DOMÍNGUEZ, GUIJARRO, TRUEBA: “Recuperando la di-

According to Gadamerian philosophy, the goal of interpretation is not simply to retell events as they happened. The interpreter/researcher enters a dialogue with the texts, not only asking certain questions but also listening critically for questions that arise from interpreting the texts. A willingness to work between the “familiarity and strangeness” of texts is required in this form of inquiry because “the true locus of hermeneutics is this in-between” (Gadamer, 1996, p.295). At the same time that meaning is given, meaning also remains hidden. Thus analysis requires reflexive engagement within the hermeneutic circle of understanding (Koch & Harrington, 1998).

Hekman’s (1986) discussion of the methodological implications of Gadamer’s hermeneutics for the social sciences proposes that analysis should begin with the researcher seeking to define the cultural and historical horizons of the participants. She argues secondly, that there needs to be an awareness that the researcher necessarily imposes his or her own understandings on those of the actors or text and, thirdly that in choosing to focus on a phenomenon, the researcher is aware of, and thus makes explicit, the effect of his or her knowledge on the interpretation. Although listed sequentially, the recognition that these processes interrelate and overlap with the each other is important. The focus of exploration in Chapters Two and Three addressed the first of these recommendations. Attention will now be given to explaining the ways in which Hekman’s second and third recommendations were implemented.

Surfacing pre-understandings

Prior to submission of the research proposal, a colleague had interviewed me in order to clarify a number of issues relating to the study. This also served to assist the identification and documentation of the assumptions and expectations that I held in relation to the topic. The aim was not to ‘bracket’ or set these aside, but rather to bring them to the surface in dialogue so that they became more amenable to scrutiny. I needed to clarify, as much as possible, the direction and limitations of my guiding interests.

Another way in which I sought to increase understanding of my ‘horizon’ and ‘prejudices’ was in talking with people and interacting with texts outside my circle of familiarity. Recognising the limitation of self-reflection when trying to surface my prejudices, I consciously sought non-female, non-nurse, non-teacher and non-Pakeha sources of dialogue. Of particular value, in this way, were my business-oriented husband, a Maori woman with whom I shared an office and one of my supervisors, a male sociologist.

Ongoing exploration of prejudices

Throughout the study, I documented my experiences as a researcher in a journal. I recorded, along with the rationale, the decisions made regarding method. I described my reactions to the participants’ stories, the literature I was reading and the media events relating to cultural issues. I took the journal to work. Locked in my brief case, it accompanied me to seminars and conferences, meetings with my supervisors and my

study support group. Using Peshkin’s (1988, p.18) notion of “warm and cool spots”, I wrote about situations and ideas that encouraged me, as well as those about which I preferred not to hear. There were times, for example, when I noted my disappointment at the seeming inability of participants to see patients’ points of view. In relation to one transcript I jotted:

Nurse X mentions client vulnerability but does not see this as a reason for nurses to take more responsibility or make effort in terms of compromise and flexibility. It’s hard trying to avoid being judgmental about nurses’ attitudes and their ability to be culturally sensitive.

Although knowing the difficult circumstances in which this person worked, I found myself expecting that she should be able to overcome these in order to meet patients’ individual needs. This was a ‘cool spot’. I needed to explore the origins of this bias or prejudice in order to be able to see beyond it. The purpose was not to necessarily discount the prejudice but to engage with it in a way that extended, rather than restricted, understanding. Further exemplification of the ways in which such ‘cool’ and ‘warm’ responses influenced the thesis findings will be provided in Chapter Nine in relation to the stories selected to illustrate the over-arching theme: working with prejudice, paradox and possibility.

Also documented was any personal action taken beyond the role of researcher. An entry, in July 1995, recorded a discussion with colleagues that resulted in my drafting a series of letters to the Members of Parliament involved in the debate over cultural safety. I was concerned by, what I perceived to be the one-sided and destructive nature of media reporting and felt obliged to contribute another view of the issues involved. As someone whose understanding was increasing through involvement with the topic, I was taking action beyond that required for the purposes of research. The response was important in demonstrating my moral position in relation to the sociopolitical context and again its influence on the interpretation needed to be recognised.

At a mid-point in the analysis phase, my colleague interviewed me again, the aim being to record and clarify the nature of my changing understandings in relation to the topic. Each time a journal was completed (there were four in total), I reviewed and wrote notes tracking the progress of my understanding. Regular conversations with fellow interpretive researchers also served to clarify both methodological and substantive interpretations (Smythe, Spence, & Gasquoine, 1995). Other important challenges

came from clinical colleagues. For example, it was a comment from a friend that not all nurses can or do attempt to meet patients’ cultural needs, that led to my asking: “What about the times when nurses do not seem to make an effort?” Wondering what ‘not striving’ might look like, thus helped me to see the possibility of different directions and intensities within striving. It also prompted reconsideration of the contradictions inherent in this notion (this is discussed in Chapter Eight).

Isabelle Sherrard49

The hermeneutic creation of texts

provided a valuable critique of the chapter that explored the meanings of culture in nursing. I also met with academic staff from the University of Auckland’s Department of Philosophy and was, of course, often challenged and guided by my own research supervisors. Such action is illustrative of the ongoing self-critique and self-appraisal argued to characterise the ‘reconceptualised rigour’, proposed by Koch and Harrington (1998).

In hermeneutic study of this type, texts are co-created through dialogue. During our discussions the nurses and I, through the processes of question and answer, disclosed and created meanings that, in this interplay, extended beyond the original horizons. The text analogues thus represent another layer or second level of interpretation, the first having been the nurse’s recollections of the phenomenon in question.

In the following excerpt, Sue and I were discussing media use of the words ‘sensitivity’ and ‘safety’ in relation to cultural issues in nursing.

Me: I know these terms have been bandied around a lot, but do you feel essentially OK about the ideas behind them - for nursing?

Sue: ... Oh dear ... Yes, in way I do and in a way I don’t. Sometimes I feel there are double standards; that we are expected to be culturally sensitive towards clients, but what about our own culture?

Me: Can you tell me about the double standards? Is it that our culture is not acknowledged? Is it our nursing culture or is it our cultures as individuals?

Sue: Our cultures as individuals. We come from different cultures. Our nursing culture - I suppose people expect nurses to be culturally sensitive and culturally safe ... And the minute we step out of line there’s a big hue and cry about it. But we’re human.

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At that point, Acting Head of UNITEC’s School of Nursing: a nurse with long-standing interest and involvement in cultural issues in nursing education.

Me: Mmmm … So you would like to see more of a two way process? Sue: Yes. There’s too much cultural safety on the Maori side ... on the Polynesian side. What about cultural safety on the New Zealand kiwi side. This is where I think there are double standards.… [There are people], who are European, that get very irate about this.

This discussion had taken place towards the end of our conversation. In raising the issues of sensitivity and safety, I was seeking to understand the context influencing Sue’s practice experiences. The beginning question raised a topic of interest to me. Sue’s response then decided the direction of the ongoing exchange but was contributed to by the questions I asked when seeking clarification. Thus the interview transcript is co-created. It represents an understanding that is contributed to by both parties but which differs from the original view of either party.

The interviews were informal in nature. My intention was to make them more like discussions between colleagues. I focused on the natural expression of thoughts, ideas and feelings, encouraging the participants to respond in whatever way they felt most comfortable. For example, having begun Jo’s interview by asking her to think of herself in a situation with a person from another culture and then to describe what that experience was like, Jo preferred to begin differently:

Jo: OK, what it’s like to nurse someone from another culture.

Once I get started I’ll be fine. I just have to think. ... Do you think I could start off with what it’s like nursing someone from my own culture?

Me: Mmmm, that will be a good idea Jo: It might get me started, OK...

The next six pages of transcript were focused in this way.

An attitude of gentle probing also characterised my interviewing. The questions used sought to clarify the nature of the experience. Further into the above discussion, I asked:

Me: OK ... Can you move now to talk about how it is different when you are nursing someone from a culture that you are less familiar with? Jo: Mmm ... How is it different? ... I suppose there are a lot more things that I don’t take for granted. There is a lot more learning, not that I take every Maori person for granted, but there are things that sort of naturally come ... Yeah. So it’s taking a longer time to get to know the person. You’ve got to have a lot of respect for people just to build any kind of rapport, and just always checking their needs and watching, you know,

getting signals from them. If they’re not talking, you are watching their body language, what they do, trying to pick up how they’re feeling, their behaviour.

Me: So your brain’s actually working to assess all the time, and to interpret?

Jo: Yes. That’s right.

There were times when personal experiences were offered to affirm and assist further disclosure. Interested in clarifying the meaning of the previously used term ‘driving me nuts’, the following excerpt from a second interview provides an example:

Me: Now ... this business of having a patient who is driving you nuts. I’m interested in what sorts of things drive you nuts. What is it that makes you feel like this?

Theresa: ... I don’t know about the driving me nuts bit ... It seems a bit harsh in hindsight.

Me: Mmm, ... But things do drive us nuts at work don’t they?

Theresa: Yes they do ... I think one of the biggest stresses that I find is ...

More than a page of enthusiastic, uninterrupted and vivid description ensued and Theresa’s relief at being able to pour out these pent up feelings was palpable. Located towards the end of our second conversation, this excerpt demonstrates the developing level of trust between Theresa and myself. In this instance, the shared nature of our nursing backgrounds appears to have facilitated empathy for each other’s experiences.

In order to check the accuracy of my interpretations, I often sought clarification of the words used by participants. When Anne talked of enjoying her experiences in the community during our first conversation, she explained that:

[G]oing into their home ... you’re a visitor and I think that’s really nice because they have the power. You’re not lording it over them. You wait for them to say “Would you like a seat?” That sort of thing keeps the balance (Anne, 1:75).

During the second interview, I checked my interpretation:

Me: Now, about balance and power. I’ve interpreted that as balance of power. Is that correct?

Anne: Yes it is, the balance of power, definitely.

There were also occasions when such clarification illuminated differences in understanding. Tara had been talking about her constant feelings of guilt and the need to apologise to patients and relatives in an accident and emergency setting.

Tara: I spend a lot of time apologising. What else can I say? Sometimes I say to parents, “There’s no use apologising to you is there?” They know. But yes, I do. I spend a lot of time apologising.

Me: That’s not necessarily a cultural issue is it? Perhaps it’s because of the system and the delays?

Tara: No, in our culture you have to apologise. Me: So you do that more than other nurses?

Tara: Well ... maybe? ... Well I notice other nurses doing it too. Even though it’s not our own fault. I suppose it’s the only way we can make them feel a little happier.... It’s usually nurses who do that.

In this interchange, I had initially interpreted the setting to be more influential than the nurse’s cultural background and then, knowing Tara to be Samoan, I had wondered whether cultural values contributed to her behaviour. In asking whether she apologised more than her colleagues did, I was asking her to reflect on the influence of personal difference relative to other nurses. Yet this seemed only partially true from Tara’s perspective. Her use of the words ‘we’, ‘nurses’ and ‘our’ suggests a common experiencing related to being a nurse. Thus my understanding of culture in this context was extended to encompass the culture of nursing.

Hermeneutic interpretation of the experiential texts

In the same way that interpretation influences the options taken and not taken during the construction of text analogues, the researcher continues to participate in the interpretation through ongoing interaction with the interview data. Researcher interaction with the experiential texts collectively thus constitutes another layer or level of interpretation.

Van Manen (1990) describes the dynamic interplay of turning to a phenomenon, investigating it, reflecting on themes, describing the phenomenon, staying oriented and continually considering parts and the whole. The processes involved are those of reading, thinking, questioning, writing, re-reading and re-writing. It is the data that

drives this hermeneutic circle of understanding but the overlapping and dynamic nature of the processes makes description of the method difficult.

After transcribing the interviews and re-reading each participant’s interviews together, I wrote a description of ‘overall impressions’ to gain a sense of their whole. Returning to the transcripts, I then began highlighting ‘significant statements’, writing interpretations in the margin and earmarking ‘gems for preservation’. The questions that I asked of the texts at this point were: “What does this mean?” “What seems to matter most?” and “What must I not forget?”

A list of interpreted statements and the description of overall impressions for each participant thus constituted the beginnings of analysis. This was sent with the transcribed interviews to their various owners for validation and further comment. Telephone conversations with each participant then served to clarify and prioritise these interpreted meanings.

As soon as I discovered some initially understandable elements, I began to sketch meanings for the texts collectively and from this point on, the interpretations that developed were my own. Although concerned to achieve a fair and trustworthy account, I decided against further member checking (Lincoln & Guba, 1985) for the following reasons. Within the framework of philosophical hermeneutics, experiences are recognised to be time-bound and situation-specific. I had been reminded of this fact during the earlier pilot study when one of the participants decided she could not continue, because having re-read her transcript, she had come to understand her experiences differently. A fusion between past and present understanding had resulted in a new and different understanding.

Sandelowski (1993) suggests furthermore that the representation of multiple realities requires greater abstraction than is necessary when interpreting individual member’s realities. This is congruent with Gadamer’s explanation that the interpretation is about the subject matter and not the reliving of another person’s experiences (see earlier discussion re Schleiermacher, Chapter Four). Bringing the texts together generated more questions and it was through reading, questioning, re-reading, and experimenting with structure progressively, that the interpretation developed. Thus, as individual statements are crafted into themes and sub-themes in hermeneutic analysis, the identification of specific contributions becomes problematic (Koch & Harrington, 1998).

By drawing the reader in, and at the same time prompting the reader to reflect, texts create a questioning that opens new directions of meaning. Searching the data thus focused on finding descriptions of experience, focusing on what was said, yet also wondering about what was not said. In questioning the texts further, I asked: “What am I not seeing?” “Who am I not hearing?” “What appears ordinary because it occurs so often?”

The interpretations were continually modified and replaced by more adequate ones. However, the preceding interpretations were not cast aside. They were the means through which new understandings gained entry and came to the fore. At times these new interpretations extended the old but on occasions they denounced the previous interpretation (Gadamer, 1979).

Understanding meanings in context also involves examining how ideas are expressed. In addition to noting emphasis and tone, it means noticing the words selected and exploring the ways in which word meanings may have evolved, changed or been used differently in other contexts. Tracing etymological sources and searching idiomatic phrases (van Manen, 1990) helped extend the interpretation. The repeated reference by participants to “relationships”, “establishing rapport” and “nursing holistically”, for example, required that I explore the meaning and significance of these concepts.