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Two to Tanka: Poetry as a duoethnographic method for exploring sensitive topics AbstractDuoethnography is a method of dialogical reflection that combines different voices and juxtaposing worldviews in order to glean fresh perspectives on wider social or professional issues. In this paper, we use poetry to support an inter-professional duoethnographic exploration of sensitive issues in nursing and healthcare. Using a method of linked tanka poetry, we bring together perspectives from our respective work in nursing and occupational therapy to explore the sensitive issues of loss, death, dementia, cultural conflict and trauma. We demonstrate collaborative poetry writing as a novel useful approach in duoethnography, demonstrating how tanka poems - short, structured poems originating from 7th Century Japan – are effective in supporting reflexive dialogue. Drawing on theoretical underpinnings and practical experience, we highlight the opportunities and challenges of using tanka poetry to facilitate collaborative discussion and problem solving. We highlight how tanka could support difficult conversations between practitioners, researchers, service users, educators and students through its succinct immediacy. Moreover, by showcasing the use of collaborative poetry writing as a method of inquiry, this paper offers a novel methodological contribution to the broader area of qualitative research for education, research and practice. Key words: methodology, collaboration, sensitive issues, poetic inquiry, reflexivity, duoethnographyIntroductionThis paper is about how collaborative poetry writing can be used in duoethnography to explore sensitive topics, particularly within nursing and healthcare. It is also about [Author 1] and [Author 2]. [Author 1] and [Author 2] met on, what we now describe as, an academic blind date. Inspired by the power of poetry to express deep emotion and advocate on social issues, [Author 1] (date) wrote a paper about a series of tanka poems she had written during a research project on disability, domestic abuse and pregnancy. [Author 2] was one of the blind peer reviewers for the paper and, quite controversially for the formal peer review process, responded with a poetic reply that was subsequently published alongside the paper ([Author 2] date). Between review and publication, we communicated with each other anonymously through the editor, sharing a mutual interest in working together once our identities could be revealed. Excited by our dialogical approach to peer review, we leapt at the opportunity to explore our creative connection in this paper, which showcases our lived transition from a relationship defined by distance and objectivity, to a collaborative friendship: the poetic journey through which [Author 1 surname] and [Author 2 surname] became [Author 1 first name] and [Author 2 first name], and the separate “I” became a collective “we”.Duoethnography: writing between the two Duoethnography is a method of shared critical reflection. It brings together multiple voices into one dialogue to explore how different life experiences construct meaning (Sawyer and Norris, 2015). Whereas autoethnography involves better knowing oneself, duoethnography is about knowing oneself in relation to another (Shelton and McDermott, 2015). One notable example is Gale and Wyatt (2010), who used collaborative writing as a reflexive, dialogical device in the first co-written PhD. They argued that understanding the space between individuals is crucial, drawing upon the Deluezian logic of sense to explain how “notions of self are deeply wound up in notions of other” (Gale and Wyatt 2010: 85). In duoethography, the lens is turned onto the ‘self’, not as the topic for exploration, but the vehicle through which beliefs, values and practices are formed and enacted (Sawyer and Norris, 2015). Reflecting on one’s own experiences in the light of another’s can illuminate the cultural ideologies shaping societal beliefs, attitudes and behaviours (Grant & Radcliffe, 2015). Exposing unconscious bias and interrogating dominant discourses through critical comparative dialogue with another leads to new perspectives on wider social, intellectual, political or professional issues (Pinar, 2010). This can include challenging comfortable ways of knowing and “personal and cultural ontological traps” (Sawyer, 2016).Given its focus on learning through difference, duoethnography is highly relevant to inter-disciplinary working in health-related research and practice. Although duoethnography has been used to some extent within nursing (for example, Grant and Radcliffe 2015) we could find few cross disciplinary duoethnographies between nurses and other professional groups. Juxtaposing voices from different backgrounds has the potential for learning about individual professions, establishing inter-disciplinary collaboration, and challenging typical ways of knowing and doing within different professional cultures. Thus, coming from different professions ([Author 1] is an occupational therapist, [Author 2] is a nurse) we were keen to embrace our difference in a way that would challenge and consolidate new understandings of our individual, and shared, professional concerns. We are women of different ages (15 years between us). We live and work in very different regions of the UK ([Author 1] in Scotland and [Author 2] in England) and in different fields ([Author 1] is a researcher and [Author 2] is a lecturer in nursing). Poetry as method in duoethnography Duoethnography typically relies on narrative methods. Gale and Wyatt (2010) wrote emails to one another; what they describe as an interactive interview. Grant and Radcliffe (2015), in a duoethnography of mental health nursing and education, audio-recorded their face-to-face conversation and reflected on key concepts through subsequent emails and telephone calls. Zaskis and Koichu (2015) wrote collaboratively about fictional characters in a duoethnography about mathematics education, arguing that fictional characters provided a safe way to explore difference and reflect on issues from multiple angles. Ultimately, there appears to be no right or wrong way to present a duoethnography. However, not all co-written narratives constitute duoethnographic research. Sawyer and Norris (2015) explain that duoethnographies must: 1. be dialogical and polyvocal; 2. explore individuals’ own life histories; 3. result in learning and change as key outcomes; 4. arrive at learning through juxtaposing difference (Sawyer and Norris, 2015). Moreover, learning and change should not only refer to individual narratives, but how these narratives are situated within bigger societal discourses about identity and its impact on life-work (Sawyer, 2016).We argue that poetry offers a promising vehicle for actualising these core tenets of duoethnography. Poetry has been used in qualitative research as a method for collecting data and presenting research findings. Poetic inquiry has been particularly advanced through the work of Furman (2006, 2007), who advocates the use of poetry to distil the essence of participants’ data, communicate findings in a direct and memorable way, and reduce lengthy qualitative data without losing original meaning (Furman and Dill, 2015). Although poetry has featured in some duoethnographic work – for example, Gale shares poetry with Wyatt (2010) and Huckaby and Weinburgh (2012) crafted a poem about duoethnography – the use of poetry as a primary vehicle for duoethnography has been under-explored. In our paper, poetry is not simply the means of presenting duoethnography, but doing duoethnography.Tanka as a dialogical deviceTanka poems originate in 7th Century Japan. They are short poems of five lines, using a 5-7-5-7-7 syllable pattern. The first three lines describe an image or experience, whilst the last two lines provide a personal response. Both parts of the poem are linked by a pivotal image or phrase in the third line. Historically dialogical, tankas were written as clandestine messages sent between lovers via personal messenger (Reichold, 2011). To retain privacy, poets often used metaphor to ensure that poems were indecipherable to ‘outsiders’ (Reichold, 2011). Featherstone (2009: 10) describes tanka exchange as “a form of collaborative writing, a continuous chain of exchanges built into a sequence”. Still highly popular in Japan, contemporary tanka poems continue to draw heavily on the personal life of the writer (Ishikawa, 2016). They are most commonly presented in thematic collections or edited series (Ishikawa, 2016). In a way that almost parallels the purposes of duoethnography, Rice (2011) has argued for thematic tanka collections to be written collaboratively. He suggests that writing with another creates welcome tension, clashing and consolidating different viewpoints which add surprise and fluidity to the tanka collection. The historical and cultural context of Tanka, its dialogical nature and reflective tone arguably, therefore, make tanka poetry perfectly suited to duoethnography. The start of a poetic dialogueAfter an initial phone conversation to discuss ideas for the paper and meeting briefly in person at an academic event, we emailed poems to each other between August-November 2016. We agreed a focus on ‘sensitive topics’ but did not predetermine any of the themes that emerged. We wrote 19 tankas between us, each one connected to the last. Some were accompanied by short narrative emails, whilst others were stand alone. We had three telephone discussions, at the start, middle and end of our writing project. These were always technically orientated (for example, to agree key words for the paper) and our primary method of communication was undoubtedly through poetry. Our collaborative Tanka collection, “Two to Tanka”, is presented below. [Author 2]’s tankas are written in plain text, and [Author 1]’s in italics, to indicate different voices. Two to TankaSensitive TopicsSex, Race, DisabilityReligious hatredIntersectionalityWhat's 'health' got to do with it??Health is a contractConditions to self-manageMechanics to fixIn the totality oflife, I am more than patient?Living it [Author 1]! This is really excitingWriting between twoLines of communicationThe patient self and other?Professionals seeThe otherness of patientsThe sameness of meEqual voices togetherTwo poets reawakened?Tanka is for twoPoetic conversationsOne sparks anotherShared words construct the meaningWhat if I did not speak English??Or I could not seeWhere the nurse left my house keysAs she closed the doorOn my weeping bullet woundDid she mean to, I wonder? ?Then there is RezaHe does not need protectingCancer of the eyeTook his 4 year life and face We nursed him on Mitchiner?A hospital ward Where he lived a private hellHis Father paid for ‘Miracle cure in England’Died broken hearted in Iraq?No words could prepareOr help to heal such anguishMother far away The bloodied boned shell to dressA child’s naked tortured face Your images graftfull thickness onto my soulto compel, console and challenge the truth behindthis poetic connection.?As tankas outpoura barrage of syllablesour universality falls to images not words;is poetry enough?It is not enoughTo gloriously write grief In counting movementsTrace the imaginary ??To restore a human face ?Everyone is deadshe said, flitting the moment Fred and Rita dancedand joyful respite resignedto painful pasts rememberedWhat can I grieve now?A loss which did not existUntil the pain rippedA world apart from knowingComfort in the spark light womb.Me becoming you?A threshold I cannot cross Unspoken yet feltAfraid to open my doorBecause I don’t even knowThe light disappearedNot one day but many daysUntil it was blackReminiscent ironyHappiness fades into painBetween pain and joyWhere is the thresholdIs it yours or mine?I sense a future waitingFor you to open the door Close together nowRushing streams of emotionI becoming WeIn the space between the twoThe bridge across is wordlessIn togethernessHope soars through shadows long goneAwakening lightLingering history turns?? stretching upwards for the sunFour stages of duoethnographic collaborationThe chronological progression of Two to Tanka occurs in four parts, charting the coming together of disparate identities (part 1) and experiences (part 2), a critical tension that challenges our individual worldviews (part 3), and a denouement that leads to shared learning and personal growth (part 4). The poem progresses organically from relative objectivity (writing about ideas), to extrospective subjectivity (writing about others through our own eyes), to introspective subjectivity (writing about the self), and finally arriving at inter-subjectivity (co-writing the self and other). Part 1 – Intellectuals, “writing about it”In stanzas 1-5, we write about ideas in the abstract. Though our poems are indicative of ourselves, we retain academic objectivity. Slightly stilted at first, a linking narrative binds us and the verses together. [Author 2] wrote about the concept of difference, as she prepared an undergraduate nursing module on cultural diversity. Stanzas 1 and 5 deal with the need to link nursing practice to global public health discourse on reducing health inequalities (WHO 2016). Stanza 1 challenges nurse leaders to influence health through acting on social policy to reduce inequalities, whilst stanza 5 demonstrates the need for everyday cultural sensitivity in nursing practice. For [Author 1], our poetic conversation coincided with a new research project about self-management education for people with type 1 diabetes. Stanzas 2 and 4 challenge the lack of intersectionality within popular self-management discourse; although individuals have responsibility for their own health, they cannot do this without good support from health professionals who are willing to share the power balance. This early exchange influenced how we each approached our work separately: [Author 2] found a creative way to frame the teaching ethos; [Author 1] found space for reflexivity in her research.Part 2 – Professionals, “writing others”Stanzas 6-9 are solely authored by [Author 2]. Responding directly to [Author 1]’s final line in stanza 4, she found her poet-self ‘re-awakened’. Rather than being about ideas, her poems are about people. Writing about people she had cared for as a nurse, sensitive issues (migrants’ experience of healthcare, professional-patient power dynamics, ideas of healthcare burden and healthcare tourism) become personalised in human faces: [Author 2]: My tankas reflect on the possibility of harm and neglect as a result of health professionals’ lack of awareness, knowledge, or power to transcend the human face of difference. They challenge prevailing popular discourse on ‘healthcare tourism’ by calling for cultural safety (Campinha-Bacote 2002). As nurses we should have privileged Reza’s (stanza 7) need to be with his parents. That the nursing team did not articulate our concerns and advocate for him was a breach of his dignity and right to human healthcare. Although the experience happened decades ago, writing the tanka made old emotions immediate, as if the experience were happening now.Part 3 - Colleagues, “writing between two ‘I’s”Stanzas 10-13 present a critical juncture in our poetic collaboration, captured symbolically in repeated war and conflict imagery. Rather than engaging in abstract ideas or other people’s experiences, we now respond directly to one another. But our growing closeness feels risky as our cultural and professional worldviews are challenged, and we reflectively tolerate unease about poetry as a medium for sensitive subjects: [Author 1]: Reading stanzas 6-9 for the first time was overwhelming. My immediate desire was to resolve [Author 2]’s distress and, in questioning whether poetry was ‘enough’, I was concerned about not being able to respond practically. This impulse to ‘fix’ problems is rooted in a rehabilitative framework and the socialisation of health professionals into a dominant medical model (Charon, 2001). Rather than ‘do’ something, I replied by acknowledging my uncertainty and allowing the distress to rest in the space between us (stanzas 10-11). This counteracted unconscious, acculturated habits, recognising that the act of telling (or writing) a traumatic experience, and being listened to, can be healing in itself (Harris, 2012). [Author 2]: [Author 1]’s metaphor in response to my emotional sharing (‘images grafted on my soul’) affirmed for me the therapeutic power of communicating painful experiences and emotions to and with others. The reciprocal act of tanka engaged us in a process of emotional allowing; where we allowed previously disallowed emotions to come to the fore in a way that facilitated personal insight, promoted healing and restored human resilience (Greenberg, 1996). I was able to reconceptualise a new understanding of cultural safety in practice and found some resolution to long-held dissatisfaction with Reza’s care. [Author 1]: Our tanka exchange demonstrates how ‘sensitive’ memories – like [Author 2]’s memory of Reza - can arise unpredictably. Reflecting on [Author 2]’s tracing imagery (stanza 12) – the idea that overlaying tracing paper on an image retains the outline but blurs the detail – I was inspired to write stanza 13 about my experience of doing research with people with dementia. Although widely promoted within occupational therapy to promote wellbeing, there has been little research about how to support distress which can arise during reminiscence therapy (Zuiderveen et al., 2016; Woods et al., 2005). It led me to reflect on the importance of emotional allowing in this context and to ensure staff are prepared to support difficult, as well as happy, memories. Part 4 (stanzas 14-19) – Friends, “writing We”Stanzas 14-19 are explicitly [Author 1] and [Author 2]. We are not writing to one another, but being with one another. We continued on the theme of loss: [Author 2] sharing her experience of miscarriage (stanza 14) and [Author 1] responding with two tankas, frustrated by the fragility of empathy (stanza 15) and reflecting on her own losses (stanza 16). These tankas are reminiscent of traditional clandestine tankas in Japan, as we relied on the privacy of metaphor to uncover similar childhood and adult losses in the face of difference. In making the mutual effort to understand each other’s differences, trust was born. The sensation of having crossed a personal threshold is evident in our word choice throughout this last part of the poem and our poetic crisis of confidence is resolved. Duoethnography characterises the ‘self’ as ever developing (Grant and Radcliffe, 2015) and therefore this endeavour is not simply about identifying existing worldviews, but in shaping and altering the future. Duoethnography is not, therefore, a self-indulgent spiralling into the inner self, but a transformative process. The healing power of poetry is captured in uplifting nature images in the stanzas 18-19. The growing closeness is a structural demonstration of how we grew together, sharing things with one another that we had never shared with anyone before. Exploring sensitive topics through collaborative poetry: implications for research, education and practiceWe contribute to the duoethnographic literature by highlighting poetry as a primary method for establishing duoethnographic intimacy. Our use of tanka is novel and effective in facilitating dialogue that opens up “potentially dangerous conversations” (Huckaby and Weinburgh, 2015: 49). Traditionally bound to certain themes (nature, love, or the seasons), tanka poets usually avoid ugly or violent imagery (Reichold, 2011). However, our approach subverts the genre, harnessing the reflective poetic form to dwell upon and process distressing experiences. Tanka calls for immediacy of language and an emotional directness that is rare within person-to-person conversations. Experiences and emotions are condensed into succinct snapshots and the predominant use of present tense brings past images and experiences into the immediate present. The first-person narrative (whether explicit or implicit) also creates a degree of aesthetic illusion, which transports the reader directly and immediately into the lifeworld of another (Wolf, 1998). This is dependent on the receptiveness on the reader (Wolf, 1998) and thus, it would make sense that – as suggested by others (Brown, 2015; Shelton and McDermott 2015) – duoethnography is most effective in the context of an established relationship, where trust is high and there is low risk of conflict. In contrast, we came together as relative strangers and argue that the directness of the poems accelerated the development of our rapport. Whilst our experience was positive and supportive, we recognise that this might not be the case for everyone and it would be interesting to explore whether conflict between authors would have heightened or compromised the duoethnographic ing together to write this paper was risky and it was impossible to predict the tone and outcome of our poetic communication from the outset. The combination of the creative medium and the focus on sensitive topics placed us in a somewhat precarious situation. In our duoethnographic partnership, we risked exposure of our own worldviews, prejudices and opinions. We embarked upon a discussion that could potentially explode our relationship before it had truly begun. Although we both had a passion for poetry, sharing our own poetry left us each open to literary scrutiny and compounded the vulnerabilities already established by the method and the topic. As a relational process, duoethnographic collaboration requires researchers to recognise knowledge as fluid. Dueothnography requires researchers to care for one another and engage in thoughtful interrogation of the other’s ideas (Brown 2015). Researchers embarking upon duoethnography must embrace each other’s differences without turning either partner into the ‘other’. This is paralleled in our poetic conversation. Ogawa (2011) advocates for self-abandonment in collaborative poetry writing, requiring authors to have the openness to see something through someone else’s eyes and to demonstrate willingness to suppress one’s own ego. Throughout our poetic conversation, we gave each other permission to allow for distance and to be relatively unconcerned about the quality of the poems. This prevented us from feeling unduly pressured to perform poetry even though the last line of each Tanka poem was an invitation for response. Collaborative poetry writing in duoethnography requires a relinquishing of control. Unlike a sole authored poem, where the individual poet has total control over the direction the poem will take, collaborative poems are unpredictable and uncontrollable (Ogawa, 2011). Collaborative poetry is living poetry. It parallels the social construction of identities in daily life. As opposed to being simply a means of self-expression, collaborative poetry is characterised by plural voices. As such, duoethnographies have a trademark element of chaos in the way they are presented. Authors have found various ways around this, for example, Huckaby and Weingburgh’s (2015) duoethnography exploring black feminism in American folk songs contravenes typical journal formatting, using blocks and opposing colours to represent letters written between two authors. We argue that, by creating a series of linked tanka poems, this formatting difficulty is partially overcome. The poem reads as individual stanzas, but also as a whole poem in its own right, with its own narrative flow and connecting images. This prevents the individual voices from being seen as binary ([Author 1]’s voice, then [Author 2]’s voice), but instead fulfils duoethnography’s postmodern conceptualisation of identity as a co-created hybrid (Sawyer, 2016). The dialogic format of the poem does not simply offer a disparate series of contrasting incidents and experiences, but a collaborative analysis of these incidents as each new tanka poem interprets and responds to the one before. Although the dialogue is, initially, shared between the authors themselves, the reader also becomes a third analytic voice as they reconstruct their own personal and social narratives in response to the poetic experiences of others ([Author 1], date; Sawyer, 2016). Our paper demonstrates that tanka poetry is an effective method for duoethnographic co-production. Learning and change occurred in reflection alone and together when considering our poetry as data. How one poet influenced the other in remembering or sharing a discussion point occurred through prompting and juxtaposing the differences between us. However, poetic endeavour in nursing and healthcare remains a marginal craft. Our duoethnographic journey was enabled through poetic efforts outside the boundaries of everyday work. By demonstrating the use of tanka poetry in learning through difference, engaging in sensitive conversations and developing relational closeness, our paper models the use of poetry as a reflective tool with potential for application in teaching and learning, as well as research. The structure of tanka poems guides poets through a reflective process – describing an experience and attaching personal meaning – and, by collaborating in a dialogical way, allows for prompting and challenging from another perspective. In this way, linked tanka poems provide a tool for reflection and reflexivity that could be usefully applied in practice or education settings to support learning and development of cultural sensitivity. Moreover, our four stages of duoethnographic collaboration could be applied both proactively and retrospectively to guide or interpret reflexive relationship development.The willingness to learn from those who experience the world differently is an important characteristic of culturally-sensitive nursing and healthcare (Campinha-Bacote 2002, Papadopolous 2016). The duoethnographic approach has clear lessons for research, education and practice for nursing and other health professions. Learning through difference underpins effective inter-professional working and provides a sensitive and non-judgemental foundation for all clinician-patient interactions. Despite coming from different professional worlds, we both clutched at the same frustrations with uni-disciplinarity and rigid identity definitions within our respective professions. These concerns were processed and, in part, resolved through joint-reflection supported by collaborative poetry writing. Together, we were able to challenge the privilege given to the ‘professional’ voice in caring interactions and to critique the unhelpful divide between education, research and practice. The dialogical and polyvocal principles of duoethnography and the emphasis on learning in the context of others could be applied within university education, continuing professional education or supervision as a means of increasing nurses’ cultural sensitivity. Learning to not only tolerate others’ worldviews but critically reflect upon and change one’s own identity is a crucial part of providing inclusive care and dealing appropriately with sensitive conversations when they arise.ConclusionWe started this paper by saying it was about us, [Author 1] and [Author 2]. In many ways, of course, it is not about us. We were the research sites through which to test and examine the use of tanka poetry in exploring sensitive topics. However, by the very nature of duoethnography, we are changed as a result of writing this paper. We have processed personally difficult emotions and gleaned new perspectives on communicating about trauma, memory, loss, and cultural conflict. We have become friends. Were it not for the immediacy of tanka poetry in reflecting and prompting a current duo-ethnographic response, we do not believe we could have achieved such deep intersubjective connection. Tanka forced us to get to the point, whilst still providing the comfort of metaphor in which to veil or temper our raw feelings. Whilst sharing ourselves, tanka also allowed us to hold something back, to retain privacy. Two to Tanka is a lived duoethnographic device which has the potential to be applied in a range of contexts, including undertaking difficult conversations about sensitive topics. We look forward to developing the duo-genre to inform future interdisciplinary practice and research in nursing and healthcare. Key pointsDuoethnography is a useful and relevant methodology for exploring interdisciplinarity in nursing and health related research, education and practice.The dialogical, reflective and reflexive nature of linked tanka poetry makes it an ideal method for doing and disseminating duoethnographic research.Collaborative poetry writing is a powerful vehicle for developing interpersonal capacity for intimacy, immediacy, and direct communication whilst allowing metaphorical self-preservation.Collaborative poetry writing could be adopted in nursing research, education and practice settings to aid reflection, reflexion, and learning through difference in order to promote cultural sensitivity.Declaration of conflicting interestsThe Authors declare that there is no conflict of interest. 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