Unsettling Knowledge Synthesis Methods Using Institutional Ethnography: Reflections on the Scoping Review as a Critical Knowledge Synthesis Tool

Abstract

Scoping reviews are an increasingly popular knowledge synthesis method. While knowledge synthesis methods abound in evidence-based practices, these methods are critiqued for their reliance on positivism. Drawing on a scoping review that mapped scholarly conceptualizations of family caregivers’ information-related dementia care work, in this article, I reconcile institutional ethnography’s epistemological and ontological assumptions with the prescribed scoping review framework. I first explore the textual organization of scoping reviews. I then unpack the process of modifying three scoping review stages in keeping with an institutional ethnography method of inquiry, and in doing so, transform the scoping review into a critical knowledge synthesis tool. Through a reflexive process, I deconstruct scoping review’s textual authority and uncover that scoping reviews bring about a double decontextualization of family caregivers’ information work, removing family caregivers from their experiences of their information-related care work while simultaneously reducing them to objects of techno-scientific interventions.

Keywords

institutional ethnography epistemology knowledge synthesis critical methods scoping review family caregivers older adults dementia information work Canada

Introduction

Evidence-based practices (EBPs) emerge from the evidence-based medicine movement of the 1990s, where “the conscientious, explicit and judicious use of current best evidence” (Sackett et al., 1996, p. 71) is incorporated with clinicians’ expert practices to make decisions about patients’ care (Pope, 2003). Knowledge synthesis methods are cornerstones in EBP (Chambers et al., 2018; Grant & Booth, 2009; Kastner et al., 2012). One increasingly popular knowledge synthesis method is the scoping review, “a preliminary assessment of the potential size and scope of available research literature” (Grant & Booth, 2009, p. 95). In contrast to systematic reviews’ exhaustive synthesis of the best available evidence on a particular question (Grant & Booth, 2009), scoping reviews aim to “map rapidly” (Mays et al., 2001, p. 194; emphasis in original) the body of available literature on a particular topic, regardless of study design or method (Pham et al., 2014). This method of knowledge synthesis is quickly gaining traction: Colquhoun et al. (2014) identified “consistent yearly increases” (p. 1291) of scoping reviews published between 1997 and 2013. Such methods for synthesizing available evidence have, however, received criticisms for their positivistic leanings and their presenting procedural objectivity (Eakin & Mykhalovskiy, 2003; MacLure, 2005; Pope, 2003). Mindful of these criticisms, Chambers et al. (2018) provide an insightful reflection regarding their unanticipated journey of “ontological and epistemological (re)knowing” (p. 183) as they struggled with the “Western ways” of doing a scoping review while synthesizing literature on decolonizing, Indigenous, and Afrocentric knowing.

In this article, I unpack and analyze the process and struggles of conducting a scoping review as part of an institutional ethnography (IE) study of the information-related work of family caregivers of older adults living with dementia. To my knowledge, this is the first article to examine the tensions and insights that emerge when conducting a scoping review within an IE method of inquiry. This companion article to the scoping review results already published (Dalmer, 2020) is inspired by Chambers et al.’s (2018) and Harden et al.’s (2004) reflective analyses that have each stretched conventional approaches to systematic reviews to integrate individuals’ perspectives and experiences. This article takes further inspiration from an ongoing, fulsome methodological dialogue, starting with Thorne et al. (2004) and continuing between Thorne (2017a, 2017b) and Britten et al. (2017), that continues to critically grapple with the problematic assumptions and misconceptions surrounding qualitative knowledge synthesis methods. In this article, drawing from other frameworks offered for critical knowledge synthesis, including Alvesson and Sandberg’s (2011) problematization approach and Dixon-Woods et al.’s (2006) critical interpretive synthesis approach, I critically reflect on the scoping review as both an analytic strategy and as a text and I offer guidance for thinking critically about the scoping review as a method for knowledge synthesis and for employing the scoping review within an IE method of inquiry. In doing so, I join Chambers et al. (2018) in a reflective process of “dialoguing with the tensions” (p. 175) between the ways of knowing set out by an IE method of inquiry and the prescribed processes of conducting a scoping review.

After providing a brief overview of my scoping review, I examine IE’s specific epistemic and ontological assumptions that enable a tracing of the textually mediated social organization of knowledge synthesis methods. I then consider how an IE method of inquiry inspires a deviation from the boundaries of three specific stages of the scoping review.

An Overview of the Scoping Review Exemplar

The scoping review exemplar that I draw upon in this article (Dalmer, 2020) is one part of a broader IE study of the ways family caregivers of community-dwelling older adults living with dementia find, use, and make sense of information to guide and support their care work, and how their information-related care work is shaped and coordinated by aging in place policies and processes (Dalmer, 2018). In this scoping review exemplar, I gathered published research articles that studied the complex relationship between families’ information work and care work.

Arksey and O’Malley’s (2005) pioneering articulation of the scoping review approach outlines a six, successive stage framework: (a) identification of research question, (b) identification of relevant studies, (c) selection of included studies, (d) data extraction and charting, (e) summarization and dissemination of findings, and (f) a consultation stage with stakeholders. Following this six-stage structure, I designed a scoping review, asking “how does scholarly research conceptualize informational components of family caregivers’ care work and to what degree are these components acknowledged as work?” to capture the degree to which scholarly writing about family caregivers might come to alienate, obscure, or overlook their everyday information work. Critically unpacking how information-related activities within dementia care work are constructed and synthesized in academic literature is significant for two reasons: first, academic texts create and perpetuate knowable and governable categories and frameworks that subsequent researchers, articles, and disciplines take up, and second, these works contain assumptions that are often taken as influential evidence that underpin policies and practices that shape family care partners’, older adults’, and their communities’ experiences and quality of life.

I searched 12 databases using keywords and terms to capture peer-reviewed research articles written between January 1990 and August 2017 that studied the informational activities of family and friend (unpaid) caregivers who were caring for a community-dwelling older adult living with dementia. I then examined the 72 articles meeting the inclusion criteria for the positioning, range, and nature of the research on this topic in addition to the language used to frame and understand information and caregivers in relation to one another. In the sixth stage (the consultation exercise), I interviewed 13 family caregivers to understand whether the scoping review’s findings were in alignment with their own lived care experiences. Participants provided informed consent and consent was written, with the Ethics Review Board of The University of Western Ontario providing ethics approval.

IE and Texts

Developed and named by Canadian feminist sociologist Dorothy Smith (1987, 1990a, 1990b, 1999, 2005, 2006b), IE is a method of inquiry that brings attention to people’s everyday work while simultaneously highlighting broader sites of administration and governance that are (often invisibly) organizing that work. Smith defines work generously as “anything done by people that takes time and effort” (Smith, 2005, p. 151), regardless of whether those activities occur in the home, at work, or elsewhere. To explicate the invisibility of people’s everyday work, an institutional ethnographer will map the ruling relations, that is, the invisible, translocal forms of organization that coordinate what people do with what others are doing “elsewhere and elsewhen” (Smith, 2005, p. 225). To trace how people’s experiences come to be hooked into ruling relations, an institutional ethnographer will often analyze the role of texts in the invisible coordination of individuals’ everyday work. These texts may be policy documents, forms, signs, guidelines, or other formal documentation. Smith’s (1990a, 1990b) term “textually-mediated social organization” is in recognition that texts are more than a specimen or sample for study, but are instead a “means of access, a direct line into the relations it organizes” (Smith, 1990a, p. 4). Texts can acquire the capacity to coordinate the actions and experiences of people, even if people are not in direct contact or engagement with them.

Text-based IE studies typically focus on policy documents and institutionally developed or sanctioned forms. Examples of past policy-focused IE investigations include an examination of policies that shape educational governance in public schools (Nichols & Griffith, 2009), the activation of texts in United Nations forest policy deliberations (Eastwood, 2006), the shaping of administrative language in Danish universities’ language policies (Siiner, 2016), an exploration of Norwegian workline policies’ coordination of interactions between service users and social workers (Hansen, 2019), and tracing the unexpected impact of a provincial policy to reduce emergency department wait times on medical students’ training (Webster et al., 2015). A second category of IE text-based studies include investigations of texts that invisibly enter into and shape people’s everyday lives, including youth intake and assessments forms (Halsall, 2004), hospital computer software systems that manage nurses’ work (Campbell & Rankin, 2017), and flyers distributed in the process of land development and municipal planning (Turner, 2003).

While a popular tool to survey and generate a topography of scholarly findings across a number of disciplines, scoping reviews are overlooked data for textual analyses in IE.¹ As Rankin (2017a) explains, “people’s use of texts gives ruling relations a material form that institutional ethnographers can use to investigate social organization” (p. 2). If texts serve as instruments through which ruling relations take shape and can be identified, this raises the question of whether a scoping review that aggregates a number of texts could be an appealing data source for institutional ethnographers.

As a student, a researcher, and a librarian, I had carried out a number of scoping reviews but never before had I critically examined or questioned the conceptual work inherent in the selection, revision, and synthesis processes that structure a scoping review’s six stages. My desire to more specifically examine how the “phenomena” of families’ information-related care work are constructed and studied in scholarly texts stemmed from my readings of the conditions that instigated the advent of IE: Smith (1987) grew frustrated with mainstream sociological research’s tendency to objectify, alienate, or distort different groups’ experiences (women included). I therefore began to contemplate the ways an institutional ethnographic approach to synthesizing the articles had disrupted my assumptions about the scoping review stages, allowing me to go beyond the “rational-technical thrust” (Pope, 2003, p. 279) characteristic of knowledge synthesis methods. It was through this process of upholding an institutional ethnographic method of inquiry while selecting, reading through, and synthesizing the scholarly literature that my relationship with the articles and my understanding of the scoping review method began to shift. As I attempted to reconcile IE’s epistemological and ontological assumptions with the linear procedures prescribed by the six scoping review stages, reflecting on the process of reviewing and synthesizing the scholarly literature became of analytical and methodological interest. In the following three subsections, I outline how IE’s unique conceptualization of texts avoided knowledge replication (Thorne, 2017a) and mirroring (Lather, 1999) common in knowledge synthesis methods and instead transformed my scoping review into a critical knowledge synthesis tool.

The Active Text: Institutional Ethnography’s Approach to Texts

Scoping reviews are often characterized by verbatim summaries of the articles meeting prescribed inclusion criteria. The impetus for looking beyond scholarly articles’ content for indications of their textually mediated organization originates with ethnomethodology. Garfinkel (1967) observed that records themselves cannot be treated as objective accounts nor as independent from the organizational contexts from which they arise. Smith (1990a), drawing from this ethnomethodological philosophy, observed that “textual materials have generally presented themselves to the sociologist as sources of information about something else, rather than as phenomena in their own right” (p. 120).

IE offers an epistemology not commonly used within traditional knowledge synthesis methods, in part because IE emphasizes the centrality of texts’ organizational and coordinating abilities. In IE studies, texts are broadly construed as “material objects that carry messages” (Smith & Turner, 2014, p. 5). Texts include paintings, music, television, writing or “words, images, or sounds that are set into a material form of some kind from which they can be read, seen, heard, watched, and so on” (Smith, 2006a, p. 66). Smith (2005) stresses that texts are “occurring”; as texts are drawn into sequences of activity, they acquire the capacity to coordinate actions and consciousness. Focusing not on the text but instead how it becomes activated as it “enters into and coordinates people’s doings” (Smith, 2005, p. 170) helps to “escape our experience of [texts] as passive and enables us to see them as in action” (p. 169), exposing how local activities extend beyond to the extralocal. Smith (2005) outlines two key characteristics of texts that enable ruling relations to proliferate: the replicability of texts and their ability to be read or heard by any number of individuals in identical form across time and place. These two characteristics enable institutional ethnographers to map and expose the ruling relations that simultaneously exist outside of, yet have direct impact on, people’s everyday work. A text’s replicability enables its coordination of people’s work from a distance and across local settings. This replicability also ensures a certain degree of standardization of people’s doings and thinking regardless of time, person, or place. As a result, texts, such as peer-reviewed research articles, become instances of “crystalized” ruling relations (Campbell & Gregor, 2004, p. 79) and ultimately “provide for the standardized recognisability of people’s doings as organizational or institutional” (Smith, 2001, p. 160).

Texts are ubiquitous in academic environments. While students, researchers, and scholars engage with textual materials on a daily basis, these textual events, that is, the engagement with and activation of texts, go almost entirely undetected (Smith, 2005). This pervasive, yet undetected use of texts ensures a standardized framework and a particular way of “produc[ing] and transform[ing] as well as limit[ing] and regulat[ing]” (Katz, 1996, p. 48) knowledge that is replicated for other academics to read and take up. In my scoping review considered herein, I discovered that particular framings of caregivers’ information work were taken up and replicated in subsequent studies, eventually legitimizing the boundaries and categories that academic knowledge synthesis practices place around caregivers and their information work. As texts are replicated and standardized across time and place, institutional ethnographers can begin to map and trace how scholars activate other texts within their own writing through the use of citations to other texts and ideas, ultimately revealing how texts coordinate disciplinary thinking over time.

Forms of Textual Organization: Intertextual Hierarchy and Intertextual Circles

As scoping reviews aggregate and synthesize articles from many disciplines, often regardless of method or research design, institutional ethnographers can identify the concepts and terms that surface and may be taken for granted as they become progressively integrated into a discipline over time. As McCoy (2006) elaborates, “many linguistic forms that organize knowledge in institutionally relevant ways have spread so far into common speech that we are not always aware how they are operating” (p. 122). Smith outlines two concepts integral to the analysis of texts’ organizational capabilities: intertextual hierarchy and intertextual circles. Adopting an IE lens sensitized me to the presence of these forms of textual coordination in my scoping review.

Institutional ethnographers carrying out a scoping review can identify intertextual hierarchies by tracing the lineage of references and citations to other scholarly articles. In Smith’s (2006a) definition of intertextual hierarchy, “higher-order texts regulate and standardize texts that enter directly into the organization of work in multiple local settings” (p. 79). An early, highly cited article could be interpreted as an example of a higher-order, regulatory text as it enters directly into differently located scholars’ thinking and writing. Institutional ethnographers can also use the chronology of publication as an indication of earlier texts’ regulation and activation of subsequent research. While texts in and of themselves do not regulate other texts (Smith, 2006a), because texts are “active,” they become activated as their ideas, results, or conceptualizations of a concept are projected into subsequent articles. As I searched for the presence of intertextual hierarchies in my own scoping review, I was able to approach the analysis of scholarly texts with a unique lens: each component of the scoping review (each article) was interpretable as an expression of a ruling relation, as a higher source of organization emanating from past articles or disciplinary thinking and independent of any particular author or article.

My scoping review also provided evidence of Smith’s (2006a) concept of intertextual circles, the “characteristic circularity discernible in the ongoing organization of this intertextual hierarchy” (p. 85). This circularity is evident in the activation of earlier published articles, which influence later-produced articles, reflecting what was published in earlier articles. As a catalyst for perpetuating intertextual hierarchies, intertextual circles are crucial in enabling, constructing, and propagating ruling relations.

Using intertextual hierarchies and intertextual circles as analytical structuring devices when reading through and synthesizing the 72 included articles, I was able to go beyond the traditionally descriptive findings in a scoping review. I traced how the study and writing about the information-care relationship has evolved and has, over time, made family caregivers’ information work invisible. As I read through these articles, I recorded the ways that the authors² conceptualize information. Much like Greyson and Johnson (2016) uncovered in their scoping review of the use of information as a concept within public health behavior models, authors in my scoping review conceptualized information as a “thing” (Buckland, 1991) to be sought, used and understood, ignoring information’s more invisible or intangible qualities (such as information-as-process). Twenty-nine (40%) articles explicitly spoke of information as an intervention or as part of an intervention, designed and provided by the study’s author(s) to deliver information to prevent or reduce the negative consequences of caregivers’ burden, with an unstated assumption that more information is necessarily helpful. Furthermore, 25 articles (86% of intervention-based articles) integrated one or more forms of technology (including computers, telephones, videophones, internet/email, assistive technology, and VHS tapes) to deliver information to caregivers. Articles advocating these technological information interventions lauded the intervention’s ability to remove barriers to access information and to facilitate caregivers’ access to assistance (equated with information) at the touch of a button. Eleven of these technology-based, intervention-focused articles (44%) were written between 1990 and 1999, representing 73% of the sample published during this time period. These early “higher-order” articles established a standardized way upon which more contemporary authors base their thinking and writing about caregivers’ information-based care work. Based on these findings, I identified two intertextual circles working in tandem in my scoping review articles (information as intervention and information as technological intervention) that appear throughout the scoping review’s time frame (1990–2017) due to an intertextual hierarchy. Information as a technological intervention appeared in the two earliest articles (Goodman, 1990; Goodman & Pynoos, 1990) and in 13 (52%) of the articles written in the most recent decade. These early-established intertextual circles have regulated the ongoing invisibility of family caregivers’ information work; technological devices were conceived from the earliest articles as doing the work of providing and making information available. As a result, authors of the scoping review articles treated caregivers as secondary to information and its delivery mechanisms in the information-care relationship. Authors therefore attributed any measured or reported decline in caregivers’ burden to the information itself (and the technology delivering the information) and not to the work the caregivers performed to obtain, understand, manage, and share information.

Through the interconnected processes of the intertextual hierarchy and intertextual circles I identified, my scoping review findings (Dalmer, 2020) suggest that the two concepts information and care come to constitute a particular shared and objectified mode of organizational consciousness, as empty conceptual shells,³ at the level of academic discourse. As Smith (1990a) explains,

Progressively over the last hundred years a system of organizational consciousness has been produced, constructing “knowledge, judgement, and will” in a textual mode and transposing what were formerly individual judgements, hunches, guesses, and so on, into formulae for analyzing data or making assessments. Such practices render organizational judgement, feedback, information, or coordination into objectified textual rather than subjective processes. (p. 158)

Not one of the 72 included articles provided an operational definition of either information or care, nor did the authors include caregiver participants’ understandings of either concept. The articles’ authors primarily focused on physical, instrumental, and observable dimensions of care. Furthermore, information was generally studied and written about in a narrow fashion and was often conflated with training, knowledge, skills, communication, advice, education, support, understanding, or as a mediator that decreases burden. With this simplified understanding of information, authors tended to conflate the mere provision of or access to information with being informed, thereby neglecting the work (including the resources, time, relationships, emotional impacts, etc.) that makes becoming informed possible. Failing to involve participants in the creation of definitions of information or care may not only result in the gradual removal of these terms from participants’ everyday lives, but the authors’ understandings of and approaches to information and care are what come to count and proliferate in subsequent academic writing. This makes it increasingly difficult to elude the prevailing (narrow) ways of thinking about and defining information and care. Better understanding how authors create or adopt the categories and discourses about information and care not only deconstructs textual authority but also makes visible that academics (and their works) are not outside of and may, in fact, contribute to the ruling relations that impact the very people or concepts they study.

Nominalization: Challenges to the Visibility of Information Work

Maintaining an IE lens during the analysis of my scoping review highlighted the proliferation of Smith’s (1990b, 2005) concept of nominalization in which authors suppress the presence of active subjects: “things are getting done, but no one is present to do them” (Smith, 2005, p. 111). In my scoping review, authors of the articles treated information as a nominal, as an “abstract noun capable of functioning as an agent” (Smith, 1990b, p. 44). This nominalization resulted in the extraction, depersonalization, and decontextualization of information from its everyday contexts, enabling the proliferation of the textually mediated ruling relations that coordinate this term. As previously noted, the articles’ authors used information synonymously with training, knowledge, skills, communication, advice, education, support, and understanding. The use of these synonyms conceals how things are getting done and overlooks “the idiosyncrasies of experiences, interest, and perspectives” (Smith, 2005, p. 43). As authors employ these synonyms for information, it gradually occludes this type of care work and separates family caregivers from what information might actually mean to them in their everyday lives. Furthermore, authors’ use of these synonyms suppresses family caregivers’ work, including the work of understanding and implementing the information interventions and of manipulating the many forms and topics of information they need to guide or support their care work. I suggest that as a result of nominalization, information becomes subject to conceptual inflation, whereby a term comes to mean almost anything, and, relatedly, conceptual conflation, where similar terms are merged, erasing their variances (Frohmann, 2004; Sandelowski et al., 2008).

Nominalization occurs not only in the articles that a scoping reviewer synthesizes but also in the scoping review process itself. Scoping reviewers must collect and summarize highly divergent data, necessitating conversions, manipulations, modifications, and reconfigurations (Sandelowski, 2008) to make the included articles pliable to the scoping review stages. This creates an environment in which scoping reviewers may inadvertently conflate or inflate the concept or topic under investigation. As I attempted to synthesize the 72 articles in my sample, I became aware that I was unintentionally removing family caregivers from their information work. As authors differently labeled and described information in each article (due, in part, to nominalization), I was creating a broader, more ambiguous concept of information to capture the varied conceptualizations in the sample. As a result, my scoping review came to represent a double decontextualized account of caregivers’ information work; removed once in the writing of the articles included in my scoping review sample and removed further a second time in the construction of my scoping review. This finding supports Lather’s (1999) observation that “a review is gatekeeping, policing, and productive . . . in short, a review constitutes the field it reviews” (p. 3).

Rethinking the Scoping Review in Response to IE

In their articulation of the scoping review, Arksey and O’Malley (2005) call for their article to be but a starting point and conclude with an invitation to discuss and debate “the merits of scoping studies” (p. 31) to further the development of the method. While this invitation is slowly gaining traction (Chambers et al., 2018; Colquhoun et al., 2014; Daudt et al., 2013; Levac et al., 2010), a majority of scoping reviews continue to operate within and retain the structure of Arksey and O’Malley’s original six-stage framework. While conventional scoping reviews implicitly acknowledge an article as an objective piece of the knowledge puzzle, IE rests on an epistemic assumption that all knowledge is socially constructed, containing particular positions and interests (Rankin, 2017b; Smith, 2005, 2006b). Smith critiques objectified forms of knowledge, calling for institutional ethnographers to expose “the social organization and social relations through which objectified forms of knowledge are created” (Mann & Kelly, 1997, p. 393). My scoping review became a critical knowledge synthesis tool in part because of IE’s resistance to viewing texts as inert or accepting knowledge merely due to its status as knowledge. In this section, I demonstrate how IE’s ontological and epistemological assumptions trouble and modify three specific stages of the scoping review method.

Stage 4: Data Extraction and Charting

Scoping reviews are known for their ability to provide a “comprehensive and panoramic overview” (Davis et al., 2009, p. 1388) of the literature. Arksey and O’Malley (2005) describe scoping reviews as not seeking to assess the quality of the evidence in each article, one of the key aspects that differentiate this review type from systematic reviews. Because of these two factors, the fourth stage (data extraction and charting) is not focused on any one article. Instead, scoping review authors describe data so as to illuminate “key themes, trends, and patterns in the articles under study—all at a general level rather than highlighting individual studies or particular findings” (Rumrill et al., 2010, p. 403). This approach to analyzing a scoping review is in alignment with the suggested approach to IE analysis, which refuses any single view or narrative and “supersedes any one account and even supersedes the totality of what informants [and texts] know and can tell” (Campbell & Gregor, 2004, p. 85).

While traditional analytical approaches to scoping reviews in this fourth stage will take inventory of topics such as date of publication, author’s affiliation, populations under study, methods used, and key themes found, this approach lacks a critical reading into the invisible, including what remains unsaid, undisclosed, or understudied. The very work of writing scholarly articles is in and of itself shaped by ruling relations emanating from institutions of health care, funding, and academia (Solomon, 2008). Authors’ decisions regarding which articles to include and cite are also influenced by ruling relations. Hemmings (2011), for example, draws attention to authors’ citations tactics that exclude certain texts from the historical record and to “citation practices [that] secure the chronology and affect central to narrative momentum” (p. 163). Therefore, analyzing the activation of scholarly literature in keeping with an IE study necessitates that institutional ethnographers undertake a different kind of reading, identifying instead “how the [article’s author] is located, the purposes for which a particular account is written and what activities this particular account supports—or, alternately, makes invisible” (Campbell & Gregor, 2004, p. 83). Turner’s (2003) summary of texts’ activation and how texts come to coordinate people’s everyday work is a helpful framework for an institutional ethnographer analyzing the contents of their scoping review:

The active (text) organizes institutional processes and relations that govern and regulate the society that we produce and live;

We are constantly engaged in textually mediated forms of action and thus in ruling relations;

The operation of texts is pervasive, relatively unnoticed in people’s behaviour; and

Textually-mediated social organization is observable as people’s actual practices (p. 91).

With its generous conceptualization of work, an IE-informed scoping review is attuned to illuminate invisible forms of work that a traditional scoping review is not designed to examine. Accordingly, I read each of the articles in my scoping review sample looking for instances of assumed or unrecognized work and for connections between articles; treating each article simultaneously as a separate entity but also as part of a body of work in and through which ruling relations may be operating. Only four articles (6% of the scoping review sample) tangentially addressed family caregivers’ information work. I therefore broadened my conceptualization of information work in attempt to capture a greater number of articles, examining whether articles demonstrated an awareness that caregivers’ information practices might evolve over the course of the caregiving trajectory. Nearly three quarters of the sample (74%; 53 of 72) provided no evidence that caregivers’ information practices may change as their caregiver role shifts or the needs of the care recipient evolve.

As I initially followed Arksey and O’Malley’s framework in my own scoping review, I struggled against the activation and analysis of the articles in Stage 4 (and Stage 5, further elaborated in the following section) that induced a two-stage, parallel process that further contributed to the previously described double decontextualization of caregivers’ everyday information work: that of disentanglement and qualification. Moreira’s (2007) analysis of the social organization of knowledge making in health care–related systematic reviews noted that disentanglement occurs when “knowledge practices attempt to extricate data from the milieus in which they are commonly found (databases, texts, other research centres, etc.)” (p. 180) and qualification refers to “endowing data with new qualities—such as precision, unbiasness or ‘fairness’—through the use of templates, graphical platforms and techno-political debates” (p. 180).

Anderson et al. (2008) illuminate the hidden decisions scoping reviewers make throughout the six-stage process: “contextualising knowledge in terms of identifying the current state of understanding; identifying the sorts of things we know and do not know, and then setting this within policy and practice contexts.” The scoping reviewer’s judgments, decisions, and compromises that manipulate articles into “arbitrary and reductionist categorizations” (O’Shaughnessy & Krogman, 2012, p. 504) are a reflection of the social organization of knowledge synthesis. To adhere to the six-stage protocol, the scoping reviewer must make articles “docile” to the review process (Moreira, 2007, p. 181) while simultaneously “distort[ing] them into clarity” (Law, 2004, p. 2). One facet of making articles docile is ignoring the ruling relations that shape academic and clinical authorship. A scoping reviewer’s need to make articles “docile” is especially acute when crafting a scoping review that deals with nebulous, transdisciplinary concepts, such as information or care, which are constructed, indexed, and interpreted differently between articles, databases, and disciplines. Maintaining an IE lens on my own scoping review, for example, highlighted that my data extraction and charting practices were less about caregivers’ experiences and more so about the contexts and interests of the articles’ authors and my own decisions as I attempted to make the articles compliant with the fourth stage. The boundary and category-making inherent in a scoping reviewer’s “practices of including and excluding” (Lather, 1999, p. 3) allow institutional ethnographers to acknowledge that “data are never simply ‘extracted intact’” (MacLure, 2005, p. 394) and contemplate the scoping review as “not exhaustive; it is situated, partial, perspectival” (Lather, 1999, p. 3).

Stage 5: Summarization and Dissemination of Findings

As previously noted, IE rests on an epistemic assumption that all knowledge is socially coordinated and constructed, containing particular positions and interests (Rankin, 2017b; Smith, 2005, 2006b). IE therefore brings attention to the often-imperceptible ways texts, such as scoping reviews, interact with and serve as organizers of different forms of knowing and power. Approaching the scoping review with an IE lens highlights academic articles as “productive relays between power and knowledge” (Katz, 1996, p. 102), revealing the invisible ruling relations emanating from funding institutions, teaching curricula, university programs, academic library access, and academic institutions that each article encapsulates. With this lens, an institutional ethnographer can interpret the scoping review as a textual technology that summarizes knowledge and therefore orients readers to a particular segment of the literature, ultimately shaping how readers think about and engage with large numbers of academic articles.

In analyzing how power enters into and manifests in scoping reviews, I argue that the development and application of the fifth stage can be interpreted both as a method that can repress or constrain what literature is summarized and as a method that opens up fields for interventions, promoting “new ways of being and acting in relation to evidence” (Mykhalovskiy, 2003, p. 335). A scoping reviewer’s summarization practices in the fifth stage are inextricably linked with IE concepts concerning authoritative knowledge and expertise. An institutional ethnographer can differently approach the scoping review’s fifth stage by attending to the centrality of textual practices in the organization of contemporary forms of power (Frohmann, 2004). As Mykhalovskiy (2003) (and later with Mykhalovskiy (2004)) observed while deciphering the social organization of evidence-based medicine, thinking more broadly about power not as a negative mechanism, but as a productive relation, offers an innovative way to summarize family caregivers’ information work in academic writing. Taking up power not as a limiter but as a productive relation (Foucault, 1978) provides an explanation for the prevalence of the information interventions that I identified in my scoping review. I interpreted these information interventions as extensions of the article authors’ expertise (a form of power). In this fifth stage, an IE lens helped me to question the characteristic scoping review summarization practices that would preserve the power (expertise) enacted in these interventions with the creators of the intervention and would reduce family caregivers and the experiences of their everyday information-related care work to objects of techno-scientific intervention. Without this lens, my scoping review would have removed caregivers from their experiences of their own work. Conceptualizing caregivers as objects of an information intervention, not as creators (or co-creators) of an intervention, can occlude the complexities and contradictions of each caregiver’s experience of their information work. Without an IE lens, the fifth stage becomes a summary of the authors’ view of caregivers’ experiences, that is, knowledge replication (Thorne, 2017a) or knowledge mirroring (Lather, 1999). The actualities of family caregivers’ information work are rendered knowable, not by the caregivers, but first through the authors of each article and second through the scoping reviewer. Combined with the effects of nominalization, the fifth stage provides further evidence of a scoping review’s double decontextualization of family caregivers’ information work.

Stage 6: Consultation Exercise

The rarely implemented sixth stage of a scoping review (Pham et al., 2014), the consultation exercise with stakeholders, supports IE’s privileging of informants’ work knowledges: “a person’s experience of and in their own work, what they do, how they do it, including what they think and feel” (Smith, 2005, p. 151). It is IE’s privileging of people’s standpoint and their experiences of their everyday lives that prompts a focus and an emphasis on ensuring their voices are not muddled or lost through the knowledge synthesis processes. This rooting in people’s standpoint stems from IE’s social ontology and focus on descriptions of the social world as it is actually happening (Rankin, 2017b; Smith, 2005, 2006b). An IE-informed consultation exercise is an opportunity for an institutional ethnographer to contextualize the knowledge (and power) uncovered in the scoping review, to challenge the articles’ authors’ expertise, and to prioritize elucidating the everyday work done by those who are the focus of study. This corresponds to the institutional ethnographer’s overall aim to explore the “ruling relations as they are encountered by people whose experiences are under study . . . maintain[ing] that standpoint throughout” (Dalmer et al., 2017).

For my larger IE study, of which the scoping review is one component, I interviewed 13 family caregivers about the intersections of their care work and information work. At the end of each interview, I provided informants an overview of my scoping review findings (including biomedical/expert approaches to information, information as intervention, information as intervention via technology, and information as a one-time, stagnant application (Dalmer, 2020)) and asked them to provide their general impressions as well as the degree to which the findings were in alignment with their own care experiences. I considered the 13 caregivers to be “standpoint informants” or “expert knowers” (Rankin, 2017a) about their everyday care (and information) work. Adopting a specific standpoint (such as the standpoint of family caregivers of community-dwelling older adults living with dementia) affords the opportunity to “examine how knowledge works; whose knowledge counts” (Rankin, 2017a, p. 2). My understanding of the ruling relations coordinating caregivers’ experiences of their information work grew recursively and abductively in alignment with the discovery-laden nature of IE, as summarized by DeVault and McCoy (2002):

The process of inquiry is rather like grabbing a ball of string, finding a thread, and then pulling it out; that is why it is difficult to specify in advance exactly what the research will consist of. The researcher knows what she wants to explain, but only step by step does she know who she needs to interview, or what texts and discourses she needs to examine. (p. 755)

This consultation exercise was especially adept at distilling caregivers’ points of disjuncture—that is, when a caregiver or I identified a mismatch between what I had uncovered in the scoping review and what the expert knower experienced. Points of disjuncture represent differences in reality, the “knowing something from a ruling versus an experiential perspective” (Campbell & Gregor, 2004, p. 48), revealing the “trouble that arise for people at the interface between their everyday lives and translocal relations of knowledge and coordination” (DeVault & McCoy, 2012, p. 384). Points of disjuncture surrounded one of three areas. First, that of information as a stagnant tool (caregivers talked about their information needs changing over time as the prognosis of dementia changed and their relationship with the older adults changed). Second, an emphasis on technology (caregivers primarily relied on receiving information through word of mouth from other caregivers, family members, and health care professionals). Third, the construction of information as an intervention (this appeared to be a formal construction created by the authors that did not match the everyday lives, experiences, or understandings of caregivers’ interactions with information).

Alice,⁴ a wife caring for her husband diagnosed with early-onset Alzheimer’s, illuminates the first disjuncture (information as a stagnant tool) as she describes the work she does to gather, filter, and store information—work that evolves with the fluctuating trajectory of her husband’s dementia:

I sift through what I need for now and I can put the info over there because I don’t need that yet and I know it’s there. So this information that I’ve got here . . . I don’t need to really act upon that now. It’s in a folder and it’s in the back of my head. When there was a first diagnosis, there’s a need to know. I was trying to grab as much information as I could. Over time, you filter and you use what is needed—use what is needed in the present.

Sophia, a wife caring for her husband who is living with Alzheimer’s, speaks to her relationally influenced information work:

Without people, I would be . . . I don’t know where I would be. And I feel that with the people I have met at the Alzheimer’s Society, like the other caregivers . . . I think people like to be connected. And they are some of your biggest resources—those people . . . They’re really good. People going through it. The voice of experience, that’s what they are. Empathetic. Empathy is a huge thing. Huge.

Sophia’s quote is evidence that the second and third points of disjuncture (information as an intervention and information delivered through technology) work in tandem, much like the intertextual circles of the same name. Sophia’s work knowledge corroborates Barnes et al.’s (2016) findings, in that “we should not understand information simply as a neutral or cognitive resource that can be drawn upon” (p. 520). Like other family caregivers indicated, Sophia prefers to both receive and deliver information in person and places great value in other care providers’ experiences. This may be because Sophia imbues information with a deeply affective element. The information she decides to share and receive and with whom she shares information is dependent on the relationships and care contexts she is (or is not) in.

In my scoping review, I used these points of disjuncture as opportunities to begin to question the nominalization of information and to highlight family caregivers’ hidden information work. These points of disjunctures have the potential to serve as openings for researchers, policy makers, and institutional leaders to better understand how academic writing and knowledge or evidence synthesis methods may inadvertently marginalize or remove those it studies and provide an opportunity to reunite caregivers (the “expert knowers”) with their information work from which they have been separated through the scoping review process.

Conclusion

The growing body of scoping review methods-based papers (Anderson et al., 2008; Colquhoun et al., 2014; Morris et al., 2016; Pham et al., 2014) draw exclusively on Arksey and O’Malley’s (2005) six-stage protocol and continue to convey the six stages as an impartial process. This protocol prescribes a specific way for conducting and reporting scoping reviews and could be interpreted to “represent efforts to shape, direct, orient and otherwise intervene in how and what” (Mykhalovskiy, 2003, p. 332) academics read, think, write, and research. Without an IE lens on this process, it is easy to lose sight of the ways by which the construction of a scoping review contributes to the textually mediated organization of knowledge synthesis.

Smith (2006a) articulates that “texts don’t achieve the capacity to regulate just by their existence” (p. 81). Indeed, it is not the texts, but the intertextual circles identified in my scoping review (information as intervention and information delivered through technology) passed (via the intertextual hierarchy) from the earliest articles to those most recently published that have enabled academic writing to regulate family caregivers’ information work. As contemporary authors draw from and cite earlier works within these intertextual circles, earlier articles accrue authority over time, legitimizing the boundaries placed around the methods applied and the language used to study and describe the information work done by family caregivers of community-dwelling older adults living with dementia. The nominalization of information (closely linked to conceptual inflation and conflation) combined with the summarization practices in the scoping review’s fifth stage results in a double decontextualization of family caregivers’ information work.

IE’s focus on “active” texts prompts researchers to acknowledge that knowledge synthesis methods are neither neutral nor objective exercises. While researchers study individuals or concepts and then write about and share their findings, this is not where the reach of scholarship ends. IE illuminates how the writing and dissemination of studies begin to give shape to and coordinate the everyday experiences of those individuals under study, for example, by informing the development of policies. The self-perpetuating nature of the complex of intertextual hierarchy, intertextual circles, and nominalization legitimizes and organizes a particular way of approaching, thinking, studying, and writing about caregivers’ information work, making it difficult to break out from this institutional discourse that defines and shapes the understandings of caregivers’ information work. My findings serve as an invitation for future studies to examine how database configurations in conjunction with scoping reviewers’ inclusion and exclusion decisions in Stages 2 (identification of relevant studies) and 3 (selection of included studies) coordinate knowledge synthesis.

The process of undertaking the first IE scoping review was a creative (and sometimes tedious) sequence of iteration and contemplation as I reflected on each stage of the scoping review independently as well as on its contribution to the whole. My critical reflections regarding the reconciliation between the ways of knowing set out by an IE method of inquiry and the prescribed scoping review stages aim to support researchers in mindfully and reflexively questioning and troubling the six-stage framework, ultimately transforming the scoping review into a critical knowledge synthesis tool. Exposing the structures that scoping reviews impose contributes to continued discussions of the evolution of the scoping review method as well as IE’s conceptualizations of texts.

Footnotes

Acknowledgements

An earlier version of this article benefited from discussions at The Society for the Study of Social Problems’ Institutional Ethnography workshop in Montréal, Canada (August, 2017). Thank you to Dr. Marjorie DeVault and Dr. Eric Mykhalovskiy for the feedback you provided. I am also grateful for the thoughtful and constructive feedback I received from the anonymous reviewers. Finally, and in particular, I would like to thank Dr. Pam McKenzie, who ever so patiently nudged me toward thinking through and writing this article.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research on which this paper is based took place during my doctoral work at The University of Western Ontario’s Faculty of Information and Media Studies. My doctoral work was supported by the Social Sciences and Humanities Research Council’s (SSHRC) Joseph-Armand Bombardier Canada Graduate Scholarship Program (CGS)—Doctoral and the Medical Library Association’s Eugene Garfield Research Fellowship. The funders had no role in the study design, the data collection and analysis, the decision to publish, or in the preparation of the manuscript.

ORCID iD

Nicole K. Dalmer

Notes

Author Biography

Nicole K. Dalmer is an assistant professor in the Department of Health, Aging and Society at McMaster University’s Faculty of Social Sciences. Nicole’s work resides at the intersection of information and care, studying how aging in place contexts, assumptions surrounding digital literacies, and evolving family responsibilities shape who is able and who is expected to be informed in care relationships. Other ongoing projects include an international collaboration examining the impact of digital infrastructures on feelings of connectedness in later life as well as an investigation into the role of community infrastructures (including public libraries) in mitigating older adults’ experiences of social isolation/incluson.

References

Alvesson

Sandberg

(2011). Generating research questions through problematization. Academy of Management Review, 36(2), 247–271. https://doi.org/10.5465/amr.2009.0188

Anderson

Allen

Peckham

Goodwin

(2008). Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services. Health Research Policy and Systems, 6, 7. https://doi.org/10.1186/1478-4505-6-7

Arksey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

Barnes

Henwood

Smith

(2016). Information and care: A relational approach. Dementia, 15(4), 510–525. https://doi.org/10.1177/1471301214527750

Britten

Garside

Pope

Frost

Cooper

(2017). Asking more of qualitative synthesis: A response to Sally Thorne. Qualitative Health Research, 27(9), 1370–1376. https://doi.org/10.1177/1049732317709010

Buckland

M. K.

(1991). Information as thing. Journal of the American Society for Information Science, 42(5), 351–360. https://doi.org/10.1002/(SICI)1097-4571(199106)42:5<351::AID-ASI5>3.0.CO;2-3

Campbell

Gregor

F. M.

(2004). Mapping social relations: A primer in doing institutional ethnography. Altamira Press.

Campbell

M. L.

Rankin

J. M.

(2017). Nurses and electronic health records in a Canadian hospital: Examining the social organisation and programmed use of digitised nursing knowledge. Sociology of Health & Illness, 39(3), 365–379. https://doi.org/10.1111/1467-9566.12489

Chambers

L. A.

Jackson

Worthington

Wilson

C. L.

Tharao

Greenspan

N. R.

Masching

Pierre-Pierre

Mbulaheni

Brownlee

(2018). Decolonizing scoping review methodologies for literature with, for, and by Indigenous peoples and the African diaspora: Dialoguing with the tensions. Qualitative Health Research, 28(2), 175–188. https://doi.org/10.1177/1049732317743237

10.

Colquhoun

H. L.

Levac

O’Brien

K. K.

Straus

Tricco

A. C.

Perrier

Kastner

Moher

(2014). Scoping reviews: Time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology, 67(12), 1291–1294. https://doi.org/10.1016/j.jclinepi.2014.03.013

11.

Dale

Angus

J. E.

Sinuff

Mykhalovskiy

(2013). Mouth care for orally intubated patients: A critical ethnographic review of the nursing literature. Intensive and Critical Care Nursing, 29(5), 266–274. https://doi.org/10.1016/j.iccn.2012.09.003

12.

Dalmer

N. K.

(2018). Informing care: Mapping the social organization of families’ information work in an aging in place climate [Doctoral thesis, The University of Western Ontario]. https://ir.lib.uwo.ca/etd/5948/

13.

Dalmer

N. K.

(2020). ‘Add info and stir’: An institutional ethnographic scoping review of family care-givers’ information work. Ageing & Society, 40(3), 663–689. https://doi.org/10.1017/S0144686X18001125

14.

Dalmer

N. K.

Stooke

McKenzie

(2017). Institutional ethnography: A sociology for librarianship. Library and Information Research, 41(125), 45–60. https://doi.org/10.29173/lirg747

15.

Daudt

H. M. L.

van Mossel

Scott

S. J.

(2013). Enhancing the scoping study methodology: A large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Medical Research Methodology, 13(1), Article 48. https://doi.org/10.1186/1471-2288-13-48

16.

Davis

Drey

Gould

(2009). What are scoping studies? A review of the nursing literature. International Journal of Nursing Studies, 46(10), 1386–1400. https://doi.org/10.1016/j.ijnurstu.2009.02.010

17.

DeVault

M. L.

McCoy

(2002). Institutional ethnography: Using interviews to investigate ruling relations. In Gubrium

J. F.

Holstein

J. A.

(Eds.), Handbook of interview research (pp. 751–776). Sage.

18.

DeVault

McCoy

(2012). Investigating ruling relations: Dynamics of interviewing in institutional ethnography. In Gubrium

J. F.

Holstein

J. A.

Marvasti

A. B.

McKinney

K. D.

(Eds.), The SAGE handbook of interview research: The complexity of the craft, (pp. 381–396). Sage.

19.

Dixon-Woods

Cavers

Agarwal

Annandale

Arthur

Harvey

Hsu

Katbamna

Olsen

Smith

Riley

Sutton

A. J.

(2006). Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6(1), 35–47. https://doi.org/10.1186/1471-2288-6-35

20.

Eakin

J. M.

Mykhalovskiy

(2003). Reframing the evaluation of qualitative health research: Reflections on a review of appraisal guidelines in the health sciences. Journal of Evaluation in Clinical Practice, 9(2), 187–194. https://doi.org/10.1046/j.1365-2753.2003.00392.x

21.

Eastwood

L. E.

(2006). Making the institution ethnographically accessible: UN document production and the transformation of experience. In Smith

D. E.

(Ed.), Institutional ethnography as practice (pp. 181–198). Rowman & Littlefield Publishers.

22.

Foucault

(1978). The history of sexuality: The will to knowledge. Penguin.

23.

Frohmann

(2004). Deflating information: From science studies to documentation. University of Toronto Press.

24.

Garfinkel

(1967). Studies in ethnomethodology. Prentice Hall.

25.

Goodman

(1990). Evaluation of a model self-help telephone program: Impact on natural networks. Social Work, 35(6), 556–562. https://doi.org/10.1093/sw/35.6.556

26.

Goodman

C. C.

Pynoos

(1990). A model telephone information and support program for caregivers of Alzheimer’s patients. The Gerontologist, 30(3), 399–404. https://doi.org/10.1093/geront/30.3.399

27.

Grant

M. J.

Booth

(2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26(2), 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

28.

Greyson

D. L.

Johnson

J. L.

(2016). The role of information in health behavior: A scoping study and discussion of major public health models. Journal of the Association for Information Science and Technology, 67(12), 2831–2841. https://doi.org/10.1002/asi.23392

29.

Halsall

E. C.

(2004). What is measured matters: A textual analysis of screening and intake tools used with youth [Master’s thesis, University of Victoria, Victoria].

30.

Hansen

H. C.

(2019). Institutional paradoxes in Norwegian labour activation. In Lund

R. W. B.

Nilsen

A. C. E.

(Eds.), Institutional ethnography in the Nordic region (pp. 151–162). Routledge.

31.

Harden

Garcia

Oliver

Rees

Shepherd

Brunton

Oakley

(2004). Applying systematic review methods to studies of people’s views: An example from public health research. Journal of Epidemiology and Community Health, 58(9), 794–800. https://doi.org/10.1136/jech.2003.014829

32.

Hemmings

(2011). Why stories matter: The political grammar of feminist theory. Duke University Press.

33.

Kastner

Tricco

A. C.

Soobiah

Lillie

Perrier

Horsley

Welch

Cogo

Antony

Straus

S. E.

(2012). What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Medical Research Methodology, 12(1), Article 114. https://doi.org/10.1186/1471-2288-12-114

34.

Katz

(1996). Disciplining old age: The formation of gerontological knowledge. University of Virginia Press.

35.

Lather

(1999). To be of use: The work of reviewing. Review of Educational Research, 69(1), 2–7. https://doi.org/10.2307/1170641

36.

Law

(2004). After method: Mess in social science research. Routledge.

37.

Levac

Colquhoun

O’Brien

K. K.

(2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 1–9. https://doi.org/10.1186/1748-5908-5-69

38.

MacLure

(2005). ‘Clarity bordering on stupidity’: Where’s the quality in systematic review? Journal of Education Policy, 20(4), 393–416. https://doi.org/10.1080/02680930500131801

39.

Mann

S. A.

Kelly

L. R.

(1997). Standing at the crossroads of modernist thought: Collins, Smith, and the new feminist epistemologies. Gender & Society, 11(4), 391–408. https://doi.org/10.1177/089124397011004002

40.

Mays

Roberts

Popay

(2001). Synthesising research evidence. In Fulop

Allen

Clarke

Black

(Eds.), Studying the organisation and delivery of health services: Research methods (pp. 188–220). Routledge.

41.

McCoy

(2006). Keeping the institution in view: Working with interview accounts of everyday practice. In Smith

D. E.

(Ed.), Institutional ethnography as practice (pp. 109–125). Rowman & Littlefield Publishers.

42.

Moreira

(2007). Entangled evidence: Knowledge making in systematic reviews in healthcare. Sociology of Health & Illness, 29(2), 180–197. https://doi.org/10.1111/j.1467-9566.2007.00531.x

43.

Morris

Boruff

J. T.

Gore

G. C.

(2016). Scoping reviews: Establishing the role of the librarian. Journal of the Medical Library Association, 104(4), 346–354. https://doi.org/10.3163/1536-5050.104.4.020

44.

Mykhalovskiy

(2003). Evidence-based medicine: Ambivalent reading and the clinical recontextualization of science. Health, 7(3), 331–352. https://doi.org/10.1177/1363459303007003005

45.

Mykhalovskiy

Weir

(2004). The problem of evidence-based medicine: Directions for social science. Social Science & Medicine, 59(5), 1059–1069. https://doi.org/10.1016/j.socscimed.2003.12.002

46.

Nichols

Griffith

A. I.

(2009). Talk, texts, and educational action: An institutional ethnography of policy in practice. Cambridge Journal of Education, 39(2), 241–255. https://doi.org/10.1080/03057640902902286

47.

O’Shaughnessy

Krogman

N. T.

(2012). A revolution reconsidered? Examining the practice of qualitative research in feminist scholarship. Signs, 37(2), 493–520. https://doi.org/10.1086/661726

48.

Pham

M. T.

Rajić

Greig

J. D.

Sargeant

J. M.

Papadopoulos

McEwen

S. A.

(2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 371–385. https://doi.org/10.1002/jrsm.1123

49.

Pope

(2003). Resisting evidence: The study of evidence-based medicine as a contemporary social movement. Health, 7(3), 267–282. https://doi.org/10.1177/1363459303007003002

50.

Prodinger

Shaw

Rudman

D. L.

Townsend

(2012). Arthritis-related occupational therapy: Making invisible ruling relations visible using institutional ethnography. British Journal of Occupational Therapy, 75(10), 463–470. https://doi.org/10.4276/030802212X13496921049707

51.

Rankin

(2017a). Conducting analysis in institutional ethnography: Guidance and cautions. International Journal of Qualitative Methods, 16(1), 1–11. https://doi.org/10.1177/1609406917734472

52.

Rankin

(2017b). Conducting analysis in institutional ethnography: Analytical work prior to commencing data collection. International Journal of Qualitative Methods, 16(1), 1–9. https://doi.org/10.1177/1609406917734484

53.

Rumrill

P. D.

Fitzgerald

S. M.

Merchant

W. R.

(2009). Using scoping literature reviews as a means of understanding and interpreting existing literature. Work, 35(3), 399–404. https://doi.org/10.3233/WOR-2010-0998

54.

Sackett

D. L.

Rosenberg

W. M.

Gray

J. M.

Haynes

R. B.

Richardson

W. S.

(1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72. https://doi.org/10.1136/bmj.312.7023.71

55.

Sandelowski

(2008). Reading, writing and systematic review. Journal of Advanced Nursing, 64(1), 104–110. https://doi.org/10.1111/j.1365-2648.2008.04813.x

56.

Sandelowski

Voils

C. I.

Barroso

Lee

E. J.

(2008). “Distorted into clarity”: A methodological case study illustrating the paradox of systematic review. Research in Nursing & Health, 31(5), 454–465. https://doi.org/10.1002/nur.20278

57.

Schmid

H. J.

(2000). English abstract nouns as conceptual shells: From corpus to cognition. Mouton de Gruyter.

58.

Siiner

(2016). University administrators as forced language policy agents. An institutional ethnography of parallel language strategy and practices at the University of Copenhagen. Current Issues in Language Planning, 17(3–4), 441–458. https://doi.org/10.1080/14664208.2016.1204058

59.

Smith

D. E.

(1987). The everyday world as problematic: A feminist sociology. University of Toronto Press.

60.

Smith

D. E.

(1990a). Texts, facts and femininity: Exploring the relations of ruling. Routledge.

61.

Smith

D. E.

(1990b). The conceptual practices of power: A feminist sociology of knowledge. University of Toronto Press.

62.

Smith

D. E.

(1999). Writing the social: Critique, theory and investigations. University of Toronto Press.

63.

Smith

D. E.

(2001). Texts and the ontology of organizations and institutions. Studies in Cultures, Organizations and Societies, 7(2), 159–198. https://doi.org/10.1080/10245280108523557

64.

Smith

D. E.

(2005). Institutional ethnography: A sociology for people. Altamira Press.

65.

Smith

D. E.

(2006a). Incorporating texts into ethnographic practice. In Smith

D. E.

(Ed.), Institutional ethnography as practice (pp. 65–88). Rowman & Littlefield Publishers, Inc.

66.

Smith

D. E.

(Ed.). (2006b). Institutional ethnography as practice. Rowman & Littlefield Publishers, Inc.

67.

Smith

D. E.

Turner

S. M.

(Eds.). (2014). Incorporating texts into institutional ethnographies. University of Toronto Press.

68.

Solomon

C. R.

(2008). Personal responsibility in professional work: The academic “star” as ideological code. In DeVault

M. L.

(Ed.), People at work: Life, power and social inclusion in the new economy (pp. 180–202). New York University Press.

69.

Thorne

(2017a). Metasynthetic madness: What kind of monster have we created? Qualitative Health Research, 27(1), 3–12. https://doi.org/10.1177/1049732316679370

70.

Thorne

(2017b). Advancing the field of synthesis scholarship: A response to Nicky Britten and colleagues. Qualitative Health Research, 27(9), 1377–1379. https://doi.org/10.1177/1049732317711902

71.

Thorne

Jensen

Kearney

M. H.

Noblit

Sandelowski

(2004). Qualitative metasynthesis: Reflections on methodological orientation and ideological agenda. Qualitative Health Research, 14(10), 1342–1365. https://doi.org/10.1177/1049732304269888

72.

Turner

(2003). Municipal planning, land development and environmental intervention: An institutional ethnography [Doctoral thesis, University of Toronto’s Ontario Institute for Studies in Education].

73.

Webster

Rice

Dainty

K. N.

Zwarenstein

Durant

Kuper

(2015). Failure to cope: The hidden curriculum of emergency department wait times and the implications for clinical training. Academic Medicine, 90(1), 56–62. https://doi.org/10.1097/ACM.0000000000000499