Monday, 18 May 2020

Thematic Analysis: A Research Method

Catherine Best


Webmaster for the Phi Mu (All England) Chapter of Sigma
Qualitative research is described as a process through which, an open and flexible approach to enquiry and data collection can emerge (Kumar, 2014). It seeks to explore diversity, emphasise feelings and critique the lived experience, the findings of which can be communicated using a narrative approach (ibid).

Moreover, qualitative research has been widely used within healthcare as a means of acquiring knowledge and to provide insight into the real lives, events and perspectives of both patients and health care professionals (Braun and Clarke, 2014).

One way in which qualitative data can be analysed is through the process of thematic analysis, described by Clarke and Braun (2017, p.297) as ‘a method for identifying, analysing and interpreting patterns of meaning (‘themes’) within qualitative data’.

Such patterns emerging through a meticulous process of data familiarisation and data coding; theme development and revision (Guest et al, 2012). Coding, being used to represent identified themes and provide summary markers for further development (ibid). There is however, much more to thematic analysis than simply summarising the data, for as Maguire and Delahunt, (2017, p.3353) purport ‘a good thematic analysis’ also ‘interprets and makes sense’ of the data collected.

Furthermore, thematic analysis also offers a set of established tools that researchers can use, to ensure the development of a robust and high-level critique of qualitative data; making the data more easily accessible to those not considered part of academia (Braun and Clarke, 2014).

It could be argued therefore, that this type of research method, is the most empowering of all research. For ultimately it allows early career researchers to develop an understanding of how to interpret data (Braun and Clarke, 2006). Research and its outcomes should not be confined to the ivory towers of universities, but made widely available to a more expansive audience, delivered in such a way that it can be understood by the many, rather than the elitist few.

Thematic analysis therefore, offers a flexible approach [within qualitative research] towards the analysis of data, creating a more structured and implicit construct, without compromising depth of the analysis undertaken (Javadi and Zarea, 2016). Moreover, an effective thematic analysis enables both reflection and clarification of the research itself (ibid).

Any form of research is required to demonstrate rigour, reliability and validity, a process which helps to determine trustworthiness (Roberts et al, 2019) and a critique of the literature as to the rigour of thematic analysis, has generated an interesting discourse. Thematic analysis, argues Bazeley (2009), fails to stand up to scrutiny as a valid research method and asserts that problems can occur with the interpretation of data, with particular reference to themes. Furthermore, reliability is of greatest concern within thematic analysis because more interpretation is required when defining the codes used (Guest et al, 2012).

Moreover, the lack of extensive literature on thematic analysis compared to other types of research, may lead to novice researchers being unclear as to how to undertake such research (Nowell et al, 2017).

On a more positive note, however, thematic analysis argues Braun and Clarke, (2006) provides a flexible and accessible form of analysis, an understanding of which, can be easily grasped. It can also be useful in analysing small, medium and even large sized data sets (Herzog et al, 2019), although as Guest et al, (2012) argue, interpretation of large amounts of data, using thematic analysis, can also be challenging.

To demonstrate a clear, replicable and transparent method and therefore effectively manage direct criticism, Braun and Clarke (2006) outline a series of phases which researchers must embrace in order to produce a thematic analysis. This phased approach is considered the most influential and the clearest of the frameworks as it offers a well-defined structure upon which to theme and analyse data (Maguire and Delahunt, 2017). This framework argues Braun and Clarke, (2006) ensures the researcher familiarises self with the data, adequately prepares the data for analysis, reduces the data into a set of codes, searches for themes, reviews and then define themes and ultimately critiques the findings in the format required.

Overall, considering the advantages and limitations of this method, thematic analysis could be considered a valid research method as it enables the generation of a rich source of information, through which a clear unbiased approach to the analysis of data can emerge and effective interpretations made.

References

Bazeley, P (2009) Analysing Qualitative Data: More than ‘Identifying Themes’. The Malaysian Journal of Qualitative Research, 2 (2) pp. 6-21.

Braun, V. and Clarke, V. (2014) What can ‘‘thematic analysis’’ offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Wellbeing 9 (1), pp.1-2.

Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3 (1) pp.77-10.

Clarke V. and Braun V. (2017) Thematic analysis, The Journal of Positive Psychology, 12 (3) pp.297-298.

Guest, G. Macqueen K.M. and Namey, E.E. (2012) Applied Thematic Analysis. Sage Publications.

Herzog, C. Handke, C and Hitters, E. (2019) Analyzing Talk and Text II: Thematic Analysis. In: Van den Bulck, H. Puppis, M. Donders, K. and Van Audenhove, L. (Eds.) The Palgrave Handbook of Methods for Media Policy Research. Basingstoke: Palgrave Macmillan.

Javadi, M. and Zarea, K. (2016) Understanding Thematic Analysis and its Pitfalls. Journal of Client Care 1 (1) pp.33-39.

Kumar, R. (2014) Research Methodology. A step-by-step guide for beginners. 4th edition. Sage.

Maguire, M. and Delahunt, B. (2017) Doing a Thematic analysis: A Practical, step-by-step Guide for Learning and Teaching Scholars. All Ireland Journal of Teaching and Learning in Higher Education, 8 (3) pp.3351-33514.

Nowell L. S. Norris J. M. White D. E. and Moules N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16 (1) pp.1-13

Roberts, K. Dowell, A. and Nie, J. Attempting rigour and replicability in thematic analysis of qualitative research data; a case study of codebook development. BMC Medical Research Methodology, 19 (66) pp.1-8

Editorial note: entries to JAN interactive are not reviewed and are published at the discretion of the Editor-in-Chief and may be subject to editing or removal by Wiley. We welcome replies, rejoinders, comments and debate on all entries provided they are not offensive or personal.

Monday, 11 May 2020

Using Autoethnography as a critical path in research


Catherine Best
Webmaster for the Phi Mu (All England) Chapter of Sigma
Autoethnography, I am reliably informed, evidently features in some of my published work. So, armed with this knowledge, I began to explore autoethnography as a viable research tool, a model through which I can build upon my personal experiences as a human being, a woman and a Registered Nurse.

This research methodology, which draws upon ‘subjective experience to examine the interplay between self and culture’ (Peterson, 2014, p.227) allows me to step beyond [my own] personal and professional opinions and in so doing creates a significant paradigm shift, one which empowers me to scaffold my thoughts, feelings and experiences within the cultural, political and social constructs in which I live, work and play.

Autoethnography can be defined as the ‘inclusion of the self (auto) in an investigation (graphy) of cultural process (ethno)’ (Liggins et al. 2013, p.106) and as Grant (2019, p. 88) posits, is a type of ‘narrative qualitative inquiry’, an approach which values relationships, revelations and other powerful experiences as acceptable research data. This is supported by (Uotinen, 2011) who argues that autoethnography allows the personal experiences of the researcher to become entwined in the research undertaken and by Wall (2016) who opines that autoethnography can be used to explore social phenomena through the researcher's own experience.

The use of autoethnography as a research process argues Chang and Bilgen (2020) propels self-exploration, through which a deeper and broader level of both social and cultural understanding can emerge, a process based on one’s lived experience. Furthermore, through ‘self-reflection and self-reflexivity’, autoethnography has the capacity to facilitate ‘internal dialogues’, the ‘reconstruction of memories’, and ‘the analysis of meanings’ (Chang and Bilgen, 2020, p.94).

Disappointingly however, despite autoethnography being recognised as a viable research method, it remains in its infancy within the nursing profession, or as Peterson (2014, p227) purports ‘understudied and underused’. There could be many reasons for this. When exploring autoethnography as a valid research framework, some researchers consider this approach as being narcissistic and self-indulgent (Roulston, 2018). This is reiterated in the work of Chang (2016) who argues that a continued criticism of autoethnography is its excessive focus on self. This it could be argued, goes against the very essence of what it means to be a nurse.

Just as uncomfortable a scenario is the notion of vulnerability on the part of the researcher and disconcertingly this cannot be avoided (Chang, 2016). Furthermore Hamood, (2016, p.47) argues that autoethnography is simply considered too ‘artful’ and ‘literary’ due to a perceived lack of rigour, theory and analysis. At a time when emphasis continues to be placed on nursing as a science, one which requires rigorous evidence-based outcomes, is it no wonder that autoethnography as a viable research method continues to remain in its infancy.

Despite these challenges however, autoethnography argues Peterson, (2014) has the potential to raise the voice of nurses and create new insights and knowledge into the ways in which practice can be improved. Furthermore, autoethnography encourages the researcher to write using reflection and inquiry, (McCormack, 2009). Interestingly, attempts to encourage nurses to become reflective practitioners has assumed a strong position in recent years with Revalidation (NMC, 2015), (a process through which nurses meet their fitness to practice requirements), becoming firmly embedded within the profession.

The ability to reflect on professional practice has therefore become essential and requires nurses to understand the importance of analysis a means by which, they have the potential to gain greater insight into their personal and professional experiences and in so doing help to secure new ways of working. Perhaps this is no more required than during the current pandemic crisis, when nurses need to think creatively and with compassion to meet the continued needs of patients and their families, with social distancing being the norm.

The nursing profession, therefore, is currently working in a time of unprecedented change, when the health of the nation is at stake and new ways of working have been adopted quickly to reduce the significant impact of the Covid-19 pandemic. This on the back of increasing nurse shortages, (NHS Providers, 2019) a lack of resources, no more evident than the current lack of personal protective equipment (Campbell, 2020) and with average student attrition rates in 2019 at 24% (The Health Foundation, 2019) means the profession is under enormous pressure. Many of these pressures and in particular nursing shortages are not unique to England or indeed the UK, but across the globe (WHO, 2020). The continuance of which could be catastrophic.

The exemplary way nurses have embraced the significant challenge that the pandemic has created is firmly embedded in the hearts and minds of the nation; their sacrifice unchallenged. But what will happen when this is all over and we return to some degree of normality. Will their commitment be forgotten as the political and financial crisis that is likely to occur becomes apparent and the failings, as well as the successes emerge?

Conclusion

So, what will emerge is yet to be seen. What is clear however, is that nurses are in a unique position to explore and critique their experiences of Covid-19 within the cultural, social and political paradigms that exist, not only within the NHS, but the healthcare sector as a whole.

Moving forward, the nursing profession could crucially benefit from undertaking or commissioning research that puts nurses at the heart of the crisis; enabling the creation of personal narrative seen through the lens of a political, social and emotionally charged storm.

But is this something that is likely to happen, or will nurses simply want to metaphorically forget about the crisis and move on? Disappointingly, this may become the increasing consensus, however if we can encourage some to become active researchers or work with others to raise awareness of nurses experience during this time, then the voice of nursing will not diminish, but become a thunderous roar, which will eventually be heard globally.

References

Campbell, D. (2020) Hospital leaders hit out at government as PPE shortage row escalates. [Online]. The Guardian. Available from: https://www.theguardian.com/society/2020/apr/19/hospital-leaders-hit-out-government-ppe-shortage-row-escalates-nhs [Accessed 6 May 2020].

Chang, H and Bilgen, W. (2020) Autoethnography in Leadership Studies: Past, Present, and Future. Journal of Autoethnography, 1 (1) January, pp. 93-98.

Chang H. (2016) Autoethnography in health research: Growing pains? Qualitative Health Research, 26 (4) March, pp. 443-51.

Grant, A. (2019) Dare to be a wolf: Embracing autoethnography in nurse educational research. Nurse Education Today, 82, November, pp. 88-92.

Hamood, T. (2016) An autoethnographic account of a PhD student’s journey towards establishing a research identity and understanding issues surrounding validity in educational research. The Bridge: Journal of Educational Research-Informed Practice, 3 (1) June pp. 41-60.

Liggins, J. Kearns, R.A. and Adams, P.J. (2013) Using autoethnography to reclaim the ‘place of healing’ in mental health care. Social Science and Medicine 91, August, pp. 105-109.

McCormack, D. (2009). A Parcel of Knowledge: An Autoethnographic Exploration of the Emotional Dimension of Teaching and Learning in Adult Education, Adult Learner: The Irish Journal of Adult and Community Education pp.13-28.

NHS Providers (2019) The State of the NHS Provider Sector. London: Foundation Trust Network

Nursing and Midwifery Council (2015) Revalidation. NMC. [Online]. Available from: http://revalidation.nmc.org.uk/ Accessed 6 May 2020.

Peterson, A.L. (2014) A case for the use of autoethnography in nursing research Journal of Advanced Nursing, 71 (1) August, pp. 1-19.

Roulston, K. (2018) What is Autoethnography. [Online]. Available from: https://qualpage.com/2018/11/15/what-is-autoethnography/ [Accessed 7 May 2020].

The Health Foundation (2019) Nursing students are still dropping out in worrying numbers. [Online]. Available from: https://www.health.org.uk/news-and-comment/news/a-quarter-of-all-nursing-students-are-dropping-out-of-their-degrees [Accessed 6 May 2020]

Uotinen, J. (2011). Senses, bodily knowledge, and autoethnography: Unbeknown knowledge from an ICU experience. Qualitative Health Research, 21 (10) June, pp. 1307-1315.

Wall, Sarah S. (2016) Toward a moderate autoethnography. International Journal of Qualitative Methods, 15 (1) October, 1-9.

World Health Organisation (2020) Nursing and midwifery. [Online] Available from: https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery [Accessed 6 May 2020]


Editorial note: entries to JAN interactive are not reviewed and are published at the discretion of the Editor-in-Chief and may be subject to editing or removal by Wiley. We welcome replies, rejoinders, comments and debate on all entries provided they are not offensive or personal.

Wednesday, 6 May 2020

Advancing the nursing profession through the synergy of praxis


Catherine Best


Webmaster for the Phi Mu (All England) Chapter of Sigma
email: catherine.best23@gmail.com


Nursing is both an art and a science (Jasmine, 2009). This understanding precipitates the need for a plethora of teaching and learning approaches that ensures the continued development of nurses who not only, have the ability to advance practice through evidence-based knowledge, but also have the capacity to act with kindness and compassion. This is supported by Renolen and Hjalmhult (2015) who argue that nurses are required to apply evidence-based practice and provide effective patient care based on the best knowledge available. Central to these tenets therefore is the ability to integrate theory and empirical research findings into professional practice.
 
Nurse education, with its emphasis on fitness to practice is experiencing fundamental change within the UK. This is no more evident than with the newly adopted Nursing and Midwifery Council Standards of Proficiency for Nurse Education (NMC 2018), the aim of which is to develop future healthcare professionals who are sufficiently skilled and knowledgeable to deliver care needs for the 21st Century. In a global healthcare arena where a shortage of healthcare professionals exist, nurses within the UK are being asked to develop new skills that were once considered solely the domain of the physician, (Neiezen and Mathijssen, 2014).

In order to develop these skills and thus build capacity however, the ability to critically reflect and act, a term coined praxis, by Paulo Freire in his work Pedagogy of the Oppressed published in English in 1970, (Freire, 2017) and developed further by Chinn and Kramer, (2018) within professional nursing practice, could be considered a fundamental requirement if nurses are to transcend the often restrictive nature of traditional learning and teaching strategies such as banking, (Freire, 2017). Banking a process through which teachers teach and learners repeat, rather than effectively applying their learning, limits the ability of the learner to reflect and act, for by its very nature it is passive. Learners, therefore need to adopt new ways of learning, such as self-directed learning through which, the capacity to challenge any given situation is increased.

To adopt this model of reflection successfully however, the learner is required to have the aptitude to self-regulate personal learning needs and therefore embrace a self-directed learning style, although essentially some level of guidance such as an inspiring curriculum, is still a necessity (Bodkyn and Stevens 2015).

Heutagogy

In order to develop a self-directed or heutagogical approach to developing knowledge; nurses can benefit from adopting a blended style of learning that sees them become active participants in their own professional development. Heutagogy empowers learners to take responsibility for ‘how, what and when they learn’ (Blaschke et al. 2014), examples of which include the use of social media technology (Blaschke, 2014) work-based learning (Nisbet et al. 2013), competency-based learning (Pijl-Zieber et al. 2013) and portfolio development (Ryan, 2011). Blaschke (2012) argues that such an approach to learning is feasible through the development of learning contracts defined by the learner, curriculum or curricula which is flexible, questions, which are learner directed; assessments which are both flexible and negotiated and collective learning. Ultimately, heutagogy is considered a powerful learning strategy - one that provides learners with the means by which, they can learn and grow throughout their lives (Davis, 2018).

By becoming self-directed learners, learners are able to effectively utilise education, undertake research and analysis, increase personal motivation and assertive behaviours (Avdal, 2013) and self-nurture high order thinking skills, an example of which is emancipatory reflection, a process which seeks to transform the way in which nurses construct, confront, deconstruct and reconstruct professional experiences (Taylor, 2010). In order to do this successfully however, requires nurse educators to be aware of how praxis can be integrated successfully, not only into nurse education but also clinical practice.

Educating the Workforce

Nurse educationalists ultimately play a significant role in educating the nursing workforce; others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges integrating praxis into nurse education at all levels can facilitate a collaborative partnership between both the student and educator; essentially learning can become of high quality, promote critical thinking and create a shared social purpose (Bono-Neri, 2019), perhaps more relevant in a world where technology has made sharing knowledge globally relatively trouble-free.

Encouragingly, nurses are now considered to be global nurses, with a role that challenges the impact of social inequality on public health and wellbeing, as evidenced in the Nursing Now Campaign (Crisp, 2017) and yet there continues to be a lack of understanding of the public health role of nurses. Not all nurses have the title of public health nurse, however in reality all nurses should have an understanding of the impact of policies that fosters social injustice; processes which Galtung (1969) called ‘structural violence’ and by their actions seek to reduce the continued inequalities, not only nationally, but globally. Nurses who are able to understand and invoke praxis (Freire, 2017) are invaluable to their professional colleagues, their workplace and the wider economic communities in which they live and work. For if nurses are able to understand the social, political and economic constraints under which healthcare is delivered and social injustice prevails, then by taking one step further from reflection to action, nurses can become the catalyst for fundamental change.

Conclusion

Nursing lecturers play a significant role in educating the nursing workforce, others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges and time constraints continue to exist, introducing the concept of praxis into nurse education may be deemed challenging, although having a capable workforce of the future may depend upon it.

Understanding praxis therefore can be the force that enables nurses to become independent heutagogical researchers, activists and a force for change. Integrating praxis into nurse education, however will not be easy and the limitation of this work has already become evident as nurses continue to work in challenging, dynamic environments where the emphasis is on the diagnosis, treatment and discharge, only to see many return through a revolving door of the same. Nurses however must begin somewhere. Through my continued research, how nurses achieve this, I hope will become evident.

In order to instigate social reform, nursing as a profession, with its increasing emphasis on global healthcare is in a strong position to continue to promote the development of advanced skills and high order thinking in order to influence future nursing care. It is important however that nurses have the support of leaders, managers and governments to do this. A nurses role is to honour humanity and foster nursing scholarship, (Taylor, 2010) for it is these behaviours along with those associated with praxis (Freire, 2017) that could begin to see the reform that is so badly needed.

References

Avdal, E.Ü. (2013) ‘The effect of self-directed learning abilities of student nurses on success in Turkey’, Nurse Education Today 33: 838-841.

Blaschke, L.M. (2012) ‘Heutagogy and lifelong learning: A review of heutagogical practice and self-determined learning’, The International Review of Research in Open and Distributed Learning, 13, 1. doi:10.19173/irrodl.v13i1.1076.

Blaschke, L.M. (2014) Using social media to engage and develop the online learner in self-determined learning, Research in Learning Technology, 22: 21635, doi.org/10.3402/rlt.v22.21635.

Blaschke, L.M. Kenyon, C. and Hase, S. (eds) (2014) Experiences in Self-determined Learning. Createspace Independent Publishing Platform.

Bodkyn, C. and Stevens, F. (2015) Self-directed learning, intrinsic motivation and student performance Caribbean Teaching Scholar, 5, 2: 79–93.
Bono-Neri, F. (2019) Pedagogical Nursing Practice: Redefining nursing practice for the academic nurse educator, Nurse Education in Practice, 37, 105–108.
doi:10.1016/j.nepr.2019.04.002

Chinn, P.L. and Kramer, M.K. (2018) Knowledge Development in Nursing. Theory and Process. St Louis, Missouri: Elsevier.

Crisp, N. (2017) ‘Nursing Now’, n.d. [Online]. Available at https://nigelcrisp.com/nursing-now/ (accessed 15 May 2018).

Davis, L. (2018) ‘Heutagogy Explained: Self-Determined Learning in Education’. [Online].

Freire, P. (2017) Pedagogy of the Oppressed. London: Penguin.

Galtung, J. (1969) ‘Violence, Peace, and Peace Research’, Journal of Peace Research, 6, 3: 167-191.

Jasmine, T. (2009) ‘Art, science, or both? Keeping the care in nursing’, Nursing Clinics of North America, 44, 4, 415-21. Doi: 10.1016/j.cnur.2009.07.003.

Niezen, M.G. and Mathijssen, J.J. (2014) Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain, Health Policy, 117, 2, 151-69. Doi: 10.1016/j.healthpol.2014.04.016.

Nisbet, G. Lincoln, M. and Dunn, S. (2013) ‘Informal interprofessional learning: an untapped opportunity for learning and change within the workplace’, Journal of Interprofessional Care, 27, 6, 469-475.

Nursing and Midwifery Council (2018) ‘Future nurse: Standards of Proficiency for registered nurses’, n.d. [Online]. Available at https://www.nmc.org.uk/standards/standards-for-nurses/ (accessed 1 June 2018).

Nursing and Midwifery Council (2018a) ‘Realising professionalism: standards for education and training’, n.d. [Online]. Available at https://www.nmc.org.uk/standards/standards-for-nurses/ (accessed 1 June 2018).

Pijl-Zieber, E.M., Barton, S, Konkin, J, Awosoga, O, Caine, V. (2014) Competence and competency-based nursing education: finding our way through the issues, Nurse Education Today, 34, 5, 676-8. Doi: 10.1016/j.nedt.2013.09.007.

Renolen Å, and Hjälmhult E. (2015) Nurses experience of using scientific knowledge in clinical practice: a grounded theory study. Scandinavian Journal of Caring Science, 29, 4: 633-41. doi: 10.1111/scs.1219.

Ryan, M. (2011) ‘Evaluating Portfolio Use as a Tool for Assessment and Professional Development in Graduate Nursing Education’, Journal of Professional Nursing, 27, 2, 84-91.

Taylor, B.J. (2010) Reflective Practice for Healthcare Professionals. 3rd ed. Open University Press: Maidenhead.

Editorial note: entries to JAN interactive are not reviewed and are published at the discretion of the Editor-in-Chief and may be subject to editing or removal by Wiley. We welcome replies, rejoinders, comments and debate on all entries provided they are not offensive or personal.