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Value-Based Mavericking

Maureen P. Molinari, Saybrook University, USA Kara Vander Linden, Saybrook University, USA Abstract This classic ground theory (CGT) study presents a theory to explain a four-stage process for resolving moral distress encountered in professional environments. Value-based mavericking explains that misalignment between personal and professional values may lead to moral distress and burnout and, that while coping strategies may ease symptoms, the underlying problem still exists. Value-based mavericking presents a process that includes evaluating professional alignment and values and then choosing if and how to continue working in the current professional environment. Following the CGT method, data from primarily healthcare professions were collected. Data were analyzed using coding and constant comparative analysis to develop the theory. Value-based mavericking presents a different way of approaching moral distress and burnout that has not been previously addressed in the literature. Keywords: classic grounded theory, moral distress, burnout, values Introduction Burnout has been recognized as an occupational hazard and widely researched since the mid-1970s, when psychoanalyst Herbert J. Freudenberger first coined the term (Freudenberger, 1977). Freudenberger (1977) observed a concerning trend in some of his patients.  People who were once enthusiastic and dedicated employees began reporting fatigue, boredom, or feelings of being overworked despite the fact that no other factors in their lives seemed to have changed.  Since burnout was recognized and the term coined, numerous researchers have been trying to determine ways to lessen the burden of burnout in the professional environment.  Consequences of burnout are pervasive, including affecting physical and emotional health and organizational loss (Awa, Plaumann, & Walter, 2010; Marine et al., 2006).  The economic impact of burnout is challenging to quantify and is often measured in terms of absenteeism and turnover (Jacobson et al., 1996; Raiger, 2005).  Some of the suggested causes of burnout at the organizational level include “insufficient time, skills, and or lack of social support at work” (Marine et al., 2006, p. 1).  Due to significant consequences for individuals and organizations, numerous researchers are searching for ways to ease the effect of burnout. Throughout the literature, moral distress and burnout are recognized as potential threats to wellbeing.  People experiencing moral distress and burnout may not experience optimal wellbeing or experience job satisfaction. This study began by looking at the relationship between healthcare practitioners and their clients. However, the main concern of participants that emerged from the data of this classic grounded theory study was the impact of moral distress and burnout on their professional and personal lives.  This occurred as the first practitioner interviewed discussed the role that one client had in becoming her champion as she modified her career path.  The main concern that emerged from this interview and the ones that followed was related to moral distress and burnout experienced by healthcare professionals when various aspects of the healthcare system prevented them from being able to best serve the needs of their clients.  Thus, moral distress frequently leads to burnout.  Value-based mavericking presents a process that includes evaluating professional alignment and values to then choosing if and how to continue working in the current professional environment. Methodology This classic grounded theory study was performed by a doctoral student studying Mind Body Medicine at Saybrook University. To arrive at a theory based on “an integrated set of conceptual hypotheses” (Glaser, 1998, p. 3), the authors were guided by six stages, many which occurred simultaneously throughout the research process. The stages of a CGT study are preparation, data collection, constant comparative analysis, memoing, sorting and theoretical outline,...

Manipulative Dominant Discoursing: Alarmist Recruitment and Perspective Gatekeeping...

Debbie Garratt, Notre Dame University Joanna Patching, Notre Dame University Abstract This paper is a grounded theory explaining the main concern of practitioners in Australia when interacting with women on the issue of abortion.  Based on a broad data set including practitioner interviews, professional notes, and discourse data, collection and analysis were undertaken using Classic Grounded Theory research design. The analysis led to the development of the grounded theory, Manipulative Dominant Discoursing: Alarmist Recruitment and Perspective Gatekeeping. Keywords: Classic grounded theory, alarmist recruitment, abortion, perspective gatekeeping Introduction This paper presents a grounded theory on manipulative dominant discoursing developed as a research project undertaken for a Doctor of Philosophy degree.  The theory provides a conceptual model of the way in which a dominant manipulative discourse can be identified, is maintained, and is perpetuated.  Alarmist Recruitment and Perspective Gatekeeping work together to create an environment within which the thoughts, beliefs and actions of those exposed to the discourse are controlled in some way. The theory was developed in the context of abortion discourse in Australia. The study began with the researcher seeking to understand the knowledge and practises of practitioners interacting with women who disclose an abortion experience or concern. Responding to the expectations of the dominant discourse became the primary concern of practitioners who came into contact with abortion disclosing women.  Practitioners are defined as any professional who may encounter women who have ever had or may be considering, an abortion. Abortion is considered one of the most common procedures undertaken by women in Australia with an estimated 80,000 per year (Chan & Sage, 2005).  Current research demonstrates that up to 20% of women can suffer serious, prolonged mental health disorders following abortion (Coleman, 2011), the number of women negatively impacted by this, and other adverse effects is cumulatively very large over time. The impetus for undertaking this study was sparked by almost two decades of working with women impacted by abortion and in the provision of resources and education to the community and professional sectors on the impact of abortion on women’s mental health and wellbeing.  Talking with hundreds of women and practitioners through conferences, education and private consultation suggests that women are generally not effectively supported after abortion. The motivation for the study was to identify practise issues that may inform the development of practitioner education which in turn could enhance their ability to more effectively support women.  It became clear very early in the data collection that knowledge about abortion or its adverse impact was not the main, or even a minor identified concern of practitioners.  It became evident that practitioners’ concern lay predominantly in what they felt they were expected to communicate, or not communicate to the women. This article briefly describes the methodology, introduces the main concern, and resolution of practitioners within the context of the broader theory of dominant discourse and includes relevant data as quotes throughout. Methodology and data collection Classic Grounded Theory as developed by Glaser and Strauss (1967) was the chosen research design for this study. Initial data were derived from 12 practitioner interviews, with further practitioner experiences drawn from the literature after the core category of the dominant discourse had been determined.  Using the dictum that “all is data” (Holton & Walsh, 2017, p.59), data were also collected from mainstream media articles, political documents, professional organisation policy documents, journal articles, and my own professional notes gathered over many years.  To ensure I was absolutely true to the methodological process, I...

About the Authors

Andrew P. Carlin, Ph.D., is a Visiting Fellow at the University of Macau, SAR China. His central concern is the social organization of scholarly communication. This has provided him with specific research interests including disciplinarity, disciplinary contexts for teaching, the problem of what constitute data for sociology, the history of sociology, information, methods and methodology. He teaches qualitative research at Manchester Metropolitan University, and Library & Information Management at Ulster University. His current projects are on teaching and learning in the higher education sector at undergraduate and postgraduate levels; and in online environments. He has published in a range of international journals. Email: acarlin@um.edu.mo Debbie Garratt, PhD Candidate, Notre Dame University, Sydney is a clinical nurse consultant, qualified counsellor and adult educator, and founder and Executive Director of Real Choices Australia, an organisation established to provide quality research and education on reproductive health issues.  As part of this work, Debbie also consults to community groups and the health sector on professional standards and organisational development for services for women experiencing challenges during the perinatal period. For 20 years she has divided her time between the provision of education and clinical supervision to practitioners and clients locally through her private practice, and research, education and speaking engagements both nationally and internationally. This paper is an abridged version of her thesis prepared for a Doctor of Philosophy Degree (post examination and awaiting review: December 2019). Email: dgarratt@realchoices.org.au Karen Jagiello, PhD, RN, CNE, has served as an Assistant Professor and RN-BSN Program coordinator in the School of Nursing at James Madison University in Harrisonburg, VA. She has shared her passion for women’s health with undergraduate students for the last 13 years.  Prior to moving into academia, Dr. Jagiello practiced at the bedside with more than 20 years as a labor and delivery nurse. Her research interests include women and infants, breastfeeding, and rural health. This publication is portion of her dissertation research completed through West Virginia University School of Nursing. She wishes to thank the participants without whose help this work would not have been completed. Email: jagielkp@jmu.edu Rúni Johannesen comes from the Faroe Islands recently finished a master’s degree in Social analysis and planning at the University of Faroe Islands (Fróðskaparsetur Føroya).  In Rúni Johannesen’s words, “I have been working with classic grounded theory for three years and have been working with three different subjects in regard to my education and in regard to my own independent research.” The subjects are grounded theory methodology, political economics, and global ideology. Global ideology, rhetoric, and social group-dynamics are the areas of this particular grounded theory. Email: hr.johannesen@gmail.com Younhee H. Kim, Ph.D., is an Assistant Professor in the Department of English at the University of Macau, in Macau SAR China. She has a research interest in the teaching of qualitative methods. Her main research interests are (second) language acquisition/learning and teacher education, and she has been exploring these areas using qualitative research methods. Most recently, she has been examining parent-child interaction using longitudinal Conversation Analysis. She teaches Qualitative Research Methodology, Discourse Analysis, Second Language Acquisition, and Language Acquisition Studies at the University of Macau. She has published in a range of international journals including Applied Linguistics, East Asian Pragmatics, Journal of Pragmatics, Journal of Teacher Education, and a few other book chapters. Email: yhkim@um.edu.mo Maureen P. Molinari, PhD, RDN, LDN, CDE, NBC-HWC is a faculty member in the Integrative and Functional Nutrition Department at Saybrook University, College of Integrative Medicine and Health Sciences.  In addition to her...

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...