The Everyday Phenomenology of Bedside Insight: A Response to Shira Birnbaum

Shira Birnbaum (2024) makes several interesting observations in her recent article, many of which I agree with. However, I have a couple of reservations about her paper, which I would like to outline briefly. The first concerns the criteria for determining who is—and more particularly who is not—qualified to write about phenomenological research in nursing. The second concerns her reasons for claiming that ‘nursing remains a fundamentally phenomenological enterprise’. The problem with Paley's critique of phenomenological research in nursing, ultimately, is that it bypasses actual patients. Written from the perspective of someone who does not spend day or night shifts caring for bodies in pain and illness… (p. 7). This prompted various memories. One was giving a paper at a nursing conference in Stirling in 2001 (the paper was eventually published, in a subsequent draft, as ‘An archaeology of caring knowledge’: Paley 2001). After I had finished, the session chair invited questions, and a conference participant at the front promptly stood up and delivered the following short speech: ‘Well, in the first place, you're not a nurse. And, in the second place, you're a man.’ She then sat down again. So that was two strikes against me, two reasons why I was not qualified to talk/write about nursing, and specifically about caring. During the next few years, I heard ‘you're not a nurse’ regularly, but since I retired, I've heard it hardly at all. Seeing a version of it in Birnbaum's paper made me feel oddly nostalgic. I had not realised that this sort of ad hominem comment was still doing the rounds. On the other hand, suggesting that I have ‘bypassed actual patients’ is, I suppose, a convenient way of bypassing actual arguments. So here's another memory. Another conference, another city, but the same argument: ‘You're not a nurse’. This time, however, I recalled that the conference participant who made this comment had, in a previous session, suggested that ‘the patient's voice must be heard’. So my reply was, ‘No, I'm not a nurse, I'm a patient. And, according to you, the patient's voice must be heard.’ In her paper, Birnbaum says something similar, if in a different context: ‘Our patients speak to us…’. So my reply is roughly the same: ‘Fine, this is me speaking to you.’ Some aspects of my patient-hood: I have two chronic conditions, both potentially life-threatening. In the last dozen years, I've had… where do we start?… cataract surgery on both eyes, two colonoscopies, two gastroscopies, a week's stay in an orthogeriatric (!) ward, while I was having a complex subtrochanteric fracture repaired, two visits to A&E (one of which resulted in a diagnosis of atrial fibrillation, so that probably makes three chronic conditions) a bout of amaurosis fugax, leading to ophthalmology tests, cardiac tests and an eventual diagnosis of a TIA by the stroke consultant… plus annual reviews, retina screening, regular blood tests. I've been an inpatient and an outpatient and had dealings with more nurses (and, of course, sundry other health professionals) than I could shake a stick at. And I have not had all this experience with my eyes shut and my fingers in my ears. I've observed, listened, thought, inferred, commented… and, as a result, I have my own ideas about the extent to which nursing is a phenomenological enterprise. I won't go into detail here, but I'll say something in a moment about Birnbaum's view. So, to recap, according to Birnbaum, my critique has ‘bypassed actual patients’. Which brings us to the irony in her paper. She says I write ‘from the perspective’ of someone who hasn't done the night shift, and who knows nothing about caring for bodies in pain and illness. By the same token, she writes ‘from the perspective’ of someone who is unacquainted with me—someone who, for example, knows nothing about my experience of illness and injury, or my numerous encounters with health care professionals (I should perhaps include the nurses, clinical specialists, who I supervised at postgraduate level, and from whom I learned enormous amounts). But she licences herself to make the comment above nonetheless. Implicitly, however, she does raise an interesting question: Who is qualified—if, indeed, anyone is—to discuss nursing or nursing phenomenology other than nurses? And on what basis? A serious discussion about that, rather than the casual dismissal inherent in ‘not a nurse’, is something I'd really like to see. Coming back to phenomenology. Last year, I was invited to write a chapter on ‘qualitative research and phenomenology’ for the Springer Encyclopedia of Phenomenology. I agreed to do so and spent several months reading stuff on phenomenology I hadn't looked at before or not for a long time. Here was an opportunity to read a lot of interesting material and think about it in different ways. One conclusion I reached was that everyone who writes about it has a different understanding of what phenomenology is. It's not just the subtleties. They can't agree about the basics, and they certainly can't agree about what, if anything, gives a qualitative study the status of ‘phenomenology’. Crotty, Giorgi, van Manen, Zahavi, Gallagher, Smith, Thompson, Petitmengin… and so forth. Qualitative research studies can be phenomenological; qualitative research studies can't be phenomenological. The epoché is necessary for phenomenology; the epoché is not necessary for phenomenology. What counts as a ‘reduction’ for Crotty doesn't count as a reduction for van Manen (and vice versa). Giorgi thinks the researcher must perform a reduction when analysing respondent experience; Petitmengin thinks a reduction can be elicited in the respondent. The researcher necessarily turns her gaze toward ‘inner’ experience; the researcher need not turn her gaze toward ‘inner’ experience. Gallagher and Zahavi criticise Smith because, on his account, all qualitative studies can be classified as phenomenology; but the same is true of their own account. And on it goes. What struck me is that, while all this appears to be disagreement about what phenomenology is, and what you have to do to make your qualitative study genuinely ‘phenomenological’ (someone has to be right, someone else has to be wrong), there's another way to look at it: as a verbal dispute about what kind of study gets called ‘phenomenology’, and who gets to decide. Whose persuasive definition will triumph? In which case, all you have to do as a would-be phenomenological qualitative researcher is decide how you'd like to do the research, and then adopt a definition of ‘phenomenology’ that justifies that. In effect, Birnbaum is offering us another definition. It's partially a ‘back to Benner’ project, and the claim that something about nursing corresponds to something about phenomenology. There are different versions of this, of course: something to do with intuition, something to do with forms of reasoning, something to do with perception, something to do with both of them 'valuing' something… and so on. However, Birnbaum's three cases involve nurses doing things any decent professional, in virtually any profession would do: observe, notice, listen, think, imagine, infer. Other health care professionals do it, detectives do it, lawyers do it, journalists do it. Even accountants do it. I spent a day with an architect once, and he did it. My physiotherapist was brilliant at it. And it's what I do as a patient. Are we all doing phenomenology? I don't think so. Birnbaum is just telling us how she proposes to use the word ‘phenomenology’. There's nothing wrong with that: she's entitled to use words as she likes, provided she makes her usage clear to the rest of us, and provided she acknowledges that this usage is the reason why nursing ‘remains a fundamentally phenomenological enterprise’—given that her use of the word ‘phenomenological’ makes this statement come out trivially true. ‘My intent here’, she says, ‘is not to reduce phenomenology to something so generic and deracinated that virtually anything could be called phenomenological.’ No, I imagine not. But sometimes we do things it wasn't our intent to do. And how she proposes to use the word has, in my judgement, precisely that consequence. Finally, and just to be clear. I don't myself have a view about how ‘phenomenology’ should be defined. That's none of my business, and up to phenomenologists. My book reviewed the work of qualitative researchers who describe their studies as ‘phenomenology’, along with the methodological writers they reference, and it examined in close detail, step by step, line by line, how they get from their data to their conclusions. I think of it as an operational analysis. More recently, my interests have shifted a bit—to the metaphysical claims made by qualitative methodologists and the question, ‘What precisely are these claims supposed to mean?’ I started with constructivism (Paley 2025), but I've now begun to wonder whether phenomenology should be next. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.