Literature Review of Reflexivity in Qualitative Studies

Every research study needs to be contextualised, understood within the background and context of its place within the theoretical and practice spectrum (Fink, 2005). Nursing research, as with every other aspect of nursing practice, should be ethically sound (Carrick, 2000), and should also be founded within sound methodological principles and developed along the lines of evidence for practice. Within a primary research study such as this, the ability to understand the nature of the practice and evidence base of the study is very important, and there are two pre-existing spheres of theory which can support this. The first of these is the field of evidence-based practice, and the second is reflective practice, both of which contribute to the processes of critical thinking which are involved in research practice as much as they are in clinical practice.

The combination of these two practices within this primary research study relates to the need to in-build a clear decision trail and map of the reflexivity involved in a qualitative approach to generating and analysing data. Reflection in nursing practice is an importnat component of ongoing professional development (Driscoll, 1994; Gustafson and Fagerberg, 2004), how it contribues to professional development is what concerns the author here. Processes of structured and purposive reflection on practice, and on learning and knowledge acquistion of development (Coutss-Jarman, 1993), contribute to the development of critical thinking skills which contribute to the processes of applying evidence to practice and assimilating knowledge into the wider schema which relate to nurses’ ways of knowing (Daly, 1998;Rolfe, 2005). Therefore, the author, being aware of the contribution of good reflection to a reflexive process of clinical learning and application of knowledge (Gibbs, 1988; Hargreaves, 2004), aimed to apply a similar critical and reflexive approach to the process of reviewing and critiquing the literature relevant to this research study. Although there are those who argue that reflection per se is a biased and often self-referential (Jones, 1995), this author would argue that reflexivity is a fundamental component of inductive processes of qualitative research practice, particularly in relation to the interpretation of data (Silverman, 2001). and therefore, set out to review the literature using a critical and reflexive approach, building in principles of reflection and critical thinking (Price, 2000), but applied to the relationship between the nurse as researcher and their burgeoning knowledge and understanding, as it feeds into their tacit and intellectual knowledge.

Critical science within nursing is established as a means of developing critical thinking and analysis skills and incorporating multiple ways of knowing into the theory and practice domains (Fontana, 2004). Nursing research and the principles of theory generation intersect naturally with this kind of approach, because nursing research is, however abstract or applied, concerned with the improvement of nursing practice, one way or another (Freshwater and Bishop, 2003). It is also imperative that nurses who carry out research ensure that the research is of the highest possible methodological quality, so that it can be used as evidence for practice, or else it would not be ethical to carry it out, particularly if vulnerable people are being asked to participate (Hedgecoe, 2008; Carrick, 2000). Thus the author set out to ensure that the critical reflexive review of the literature was carried out to the highest possible quality, by combining the critical principles of research critique and evidence based practice with research searching skills.

Therefore, the author structured the literature review as a means of both identifying relevant research and discussion or commentary on the research question, and critiquing the quality of that research as evidence for practice in its own right, as a means of taking a more rigorous and focused means of contextualising the research study and contributing to the ultimate process of theory generation.

The focus of the literature review is literature available, and literature as evidence for practice, because this focus on evidence is part of the current trend towards quality of care (Elliot, 2000). All those involved in the provision of healthcare at a professional level are required to be able to identify and apply research for their sphere of practice (Rycroft-Malone et al, 2004), particularly if this evidence can improve practice. But for this, the nurse must be able to evalute the evidence in relation to methodological quality (Freshwater and Bishop, 2003; Hek, 2000; Elliott, 2001).

Thus, to begin with, the author considered the kinds of research evidence available, fully aware that the scientific rationalist paradimg is considered to provide the highest quality of research for practice (Upshur, 2001; Sackett et al, 1996 ), but also fully espoused to the value of qualtative research in the evidence paradigm (Rycroft-Malone et al, 2004, Upshur, 2001; Stevens and Ledbetter 2000 ). A nurse evaluating research to feed into their own study needs to understand research methodology and practice, and to understand the principles of research critique and evaluation. A range of critiquing frameworks exist which provide useful insight into the quality and usefulness of research, as a foundation for developing the inteded reflexive critical review of the literature, such as the ones suggested by Cormack (2000), CASP (2004), Daggett et al (2005), Duffy (2005). These provide clear guidelines for the critiquing of both qualitative and quantitative research articles, as well as case studys and systematic reviews. The author proposes to develop a critiquing framework using a combination of these approaches, which feeds into the process of reflection so that the author will reflect on every step of the literature review whilst carrying it out, and modify their approach according to what that reflection brings to the surface. The aim, as stated earlier, is to use reflexivity to evaluate the evidence base for practice (Stevens and Ledbetter, 2000; Sackett et al, 1996).

Evidence based practice is both a goal and a process, and therefore it could be argued that identifying the state of the evidence base is a fundamental starting point for the research project overall, not just an element of the required research process. This may be all the more important in this study because of the challenges of ensuring qualitative research is viewed as a valid contribution to theory and to practice (Cohen and Crabtree, 2008; Kearney, 2001). Thus the process of literature review is aimed at providing something which, on its own, will contribute to the evidence base for practice (Pepler et al, 2006), as well as providing the necessary critical, clinical and thoeretical context for the author’s own study.

Following on from the development of the critiquing model, with its in-built reflexivity, the author wil carry out an initial search of the literature using a set of key words and search terms that wil be developed using a brainstorming technique. Given the author’s pre-existing knowledge of the topic, informed by the literature which was used to develop the research proposal, this brainstorming exercise is also an exercise in reflexivity. The author will then develop a short list of search terms to be used in isolation and in combination to search the available literature.

The search will be carried out in all the relevant and available electronic gateways and search engines, including BNI; CINAHL; EMBASE; MEDLINE; Cochrane Collaboration; Science Direct; and Google Scholar. The author will also search online to look for guidelines and recommendations using the same search terms. As the search continues, the author will revise the search terms in response to the kinds of papers that are returned, keeping a record of these revisions, until they feel they have accessed all the relevant articles. Those deemed relevant to the study will be retrieved, and the most pertinent will be critiqued according to the model the author will have developed. The literature review will be presented in themes, but containing comparative analysis, and the author will ensure that, in order to fit in with the overall study, that there is a balance of qualitative and quantitative studies included.