Lifeworld-led healthcare is more than patient-led care: an existential view of well-being

Abstract

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense.

This is a preview of subscription content, access via your institution.

References

  1. Bremer, A., K. Dahlberg, and L. Sandman. 2008. To survive out-of-hospital cardiac arrest: A search for meaning and coherence. Qualitative Health Research (in press).

  2. Carlsson, G., K. Dahlberg, K. Lützen, and M. Nyström. 2004. Violent encounters in psychiatric care—A phenomenological study of embodied caring knowledge. Issues in Mental Health Nursing 25 (2): 191–217.

    PubMed  Article  Google Scholar 

  3. Carlsson, G., K. Dahlberg, H. Dahlberg, and M. Ekebergh. 2006. Patients longing for authentic personal care: A phenomenological study of violent encounters in psychiatric settings. Issues in Mental Health Nursing 27 (3): 287–305.

    PubMed  Article  Google Scholar 

  4. Dahlberg, H. 2008. On movement and life. Unpublished paper presented at Kinaesthesia and Motion Conference. Tampere, Finland, October 2–4.

  5. Department of Health. 2005. Creating an Patient-led NHS: Delivering the NHS improvement plan. London: Department of Health.

    Google Scholar 

  6. Frank, A. 1995. The wounded storyteller. Body, illness and ethics. Chicago: The University of Chicago Press.

    Google Scholar 

  7. Galvin, K., and L. Todres. 2007. The creativity of ‘unspecialisation’: A contemplative direction for integrative scholarly practice. Phenomenology and Practice 1 (1). http://www.phandpr.org/index.php/pandp.

  8. Galvin, K.T., and L. Todres. 2008. Embodying nursing openheartedness: An existential perspective. Journal of Holistic Nursing (forthcoming).

  9. Heidegger, M. 1962/1926. Being and time (trans: Maquarrie, J., and Robinson, E.). Oxford: Basil Blackwell.

  10. Heidegger, M. 1975/1955. Poetry, language and thought (trans: Hofstadter, A.). New York: Harper & Row.

  11. Johansson Sundler, A. 2008. Mitt hjärta, mitt liv: Kvinnors osäkra resa mot hälsa efter en hjärtinfarkt (My heart my life: Women’s insecure travel to health after cardial infarction). Vaxjo: Växjö University, School of health sciences and social work.

    Google Scholar 

  12. Källerwald, S. 2008. I skuggan av en hotad existens—om den onödiga striden mellan biologi och existens I vården av patienter med malignt lymfom (In the shadow of threatened existence. On the unnecessary battle between biology and existence in the carwe of malignant lymphoma patients). Växjö, SE: Växjö University Press.

  13. Merleau-Ponty, M. 1968/1948. The visible and the invisible (trans: Lingis, A.). Evanston, IL: Northwestern University Press.

  14. Merleau-Ponty, M. 1987/1960. Signs (trans: McCleary, R.). Evanston, IL: North Western University Press.

  15. Merleau-Ponty, M. 1995/1945. Phenomenology of perception (trans: Smith, C.). London: Routledge.

  16. McCardle, S., and R. Byrt. 2001. Fiction, poetry and mental health: expressive and therapeutic uses of literature. Journal of Psychiatric and Mental Health Nursing 8: 517–524.

    Article  Google Scholar 

  17. Nordenfelt, L. 1995. On the nature of health: An action theoretic approach. Dordrecht: Reidel Publ.

    Google Scholar 

  18. Nordgren, L., M. Asp, and I. Fagerberg. 2007. Support as experienced by men living with heart failure in middle age: A phenomenological study. International Journal of Nursing Studies 45 (9): 1344–1354.

    PubMed  Article  Google Scholar 

  19. Öhlen, J. 2003. Evocation of meaning through poetic condensation of narratives in empirical phenomenological inquiry into human suffering. Qualitative Health Research 13 (4): 557–566.

    PubMed  Article  Google Scholar 

  20. Polkinghorne, D. 2004. Practice and the Human Sciences: The case for a judgement based practice of care. Albany, NY: SUNY.

    Google Scholar 

  21. Sheets-Johnstone, M. 1999. The primacy of movement. Amsterdam/Philadelphia: John Benjaminms Publ. Co.

    Google Scholar 

  22. Smith, S.J., and R.J. Lloyd. 2006. Promoting vitality in health and physical education. Qualitative Health Research: An International. Interdisciplinary Journal 16 (2): 245–267.

    Google Scholar 

  23. Svanström, R. 2008. The everyday life of dementia. Manuscript.

  24. Svenaeus, F. 2000. The hermeneutics of medicine and the phenomenology of health: Steps towards a philosophy of medical practice. London: Kluwer Academic Publisher.

    Google Scholar 

  25. Todres, L. 2003. Humanising forces: Phenomenology and science; psychotherapy in technological culture. Counselling and Psychotherapy Research 3 (3): 196–203.

    Article  Google Scholar 

  26. Todres, L. 2007. Embodied enquiry: Phenomenological touchstones for research, psychotherapy and spirituality. Basingstoke: Palgrave Macmillan.

    Google Scholar 

  27. Todres, L., and K.T. Galvin. 2006. Caring for a partner with Alzheimer’s: Intimacy, loss and the life that is possible. QHW: International Journal of Qualitative Studies on Health and Well-Being 1: 50–56.

    Article  Google Scholar 

  28. Todres, L., K.T. Galvin, and K. Dahlberg. 2007. Lifeworld-led care: Revisiting a humanizing philosophy that integrates emerging trends. Medicine Health Care and Philosophy 10 (1): 53–63.

    Article  Google Scholar 

  29. Todres, L., and K.T. Galvin. 2008. Embodied Interpretation: A novel way of evocatively re-presenting meanings in phenomenological research. Qualitative Research 8 (5): 568–583.

    Article  Google Scholar 

  30. Toombs, K. 1993. The meaning of illness—a phenomenological account of the different perspectives of physician and patient. philosophy and medicine, vol. 42. Boston: Kluwer Academic Publishers.

    Google Scholar 

  31. Van den Berg, J.H. 1980/1966. The psychology of the sickbed. New York: The Humanities Press.

  32. Wainwright, S.P., and C. Williams. 2005. Culture and ageing: Reflections on the arts and nursing. Journal of Advanced Nursing 52 (5): 518–525.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Karin Dahlberg.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dahlberg, K., Todres, L. & Galvin, K. Lifeworld-led healthcare is more than patient-led care: an existential view of well-being. Med Health Care and Philos 12, 265–271 (2009). https://doi.org/10.1007/s11019-008-9174-7

Download citation

Keywords

  • Lifeworld
  • Lifeworld-led care
  • Phenomenology
  • Patient-centred care
  • Vitality
  • Peace
  • Movement
  • Well-being