Little is known about the reciprocal influence of communication difficulties on the care relationship. To illuminate care providers’ lived experiences of relationships with stroke and aphasia patients, narrative interviews were conducted with providers particularly successful at communicating with patients. A phenomenological hermeneutic analysis of the narratives revealed three themes: Calling forth responsibility through fragility, restoring the patient’s dignity, and being in a state of understanding. The analysis disclosed caring with regard to the patient’s desire, which has its starting point in intersubjective relationship and interplay, in which nonverbal communication is essential—that is, open participation while meeting the patient as a presence. Thus, care providers prepare for deep fellowship, or communion, by being available. They described an equality with patients, interpreted as fraternity and reciprocity, that is a necessary element in presence as communion. The works of Marcel, Hegel, Stern, and Ricoeur provided the theoretical framework for the interpretation.
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References
1.
Åström, M. , Asplund, K., & Åström, T. (1992). Psychosocial function and life satisfaction after stroke. Stroke, 23, 527-531.
2.
Code, C. , & Müller, D., (Eds.). (1995). The treatment of aphasia: From theory to practice. London: Whurr.
3.
Damasio, A. R. (1991). Signs of aphasia. In M. T. Sarno (Ed.), Acquired aphasia (2nd ed., pp. 27-44). San Diego: Academic Press.
4.
Ekman, S.-L. , & Norberg, A. (1993). Characteristics of the good relationship in care of bilingual demented immigrants. In S.-L. Ekman (Ed.), Monolingual and bilingual communication between patients with dementia diseases and their caregivers (New series no 370, pp. 139-158). Umeå, Sweden: Umeå University.
5.
Ekman, S.-L. , Norberg, A., Viitanen, M., & Winblad, B. (1991). Care of demented patients with severe problems of communication: Time-studies and interviews with caregivers. Scandinavian Journal of Caring Sciences, 5, 163-170.
6.
Gadamer, H. G. (1975). Truth and method. London: Sheed and Ward.
7.
Gallagher, K. T. (1962). The philosophy of Gabriel Marcel. New York: Fordham University Press.
8.
Haarmann, H. J. , Just, M. A., & Carpenter, P. A. (1997). Aphasic sentence comprehension as a resource deficit: A computational approach. Brain and Language, 59, 76-120.
9.
Hegde, M. N. (1994). A coursebook on aphasia and other neurogenic language disorders. San Diego: Singular.
10.
Hegel, G.W.F. (1967). The phenomenology of the mind. Sydney, Australia: Allen & Unwin.
11.
Jansson, L. , Norberg, A., Sandman, P. O., Athlin, E., & Asplund, K. (1993). Interpreting facial expressions in patients in the terminal stage of the alzheimer disease. Omega, 26, 309-324.
12.
Jones, M. , O’Neill, P., Waterman, H., & Webb, C. (1997). Building a relationship: Communications and relationships between staff and stroke patients on a rehabilitation ward. Journal of Advanced Nursing, 26, 101-110.
13.
Kihlgren, M. , Hallgren, A., Norberg, A., & Karlsson, I. (1994). Integrity promoting care of demented patients: Patterns of interaction during morning care. International Journal of Aging and Human Development, 39, 303-319.
14.
Lindseth, A. , Marhaug, V., Norberg, A., & Udén, G. (1994). Registered nurses’ and physicians’ reflections on their narratives about ethically difficult care episodes. Journal of Advanced Nursing, 20, 245-250.
15.
Lögstrup, K. E. (1997). The ethical demand. South Bend, IN: University of Notre Dame Press.
16.
Månsson, M. , Fredriksson, B., & Bränholm, I.-B. (1995). On life satisfaction and activity preferences in long-term survivors after stroke. Scandinavian Journal of Occupational Therapy, 2, 51-55.
17.
Marcel, G. (1950). The mystery of being I. Reflection & mystery. London: Harvill.
18.
Marcel, G. (1963). The existential background of human dignity. Cambridge, MA: Harvard University Press.
19.
Marcel, G. (1967). Presence and immortality. Pittsburgh, PA: Duquesne University Press.
20.
Marcel, G. (1982). Creative fidelity. New York: Crossroad.
21.
Marcel, G. (1984). The idea of mystery in the philosophy of Gabriel Marcel: Reply to Gene Reeves. In P. A. Schlipp & L. E. Hahn (Eds.), The philosophy of Gabriel Marcel (pp. 245-274). Carbondale: Southern Illinois University.
22.
Marcel, G. (1995). The philosophy of existentialism. New York: Carol.
23.
Mishler, E. (1986). Research interviewing: Context and narrative. Cambridge, MA: Harvard University Press.
24.
Morse, J. M. (1994). Designing funded qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 220-235). Thousand Oaks, CA: Sage.
25.
Norberg, A. (1996). Caring for demented patients. Acta Neurologica Scandinavica, 165, 105-108.
26.
Rasmussen, B. H. , Norberg, A., & Sandman, P. O. (1995). Stories about becoming a hospice nurse: Reasons, expectations, hopes, and concerns. Cancer Nursing, 18, 344-354.
27.
Ricoeur, P. (1976). Interpretation theory: Discourse and the surplus of meaning. Fort Worth: Texas University Press.
28.
Ricoeur, P. (1991). From text to action: Essays in hermeneutics (Vol. 2). London: Athlone.
29.
Ricoeur, P. (1996). The hermeneutics of action (R. Kearney, Ed.). Thousand Oaks, CA: Sage.
30.
Robey, R. R. (1998). A meta-analysis of clinical outcomes in the treatment of aphasia. Journal of Speech, Language, and Hearing Research, 41, 172-187.
31.
Sandelowski, M. (1991). Telling stories: Narrative approaches in qualitative research. IMAGE: Journal of Nursing Scholarship, 23, 161-166.
32.
Sandelowski, M. (1995). Focus on qualitative methods, sample size in qualitative research. Research in Nursing & Health, 18, 479-482.
33.
Sarno, M. T. , (1986). The fifth annual Hemphill lecture. In M. T. Sarno (Ed.). Acquired aphasia (2nd ed., p. 499). San Diego: Academic Press.
34.
Small, S. L. (1994). Pharmacotherapy of aphasia: A critical review. Stroke, 25, 1282-1289.
35.
Söderberg, A. , Gilje, F., & Norberg, A. (1997). Dignity in situations of ethical difficulty in intensive care. Intensive and Critical Care Nursing, 13, 135-144.
36.
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
37.
Straus, E. W. , & Machado, M. A. (1984). Gabriel Marcel’s notion of incarnate being. In P. A. Schlipp & L. E. Hahn (Eds.), The philosophy of Gabriel Marcel (pp. 123-156). Carbondale: Southern Illinois University. (Original work published 1970)
38.
Sundin, K. , Axelsson, K., Jansson, L., & Norberg, A. (2000). Suffering from care as expressed in the narratives of former patients in somatic wards. Scandinavian Journal of Caring Sciences, 14, 16-22.
39.
Talseth, A.-G. , Lindseth, A., Jacobson, L., & Norberg, A. (1997). Nurses’ narrations about suicidal psychiatric inpatients. Nordic Journal of Psychiatry, 51, 359-364.
40.
Weil, S. (1962). Selected essays 1934-1945 (R. Rees, Trans.). Oxford, UK: Oxford University Press.
