Narrative Inquiry

Indroduction

“How did your meeting go with Michael?” On the phone together in the early 2000s, we compare notes, unpack questions and consider nuances of our respective meetings with our doctoral supervisor, Michael Connelly, who is one of the founders of Narrative Inquiry. To distinguish our methodology within the field of narrative research, which includes diverse narrative approaches (Leggo, 2008; Lieblich, Tuval-Mashiach, & Zilber, 1998; Josselson & Lieblich, 1993; Riessman, 1993), we capitalize our key term. Immersed in exploring our respective research questions about nursing and health-care reform (Lindsay, 2001), and the impact of serious personal illness of nurse-teachers on their teaching–learning practice (Schwind, 2003), we learn how to do Narrative Inquiry. “It’s the experience we are concerned with, not stories” Michael stresses. More than a decade on, with a shared research program using Narrative Inquiry, a coedited book (Schwind & Lindsay, 2008), research-based publications (Lindsay & Schwind, 2014a, 2015; Schwind, Lindsay, Coffey, Morrison, & Mildon, 2014), and a website (Lindsay & Schwind, 2014b), we continue to explore, through the lens of philosophy, methodology, and our work with graduate students, what Narrative Inquiry is and how it matters in nursing and healthcare.

In this article, we explicate how Narrative Inquiry may be lived in health-care education and practice, with a primary focus on nursing. We illustrate the process of the Narrative Inquiry approach through elaboration on the inquirer-participant relationship, storying of experience, and circles of analysis. We reveal how we support our graduate students, the next generation of narrative inquirers, through a Narrative Inquiry Works-in-Progress group.

What is Narrative Inquiry?

Dr. F. Michael Connelly and his former student Dr. D. Jean Clandinin pioneered Narrative Inquiry for curriculum studies in higher education, conceptualizing narrative as both methodology and phenomenon (Clandinin & Connelly, 1991, 1996, 1998, 2000; Connelly & Clandinin, 1987, 1988, 1990, 1995, 1996). Concurrent with development of Narrative Inquiry, an interest in narrative appeared in diverse disciplines, such as anthropology (Bahar, 1996; Geertz, 1995), psychology (Bruner, 1986; Polkinghorne, 1988), ethics (McIntyre, 1984), and medicine (Charon, 2006; Charon et al., 1995). Connelly and Clandinin’s Narrative Inquiry is increasingly recognized as a valued qualitative approach in contemporary health research textbooks (Creswell, 2013; Kim, 2016). Clandinin and Connelly (2000) build on Dewey’s (1938) notion that experiences are continuous and interactive, and if intentionally reflected upon, may be educative:

Narrative inquiry is a way of understanding experience. It is collaboration between a researcher and participants, over time, in a place or series of places, and in social interaction with milieus. An inquirer enters this matrix in the midst and progresses in the same spirit, concluding the inquiry still in the midst of living and telling, reliving and retelling, the stories of the experiences that made up people’s lives, both individual and social. (p. 20)

When we engage in an inquiry puzzle with our participants, we become co-participants in this endeavor. We observe, listen, and live alongside our participants, which allow us a deeper insight into the research phenomenon. As the stories are lived and told in a given place and in relationship, we co-construct the emerging knowledge, which is at once particular and localized, and yet transferable to other persons and contexts by means of reflective self-inquiry of the audience.

What is the Narrative Inquiry process?

In our experience of Narrative Inquiry, a research phenomenon arises from a personal–professional dilemma or puzzle. Considerations of the audience for the inquiry are foregrounded throughout the iterative inquiry process: To whom does it matter and how? Our narrative interviews and creative activities have been conducted in schools, healthcare organizations, libraries, and participant homes. Participants recruited for Narrative Inquiry may be known to the inquirer (purposive sampling), such as colleagues or students, or may be persons previously unknown. By definition of the research phenomenon, and according to ethics approval, participants self-select to contribute to the inquiry. They are interested in the experience being explored, usually are implicated in it autobiographically and willing to discuss their perspectives. In-depth narrative interviews are held over a length of time and the number of participants may be one, as in a researcher self-study (Shields, 2005), two including the researcher, or more. Narrative interviews can be held with one participant at a time or with small groups.

The purpose of Narrative Inquiry research is the desire for a more holistic exploration of the chosen phenomenon: its depth and breadth. Relational ethics guides each element of the inquiry process (Clandinin & Connelly, 2000), such that consideration of consequences for participants’ lives is always a fundamental concern. The inquiry starts with an open-ended request to share experience of the research phenomenon. By listening attentively, paraphrasing back to ensure understanding and asking clarifying questions, the narrative inquirer learns what the participant has to share about the inquiry puzzle. Although there is a lot of movement backwards and forwards in a Narrative Inquiry, this stage is usually identified by the gathering of fragments of stories or field text. While earlier literature review to establish the need for the inquiry has been completed, ongoing visits to the literature are iteratively made to explore concepts and theories relevant to what is emerging in the conversations. Often the narrative inquirer will return to participants with stories, interim text, constructed from interviews, transcripts, and field notes so that the story can be affirmed, challenged, or extended.

In order for participants’ stories, field text and interim text, to be transformed to research text, the interim text needs to be examined using the three levels of justification: the personal, the practical, and the social (Clandinin & Connelly, 2000). After many years of working with Narrative Inquiry, we have come to view the levels of justification less as a hierarchical process (which the word “level” suggests to us) and more as concentric circles. For us, this image aligns more accurately with the philosophical underpinnings of Narrative Inquiry. In other words, we begin with the personal response to the stories, move to the practical or professional perspective, and finally consider the larger whole, the social; each mutually informing. Each analytic concentric circle of justification sheds light on how participants’ storied experiences inform the inquiry puzzle. Temporality is a quality of narrative that recognizes the holographic nature of reflecting on and reconstructing experience through the analytic process. It is relational and iterative with new knowledge revealed within each circle. Schwind has extended the questions of justification from the initial considerations in the research, which serve to justify the reason for engaging in the inquiry puzzle, into how analysis is conceptualized in Narrative Inquiry. Having discussed her analytic conceptualization with M. Connelly (personal communication, January 30 and February 2, 2015), Schwind illustrates the analytic process, using the metaphor summertime street party, as follows:

Personal justification

For the personal justification, imagine living in an apartment building and there is a street party going on in front of your building. You join the party with all the neighbours, meeting people, making connections, engaging in conversation, listening, and observing. Immersed in the party, you are aware of your thoughts and feelings in an immediate way. Once you have a sense of completion, you go back to your apartment.

During this first circle of analysis, we are prompted by fragments of participants’ stories to enter into our own inquiry. We accomplish this by reading and re-reading participants’ stories, listening to the audio recordings, and reviewing the field notes, while we reflect on our personal life experiences, thoughts, feelings, tensions, observations, and insights related to the narrative interview. Such insights, along with our personal experiences, may be intertwined throughout the participants’ stories, to visually appear as a dialogue (Aksenchuk, 2013, Gaudite, 2015; Sharma, 2015; Walji, 2014), or it could be written as a reflection prompted by participants’ stories, for example, in the form of a letter (Manankil-Rankin, 2015). The choice of how to represent this circle of justification is influenced by the emergent understanding of the inquiry puzzle.

Practical justification

After you leave the street party, you return to your apartment on the tenth floor and look over your balcony at the street below. Now, having stepped away from the festivities, you see the party in the context of your street and the neighbourhood. Observing the goings on, you wonder how far the noise of the party can be heard. You imagine there are people who did not attend and wonder how they are experiencing the music and the noisy conversations.

In this second circle of analysis, we discern emerging narrative threads within and across the stories, which, upon further reflection become visible as narrative patterns. We then consider these within the professional context of nursing by asking: What further reflection and inquiry are we drawn into by these emerging patterns? Simultaneously, the narrative inquirer seeks literature relevant to the emergent patterns in order to deepen understanding of the phenomenon under investigation. Concurrently, we also consider various theoretical frameworks and choose the one that would best illuminate the inquiry puzzle. As Narrative Inquiry is a qualitative research approach, the revelations and the learning possibilities are vast.

Social justification

You now decide to go to the rooftop garden on the twenty-first floor of your apartment building to take a look at the street party from that vantage point. From this perspective you see the party as a small conglomeration of people on the street. The music is still audible, but much more distant than from earlier viewing positions. Now you see the street party contextualized within the larger city landscape.

What earlier seemed all encompassing (the immediacy of the personal justification) now is contextualized beyond the immediate neighborhood (the second justification) and examined within the greater city space and surrounding area. From this vantage point, the inquirer has a global perspective on the party and its impact on the social environment. We can ask questions such as: How does a street party in my neighborhood inform the greater sociopolitical wellbeing of the city at large? What difference does it make to have a street party in a city with so many issues? and so on.

In this third circle of analysis, the social justification, we delve deeper into research literature that expands beyond the nursing profession and interrogate the purpose of the inquiry puzzle: What is it teaching us and to whom, and in what circumstances would this be important? As we deliberate on the significance of participants’ stories within the greater social context, we explore how the gained insight about the investigated phenomenon contributes to the expansion of inter-professional and inter-disciplinary knowledge. It is worthwhile to reiterate at this point that, throughout the three concentric circles of analysis, the narrative inquirer is continuously examining the inquiry puzzle through the three commonplaces: temporality, sociality, and place (Connelly & Clandinin, 2006).

Following the three circles of analysis, the reconstructed stories (narratives) are then represented in a relevant form (prose, poetry, fine arts, etc.) to illustrate the knowledge gained through the investigative process of Narrative Inquiry. In this way, participants’ stories are given voice, and as such have the potential to inform care practices across the health-care system and beyond. As inquirers, we are also concerned on how we would evaluate rigor of a Narrative Inquiry. According to Clandinin and Connelly (2000), a good narrative would have “an explanatory and an invitational quality, [an] authenticity, adequacy and plausibility” (p. 185). So, we would ask the questions: Are the narratives authentic and true to the participants’ experiences as they told them? Are the narratives written, examined and explained in a sufficient enough manner to be adequate and logically plausible. As for invitational quality, we believe that Narrative Inquiry is working when the audiences are prompted to enter their own inquiry, asking questions about their own practices and about their own way of being in the world.

Context: Where would we use it?

We have conducted various Narrative Inquiry studies, with nurse-teachers (Lindsay, 2005, 2006b; Lindsay, Kell, Ouellette & Westall, 2010; Schwind, Cameron, Franks, Graham, & Robinson, 2012; Schwind, Beanlands, et al 2014; Schwind, McCay et al, 2014), with students and nurses in a variety of clinical settings (Lindsay, 2008b; Lindsay & Smith, 2003; Schwind, Zanchetta, Aksenchuk, & Gorospe, 2013; Schwind, Lindsay et al 2014; Schwind, Santa Mina, Metersky, & Patterson, 2015), and with patients in hospitals and in community (Lindsay, 2011; Schwind, Fredericks, Metersky, & Gaudite Porzuczek, 2015). Schwind’s focus is illuminating the humanness of care and Lindsay’s relates to showing how identity and knowledge are constructed, both relevant in professional practice and education.

We are working with graduate students undertaking Narrative Inquiry puzzles at three different universities. We meet with them in a Narrative Inquiry Works-in-Progress group, much as Michael and our peers did with us, when we were graduate students. Our students are on a scholarly trajectory from conducting their respective inquiries, successfully completing their graduate studies, to disseminating their research findings through conference presentations and publications. Our bimonthly meetings, usually 4 to 6 hours in length, consist of a check-in, discussion of students’ inquiry processes, including their writing, discoveries, and sharing of resources. We often engage in rigorous discussions as individual group members puzzle through dilemmas, a process which is mutually supportive and educational.

Our students’ research is highlighted below to show how Narrative Inquiry, as a qualitative research methodology, is transferable to diverse participants and settings. All of the research presented has significance for policy development and within the domains of healthcare, and specifically nursing: practice, education, administration, and research.

Kateryna (Aksenchuk) Metersky, as a novice nurse in an acute care hospital, often worked within interprofessional care (IPC) teams. Personally, she encountered IPC as a family member. It is these interactions that piqued her curiosity to delve into the literature on this relatively new care model. Using Narrative Inquiry, she explored patient’s experience of receiving IPC. Three narrative threads, which demonstrate what is important to patients when receiving IPC, emerged: clear communication, patient role within the IPC team, and professional membership of the IPC team (Aksenchuk, 2013; Metersky & Schwind, 2015).

Neelam (Walji) Walji-Jivraj’s passion for the arts motivated her to create an artistic instrument, which could be used in teaching patients or families, and peers, about Cystic Fibrosis. This led her to explore, using Narrative Inquiry, nurses’ experiences of creating their own artistic instruments, and what meaning these hold for their practice and their identity as caregivers. The inquiry revealed six narrative threads: empathy, quality of life, communication, power imbalances, and personal and professional development. The findings emphasize the importance of person-centered care and the value of reflective practice in how nurses live out their practice (Walji, 2014).

Poonam Sharma’s interest to explore the experiences of Punjabi immigrant mothers stems from her own personal experience as a young Punjabi woman. Today, in her role as a public health nurse, she works with immigrant women to provide prenatal education. It is in that context that she noticed many Punjabi immigrant women had trouble expressing their feelings in the postpartum period. Poonam wondered about their postpartum experiences and how they understood postpartum depression. The connecting narrative patterns that emerged from her participants’ stories are the following: the transition to motherhood, relationships, and loneliness (Sharma, 2015).

Louela Manankil-Rankin, as a nursing professor, wondered how her students would be able to live out their values when others within their workplace environment responded in ways that were incongruent with their sense of what matters. To understand this phenomenon more fully, she explored how nurses experience living their values amidst organizational change. This study revealed that the conceptual lens of stories provides a unique perspective of viewing familiar stories from practice. Four narrative terms emerged: stories in a parade, disruptive stories or stories to change, process for re-storying, and stories to commit by (Manankil-Rankin, 2015).

Victoria (Gaudite) Porzuczek witnessed nursing leadership practices every day in the operating room (OR), yet the voice of perioperative nurses and their leadership stories remained largely underrepresented in the nursing leadership literature. This led Victoria to explore how perioperative nurses experience point-of-care leadership in the OR. Through storytelling, drawing, and metaphors, the research text revealed the narrative patterns of advocacy, relationships, teaching and learning, and communication. Victoria then developed the concept of person-centred point-of-care leadership (Gaudite, 2015) to capture the point-of-care leadership practices that are informed by person-centred care.

Nicole Kruczek’s passion in nursing is disability research, specifically understanding how disability and educational supports are experienced by those who use them. Her Narrative Inquiry puzzle was “How does an Ontario Practical Nursing Program graduate, with a diagnosed disability that impacts learning, experience private tutoring?” Findings reveal four narrative threads: barriers to access, stigmatization, individuality in education, and paradoxical conflicts among caring professions. Her research also highlights the importance of reflective practice, barrier-free inclusive education, and the need for further research into tutoring practice, education, and policy (Kruczek, 2016).

Elizabeth Suen, using arts-informed Narrative Inquiry, explores how an older Chinese immigrant experiences depression. Her interest in this phenomenon started with her grandfather, who lived with depression during the final years of his life. Her research is further informed by her experience of depression and awareness of the stigma of mental health challenges in Chinese immigrant communities, leading to underutilization of mental health services. The told stories of an older Chinese immigrant living with depression inspired a questioning of the hegemonic distinction between the “progressive West and oppressive non-Western world” (Rosenlee, 2014, p. 316) in North American mental health-care practices.

Megalai Thavakugathasalingam, at age 13, read Sadako and the Thousand Paper Cranes (Coerr, 1977). She realized a new-found appreciation for the meaning of her life and an awareness that anyone, at any given time, can be diagnosed with cancer. She did not understand the impact of cancer or the complications associated with the disease. Now, as a Health Sciences graduate student, she is exploring the experience of a survivor of childhood cancer to explore the inquiry puzzle, “How is experiencing childhood cancer biographically meaningful?”

Significance

Narrative Inquiry, as a relationship, process, and phenomenon, illuminates the experience of people related to an inquiry puzzle. It makes transparent how assumptions, values, and beliefs inform our worldviews. It is possible to challenge the taken-for-granted through reflecting on and reconstructing experience. Within a relational ethics framework, people (inquirer, participant, reader) are invited to see choices that were previously unknown. In this way, Narrative Inquiry is educative and transformative. It is a way to show practice-based theory development and how the personhood of each individual (researcher, nurse, teacher, policy maker) contributes to patient care, student education, and policy development.