Abstract: This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method.The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure or the lived experience of the patients and the nurses concerned.The phenomenon of clinically inflicted pain is described in terms of four isolated themes: (1) the hurt and painfulness of inflicted pain; (2) handing one's body over to others; (3) the expectation and experience of being wounded, and (4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain, often as punishment and almost always a something avoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time.Nurses who themselves helped to generate pain, frequently overlooked the patient's lived experience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently become invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived inevitable , non-harmful and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse.The study points to dangers for both patients and nurses when clinically pain is ignored, overlooked or treated with detachment. It also points a way toward nursing practice, that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention and relief

Abstract: Hospice nurses in New Zealand provide supportive care to patients of settings. In doing so, the hospice nurse and team are likely to have an ideal of a “good death” that guides their practice.A 'good death“ is one where symptons are well controlled without over medicalisation, where there is an acceptance of death by the patient and loved ones and where appropriatepreparation and completion of unfinished business has occurred. The death itself is peaceful and the loved ones are present. However, patients or their families do not always accept the treatment or care that the nurses offer to facilitate the best quality of life and a ”good death“ for the patient. This may leave the nurses involved feeling distressed and confused, as they are confronted with the conflict between the patients' path and the nurses' ideals.This study employs critical incident technique to explore how nurses respond and feel when the patients decline the treatment or care the nurse feels will improve their quality of life and eventually lead to a ”good death“. The findings illustrate a broad range of treatment or care that is declined by either patients or their families in the first instance. This study uncovers a number of action responses nurses use in these situations, which demonstrate acceptance of patient choice but also need to help the patient experience a ”good death". In addition it demonstrates that nurses experience a gamut of emotional responses to such situations, some of which are painful for the nurse and have the potential to cause stress. Recommendations are made which may assist nurses limit the distress they experience when patients of their families decline the treatment or care, and empower nurses with further strategies to use in such situations

Abstract: The purpose of this study was to provide a partial theoretical description of the phenomenon of caring in nursing practice. Three practice settings involving cancer patients were selected: hospital, hospice, and community with thirty patients and thirty-two nurses participating in the study. A research design combining a phenomenological perspective and grounded theory strategies was implemented. Data were collected by interview, participant observation and records. The data were analysed by the method of constant comparative analysis.A number of concepts were developed from the data and the theoretical framework of “The Actualized Caring Moment” was formulated to explain how the actual caring process occurs in nursing practice. This caring moment is the moment at which the nurse and the patient realise their intersubjective connectedness in transforming healing-growing as human beings in a specific-dynamic changing situation. The actualized caring moment is a gestalt configuration of three carting moments. The pre-conditions, The on-going interaction, and The situated context.The Pre-conditions, which consist of the nurse, personally and professionally prepared to care, and the patient, a person with compromised health and wellbeing, are pre-requisites for the occurrence of the caring process. The nurses has the qualities of benevolence, commitment, and clinical competency to be ready to care. The patient is a unique person in a vulnerable state and requires assistance from the nurse to meet personal health needs.The on-going interaction, the actual caring process, is the continuity of the nurse-patient interaction moment by moment which brings together six caring elements: Being there, Being mindfully present, A relationship of trust Participation in meeting needs, Empathetic communication, and Balancing knowledge-energy-time. The Situated Context is the situation and environment where the actual caring process is taking place, and this is comprised of circumstances of the nurse-patient meeting and care-facilitating working conditions.The conceptual framework of “The Actualised Caring Moment” offers nurses an opportunity to understand their practice more fully in providing effective nursing service. Consequently, its implications are valuable for education, research, and the development of knowledge focussed on the discipline of nursing