Volume 19

From the Editor’s Desk

As with many aspects of life during the age of covid-19, the summer issue of the Grounded Theory Review has been delayed.  We are pleased to publish, however late, this issue.  The Grounded Theory Review is dedicated to supporting researchers who conduct classic grounded theory research.  Classic grounded theory is a unique method of discovering never before recognized processes and patterns of human behavior, a method well-suited to studying current issues and processes. These are troubling days of pandemic illness, cultural upheaval, racial animus, international disruption, and political turmoil.  Although politicians and opinion journalists predict the future, the coming months are uncertain.  We are in uncharted territory.  In response, particularly to covid-19, structural and psychological social processes are changing.  Education, family life, health care, work life, business, consumerism, sports, trade, entertainment, government institutions, and travel are all changing.  People are assuming new roles or are adjusting their roles to fit new life circumstances.  This is a time of great upheaval—a time particularly ripe for grounded theory research. The beauty and value of classic grounded theory is the nature of honest, unbiased discovery of social processes.  Proper classic grounded theories cannot be preconceived or conjectured.  Unlike verification research, grounded theories provide insightful, enlightening, and often surprising revelations—discoveries.  As data is gathered, conceptualized, and organized by the investigator, concepts and processes emerge. Emergence is the key to the discovery of grounded theories.  Researchers who use other, usually deductive, methods are sometimes confused by the idea of emergence, which is mostly inductive.  We can compare the concept of emergence in grounded theory with how we have learned about covid-19.  Since it was a newly discovered virus, there were no textbooks to guide health professionals as they tried to combat the virus early on.  Facts have emerged from data as a cascade of covid-19 patients has appeared in hospital emergency rooms in the intervening months.  Although it was thought at first that serious cases of covid-19 generally presented as pneumonia for a relatively short duration, we now know that the virus can affect many different parts of the body in unusual ways for an unknown duration.  Months later, facts and patterns are still emerging.  The process of learning about the disease can be compared to the use of grounded data to discover conceptual theories.  In the same way that physicians with open minds collected, organized, and examined medical data to guide their diagnosis and treatment of covid-19, grounded theorists can gather, organize, and interpret data that will help us to understand and navigate the many social changes that are occurring. Explaining grounded theory, Glaser tells us to ask “what is going on” in a substantive area.  Today, we have few referents to help us understand what is going on.  As a family member who suddenly took on the role of home schoolteacher, I know that traditional ideas about family and school have been turned on their heads and I wonder about other changing social processes.  Thinking about grounded theory research projects in the age of covid-19, researchers whose curiosity is sparked might ask questions such as, “What is going on in a given population when suddenly: teachers who are accustomed to classroom teaching are thrust into distance learning modalities? breadwinners lose jobs due to covid? farmers cannot find a way to gather or move their produce to markets? parents work from home while caring for children? physicians must ration care because of high demand and a scarcity of equipment or supplies? business owners...

Getting Started

Barney G. Glaser Editor’s note:  Especially helpful for those thinking of beginning new research projects, this paper addresses common questions about the particular way in which grounded theorists identify a research problem and craft a research question appropriate for classic grounded theory.  Getting Started was first published by Sociology Press in Glaser’s Emergence vs Forcing: Basics of Grounded Theory Analysis (1992).  This important chapter has been excerpted and lightly edited for clarity and context. 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 principal 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 emergent as the open coding begins on the first interviews and observations.  They soon become quite clear and structured as coding, collection, and analyzing begin and 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 in the 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 of population with which to study it.  But this is not [classic] 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 the researcher discovers and attends to it or not.  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 describe what is going on.  Squelching it from focus does not remove its relevance. In vital contrast, the grounded theory researcher whether in qualitative or quantitative data, moves into an area...

Strengthening Devotion: A Classic Grounded Theory on Acceptance, Adaptability, and Reclaiming Self, by Parents of Children with Autism Spectrum Disorders...

Ramona Rolle-Berg, Ph.D., HTCP, MS, CPGL Kara Vander Linden, EdD, MS, BA Abstract The experiences of parents rearing an autistic child(ren) framed an exploration of caregiver well-being using Glaser’s classic grounded theory.  The theory delineates struggles, stress, and self-growth through service.  Viewed as a roadmap, strengthening devotion guides caregivers through a fear-driven landscape of altered perceptions that fuels evolution in awarenss about what it means to love nonjudgmentally with unqualified faith not only in a child(ren) but in one’s own resilience. Acceptance, adaptation, and a reclaiming of relinguished self-focus define strengthening devotion.  In accepting, entrapment wanes as emotions signal reengagement; in adapting, self-esteem develops with emotion regulation; and in reclaiming life, resilience signals reimagining of self. As uncertainty and reactivity are delimited through activities of service, devotion evolves, conceptualized as a stage-dependent growth continuum, namely: Strengthening Parental Devotion, Strengthening Relational Devotion, and Strengthening Personal Devotion.  Ultimately, parents may use the strengthening devotion roadmap to corroborate where they have been, how far they have traveled, and chart proactively to lower stress, improve health outcomes and re-engage with life’s unlimited potential. Keywords:  caregiver, autism spectrum disorders, devotion, classic grounded theory, parenting, presence Introduction One in 45 US children exhibits behaviours representative of autism spectrum disorders (ASD) (Zablotsky, Black, Maenner, Schieve, & Blumberg, 2015).  These behaviours produce post-traumatic-stress syndrome-conditioned reactivity in parent caregivers.  This research offers caregivers a pathway to thrive rather than survive on the frontlines of daily caregiving. Glaser’s classic grounded theory (CGT) method provided the systematic structure through which Strengthening Devotion emerged as a roadmap for parent caregivers’ experiences of self-growth through service.  The Basic Social Process (Bigus, Glaser, & Hadden, 1982; Glaser, 1978) that arose is grounded in data, conceptualizing experiences of parent caregivers for wellness professionals engaged with this population. Source data integrated 33 items, including first-person published accounts in books, web pages, blogs, and direct interviews of parent caregivers responding to the grand tour question: “Tell me about your experience as a caregiver.” Method The purpose was to develop a theory to explain and to categorize the experiences of parents who provided caregiving to their children with ASD. Varied perspectives were sought. Classic grounded theory was used to analyze data systematically. Discovery of underlying patterns of behavior that might lead to escalating levels of abstraction and conceptualization was the goal (Glaser, 1978). Participants were adults 21 years of age and older, who are parents and primary caregivers for a child with ASD and adults identified through theoretical sampling prepared to share experiences of caregiving for a child.  Years of caregiving ranged from a minimum of eight to a maximum of several decades.  Study participants were also single or married and provided caregiving in situations that included neurotypical children and multiple children with ASD families. Establishing the boundaries of the emergent theory required interviews with participants outside the primary study group (e.g., caregivers of neurotypical children). Recorded participant experiences were transcribed into digital data and then underwent considerable and deliberate fragmentation through conceptual coding, the core CGT process (Holton, 2007).  Constant comparison of incident with incident, and incident with concept, etc., initially generated substantive descriptors and later theoretical categories (Glaser, 1992).  Incidents were identified line-by-line within the empirical data and then assigned a code.  Codes were grouped and compared when patterns or variations on patterns were recognized. Two types of CGT coding procedures were utilized: substantive coding, which collectively comprise open and selective coding, and theoretical coding.  Open coding supported the early work with the raw data. ...

Self-Balancing Sanctuarying: A Classic Grounded Theory of Relaxation

Ruth Tiffany Naylor, CPsychol, British Autogenic Society, Ltd., London, England Abstract This author aimed to set out a grounded theory (GT) of relaxation as it is carried out under the normal pressures and tensions of everyday life. After switching from using the Corbin and Strauss grounded theory (2008) design to classic grounded theory, the author discovered a five-step theoretical causal-consequence model emerged from the analysis of what 21 non-anxious-to-slightly-anxious people from the community said what they do to relax. Their main concern is self-balancing. A disturbed sense of ease (cause) arising from internal and external threats (context) leads to resolution by switching (core category) in safety (condition). The chosen switching activities are self-emergent. Their continuing use depends upon transforming hindrances and integrating feedback to the process to maximize benefits (contingencies and consequences). Three switching strategies are central. Benefits not consciously or analytically generated are restoring, refreshing, and re-energizing me; maintaining and building me; and growing and developing me. Restoring, refreshing, and re-energising me is characterized by a sense of well-being and lifted mood; maintaining and building me is characterized by integrating and strengthening the core self and connecting to the community; growing and developing me is characterized by expanding self-discovery. Theoretically situating extant descriptive and conceptual models of relaxation is one of the many contributions this research makes. Keywords: anxiety, classic grounded theory, relaxation, positive psychology, interacting cognitive subsystems model. Introduction Prior to this research, relaxation has been viewed as a process of letting go of all tension not only in the body, in the sense of micro-factors of muscle physics and electrical activity (Jacobson, 1964), but also of macro-factors of such as those arising in the environment (Selye, 1946), the mind, and the spirit (Benson, 1975). The debate about psychophysiological relaxation that took place in terms of Claude Bernard’s abstract concept of the constancy of the milieu intérieur (Modell, et al., 2015) and which was made more concrete and practical by Cannon (1932) and then by Selye is now taking place in terms of allostatic balance, load, and overload (Chuang, Glei, Goldman, & Weinstein, 2007). This historic focus on release of muscle tension was driven by a mechanistic medical view of how humans “work.” This means that active relaxation activities have rarely been studied together with passive ones, and that neither have been studied in the context of life as lived. Theoretically, while relaxation is mentioned in related disciplines which do include contextualised activities involving significant body movements, such as in Csikszentmihayli’s extensive empirical, conceptual, and theoretical work on “flow” in work and play (1975), the largest body of recent empirical work directly focusing on relaxation, per se, is Smith’s (1990, 1999) which focuses on passive relaxation activities. Smith (1990) developed a set of structured inventories using factor analysis of words and phrases culled from passive relaxation therapy text books. These questionnaires were then used to develop “R[elaxation]-State” concepts which are said to be emotional, mental, and physical states. Smith (1990) first hypothesized a hierarchical linear model of how people progress through the R-States and later a “dual path” (Smith, 1999, p. 45) model, with the suggestion that any sequence through the R-States may be possible. As mindfulness took hold in the United States, the dual-path model has been re-framed in a mindfulness context and re-named “window of renewal” (Smith, 2007, p. 41). ”Core mindfulness” and “transcendence” were then hypothesized to be anchoring concepts in the new conceptual model, which focuses on the activity itself and not on...

Rolling with the Punches: Clinician Resistance in a Managerial NHS Hospital...

Mogamat Reederwan Craayenstein, University of the Witwatersrand, South Africa. Teresa Carmichael, University of the Witwatersrand, South Africa. Awaatief Musson-Craayenstein, University of the Witwatersrand, South Africa. Abstract The substantive area explored in this article is hospital consultants in an English Acute NHS hospital dealing routinely with increasing managerialism. Data were drawn from 49 interviews with hospital consultants, at one English Acute NHS hospital Trust. The classic grounded theory named “Rolling with the Punches” that emerged was enriched by literature relating to everyday resistance, labour process theory, institutional complexity and organisation studies by considering public and private (internal) scripts. Interpretation of the emergent theory also drew from everyday resistance narratives from rural peasantry applied to the highly qualified public sector hospital professionals. The theory reiterates the role of discursive resistance in the workplace. Keywords: hospital, managerialism, resistance, NHS, workplace, resistance, professional, doctor Introduction The National Health Service, NHS in the United Kingdom has come into its own as crown jewel of the public services. What happens in the NHS affects the entire UK. For the past 30 years, the NHS has experienced radical changes in its organisation structures and managerial regimes (Ackroyd & Thompson, 2003b; Thompson & Ackroyd, 1995). Healthcare delivery has been transformed with metrics-based performance management, electronic monitoring (Farrell & Morris, 2003), and enhanced audit and accountability (Ferlie, McGivern, & FitzGerald, 2012). Work intensity increased. Changes in the modes of control have resulted in shifting power relations between non-clinical managers and clinicians, especially hospital consultants. There is a lack of understanding about how clinicians and non-clinical managers routinely interact (Kuhlmann et al., 2013b). These changes mean that professional agency within a managerial context should be clarified (Correia, 2013; Muzio, Brock, & Suddaby, 2013). Dissatisfaction is evident (Dickinson, Ham, Snelling, & Spurgeon, 2013; Exworthy et al., 2010; Morris & Farrell, 2007; Spyridonidis & Calnan, 2011); however, the repertoires of dissatisfaction in such a context are not well-studied (Reay & Hinings, 2009) (Bélanger & Edwards, 2013), highlighting an opportunity for exploration. This study goes beyond a simple binary of non-clinical managers versus hospital consultants. It shows that the responses of doctors are socially constructed, situated, complex and complicit. Managerial initiatives shape, constrain and stimulate clinical practice in non-hegemonic ways and doctors find spaces to evade managerial control (Ackroyd & Thompson, 2016).  Clinicians do not have grand visions of resistance, but they do whatever they can, as bricoleurs (Levi-Strauss, 2004), using the tensions between structures that constrain and those that enable (Giddens, 1984). This study illuminates the routine responses of doctors as they encounter managerialism in their clinical practice in an acute hospital setting. Methodology: Classic Grounded Theory The researchers followed classic grounded theory procedures during data collection, coding, and analysis. The emergent grounded theory and its constructs were the basis of the literature review that followed. We conducted 49 interviews that were recorded in mind-map format and written up as field notes immediately after the interview. Audio recording and transcription were deemed unnecessary (Glaser, 1998), and the participants were unwilling to be recorded for fear that the recordings, with their recognisable voices, may fall in the wrong hands. In addition to the interviews, 20 observation encounters were captured, also in mind-map format. These observation sessions allowed the researchers to view the participants going about their everyday work within the research context (Barley & Kunda, 2001; Zilber, 2002). The observation sessions were those of a “complete” (or detached) observer (Burgess, 2006). Documentary evidence from the Trust website and other relevant NHS bodies...

Positioning: A classic Grounded theory on nurse researchers employed in clinical practice research positions...

Connie Berthelsen, RN, MSN, PHD, Aarhus University, Denmark Abstract The purpose of this classic grounded theory was to discover the general pattern of behavior of nurse researchers employed in clinical hospital research positions. Internationally, efforts have been made to strengthen evidence-based practice by hiring more nurses with a PhD for research positions in clinical practice. However, these nurse researchers are often left to define their own roles. I used data from a Danish anthology of six nurse researchers’ experiences of being employed in clinical hospital research positions. The theory of Positioning emerged as the general behavior of the nurse researchers, involving seven interconnected actions of building an identity and transformations of self, which varied in intensity and range of performance. Positioning characterized nurse researchers’ actions of following and connecting two paths of working as a postdoctoral researcher in clinical practice and moving towards a career in research, both guided by their personal indicators. Keywords: nurse researchers, grounded theory, positioning, clinical hospital research, building an identity Introduction Traditionally, nurses with a PhD degree are employed at Universities, where they educate nurses in scientific and academic programs, supervise PhD students, and conduct research (Orton, Andersson, Wallin, Forsman, & Eldh, 2019). However, times are changing and the paths into hospital positions are steadily growing worldwide for nurses with PhD degrees. In Denmark, we see an increase in nurses with a PhD in clinical hospital settings, where they are employed in academic positions such as clinical nurse specialists, postdoctoral researchers, senior researchers and clinical professors (Berthelsen & Hølge-Hazelton, 2018a). However, academic nurses holding Master’s degrees are also finding their way into hospital and primary care settings as clinical nurse specialists, advanced practice nurses, and PhD students. Due to the low level of evidence-based practice in nursing, academic nurses are needed as role models and leaders of research and development in clinical practice (van Oostveen, Goedhart, Francke, & Vermeulen, 2017; Orton et al., 2019). Even though nurse researchers, holding PhD and/or Master’s degrees, are multiplying in clinical practice, their roles and specific tasks are somewhat ambiguous, which can create insecurity and confusion about how to perform at their best (Berthelsen & Hølge-Hazelton, 2018c ). This aspect was seen in an intrinsic single case study of nurse researchers in clinical hospital positions, where the main theme of being “Caught between a rock and a hard place” identified the nurse researchers’ experiences of being in clinical practice in hybrid roles, feeling that they did not fit in anywhere (Berthelsen & Hølge-Hazelton, 2018c ). The nurse leaders play a particularly important role in the integration of nurse researchers in clinical practice, as they can help to create and support the optimal environment for research in the department (Bianchi et al., 2018). Data from a Danish anthology of six nurse researchers’ narratives about being employed in clinical hospital research positions were used in an attempt to discover the actions, processes, and behaviors of nurse researchers in clinical practice (Hølge-Hazelton & Thomsen, 2018). The aim of this study was to generate a classic grounded theory on the general pattern of behavior of nurse researchers employed in clinical hospital research positions. The research question that guided the study was: What are nurse researchers’ main concern in their clinical hospital research positions and how do they resolve it? Methods Classic grounded theory, based on Barney G. Glaser’s (1978, 1992, 1998) methodology, was chosen in order to discover a substantive theory on the general pattern of behavior of nurse researchers employed in...