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]


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