Data Analysis

The aim of hermeneutic analysis is to generate greater understanding by taking note of specific meanings within the text (Benner, 1 994), bringing something "to speech" (van Manen, 1 990, p.32). This approach requires

readers to read individual texts to determine what new interpretations emerge (Benner, 1 994; Dahlberg et aI. , 200 1 ) . While phenomenology provides a description of the phenomenon, and avoids interpretations or constructions, hermeneutic phenomenology interprets the understanding of life that emerges from the experience (Dahlberg et aI., 200 1 ; Leonard, 1 994). Unlike

quantitative methods that begin analysis processes once all data is collected, when using hermeneutic phenomenology, analysis begins before data collection is completed. This is because analysis requires the researcher to engage in critical dialogue with the text, drawing on key aspects, impressions and interpretations (Benner, 1 994; Dahlberg et aI., 200 1 ; Leonard, 1 994). Heidegger's process of data analysis is more obscure, as one does not 'do' phenomenology. He suggests that if the causality between two events is

interpreted, the phenomenon is only interpreted as being-alongside Da-sein.

By this he means that this kind of knowing identifies a "kind of Being which belongs to Being-in-the-world" (Heidegger, 1 962, p.88). On the other hand,

the way Da-sein 's potentiality-for-being is projected discloses its significance

to the world. Through this projection being is understood, but the "meaning

of this understanding of Being cannot be satisfactorily clarified . . . except on the basis of the Temporal Interpretation of Being" (Heidegger, 1 962, p . l 88). The process of data analysis is difficult to explain because it is not sequential (Walton, 1 995). Furthermore words do not describe the moments when suddenly the significance of something becomes so apparent that you wonder at it being there all the time, yet being so invisible. For example, in the busy activities of living in the natural world, understanding of that world is not reflected upon (Dahlberg et aI., 200 1 ) . In contrast, it was not an everyday occurrence to have one's spouse hospitalised in a tertiary centre. Once the research participants began to describe their experiences, they revealed their interpretations of the situations. The research participants' familiar worlds no longer provided interpretive frameworks to make sense of life as it had now become.

Early during the analysis, it seemed to me that most of my research

the condition was being treated, rather than worrying about where it was being treated. I consistently questioned, "so what?" "What would be the difference if one's spouse were hospitalised locally?" It could be thought that there is a difference if these research participants do not have regular support systems during this time. If you go and visit your spouse in the local hospital, you can return to your own home at night. Although it may be lonely, the familiar surrounds you. However, those who did not accompany their spouse out-of­ town were surrounded by the familiar, but without the comfort of the spouse to visit every day. In contrast those who had the comfort of visiting their spouse sacrificed the comfort of having familiar environs.

Extricating the meaning from the texts requires the researcher to examine each part in terms of the whole and vice versa until there is harmony between both the parts and the whole (Gadamer, 1 975). During this stage the interpreter moves back and forth between the worlds that the participants describe, the world that the researcher understands, and the history, culture, and other parts that make up the whole of those worlds (Benner, 1 994). Hermeneutic analysis also requires the listener to actively listen to what has been described (Benner, 1 994; Walton & Madjar, 1 999). By actively listening the interpreter seeks to make sense of the spoken, innuendoes, and aspects of the story that facilitate understanding. The usage of language(ing) facilitates description of the subjective world, thus creating "greater access and understanding of the text in its own terms, allowing the reader to notice meanings and qualitative

distinctions within the text" (Benner, 1994, p. 1 0 1 ).

In presenting the text, at times it was necessary to insert words to make grammatical sense of the research participants' stories, and for ease of reading. Insertion of my words is indicated by usage of square parentheses. The research participants' stories are referenced by their pseudonyms that were woven into the transcript, and providing the page numbers of their interview transcript. In addition, I have used round parentheses when I asked the research participants a question and included that in order to contextualise, or raise awareness of their responses to the time of having their spouse

Central to hermeneutic phenomenology is an appreciation that understanding is tested and recorded by writing, and further re-writing (Benner, 1 994; Dahlberg et aI., 200 1). During this process, ideas are set down so that they can be reflected upon, revealing the underlying components of the experience. The process of continued writing and reflecting upon the writings relates to Heidegger's ( 1 982) processes of r.e-duction (or leading back), reconstruction (projecting not only the phenomenon into view, but also its structures of

being) and de-struction (during which the concepts are de-structed down to

their original source). The key to data analysis, according to Gadamer ( 1 975), is that of openness. Such openness leads to the hermeneutic 'as '. The

hermeneutic 'as' contextualises understanding (Dahlberg et aI. , 200 1), such as in the case of the current study, living with a specific illness.

Each transcript was read several times as I attempted to understand the world of those who had their spouse hospitalised in a non-local tertiary centre. I made notes down the side of each transcript, and frequently noted similar comments made of experiences by other research participants. However, I resisted searching for meanings as interpretations of the experiences, and focussed instead on the descriptions that were before me. Furthermore, as I made note of some ideas that were emerging from the data, I talked these over with colleagues in clinical practice. Through this reflection, the connection between Da-sein and the world is revealed in moods disclosing ontological understanding (Heidegger, 1 968; Kaelin, 1 987) . Through writing and rewriting, it was possible to reflect upon the first ideas and determine the temporary interpretations of being as the research participants recalled this time of being-in-the-world.

I found that as I was conducting the research, participants were interested to find out that other people had had similar experiences, or made similar observations. They found comfort in knowing that they were not alone. However, the significance of others' experiences did not dominate each current interview that I conducted. After I had conducted interviews with 1 3 research participants either alone, or with their spouse, I was beginning to hear

there is enough data that the researcher can present the findings in such a way that the text answers the original concern (Leonard, 1 994). I reached this point, but wanted to conduct two more interviews, the first because one of the couples had young children at the time of the transfer, and the second because of the adaptations the couple made as a result of the ill health. Unfortunately, I was only able to interview one of the volunteers. During the initial time of questioning, this participant also felt she did not have much to say. I began by reading out sections of my research findings, and was not surprised to have her engage with some of the stories she was hearing. Furthermore, I found that when I was talking to student nurses about my initial findings they could relate my presentation to their personal experiences, and to experiences when they had arranged for the transfer of patients. I discovered that engaging listeners or readers of the study in this process of data analysis not only validates the understanding, but also strengthens the data findings of 'being there' at this time.

Having one's spouse hospitalised in a non-local tertiary centre was an individual j ourney. This was not a journey about how major the operations were, or for how long the spouse was having radiotherapy. It was rather determining how the individual research participant predicted a future over which they perceived they had no control. The unpredictability of the future was exacerbated because these participants were required to make life­ changing decisions without the social support of familiar people if they accompanied their spouse, or from a distance when the supporting spouse was unable to physically be with the sick spouse at that time.

Hermeneutic phenomenologists are interested in both the tradition from which the individual interprets the experience and the specific way the experience is interpreted. According to Gadamer (1 975) the tradition is language; the way people talk about the world in which the experience occurred. I needed to be mindful of the language used by those who have their spouse hospitalised in non-local tertiary centres. If ! consider the world of a hospital, with which I am relatively familiar, the language used by nurses is quite different from the language used by people entering the environment for the first time.

Therefore, is it the hospital world that can become overwhelming, or is it the hospital world out-of-town? Does someone, whose spouse has a life­

threatening condition, such as cancer, and who is facing the possibility of death, express a language similar to the language used by those who have more hope? Hermeneutic phenomenology challenges us to discover truth by

disclosing Da-sein. Through understanding individual stories, I will be able

to answer these and the original research questions. It is not an assertion of the facts that they were hospitalised in non-local tertiary centres for such and such a period of time, but rather 'this meant this' to these spouses.

4.5 Chapter Review.

The purpose of hermeneutic phenomenology is for the researcher to interpret and communicate life-world experiences to others, enabling others to

understand the experiences. Therefore, hermeneutic phenomenology is a logical approach to explore the realities of having one's spouse hospitalised in non-local tertiary settings

Although Heidegger detailed an explanation of hermeneutic phenomenology, he intended this to form the basis of philosophical enquiry, not a research methodology. Therefore, in his writings Heidegger did not detail processes of data analysis. Other writers such as Benner (1 994), Dahlberg et al. (200 I), and van Manen (2000) proposed that the researcher becomes immersed in each text, drawing on the patterns that describe life-worlds. Unlike traditional processes of data collection followed by data analysis, those who use

hermeneutic phenomenology appreciate that analysis begins at the moment of collection. Through this process, themes emerge. While Crotty ( 1 996) criticised nurses' usage of phenomenology claiming that they focus on exploring the text for commonalities, I contend that the themes presented in the next three chapters emerged from the data; that is, I did not search through the data to validate pre-determined themes.

A background introduction to the 1 4 participants of this study has been presented. Interpretations of their stories are presented over the next three chapters. Chapter Five tells of the times when the research participants

waited, and because the familiarity of their world dissolved, and a _priori understanding did not provide a foundation for the future, the research participants found themselves in a state of suspension.

5.1 Introduction.

CHAPTER FIVE BEING-IN-SUSPENSE.

This chapter is the first of three chapters that present the findings that emerged from the research participants' experiences of having their spouses

hospitalised in non-local tertiary hospitals. The impact of thrownness caused by the experiences is discussed as the research participants came to terms with the ramifications of the spouse's medical condition that could not be treated at the regional hospital. Research participants talked about the periods of waiting either for diagnosis or treatment, and waiting to see whether the treatment was successful. Overarching all states of waiting was that of facing death.

Chapters Six and Seven examine the state of thrownness as the research participants fitted into being in the world of out-of-town hospitalisation, and

finally, how they negotiated being-with-others in a world with which they

were unfamiliar.

5.2 Disturbing The Presence-At-Hand.

Prior to the experience of one of them being hospitalised, most of the couples had taken their health for granted. Although it was a shock to get the

diagnosis, the participants also felt that they should have realised that something significant was happening, and used expressions such as "I would

never have thought he was as sick as he was" (Nancy, p.2). Another research

participant felt guilty that she had not recognised the warning signs that her husband had, as there was a family history of this illness. The concept of

unreadiness-to-hand was presented in Chapter Three. In the case of the

current study, it was the unreadiness-to-hand of the spouse's health that caused the state of thrownness. One research participant summarised the thrownness of the situation:

And through that whole winter he was getting the flu a lot. And he has never, ever got the flu. He just .. . even now, never gets colds, or sore throats or anything. But he was all winter getting it. And we just thought, because I was getting them as well; catching them off him, and the children, because we all had colds

went to the doctor, and our GP was away, and they just sent him home and said "look it is just [minor], don 't worry about it. He 's probably just caught something " . . . A couple of weeks later he was actually getting the spins. I rang a friend, we didn 't go to a GP, and I said, because he almost collapsed, and it was at night, and I said "could you take him over to the hospital, to A &E ". [He] went to the doctor with just 'flu symptoms and [an aching leg] . We just didn 't think anything of it. It was just a sore leg. It was a huge shock.

. . . [Later, when they decided to transfer him to the non-local tertiary centre, it was] just terrible [having to suddenly go with him, and leave the children] . Ijustfelt terrible that I couldn 't see them [before we left for the non-local centre]. I was going to see them, but I thought if they see me in such a mess, it would make it worse. [I] hated it. And it was the first time I had ever left [our youngest] . That was hard .. . Yeah it was horrific to drop everything and go [to that out-of-town city] (Alice, p.2).

As illustrated not all research participants had warning of the impending adjustments to their life-world. In the previous exemplar, although Alice' s husband was unwell enough to go to the emergency department during the night, they had not anticipated that he had a life-threatening illness. Not only was her husband ill, but also the couple had to adjust their lives to manage the non-localised hospitalisation. The couple's immediate adjustments required them to arrange care for their children while Alice accompanied Warren to the non-local tertiary centre 400km from home. Another couple faced the

possibility of sudden death, resulting in admission to one hospital before being transferred to the non-local tertiary centre. They had to adjust to being the spouse of ' someone who was sick', facing an uncertain future.

The shock of the illness that requires non-localised hospitalisation, affects the ability to be able to interpret any information that is provided. As identified in Chapter Two, sudden admission results in confusion and uncertainty (Stewart et al., 2000; Thompson & Cordle, 1 988). Other research findings suggest that information given at this time of stress is not retained or fully understood (Hanger et al., 1 998; Stewart et al., 2000). Findings of the current study are that confusion, uncertainty, and an inability to fully appreciate the information were exacerbated if the spouse was transferred to the non-local tertiary setting. Not only were their previous interpretive frameworks of life disturbed, the

couple were receiving the information alone in the non-localised tertiary setting. The couples were trying to make sense of the information

unsupported by other family members. In addition, the research participants also had a responsibility to accurately remember the infonnation for family members waiting at the other end of the telephone.

It was just so overwhelming that you . . . well I could never remember everything that the doctor would say in every detail, so I would just write everything down. Because people always asked of course, "what is happening "? The family would get in contact and would ask, "what 's what " and "well, what else did he say? "

(Therese, pA).

While some research participants were uncertain of the cause of the ill health, other research participants had been concerned about their spouse's well­ being for some time. These participants talked about the period of time knowing that something was wrong with their spouse, but not having a finn diagnosis to deal with. For example, Trevor had been back to the doctor several times with complaints of the same symptoms. Each time he went

back, Trevor was told "there is nothing wrong with you" (p.2), until finally

Zoe was not going to rest until referral was made to see a specialist. Another participant thought that she might be the cause of her husband's problems so "I had said to him one day "Well I've gone and got myself checked, so I think

that the least you could do is for you to do that ' " (Nancy, p. l ).

In the fearl that resulted from the unreadiness-to-hand of health, the research

participants struggled to anticipate the implications of the unknown. Da-sein

anticipates that previously held interpretations of being-in-the-world are

crumbling, and faces the future with uncertainty as the interpretive horizons are blurred (Fell, 1 992).

5.3 Temporality Of The Presence-At-Hand Of Health And Dis-Ease2• As I analysed the data, it became apparent that during the time when the research participants' spouses were hospitalised in non-local tertiary settings,

I Refer to Section 3 .7. 1 for the differentiation between anxiety, fear and dread.

they all had a period of being-in-suspense. What do I mean by this expression? I mean putting life 'on hold' until the situation could be

managed. The process of coming to terms with the dis-ease and the need for out-of-town transfer means that the potentiality-for-being hangs in suspense,