The general aim of this thesis was to examine how nurses can use photography to assist psychiatric patients in making meaning of experiences of illness and to help them in the process of recovery. The study is based on a hermeneutic-phenomenological perspective,
focusing on processes of experiencing and meaning making in the life world. Existential issues, e.g. the way how people give meaning to their suffering, play an important role in this process of being-in-the world. From a hermeneutical-phenomenological perspective,
caring can be seen as the core mission of nursing, tying in with a definition of health and health promotion that is broader than the absence of physical defects and functional impairments and encompassing quality of life and the possibilities for directing one’s life, even when one feels impeded by the impact of sickness. Caring can be seen as rooted in the nurses’ response to the suffering of patients, which we conceptualized as a lack of agency (Ricoeur, 1992). ‘Agency’ concerns the extent of direction people feel in exercising influence on domains of their lives that matter to them. Whereas patients’ suffering compromises their agency to direct their own lives (being impeded by the impact of illness), nurses’ caring focuses on giving attention to the patient’s needs, e.g. safety, comfort, relieve of pain and stress, etc. By responding to their needs, nurses empower patients and strengthen their agency. Processes of meaning making and expression of suffering in narrative play a crucial role. Since narratives are based on a shared understanding between patients and nurses and other caregivers, narratives are relational. Relational narratives are developed through dialogical interaction. We
connected this conception of a relational narrative with the agenda of recovery and empowerment, which stands for the struggle of patients in mental health care to live a
life beyond illness and regain more agency and more direction in life in order to realize a better quality of life. Basing ourselves on Gadamerian hermeneutics we postulated that the (facilitation of) expression of this struggle plays an important role in the process of
meaning making which underlies recovery.
Departing from these notions we examined hermeneutic photography, assisting people in constructing meaning from experiences in their life world. More concretely we examined our application of hermeneutic photography: the photo-instrument. We did so from two perspectives, that of meaning making and that of the therapeutic potential in the context of nursing. In chapter 2 we studied how the hermeneutic philosophy of Ricoeur could
provide us with a theoretical framework to understand processes of meaning making.
In chapter 3 the focus is still on processes of meaning making, but now more from a phenomenological point of view, i.e. departing from the existential problem of suffering we found in empirical data. In chapter 4 and 5 we shifted the focus to the therapeutic significance of the intervention. In chapter 6 we described the methodical steps (actions) of hermeneutic photography as a nursing intervention and discussed what it might
contribute to professional agendas of recovery-oriented rehabilitation.

The photo instrument as nursing intervention
The specific application of hermeneutic photography that we used was the photoinstrument.
The photo-instrument has been developed by the author in an action research during which the intervention has been adapted, complemented and refined
over a period of two years (2000-2002) and repeatedly tested with new groups of patients in mental health care (Bouhuis et al, 2003). The result was a protocolled intervention that nurses and other health professionals can use to direct group sessions with patients
who are no longer in a hectic period of psychiatric crisis and are now working on further recovery.