Self-Reflection as a Research Instrument in Interpretive Phenomenology

Purpose:  Nurses provide the majority of cancer care and play a principal role in patient experiences, particularly within marginalized populations such as American Indians (AI). The significant AI cancer inequity is marked by elevated mortality and morbidity, and although the literature suggests that nurses can positively impact patient outcomes they may also contribute to negative cancer experiences due to high levels of compassion fatigue and cross-cultural conflict. The purpose of this presentation is to describe the utility and value of using self-reflection as a research instrument during the first phase of a phenomenological study exploring the meaning of providing nursing care to AI cancer patients. 

Rationale: Interpretive phenomenology requires that the researcher integrate his or her own biases and assumptions into the investigation as a conscious act of enmeshment between philosophical orientation and the phenomenon of study.  Researchers engage in immediate, insightful, and intensely reflective writing in an effort to avoid contamination of the study by superficial preconceptions.  During this critical first phase, self-reflection allows meaning to be assigned while recognizing the inseparability of emotion, thought, and language in human experience.                   

Methods:  A comprehensive personal reflection on the meaning of providing cancer care to AI patients was undertaken using a modified process for producing lived-experience descriptions:  1) an initial description of the experience was handwritten using a journal with careful attention given to avoiding causal explanations, generalizations, or initial interpretations; 2) feelings, moods, emotions, and embodied sensations were detailed; 3) particularly vivid events and experiences were identified and further described in subsequent writings after dwelling within previous journal entries; 4) constant attention was given to how the body felt as well as other sensory responses resulting in increasingly corporeal writing; 5) language and text remained authentic and reflective of how the experience felt at a particular moment in time. 

Results:  Analysis is ongoing although findings will describe and explore one nurse’s personal experience, including its meaning within the context of the persistent AI cancer inequity.  Preliminary results emanating from self-reflection will help to identify the limitations and boundaries surrounding individual interpretation of an experienced phenomenon; encourage greater reflexivity, resulting in a richer overall interpretation; guide productive hermeneutic interviews among future nurse participants as they express the meaning of providing nursing care to AI cancer patients; and improve the rigor within the larger investigation.

Implications: Personal reflection can illuminate the lifeworld of a cancer care nurse and may be used as a tool for exploring the nurse’s role in the ongoing AI cancer inequity in clinical practice. The nuances and hidden meaning within the AI patient-nurse relationship likely impact the delivery and quality of cancer care provided to this population.  Completion of this first turn of the hermeneutic circle through self-reflection during an interpretive phenomenological study will contribute to our understanding of the phenomenon as a whole through appraisal of the many parts.