Phenomenology of Practice in full colour

Felicity and I are deeply grateful for Professor Michael van Manen’s seminar yesterday. Prior organisation was a little stilted by email, and the announcement somewhat belated. Nevertheless, we were encouraged by the turnout, a respectful group of almost 50 tuned in. Michael gracefully took us through an illustrated tour of phenomenology of practice, with reference to the ‘Classic Writings’ book and his own research related to his work as a neonatologist.

Professor van Manen presenting

Michael kindly allowed us to record the presentation although his use of many evocative images makes it impossible to share very widely. If you would like to view, please get in touch with us using the info@hanfod.NL email address.

Here are references shared in the seminar:

Networked Learning Editorial Collective (NLEC) et al. 2021. Networked Learning in 2021: A Community Definition. Postdigital Science and Education 3(2), pp. 326–369. doi: 10.1007/s42438-021-00222-y.

van Manen, Max 2016. Researching lived experience: human science for an action sensitive pedagogy. Second Edition. London New York: Routledge, Taylor & Francis Group.

van Manen, Michael 2012. Carrying: Parental Experience of the Hospital Transfer of Their Baby. Qualitative Health Research 22(2), pp. 199–211. doi: 10.1177/1049732311420447.

van Manen, Michael 2018. Phenomenology of the Newborn: Life from Womb to World. 1st edition. New York: Routledge.

van Manen, Michael and van Manen, Max 2021. Classic writings for a phenomenology of practice. New York: Routledge. Available at: https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=6280232 [link to CU Library record]

I stopped recording at the start of the question/discussion part to help everyone feel less inhibited. I have anonymised and reproduced the four questions and answers here though:

What makes your approach specifically phenomenological?

Since I talked about NICAP (Neuroimaging of the Children’s Attention Project, see this article) I can use that as an example. NICAP is from a behavioral paradigm, and you know I want to be clear that I don’t have anything negative to say about NICAP as a whole. We’re in a NICAP training center in Edmonton, and we very much feel that it contributes positively to infants care. Because what it does is it focuses our attention on a particular child. But the language of NICAP would look at babies more mechanistically. It’s from that perspective of, Well, how do I help a baby to stay somehow integrated. If I was out on the playground, and my child fell off a swing, for example. And he started crying, and he just couldn’t seem to get himself together, NICAP would label that behavior rather disorganized right now. He needs to hold himself together. Well, maybe his behavior is disorganized. Maybe he can’t seem to stop sobbing and crying and breathing, you know, these are all out of sync with one another. But somehow there’s something missing from that assessment or that judgment. It’s missing that sense of, well, what might it be like in that moment? For a child to suddenly fall, not just to experience a fall in that sense of, have I hurt my leg, have I hurt my hand? But then, to have that moment where one looks around, and, asks where is my mom, or where’s my dad? Or where’s my aunt, or some other caring person. I think a phenomenological approach, whether we’re talking about to a newborn or to a child, or any other paediatric situation, oriented the question as, well, what’s it actually like in that moment for a child before we begin abstracting about it, or conceptualising their experience, or trying to otherwise explain it away? What is it like, you know, my dad tends to use the term ‘lived experience’ in the pre-reflective sense? What is that actually like before, as someone might say, Oh, I’m just so disappointed in myself… I thought I could, you know, go across the monkey bars…? What is it actually like to experience such a moment? So, for me, and approaching, you know the lifeworld of a baby, or a child, phenomenology is a wondering kind of reflection, which asks what it’s like, without maybe being able to fully answer it, but by asking it and leaving the question open. To me that’s a profoundly ethical gesture. We’re not trying to reduce another’s work, another world to the same as ours. I’m not going to say I can understand exactly what it’s like for a child. I’m not a child anymore, despite what my wife would say(!).

How have your findings been implemented in practice?

I was really interested in what you were talking about with regards to hospital transfer, and how disorientating and distressing that is, for parents, and particularly, the quote from the mother saying I’ve been I’ve birthed this baby, but I can’t find the baby, they kind of says, and disorientated just as thinking about that. I was also thinking about the quote from the story that you gave with regards to disorganized behavior, where may be pride in coming up with that phrase, but you interpret this has been quite dismissive of both the nurses observations and the baby’s experience. Have you gone that step further with regards to them moving on from the research to evidence implementation.

So that’s an important question. A nice book, it goes on the shelf somewhere. How does it actually translate into practice? So I see the importance of phenomenology in clinical practice in a number of different ways. One is ultimately when I think about medical education or nursing, or education, and the health sciences, and I do a lot of teaching of medical students, and other disciplines, and I teach them about ethics, the value from this work is ultimately, if it makes individuals more sensitive to the experiences of others. It’s not simply that, having your baby transferred can make you feel lost in a hospital when you don’t know where the Nicu is, so we need to have better signage. That’s not just it as far as the findings, but rather, if we have healthcare professionals who ultimately approach a parent, or a patient in such a way that they have a sense of what it might be like, but also appreciating someone else’s experience might be different from this. Still, then I think we ultimately have people who are more reflective in their practice. So, my hidden agenda when I teach our medical student class of you know, 100 to 200 students is to make a 100 to 200 little phenomenologists; and I’m joking but, to somehow help to cultivate that sensitivity in physicians, colleagues, and trainees.

The other place where I have found it helpful, is bringing phenomenology to the stage of either design or our policy formation. So often, phenomenology can help to reveal very important considerations. Around hospital transfer for example, we ended up producing a whole bunch of different materials around way-finding for parents, kind of best practices. It’s not necessarily the appropriate thing for every parent: some parents work in the hospital! They know exactly where things are. For some parents it’s very welcome or a wonderful thing to have your baby transferred because they didn’t get along very well with the team who was taking care of their baby before. But what are some important considerations? Engaging in some way with the findings of phenomenological studies are strangely what we already know, but they’ve helped to make something explicit that we tend to forget, and the same can be true for design. So when we talk about designing different technologies or using different technologies and clinical practice, well, what considerations are there for those technologies? Or how should we look at potentially redesigning them to better suit what we’re what we’re aiming for? So I have found, like, as far as knowledge translation, that phenomenology both has strong import for teaching of ethics, hopefully cultivating a particular attitude towards patients and their families, and then as well, potentially, guideline development, and other design aspects.

Just a comment: I really like the sensitivity angle…

…and how that could be used in training. From my experience, personal and also professional, of helping families, phenomenology, could really help. For instance, within the field of autism, autistic children and their parent cares, because their life worlds are rarely considered, certainly not in a positive way, and they’re not really considered by any of the professions, I haven’t felt, professionally, including social care education health, and I think if they were, I think this could be really helpful in smoothing relations and understanding and moving forwards progressively, is what I mean. Thank you for that! [Michael agreed strongly!]

Do you think that, in some ways, babies are easier to study than adults because of the challenges of intersubjectivity?

I think every kind of phenomenological study can present its own difficulties and challenges, depending on the pragmatics of that study. One of the so-called facilitators of engaging and working in the NICU is you in some sense we have a captive audience. On a given day in Edmonton, which is, you know, a fairly large Canadian city. It’s a large referral center from a NICU perspective. We have about 140 babies in the hospital on any given day in our program. It’s very easy to engage with the community of parents. Because, quite simply, there are so many. Our program graduates continue to identify as being a parent in the NICU.  Depending on the community that one is in engaging with, it can be a challenge, as, you know, there are certain communities that may have a particular perspective, or a narrative about a particular health condition that they would like to have brought forward, that’s also true for paediatrics. I’m thinking recently of a manuscript that was submitted to qualitative health research journal that I’m involved with as an editor. It wasn’t a phenomenological study. But it was dealing with individuals who have chronic fatigue syndrome, and there was backlash, or an outcry from the community that it wasn’t presenting the narrative that community wanted to be presented of their illness. I think many of us would not think of phenomenology as participatory action research. I do think that the questions that are asked in phenomenological research should have relevance. They should have relevance for that community and those practitioners who are engaged in supporting them, for all of us work in public funded institutions. It’s not the responsible thing just to sit in your university office on a chair, and write books all day, right? I mean you have a responsibility towards others, towards society. But I do think, if you’re talking about challenges, negotiating some of those groups can be challenging.  The way that my father has articulated or pursued phenomenological research is the focus is on the phenomena, not on the participants: the experience of hospital transfer as a phenomena. The aim was not to represent the parents’ perspectives, who I interviewed. It wasn’t a qualitative description or perception or opinion type study, and sometimes that’s what people hope for from qualitative research, and from phenomenological research. For better or for worse the phrase lived experience is very popular in Canada, in the media, etc. Just yesterday I was reviewing a grant application for a colleague, and they have lived experience participants. I’d never heard that phrase before, but I guess now you have participants that have not only lived in experience, but they are lived experience participants. I do wonder if we take a term, and we use it rather too loosely, because then it stops having meaning – any experiences are lived experience technically. But is it when we’re exploring it in that pre-reflective sense.

In a research tradition such as phenomenology, how can we distinguish better work when one is just starting to try and understand it?

It can be hard to kind of get into this this field. There are so many different interpretations of phenomenology. I mean, it’s been said, there isn’t actually such a thing as phenomenology. There’s only phenomenologists, right? So that’s like almost a cliché comment. What I usually do when I have a student who approaches me and says, you know, I’m interested in doing a phenomenological study, I usually advise them, Well, why don’t you find a few examples of phenomenological studies that you feel were really worthwhile, that contributed to practice. They don’t even have to be paediatric. They can be on Alzheimer’s. They can be a multiple sclerosis. They could be on, you know, PowerPoint, or they can be in the classroom right? But, you know, often it’s fruitful to start there rather than starting with the books like ‘Being and Time’, and I’ve read ‘Being and Time’, but, for students, you know, how do you introduce them to this kind of reflective research?

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