COMPARACIÓN DE LAS VARIABLES

Narrative methodology is situated within both the social constructionist and

postmodern paradigm. The social constructionist emphasis of knowledge being socially and culturally grounded in discourse through social interactions forms the basis of the application of narrative (Mitchell & Egudo, 2003). Postmodernism’s contribution is the importance of multiple perspectives and questioning of objective truth in favour of reality grounded in everyday life (Mitchell & Egudo, 2003). This is congruent with the personal, social and contextual elements of experience described by the philosopher John Dewey who initially shaped Clandinin and Connelly’s work in narrative inquiry (Wang & Geale, 2015).

McAdams (2005) says a story is a way to organize a life into past, perceived present and anticipated future. As all the different identities of self are constructed within stories, the teller re-organizes the content to gather critical experiences, important relationships

58 and represent their values and norms to portray that identity (McAdams, 2005). The resulting story is not “the one and only” life story but is instead he says, a representative of the plethora of possible images, metaphors and significant moments the person has in their repertoire. Each person chooses the stories they tell and these would differ,

depending upon their aim in telling the story and potentially the audience and context (McAdams, 2005).

Meaning is developed as a person shapes and orders their stories. The process of choosing what to tell or not tell, and explaining their actions and thoughts, aids reflection and identification of consequences as well as linkages (Chase, 2011).

Narrative therefore is capable of giving insight into the lived experience of the narrator with attention to their cultural context and the maintenance of identity (Chase, 2011). Through the narrator’s stories the researcher enters the world of experience of the narrator and together they construct an understanding of the forces and beliefs shaping and influencing the narrator (Denzin, 1971). Wang and Geale (2015) describe this understanding as an insider’s view, signifying the depth of understanding of the participants’ perspective.

As a story unfolds we recall the events that are important but do not include all the minutiae in the telling routinely. The actions are told, accompanied by the consciousness of explanation and choice, thus privileging the listener to two landscapes as Bruner (2004) describes them: the action landscape and the landscape of consciousness. This insight into consciousness results in richness and detail, beyond just an account of an event to include cultural and linguistic perspectives (Bruner, 2004). The experiences that shape peoples’ lives and influence the way they identify themselves are articulated and revealed through the narrative process (Wang & Geale, 2015).

The researcher seeks specificity in storytelling from the narrator so that events are told in detail. The focus in narrative is away from participants generalizing about their experience (Chase, 2011). The narrator controls the detailed telling of a story, as they present the elements they deem important. Meaning is then developed in concert with the researcher as further aspects are requested or clarifying elements are invited (Riessman, 1993). Importantly, the context and interaction of the participant and researcher influence the data (Lieblich, Tuval-Mashiach, & Zilber, 1998).

59 There are three predominant methodological approaches according to McAlpine (2016), who lists sociocultural, naturalist and literary as types. The sociocultural type addresses the stories told as part of participant practice in particular states. This would seem fitting for a study of simulated patient activity where the simulation is the particular state and the participant practice is the simulated patient experience. However, the naturalist methodological approach focuses on rich description of significant issues, and spotlights the experiences of the person and the meaning that person has drawn from the experience (McAlpine, 2016). This naturalist approach is the nexus of this enquiry with concern for the experiences that each participant has had that lead them to work as a SP, and the meaning and relationship that each person applies to being a CALD SP. For this reason I refer to the participants as CALD SPs rather than SPs with CALD

backgrounds. Each of the participants self-identified as CALD prior to identifying as a SP. The naturalist, narrative methodological stance focuses the enquiry on the experiences of the individual predominantly. While group membership as a SP is relevant and even a vital element, I do not seek a study of SP experience in isolation but rather to know of the CALD people who undertake the SP role.

3.6.1 (Culture and) Narrative

Narrative is a research method that can be used to uncover nuances and give voice to those who may otherwise have been silenced (Wang & Geale, 2015). Narrative is frequently used to represent subgroups in society who are often discriminated against such as women, cultural and ethnic groups (Lieblich, Tuval-Mashiach, & Zilber, 1998). The research method needs to be suitable to the research question or problem. If real- life experience is sought to answer a research question then narrative suitably explores the subjective inner experience (Lieblich, Tuval-Mashiach, & Zilber, 1998).

Narrative analysis, says Daiute and Lightfoot (2004), facilitates the holistic examination of issues in people’s lives and thereby elicits “descriptions of identity, knowledge, and social relations from specific cultural points of view” (p.xii). And further, that narrative is an appealing method of inquiry because it provides context for examining identity and development, and also provides insight into the multiple intersecting forces in play between self and society (Daiute & Lightfoot, 2004). The adage about something being too good to be true comes to mind when I consider the methodology of narrative and my path to investigate the lived reality of people from diverse backgrounds using the

60 framework of intersectionality. From the outset narrative methodology appeared a good fit. But, the more I learned about narrative the closer the fit between the research question and the research method became and the more congruous with my theoretical framework.

Connelly and Clandinin (1990) set out some useful clarifications of language concerning narrative. They argue that narrative is both a phenomenon and a method. This is true for my study. My phenomenon is the narrative of CALD SPs. Narrative is the term I will use for the unified whole or episode of the events told from each participant

(Polkinghorne, 1995). Polkinghorne (1995) talks of storied segments creating the boundaries of the narrative. I will use the term ‘story’ to indicate the multiple segments that create the unified whole narrative. The meanings of narrative and story differ between the seminal authors. Connelly and Clandinin (1990) define the phenomenon as story and the inquiry as narrative, whereas Bruner (2004) alludes to stories or

narratives as if these terms are interchangeable.

The method I am using is narrative also. In order to follow the work of Polkinghorne (1995) I will describe this as analysis of narratives. I will describe my methods in detail in later in this chapter; however, analysis of narratives, Polkinghorne (1995) says, moves from the stories to common elements. In this instance the common elements are themes and threads.

The narratives that will be presented in chapter 4 and the appendices represent the voice of the CALD SPs rich culture and values. While my presence in the stories is inferred through open-ended questions I used to elicit storytelling and my

encouragement and probing, I cannot and would not claim neutral observation but seek to expose my own subjective positioning. Riessman (2008) says the response of the listener is implicated in the storytelling. In keeping with this, I have preserved the authentic language, cadence and grammar of the participant’s spoken word and avoided discursive control in presenting the narratives (Presser, 2005). I chose to present the narratives “as told” to preserve each person’s own constructions and avoid shaping my participants accounts. Holloway and Freshwater (2007) state that images, metaphors and content of stories are all important effects and individual characteristics should be retained.

61 Narrative takes into account where we have been, where we are presently and suggests future direction (Martin-McDonald & Biernoff, 2002). In seeking to understand the cultured, socially shaped lives of CALD SPs, narrative serves to pay homage to past and present while preserving the nuances of intersectional identity. Identity is a vital concept common to SP work, culture, intersectionality and narrative. Riessman (2008), a notable narrative expert, says the construction and performance of identities is central to narrative inquiry.

3.6.2 Fit of narrative methodology to this study

As little is known about the people who work as SPs and, in particular, CALD people working as SPs are hardly recognized in the literature, this research aimed to expose something of the experience and perceptions of CALD SPs. The outcome measures include insight, mindfulness and awareness. Lindsay (2006) describes outcomes of narrative research as “exploring experience for meaning making, knowledge

construction and living a life in more awareness” (p. 41). The methodology needs to be suited to the underlying purpose the narrator has for telling the story (Treloar, Stone, McMillan, & Flakus, 2015). Storytelling enables the capture of the subjective experience of the narrator and in the analysis of narrative; meaning can be drawn from the study. Treloar et al. (2015) explain that narrative inquiry studies the development and transitions in people’s lives, making meaning retrospectively from the narrator’s point of view. In doing so, the uniqueness of individual action and events is exposed.

Holloway and Freshwater (2007) suggest some qualitative data collection techniques lead to fragmentation. In narrative the stories may not be told chronologically; nonetheless the narrative is considered as a complete text and the coherence of the whole is important to connecting events, responses, understanding and motivation. These are significant aspects of narrative methodology that are desirable in this research: “The very act of relating the story brings together and links the fragments to create a coherent whole” (Holloway & Freshwater, 2007, p. 709).

When investigating specific populations and seeking detailed insightful information the research methodology must be congruent with those intentions. Narrative research fits those aims and is noted to amplify the voices of the oppressed and disadvantaged

62 (McQueen & Zimmerman, 2006). Finally, narrative provides a deep understanding from the participant’s perspective.

Intersectionality and the idea that identity is located at the intersection of categories, such as race and gender, are central to this research. These characteristics shape experience and cannot be captured readily with quantitative research (Trahan, 2011). Reducing the characteristics of identity to categorical variables fails to recognize compounding effects and overlooks the issues of culture and environment. The

meanings and effects of these forces are relevant to the individual. It is the meaning that is ascribed by the individual that can be captured in a rich detailed account through narrative.

3.6.3 Limitations of narrative

In collecting data through interview to form a narrative, the relationship between the researcher and participant needs to alter to reflect that of narrator and listener. The shift from generalized answers to structured questions becomes broad open

questioning inviting storytelling of specific instances (Chase, 2011). In simulation facilitation it is necessary to explore the frames of reference of participants during the debrief. Simulation participants are emotionally activated and frequently exhibit heightened emotional states. Accepting this situation the simulation facilitator works through the reflections and encourages the participant to explore their action and inaction. Similarly, the narrative interviewer works with the narrator to encourage them to explore their experiences and bears witness to the emotions that surface (Chase, 2011). Kirsch (2005) acknowledges that even commonplace impersonal interviewing can lead to revelations of deeply personal and emotionally laden information. She extrapolates this point to link the rapport and trust implicit in the feminist research style to more open communication, despite the flow of information being largely one sided.

The results of an analysis of a narrative study are not intended to be generalizable (Martin-McDonald & Biernoff, 2002). The study represents insight into the experience of a small sample of people. Chase (2011) contrasts the observation that while narrative allows us to see through the window into the narrative environment through stories

63 told, it also limits our visibility to what can be seen through that window and nothing further, suggesting part of the environment may not be visible.

Connelly and Clandinin (1990) state that a frequently levelled criticism of narrative is the pre-eminence of individual over social context. In their discussion of individual psychology this may have bearing; but the influences of social constructionism and postmodernity consider the social reality of the experience as lived by the individual in context. Therefore, theoretical influences emphasize social context and in my view address the criticism.

3.7 Methods