Current issue

Editorial: From Grounded Description to Grounded Theory

Astrid Gynnild, University of Bergen, Norway What is the difference between grounded description and grounded theory?  Many researchers and supervisors of grounded theory ponder that question. It is not always easy to identify the difference, especially since GTs are written up as running conceptual discussions and, as such, might give individuals new to the method a feel of description. As Dr. Glaser points out in his first article in this issue, “Grounded Description,” it is easy to overdo the open coding stage and incidentally move from potential theory generation into “trying to describe the population studied, like a QDA study requires, by describing all the interchangeable indicators that grounded the concept.” But GT is not about descriptive accuracy and full coverage— a fact which, at times, might be hard to grasp. Up till now there hasn’t actually been much qualified discussion on grounded description in the literature, but that doesn’t mean that the boundaries between GT and grounded description are clear-cut and simple to understand. More often than not, GT papers submitted to our journal contain bits and pieces of grounded description. That is very understandable; GT authors want to do a good job and are quite naturally afraid of missing out on something in the data. Thus, Dr. Glaser’s upcoming book on grounded description is most welcome and much needed. In this issue of the Grounded Theory Review I am happy to present no less than the three first chapters of Barney G. Glaser’s upcoming book, one full article, and two short format papers that focus on the increasing use of grounded description, reasons for ignoring it, and challenges of open coding descriptions. Our reviewers do a great job in supervising the authors on how to develop further their emerging theories. And the experience is that with targeted feedback, the authors find it worthwhile to revise their papers several times. Tendencies of conceptual descriptions are often hard to fight, as leaving out data tends to be a bigger problem than including it. But I am impressed by the energy that GTers display in reworking their papers to make their theories as fit and relevant to the substantive fields as possible. In the general section, you will find four new grounded theories provided by researchers from Asia, Europe, and the United States. Alan Oh, Puteri Hayati Megat Ahmad, Ferlis bin Bullare @ Bahari, and Peter Voo from Malaysia have generated an amplifying theory on “Pain resolving in addiction and recovery.” Based on analyses of secondary data Alan and his colleagues identified pain resolving as a two-stage basic social psychological process of becoming. The addicts’ identity is formed based on how they resolve their pain; the stages are instantaneous pain relieving and honesting. The next theory by Norwegian researchers Cathrine Moe and Berit Støre Brinchmann explains how service users and caregivers might cooperate to achieve reablement through optimizing capacity. Reablement of the elderly is a relatively new research field, but the authors of this study indicate that by optimizing capacity with the help of caregivers, elderly individuals are able to regain independence and stay longer in their own homes. Tracy Flenady, Trudy Dwyer and Judith Applegarth from Australia have studied the patterns of behavior of nurses in emergency departments. Their new theory on rationalising transgression explains how nurses compensate, minimalize or trivialize emotional discomfort associated with erroneous behavior. At first sight, the locus of attention of the theory might seem like a tiny topic but the theory speaks to a...

Pain Resolving in Addiction and Recovery: A Grounded Theory Study

Alan Kim-Lok Oh, Puteri Hayati Megat Ahmad, Ferlis bin Bullare Bahari, Peter Voo, Universiti Malaysia Sabah, Malaysia Abstract The aim of this study is to develop a classic grounded theory about how addicts resolve their pain during addiction and recovery. Interviews and observations were analyzed and secondary analyses were carried out. Pain emerged as the main concern with pain resolving as the emergent pattern of behavior through which they deal with this concern. Pain resolving is a two-stage basic social psychological process of becoming where their identity is formed based on how they resolve their pain. This process of becoming is progressive over time. These two stages are instantaneous pain relieving and honesting. Trapped in instantaneous pain relieving leads an addict to become a worthless person while continuous life-long implementing of honesting brings the addict towards becoming a fully functioning person. Instantaneous pain relieving and honesting account for the patterns of behavior in resolving pain when an addict is in addiction and during the recovering process respectively. Keywords: pain, addiction, recovery, obsessing, instant pain relieving, vicious cycling. Introduction Theories of addiction are models that explain the causes of addiction and its obsessions. By using these models, addiction could be understood and thus treatment and interventions could be implemented to help addicts. An accepted model currently used in explaining addiction is the medical model. The medical model of addiction views addiction as a progressive disease with symptoms characterized by an individual’s loss of control over the addiction and the progression of the disease that leads to death (Miller, 2005). It also views that addiction could not be cured; however, it could be managed in the long term throughout an individual’s life. It allows the individual to be medically cared for without any moral judgment. The medical model has also evidenced that addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors (American Society of Addiction Medicine [ASAM], 2011, para. 1). Brain scans have shown that there are abnormalities in the individual’s brain and the brain improves when the individual abstains from drugs (National Institute on Drug Abuse [NIDA], 2014). These findings are very encouraging. The medical model of addiction has conceptualized addiction with scientific and clinical evidence; it is useful in understanding addiction and thus able to guide treatments and interventions in addiction recovery. Nevertheless, a social psychological study grounded in data on how addicts continue to resolve their main concerns in addiction and recovery would be beneficial to contribute to the existing body of knowledge on addiction. Purpose of the Study The purpose of this study is to develop a substantive grounded theory (Glaser & Strauss, 1967) theory that explains how addicts continue to resolve their main concerns during their addiction and recovery. Grounded theory study is not to produce factual, detailed descriptions of data, but an integrated set of related concepts identifying a main concern for participants, as well as the latent pattern underlying how they continually work to resolve their main concern (Glaser, 1998). It focuses of conceptual abstraction and not conceptual description (Glaser, 2001). It is not to be assessed, judged, and evaluated in terms of descriptive accuracy and prediction of a phenomenon of interest. By staying close to the process of theoretical sampling and constant comparison, an emergent theory relevant to...

Grounded Description: No No

Barney G. Glaser, PhD, Hon PhD Grounded description is on the increase with the increase of grounded theory throughout the world. Much grounded description is jargonized as GT and it is not GT. Grounded description is trying to describe the population studied, like a QDA study requires, by describing all the interchangeable indicators that grounded the concept. In contrast, GT is not to describe the population. GT is the relation between concepts  which emerged from the population by constant comparing and then are related to each other by a theoretical code. The GT theory then becomes general and abstract of the study population by time, place and people. The GT stands on its own, and the data on which it is grounded is often forgotten for the grab and general implications of the theory. For example, rooting from here to there is based on BMRs (eg, planning basic mobility resources for a trip). Why is this happening? There are several reasons. Description is  frequently demanded by an academic department perspective and professor demands since research is traditionally descriptive nearly 100% of the time. Being abstract of time, place and people is not the normal quest of academic research. Accurate description is the quest.  The generated concepts used for normal description can be very discreet and its indicators also. They prove relevance and fit for population data. The abstract nature and its general implications of a GT core concept and its potential for generating a GT are ignored or lightly referred to while describing takes over. Grounded description is a step toward discovery of a GT, not a GT. But many new to the GT methodology do not realize this. They become thrilled with generating a grabby concept and think that it is the final step to generating a GT and then describe it at length to prove its accurate existence. This approach, of course, suites the descriptive perspective of most academic research. Grounded description is further supported by the simple fact that most people, including academics, cannot conceptualize. It is best, if at all, if they can come up with one generated concept. Or if not they can use a conjectured—usually ungrounded—concept, taken from their field literature. That is fine, since description proven accurate, runs the world, with conjectured concepts based on no facts a close second. A distant third is conceptualizing concepts, however powerful they may actually be. There are many books written now on GT that are actually about grounded description. They confuse the definition and methodology of GT with lofty academic scholarship backed by high-level positions in a university department. They bring GT back to description. Mixed writing on QDA and GT often tend to regress GT to description procedures, such as taping preformed interviews. In this paper I will discuss many of the differences between GT and conceptual description, so the reader can spot the latter being termed the former. Conceptual description easily results in data overload in quest of full coverage.  For a GT concept why keep collecting interchangeable indicators as required by full accurate description once you a have a concept? Five or six indicators can be enough, as apposed to dissertation requirements to get data from all respondents on a concept for descriptive generality that will soon become stale dated anyway. Full coverage of data collection is a waste of research resources for generating a GT once a core concept pattern is discovered and theoretically sampled for. Since concepts are abstract of...

Optimising Capacity – A Service User and Caregiver Perspective on Reablement...

Cathrine Moe, Nord University, Norway Berit Støre Brinchmann, Nord University, Norway Abstract Reablement focuses on offering individuals the opportunity to regain independence and thus stay longer in their homes. Few studies have looked at service users and caregivers’ perspectives on reablement. There is also a lack of theories grounded in this relatively new field of practise. This study aims to generate a grounded theory of service users’ and their caregivers’ experiences of reablement. The empirical data are based on interviews with 17 service users and 10 caregivers and observations of reablement provision. For seniors to manage as well as possible in their own homes emerged as the main concern. The core category is optimising capacity. The grounded theory builds on the core category, integrating identified strategies and concepts of health and coping.  The conditions of reablement are grounded in the social and cultural life of the recipient. We conclude, therefore, that including the individual’s life history and existing coping strategies is essential to the success of reablement. Keywords: grounded theory, reablement, service user, caregiver, optimising capacities, open concept of health, coping. Background Reablement (also known as restorative care) is an approach focused on offering individuals the opportunity to regain independence and thus stay in their own homes longer. The goal of reablement is for service users to re-learn skills and find new ways to perform daily activities, be active, socialise, and participate in society. The method consists of using physical training and adaptive equipment to strengthen actions the individual defines as important (Tuntland, Espehaug, Forland, Hole, Kjerstad, & Kjeken, 2014.; Winkel, Langberg, & Wæhrens, 2014). Reablement is time-limited, person-centred, and typically delivered by an integrated team consisting of various health professionals such as nurses, occupational therapists, physiotherapists, and nurse assistants (Kjerstad & Tuntland, 2016; Wilde & Glendinning, 2012). Reablement services are increasingly offered to everyone who meets local eligibility criteria for home-care services. Still, aging persons (65+) are the most common recipients of reablement. The targeted populations are individuals with diverse mortality and morbidity risks, multimorbidity, and diverse prognostic outcomes, symptoms and disabilities. Exclusion criteria are typically advanced cognitive impairments and end-of-life care (Legg, Gladman, Drummond, & Davidson, 2016; Wilde & Glendinning, 2012). Reablement is supposed to represent a shift from reactive home care services to preventative and proactive models based on early intervention and active engagement (Legg et al., 2016). The evidence for reablement is growing, but the ill-defined intervention towards a heterogeneous service user group means that it is complicated to get an overview of the state of knowledge (Legg et al., 2016). Reablement is found to improve the ability of aging persons receiving reablement services to engage in daily activities (Lewin & Vandermeulen, 2009; Winkel et al., 2014) and to have positive impacts on their health-related quality of life and social care outcomes (Glendinning et al., 2010). Reablement is often presented as a solution to future health service challenges. However, there is still very little knowledge about what recipients of this service view as important. Few studies have looked at service users and caregivers’ perspective on reablement. It is not clear who benefits most from reablement and which barriers to independence arise (Glendinning et al., 2010; Ryburn, Wells, & Foreman, 2009; Wilde & Glendinning, 2012). Barriers may be compounded when service users live alone or have few social contacts, or when they have a limited understanding of the purpose of reablement. It is unclear how reablement affects relatives and whether their involvement influences the outcomes (Glendinning...

Rationalising Transgression: A Grounded Theory Explaining how Emergency Department Registered Nurses Rationalise Erroneous Behaviour...

Tracy Flenady, Trudy Dwyer, and Judith Applegarth, Central Queensland University, Australia Abstract The aim of this classic grounded theory study was to unearth the main concern of emergency department (ED) registered nurses (RN) when they perform respiratory rate observations to generate a substantive theory that explicates how the identified problem is resolved.  Analysis of data collected from 79 registered nurses revealed that health sector forced compliance in recording observations meant that ED RNs are more than likely to record a respiratory rate without actually counting respirations. This erroneous behaviour provokes varying degrees of emotional discomfort as the nurses’ actions are often incongruent with their professional values and beliefs. The theory Rationalising Transgression explains how nurses continually resolve this issue by compensating, minimalizing, or trivialising to titrate the level of emotional discomfort associated with erroneous behaviour, consequently facilitating the rationalisation of transgression. Keywords: nursing, wasting time, trivialising, cutting corners, emotional discomfort, social norms. Background It is internationally acknowledged that inconsistent monitoring of vital sign observations and lack of understanding regarding the significance of physiological changes patients experience are two contributing factors of undetected clinical deterioration (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2012; National Institute for Clinical Excellence, 2007; National Patient Safety Agency, 2007). Vital sign observations provide health care clinicians with valuable information regarding each patient’s clinical acuity throughout all stages of their emergency department stay. Many hospitals now employ observation charting systems that require nurses to measure and record scores for each vital sign observed, with the combined value of scores referred to as an early warning score (Day & Oxton, 2014; Prytherch, Smith, Schmidt, Featherstone, Stewart, Knight, & Higgins, 2006). The total score from each round of observations is a reliable predictor of clinical deterioration; when the score reaches a certain threshold, a predetermined response is triggered (Ludikhuize, Smorenburg, de Rooij, & de Jonge, 2012; Silcock, Corfield, Gowens, & Rooney, 2015). There are many studies whose authors reported the efficacy of these early warning scores in regards to the timely identification of clinical deterioration of patients in an emergency department setting (Hogan, 2006; Hosking, Considine, & Sands, 2014; Lam, Mak, Siu, Lam, Cheung, & Rainer Lam, 2006; So, Ong, Wong, Chung, & Graham, 2015). The respiratory rate, one of the vital signs that contribute to the early warning score, is significant in that abnormal respiratory rates alone are widely reported as accurate indicators of clinical deterioration (Considine, 2004; Considine, Charlesworth, & Currey, 2014; Hosking et al., 2014; Jonsson, Jonsdottir, Möller, & Baldursdottir, 2011; Ljunggren, Castrén, Nordberg, & Kurland, 2016; Parkes, 2011). Abnormal respiratory rates herald potentially life-threatening conditions and provide health care clinicians with the opportunity to respond expediently to these episodes of clinical decline. Timely recognition and response to clinical deterioration have the potential to prevent high acuity unit admissions, reduce hospital admission length of stay and significantly improve overall mortality rates (Ljunggren et al., 2016; McBride, Knight, Piper, & Smith, 2005). Accordingly, to achieve optimal patient outcomes, it is integral that respiratory rate observations are collected regularly, obtained correctly, and recorded accurately for every patient. Despite this acknowledged importance of the respiratory rate observation, Ansell, Meyer, and Shona (2014), Cooper, Cant, and Sparkes (2014), Cretikos et al., (2008), Hosking et al., (2014), Odell et al., (2007) and Parkes (2011) revealed this vital sign is often absent or erroneously recorded on emergency department observation charts. While emergent literature confirms this practice occurs, what is not known is why it occurs. One of the...

Wayfinding: A Grounded Theory Study

of the Information-Seeking Behavior of Constructors James W. Jones, Ball State University, Indiana, United States Abstract This study examined how and why practitioners in the construction industry sought information in their routine work activities. A grounded theory method found the main concern of constructors is the ability to seek accurate information efficiently and effectively. A substantive theory termed wayfinding was developed through interviews with 24 constructors, which is applied using five strategies. These strategies include clarifying, confirming, sourcing, preparing, and managing risk. Strategies are adopted based on the intent and type of information being sought within perceived boundaries of time and accuracy required. Techniques used to implement these strategies include networking, branching/filtering, and cost-saving. The implementation of the strategies varied with experience, with novices using a more limited range of strategies and techniques than experienced constructors. Keywords: Wayfinding, Information-seeking, constructors, strategies, managing risk. Introduction Those people involved in the management of construction work in a fast-paced, high-pressure environment where decisions must be made quickly and effectively. The ability to find accurate information rapidly is an important part of this environment (Sears, Sears, & Clough, 2008; Stowe, 2009). Although it is an essential process for the constructor, it is barely mentioned in most texts developed for construction curricula in higher education; the result is that it is not a standard subject of study and hence is learned through personal experience in the “school of hard knocks” once the field is entered. In this study, the author examines the professional lives of constructors using a classic grounded theory method and finds that seeking information is their main concern. The result of the study is a theory that explains how and why constructors seek information as part of their day-to-day activities. This theory, called wayfinding, explains the information-seeking behavior of constructors so that it may be used by people currently in industry, educators preparing people to enter the field, and other related, interested parties. Method The author of this study examines the way that practitioners in the construction industry seek information in the course of their work. The selection of a grounded theory approach was driven by the intent of the investigation. The objective was to provide an integrated explanation of how this information-seeking behavior takes place in the working lives of constructors to inform practice and praxis. Grounded theory is particularly well-suited for fields of practice, as it can be used to “give the practitioner a conceptual tool with which to guide practice” (Merriam & Simpson, 2000, p. 113). The developed theory may therefore be usefully employed by those in practice, teachers in the field, and other related disciplines. A classic grounded theory approach was used, as described by Glaser (1964, 1968, 1972, 1978, 1992, 1998), Glaser and Kaplan (1996), and Glaser and Strauss (1965, 1967). Individual interviews were the primary data collection tool; 23 interviews were conducted with a total of 24 participants. Interviews started after the research protocol was approved by the Institutional Review Board; analysis commenced with the first interview and continued throughout collection. Categories emerged as data were initially open-coded directly on the transcripts and field notes. The memoing process helped the researcher to discover the main concern and core category quickly; selective coding and theoretical sampling were then emphasized until saturation of concepts was reached. After temporal spacing, the researcher returned to the data and memoranda for theoretical coding to integrate the categories into a cohesive theory, finding all approaches to be members of the strategy...