Dawn Freshwater

Transforming Nursing Through Reflective Practice

Foreword by Jean Watson.List of Contributors.1. Expanding the Gates of Perception.2. Evidence, Memory and Truth: Towards a Deconstructive Validation of Reflective Practice.3. Living Relational Ethics in Health Care.4. Reflective Practice and Socratic Dialogue.5. Clinical Supervision in the Context of Custodial Care.6. Developing Prison Health Care through Reflective Practice.7. Voice as a Metaphor for Transformation through Reflection.8. Reflexivity and Intersubjectivity in Clinical Supervision: On the Value of Not-knowing.9. The Beast and the Star: Resolving Contradictions within Everyday Practice.10. Using Reflection in Complementary Therapies: Critical Reflection and Pain Management.11. Creating Sacred Space: A Journey to the Soul.12. Constructing the Reflexive Narrative.Index

Critical reflexivity: A politically and ethically engaged research method for nursing

Traditional interpretations of research tend to bifurcate research knowledge and practice knowledge, with knowledge derived from practice and direct interaction with patients being perceived as knowledge that is not formally admissible by the traditional scientific model. This paper proposes a research method that legitimises practice as a source of knowledge. Building upon the concepts of situational understanding and contingent knowledge, we advocate an integral research methodology, one which draws on the notion of the researcher-practitioner. Beginning with an analysis of knowledge and power we explore the contribution of reflexivity to the development of a politically and ethically engaged research process in nursing. In discussing critical reflexivity as a research method, we will outline the focus of reflexive research and the role of the reflexive researcher. Arguing against the superiority of theoretical research over practitioner research, we present a challenge to technical rationality, suggesting not only a new approach to research but also a new approach to practice.

Qualitative research as evidence: criteria for rigour and relevance

This paper is about the nature and construct of evidence and its relation to qualitative research. Using a post-modern lens, we begin by defining evidence, signifying the importance of context, and use discourse as a vehicle for looking at the ways in which qualitative research evidence struggles to achieve the equivalent standing of its quantitative counterpart. In outlining the role of discourse in the creation of research paradigms, we offer a conceptual map that enables a repositioning of qualitative research in the evidence-based genre. In order to best illustrate our standpoint, we then provide two examples of qualitative, transformational research approaches and relate these to the criteria of rigour and relevance, criteria which we would argue when met are examples of high-quality evidence. Having used the examples of discourse analysis and auto-ethnography, we then conclude by exposing and decentralising the myth that surrounds the discourse of evidence-based practice, which continues, albeit unintentionally, to discredit any evidence that falls outside of its parameters.

Paradigms Lost and Paradigms Regained

Almost a year since my inaugaral editorial: Managing Movement, Leading Change (Freshwater, 2012) where I highlighted the importance of challenging philosophical and epistemological stances; we are taking the opportunity to do just that in relation to the elusive concept of ‘‘paradigm’’ through the highly versatile and dialogic form of the editorial. Conceptualizing the concept of paradigms as ‘‘elusive’’ is an important metaphor and one to which we will allude througout this editorial. In our editorial: Why Write (Freshwater & Cahill, 2012), we put into tension some competing definitions of paradigm in order to open up the debate on what constitutes a paradigm and to outline why we felt it is important for this debate to be held in the mixed methods community. Since that editorial, we have had a very interesting response from the coeditor, Donna Mertens: What Comes First? The Paradigm or the Approach? (Mertens, 2012). Mertens argued against the school of thought that paradigms can be methdological in their foundation (Freshwater & Cahill, 2012) and offered the use of ‘‘paradigms as philosophical frameworks that delinieate assumptions about ethics, reality, knowledge, and systematic enquiry’’ as a way of ‘‘[clarifying] the basis of disagreements’’ (Mertens, 2012, p. 256) with regard to the use of paradigms in mixed methods research. At this juncture we would like to take a step back, into the nexus of the disagreements themselves: We believe that ‘‘disagreement’’ offers a more interesting space in which to hold a debate and refine a discourse rather than the seemingly solid ground of a solution. And one that potentially continues to delineate paradigms as philsophical frameworks that lead to choices in methods. We contend that engaging with disagreements and their constructions and deconstructions can underpin some of the most progressive and innovative of debates. Rather like this one, we hope! As an exemplar, we draw on some of the argument presented by Mertens (2012) in the October editorial. Mertens (2012) cites Greene and Hall who caution against using qualitative, quantitative, and mixed methods as labels for paradigms—arguing that this is to ‘‘reify and essentailize them and thereby disregard their constructed nature . . .’’ (p. 255). The association of a paradigm with a reified and essential entity is interesting in this context. We would argue that understanding the constructed nature of paradigms is key, and in this context we would question the association of paradigms with something that is ‘‘reified’’ or ‘‘essential.’’ As noted in our editorial Why Write (Freshwater & Cahill, 2012), discourse development (including the discourses that underpin paradigms) is inherently relational, iterative, and responsive—and subject to its own deconstruction. That is why it would be misleading to associate paradigms and the paradigmatic structures

Publishing a Methodological Mixed Methods Research Article

The abstract includes information about the type of mixed methods design and integration used. The word distribution of the abstract parallels the structure of an empirical mixed methods methodology paper with a 1:2:2:1 words breakdown, so for a 120 word abstract, roughly a 20:40:40:20 distribution (Figure 2). Effective manuscripts start with a statement of the methodological problem to hook the multidisciplinary readership. In this approach, authors introduce briefly the topic of research including a statement as to why it is informative for understanding the methodological issue. This is followed by stating the mixed methods design, the qualitative and quantitative data sources, and the type of integration used. It is preferable to mention how data were integrated. Succinctly, the article should end with a conclusion about what is known anew as a result of the research findings that was not known before. Structure of the Empirical Paper Depends on the Design Our advice draws from and builds on the sage wisdom of JMMR cofounder John W. Creswell as articulated in his recent book, ‘‘A Concise Introduction to Mixed Methods Research’’ (Creswell, 2015). Creswell notes that the structure of empirical mixed methods papers depend on the design. We agree with Creswell that most integration occurs in the methods, results, and discussion. While the background of empirical mixed methods studies is similar regardless of the design, certain additional features are desirable in an empirical mixed methods paper.

Writing, rigour and reflexivity in nursing research

Reflexivity presents a challenge to traditional ideals of science that privilege professional distance and objectivity over engagement and subjectivity. A defining feature of human consciousness, reflexivity both transcends paradigmatic polarisations in that it has the potential to speak equally to all research and is also an approach to research in its own right. Not always explicitly referred to as reflexivity, the process of examining and recording the impact of researcher and intersubjective elements in research has a long history spanning many decades and disciplines. Described as an assault on unity reflexive research then is a humble and subjective human enterprise which is characterised as tentative and indeterminate (Alvesson, 2002). The four papers that comprise this focus issue concentrate on the significance of positioning, rigour and application in the utilisation of reflexive pragmatism within nursing. An approach that means working with alternative lines of interpretation and vocabularies to balance endless reflection and radical scepticism with a sense of purpose and execution of results. I begin with Mantzoukas who attends closely to the notion of bias, as it is understood across research paradigms. His treatise is built around the argument that, and here I borrow from Finlay (2003: 5), we should no longer work towards abolishing the presence of the researcher; instead, ‘subjectivity in research is transformed from a problem to an opportunity’. Many writers, including myself, argue for this position, that is, the acceptance of the inevitability of bias in any research. That this bias exists is, of course, also true of Mantzoukas’ own work, as indeed it is of my own comments here. Moreover, such bias is not always fully known or understood, hence I disagree with Mantzoukas when he writes that reflexive studies are valid ‘only if the researcher’s bias is fully incorporated and becomes transparent throughout the study’. A researcher’s bias can never be fully known, what is conscious and in awareness can be articulated,

Methodology and mental illness: resistance and restorying.

Concerns with social justice have been traditionally associated with a modernist concept of the individual whose actions express an underlying, essential and unified self. This paper compares the usefulness of two methodologies (post-structuralist and narrative) that are based on a rejection of identity of a unified self and compares their usefulness in relation to the development of a social justice paradigm within mental health. It considers how professional forms of knowledge may be deconstructed by post-structural analyses, arguing that these have also been used by service users to articulate more enabling discursive alternatives. The notion of agency is central to our understanding of social justice. We question the commonly held assumption that although post-structuralism deconstructs power and challenges its legitimacy, it is nevertheless unsuited to facilitating the necessary agency to put forward viable alternatives. The second half of the paper considers how narrative research offers greater emancipatory potential by enabling the research subject to author their stories and thereby brings about their own subjective transformation. Nevertheless, the interpretation of peoples stories by researchers may result in the imposition of narrative templates that erase complexities and contribute to the perpetuation of oppression. This raises ethical implications in relation to how peoples stories are interpreted.

The mental well-being of prison nurses in England and Wales

Much has been written about the mental health of prisoner patients; however, consideration of the mental well-being of the prison nursing workforce has been limited. In this paper, we highlight some of the key issues currently affecting the mental well-being of nurses working in prison and, through a discussion of a nationally funded study, share our experience of the value both of clinical supervision and action learning in providing a supportive environment for those working with prisoner patients. Policy agendas such as overcrowding and organisational change affecting commissioning arrangements were pivotal to both the scope and findings of the study. This paper foregrounds clinical supervision and reflective practice but considers emotional labour to be a fundamental premise when considering their importance for prison nurses.

Practitioner-Based Research: Power, Discourse and Transformation

Practitioner-Based Research is concerned, in particular, with the research which is undertaken by healthcare practitioners and the evidence which they generate as a result of investigating their practice. In so doing it recognizes that, as well as working in academic life, practitioner researchers are often working as practitioners outside the Academy. It argues that the work of practitioner researchers has a significant contribution to make to healthcare research and so needs to be disseminated further in order to create balanced research communities within the healthcare professions.This book will help academic researchers to broaden the limited ontological and epistemological perspectives of their research. It will also encourage healthcare practitioners who have not been trained academically to develop their research skills and to realize that they are actually researching in their practice on a day-to-day basis. Finally, it will provide a degree of transparency about therapeutic processes to help clients and patients to see aspects of professional practice and development which are usually hidden from them. The contributors cover a wide range of themes, such as the limitations of academic life and conventional medical models; ethics; the importance of imaginative writing and the use of story; metaphor and myth; the importance of personal transformation in the professional development of healthcare workers; and the relevance of belief and spirituality to healthcare research.

Art and Science in Health Care Research Pushing at Open Doors or Locked in Institutions

Research methods are usually dictated and driven by the research question. In the context of research in “closed” systems—for example, offender health settings—it is imperative that the research question takes into consideration the context in which the research is located. Conducting research that has action, transformation, and creativity at its heart is a significant challenge in closed cultures, for both the researcher and the researched. Using two exemplars, we question whether researchers should adopt a safe approach to researching these closed cultures and to what extent they should engage in methodological tensions and ethical dilemmas that provoke and support reflection on change. By reflecting on our previous research studies, we aim not so much to provide a definitive answer to this question but to suggest that researchers give careful consideration to the methods appropriate to both the context of the research and its purpose.