Introduction
This chapter provides a critically reflective analysis of the research design and implementation. It presents the philosophical standpoint, theoretical framework and methodology that underpin the methods used. In doing this, I offer a rationale for the research design implemented, and offer a critical reflection on the research conducted.
To provide clarity, I have utilised Crotty’s (2009) ‘four elements’, which provide a framework to articulate the research design. Crotty (2009) asserts that there are four basic elements of any research process which inform each other; epistemology, theoretical perspective, methodology, and methods. The elements informing the research design in this study are identified in the table below, and a justification for their use is offered throughout the chapter.
Table 1: Research Elements
Epistemology Social Constructionism
Theoretical Perspective Hermeneutics
Methodology Hermeneutic Inquiry
Methods Focus Groups & Interviews
Epistemology
The philosophical underpinnings of any study are its epistemology, which refers to the nature of knowing. This in turn is influenced by ontology, which refers to the nature of existence (Crotty 2009). There are different theories of how knowledge is created and understood, and these theories determine the research design and the approach taken in research studies.
This research adopts a social constructionist position reflecting my belief that the meanings we hold about the world are socially constructed, therefore the knowledge and perceptions that nurses have about media representations are socially
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constructed, as opposed to stable and absolute (Crotty 2009). As Crotty (2009, p.42) asserts, “all knowledge, and therefore all meaningful reality as such, is contingent upon human practices, being constructed in and out of interaction between human beings and their world, and developed and transmitted within an essentially social context”.
A social constructionist epistemology is a naturalistic/relativist position, which assumes that reality is multiple and subjective, created through our interactions with others (Burr 2003). This philosophy stands in opposition to an objectivist epistemology, which is bound up with the scientific method, which sees an objective reality, that is fixed and absolute, regardless of the meanings we attribute to it (Polit and Beck 2014). As the aim of this thesis was to explore nurses’ own interpretations of representations, an objectivist position, which implies a search for a single, objective ‘reality’, was rejected.
Berger and Luckmann (1971) and Burr (2003) argue that all meaningful reality is socially constructed through language, therefore when we talk about the world we enter the process of social construction. This meaningful reality is also culturally and historically dependent, therefore as Berger and Luckmann (1971, p.15) assert, “what is real to a Tibetan monk may not be ‘real’ to an American businessman”. From this position, then, different ‘realities’ exist, with meaning constructed through our own cultural and historical contexts. A social construction, then, is anything that is given meaning through social interaction. This could be, for example, a nurse, a tree or the sun. It does not mean that these things do not exist, just that they do not have meaning without human interaction.
As Burr (2003) argues:
A lot of things we take for granted as given, fixed and immutable, whether in ourselves or in the phenomena we experience, can, upon inspection, be found to be socially derived and socially maintained. They are created and perpetuated by human beings who share meanings through being members of the same society or culture. (Burr 2003, p.45)
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In this study then, how nurses are perceived and represented, are social constructs and are historically and culturally dependent. Indeed, as I have already established in Chapters One and Two, the representation of nurses in the media and the public image of nursing have certainly changed over time. Furthermore, when nurses talk about the representation of nurses in the media, they are also constructing meaningful reality through language.
Burr (2003) asserts that social constructionism has four key assumptions and, here, I reflect on how these assumptions underpin the approach adopted in this study. I will now consider each in turn:
A critical stance is taken toward ‘taken for granted’ knowledge
In assuming a critical stance in this thesis, , I was able to consider why women nurses are stereotyped in the media and how this relates to the social construction of gender. As Burr (2003, p.2) argues, social constructionism enables us to challenge “taken for granted knowledge”, allowing us to be critical of our assumptions about the world. Taking a critical stance in this thesis also allowed me to consider how nurses, including myself, interpret nurse representation in terms of their own experiences and assumptions about the world.
How we understand the world is historically and culturally specific
I take the position that both nurse representations, and nurses’ interpretations of such, are historically and culturally specific. This allows a consideration of how representations have changed over time and an exploration of participants’ interpretation of nurse representations, which takes account of their own historical contexts and cultural position. There were two ways that I was able to consider the participants’ contexts; firstly, participants were encouraged to talk about their own experiences; why they joined the profession and their experiences of being a nurse. Secondly, demographic details of all participants were noted; their occupation, age and gender, which allowed the researcher to consider the demographic context in which participants talked about nurse representations in the media.
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Knowledge is sustained by social processes
I examine how nurses construct a meaningful reality about nurse representations and how this is influenced by social discourse, including the media, and the public opinion of nursing. As Burr (2003) claims our understanding of the world is constructed between people in our daily lives. I was also mindful of how the actual process of interviewing participants and the interaction between focus group participants led to the construction of meaning between participants and the facilitator, with participants developing, changing and clarifying their interpretation of media representations.
Knowledge and social action go together
Burr (2003) asserts that, how we currently understand the world may also result in specific actions. For example, a societal assumption that nursing is a woman’s job may make men more reluctant to join the profession. This assumption is based on a gendered construction, implicated in power relations in society, which ascribes what is appropriate for women, in terms of jobs and behaviour. As Burr (2003,p.5) writes, “our constructions of the world are therefore bound up with power relations because they have implications for what is permissible for different people to do, and for how they may treat others”.
A social constructionist epistemological standpoint therefore, compels me to offer critical consideration of the social construction and historical development of nurse representations in the media from a nursing perspective. This enabled an in depth exploration of how different nurses interpret the representation of nurses in the media within their own specific contexts.
Theoretical Perspective
The theoretical perspective of any research study is embedded within the epistemological standpoint, and thus informs the research aims and questions. The
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theoretical perspective, therefore, provides a philosophical underpinning to the methodology chosen (Crotty 2009).
Positivism, a theoretical perspective, is embedded in an objectivist epistemology and is considered the “traditional scientific approach” to research (Polit et al. 2001). This paradigm is based on the assumption that there is a single discoverable, objective reality, which exists independently of human interaction. The researcher, from this perspective, is considered value neutral and is cautious not to influence any results (Polit et al. 2001). The researcher working within this paradigm searches for cause and effect relationships in the aspects of reality they are interested in exploring. For example, they may hypothesise that media representations affect nurse recruitment. The researcher would then test the hypothesis in order to prove, or disprove it. The methods used by the researcher would be objectivist, based on “value free, detached observation”, using, for example, a pre-validated scale or questionnaire (Crotty 2009, p.67).
Interpretivism provides an alternative to the positivist search for ‘reality’ and ‘truth’ (Crotty 2009). Interpretivism is an umbrella term for a whole range of theoretical perspectives and is particularly associated with the work of Max Weber (1864-1920), a German sociologist. Weber (1864-1920) suggested that interpretivist human sciences ought to be concerned with ‘Verstehen’ (understanding), as opposed to ‘Erklaren’ (explaining), which is associated with a positivist paradigm. This splitting of approaches, Crotty (2009) asserts, led to a clear delineation between the methods used for each approach; namely qualitative and quantitative research methods. However, these are often unhelpful distinctions as they traditionally have invoked a hierarchy, which pits one approach against the other (Cooper et al. 2012). Nevertheless, both terms continue to assume dominance in the academic literature, and both are considered key research approaches. In view of this and the aims of this thesis, to explore nurses’ understanding of media representations, a qualitative methodology is adopted in this study.
In assuming an interpretivist perspective, this thesis is premised on the assumption that reality is not fixed; indeed, I expected participants to hold multiple accounts of
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the ‘truth’. In addition, as an interpretivist researcher I approached this work by looking “for culturally derived and historically situated interpretations of the social life-world” (Crotty 2009, p.67).
Hermeneutics, was identified as an ideal theoretical position to underpin this research (Crotty 2009), because it provides a flexible and interpretative approach, allowing an in-depth exploration of nurses’ interpretations of the representation of nurses in the media. Hermeneutics is the theory of interpretation, which was originally used to study the Bible (Higgs et al. 2012). The term originates from Hermes, the Greek God, who relayed and interpreted messages from God (Ortiz 2009). Hermeneutic theory emphasises that understanding and interpretation is shaped by historical and cultural contexts, as we interpret everything through, “concepts, language, symbols, and meaning of our time” (Bentz and Shapiro 1998, p.40). Parallel to a social constructionist epistemology, a hermeneutic perspective assumes that we experience the world through language and that this language provides us with meaning (Dowling 2004).
Heidegger (1889-1976), a German Philosopher and a student of Husserl (1859-1938) (the founder of Phenomenology), developed the study of hermeneutics in social science. He conceived it as a method of interpretation that considered the nature of existence; an ontological position. Gadamer (1900-2002), a student of Heidegger (1889-1976), developed the field of hermeneutics further in what Wilcke (2002, p.1) calls, “Gadamer’s three metaphors of understanding”; the fusion of horizons, the act of dialogue and the hermeneutic circle, each of which informed the methodological strategy employed in this research.
Hermeneutics is considered to be one of three schools of phenomenology (Dowling 2004). Consequently, there is much discussion and confusion in the academic literature concerning the distinction between hermeneutics, which is concerned with people’s interpretations of experience, and phenomenological theory, which involves describing the lived experience of humans (Laverty 2003). The terms hermeneutics and phenomenology are often used interchangeably by academics; however, they are both distinct philosophies with their own aims and objectives (Laverty 2003).
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Phenomenology, an interpretative perspective concerned with describing participants’ ‘lived experiences’(Crotty 2009), could have been chosen for this thesis; however, as it was my intention to consider how nurses talk about, understand, interpret and interact with media representations, whilst also taking account of their social and historical context, hermeneutics was considered most appropriate.
One important distinction between hermeneutics and phenomenology is the issue of Bracketing. Bracketing, in Husserl’s phenomenology, involves the researcher highlighting and simultaneously suspending her own perspectives of the subject under study, to get closer to the individual participant’s ‘truth’ (Dowling 2004 and Beck 2010). As Dowling (2004, p.32) asserts, “bracketing is the suspension of all biases and beliefs regarding the phenomenon being researched prior to collecting data about it”.
In contrast with ‘bracketing’ in phenomenology, one of the central tenets of hermeneutics is the belief that the interpreter’s perspectives cannot be separated from the interpretation of the text and, is in fact, an integral part of it. Indeed, Heidegger (1889-1976) argued that the researcher’s perspective cannot, and should not, be bracketed as they play an integral part in the interpretation of participants’ experiences (Dowling 2004). Throughout the conception and execution of this research strategy, I was aware that my closeness to the subject area meant that my own interpretation could not be separated from the setting, from which, and in which, it occurred; this included the social and historical situation of the participants and myself (Crotty 2009). Therefore, in this study, my own social and historical context is seen as critical to the hermeneutic endeavour and as such is highlighted further in this chapter.
Methodology
The methodological strategy adopted in this study is ‘hermeneutic inquiry’. This qualitative methodological approach arises from the theoretical framework of hermeneutics and the epistemology of social constructionism. Hermeneutic inquiry is underpinned by the theory of hermeneutics and is an inductive and qualitative
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approach to research, which is concerned with accessing and understanding people’s “meanings and intentions”, both in written and in verbal dialogue (Kinsella 2006).
Hermeneutic inquiry was considered the most appropriate methodological strategy for this study as the focus is on how nurses interpret representations of nurses in the media and the contexts within which such interpretations emerge. As this research is underpinned by a naturalistic/relativist position which assumes that reality is multiple and subjective, a qualitative approach which explores the quality, meanings and nature of the participants’ narrative in relation to the representation of nurses in the media was required.
Qualitative research involves understanding human experiences, which are considered complex and dynamic; these experiences are not easily suited to the strict classification and measurement of quantitative approaches, which are underpinned by a positivist perspective (Cormack 2000). Indeed, the purpose of this research was not to find objective ‘truths’ that can be easily observed and measured, but to acknowledge that there are multiple realities which are “provisional and context dependent” (Freeman 2006, p 494).
As this study is the first to explore how British nurses make sense of media representations, it required an exploratory, open and flexible approach. Indeed, alternative qualitative methodologies could also have been adopted. Whilst phenomenological research would have been appropriate to examine nurses’ perceptions of representations, it would not have enabled, contrary to hermeneutic inquiry, an appreciation of the condition in which this interpretation takes place or my own influence on the interpretation. Grounded theory, a form of ethnographic inquiry, which Crotty (2009) asserts develops theoretical ideas, could have also been chosen for this research; however, questions for this thesis arose out of the academic literature and the researcher’s perspectives as a nurse and academic, not from the raw data, as required in grounded theory (Corbin and Strauss 2008).
As previously stated, whilst Gadamer (1900-1976) presented a theoretical perspective for research, he was relatively silent on the methodological prescriptions for hermeneutics. However, as Austgard (2012) states, hermeneutic inquiry needs to
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be carefully constructed around the beliefs of Gadamer. Austgard (2012) considered six central concepts of Gadamer’s hermeneutics; ‘belonging to tradition’, ‘situation’, ‘text’, ‘true questions’, ‘the dialogue’ and the ‘fusion of horizons’. Consequently, I underpinned the methodological strategy utilised in this research with Gadamer’s hermeneutics utilising Austgard’s (2012) concepts. I now consider the relevance of each of Gadamer’s concepts to the research design.
Belonging to tradition
Gadamer et al. (2004) argue that interpretation comes from shared understandings, and this commonality make understanding possible. Gadamer et al. (2004) call this ‘fore understanding’. The researcher’s situation in interpretation is, therefore underpinned by their relationship to the tradition to which they belong. In this research, in common with the participants, the researcher is both British and a Registered Nurse and like most participants, a woman. This suggests common experiences between the researcher and the participants in which the interpretation of participants’ narrative took place. My own ‘fore understanding’ is presented in more detail later in this chapter.
Situation
The researcher is always located in a context which represents a finite standpoint. Gadamer et al. (2004) call this a ‘historical horizon’. The researcher needs to be aware of this hermeneutic situation, by considering their own “fore understanding”. As Kinsella (2006, p.5) asserts, “texts are considered through the historically and culturally situated lens of the researcher’s perceptions and experience”. For Kinsella (2006), language and history are both conditions and limitations of understanding. It is therefore important in hermeneutic inquiry, to acknowledge prejudices, but not bracket them, as advocated by the descriptive phenomenological tradition (Crotty 2009). I have highlighted my ‘fore understanding’ in this thesis and have acknowledged that the original premise for this study came from my own dissatisfaction with the representation of nurses in the media. This provides the ‘historical horizon’ through which the participants’ narrative has been interpreted.
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This researcher was also aware of how nurses’ interpretations of representations related to the participant’s own ‘historical horizon’. Therefore, during the interpretative process I was also cognisant of the participants’ ‘foregrounding’. This allowed me to reflect on how a participant’s context affected their own interpretation of media representations. This is particularly important from a hermeneutic perspective, as it illuminates a finite standpoint within which interpretation occurs.
Text
One assumption of hermeneutics, Gadamer et al. (2004) assert, is that all written language is an “alienated speech” that needs to be converted back into meaning by the researcher (Austgard 2012, p.831). As Higgs et al. (2012, p.2) state, “meaning emerges through a dialogue or hermeneutic conversation between the text and the inquirer”. In the case of interview and focus group transcripts, this required me to interpret participants’ narrative, within my own finite standpoint, neither adding anything extra nor taking anything away from the existing text. As Austgard (2012, p.831) also asserts, the researcher must be “provoked” by the text because it answers the questions posed by the research. In this case, I reacted to the data, critically exploring the academic literature that concerned nurses’ perceptions of nurse representations in the media. I was also motivated by the questions posed in this research, as they arose from my own experience and history as a nurse and academic, and from my critical engagement with the academic literature. As Laverty (2003) asserts:
Hermeneutics must start from the position that a person seeking to understand something has a bond to the subject matter that comes into language through the traditionary text and has, or acquires a connection with the tradition from which it speaks. (Laverty 2003, p.10)
True Questions
Austgard (2012), drawing on the ideas of Gadamer et al. (2004), states that research questions arise from our participation in the world, or when something does not fit with our expectations, or we need to know more about something. Gadamer et al.
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(2004) also asserts that these questions must also have a sense of direction and should be limited by the context from which they arise. Gadamer et al. (2004) call this, the ‘horizon of the question’. Thus, in this study it became clear that there was a poverty of academic consideration of how nurses make sense of nurse