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Intersubjectivity in nursing student’s care of hospitalised infants: a phenomenological study

Sueli Maria Refrande1, Rose Mary Costa Rosa Andrade Silva1, Eliane Ramos Pereira1, Marcos Andrade Silva1, Enéas Rangel Teixeira1, Patrícia da Silva Trasmontano1
1Federal Fluminense University

ABSTRACT

Aim: to understand what the nursing student participants experienced when taking part in a theoretical-practical course focused on the subject of infant health. Method: this was a phenomenological study, based on the theoretical framework of Maurice Merleau-Ponty. This study was carried out using a qualitative approach. The participants were 30 undergraduate nursing students who were, at the time, in the eighth semester of the course. Results: students can be found everyday in different environments and with the children's family members. Once they allow themselves to be dazzled by the children, they are under their watching eyes and of their family members. Then, the phenomenon occurs, creating the following categories: intersubjectivity as a relationship between students and infants and the intersubjectivity and empathy experienced while caring for children. Practical implications: the implementation of theoretical knowledge in practice will strengthen strategies such as empathy, leading to the establishment of an intersubjective involvement for those caring for infants. Conclusion: the relation of intersubjectivity is established between students and infants due to the student entering the child version of reality.

Descriptors: Child Care; Students, Nursing; Hospitalization.

RESEARCH UNIQUENESS

table 1

AIM

The aim of the study was to understand the lived experiences of nursing students during the theoretical-practical teaching of the subject of infant health. The study aimed to understand these experiences using a qualitative approach based on the theoretical framework of Merleau-Ponty. The study sought to fully understand the experience of people in their lived world.

METHODS

In Merleau-Pontian phenomenology, people perceive the world in different ways and the theory argues that perception “is not a science of the world, it is not even an act, a deliberate taking up of a position; it is the background from which all acts stand out, and is presupposed by them”(1:6). Thus, perception is, first and foremost, the act of placing yourself before the world, a way of looking at yourself based on what you are and how you live.

The study participants were 30 undergraduate nursing students enrolled in a private higher education institution located in the city of Niterói, in the state of Rio de Janeiro. The inclusion criteria were students who were in the eight semester of the nursing course; the students were also required to be supervised interns at a local hospital, as part of studying paediatrics and neonatology. The exclusion criteria were students who did not work directly in childcare.

For data collection, the phenomenological interview method was chosen as it offered flexibility while collecting data about the study participants(2). Data collection occurred between February and March 2013. The interviews were scheduled with each participant and took place on the university campus. The interviews followed a set of open questions guided by the following question: what have been your lived experiences during the theoretical-practical teaching of the subject of infant health?

The interviews were audio recorded (with participants’ permission) and fully transcribed. The data were analysed using Giorgi’s phenomenology approach(3), which is one of the most well-known and most often used methods in the field of phenomenological psychology. The goal was to obtain “units of meaning” (themes or topics) included in the descriptions, which would reveal the phenomenon’s structure. This process involved four steps. The first was general reading (the researchers had to feel comfortable with the material and had to read it as many times as it was necessary) and the second was the determination of the meaning of each unit (because the material could not be analysed at once it was divided into smaller parts).

Once the meaning units were outlined, the researcher indicated more directly what was included in the units and the researcher converted the study subject’s everyday language into a more appropriate language. Finally, the researcher combined the meaning units with the study subject’s experience.

Giorgi(3) has argued that hardly any research can be conducted with only one study subject. The more study subjects a study has, the better the researcher will be able to see the essential findings and the more variables he will find. Therefore, the meaning units that had content were identified and then the comprehension of the student’s perceptive experience in the theoretical-practical teaching of the subject of infant health was determined. These units were investigated in light of Merleau-Ponty’s theoretical framework. The research followed the ethical precepts of Resolution 466/12.

The study was approved under ruling number 162.518, on 12/04/2012, by the Universidade Federal Fluminense (Fluminense Federal University) research ethics committee.

RESULTS

In terms of participants’ characteristics, 87% of the interviewees were female and 13% were male; 57% had children while 13% did not. The largest age group ranged between 20 to 29 years old (53%). As for marital status, 43% of the participants were single, 40% were married and others, such as those who were divorced or widowed, comprised 17% of the study’s participants.

In the overlap of intersubjectivities between students and infants, which is physically established during the care process, nursing care becomes important as it represents movements that emerge in our body as reflections that are outlined or concluded. As they are objective processes, the mind registers the clarification and the results.

True reflection arises not as an idle and inaccessible subjectivity but, rather, it is identical to my presence with my presence in the world and with others as I now realise it: “I am all that I see, I am an intersubjective field, not despite my body and historical situation, but, on the contrary, by being this body and this situation, and through them, all the rest”(4:606).

The relationship between students with infants is influenced by the process of care and the hospital environment, which raises questions about not only the ethical qualification. The ethical qualifications developed by nursing students as they practise, but also the teaching and instruction methods that are used.

Consequently, it is important to highlight the inseparability between subjectivity and intersubjectivity; for instance, a past experience that has moved into the present by learning the theory and applying it in practice.

When remembering the principles that rule the single health system, embracing everyone in order to ensure successful healthcare is not enough; the particularities of each client must prevail during the development of healthcare. This has been a great challenge for the Ministry of Health over the past few years(5). Corroborating with researches about ideal levels of development and of health of new-born babies, children and teenagers, the importance of promoting coping skills and the need to minimise the adverse effects of hospitalisation and other potentially stressful experiences is highlighted in this study(6). This study has considered the fact that the prevalent intersubjectivity present in the relationship between students and infants and the empathy experienced while caring for children represents a developing relationship.

Therefore, by analysing the data, we were able to see the phenomenon which involves nursing students caring for hospitalised children: the nurses showed affinity with the hospitalised children when taking care of them and they showed that they did not need to be with infants within the hospital environment to understand how to deal with them. Thus, students can be found everyday in different environments and with the children's family members. Once they allow themselves to be dazzled by the children, they are under their watching eyes and of their family members. Then, the phenomenon occurs, producing the following categories: intersubjectivity as a relationship between students and infants and the intersubjectivity and empathy experienced while caring for children.

DISCUSSION

INTERSUBJECTIVITY AS A RELATIONSHIP BETWEEN STUDENTS AND INFANTS

Comments made by the nursing students demonstrated that intersubjectivity is present in the relationships that are established as they take care of children, performing the mediation of “for me” and of “to another”, of individuality and generality, in which students allow for the possibility of overlap between their reality and the reality of each child:

I have had a brief experience and it was very pleasant because, at first, the child was insecure but I was able to get around that, bringing the child closer to me, gaining his/her trust. From this moment on I was able to do what I had established before and it was very pleasant to feel useful (E25).

Considered vital in the globalisation of nursing, the standardisation of clinical trial regulations and the evaluation methods used for students during their professional training, intersubjectivity, involvement and empathy are unique aspects that, as shown in one European study(7), are essential for building the student-hospitalised child relationship.

INTERSUBJECTIVITY AND EMPATHY WHILE CARING FOR CHILDREN

The study has illustrated how the dimension of empathy is linked to the way students take care of children, enabling them to gain children’s trust in relationships open to intersubjectivity. It can be said that somehow, while caring for children, intersubjectivity and empathy are a relationship between creating and placing a bet on life, in existence and in an interconnection with existence:

People who have kids like me have it worse. I think about my son and that he could be in the same situation. This is how you should act: treat them with kindness, care and love. It doesn't matter if it’s an adult or a child. I think it’s a lot harder on us compared to adults (E22).

Being in touch with the child is different; noticing how I expect to experience that and thinking about how we’re going to put into practice what we learnt in theory (E18).

In this sense, the past merges with intersubjectivity. In other words, I continue my involvement with the involvement of someone else in the field of practice. Besides, giving feedback to students to let them their progress in the practical field is very important; this is already practised in countries such as the UK(8), which has changed its nursing curriculum.

Therefore, the development of the clinical thought process and technical abilities is a challenge(9) for nursing students who must be prepared to deal with the unknown and with challenging moments while caring for infants. Thus, the relevance of discussions that can help educate both nursing professors and students must be emphasised(10). A limitation of the study is that only a private institution was taken into account. Consequently, there is a need to expand the research to other institutions, even to public institutions, with a view to producing future phenomenological studies and related concepts that can help improve nursing training.

CONCLUSION

The study focused on understanding students’ perceptions while caring for infants. It focused on the important issue of intersubjectivity, in which there is overlap between a student's world and a child's world; this happens while students listen, care for and establish an empathetic relationship with children. These abilities can be developed through instruction.

PRACTICAL IMPLICATIONS

When taking care of hospitalised children, it is necessary for nursing students to take into account, since their academic training, the intersubjectivity involved in the care process, thus contributing to good nursing care practices. Finally, the application of theoretical knowledge leads to the strengthening of strategies such as empathy and to an intersubjective involvement for those caring for infants.

REFERENCES

  1. Merleau-Ponty M. Fenomenologia da percepção. Tradução Carlos Alberto Ribeiro de Moura. 4. ed. São Paulo: Martins Fontes; 2015.
  2. Minayo MCS. Ciência, técnica e arte: o desafio da pesquisa social. In: Minayo MCS. Pesquisa social, teoria, método e criatividade. 30. ed. Petrópolis: Vozes; 2011.
  3. Giorgi ASD. Método Fenomenológico de Investigação em Psicologia. Lisboa: Fim de Século; 2010.
  4. Merleau-Ponty M. Le visible et l'invisible: Notes de cours (1959-1961). Paris: Gallimard; 1996.
  5. Ministério da Saúde (Brasil), Departamento de Ações Programáticas Estratégicas. Agenda de Compromissos para a Saúde Integral da Criança e Redução da Mortalidade Infantil. Brasília, DF: MS; 2005. [acesso em 2016 Ago 18]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/agenda_compro_crianca.pdf
  6. Brown Chris, Chitkara MB. POLICY STATEMENT: Child Life Services. Pediatrics [internet]. 2014 may [Cited 2015 sep 13]; 133(5):1471-8. Available from: http://pediatrics.aappublications. org/content/133/5/e1471.full.pdf+html
  7. Dobrowolska B, McGonagle I, Jackson C, Kane R, Cabrera E, Cooney-Miner D, et al. Clinical practice models in nursing education: implication for students' mobility. Int Nurs Rev [internet]. 2015 jan [Cited 2016 aug 19]; 62(1):36-46. Available from: http://onlinelibrary.wiley.com/doi/10.1111/inr.12162/full.
    doi: http://dx.doi.org/10.1111/inr.12162.
  8. McMahon-Parkes K, Chapman L, James J. The views of patients, mentors and adult field nursing students on patients' participation in student nurse assessment in practice. Nurse educ pract [internet]. 2016 jan [Cited 2016 aug 19]; 16(1):202-208. Available from: http://www.sciencedirect.com/science/article/pii/S1471595315001353.doi: http://dx.doi.org/10.1016/j.nepr.2015.08.007
  9. Refrande SM, Silva RMCRA, Pereira ER. Descriptive study of hospitalized child care: a merleau-ponty phenomenological approach. Online braz j nurs [Internet]. 2012 oct [Cited 2015 sep 13]; 11(2):524-7. Available from: http://www.objnursing.uff.br/ index.php/nursing/article/view/3972.
  10. Teixeira CRS, Pereira MCA, Kusumota L, Gaioso VP, Mello CL, Carvalho EC. Evaluation of nursing students about learning with clinical simulation. Rev. bras. enferm. [Internet]. 2015 apr [cited 2015 sep 13] ; 68(2):311-319. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672015000200311&ln g=en.http://dx.doi.org/10.1590/0034-7167.2015680218i.

All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf

Financial support: Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro - FAPERJ

Received: 09/17/2015 Revised: 08/29/2016 Approved: 08/30/2016