Jonathon Slater

Correspondence: jonathon.slater@nottshc.nhs.uk

Abstract Reflective practice is integral to effective nursing. Autoethnography is used within this article as a means of reflective practice to help the author better understand what motivates him as a nurse. Wider relevance and application are explored. Conclusions are drawn regarding professional identity, pluralism and chief complaint care orientation. The integral role of nurses in reducing dissonance between services and those who seek help from them is highlighted.

Key words Health dissonance, autoethnography, service-user, nurse, chief complaint orientated

Introduction

Reflective practice is integral to effective nursing (Nursing & Midwifery Council (NMC), 2015). Our ability as nurses to ‘know’ ourselves and understand what motivates us remains central to the relationships we build with those we seek to help (Peplau, 1997).

As part of completing my doctoral thesis I was asked what motivated me professionally. As I began to explore my response to this question I began to appreciate more deeply that its genesis lay in the first time I was assessed by a mental health professional, a psychiatric nurse, almost 25 years ago.

Using autoethnography I hope to have purposefully captured this deeper appreciation in a way that may prove meaningful and helpful to others, while also limiting any adverse consequences to those people other than myself to whom the narrative refers (Tolich, 2010).

Introduction

Autoethnography has been described as a qualitative methodology that uses autobiographical literary expression to explore an author’s vulnerability during exposure to de-synchronous or novel cultural, political and social conventions (Ellis, 2004).

It can be a research process and a research product in which the author is both storyteller and story (Altheide and Johnson, 2011).

While critics claim that the approach lacks rigour and consistency, and remains anecdotal in comparison to ‘gold standard’ scientific research criteria (Savin-Baden and Howell-Major, 2013), proponents suggest it has the capacity to enable the author to uncover transgressions against dominant perspectives that lie deep within; thereby giving voice to those facets of ourselves we may have silenced in order to conform (Spry, 2011).

However, proponents equally warn against the potential for self-indulgence and stress the need to ensure wider purpose and applicability while also protecting one’s own vulnerability as well as that of others who may be included in the narrative (Pearce, 2010).

Application

Over the course of approximately six months I began to amass evidence that might help deepen my understanding of what motivates me professionally.

This process included writing down thoughts, feelings, actions and memories I thought might have relevance and gathering together linked drawings and photographs.

As I did so, I also found myself engaging in a parallel iterative process of narrative development illustrated by the photographs and drawings dug out from attic boxes and old albums.

What emerged was a deeply personal, raw, sometimes upsetting, sometimes cathartic account of the first time I was assessed by psychiatric services, illustrated with personal photographs and artwork. It then became important to further evolve the narrative and engage with others so as to mediate potential vulnerability, explore appropriate consent and ensure internal and external confidentiality. It was this latter phase that matured the narrative from a raw account into something more purposeful and considerate.

Ethical considerations

Little guidance exists with regard to both the process and practice of ethical auto-ethnography. That which does exist is often contradictory, not adhered to by those asserting the need for ethical practice or is focused entirely on process with few practice examples (Altheide and Johnson, 2011).

While process suggestions include the necessity to anticipate and therefore gain a priori (knowledge that proceeds from theoretical deduction rather than from observation) consent, this was not possible during my own practice. Other than myself, I was not aware during early development who else the narrative might involve or in what capacity.

It was only once the raw narrative had emerged that ethical considerations regarding content could be explored. Tolich’s (2010) Ten Foundational Guidelines, which are split into the categories of consent, consultation and vulnerability, proved integral to this practice and to shaping the final narrative. There has only been one individual with whom I have been unable to consult or seek consent from and this is my assessor.

I hope by taking steps to ensure their anonymity I have mediated any potential vulnerability the narrative may expose them to.