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From the Editor’s Desk

I am humbled by the opportunity to work with the classic grounded theory community and to follow in the footsteps of the previous two editors, Judith Holton and Astrid Gynnild. I am excited to work closely with Barney Glaser, the editorial board, and peer reviewers. One of the most exciting aspects of the Review is the engagement of a global community of classic grounded theorists. Internationally diverse researchers from many disciplines collectively engage in this important research method. As editor, I pledge to continue international multi-disciplinary collaboration and promote the conduct and dissemination of classic grounded theories. Glaser and Strauss developed the classic grounded theory over 50 years ago. Barney Glaser has continued to teach the classic method through writing more than 29 books and dozens of papers, leading seminars in the U.S. and Europe, and mentoring PhD students. Conducting a classic grounded theory study requires adherence to the essence, procedures, and language of the method as described by Glaser. Getting the basics right is key to developing a grounded theory. This issue includes a reprint of a chapter from Glaser’s 1992 book, Basics of Grounded Theory Analysis. In this chapter Glaser discusses how to get started, how to avoid preconception, and how to think about the grounded theory research question. Grounded theory reverberates with diverse people because, when executed well, grounded theories illustrate human truths that are recognized beyond geographic or disciplinary boundaries. That is why a physician or sociologist can read a theory discovered by a mathematician, nurse, or dietician and acknowledge the truth embedded in the theory. This issue of the Review includes contributions from authors from Australia, Ireland, Sweden, and the U.S. with fields of study as diverse as nursing, engineering, education, psychology, and dietetics. Susan Bush Welch delivers a powerful theory exploring how parents experience the expected death of an infant from a life-limiting congenital anomaly. The grounded theory Navigating Infant Death from Life-Limiting Congenital Anomaly includes three stages and two cutting points. The first stage is living in innocence which ends with the first cutting point of getting the bad news. The second stage is parenting in the new reality which ends with the second cutting point, death of the baby. The final stage of the theory is going on. This powerful new theory has practice implications for nurses, physicians, and other health care professionals. In the paper Negotiating Emotional Order, Jennifer A. Klimek Yingling captures the processes that occur when women have completed initial treatment for breast cancer. The theory consists of five stages of negotiating emotional order emerge. This study will help healthcare providers who care for breast cancer survivors understand the depth of perpetual emotional impact that breast cancer survivors endure. Siri Khalsa-Zemel and Kara Vander Linden explore hunger in the paper, Developing Mind Body Hunger Mastery. The theory touches on overweight and obesity, mind body medicine, and personal development. The substantive theory depicts two types of hunger, physical hunger and abstract hunger, each requiring separate nourishment processes. The authors conclude that it may be possible to escape confusion and hunger suffering through self-awareness and development of mind body hunger mastery. Bonnie Johnson, Karen Holdness, Wayne Porter, and Alejandro Hernandez’s paper details the classic grounded theory approach to develop a conceptual theory for an engineering solution to address highly complex problems. The project resulted in the emergence of a theory for a new class of engineered Complex Adaptive Systems of Systems solutions. In A Grounded Theory on Obtaining Congruence in...

Getting Started

Editor’s Note: In my career as an educator, I found that PhD students stumbled on the most basic questions about how to get started with a grounded theory study, what to study, and how to craft the research question. Students find it most difficult to be open to emergence—to trust that the core category will emerge if study participants are allowed to divulge their main concern as they perceive it. The following is advice from Barney Glaser on how to overcome these fears. Excerpted from chapter 4 of Basics of Grounded Theory Analysis (1992), and edited for clarity, Barney Glaser’s advice on these issues is timeless. Getting Started It may sometimes be said that one of the most difficult parts of doing research is to get started. The making of choices and commitments to a research problem seem less secured and structured when doing descriptive research in quantitative or qualitative research. This occurs because the research problem is chosen beforehand and therefore forces the data, thus the yield may be small or nothing since the problem in fact may not be relevant. A “thought up” problem may sound juicy, but the preconception leads nowhere. The underlying principle in grounded theory which leads to a researchable problem with high yield and relevance is that the research problem and its delimitation are discovered or emerge as the open coding begins on the first interviews and observations. They soon become quite clear and structured as coding, collection, and analyzing begin, a core variable emerges, and saturation starts to occur. In short, getting started in grounded theory research and analysis is as much a part of the methodological process as are the ensuing phases of the research. The researcher should not worry. The problem will emerge as well as the manner by which the subjects involved continually process it. As a matter of fact, it emerges too fast most of the time and the researcher must restrain herself until sure if it is core and will account for most of the variation of action in the substantive area under study. As categories emerge in open coding, they all sound like juicy problems to research, but all are not core relevant. Only one or at most two. Remember and trust that the research problem is as much discovered as the process that continues to resolve it, and indeed the resolving process usually indicates the problem. They are integrated. Area vs Problem There is a significant need to clarify the distinction between being interested in an area compared to a problem. A researcher can have a sociological interest which yields a research problem and then look for a substantive area or population with which to study it. But, this is not grounded theory. It is a preconceived, forcing of the data. It is okay and can produce good sociological description, but it usually misses what subjects in the substantive area under study consider, in their perspective, the true problems they face. This kind of forcing with the support of advisor and colleagues can often derail the researcher forever from being sensitive to the grounded problems of the area and their resolutions. A missed problem is a problem whether or not the researcher discovers and attends to it. It does not go away. We find, as grounded theorists, so often in preconceived research that the main problem stares us in the face as the researcher just attends elsewhere and misses it completely, in an effort to...

Navigating Infant Death from Life-Limiting Congenital Anomaly: A Classic Grounded Theory Study...

Susan Bush Welch, PhD, RN Abstract The purpose of this classic grounded theory study was to explore how parents experience the expected death of an infant from a life-limiting congenital anomaly. These anomalies are the leading cause of death of infants in the United States. Death typically occurs in intensive care units with limited access to adequate palliative/end-of-life care.  An extensive knowledge gap about the experience of these parents exists. The grounded theory Navigating Infant Death from Life-Limiting Congenital Anomaly contains three stages and two cutting points. The first stage is living in innocence which ends with the first cutting point of getting the bad news. The second stage is parenting in the new reality which ends with the second cutting point, death of the baby. The final stage of the theory is going on. This new theory has implications for nursing/health care professionals in practice and research. This study was conducted as the dissertation while the author was a student in the doctoral program at West Virginia University. Keywords: classic grounded theory, infant death, congenital, parenting, anomaly Introduction Birth and death are two end-points on the continuum of life. For some infants, the space separating birth and death is very close with death occurring just minutes after birth. Many of these children are infants born with life-limiting congenital anomalies. In 2016, 23,000 infants died in the United States with congenital anomalies the leading cause of death (20%, n=4816) (Xu, Murphy, Kochanek, Batian & Arias, 2018). Worldwide the percentage of deaths from congenital anomalies is 11.3% for neonates, and 6.5% for 1-59 month old infants/children (World Health Organization [WHO], 2018). There is much literature about the impact of infant loss on parents. However most of it focuses on death through sudden and unexpected mean such as Sudden Infant Death syndrome (SIDS), stillbirth, extreme prematurity, or miscarriage. The experience of parents whose infant has a life-limiting congenital anomaly is different. These parents know their baby will die. Scant research exists in which authors explored the experience of parents who had an infant die from life-limiting congenital anomalies. Recent authors have focused on adequate palliative and end-of-life care for infants with life-limiting congenital anomalies and the families (American Academy of Pediatrics, 2013; Dahlen, 2013; National Association of Neonatal Nurses, 2015). Unfortunately, little empirical evidence defines and describes adequate palliative and end-of-life care. Of special note is the scarcity of evidence describing parents’ experiences. Classic grounded theory was used to explore the process parents experienced during the birth, life, and death of an infant with a life-limiting congenital anomaly. The development of a substantive theory using classic grounded theory methodology will assist health care professionals to understand and address parental needs through this process. Method, Data Collection and Analysis The dearth of literature specific to this population supported the use of qualitative methods. Health care professionals cannot develop appropriate interventions when so little is known about the experience of these parents. Classic grounded theory was chosen because it is a powerful method to understand unfolding processes. The parents’ experience from birth to death was an unfolding process. The study was approved by the Institutional Review Board to ensure the protection of participants. Data collection, sampling and data analysis/interpretation occurred iteratively. Almost all sampling was purposive. To qualify for the study, each participant was (a) the biological mother or father of an infant who died of a life-limiting congenital anomaly within the first 15 months of life, (b) over 18, and (c) understood/spoke...

Negotiating Emotional Order: A Grounded Theory of Breast Cancer Survivors...

Jennifer A. Klimek Yingling, Utica College Abstract In this article, classic grounded theory captures the processes of 12 women who had completed initial treatment for breast cancer. The qualitative data analysis reveals the basic social process of negotiating emotional order that describe how breast cancer survivors perceive their illness and decide to take action. From the data, five stages of the process of negotiating emotional order emerge: 1) Losing Life Order, 2) Assisted Life Order, 3) Transforming 4) Accepting, and 5) Creating Emotional Order. This study may help healthcare providers who care for breast cancer survivors understand the depth of perpetual emotional impact that breast cancer survivors endure. This study will potentially serve as a path for future research and aid in the understanding of the psychological impact that breast cancer has upon survivors. Keywords: breast cancer, survivor, chemotherapy, emotional order What Sparked This Research I cared for a patient who I had gotten to know as her child often visited the emergency department due to hemophilia. She was a pleasure to work with, strong, level headed, and upbeat. On this particular day she was the patient. Her complaint was simple: a cough and she clearly wasn’t herself emotionally.  I was surprised to discover, when I took her past medical history, that she was a breast cancer survivor. After I discussed her chest x-ray results I sensed she was still upset and filled with uncertainty. Then the lightbulb went on. I asked her directly if she was concerned if the cancer was recurring. She said yes and her tears flowed. I do believe if I had not dug a little deeper into her emotional state she would have left the emergency department with much of the same emotional duress that she initially had. This interaction sparked my research as it was clear that breast cancer survivors endure a process after treatment ends. For these survivors the treatment is over but the emotional aspect of breast cancer is not. It also became evident to me that health care providers need to know more about this process on order to be able to treat patients holistically. Negotiating Emotional Order: A Grounded Theory of Breast Cancer Survivors Breast cancer is the most prevalent cancer found in women worldwide (American Cancer Society [ACS], 2016; Ferlay et al., 2104). In the United States, it is estimated that 3.5 million women have been diagnosed with breast cancer; 245,000 will be newly diagnosed; and, approximately 40,000 women will succumb to breast cancer annually (ACS, 2016; Breastcancer.org, 2016). Early detection and improved treatment is credited to the rising population of women who are breast cancer survivors (Howlader et al., 2015; McCloskey, Lee, & Steinburg, 2011). Concerns about the psychosocial ramifications of chronic illness have a long history. The Institute of Medicine (2009), American Cancer Society (2015), and the American Society of Clinical Oncology (2015) resonate concern about psychosocial hindrances regarding cancer patients, citing them as a critical area needing improvement within the nation’s health care system. The literature suggests breast cancer survivors endure psychological stressors after the completion of treatment including the following: loneliness (Marroquin, Czamanski-Cohen, Weihs, & Stanton, 2016; Rosedale, 2009), anxiety and depression (Walker, Szanton, & Wenzel, 2015), uncertainty (Dawson, Madsen, & Dains, 2016; Mishel et al., 2005), and fear of recurrence (McGinty, Small, Laronga, & Jacobsen, 2016). The phenomenon of breast cancer survivorship has been identified with qualitative methods, yet is lacking explanatory theory (Allen, Savadatti & Levy, 2009; Pelusi, 1997). Qualitative analysis uses...

Developing Mind Body Hunger Mastery

Siri Khalsa-Zemel, Focus Treatment Centers, USA Kara Vander Linden, Saybrook University, USA Abstract This quest to explore hunger using classic grounded theory was sparked within a dietitian who was hungry for a deeper understanding of her patients.  The high rates of overweight and obesity in the United States are alarming and the mind body link with hunger is a rich area for study. The grand tour question for this classic grounded theory study was “can you tell me about your experience with hunger?”  The resulting theory touches on some of the fastest growing fields of study in the United States: overweight and obesity, mind body medicine, and personal development.  The substantive theory of developing mind body hunger mastery depicts two types of hunger, physical hunger and abstract hunger, each requiring separate nourishment processes.  Nourishment can be interrupted at the physical and the abstract levels, leading to hunger confusion and hunger suffering.  It may be possible to escape this maze through self-awareness and development of mind body hunger mastery. Keywords: Mind, Body, Overweight, Obesity, Personal development, nourishment, hunger suffering Introduction Eating for pleasure (hedonic eating) is shown to be associated with overeating and loss of control over eating (Stroebe, Papeis, & Aarts, 2008; Witt & Lowe, 2014), which is influenced by emotional eating (Heatherton & Baumeister, 1991; Hernandez-Hons & Woolley, 2012).  Emotional eating is strongly correlated with psychological distress, such as depression, anxiety, anger, and loneliness (Ganley, 1989; Geliebter & Aversa, 2003; Pidgeon, Lacota, & Champion, 2012).  There are many perspectives that aim to explain emotional eating.  From a brain science perspective, obese individuals may experience food as more rewarding than normal weight individuals due to decreased dopamine activity (Nathan et al., 2012; Volkow et al., 2003). Considering emotional regulation as a key to understanding emotional eating, eating in response to emotional cues is shown to be associated with a lack of emotional awareness (Moon & Berenbaum, 2009; Pidgeon et al., 2012; Salovey et al., 1995).  In fact, the desire to escape emotional awareness is a plausible theory to explain the cause of emotional eating (Blackburn et al., 2006; Heatherton & Baumeister, 1991; Polivy & Herman, 1999).  The sensitivity to perceive, understand, and respond to interoceptive signals plays a central role in emotional regulation (Pollatos & Schandry, 2008; Nentjes, Meijer, Bernstein, Arntz, & Medendorp, 2013), and interoceptive awareness has been shown to mediate the relationship between self-objectification and disordered eating (Frederickson & Roberts, 1997; Myers & Crowther, 2008). Theory Development This classic grounded theory study was performed as a doctoral dissertation study by a Registered Dietitian studying Mind Body Medicine at Saybrook University, College of Integrative Medicine and Health Sciences. The topic area of interest for this research included emotional eating; however, utilizing the terms “emotional eating” and “emotional hunger” may have contradicted the no-preconception rule of CGT, as these fundamental preconceived ideas and widely researched topics may have shaped and limited the data collection, and emergent variables during participant interviews.  Therefore, a broader grand tour question was used to cast a wide net and allow all relevant data to emerge: “Can you tell me about your relationship with hunger?”  Adult participants included those who struggled in their relationships with hunger, with theoretical sampling leading to additional interviews with those who did not struggle with hunger at any level.  A total of nine interviews lasting 45-120 minutes were audio recorded, transcribed (as required by the university), and coded as data.  Two additional publicly accessible interviews and relevant literature were also...

Complex Adaptive Systems of Systems: A Grounded Theory Approach

Bonnie Johnson, Naval Postgraduate School, United States Karen Holness, Naval Postgraduate School, United States Wayne Porter, Naval Postgraduate School, United States Alejandro Hernandez, Naval Postgraduate School, United States Abstract This paper details the classic grounded theory approach used in a research project to develop a conceptual theory for an engineering solution to address highly complex problems. Highly complex problem domains exist and are on the rise as we enter an Age of Interactions and Complexity. Our current world has been characterized by the plethora and ubiquity of information and global interconnections that link events and decisions to outcomes and effects that are often unpredictable and result in severe unforeseen and unintended consequences. Technological advances such as computers, the internet, Big Data, social media, artificial intelligence, and communication networks have expanded complex problem spaces. However, these same technologies present an opportunity to engineer a complex adaptive system of systems solution to address these challenging problems. This research project embarked on a classic grounded theory approach to study a number of knowledge domains and engineering processes, allowing a conceptual theory to emerge that offers an engineering solution to address highly complex problems. The project resulted in the emergence of a theory for a new class of engineered CASoS solutions. This paper details the classic grounded theory approach taken to conduct the research. Keywords:  complex adaptive systems of systems, grounded theory, systems engineering, complexity Introduction Most people would agree that the world is becoming more complex.  Much of this is driven by two phenomena that have started to dominate our lives in recent years. First, we face an unprecedented level of integration and are immersed in a complex web of interacting technologies and processes, dominated by the developments in information and communication technologies. Second, rapid change has become the norm with technologies, practices, and organizations being introduced continuously into this highly integrated web. (Calvano and John, 2004, p.29) The rise of automation in many systems, and technological ubiquity in general, present complex problems that require a solution that can continually adapt to meet the changing demands of the operational environment. The interaction of heterogeneous and increased technologies introduces multi-faceted problems that are unlike any before seen. Alberts (2011) stated that we have entered the Age of Interactions in which events and decisions are linked to many outcomes that affect many other events. Bar-Yam (2004b) cited many examples of complex problem spaces including military conflict, health care, education, international development, large scale natural disasters, ethnic violence, and terrorism. National strategies often invoke the DIME (diplomatic, information, military, and economic) construct, as is the case when countries apply economic sanctions, or use diplomatic negotiations. Hillson (2009) explained that the DIME components constitute actions and consequential effects that can be highly interactive, complex, and unpredictable. As nations implement the DIME construct, the effects can be highly interrelated and can have unpredictable consequences. Technological advances in global information and communication infrastructures accelerate these complex interactions and the tempo of cause and effect. Complexity scientists are studying the causes and effects of seemingly unrelated events that have significant repercussions. Lagi, Bertrand, and Bar-Yam (2011) found that agricultural price increases in North America due to droughts were indirectly and inadvertently linked as a causal factor to violent protests in North Africa and the Middle East. Technological advances in computers, Big Data, artificial intelligence, global information and communication networks have contributed to complex problem spaces. Big Data refers to the current paradigm of enormous amounts of data and information...