A PHENOMENOLOGICAL DESCRIPTION OF THE LIVED EXPERIENCE OF CREATING ART FOR WOMEN WITH BREAST CANCER by LAURIE STARK A.D.N. North Central Michigan College, 1974 M.S.N. University of South Florida, 2005 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Nursing in the College of Nursing at the University of Central Florida Orlando, Florida Summer Term 2010 Major Professor: Angeline Bushy © Laurie Stark ii ABSTRACT Conventional approaches to cancer treatment typically do not address the personal experiences of the women with breast cancer. The aim of this study was to develop a structural description of the lived experience of women with breast cancer who create art, specifically through painting, sketching or drawing. A phenomenological approach was employed to explore the meaning of creating art for four women with a diagnosis of breast cancer. The philosophical underpinnings for this study were based on the phenomenological method of bracketing which allows the researcher and subjects to focus on lived experience. This qualitative methodology provided a means to examine the phenomenon of interest in depth from the participants‟ subjective perspective. Data were collected through face-to-face interviews and follow up telephone conversations. Giorgi‟s method for analyzing phenomenological data was used to elicit an invariant description of the meaning that creating art had for the participants. Three predominate themes emerged from the analysis. Contextual constituents of the phenomenon were identified as that of giving back and time to create. Dynamic components consisted of creative space and creative expression. Enduring factors consisted of the creative experience and sense of self. Nurses are in a unique position to facilitate the creative art process which holds the potential for self-healing and self- responsibility for their patients. Included are limitations of the study and recommendations for future research. iii This study is dedicated to every woman who has heard the life-changing words, “You have breast cancer.” May this work provide you, your loved ones, the nurses and physicians who care for you with an additional option for dealing with the aftermath of this disease. For the women in this study who said, “Yes” to participating in this research project. For my sister, Lei Ann, whose valiant battle with breast cancer and a drawing of a red house on notebook paper planted the seed for this dissertation. For my sister, Joey, whose work with watercolor with women receiving chemotherapy for breast cancer germinated the seed. For my sister, Amy, who did much to keep the idea alive when the sun didn‟t shine. For my parents, Ron and Joan, who have always believed in me. For my husband, Steve, without whom this journey would not have been possible. For our son, Andrew, whose keen mind keeps me energized. For his lovely bride-to-be, Jackie, who has been with me through the many ups and downs. Most especially, for our daughter Sarah, whose passion for art has opened my eyes to many of the possibilities of healing through creativity. iv ACKNOWLEDGMENTS I would like to extend my many thanks to the members of my dissertation committee: Dr. Pamela Ark, Dr. Jacquie Byers and Dr. Shaun Gallagher. I would like to thank most especially, the chair of my committee, Dr. Angeline Bushy. To each of you I would like to say: Without your tireless support, mentoring and hours of editing, this dream would not have been realized. A very special thank you goes to Drs. Vicky Loerzel and Laura Gonzalez for their selfless sharing of time and talent in showing me the way. My gratitude is also extended to my dear colleagues; Dr. Sandi Knapp, Allison Edmonds and Sigrid Ladores. Your unfailing support of me and your vision for me and my work when I had lost focus helped to see me to the finish line. A particular note of thanks goes to Dr. Mary Ann Lynn for her editing expertise and her confidence in my writing abilities. v TABLE OF CONTENTS LIST OF FIGURES ........................................................................................................... ix LIST OF TABLES .............................................................................................................. x CHAPTER 1 THE PROBLEM AND ITS CLARIFYING COMPONENTS .................... 1 Introduction ............................................................................................................. 1 Background of the Study ........................................................................................ 1 Purpose of the Study ............................................................................................... 8 Research Aim .......................................................................................................... 8 Method of Inquiry ................................................................................................... 9 Significance of the Research ................................................................................. 10 Organization of the Dissertation ........................................................................... 12 CHAPTER 2 REVIEW OF RELEVANT LITERATURE .............................................. 13 Introduction ........................................................................................................... 13 The Evolution of Art as a Healing Modality ........................................................ 14 Art Therapy as a Profession .................................................................................. 14 Research Conducted by Those Other Than Art Therapists .................................. 21 Research Conducted of Women with Breast Cancer by Art Therapists ............... 24 Research in Creating Art Conducted by Nurses ................................................... 28 Research Conducted by Nurses of Women with Breast Cancer ........................... 32 Summary ............................................................................................................... 33 CHAPTER 3 METHODS ................................................................................................ 34 Introduction ........................................................................................................... 34 Phenomenology: A Description of the Lived Experience .................................... 34 Rationale ............................................................................................................... 35 Methodological Assumptions ............................................................................... 37 Integration of Phenomenological Principles ......................................................... 38 Epoché................................................................................................................... 39 Eidetic Variation ................................................................................................... 41 Protection of Human Subjects .............................................................................. 42 Recruitment, Selection and Protection of Participants ......................................... 43 Data Collection Procedures ................................................................................... 46 Interviews .............................................................................................................. 47 Enhancing Data Quality ........................................................................................ 49 Reflexivity................................................................................................. 51 Journaling .................................................................................................. 51 Data Management and Analysis ........................................................................... 53 Phenomenological Reduction ................................................................... 54 Intersubjective Corroboration ................................................................... 56 Initial Reading of Each Transcript ............................................................ 57 Identifying Meaning Units ........................................................................ 57 Imaginative Variation Conveys Data into Scientific Meaning ................. 58 Summary ............................................................................................................... 60 vi CHAPTER 4 FINDINGS ................................................................................................. 62 Introduction ........................................................................................................... 62 Description of Participants .................................................................................... 62 Anna .......................................................................................................... 62 Beth ........................................................................................................... 64 Claire ......................................................................................................... 65 Diana ......................................................................................................... 67 Accessing the Natural Attitude for the Phenomenon of Interest .......................... 68 Data Analysis Processes ....................................................................................... 70 Meaning Units ....................................................................................................... 71 Giving Back .............................................................................................. 71 Time to Create........................................................................................... 73 Creative Space .......................................................................................... 75 Creative Expression .................................................................................. 77 Sense of Self ............................................................................................. 80 The Creative Experience ........................................................................... 80 Transformed Meaning Units for Nursing ............................................................. 82 Contextual ................................................................................................. 83 Giving Back .............................................................................................. 84 Time to Create........................................................................................... 84 Dynamic .................................................................................................... 85 Creative Space .......................................................................................... 85 Creative Expression .................................................................................. 86 Enduring .................................................................................................... 86 Creative Experience .................................................................................. 86 Sense of Self ............................................................................................. 87 Summary ............................................................................................................... 87 CHAPTER 5 FINDINGS, CONCLUSIONS, AND IMPLICATIONS ........................... 88 Introduction ........................................................................................................... 88 The Lived Experience of Creating Art.................................................................. 88 Methodological Strengths and Limitations ........................................................... 92 Implications and Conclusions ............................................................................... 94 Nursing Practice ........................................................................................ 94 Nursing Education .................................................................................... 96 Nursing Research ...................................................................................... 97 Summary ............................................................................................................... 98 APPENDIX A UCF INSTITUTIONAL REVIEW BOARD APPROVAL ................. 100 APPENDIX B COVER LETTER ................................................................................. 102 APPENDIX C INFORMED CONSENT FORM ......................................................... 104 APPENDIX D CONSENT TO PHOTOGRAPH ......................................................... 107 APPENDIX E INITIAL RECRUITMENT BROCHURE ........................................... 109 vii APPENDIX F RECRUITMENT BROCHURE ........................................................... 111 APPENDIX G INTERVIEW GUIDE .......................................................................... 114 LIST OF REFERENCES ................................................................................................ 116 viii LIST OF FIGURES Figure 1. Contrasting 2004 (left) and 2008 (right) paintings created by cancer patient. .. 79 ix LIST OF TABLES Table 1 Giorgi's Process for the Analysis of Phenomenological Data ............................ 38 Table 2 Imaginative Variation and the Resultant Transformed Meaning Unit ............... 60 Table 3 Transformed Meaning Units for Nursing ........................................................... 71 x