Chapter 3 Methodology
3.2 Narrative Inquiry
The term narrative is commonplace in popular culture, used often within literary fields, journalism, and the arts to describe the ‘telling of a story’. Within the area of social research, narratives are a source of data in a range of disciplines including
Education, Psychology, Nursing & Medicine (Holloway & Freshwater, 2007). However, it is only relatively recently that narratives have been viewed as appropriate material for research. Emphasis in the post-war period on humanistic approaches to social research have seen the development of person-centred approaches; case studies, life histories or biographies, all of which may contain a narrative element, and, whilst approaches my vary, it is the potential of stories to uncover meaning within people’s lives that underpins narrative inquiry. The increase in the profile of narrative methodologies in social research has led to debate and dispute around definitions of narrative (Andrews, Squire & Tamboukou, 2008). Plummer, in explaining life stories, states that ‘the narrative can be ‘seen as a most basic way humans have of apprehending the world’.’ (2001, p.185). Hurwitz et al. use the following definition to highlight the potential of the narrative: ‘Polymorphous in content, malleable in form and dynamic in expression, narratives are compositions of unfolding meanings which can be discerned and followed by an audience.’ (2004, p.1)
There are diverse definitions of narratives within nursing which largely focus on patients' stories as narrative (Thomas, 2010; Corbally & O’Neill, 2014). However, it is also suggested by Corbally & O’Neil (2014) that the classifications of narratives outlined by Ricouer in 1981 as ‘operating on two distinct levels: the socio-cultural and personal’ (p.35) still stand. The socio-cultural narrative provides a meta narrative of societies, organisations or groups and these ‘shape the meaning and experiences of the individual’ (Corbally & O’Neill, 2014, p.35). This is important in relation to my understanding of narrative, as the meta narrative of learning disability nursing shapes the narrative of the individuals involved in my study. Narrative inquiry provides an understanding of how personal narratives influence professional narratives, how individuals perceive their role as learning disability nurses and how identity is represented within these narratives. The decision to emphasise or omit particular elements, whether consciously or unconsciously, creates a picture – an identity. The narrative also places the individual within the social world in which their story exists. In telling the story of their career we also see the social and political world in which these nurses function. We not only see them as individuals, but also as nurses within what has been a changing social and political arena for the past 30 years. The dominant cultural narrative of learning disability nursing is created with
reference to society’s construction of people with a learning disability, their care, and, therefore, those who care for them. The learning disability nurse narrates their own story against a backdrop of social and political change that we can trace over the past three decades.
The construction of a narrative inherently requires personal reflection. Holloway and Freshwater (2007) postulate that the creation a narrative in terms of the creation of a plot, characters, sequence and meaning, give the researcher a rich insight into both the told and the untold. How the narrator chooses to shape the story, the structure and composition of the story, create a representation from the narrator’s perspective, which can then be interpreted from the perspective of the researcher. Ayres & Poirer in Latimer (2009) suggest that the ‘secrets’ within the story, i.e. that which is left unsaid, has a meaning not only to the narrator but also to the researcher who may use pre-understanding to interpret these ‘secrets’. This has particular relevance for this study, as the researcher is themselves part of the same group of nurses and needs to be consciously aware of the assumed secrets when listening to and interpreting these stories. The history of learning disability nursing and the position of the participants as nurses on a professional register may also impact upon what is said and what is left unsaid. The ‘choice’ to tell or not impacts on the power balance within the researcher/respondent relationship. The respondent’s role in the research process constitutes one of empowerment in which the narrative gives the respondent the opportunity to choose what to include in their ‘story’. This issue of power balance and the research process is of specific relevance to learning disability nurses as they often occupy a vulnerable place within the sphere of nursing (Mitchell, 2000).
Taking an approach that embraces narrative inquiry within this study enabled me to acknowledge my professional background as a learning disability nurse, and also the ontological assumptions around learning disability nursing as a social construct. If we assume, as discussed in chapter 2, that learning disability as a concept is constructed by society then the nature of learning disability nursing is also socially constructed. The narrative approach offers a framework to support the respondent to share thoughts, feelings and opinions, and, as Corbally states, to ‘engage in the creation of meaning in the social realm’ (2014, p. 72). Postmodern and post- structuralist views suggest that the interview can be an opportunity for meaning
generation rather than just the reporting of meaning (Holstein & Gubrium, 2004). The narrative interviews may be seen as a space for the interviewer and interviewee to create meaning through a narrative which is set in a context of place, time and the relationship between the participant and interviewer (Holstein & Gubrium, 2004; Wengraf, 2001; Holloway and Freshwater, 2007).
Narrative suppressing methods, for example, what is often seen as the traditional interview with pre-prepared questions, would not generate the data required to understand the experiences of these nurses. In contrast to question and answer exchanges of the traditional qualitative interview, the narrative allows the teller of the story to sequence events and to develop plots and characters. Wengraf (2001) argues that narrative interviews are, however, semi structured, in that the interviewer must be well prepared prior to the interview and that the interview has to be well designed in order for it to be semi structured.
Although, as previously noted, narrative can be derived from a range of media, the focus for this study is ‘narrative as story’. The story is a specific form of discourse production, which has structure and components and differs from other forms of narrative, for example poetic discourse (Hatch & Wisniewski, 1995). Using narrative in this way enables the exploration of multiple subjectivities, understanding the ‘story teller’ through their story, and also the social and political change in the past 30 years.
3.2.1 Philosophical underpinnings of narrative inquiry
In order to develop an understanding of what it means to be a learning disability nurse within the context of this study, we must first explore what it means to ‘be’ in relation to the narrative. Epistemologically, the narrative provides us both with a way of knowing and a way of telling; it can be used to interpret ‘truth’ from the perspective of the creator of the narrative. Sarbin (1989) postulates that, as social beings, we construct the stories of our lives as we live them, and develops this further by suggesting that we ‘think, perceive, imagine and make moral choices according to narrative structures’ (p.8). Lives, from childhood, are shaped though narratives that are used to instruct or inform, to empower, or to ‘cathart’ (Smith, 2003). Bruner (1991) suggests that narrative reasoning human reasoning alongside scientific
reasoning, not measuring which is more valid but accepting each is different. The telling of a story based on memories of experiences creates an individual reality, which can reflect feelings, thoughts, moral reasoning and judgments. MacIntyre (1981) and others also suggest that narrative is central to our understanding of human behaviour, suggesting that we interpret the behaviour of others through their narratives and recognise our own narrative within the narratives of others (Holstein & Gubrium, 2004; Wengraf, 2001; Gergen & Gergen, 1988; Jones, 2004). In this regard, exploring the experiences of learning disability nurses, the researcher is placed within that context as a learning disability nurse herself and interprets their ‘reality’ in the context of her own narrative. This has its own benefits and limitations, which will be discussed further.
3.2.2 Narrative within social and cultural boundaries
As Reissman (1993) identifies, stories are not only personal but they embrace the cultural and the social aspects of lives. Bruner (1991) suggests that storytellers do not ‘operate in a cultural vacuum’ but narrate their stories within the framework of their culture, beliefs and values. Holloway and Freshwater (2007) also suggest that when seen as a social process, narratives also have the capacity to explore issues of power and culture and to develop ‘local knowledge’. In exploring the narratives of learning disability nurses, we not only see the social processes at work but can also acknowledge the place of the stories within the culture of nursing and, more specifically, learning disability nursing. Nurses bound by a Code of Conduct (NMC, 2008; 2015) are aware that elements of their story may need to remain untold as they could be perceived as ‘unprofessional’. As such, the culture of the ‘profession’ influences the telling of the narrative. Ramvi, in 2015, in a single-case biographical narrative, examines the self-understanding of a nurse and identified the importance of the professional personal in creating the narrative. Whilst this study came to light post data collection for my research study, it supports the view that the nurse will create a narrative that blends the personal and the professional.
Within narratives of professionals like nurses, where they are relaying experiences over a timespan, there may also be a reluctance to use particular terminology when telling the story of their experience as a learning disability nurse due to changes over
time and not wishing to appear ‘politically incorrect’. The narrative, therefore, is created as an individual story but within cultural and social boundaries.
3.2.3 Narrative capturing time
Narratives are also constructed within the context of the life lived and experienced within a specific space and time. The experiences of learning disability nurses within this study are situated within a particular space and time, told today (on the day of interview) they are a reflection of a number of years, for some more years than others. The ‘story’ is told ‘today’ but in the context of a period, defined by the storyteller. Gergen & Gergen (1986) describe the story as a movement through time, and it was particularly this movement that the study needed to capture.
3.2.4 Narrative and identity
Smith & Sparkes (2008) suggest that narratives can shape identity and concepts of self. Further to this, Sarbin (1989) and Gergen & Gergen (1986), prior to the work of Smith & Sparkes (2008), suggest that moral choice is also often evident through narrative and stories of ‘moral choices’ can serve to maintain or enhance self- identity. Padilla & Nelson (2011) note that ‘biographies help to illuminate the elements of identity formation of interest to nursing scholars and further the development of the profession;’ (p.189) However, they also question whether there is a wider interest in these stories outside of the nursing profession, suggesting that story may be context and content specific. I argue, however, that, while the specific content of the narrative may be in a nursing context, the wider social meanings are evident in discourse around relationships, culture, organisation, and society.
In the production of a narrative, an identity is created for the individual narrating the story, but a perception of the wider social context in which that narrative takes place is present. The place of people with learning disabilities in society and, therefore, those who care for them, is evident within the story and the story is shaped by this social context. This constitutes a wider narrative than that of the individual – the story of learning disability nursing as a narrative in its own right, a collective, cultural and social meta narrative, is created by the individual narratives that make up that group of nurses and is also validated by the literature outlining the history and culture of learning disability nursing.
The narrative takes us beyond the seen world and allows the researcher to see the interaction between the participant and their world, revealing the interconnections and cultural influences. When we organise our lives into narrative structures we then assign meaning to them through the telling of stories, revealing the internalised world as well as the external. The experiences of learning disability nurses told through their individual narratives also reflect a group narrative of what it means to be a learning disability nurse and represent internalisation of the many changes to care of people with learning disabilities.
My interest within this study focuses on the changing story of learning disability nursing, the potential influence of changing policy and societal attitude towards people with a learning disability. This interest in understanding the story of learning disability nursing from the nurse’s point of view led me to further explore narrative methodology.