ARTICLES

 

Drowning in muddied waters or swimming downstream? : A critical analysis of literature reviewing in a phenomenological study through an exploration of the lifeworld, reflexivity and role of the researcher

 

 

Jane Fry^I; Janet Scammell^II; Sue Barker^III

^ISenior Lecturer in Midwifery, Faculty of Health and Social Sciences Bournemouth University, England. E-mail address: jfry@bournemouth.ac.uk
^IIAssociate Professor of Nursing, Faculty of Health and Social Sciences Bournemouth University, England. E-mail address: jscammell@bournemouth.ac.uk
^IIILecturer in Mental Health, Department of Psychology Cardiff University, Wales. E-mail address: BarkerS7@cardiff.ac.uk

 

 

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ABSTRACT

This paper proceeds from examining the debate regarding the question of whether a systematic literature review should be undertaken within a qualitative research study to focusing specifically on the role of a literature review in a phenomenological study. Along with pointing to the pertinence of orienting to, articulating and delineating the phenomenon within a review of the literature, the paper presents an appropriate approach for this purpose. How a review of the existing literature should locate the focal phenomenon within a given context is illustrated by excerpts from the first author's literature review within a descriptive phenomenological study. Also discussed is the important issue of when the researcher should fully enter the attitude of the phenomenological reduction and how this may influence the study.

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Introduction

Undertaking a literature review in a qualitative study has been the subject of much debate in terms of not only when it should occur and how extensive it should be, but even whether it should be avoided entirely. Disagreement in these regards has been particularly evident in relation to the methodologies of grounded theory and phenomenology (Dunne, 2011; Finlay, 2011). The issue has further been confused by the lack of definition and interchangeable use of various terms for this review, such as systematic, rapid, scoping, meta-analysis, systematised, umbrella and overview (Grant & Booth, 2009). Regardless of the term used, the thrust of the debate is that researchers may be influenced by an examination of the applicable literature and research and consequently may limit the research focus and the range of themes identified as relevant. The implications of this debate have particular resonance in the context of descriptive phenomenological studies and in relation to the phenomenological attitude adopted by the researcher towards "the thing itself" under study. This, however, needs to be weighed against the ethical demands of conducting original and rigorous research. A further concern for the phenomenological researcher is when to fully enter the attitude of the phenomenological reduction. Compounding these issues is that there is little available in the literature to guide the novice researcher on how to undertake a literature review in a phenomenological study. The novice researcher needs guidance with regard to both the process of orienting to, articulating and delineating an experiential phenomenon of interest, and also the attitude the researcher adopts in the course of undertaking these processes.

The aim of this paper is to explore the current debate and suggest a way forward for the phenomenological researcher, and in particular novices. This is with a concern both to provide an ethical and rigorous justification of the study and simultaneously to uphold phenomenological principles. In order to contextualise the procedure proposed, this paper includes a reflective analysis of the process of undertaking a literature review as illustrated by the first author's descriptive pheno-menological doctoral study of the phenomenon of "midwifery intuition". It is hoped that this paper will serve to guide the novice researcher through the "muddied waters" of undertaking a literature review in a phenomenological study and will enable him or her to "swim downstream" in order to demonstrate rigour in ethically justifying the phenomenological study undertaken.

 

The Debate Surrounding Literature Reviews in Research

It could be argued that a literature review constitutes an integral part of the research process in both the qualitative and the quantitative paradigm, given that it serves to inform the researcher of the present state of knowledge on the topic to be investigated. It also provides the researcher with valuable information regarding the methods used in previous studies that might influence the present approach, and locates the proposed inquiry within the context of previous research. Essentially, it facilitates the discovery of gaps in knowledge to provide a rationale for the research (Cluett & Bluff, 2000/2006; Todres & Holloway, 2006). Rees (1997/2003) has advocated that a literature review should contain not only description and analysis of, but reflection on, what the literature contains, and how it all relates to the question the researcher is seeking to answer. In the quantitative paradigm, its is usual for a rigorous structured review (generally referred to as a systematic review) to be undertaken, but it can also be what is termed a critical review (Grant & Booth, 2009). This is a very detailed review that follows explicit criteria for inclusion and exclusion (Aveyard & Sharp, 2009/2011). Jesson, Matheson, and Lacey (2011, p. 12) define this systematic approach as a review with "a clear stated purpose, a question, a defined search approach, stating inclusion and exclusion criteria, producing a qualitative appraisal of articles".

In the case of the qualitative paradigm, however, given its more flexible approach, other methods may be better suited, such as a traditional or conceptual review (Jesson et al., 2011). These terms, along with others used for this research activity, will be defined later in the paper. Undertaking a literature review within the qualitative paradigm will first be explored in a more generic way before moving on to more specifically addressing phenomenological concerns.

 

The Literature Review within the Qualitative Paradigm

It has on occasion been proposed, mainly with regard to phenomenological and grounded theory research approaches, that a literature review should be avoided in an attempt to elude being "contaminated" by previous research knowledge (Dunne, 2011; Rees, 1997/2003). The main premise of this assertion is that researchers are susceptible to being influenced by an examination of the applicable literature and research, and consequently may limit the topics and issues included when engaged with data collection (Dunne, 2011). This paradox is described by Kumar (1999/2014, p. 48) who argues that a literature review can "condition your thinking about your study and the methodology you might use, resulting in a less innovative choice of research problem and methodology than otherwise would have been the case".

For this reason, a systematic literature review involving an in-depth critical examination of the existing literature is often not undertaken at an early stage in the research. Utilisation of the applicable literature available plays a greater role, however, in data analysis, where it is drawn on to support and place in comparative perspective the researcher's analyses and findings (Rees, 1997/2003). Morse (2012), however, has been critical of this stand-point and strongly advises against avoiding a robust literature review, controversially suggesting that, in the conscientious pursuit of remaining unbiased and so avoiding a literature review, most qualitative researchers commence their inquiries anew: "almost everyone begins inquiry at a new, fresh starting line, deliberately ignoring previously conducted research, qualitative or other" (Morse, 2012, p. 116). It is of note that she does not provide evidence for this assertion of "almost everyone" or state where this beginning point is in the research process. Instead, Morse (2012) supports her argument on the basis that qualitative researchers tend to over-emphasise the importance of working inductively or bracketing. It is acknowledged that she here utilises the term "bracketing" to refer to qualitative research generically, and is not specifically referring to the phenomenological bracketing or epoché (Wertz, 2005). Morse (2012) queries the process of researching anew and asserts that researchers risk limiting the rigour and quality of their inquiries if they avoid previous research. She further warns that there is the danger of replication of a previous study, which consequently challenges inductive processes and threatens validity. Again, she does not justify this comment. There also remains the ethical dilemma of replicating a study and wasting individuals' time, along with institutional resources and funding. It is, however, acknowledged that there is a difference between not undertaking a systematic, critical literature review as opposed to entirely avoiding all applicable literature.

Whilst Morse advocates undertaking some sort of literature review, conversely Cluett and Bluff (2000/ 2006) concur with Rees's (1997/2003) notion of "contamination" and go as far as to suggest that, in order to ensure validity within a qualitative study, a review of the literature should be postponed and a research area selected with which the researcher is unfamiliar. The specific type of literature review they are referring to is, however, not clarified. What must be taken into consideration is that the qualitative paradigm is underpinned philosophically by the principle that science cannot be devoid of human subjectivity (Habermas, 1968/1971). Cluett and Bluff (2000/2006) argue that, rather than being driven by subjectivity, qualitative research is concerned with relationally developing understanding. This argument neglects to acknowledge the ethical and political implications of the view that the dynamics of qualitative research are inherently relational. The notion of "relational" research has been championed by Wertz (2011, p. 84), who defines relational inquiry as research that "inevitably includes and expresses the orientation, methods, values, traditions and personal qualities of the researcher".

Wertz's assertion suggests that it is almost impossible to have a complete absence of personal knowledge or bias in relation to a phenomenon. Alongside Morse's (2012, p. 116) argument that an over-emphasis tends to be placed on "working inductively" or "bracketing" what is already "known" in order to prevent bias, arguably this has resulted in researchers producing research that is both superficial and naïve. There is also the pragmatic issue that, in order for research to be undertaken, it will need to gain ethical approval. In terms of the standard ethical requirements, a literature review is a mandatory component of a research proposal. These considerations lead us to conclude that it is indeed necessary to undertake some type of literature review in qualitative research and, since knowledge and understanding are considered relational, that contamination is unavoidable. Qualitative research literature having been used as a context for general discussion of the issues, these will now be considered more specifically in relation to the methodological demands of descriptive phenomenology.

 

The Concerns of the Phenomenological Researcher

Following an analysis of the debate concerning whether a literature review should be undertaken in qualitative research, we have concluded that some kind of review of the literature is indeed necessary and that avoiding "contamination" is impossible. In this regard, it needs to be acknowledged that, whilst proceeding inductively may be of concern in the context of other qualitative methodologies, descriptive phenomenologists employ a method whereby their previous knowledge (which includes the perspective gained from a literature review) or predisposition is made transparent (Giorgi, 2012). This preliminary research process involves orienting to (Van Manen, 2014), delineating (Wertz, 2005) and articulating (Todres, 2005) the experiential phenomenon of interest to the researcher. We will argue that the articulation of this initial interest begins within what Husserl called the "natural attitude" and then moves into the "phenomenological attitude" in an intentional way at a particular stage of the research process. A type of literature review that can accommodate specifically phenomenological concerns needs to be identified. In order to ensure methodological rigour, this method of review will therefore need to be underpinned by the principles of Husserlian philosophy.

 

Husserl's Phenomenology

Before considering the identification of a phenomenon for study and formulating a research question for a literature review, it is important first to consider the philosophy underpinning descriptive phenomenology. For this purpose, it is necessary to turn to the founder of modern phenomenology, Edmund Husserl (1930/ 1980). Husserl originally focused on mathematical concerns, and, in the first part of one of his seminal works, Logical Investigations, he sought to comprehend the relationship between numbers and what they represented. In the course of this exploration, he became disillusioned with the abstract quantitative nature of mathematics and questioned what numbers were related to (Dahlberg, Dahlberg, & Nyström, 2008). He asserted that the "whatness" of a phenomenon was the most essential thing to consider, and this by its nature involved a qualitative dimension (Dahlberg et al., 2008). The qualities of a phenomenon could be elucidated only by obtaining descriptions from the "lifeworld". This Husserl later defined as "the world as immediately or directly experienced in the subjectivity of everyday life" (Husserl, 1900/1970). Husserl perceived the lifeworld in Diltheyan terms as seamless and relational, where everything is interconnected. He asserted that, in order to reach the essence of a phenomenon, it was necessary to describe, and not measure or explain, its qualities as they were experienced in the lifeworld. This illuminates the focus of the phenomenological question on the "whatness" or "quiddity" of a phenomenon. Quiddity can be defined as the inherent nature or essence of some "thing", or, more simply, the qualities that make "the thing" what it in essence is in itself. Proceeding from this understanding, the phenomenological researcher must focus descriptively on how the phenomenon is experienced qualitatively.

The task of the phenomenological researcher is thus to identify a topic, concept or phenomenon and describe its presence within the lifeworld (Wertz, 2005). This begins with identifying or delineating the phenomenon. This occurs in the researcher's natural attitude. What must be made clear at this juncture is the Husserlian distinction between the "natural attitude" and the "phenomenological attitude".

 

The Natural and Phenomenological Attitudes

Husserl's distinction between the natural attitude and the phenomenological attitude is key to comprehending our understanding of the world. An earlier philosopher, Dilthey, is helpful in indicating how our initial "taken for granted" understanding of ourselves and life begins in what Husserl later called the natural attitude, which is replete with personal and historic interests (Churchill & Wertz, 2001/2015). Dilthey conceptualised how we are already enmeshed within the life we are trying to comprehend, as we are already grounded in, and have, a pre-existing life. Giorgi (2009, p. 87) has described this as the "attitude of everyday life, the attitude that one displays in the everyday world where most things are simply taken for granted".

Conversely, the phenomenological attitude is where nothing is taken for granted, where one questions and suspends the "taken for granted" and "how things are", and adopts a more reflective perspective that acknow-ledges that any phenomenon is always appearing within a particular subjective context.

The process of delineation should clarify both the vantage point or unique perspective of the researcher and his or her embeddedness within the "natural world" of concerns and interests, as well as reviewing the academic literature in order to establish the current status of knowledge and scholarship concerning the subject. This process enables the researcher not only to define the research area, aims and objectives, but, as Wertz (2005, p. 170) asserts, to discover "some gap between knowledge and reality that requires qualitative knowledge, that is, an understanding of what occurs. Research is then designed to solve the problem, fill in the gap, and overcome the flaw".

What this process involves in terms of concrete phases will now be considered, commencing with the first steps of orienting to and delineating the phenomenon, and then detailing the process of undertaking a literature review for a phenomenological study. The proposed phases outlined in the following section are based on the acknowledgement that an interest in a phenomenon begins within the natural attitude or "from an everyday perspective" (Giorgi, 2009, p. 180). This is opposed to the phenomenological attitude, which comes into operation later, where the focus of the researcher is on "how the participant lived in the situation" (Giorgi, 2009, p. 180). It has already been established that the phenomenological methodology provides a means of making the researcher's own predispositions and prior knowledge explicit and transparent. To ensure rigour in a phenomenological study, achieving transparency of personal interests requires three steps methodologically. Each of these steps will be given context by the inclusion of reflective examples from the first author's doctoral dissertation.

Step 1 - Orienting to the Phenomenon

Before the delineation of the phenomenon occurs, a phenomenological research study must necessarily begin with "wonder". Van Manen (2014, p. 13) defines this as a process of "questioning the meaning of life as we live it", pointing to the capacity of wonder to "dislocate and displace" a phenomenon and enable reflective insight. Van Manen (1990, p. 40) goes on to conceptualise this initial wonder or interest as the "orientation" to the phenomenon. Orientation to the phenomenon also involves the description of the "vantage point in life" (Van Manen, 1990, p. 40) from which the researcher is viewing it. To exemplify this, as both a midwife and an educationalist, the first author subjectively orients to life and the research phenomenon from this dual professional vantage point. Van Manen (1990) asserts that, to be phenomenological, this interest in or wonder about the phenomenon must be experiential, or related to the human experience. The starting point, therefore, of an orientation to the phenomenon is for the researcher to find a phenomenon of interest and ponder its meaning in relation to lived experience. Ethically, the academic researcher must focus on a phenomenon that is both relevant and interesting within its field.

The focal phenomenon in the first author's doctoral study is midwifery intuition. This was considered both relevant and interesting, as intuition has been hailed for its role in advancing contemporary midwifery practice and education (Brown, 2006; Davis-Floyd & Sargent, 1997; Wickham, 1999). The fact that there was found to be a dearth of evidence for this in the existing literature and research in the field of midwifery provides the justification for this study (Fry, 2016). Within her area of work, in both education and practice, the author has always had a fascination with the notion of intuition. To summarise, the first step is to find a phenomenon of interest that is enmeshed with the lifeworld and is research-worthy. Having established an interest in and an enmeshment with, for example, the phenomenon of intuition, the next step involves the delineation of the phenomenon. The second step therefore extends this initial interest to a more formal process of locating the phenomenon in academic scholarship, as well as within the researcher's personal and professional interests.

Step 2 - The Articulation of the Phenomenon

Wertz (2005, p. 170) defines this process as "locating and delineating" the presence of a phenomenon, the importance of which is emphasised by Todres and Holloway (2004, p. 84). They, however, utilise the term "articulation of an experiential phenomenon of interest". During this stage, researchers may "acknowledge and make explicit their initial interest and agenda" (Todres & Holloway, 2004, p. 84). This stance is underpinned by Husserl's (1913/1931) assertion that the beginning of understanding is informed by human "embeddedness and participation in experiential life" (Todres & Hollo-way, 2004, p. 83). What this implies is illustrated by the first author's interests and agenda for her study. The focal phenomenon, midwifery intuition, had arisen out of a multitude of contextual factors, including personal experience from the vantage point of practising as a midwife, a converging interest in women's ways of learning, and practice knowledge as an educationalist. It had also arisen out of a professional context in which intuition had become marginalised within health care and midwifery practice due to the hegemony of evidence-based practice (Scammell & Stewart, 2014).

Whilst the phenomenologically inclined researcher has to be mindful of, and make explicit, personal interests and agendas, a more "disciplined" transparency of theoretical interests is also necessary before formulation of the research question (Todres, 2005). It is asserted that a literature review in a phenomenological study plays a role in making clear not only the academic need to study the phenomenon, but also the researcher's interests and agenda in approaching the study. From this reflection, a phenomenological research question is formulated to form the basis of the research study, orienting it towards achieving its phenomenological aim to offer an understanding of the nature or "whatness" of the phenomenon. The description of this whatness should address the boundaries of the phenomenon, the commonalities and differences between it and other connected phenomena, and how it exists in the lifeworld (Wertz, 2005). In the next section we will consider what kind of literature review is necessary to make transparent the specifically academic and professional interests vested in the phenomenon, in the process enabling further "locating and delineating" of its presence.

Step 3 - Delineating the Phenomenon through Academic and Professional Interests

Delineating the phenomenon needs to be undertaken in relation to the specific context or lifeworld in which it is to be studied; which context, as already identified, includes the researcher's natural attitude interests and concerns, as well as academic and professional interests and concerns. This can be established by reviewing the literature in an intentional way in order to become informed about the current state of knowledge, theories and unanswered questions or gaps in knowledge about the topic to be studied (Aveyard, 2010). In reviewing the literature, the researcher may also choose to focus on historical, policy and practice issues relevant to the phenomenon. A literature review in a phenomenological study is furthermore guided by a lifeworld concern (Wertz, 2005). Todres and Holloway (2004, p. 84) point to this as requiring that the researcher "locate the topic and the subject matter in a general way that can connect to everyday human concerns and directions". To embark on this process, a range of literature review methods will now be considered, and a selection will be made of a model that would seem best suited to the aims and ethos of a phenomenological approach.

 

Selecting a Literature Review

The aims of a phenomenological literature review would seem not to be served by a systematic review developed and governed by a differing methodology (Jesson et al., 2011). Such a review conventionally involves a technical, rational, standardised process that aims to provide neutrality and objectivity. As such, it can be seen to fit seamlessly within the quantitative paradigm (Jesson et al., 2011, p. 15). Jesson et al. go on to state that "a more qualitative open paradigm" such as a phenomenological approach requires a more open and flexible method. Various methods have been identified to support the researcher in a systematic review of the current state of knowledge, such as critical review, meta-analysis, scoping review, rapid review, and systematic review (Grant & Booth, 2009). Since most of these methods are rigidly boundaried and highly structured, they do not offer the open flexibility that is required. Whilst database searches can use MeSH¹ words that can be exploded and so forth, identification of key words, hits, and a hierarchy of evidence is still expected.

One of the broader methods of reviewing the field literature is the traditional approach, identified by Grant and Booth (2009) as the most detailed review, which generally adopts a critical stance aimed at assessing theories or hypotheses (Jesson et al., 2011). This method of review essentially critiques the methods and results of research studies and includes a focus on the contextual details of the study (Jesson et al., 2011). The contextual depth of previous studies can be seen to be relevant within a phenomenological study, as it links with "human concerns and directions" (Todres, 2005). The critique of methods and results does not, however, serve to explore in depth the academic and professional interests and agendas implicated, so this type of search could lead to a narrow focus despite being more flexibly open than the classic quantitatively structured systematic review. One genre of review that does serve to remedy this is the conceptual review. The conceptual review aims to blend areas of conceptual knowledge, which aids comprehensive understanding of the phenomenon being explored (Grant & Booth, 2009; Jesson et al., 2011). This method has at its core the purpose to "compare and contrast the different ways in which authors have used a specific word or concept" (Jesson et al., 2011). A conceptual review of the available literature provides a method to explore the state of knowledge of a phenomenon, but also vitally ensures that the phenomenological researcher is fully aware of the shared meaning and understanding of the words used within his or her area of research. To put this assertion in concrete context, an example will now be presented of how a conceptual review was undertaken. This is to be followed by a brief discussion of how the researcher then enters the phenomenological reduction with, and after, this accumulation of knowledge.

 

Delving into a Conceptual Review

The conceptual review is useful for clarifying terms that are often used in a confused way (Jesson et al., 2011). Different disciplines frequently differ in both their understanding of and nomenclature for concepts or phenomena within the lifeworld (Dunne, 2011). This was found to be the case with the inquiry into intuition in midwifery. Defining intuition is fraught with difficulties (Olafsdottir, 2009) and, by attempting to do so, there is a danger of restricting its full and complex meaning, particularly in respect of how it may relate to mid-wifery practice. An initial foray into the literature was undertaken with the intention to examine concepts and meanings of intuition and how they were utilised in midwifery practice. This process generated the following terminology: intuition, patterning, know how, intuitive-humanist theory, inner knowing and knowledge, tacit knowledge, habitus, reflection in action, reflexivity and practice, and embodied knowledge. A further exploration was then undertaken using these terms. This conceptual review of the field literature highlighted that intuition has been researched and conceptualised in clinical nursing practice. Evident, however, was the absence of research on the use of intuition in midwifery in the United Kingdom. Only two studies were found: one conducted in the United States of America (Davis-Floyd & Davis, 1997), and one in Iceland (Olafsdottir, 2009). A further critique of the literature cemented the findings of the review of the literature on intuition into two main themes: firstly, intuition based on patterning, tacit knowledge and habitus, reflection and reflexivity, and, secondly, intuition based on connective ways of knowing and embodied knowledge. In the course of this initial conceptual review, it became apparent that intuition was of wider concern outside health care, which led to the concept being explored in psychology as well. Whilst the work of the Nobel Prize winner Daniel Kahneman (2012) and others is acknowledged, it does not form part of this stage in the phenomeno-logical conceptual review of intuition.

The above example of a conceptual review illustrates how the notion of intuition was "exploded", illuminating different concepts within healthcare and education, the personal interests and agenda of the first author. This process served to explore the boundaries of the phenomenon within the literature. To illustrate the conceptual review, an excerpt will be presented. This concerns one of the themes illuminated by the review: intuition based on patterning, tacit knowledge and habitus, reflection and reflexivity:

There is no consensus in the literature in terms of the role and meaning of intuition. Johns (1998, p. 2) defined intuition as "tacit knowing" and visualises reflection as a means of access to previous experiences in order to develop "the reservoir of tacit knowing". Intuition has similarly been defined as "know how", consisting of tacit knowledge associated with a created understanding of a situation without having a rationale (Benner & Wrubel, 1989, p. 6). Bourdieu (1977/1990) has coined the term "habitus" to describe the tacit knowledge that inhabitants of a culture or health professionals create within complex practice. Bourdieu asserts that, as practitioners develop a habitus which involves taken for granted meanings, knowledge and skills, it recedes to the background; Benner et al. (2010, p. 178) have termed this "patterning". Wickham (2004) explores this notion, asserting that patterning is the subconscious recognising the situation but the rational brain not recognising the same signs or pattern. Benner (1984, p. 2) defines patterning as "expert know how" based on an experiential knowledge base. She based her notions of expertise on the works of Dreyfus and Dreyfus (1986), who were working in the field of artificial intelligence and came to the conclusion that human "experts" process information entirely differently from computers. In her seminal study of American nurses, she concluded that intuition could be diminished if intuitive or "expert" practitioners tried to analyse their performance (Benner, 1984). She asserted that this "know how" consisted of knowledge that did not follow a linear process and could not be expressed in words (Benner & Tanner, 1987). Rolfe (1998, p. 28) and Schön (1983) contest this, arguing that intuition is "reflection-in-action" that can become a conscious act. Benner et al. (1999) refute this and assert that, whilst a practitioner may adopt a process of thinking in action, this is related to a narrative understanding, not an intellectual, reflective process. Whilst I sanction Benner's idea that intuition is difficult to rationalise, I also concur with Rolfe that, if intuition can be a form of authoritative knowledge in mid-wifery (Davis-Floyd & Davis, 1997), it is vital that it can be rationalised, or at least explored and described, within lifeworld contexts so as to provide further learning and knowledge transfer. (Fry, 2016, p. 56)

It can be seen from this excerpt that the conceptual review serves to explore the different ways in which researchers and theorists utilise the term "intuition". This aids the process of locating the phenomenon in the available literature and research, illustrating its aptness as a method of literature review for a phenomenological study. It also helps to delineate the phenomenon. Whilst the term "intuition" itself is not easily discernible, the conceptual literature review highlighted more areas of understanding. From the term "intuition" other concepts were illuminated, such as tacit knowledge, patterning and reflexivity. It is of note that the use of the first person is included within this excerpt both to illuminate the use of self and to serve the purpose of making personal agendas and theoretical interests transparent (Todres, 2005). This transparency is enhanced by then undertaking a personal reflection, enabling the further delineation of the phenomenon by the researcher. In relation to this process, the personal, professional, historical and academic contexts may all be helpful in illuminating the ambiguities and nuances of the term and delimiting the possibilities for formulating a name for the experiential phenomenon.

The excerpt below exemplifies the notion of a personal reflection, and also illustrates how the conceptual review revealed ever more complexity of the phenomenon. On further examination, the term intuition was associated with a spiritual, psychic and emotional connection, as well as with the practitioner's personal background and experience. This provided a larger range of nuances to the phenomenon. A personal reflection on these findings makes the first author's interests transparent and also helps to further delineate the phenomenon:

A seminal study on nurses' experiences of intuition and the emerging concept of patterning (Benner, 1984) appeared reasonable. However, her assertion that this knowledge cannot be analysed means that this knowledge remains tacit and apparently cannot be imparted or reflected on individually. It also appears to place the phenomenon as one dimensional and purely in the realm of recalling previously gained knowledge, albeit tacitly. Rolfe's (1998) notion of reflexivity and reflection in action offers a remedy to unleash the knowledge and illumi-nate it for personal learning and knowledge that can be disseminated; however, it does not describe all dimensions of intuition. Opening the phenomenon into the realm of connection with others implies a relationship or "knowing" of another and offers a further dimension to intuition. Additionally, utilising emotion and acknowledging the cultural and experiential worlds of both practitioners and those they serve broadens the phenomenon and embeds this connection. The utilisation of Polkinghorne's (2004) practitioner judgement informed by a reflective understanding embracing all these concepts provides a way to utilise and explore intuition if it is to be accessed or developed by others. This also suggests an acknowledgement of both past experiences and emotional connec-tions and does not privilege or make absolute one form of knowledge over another. For me this addresses all of the forms of intuition explored and provides a means of unlocking or utilising this tacit knowledge. (Fry, 2016, p. 57)

The above excerpt served to provide some elements of reflexivity and transparency for the study. Finlay (2002, p. 531) has defined reflexivity as a process in which "researchers engage in explicit, self-aware analysis of their own role". This process increases the integrity and trustworthiness of qualitative research by reinforcing its methodological rigour. By illuminating the conceptual complexity of the phenomenon, the reflection above also facilitated its delineation. At the conclusion of the initial conceptual literature review, it appeared that the term intuition provided an umbrella concept for all the various topics identified in the review, and it was therefore selected to name the phenomenon for study. The name of the phenomenon following this process is, however, a provisional term. Giorgi (1985, p. 12) has termed this "circumscribed indeterminacy". The naming of the phenomenon establishes a starting point for the researcher, and the term intuition can be seen as "circumscribed" in that it is referring to a definite bounded phenomenon, "intuition", rather than naming another, for example, "critical reasoning". This initial term, however, develops a quality of "indeterminacy" when it is explored in the lifeworld during the data collection process. The true meaning or "circumscribed determination" of the phenomenon named can be sourced only in people's concrete experiences rather than by means of any singular conceptual or theoretical accomplishment. This is because it is the human experience, as described by the interviewees, that will determine more fully what the named phenomenon means and hence how the term lives.

The naming of an interesting and relevant phenomenon for study therefore arises from a conceptual literature review that additionally clarifies personal, professional and academic interests. Whilst this process is utilised to name and circumscribe the phenomenon, once a phenomenon has been provisionally named, it is not further determined by the review. For this, it is necessary to go to the lifeworld, enter the phenomenological reduction, and allow the "whatness" of the phenomenon to be revealed by lifeworld descriptions. The following section will consider very briefly how to enter the phenomenological reduction with the pre-understanding of the phenomenon gained from the literature review (Giorgi, 2012). This discursive overview will once again be underpinned by Husserlian philosophy.

 

Entering the Phenomenological Reduction

The naming and delineation of the phenomenon following the conceptual review undertaken resulted in the phenomenon of investigation remaining midwifery intuition. The experiential nature of the lifeworld is, however, such that terms refer to experiences that transform into each other and that also have unique resonances for different people. This means that clarifi-cation of this indeterminate part of what is circumscribed can only be achieved by going to people's lifeworlds (Giorgi, 2009). What must be remembered, however, is the need to enter into a phenomenological attitude after the literature review has been completed in order to determine the phenomenon's quiddity in the lifeworld rather than in terms of its preconceived terminology and over-determination by the pre-understandings of the researcher. The phenomenological attitude gives priority to how the phenomenon appears within the life-worlds of research participants. The phenomenological reduction furthermore requires the conscious suspension of imported theories, jargon and external interpretations when the researcher comes to analyse the data. The movement from the "knowing" of the literature review process into the phenomenological reduction at the empirical stage of the research study is underpinned by Husserl's notion of "bracketing", which was initially informed by his meditation on mathematical processes. In mathematics, it is not that an individual does not know "what is in" the brackets, as if historical know-ledge of what they contained has been annihilated. What occurs, however, is that the bracketed information is suspended or put out of play for a period of time. In a descriptive phenomenological research study, this period of time ends at the start of the discussion phase of the research, where personal, academic and professional knowledge is once more returned to and a dialogue ensues between the findings, the initial literature review and a further conceptual review based on the findings.

 

Concluding Thoughts

With regard to the lack of consensus in relation to the qualitative paradigm as to whether or not to undertake a literature review, it has been suggested that under-taking a conceptual review juxtaposed with a personal reflection of theoretical interests offers a way to reconcile the conflicting concerns. Descriptive phenomenology as a specific methodology has been considered within this context. The preliminary stages of undertaking a phenomenological study have been outlined, and the rationale of each stage clarified. Proceeding accordingly warrants that the researcher undertake a preparatory exploration of the dimensions of the phenomenon in order to delineate it. It has been proposed that, within a phenomenological study, this forms an integral part of the literature review and the formulation of the research question. While the making explicit of personal interests and pre-understandings also helps to articulate the phenomenon, the intention of this is not to privilege one form of knowledge over another, but to enable the focal phenomenon to be named in a provisional but relevant way. After this process, the researcher then adopts a phenomenological attitude and explores the phenomenon within a concrete lifeworld context. The next concern for the novice researcher is therefore how to enter the phenomenological attitude, as will be analysed in greater depth in a further publication.

That the first phase of delineating the phenomenon is undertaken from the perspective of the natural attitude accounts for the limitations of the example of a conceptual review provided. When the literature was again reviewed after analysis of the data, further related terms were identified, and the findings in this regard examined in the discussion chapter of the thesis.

There being a dearth of literature focusing specifically on this area, it is hoped that the approach proposed in this paper will prove useful in guiding the novice researcher through the muddied waters of undertaking a literature review in a phenomenological study and enable phenomenological researchers in general to "swim downstream" to ethically justify their own studies with methodological rigour. It must nevertheless be emphasised that this is not the only way to undertake such an endeavour; hopefully, however, presenting it for consideration will initiate further endeavours and debate in this area.

 

Acknowledgement

We wish to acknowledge with sincere thanks the guidance provided by Les Todres, Emeritus Professor of Health Philosophy, Bournemouth University.

 

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1 Acronym for Medical Subject Headings.

 

 

About the Authors

 

 

Dr Jane Fry is a Senior Lecturer in midwifery in the Faculty of Health and Social Sciences at Bournemouth University in England, and was previously a practising midwife in a community setting. Her areas of scholarship and publication include student case loading, the humanisation of midwifery care, midwifery epistemology, and phenomenology.

Dr Fry recently completed her doctoral research at Bournemouth University, with her dissertation entitled A Descriptive Phenomenological Study of Independent Midwives' Use of Intuition as an Authoritative Form of Knowledge in Practice.

 

 

Professor Janet Scammell is an Associate Professor of Nursing in the Faculty of Health and Social Sciences at Bournemouth University in England.

She is an experienced nurse academic with research interests in nurse education and health inequalities affecting older people as well as people from Black and Minority Ethnic (BME) backgrounds. She teaches humanising care issues at both undergraduate and postgraduate levels.

Professor Scammell is a Principal Fellow of the Higher Education Academy and has considerable experience of leading innovative curriculum development. Currently she is leading funded research concerning nurse retention in collaboration with NHS partners.

 

 

Dr Sue Barker is a Lecturer in Mental Health at Cardiff University in Wales. A mental health nurse for over 30 years, she is a Chartered Psychologist and an Associate Fellow of the British Psychological Society.

Dr Barker has a long-standing interest in emotional wellbeing, and her PhD focused on emotional care. Her phenomenological approach to understanding people's emotional experiences has supported both her practice and writing related to person-centred, humanised and compassionate care.