Conducting mixed methods research with women in a forensic mental health setting: A reflexive account from a nurse as researcher.

AIMS: To describe a reflexive account of a mental health nurse as researcher undertaking a mixed methods study as part of a doctoral degree, with women in a secure forensic hospital. DESIGN: A discursive paper that draws upon the primary author's experience of dual roles as a mental health nurse and a novice researcher, and relevant literature pertaining to positionality and reflexivity in the context of conducting mixed methods research. METHODS: A mixed methods study was conducted within a secure forensic hospital in Australia, to identify factors associated with the frequency and duration of seclusion for women and, to explore their experiences of seclusion. Notes and a reflective diary were used to demonstrate the reflexive approach and strategies used throughout the study design and data collection stages of the research. RESULTS: Women in the secure forensic hospital setting often have complex histories and experiences and are considered a vulnerable group, which can add additional challenges when undertaking research with this population. As a doctoral student with clinical experience in mental health undertaking research in the forensic hospital setting with women, positionality and the connection with reflexivity requires exploration to understand self and the influence on research. This understanding along with identified strategies to enhance reflexivity, supports the management of the dual nurse as researcher roles to enhance all stages of the research process. CONCLUSION: Doctoral nursing candidates undertaking clinical research in their area of clinical practice and at the location of previous employment, may experience challenges in relation to identity and the dichotomy of roles. Further challenges can be posed when research involves complex populations and/or controversial practices. Support to balance role conflict and maintain reflexivity is critical to understanding the role of self in research and to enhance credibility. IMPLICATIONS FOR THE PROFESSION AND/OR CLINICAL PRACTICE: Women are a complex, yet minority population in forensic mental health settings, however the numbers of women being admitted to services is increasing. Future research may consider the use of the strategies explored here to enhance the reflexive process, and support future researchers in this field to conduct research that aims to support an often-misheard population to better support health outcomes. PATIENT OR PUBLIC INVOLVEMENT: There was no patient or public contribution to this paper, however the study in which this paper is based on, is grounded in the experience of patients (women).

The Critical Social Processes for Standardising the Ecological Monitoring of Australian Landscapes.

For a long time, ecological monitoring across Australia has utilised a wide variety of different methodologies resulting in data that is difficult to analyse across place or time. In response to these limitations, a new systematic approach to ecological monitoring has been developed in collaboration between the Terrestrial Ecosystem Research Network and the Australian Department of Climate Change, Energy, the Environment and Water - the Ecological Monitoring System Australia (EMSA). A qualitative approach involving focus groups and semi-structured interviews was undertaken to review perceptions of the introduction of the EMSA protocols amongst Natural Resource Management practitioners and other key stakeholders. We found that environmental management stakeholders recognise there will be many advantages from the standardisation of ecological monitoring. However, key concerns emerged regarding the capacity needed to implement the standard protocols, the utility of the resultant data for regional projects, and the scope for adaptive co-management under the EMSA. Stakeholders emphasised the need for autonomy and flexibility, so their participation in protocol development can facilitate regional adoption of the standards. Respondents' concerns about a perceived lack of genuine consultation and acknowledgement of feedback revealed the importance of clear communication at all stages of an environmental management project aiming to standardise practices. Our findings indicate that reflexivity will be vital to address the complexity involved in standardisation of ecological monitoring. Formal processes of social learning will need to be integrated into environmental management approaches to account for the increasing complexity of socio-ecological systems as they are challenged by global change.

"(Not) knowing what you know": Exploring educators' perceptions of critical thinking in occupational therapy.

BACKGROUND: Critical thinking is key for responsible occupational therapy practice. However, the degree to which educators understand critical thinking and the conceptualizations of such concept in teaching remains unclear. AIM: This study aimed to describe occupational therapy educators' perceptions and experiences of teaching critical thinking. MATERIAL AND METHODS: Social constructivism underpins the study. Eight participants were included in three online synchronous focus groups. One participant was interviewed in person due to time constraints. Data were analysed using content analysis. RESULTS: This study reveals a considerable diversity of perceptions and experiences of ambiguity regarding educators' perceptions of what they know about and how to teach critical thinking. Most educators interpret critical thinking in ways that differs from their colleagues. Furthermore, educators encounter divergent expectations pertaining to their role as educators and the readiness of their students. CONCLUSIONS: This study reveal a paradox within the occupational therapy profession, where critical thinking is highly valued yet educators experience ambiguity, differing expectations of their role, time constraints, and lack of formal education to support students' development of critical thinking. SIGNIFICANCE: This study provides the foundation for further inquiry into the invisible effects and benefits of different understandings of critical thinking on occupational therapy practice.

Reflexivity gradient-Consciousness knowing itself.

Some consider phenomenal consciousness to be the great achievement of the evolution of life on earth, but the real achievement is much more than mere phenomenality. The real achievement is that consciousness has woken up within us and has recognized itself, that within us humans, consciousness knows that it is conscious. This short review explores the reflexivity of consciousness from the perspective of consciousness itself-a non-conceptual nondual awareness, whose main property is its non-representational reflexivity. In light of this nondual reflexivity, different types of reflexivity proposed by current theories can be seen as a gradation of relational or transitive distances between consciousness as the knower and consciousness as the known, from fully representational and dual, through various forms of qualified monism, to fully non-representational and nondual.

Dynamics of Freedom: Negotiating Constraints.

In this paper, I grapple with the question of why we, at times, experience ourselves as not free. In doing so I outline a crude theory of agency (and our experience of ourselves as free) as a dynamic process happening in irreversible time. In attempting to answer this question, I define agency as the ability to pursue our desires, and I claim that we experience ourselves as free as long as we can do this - with the caveat that the ability to reason is a necessary criterion. I show that agency is a sociocultural development that manifests as the ability to reason gradually develops through social interaction during infancy and into adulthood. Crucially, I point out that reason is a double-edged sword: It allows us to question our actions and desires and whether they are worth pursuing, which is what elevates us to agentic beings. However, it also allows us to alienate ourselves from our actions and desires, and thus rob ourselves of our experience of freedom. Lastly, I show how our subjective freedom is lost and gained in a constant process, generated by a reflexive-relating-to ourselves. As we act, we continually encounter constraints (physical and psychological) that bar us from acting upon our desires. This compels us to reflect on our actions and desires, and so, our feeling of freedom evaporates. However, through a retrospective forgetting, or reconstruction, of the constraints we encounter, we may regain our experience of being free.

Data science's cultural construction: qualitative ideas for quantitative work.

Introduction: "Data scientists" quickly became ubiquitous, often infamously so, but they have struggled with the ambiguity of their novel role. This article studies data science's collective definition on Twitter. Methods: The analysis responds to the challenges of studying an emergent case with unclear boundaries and substance through a cultural perspective and complementary datasets ranging from 1,025 to 752,815 tweets. It brings together relations between accounts that tweeted about data science, the hashtags they used, indicating purposes, and the topics they discussed. Results: The first results reproduce familiar commercial and technical motives. Additional results reveal concerns with new practical and ethical standards as a distinctive motive for constructing data science. Discussion: The article provides a sensibility for local meaning in usually abstract datasets and a heuristic for navigating increasingly abundant datasets toward surprising insights. For data scientists, it offers a guide for positioning themselves vis-à-vis others to navigate their professional future.

Centering the geographical imaginations of research participants in narrating speculative futures.

In this commentary, I consider how geographers narrating speculative futures might risk disempowering their research participants. Reflecting on my work with community cultural organizations, I discuss the importance of centering participants and their geographical imaginations of their own futures in qualitative research projects. I then consider restructuring researcher-participant voice in the narration of speculative futures, and my use of future-focused questioning.

Ethical and Epistemological Implications of Conducting Ethnographic Fieldwork as a Researcher-cum-Clinician in Brussels, Belgium.

We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one's own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers.

Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university.

BACKGROUND: An array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students' awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students' reflection on the way in which social position modulates their relationship to patients. METHODS: As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students' assignments (n=76), applying a thematic analysis framework. RESULTS: Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias. CONCLUSION: Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.

Shaping understandings through reflexive practice: Learnings from participatory research on aging with multiple sclerosis.

BACKGROUND: Participatory research has gained traction as an approach to unlock perspectives when creating scientific knowledge and to facilitate societal changes. By conducting research with people, participatory research strives to engage individuals' perspectives in designing, conducting, and disseminating the research. Nevertheless, few studies have unpacked how understandings of the studied phenomenon are shaped among diverse research partners and, concurrently, how different perspectives are combined. Nested within an overall participatory mixed methods study on aging with multiple sclerosis (MS), this qualitative study explores how understandings of aging with MS are shaped in encounters between university researchers, older adults with MS, and employees in a patient association. METHODS: The study was collaboratively conducted in Denmark by three research partners: a group of older adults with MS, employees in a patient association, and university researchers. Data on how different understandings of aging with MS were represented and shaped during the three-year research process was generated through field notes, meeting minutes, focus group interviews, and individual interviews. The collected data was analyzed through a thematic network analysis. RESULTS: The study demonstrates how different understandings of aging with MS were represented among the research partners when the research was initiated. These understandings were shaped prior to -and, therefore, outside-the research setting, drawing from the research participants' lived experiences, professional backgrounds, and organizational cultures or situated in larger societal narratives. Through a process centered on reflexivity among the engaged research partners, the understandings of what it means to age with MS was shaped and re-shaped and eventually merged into a more dynamic understanding of later life with MS where different perspectives could co-exist. CONCLUSION: The findings demonstrate that research partners, including older adults with MS and employees from a patient association, brought diverse understandings to the study. Reflexive practices enabled these perspectives to co-exist, enhancing engagement and transparency, and fostering a dynamic understanding of later life with MS. This highlights the value of reflexivity in evolving complex understandings within participatory research.

In recent years, participatory research has been increasingly utilized in various research fields (e.g., aging research) with the ambition of engaging a diverse group of research partners to leverage their perspectives and contributions. This approach aims to form a more nuanced understanding of the studied phenomenon and to identify insights useful for practice However, working in diverse research teams have also been found to be complex, and it is poorly understood how the perceptions of the different research partners shape the final research product. Based on a study conducted in collaboration with employees in a patient association, older adults with multiple sclerosis (MS), and university researchers, the present study aims to unfold how perspectives of aging with MS are represented and shaped doing a participatory research period. It occurred over a three-year period where data was collected through field notes, meeting minutes, focus group interviews, and individual interviews. The findings highlight how research partners represent different understandings of the studied phenomenon, which is embedded in their social, cultural, and professional background and which potentially influence their expectations of and contributions to the research process. Furthermore, the study demonstrates how engaging in a critical dialogue about expectations and understanding of the studied phenomenon can provide insight into which perceptions are represented, making the participatory research process more transparent. Lastly, the study conveys how such critical dialogue facilitates understandings and perspectives evolving during the research process into a potentially more dynamic understanding of the studied phenomenon.

The Remote Approach in a Qualitative Study During the COVID-19 Pandemic: A Perspective Considering the Researcher's Life Experiences and the Trustworthiness.

The COVID-19 pandemic has raised a wide range of challenges for qualitative researchers, especially when most of the world was facing isolation during the first wave in 2020. The scientific literature rapidly raised discussion regarding data collection adaptation for remote inquiry and ethical dilemmas. However, it is still necessary to discuss the implications of running qualitative studies as a researcher immersed in a global emergency, precisely when the researchers themselves are involved in this context. To what extent, or in what way, can being fully immersed in this context influence all phases of the research? What is the role of reflexivity in this context? We proposed a new discussion based on the study we performed remotely in 2020, among infected pregnant women, using concepts of the Freudian feeling of uncanny to explore the life experience of the researcher. We also considered the concept of the discourse of the master from Jacques Lacan to debate the researchers' position during the pandemic and to bring practical implications.

What can physiotherapy learn by looking more closely at 'how' research insights come about? The role of reflexivity and representation.

In this paper, we draw on an example of heuristic inquiry - (Re)imagining becoming a physiotherapist: a phenomenological approach - to illustrate the role that reflexivity and representation can play in physiotherapy research outcomes and the meaning they might have for moving the profession forward. Qualitative research in physiotherapy tends to acknowledge reflexivity as a route to objectivity by making researcher biases overt, yet the debate about data representation (a researcher's decision-making about how data are represented in a text) barely feature. This contrasts with qualitative research in other fields, including other health professions, where matters of representation (i.e., how knowledge is conveyed) are routinely debated and contested. Reflexivity, in fact, is much more than being transparent. Together with representation, reflexivity helps to position both the voices of participants and researchers within the research. The heuristic inquiry described in this paper offers new insights about learning to be a physiotherapist; it challenged assumptions about care in physiotherapy practice and it changed the first researcher's identity and practice. These insights were generated through the synergies between reflexivity and representation, and we argue that physiotherapy research has an opportunity to be more expansive by taking a commitment to reflexivity and representation more seriously.

The reflexive imperative in the digital age: Using Archer's 'fractured reflexivity' to theorise widening inequities in UK general practice.

'Reflexivity', as used by Margaret Archer, means creative self-mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in health care has been well-documented but inadequately theorised. In this article, we use Archer's theory of fractured reflexivity to understand digital disparities in data from a 28-month longitudinal ethnographic study of 12 UK general practices and a sample of in-depth clinical cases from 'Deep End' practices serving highly deprived populations. Through four composite patient cases crafted to illustrate different dimensions of disadvantage, we show how adverse past experiences and structural inequities intersect with patients' reflexive capacity to self-advocate and act strategically. In some cases, staff were able to use creative workarounds to compensate for patients' fractured reflexivity, but such actions were limited by workforce capacity and staff awareness. Unless a more systematic safety net is introduced and resourced, people with complex needs are likely to remain multiply disadvantaged by remote and digital health care.

Identifying the priorities for supervision by lived experience researchers: a Q sort study.

BACKGROUND: Lived experience researchers draw on their lived and living experiences to either lead on or inform research. Their personal experiences are relevant to the research topic and so they must manage the interplay of their health and healthcare experiences with the research, population, and data they work with, as well as the more general challenges of being a researcher. Lived experience researchers must navigate these dilemmas in addition to queries over their competency, due to issues relating to intersectionality and epistemic injustice. This justifies a motivation to better understand the experiences of lived experience researchers and develop appropriate and personalised supervision based on their preferences and needs. METHODS: Q methodology was used to identify a collection of identity-related issues that impact lived experience researchers during PhD research in the context of the UK. These issues were presented in the form of 54 statements to 18 lived experience researchers to prioritise as topics to explore in supervision. RESULT: It was found that lived experiences researchers could be grouped into three distinct factors following an inverted factor analysis: Factor 1: Strengthening my identity, skills, growth, and empowerment; Factor 2: Exploring the emotional and relational link I have with the research and Factor 3: Navigating my lived and professional experiences practically and emotionally. The findings suggest that there may be three types of lived experience researchers, each with different needs from supervision, suggesting the population is heterogeneous. CONCLUSION: The research identified a deeper understanding of the needs of lived experience researchers and highlights the importance of personalised supervision according to the individual needs of the researcher and their preferences for supervision. The findings reinforce the importance of integrating a clinical dimension into supervision to support the needs of all lived experience researchers.

The Value of Researcher Reflexivity in the Coproduction of Public Policy: A Practical Perspective.

Coproduction of public policy involves bringing together technical experts, practitioners, and people with lived experience of that policy to collaboratively and deliberatively codesign it. Coproduction can leverage different ways of knowing and evaluative perspectives on a policy area to enhance the legitimacy and efficaciousness of policymaking. This article argues that researcher reflexivity is crucial for getting the most out of coproduction ethically and epistemically. By reflecting on our positionality, habitus, and biases, we can gain new insights into how we affect the research design, production and analysis of data, and communication of findings. This reflexivity helps to disrupt power dynamics that underly research and policymaking, helping to realise the radical potential of coproduction to democratise practice, empower citizens, and make research more relational. We demonstrate the value of reflexivity through an analysis of our work coproducing a theory of thriving in financial hardship in partnership with the UK national anti-poverty charity Turn2us. We contextualise our advocacy for reflexivity within the practical realities of advancing coproduction in the UK today.

Innovative governance for transformative energy policy in sub-Saharan Africa after COVID-19: Green pathways in Egypt, Nigeria, and South Africa.

Learning from innovations that fail is imperative for innovations that succeed. The theoretical underpinnings for this innovative framing are reflexivity, transformative unlearning, and intelligent failure. This framework proposes a definition of "transformative governance" as governance that creates structural equities. Governments rebuilding their economies after the COVID-19 pandemic seek equitable green transformations; that are gendered, structural, and sustainable, learning from the implemented gender-sensitive responses (hereafter referred to as policy innovations). This paper argues that transformative practices, beliefs, values, assumptions, policies, and systematic learnings are complementary to post-crisis transformations. The aim is to promote systematic learnings from innovation governance failure regarding energy policy through the analysis of COVID-19 practices and the unlearning of policy innovation beliefs, values, and assumptions that are not transformative. I ask: how gender-equitable, structurally equitable, and green-transformative were the COVID-19 policy innovations? The study's approach is qualitative and situated within the constructivist research paradigm. It uses reflexive thematic analysis combined with innovative coded policy narrative and a transformative index-matching technique, to identify the gap within transformative interventions. The study included 58 policy innovations (n = 58) collected from the UNDP, KPMG, government reports, and news flashes from the three most populous nations in sub-Sahara Africa: Egypt, Nigeria, and South Africa. The study found that policy innovations were inequitable in terms of gender, structure, and sustainability whereas the derived transformative pathways are equitable and gender-transformative, structurally transformative, and green-transformative. The rationales behind a transformative approach to policy reflect the systemic failures across key areas: market dynamics, research and development, and green transformation. Policy innovators can align transformative pathways for innovative governance that implements transformative energy policy. To address the needs of multiple fragile and vulnerable identities, the derived post-pandemic framework is an intersectional plan with 10 policy learning pillars. The plan includes local energy transformation and reinforcement of energy justice components, such as the localization of the energy industry, community power, and social norms, including Ubuntu, which translates to "I am because we are." Reengagement in global supply chains requires South-South trade relations to be restrategized.

The Operators Model of Psychoanalytic Clinical Reasoning.

In this paper, the authors develop a model of psychoanalytic clinical reasoning as the inferential process by which analytic therapists are able to arrive at an understanding of the clinical material. Starting from Bion's theory of functions, the authors propose that a "function" can be thought of as a condition-action sequence that analytic therapists implicitly use to respond to certain configurations of elements in the material by executing conceptual or reflective operations. To investigate the main families of functions that are used by analytic therapists in everyday practice, the authors used an interpersonal process recall procedure based on supervision sessions from a theoretically heterogeneous group of participants. A consensual procedure was developed to identify operations, spell out the underlying functions, and group functions into families. Twelve families of functions were identified that appear to be used by analytic therapists regardless of their schools of thought. The authors call them the "operators" of psychoanalytic clinical reasoning. According to the operators model, the process of psychoanalytic clinical reasoning consists in the chaining together of operations using functions from different families. A specific collection of "clinical reasoning styles" seems to be interwoven in this process. Different avenues open up for research, clinical practice, and training.

Dis/re-orienting design through norm-critical gender lenses: an educational case in Turkey.

Design, as a practice of developing solutions beyond products, and increasingly services and policies, inevitably poses an impact on gender (in)equality which remains largely unrecognized by design practitioners. This paper advocates the urgent need for adopting gender lenses in design education for sustainable cultural transformation through proper recognition of the complexity of any societal and cultural issue, power relations and inequalities, and introduces an initial attempt through a graduate-level educational design project. Throughout the project, students critically reflected on existing orientations in designing to develop norm-critical gender lenses, contained the resultant disorientation emerging from the contrast between their critical approaches and local contexts, and explored novel directions as reorientation to address four different societal and cultural issues and develop 11 design outcomes aiming at gender equality, social justice-oriented empowerment, and cultural transformation. The authors analyzed the design processes and outcomes to reveal opportunities and challenges for developing and deploying norm-critical gender lenses in tackling complex, intersecting socio-cultural and political issues, under three themes: gender stereotypes, norms, expectations, and roles; intersectional power relations and inequalities embedded in the social structure; and social justice-oriented empowerment beyond the market-oriented individualistic neoliberal order. A shift in the perceptions of the role of designers, from creator/problem-solver to facilitator/participant, and design outcomes, from absolute solutions to intermediaries of sociological and political imaginations, is found crucial in this endeavor, which requires safe spaces for future designers to reflect on existing orientations, contain disorientation with negative capability, and explore novel ways through reorientation.

Epistemic Justice in International Social Work Research: Postcolonial Theory and Analytic Strategies.

Scholars have long grappled with the ways in which unequal power relations influence the creation and circulation of international social work knowledge. I outline a robust postcolonial theoretical framework to elucidate complexities of global knowledge and power and extend possibilities for considering such questions of epistemic justice. Drawing on my own research with service providers in Nepal, I suggest three analytic strategies to apply postcolonial insights in international social work research: reflexivity, critical discourse analysis, and postcolonial translation. Postcolonial theory and the strategies provided support social work researchers to comprehend, generate, and disseminate knowledge that can disrupt colonial assumptions.