Sharing the Burden of Strife in Chronic Illness: a Praxiological Study of Nursing Practice in a Community Context
This inquiry is an in-depth exploration of one middle aged woman’s, Sarah, experience of strife in chronic illness and her nursing care involving four nurses (including myself) in a community context over a three-year period. The study is praxiological in that the understanding achieved is derived from practice within a ‘research as praxis’ methodology positioned in the disciplinary perspective of nursing as a practical human science. Five methodological premises inform the research processes: reflexivity, dialogue, moral comportment, re-presentation in narrative and critique. They emanate from an eclectic ontological praxiology based on the research framework constructed from Gadamerian philosophical hermeneutics, components of other philosophical praxiologies evolved from an exploration of the practical discourse in philosophy and my preferred health and nursing assumptions.
The research processes include researcher journalling; summaries of Sarah’s nursing record, dialogical meetings with Sarah and the nurse co-participants to collect the research material and then co-construct it into narrative form. The narrative is developed around what Sarah viewed as the overall nursing contribution to her care; the ‘sharing of her burden of illness’. This, she maintained, enabled her to live safely in the community. Finally there occurs a critique of the narrative within a discursive framework.
Three themes, embedded in particular discourses, emerged from the narrative both in Sarah’s and the nurses’ experience; paradox, moral meaning and metaphor. Sarah’s experience is interpreted as taking place in the ‘in-between space’ of the disease and health-illness discourses. Two main concepts which depict the tension experienced in this space are the ‘the ontological assault of illness’ and ‘entrapment in the disease discourse’. We, the nurses, ‘pushed the boundaries’ to create a space for the nursing as a caring practice discourse on the margins of nursing as a functional service discourse. Within the nursing as a caring practice space many ‘fine lines’ were walked with Sarah. Walking the ‘fine line’ of an ‘intense relationship’ was seen as advanced nursing practice. The research highlights important implications for a person and/or families who live with chronic illness and practice and educational issues for advanced nurse practitioners. Further, it promotes praxiological methodologies as advantageous for expanding nursing knowledge. This inquiry makes a twofold contribution to the discipline of nursing: it progresses the understanding of living with strife in chronic illness and it expands the practice of praxiological inquiry within nursing.