housekeeping duties, and interference of professional with family responsibilities).

“We have a lot of work pressure in this department which makes us feel tired and angry; when I go home, I do not pay enough attention to my children, I cannot meet the needs of my spouse, and I have less patience in my housekeeping duties” (A 38-year-old woman with 10 years of work experience).

“Because we are dealing with patients’ blood in hemodialysis and take care of patients with hepatitis, we should be careful not to get needle stick” (A 38-year-old woman with 14 years of work experience).

“When I came to this department and saw the problems of these patients, I lost my mood and I feel I’m getting depressed” (A 27-year-old woman with four years of work experience).

3.6. Positive Effects of Care on the Patient

Examining nurses’ experiences showed the positive effects of care provided by nurses on patients including routine care (care before, during and after dialysis; education; referral), reduction of physical problems, reduction of complications, improvement of the patient’s mental state and sense of safety, increase in the patient’s life expectancy, and interdependencies between the patient and nurse.

“When we take good care of patients, it affects their general condition and makes them feel safer” (A 29-year-old woman with 2.5 years of work experience).

“When you take care of patients well, it has a great impact on their physical condition and reduction of complications, and even the patients’ mood” (A 27-year-old woman with four years of work experience).

“Our nursing care offers joy and life expectancy to patients” (A 32-year-old woman with four years of work experience).

4. Discussion

Nurses’ experience in hemodialysis department showed that this care was influenced by mutual factors, some of which were “inhibitors” and some “facilitators”, and the care outcomes included “positive effects of care on the patient” and “negative effects of care on the nurse”. This section discusses the research findings.

In the present study, several factors were identified as care inhibitors; some were related to nurses and patients, and some were related to management failure. Several studies have suggested these inhibitory factors. Namnabati pointed to inadequate nursing skills as one of the care challenges [ 18 ], Ebadi referred to the shortage of nurses in Iran as a serious challenge [ 19 ], and Novoboar pointed at the end of their study that the shortage of nurses and lack of staffing, called nurse assistance, are inhibitory factors in the care of hemodialysis patients [ 20 ]. Masoumi referred to heavy workloads, various job shifts, and lack of mental support as nurses’ stressors, which reduced the quality of patients’ care [ 21 ]. Ndambuki also emphasized that hospitals should increase the number of nurses and their devices in order to maintain the level of satisfaction in renal patients [ 22 ]. Dehghan Naiery mentioned in their research that providing adequate nursing staff and equipment are important factors in the prevention of missed nursing care that refers to undone and delayed care [ 23 ].

It was shown that high levels of nurse’s experience, the emotional relationship between the nurse and patient, high educational level of the nurse, and safe environment can facilitate care. Several studies have identified these facilitators. Confirming the importance of the emotional relationship between the nurse and patient, Zamanzadeh referred to compassionate care as the constructive interaction between the nurse and patient, during which the nurse places himself in the patient’s shoes and understands his circumstances, to discover his concerns [ 24 ]. Moreover, Atashzadeh and colleagues identified meeting the patients’ needs through communication, support, and mutual respect between the nurse and the patient as purposeful care [ 25 ], and Baljani declared, as a result of their study, that in order to meet the patients’ needs, it is necessary to emphasize the emotional and social aspects of care in nursing education and planning [ 26 ]. Moran, in their study on the need for increasing nurses’ awareness, pointed out the importance of effective communication in providing supportive care for renal patients [ 27 ]. Confirming the importance of the nurse’s work experience, Mohammadi declared that more experienced people in the workplace can have a stronger supportive role than other people in therapeutic team, especially those with low experience [ 28 ], and regarding the need for a safe healthcare environment, Nobahar in their qualitative study aimed at explaining the experiences of patients, nurses, caregivers, and doctors in hemodialysis department in the quality of nursing care mentioned environment as one of the important factors in this regard [ 9 ]. Mahdavi Shahri also suggested that the quality of care can improve through environmental monitoring and creating a pleasant environment with the least stress possible [ 29 ].

Confirming the importance of educational level of the nurse, Nobahar named nurses’ basic knowledge as a facilitator of hemodialysis patient care [ 20 ]. As a result of their study, Berzou also identified nurses’ knowledge as an effective factor in providing patient’s comfort during hemodialysis [ 30 ].

In the present study, the nurses stated that providing care in hemodialysis department has negative personal effects, including physical and mental harm. Confirming this conclusion, Naidoo stated that intensive care unit nurses need to provide care and give physical and psychological support [ 31 ]. Depression was another experience of the nurses in the present study. Kazemi Golghahi also suggested that the prevalence of depression was significantly higher in the studied nurses than the general population. They concluded that as far as nurses are at high levels of stress and severe workload, planning for reducing the prevalence of depression plays an important role in patients’ health [ 32 ]. Also, Letvak reported that the prevalence of depression was higher than normal in the studied nurses [ 33 ]. Feeling exhaustion was another experience of nurses in the present study. Covermasi reported a moderate level of burnout among nurses in the hemodialysis department in their study [ 34 ]. Negative family effects included negative job effects of the studied nurses. Tavangar also confirmed these negative job effects in their study. Nurses, while being familiar with various forms of work/family conflicts, should learn methods to confront them in order to minimize their negative consequences [ 35 ].

The experience of nurses showed that the outcome of the care provided by them was positive for patients. Confirming this conclusion, Castner reported that nephrology nurses can be effective in reducing patients’ problems by performing interventions before, during and after dialysis [ 36 ]. Khoieniha also emphasized that nurses are the largest occupational healthcare group with a significant potential for influencing the quality of healthcare services [ 37 ]. Asgari suggested in their qualitative research that, from the perspective of hemodialysis patients, appropriate nurses’ supportive behavior plays an important role in feelings of relaxing and comfort, safety and confidence, and speeds up adaptation to hemodialysis [ 38 ]. The interdependence between the patient and the nurse was one of the findings of this study, but it is contrast to the results of Moran on hemodialysis patients who were not satisfied with nurses’ communication and stated that nurses rarely communicated with them and mainly paid attention to the physical and technical aspects of care [ 27 ]. The differences in the research environments and cultural differences may play a role in this difference.

5. Conclusions

The experience of nurses that participated in this study provided a clear picture of the care provided in the hemodialysis department of Amir al-Momenin Hospital in Zabol and clarified that the care provided by these nurses was a challenging one, which is influenced by mutual factors, some of which are inhibitors and some facilitators. The mutual influence of these factors prevents the care outcome from being completely positive. In addition to reducing the physical and psychological problems of patients and increasing their sense of safety and hope, which leads to a sense of dependency between patients and nurses, the caring nurses suffered many physical and mental harms, and this damage even extends to their family environment: their family members were also indirectly affected the negative effects of this care. Therefore, strengthening managerial approaches toward eliminating the inhibitory factors by addressing deficiencies (shortage of manpower, eliminating department’s shortages, and providing them with new equipment) can help resolve nurses’ problems, and increasing nurses’ knowledge and experience in communication with hemodialysis patients seems necessary to resolve the challenges in the care of hemodialysis patients in order to improve the quality of care provided by nurses and prevent burnout.

Author Contributions

H.S. and M.R. designed the experiments; H.S. performed the interview; H.S. analyzed the data; M.R. wrote the paper.

Conflicts of Interest

The authors declare no conflict of interest.