Hermeneutics In Health Care What is Hermeneutics
Hermeneutics has historically been defined as the art or theory of interpretation, primarily concerning the interpretation of texts. Its roots can be traced back to theology and law, where understanding and interpreting religious texts and legal documents were essential. The early scholars of hermeneutics, particularly within theology, sought methods to interpret ancient scriptures with accuracy and relevance, applying the principles of hermeneutics to derive meaning that resonated with contemporary society. Similarly, in law, hermeneutics played a significant role in understanding legal texts in a way that applied to evolving societal norms and conditions.
One of the significant contributors to redefining hermeneutics was the German philosopher Wilhelm Dilthey (1833–1911). He extended the concept beyond its traditional domains to define hermeneutics as a science of historical understanding. Dilthey sought to establish a method for deriving objectively valid interpretations from historical texts and events. His contribution laid the foundation for hermeneutics as a field of inquiry that seeks to understand not just the text itself but the context in which it was created and the impact it has on future generations. Hermeneutics thus became a tool for making sense of the complex relationship between past and present, between the written word and lived experience.
Following Dilthey’s contributions, Martin Heidegger (1889–1976) revolutionized hermeneutics by shifting the focus from historical understanding to a more fundamental concern with human existence. Heidegger’s hermeneutics was no longer just about interpreting texts or historical events. Instead, it aimed to uncover the temporality and self-understanding of human beings. For Heidegger, hermeneutics became a way of revealing how individuals interpret their existence in time. This approach marked a significant shift in how hermeneutics was understood and applied, influencing not only philosophy but also fields such as nursing, where understanding human experiences, particularly those related to health and illness, is central.
Importance of Hermeneutics
Hermeneutics is invaluable to scholarship because it acknowledges the temporal situatedness of both the researcher and the participants involved in any study or inquiry. Time, both as a lived experience and as a continuum, plays a central role in hermeneutical research. The human experience is constantly evolving, and hermeneutics helps scholars and practitioners understand how this progression shapes individuals’ understandings of themselves and the world around them. Unlike traditional approaches to phenomenology, which may attempt to bracket or set aside the influence of time, hermeneutics embraces it, recognizing that human beings are always in the process of becoming, always already situated in a temporal context that influences their understanding of the world.
This focus on temporality differentiates hermeneutics from other forms of phenomenological inquiry, such as those inspired by the work of Edmund Husserl. In Husserlian phenomenology, the researcher attempts to “bracket” or set aside their own preconceptions to access the essence of a phenomenon. In contrast, the hermeneutic scholar acknowledges that it is impossible to approach any phenomenon without the influence of time and prior experiences. Instead of bracketing, hermeneutics involves uncovering how these experiences shape the understanding of a phenomenon.
Hermeneutics, therefore, is not a linear or straightforward method. It does not have a clear beginning or end that can be concretely defined. Instead, it is a continuous, dynamic process. Researchers, participants, and even readers of hermeneutic studies are all engaged in this ongoing process of interpretation and understanding. Each new insight or interpretation adds to the depth and richness of understanding, but it never brings the process to a definitive conclusion. In this sense, hermeneutics reflects the open-ended and ever-evolving nature of human experience itself.
Heidegger’s Fore-Structure
Central to Heidegger’s hermeneutics is his concept of the “fore-structure” of understanding. Heidegger argued that interpretation always presupposes a certain structure of understanding, which he called the fore-structure. This fore-structure consists of three key components: fore-having, fore-sight, and fore-conception. These three elements explain how our understanding is shaped by the practical contexts and background practices within which we operate.
- Fore-having refers to the practical familiarity with phenomena that individuals bring to any interpretive process. It reflects the idea that we always come to an experience or a text with certain background knowledge or practices that shape our initial understanding.
- Fore-sight represents the lens or perspective from which we approach understanding. It acknowledges that we always view phenomena from a particular standpoint, shaped by our previous experiences and the contexts in which we live.
- Fore-conception refers to our anticipated sense of what our interpretation will reveal. It reflects the expectations and assumptions that guide our interpretive efforts, which are also shaped by background practices.
Heidegger argued that understanding is inherently circular. We are always within an “interpretive circle,” where our prior understandings shape our current interpretations, and our current interpretations, in turn, influence our future understanding. This concept, known as the “hermeneutic circle,” is central to the practice of hermeneutics. It challenges the notion of objective or presuppositionless understanding. Instead, interpretation is always influenced by the prior experiences and perspectives that individuals bring to the process.
Unlike traditional phenomenologists who attempt to isolate or bracket their presuppositions, hermeneutic researchers, following Heidegger’s lead, seek to make their presuppositions explicit. Hans-Georg Gadamer, a student of Heidegger, extended this approach, emphasizing that understanding is always historically situated. We are never outside of the context of history, language, and culture, and these elements always influence our interpretations.
The essence of hermeneutics, therefore, is not about achieving a final, definitive understanding of a phenomenon. Instead, it is about remaining open to the complexities and nuances of human experience. Heidegger famously remarked that “interpretation is never a presuppositionless grasping of something previously given.” Instead, hermeneutics requires an attitude of humility and respect for the inherent complexity and ambiguity of understanding. It is a process of continuous reflection and engagement, where the goal is not to arrive at a definitive conclusion but to deepen and enrich one’s understanding of the human condition.
Interpretive Phenomenon
Interpretive phenomenology, as developed by scholars such as Heidegger and Gadamer, moves beyond traditional logical structures to reveal and explicate hidden relationships in human experience. It emphasizes the role of interpretation in understanding human practices and experiences. In this sense, hermeneutics is closely related to critical social theory, feminism, and postmodernism, as it seeks to uncover underlying meanings and structures that are not immediately apparent. However, unlike these other approaches, hermeneutics does not attempt to posit a particular political or psychological framework as the basis for interpretation. Instead, it focuses on describing the common practices and shared meanings that emerge from human experience.
For hermeneutic scholars, the goal is not to explain or reconcile a particular experience by identifying an underlying cause or theory. Instead, the purpose is to reveal and enhance understanding by describing the practices and meanings that people share. By doing so, hermeneutics seeks to illuminate the richness and complexity of human experience, particularly as it is lived in specific contexts.
Nature of Hermeneutical Scholarship
Hermeneutical scholarship is reflective, reflexive, and circular. Unlike research methodologies that follow a strict linear process, hermeneutics involves constant reflection and re-engagement with the text or phenomenon under study. This process is often seamless and fluid, mirroring the dynamic and ever-changing nature of human understanding itself. At the same time, it is essential to recognize that hermeneutical research is not a haphazard or thoughtless process. It requires careful consideration and reflection at every stage, from the initial encounter with a text or phenomenon to the final interpretation.
Although the circular nature of hermeneutics may make it difficult to describe in linear terms, scholars such as Benner (1994), Gadamer (1960, 1989), Grondin (1995), and Palmer (1969) have provided valuable insights into the process of hermeneutical research. These scholars emphasize that hermeneutics requires ongoing dialogue, reflection, and engagement with the phenomenon under study. Each new insight adds to the richness of the interpretation, but it also opens up new questions and possibilities for further reflection.
Analysis of Hermeneutical Researchers
Hermeneutical researchers often work in teams, combining their personal interests and expertise to analyze texts or phenomena. Each interview, narrative, or piece of data is read and discussed by all team members to ensure a comprehensive understanding of the subject matter. Through dialogue, the team members identify common themes and patterns that emerge from the data, refining and expanding these themes as they analyze additional texts. This process is recursive, as each new text is interpreted in light of the previous ones, and the team members continuously revisit their interpretations to ensure that they are accurate and meaningful.
In contrast to research methodologies that seek a single, definitive interpretation, hermeneutics recognizes that no single correct interpretation exists. Instead, the goal is to provide interpretations that are plausible, coherent, and comprehensive. By continuously revisiting and refining their interpretations, hermeneutic researchers aim to reveal the underlying meanings and practices that shape human experience.
Understanding Interpretation and Critique: The Benner Study
Patricia Benner introduced hermeneutics to nursing in her influential study, “Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics” (1994). This study revealed nursing as an interpretive practice that relies on practical knowledge, expertise, and skills developed over time. Rather than viewing nursing as an applied science, Benner’s work emphasized the interpretive, experiential nature of nursing practice. Nurses engage in constant interpretation and reflection, making decisions based on their understanding of the patient’s situation and the context in which care is provided.
Benner’s study has had far-reaching implications for nursing practice, research, and education. It challenged the traditional relationship between theory and practice, revealing the practical knowledge and expertise that nurses acquire through their experiences. Following Benner’s lead, hermeneutics has become an essential approach in nursing scholarship, with scholars such as Christine Tanner and Nancy Dickelman using hermeneutical analysis to explore clinical judgment, decision-making, and education practices.
Through hermeneutics, nursing is understood as an interpretive practice that requires continuous reflection and engagement. This approach has transformed how nursing is taught, practiced, and researched, offering new insights into the complex and evolving nature of health care.