Grappling with the literature in a grounded theory study

[This paper was originally published in Contemporary Nurse (www.contemporarynurse.com) and is reprinted here with the kind
permission of the publisher. Reference: McCallin, A. M. (2003). Grappling with the literature in a grounded theory study. Contemporary Nurse, 15(12), 6169.]

Antoinette McCallin, Ph.D., RN

Abstract

Student researchers often struggle to understand how
to use literature in a grounded theory study where timing
and knowing what to read are critical. Despite substantive
theoretical documentation on this topic the reality of
working through abstract ideas is more challenging. There
is a fine line between not doing a literature review in the
area of study and being informed so that a study is
focused. In this paper a practical example will be presented
illustrating how the student can integrate literature yet stay
away from preconceived notions. The topic is interprofessional
practice.

Key Words
Grounded theory, Interprofessional practice, Qualitative
literature integration

Introduction

Over and over again student researchers grapple to
understand the place of the literature review in a grounded
theory study. While the theoretical ideas are well
documented in texts on research methodology (Chenitz,
1986; Glaser, 1978, 1992, 1998; Strauss, 1987; Strauss &
Corbin, 1998) integrating abstract concepts in practice is
sometimes more challenging. Glaser (1998) recognises that
reading the literature is problematic while Strauss and
Corbin (1998) expect most professionals are familiar with
the literature in the field. Misunderstandings arise from the
tendency for novice researchers to take a purist stance
whereby they accept the general advice to stay away from
the literature literally. While the beginner researcher
receives that interpretation happily, supervisors and
institutional review committees are rather more nervous of
such a simplistic approach. Those responsible for student
researchers seek some reassurance that the student knows
what they are doing, has a general focus, and is at least
safe to enter the field.

Preparation for any research study is always essential
and some pre-research literature reading is still necessary
to “frame the problem in the introduction to a study”
(Creswell, 1994, p. 23). At the very least, a literature
review is needed to find out if the proposed study or
something similar has been done before. In addition, this
early literature review may be used to prepare a research
proposal for an ethics committee, so sound preliminary
work goes some way to demonstrate that the researcher
knows exactly what she is doing even if she does not know
what she is looking for. Thus the mental wrestle quickens
with the need to be general but focused, yes, to look at
some literature but no, stay away from the main area of
interest.

Not surprisingly, student researchers may feel baffled
with instructions that are apparently contradictory. This is
complicated further, as many qualitative researchers work
in an environment where clinicians are increasingly asked
to justify decisions with the best evidence (Street, 2001).
Such issues serve to emphasise that part of being a
qualitative researcher is learning to move beyond the
either-or way of thinking, in order to embrace bothand
thinking that recognises complex possibilities, many truths
and viewpoints, and different ways of experiencing reality
(Zohar & Marshall, 1994). In this paper the issues and
strategies for grounded theory literature integration will be
discussed and illustrated with a practical example.

What are the Issues?

Clearly literature review in a grounded theory study
must include literature on both the topic and the grounded
theory method. For example, student researchers grappling
with the literature will quickly find the debate about
emergence versus sensitisation that arose during the
period of “reformulation and repudiation” (Charmaz, 2000,
p. 512), which occurred almost a decade ago. Under
reformulation Strauss and Corbin (1990) sensitised
grounded theory researchers to the specific techniques
required to ensure the reliability and validity of data
collection and analysis in a qualitative study. Although
sensitisation supposedly refined the original methodology
(Glaser & Strauss, 1967) the detailed explanations and
underlying prescription stimulated a fervent response from
Glaser (1992). Glaser repudiated the developments,
defending the original methodology that, according to him,
was much more flexible.

Charmaz (2000) notes that Glaser challenged the
analytic questions, hypothesis testing, and methodological
techniques underpinning sensitisation, arguing that
emergence demanded that the researcher collect and
analyse data without forcing previously prepared questions
or explanations upon it. New researchers though welcomed
the introduction of axial coding, with its specific questions
related to causal conditions, context, strategies and
consequences. This coding, dimensionalising and the
conditional matrix (Strauss & Corbin, 1990) certainly
strengthened theory verification. In the meantime Glaser
(1992) concentrated on theory generation (Charmaz,
2000) and many student researchers got lost along the
way.

Indeed Charmaz (2000) suggests “grounded theory
methods have come under attack from both within and
without. Postmodernists and poststructuralists dispute
obvious and subtle positivistic premises assumed by
grounded theory’s major proponents within the logic of the
method itself” (p. 510) while Glaser (1992) and Strauss
and Corbin (1990, 1998) developed the method in very
different directions. In this context it is not unusual that
student researchers, particularly those using the method
for small-scale research projects, struggled to understand a
method that was evolving and changing.

Study of the method itself therefore is important so
that the researcher grasps the issues and is better placed
to conduct a trustworthy study. Reading may include
examination of the philosophical perspectives and the
paradigm of inquiry (Annells, 1996), literature on evolving
methods (Melia, 1996; Robrecht, 1995; Schreiber & Stern,
2001; Stern, 1994), and possibly a review of Chenitz’s
(1986) useful, compromise position that explains how to
write a research proposal for a grounded theory study.
Equally the most recent debate on the objectivist and
constructivist grounded theory methods (Charmaz, 2000)
clarifies many of the issues raised over the last decade and
moves grounded theory forward into the twenty-first
century.

So far it is evident that the literature review is vital to
research as it supports knowledge generation as a
scientific, scholarly process. Credible knowledge that will
withstand public scrutiny is necessarily embedded in sound
research design, and develops new knowledge that goes
beyond the existing literature and research. It is apparent
as well that there is a fine line between not doing a
literature review in the area of study and being informed so
that a study is focused in the particular area of interest
even though the specific problem is unknown in the early
stages of a research project.

Dey (1993, p. 63) extends this argument noting that
“there is a difference between an open mind and an empty
head” (Dey, 1993, p. 63) and ignoring the literature in the
beginning of a study does not mean discounting it
altogether (Dey, 1999). “The issue is not whether to use
existing knowledge, but how” (Dey, 1993, p. 63). Chenitz
(1986) simplifies many of the issues suggesting that a
literature review is required to write a research proposal
that will meet academic purposes and “demonstrate
knowledge about the phenomena and methods for study”
(p. 44). An ability to think through issues and to question
underlying assumptions is critical here, as the researcher
develops “a cautious and skeptical attitude about the
literature throughout the study” (Chenitz, 1986, p. 44).
Thinking ability also affects the student’s response to
strategies for grounded theory literature integration.

The Glaserian Strategy

The Glaserian position on literature review is quite
clear. Glaser (1998) states “do not do a literature review in
the substantive area and related areas where the research
is to be done; and when the grounded theory is nearly
completed during sorting and writing up, then the literature
search in the substantive area can be accomplished and
woven into the theory as more data for constant
comparison” (p. 67). This position supports emergence and
supposedly keeps the researcher free from any
preconceived documented concepts. It also assumes that
the student has plucked a research topic out of thin air and
has read little in the area of interest. The reality is quite
different in that students generally study a speciality,
developing a research interest as a result of exposure to
wide-ranging ideas over time. An increasing number of
clinicians also support evidenced-based practice and are
familiar with the wide range of literature readily available
on the electronic databases.

Glaser’s main objection to an initial literature review is
that the researcher may be sidetracked by received
knowledge and interpretations that support takenforgranted
assumptions, which are not relevant in the new
area of study. When the research goal is discovery, to
explore the main concern of participants and find out how
they continually resolve that concern, energy need not be
wasted on speculating about the problem. Doing grounded
theory is rather like being a detective – all will be revealed
in time once the researcher talks to the people and asks
questions intended to draw forth the truth.

Students who search the literature are also vulnerable
as, according to Glaser, there is potential for the researcher
to feel daunted by writers and specialists in the field to the
extent that the new researcher questions any ability to
create some knowledge of value. Furthermore, new
researchers examining the literature prior to a study may
be influenced by the “rhetorical jargon” (Glaser, 1998, p.
68) so that they sound like the literature, repeating
popular, anecdotal ideas. Those problems certainly occur
with some students but are less likely once the student has
mastered critical analysis. Equally, others may not be
“suited to doing grounded theory … [feeling] at a loss not
being able to preconceive the data” (Glaser, 1998, p. 62).
The successful grounded theory researcher must be
capable of conceptualisation and must be prepared to put
aside personal perspectives in the interests of
understanding the participant’s viewpoint.

The Strauss and Corbin Strategy

Strauss and Corbin (1998) have updated the original
grounded theory approach to literature (Glaser & Strauss,
1967) recognising that “the researcher brings to the inquiry
considerable background in professional and disciplinary
literature” (p. 49). Strauss and Corbin argue that at the
beginning of a project literature is useful “to formulate
questions that act as a stepping off point during initial
observations and interviews” (1998, p. 51). The earliest
questions identified in the literature clarify the general
research purpose and some of the concepts to be
investigated. While the researcher cannot know which
concepts, or indeed if any, will have the same emphasis
once data collection and analysis proceed it is likely that
some will remain to be integrated into new interpretations
of relationships and processes.

As a study progresses literature becomes an effective
analytic tool to stimulate thinking. “Insights do not just
occur haphazardly; rather, they happen to prepared minds
during the interplay with the data” (Strauss & Corbin,
1998, p. 47). During analysis the researcher uses literature
to heighten theoretical sensitivity, all the while comparing
and contrasting interpretations with occurrences in the
data. The research analyst is expected to contain biases by
engaging in reflexive interpretation. The key here is that “it
is by using what we bring to the data in a systematic and
aware way that we become sensitive to meaning without
forcing our explanations on data” (Strauss & Corbin, 1998,
p. 47). Literature thus furthers conceptual ordering or
theory development. However, although it is automatically
assumed that the research analyst will examine personal
assumptions, values, stereotypes and biases and
methodically analyse data to ensure that the knowledge
generated is rigorous, managing the process is much more
complicated.

Pre-Study Literature Search

In this information era where researchers are expected
to keep up-to-date in the field of study how is it possible to
stay away from the literature? Which literature? It is all
very well to state that “to avoid reading the literature
beforehand is a strategic grounded theory pacing” Glaser,
1998, p. 68), and while it is respectfully suggested that
such a stance was perfectly reasonable in a very different
research context (Glaser, 1978; Glaser & Strauss, 1967), it
is unreasonable in this day and age where information
management is a speciality in itself. Glaser (1998) urges
researchers to leave existing knowledge alone, to be open-
minded, so that the problem in the area of interest will not
be pre-empted but will be defined by the study
participants. Students embrace this idea enthusiastically
reminding supervisors that if they cannot know what the
study will be about examining literature in any area wastes
time. Open-mindedness though is not blankmindedness
(Denscombe, 1998).

What students tend to misunderstand is that every
research study is about something in the beginning, and in
grounded theory work the initial focus develops further or
moves in different directions once participants add in data.
Nonetheless, everything is data (Glaser, 1996), something
to be constantly compared and analysed with anything else
that is data, and that includes literature that may have
been examined at some time or other. Glaser’s position is
somewhat ideal. It is perhaps timely to remind ourselves
that all research begins with an idea, albeit a fuzzy idea,
and usually the researcher is sufficiently interested in that
idea to pursue it further in order to focus the research and
provide a rationale for the study, which will withstand
academic review.

Fortunately Glaser acknowledges the problems of
presenting a proposal to dissertation committees and
funding agencies and recommends that the researcher not
waste time and “do what the people want” (1998, p. 72). If
the literature is accurate or inaccurate “it will be constantly
corrected, put in perspective and proportioned in relevance
by the constant comparative method” (Glaser, 1998, p.
72). Any previous review will become integrated as a part
of the whole. In this sense literature takes its place as part
of the macro-context shaping a study, or can be woven into
the micro context if it is relevant to emerging concepts.
The macro context incorporates data about the broader
collective and institutional aspects of society while the
micro context “takes a more involved and close-up
viewpoint on individuals” (Layder, 1993, p. 5). It provides
contextual data but need not derail the research analyst
searching for alternative ways of looking at the world.

Some literature, but what, when and how?

The theoretical challenges of literature integration will
now be shared using an example of a doctoral research
project that focused on interprofessional practice (McCallin,
1999a, 1999b). The research began with a general interest
in examining nursing practice in the changing context.
Informal talks with registered nurse students had revealed
serious reservation about service provision in restructuring
organisations. Nursing practice was strongly influenced by
organisational change that was shaped by health reform on
a scale that was perhaps unprecedented in the history of
health service delivery in New Zealand.

In order to understand better some of the contextual
issues the national and international literature about health
reforms was examined to clarify the common trends.
Reading revealed that changes were by no means confined
to nurses. Everyone working in the health sector was
affected to some degree or other. Surely nursing practice
did not sit in isolation in such a volatile environment?
Perhaps scrutiny of one professional group was too narrow?
Could the topic be refined to explore professional practice
in the changing health sector?

Bishop and Scudder’s (1985) suggestion that “only
minimal consideration has been given to the moral issues
involved in the day-to-day health care and to the ongoing
relationships of physicians, nurses, and patients” (p. 2)
stimulated thinking. That statement mirrored some of the
issues raised by registered nurse students discussing
practice problems and was in keeping with the public
debate on health reform in which consumers, and health
professionals, questioned current health restructuring.
Maybe this was a study about morals and ethics and
professional practice?

General reading continued until thinking halted again.
Englehardt (1985) suggested that there were no
differences between the professions of nursing and
medicine in caring for patients as each profession simply
had a different accent and emphasis. Conflict and tension
was more likely caused by power and authority
relationships in hierarchical organisations. Perhaps long-
term study within the discipline of nursing had de-
sensitised me to the wider issues common to all health
professionals working in the health reform environment?
Even though nursing practice was the general area of
interest was it not unwise to view nursing as a separate
entity when practice responsibilities and professional
boundaries were blurring across the health professions?
But, what exactly was the problem? The issues were broad.
Confusion reigned.

Why Insist on Emergence?

Glaser’s (1992) style of grounded theory was selected
for this project precisely because of its ability to support
the emergence of problems that were to be identified by
the participants. Grounded theory is based on the belief
that, as individuals within groups comprehend events from
a personal perspective, common patterns of behaviour can
be discovered (Glaser, 1998). Hutchinson’s (1993) idea
that people make sense of their environment despite
apparent chaos was intriguing. That certainly supported
observations of professional practice in the changing
context.

Grounded theory looked promising, as the methodology
had the potential to explain what was actually
happening in practical life, rather than describing what
should have been going on. The premise was useful initially
because there were so many different perspectives in the
literature on nursing practice and the health reforms that it
was difficult to define the problem area. The grounded
theory method was ideal, as it created a scientifically
legitimate space to encourage participants to explain their
main concern and how they continuously resolved that.
Concepts did not have to be identified as predetermined
variables, but would emerge from observation and
discussion with participants.

At that stage reading began in the general area of the
professions (Abbott, 1988; Dingwell & Lewis, 1983;
Ehrenreich, 1978; Ehrenreich & English, 1973; Johnson,
1972)? The logic behind that decision was that most nurses
worked with health professionals from other disciplines and
background data of the macro context might be useful.
Then a new keyword, “interprofessional workgroup”
appeared on the databases and became a springboard for
literature searching. Further scanning of the databases
refined the focus to interprofessional practice. That concept
was daunting and there was no doubt that the researcher
was in a field “knowing nothing” (Glaser, 1998, p. 54).

The search for literature on interprofessional practice
began. According to Glaser (1978) that move was not
strictly in accordance with the emerging grounded theory
method, as the researcher runs the risk of preconceiving
the problem area. Some sense of direction though was
needed to satisfy university authorities and ethics
committees. It was also clear that any literature was data
that could be neutralised or integrated as long as it was
constantly compared with emerging concepts (Glaser,
1998). Fortunately, the literature revealed that there was
little published research on the concept of interprofessional
practice (Bishop & Scudder, 1985; Casto & Julia, 1994;
Gabe, Kelleher & Williams, 1994; Leathard, 1994;
Ovretveit, 1993; Petersen, 1994; Soothill, Mackay, &
Webb, 1995). Most readings proved to be anecdotal
accounts of interprofessional teamwork. The huge literature
on teams was not reviewed then as it seemingly had
potential to emerge as a significant concept. However,
selected general management literature was perused for a
sense of organisational issues associated with change and
restructuring (Drucker, 1994, 1995; Handy, 1990, 1994;
Morgan, 1986; Senge, 1990).

The medical sociology literature was also scanned
(Freidson, 1986, 1988, 1994; Nettleton, 1995; Turner,
1987). This was considered important to further
understanding of the sociocultural influences on
professional practice, and to gain some insights into the
historical influences that had shaped the health
professions. Familiarity with the nursing literature alone
was increasingly inadequate for the study that had moved
beyond the boundaries of nursing, so a baseline
understanding of the medical profession, the dominant
disciplinary group Among the health professionals, was
sought. Substantial controversies and contradictions
surrounding power relationships in the health professions
were revealed (Ashley, 1976; Bishop & Scudder, 1985;
Daniel, 1990; Davies, 1995; Fox, 1992; Hugman, 1991;
Willis, 1989; Witz, 1992). In fact, this heightened
sensitivity about interprofessional tensions made me wary
about predetermining problems that supported
unsubstantiated myths and assumptions.

In summary, the reading about interprofessional work
revealed a new emphasis on the development of teamwork
Amongst health professionals (McCallin, 2001). As a result,
the researcher concluded that the interdisciplinary team
was the prevailing research area even though the actual
problems of practice remained ill defined at that point in
time. In the final presentation much of the literature
discussed was integrated into separate chapters that
presented the macro context of the research. For example,
the readings about the professions, power and social
control became a chapter on the historical backdrop of
teamwork; material about health reforms was written up in
a chapter on the political context of health reform; and
literature on teams and teamwork was reviewed after data
was analysed and presented in another chapter on teams
and teamwork in restructuring organisations. This
illustrates well that the literature became “a valuable and
essential source of information” (Chenitz 1986, p. 43) even
though the focus of the review changed as the main
concern was clarified.

Conclusion

In this paper strategies for grounded theory literature
integration have been reviewed and illustrated with an
example. Today, literature cannot be ignored and it is
important that grounded theory researchers have a sound
theoretical understanding of the methods of integration so
they are well positioned to generate rigorous knowledge
that will contribute to scholarly knowledge development in
the discipline of nursing.

Author

Antoinette M. McCallin, Ph.D., RN
Head of Research
Division of Health Care Practice
Faculty of Health and Environmental Sciences
AUT University
Auckland, New Zealand
email: McCallinccalli@aut.ac.nz

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