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CHAPTER 2 PHILOSOPHICAL AND THEORETICAL FOUNDATIONS
INTRODUCTION
The purpose of this chapter is to present the theoretical foundations of the study. The discussion of the theoretical foundations focuses on two theoretical perspectives which form the basis of the study. The chapter begins with a discussion of Frankl’s existentialism which was the theoretical construct in which the conceptualization of the research is primarily rooted. Frankl’s existentialism supported the qualitative strand of the mixed methods research used in this study. The application of this theoretical construct to the study is discussed and integrated with each section in the exposition of Frankl’s existentialism.
The second section of the chapter deals with appreciative inquiry (AI) which was used as a theoretical research perspective and a strategy to transform the student nurses’ image of nursing. The researcher believes that AI accommodates and practically illustrates Frankl’s perspective on the meaning of life as well as the three values open towards the meaning of life. In the last part of the chapter the interface between AI and Frankl’s existentialism is discussed.
The use of the word man was not intended as a ‘gender insult’ but it was used philosophically and traditionally.
FRANKL’S EXISTENTIALISM
The meta-theoretical perspective of the qualitative strand of this research resided in Frankl’s existentialism. As an existential psychologist, Viktor Emil Frankl’s (1905-1997) philosophy and psychotherapy were predicated upon the existential questions of human existence (meaning of life, life purpose, death, despair, etc.) and they emphasized the human capacity for authenticity and freedom. Frankl founded a meaning-centred psychotherapy he called logotherapy which refers to the practice of helping people find meaning and purpose in life no matter what the life circumstances are (Smith & Liehr 2003:125). He described logotherapy as existential and phenomenological because of its focus on the meaning for human existence, man’s search for such meaning and on understanding the way in which an individual experiences the world (Frankl 1984:121).
Although the principles of logotherapy might be instrumental in the successful implementation of AI, the sceptic reader is reminded that logotherapy does not equate with psycho-analysis (Frankl 1984:177). So, Frankl’s existential stance and the logo-therapeutic techniques have relevance with the research topic, design and method but this study was not intended to be therapeutic.
Concepts of Frankl’s theory
The major concepts stemming from Frankl’s existentialism that were found relevant to this research include the will to meaning, freedom of the will as well as meaning of life and human suffering (Smith & Liehr 2003:125).
The will to meaning
The central concept of the theory is the ‘will to meaning’ which is defined by Smith and Liehr (2003:125) as that which one may feel called and to which one is committed, or, a summary of reasons for one’s existence. According to Frankl (1984), each individual possesses the ‘will to meaning’ which refers to the need to search for meaning which will offer a purpose for existence. In addition, the will to meaning is a desire to understand the purpose of our own lives. The importance of a search for meaning and having a meaning in life is to have a reason to continue living. However, it necessitates personal responsibility and accountability for finding our way and persisting within it once found (Eddington & Shuman 2006:11). Bellin (2012:4) further explains that striving to find meaning in one’s life is the most powerful motivating and driving force in human beings.
Smith and Liehr (2003:130) bring to attention the fact that life purpose flows from the uniqueness of the person and the singularity of the situation. This means that the meaning of life differs from one person to the other and it is specific to a person’s life at a given moment because it can only be fulfilled by an individual alone; only then does it achieve the significance that will satisfy his/her own will to meaning (Frankl 1984:121). The researcher’s argument is that having a positive image of nursing and finding meaning in nursing are reciprocal.
Freedom of the will
Freedom of the will refers to the freedom to choose and it is defined by Smith and Liehr (2003:132) as the process of selecting among options over which one has control. Frankl described the ‘freedom of the will’ as the freedom to choose one’s reaction to the tragic triad and not the freedom from it (Frankl 1969:16). According to Frankl, the tragic triad refers to those situations or conditions of life from which no human being can escape; conditions which may be circumscribed by pain, guilt and death. Moreover, Lukas (1984) introduced the idea of fate and freedom to expand the understanding of one’s freedom to choose by indicating that there are two areas in life that confront human beings, namely, an area of fate and that of freedom. The area of fate is an area in our life over which we have little or no control over and therefore, no responsibility because there is limited freedom. It is an area that applies to our genetic makeup, our upbringing and the events of fate such as accidents and our current situations. The author further explained that the area of fate is complemented by the area of freedom which includes what one can do when confronted with a situation. The area of freedom applies to the depth of our spirit where we can choose the attitude with which to respond to the area of fate (Frankl 1984:89). It might appear that the issue of being a nursing student having a negative image of nursing might be far removed from the “tragic triad”, literature abounds with reports on nurses’ anguish and despair because of either their own poor image of nursing or their awareness that nursing might be held in low esteem (Varaei et al 2012:551; Valizadeh et al 2008:1079).
Frankl (1984) observed that there was a fluid boundary between the area of freedom and the area of fate. He pointed out that the area of freedom may sometimes be big with many opportunities to actualize values and at other times it may be very small but it is never reduced to zero (Frankl 1984:176). This position presents an unconditionally positive view of life referred to as ‘the tragic optimism’ which means remaining optimistic despite the tragic triad of pain, guilt and death (Frankl 1984:161). The tragic optimism expresses Frankl’s belief in human capacity for freedom “that everything can be taken from a man but one thing; the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way” (Frankl 1984:86); implying that people have the power and freedom to decide their outcomes. With regard to choosing a positive attitude and perception on the image of nursing among student nurses, the AI as discussed later seemed a plausible technique to foster and assist such positive meaningful attitude.
The current nursing situation (an area of fate), in many instances is characterized by negative media reports and perceptions about nursing, poor image of nursing and the high rates of attrition of student nurses and newly qualified nurses (Varaei et al 2012:551; Hoke 2006:95). In South Africa, the increased disease burden as a result of HIV/AIDS and tuberculosis, heavy workloads, lack of equipment, work dissatisfactions, inequities in terms of nurse distribution have contributed to nursing shortage as many nurses leave the profession and few people choose nursing as a career (Breier et al 2009:31; Mkhize & Nzimande 2007:17; Pillay 2009). The concept of tragic optimism directly relates to the context of nursing, implying that student nurses can remain optimistic despite the current fate of nursing. In the current nursing situation, the student nurses’ area of freedom may be very small but they still have the power and freedom to decide their outcomes. The student nurses could invoke attitudinal values by choosing an attitude with which to react to the situation or by taking a stand towards those circumstances (Frankl 1984:153). In order to exercise the freedom to choose, Smith and Liehr (2003:132) suggest the use of the following questions when confronted with situations:
• Where are my areas of freedom?
Contextually this may relate to the positive aspects of the image of nursing or peak experiences or the most valued aspect of nursing.
• What possible choices do I have?
This may be related to the decisions to either leave the profession or stay committed to it in spite of the current situation in nursing or do something to improve the image of nursing within the profession and in the public.
• Which one do I actually want to actualize?
This is about making a choice from the possible choices stated in the previous paragraph.
Meaning of life and human suffering
Human suffering is a subjective experience, unique to individuals and varies from transitory discomfort to extreme anguish and despair. Frankl (1969:75) cited in Smith and Liehr (2003:139) states that suffering is part of human experience. Frankl was opposed to the idea that human beings are shaped by external forces and are dominated by the physical environment, no matter how oppressive (Eddington & Shuman 2006:12) but he admitted that man can never be free from biological, sociological or psychological conditions.
In Pirtle’s (2012:61) view, the experiences of pain, guilt and death (tragic triad) are parts of human experience and unavoidable manifestations of suffering. In essence, Pirtle (2012:62) contends that life does not guarantee happiness but it offers opportunities to find meaning and that man is capable of overcoming and rising above the unavoidable sufferings that inevitably come with life and the tragic triad (Pirtle 2012:62). In addition, the author explained that in life undeserved, unexplainable and unavoidable suffering happen to people and when it does, people should not look for meaning but meaning comes with the stance they take towards suffering.
The tenets that represented Frankl’s basic principles of logotherapy applied at this point are that:
• Life has meaning under any and all circumstances, even the most unpleasant ones;
• Meaning in life is something to be found rather than to be given, discovered rather be invented (Frankl 1969 cited in Smith & Liehr 2003:130); and
• People have the freedom to find meaning in what they do and what they experience or in the stand they take when faced with situations of unchangeable suffering (Frankl 1984:176).
Frankl (1984:176) asserts that each person must discover his/her own meaning in any situation. For example, a professional working with a person who has experienced loss of a limb cannot tell the person how to look for meaning but can help guide the person to find new avenues of meaning through shifting views and to separate themselves from their symptoms in order to tap into the resources of their spiritual dimension to arouse the power of the human spirit (Smith & Liehr 2003:142). One of the stances that can be taken towards suffering is self-transcendence, defined as by Frankl (1969) cited in Smith and Liehr (2003:142) as getting outside the self for a cause greater than self. Transcendence is distancing from oneself and once that happens, a different view of the situation comes to light. Transcendence is also related to life purpose (Smith & Liehr 2003:149). During the current research, AI was applied to guide student nurse participants to a more meaningful experience of nursing by opting to create a positive stance and attitude towards the image of nursing.
Avenues to meaning
Frankl postulated that meaning in life always changes but never ceases to be. In accordance with the humane, humanistic and caring paradigm of nursing, the three main avenues of arriving at meaning in life as proclaimed by logotherapy, stemming from Frankl’s existentialism, relate to the current research. These are, arriving at meaning in life (appreciation) by creating a work or doing a deed, experiencing something or encountering someone as well as taking a stand against fate or toward life’s circumstances which are beyond control and cannot be changed (Amber 2010:215) thereby growing beyond oneself (Frankl 1984:170). Frankl stated that the most fundamental way of discovering meaning in any present moment is through the awareness of creative, experiential and attitudinal values (Frankl 1984:133).
CHAPTER 1 ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 THE RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 DEFINITIONS OF KEY CONCEPTS
1.7 FOUNDATIONS OF THE STUDY
1.8 RESEARCH DESIGN
1.9 RESEARCH METHODS
1.10 LITERATURE REVIEW AND CONTROL
1.11 MEASURES TO ENSURE VALIDITY, RELIABILITY AND TRUSTWORTHINESS
1.12 ETHICAL CONSIDERATIONS
1.13 ORGANISATION OF THE THESIS
1.14 CONCLUSION
CHAPTER 2 PHILOSOPHICAL AND THEORETICAL FOUNDATIONS
2.1 INTRODUCTION
2.2 FRANKL’S EXISTENTIALISM
2.3 APPRECIATIVE INQUIRY (AI)
3.4 CONCLUSION
CHAPTER 4 RESEARCH DESIGN AND METHODS
4.1 INTRODUCTION
4.2 RESEARCH OBJECTIVES
4.3 RESEARCH QUESTIONS
4.4 RESEARCH DESIGN
4.5 RESEARCH CONTEXT AND SETTING
4.6 RESEARCH METHODS
4.7 MEASURES TO ENSURE TRUSTWORTHINESS
4.8 ETHICAL CONSIDERATIONS
4.9 CONCLUSION
CHAPTER 5 ANALYSIS, PRESENTATION AND DESCRIPTION OF THE QUANTITATIVE RESEARCH FINDINGS: PRE-TEST
5.1 INTRODUCTION
5.2 RESPONDENTS’ BIOGRAPHICAL DATA
5.3 STUDENT NURSES’ BASELINE PERCEPTIONS OF THE IMAGE OF NURSING
5.4 SUMMARY OF RESULTS OF THE STUDENT NURSES’ PERCEPTION OF THE IMAGE OF
NURSING
5.5 CONCLUSION
CHAPTER 6 QUALITATIVE DATA ANALYSIS, PRESENTATION AND DESCRIPTION OF THE RESEARCH FINDINGS: INTERVENTION
6.1 INTRODUCTION
6.2 APPRECIATIVE INQUIRY PROCESS
6.3 CONCLUSION
CHAPTER 7 ANALYSIS, PRESENTATION AND DESCRIPTION OF QUANTITATIVE AND QUALITATIVE RESEARCH FINDINGS: POST-TEST AND EXPERIENCES OF APPRECIATIVE INQUIRY
7.1 INTRODUCTION
7.2 THE POSTTEST SURVEY
7.3 STUDENT NURSES’ EXPERIENCE OF APPRECIATIVE INQUIRY
7.4 CONLUSION
CHAPTER 8 CONCLUSIONS AND RECOMMENDATIONS
8.1 INTRODUCTION
8.2 RESEARCH DESIGN AND METHOD
8.3 SUMMARY AND INTEPRETATION OF RESEARCH FINDINGS
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