Reflexive position and application to this study

The term reflexivity is associated with qualitative research, the domain of which is the in depth exploration of research topics in terms of concepts, beliefs and motivations (Parahoo 2014). Charmaz (2014) describes reflexivity as being how the researcher’s interests, positions, assumptions influenced his or her inquiry. A reflexive stance informs us how the researcher conducts his or her research, relates to the research participant’s and represents them in the written reports. Neill (2006) put forward the argument that reflexivity/reflection is an important part of the data analysis in a grounded theory study as long as it does not become a distraction from the data. Reflection can be an important part of the comparative process.

The concept of reflexivity is widely discussed in the literature revealing a complexity of definitions over which there is little consensus. Often in the literature the words reflexive and reflection are used interchangeably without making clear the application and not attempting to discriminate between the two terms. Finlay (2002) recognises this lack of clarity and attempts to resolve it by placing the two concepts at opposites end of a continuum with reflection at one end concerned with ‘thinking about’ and reflexivity at the other end concerned with as she puts it ‘more immediate’ continuing dynamic and subjective self-awareness’. Boud (1985) defines reflection in the context of learning as: a generic term of those intellectual and affective activities in which individuals engage to explore experiences in order to lead new understandings and appreciations. Lincoln and Guba (2005) describe reflexivity as a process of recognising constructs that implicitly and explicitly influence the research process. Finlay and Gough (2003) identify five variants of reflexivity: introspection, intersubjective reflection, mutual collaboration, social critique and discursive deconstruction. Introspection is the process of formulating the research question and it is where the researcher begins to use their own reflecting, intuiting and experiences to engage with the topic and research question.

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Intersubjective reflection requires the researcher to begin to explore the mutual meanings emerging within the research relationship. Mutual collaboration seeks ways in which to co-opt participants as co-researchers and vice versa. Social critique offers the opportunity for the researcher to reflect on power imbalances or social tensions between the researcher and the participant. Lastly, discursive deconstruction is about the meaning of language and how it’s used and how this impacts on modes of presentations. Finlay (2002) believes these five variants of reflexivity can help the researcher navigate their way through the swamp of reflexivity and credibility depending on the researcher’s aims and objectives.

Being reflexive in the research process is therefore to acknowledge that ‘we are always on the corner somewhere’ (Richardson 1992, p.104). The process of reflexivity identifies and acknowledges the limitations of research. McDermott and Varenne (2010) believe that reflexivity makes us question assumptions inherent in the research process research topic, concepts and theories which may be constructed through power and privilege. Questioning these assumptions has made it necessary to question my own philosophy, traditions and beliefs and how I position myself within this study. This involved questioning preconceived categorization of what is being researched, those being researched and how the research was being done. My background as a critical care nurse was considered and how my knowledge experiences and professionalism may in some way shape or distort my interactions with the healthcare professionals and patients in this study. These concerns and preconceptions were managed by keeping a research journal and having extensive and open dialogue with supervisors, friend’s colleagues and peers. Engward et al (2015) believes that these are important considerations in all qualitative research including grounded theory as it makes the researcher question how knowledge and understandings are situated within epistemological frameworks. When considering grounded theory studies theoretical sensitivity can emphasise the reflexive use of self particularly in the process of developing research question and doing analysis (Callery and

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Hall 2001). Reflexivity which is directed at the interview and participant observation process can supplement theoretical sensitivity because assumptions which may be taken for granted by the researcher and the participants can influence data collection. Silverman (1998) suggests the detailed audio tapes of interviews provide a method for demonstrating reliability in qualitative research. In this study all participants’ interviews were recorded and transcribed verbatim for detailed description and accuracy. This enabled the checking of the written transcript alongside the audio recordings to enhance the auditability of the analysis and provide a way for me to check and re check the dialogues in the context of each interview.

To enhance dependability (reflexivity) and keeping with the paradigm of this study and the philosophical premise in which it was undertaken I have written this study in the first person. To write in an objectivist stance or ‘third person’ would seem awkward. Sandelowski (1986) believes that the typical language of a quantitative report is the neutral passive voice which is intended to convey distance between the researcher and the participant. Clearly this style of writing would be inappropriate for a constructivist grounded theory study where the relationship and partnership with participants is both equal and reciprocal. Webb (1992, p 750) iterates these sentiments by stating that;

“it is not only acceptable but indeed for writing about qualitative research to use an active first person form or language. To do is inconsistent with the epistemology of the approach and constitutes some form of mystification in which the social elements of the research encounter are hidden from scrutiny, preventing readers from evaluating the adequacy of the research”.

With this in mind I will continue to write in the first person in order to make clear my role and/ or position in this study and the role of the participants. What is important to me is that the voice of the participants is heard and is not overshadowed by my views and opinions; clearly the data collected should be a true and accurate reflection of their experiences.

86 3.8 Conclusion

The writing of this chapter has given me an opportunity to explicitly state my research focus and questions and my rationale for choosing grounded theory method. I argue why it is an appropriate method when exploring decision making by healthcare professionals managing the care of heart failure patient’s at the end of life. This chapter began with a comprehensive discussion on symbolic interactionism (the theoretical framework underpinning this study) and its importance in framing my study. I clearly outline the different schools of grounded theory and give a rationale as to why constructivist paradigm was the most appropriate to address my research questions. In the following chapter, a full description of the research methods will be given beginning with an overview of the setting, demographics of the participants, how participants were recruited, the sampling process, data collection and data analysis.

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