Intacting Integrity in Coping with Health Issues...

Lene Bastrup Jørgensen, University of Aarhus, Denmark, Stine Leegaard Jepsen, University of Aarhus, Denmark, Bengt Fridlund, Jönköping University, Sweden, Judith A. Holton, Mount Allison University, Canada Abstract The aim of this study was to discover and elaborate a general substantive theory (GST) on the multidimensional behavioral process of coping with health issues.  Intacting integrity while coping with health issues emerged as the core category of this GST.  People facing health issues strive to safeguard and keep intact their integrity not only on an individual level but also as members of a group or a system.  The intacting process is executed by attunement, continuously minimizing the discrepancy between personal values, personal health, self-expectations, and external conditions as health- and culturally-related recommendations and demands. Multifaceted coping strategies are available and used as implements in the attuning process. Keywords: intacting, health issues, coping strategies, general substantive theory Background Creating an overview and a general explanation of how people cope with health challenges is difficult as the literature on the coping process is comprehensive and diverse.  This diversity may be due to a profound heterogeneity in literature when it comes to the conceptual structure of coping (Skinner, 2003).  Various concepts are used to explain the same complex behavioral coping processes, and no consistent structure-related terminology on coping is available (Skinner, 2003).  A fragile theoretical foundation and theoretical rationale for coping-supportive clinical actions may be a consequence of this inconsistency. Several grand theories (Bandura, 1977, 1995; Lazarus & Folkman, 1984) on coping often lay the theoretical foundation for educating healthcare professionals.  The ability and suitability of these grand theories to explain coping processes dealing with health issues has not been challenged in decades.  Healthcare professionals are consequently challenged by diversity in the structural understanding of coping and a rigidity in the theoretical understanding.  Consequently, the competencies of healthcare professionals in supporting coping behaviors, and thereby the clinical needs of understanding coping, may not be sufficiently met by using these grand theories. However, according to Glaser and Strauss (1967), moving away from “grand theories” to develop empirically grounded substantive theory gives the theory better fit while sufficiently matching clinical needs.  As there is already a plethora of research and substantive theories on coping within the healthcare field, largely differentiated by medical criteria, the aim is to raise the conceptual level by offering a more nuanced explanation and understanding of a variety of substantive areas through development of a general substantive theory of coping in healthcare.  Glaser (1978) referred to a general substantive theory as “more general than a substantive theory, but not completely general as a formal theory” (p. 52).  Holton and Walsh (2017) referred to this mid-range theory development as “substantive formalization” (p. 22) and proposed that, “The substantive formalization of a substantive theory may be obtained through sampling different substantive groups, contexts, and/or social units within the same setting/substantive area; it increases the scope of a grounded theory” (p. 22).  As such, this study of coping with health issues constitutes the first step in the process of generating a formal grounded theory on coping that could, through further theoretical sampling, be extended beyond the health domain. This general substantive theory (GST) of intacting integrity emerged from two substantive grounded theories: one developed with pulmonary patients dealing with breathlessness (Jørgensen, Pedersen, Dahl, & Lomborg, 2013a; Jørgensen, Lomborg, Dahl, & Pedersen, 2013b) and the second with patients dealing with a fast track total arthroplasty (THA) programme (Jørgensen & Fridlund, 2016).  Subsequently, comparing the two theories,...

Remodelling the Life Course: Making the Most of Life with Multiple Sclerosis...

Milka Satinovic, Western Norway University, Norway Abstract The aim of the study was to develop a substantive grounded theory on how to live a life as good as possible with multiple sclerosis (MS). The question of how to improve the quality of life is of key importance when speaking of a chronic illness like MS. We still have little knowledge of this important question from the patients’ perspective. Classic grounded theory was used to explore patients’ experiences of living with MS. The aim was to identify their main concern and how they process this concern at different phases in their life course. Twenty-one interviews were conducted with 17 participants diagnosed with multiple sclerosis. Participant observation at five courses for people with a multiple sclerosis diagnosis generated field notes. The participants’ main concern was how to live a life as good as possible in spite of their deteriorating health. The participants met this challenge through a process of remodelling the life course, in four phases: postponing (keeping up a normal life), adjusting (moving on to a changed life), restructuring (doing the best of it in a changed life), and transforming (preventing illness from controlling life). The remodelling process is influenced by the individual context, like the current health situation, biography, relations, and structural conditions. The process of remodelling helps us understand what facilitates and what hinders patients with MS from living a good life. Keywords: multiple sclerosis, patient’s perspective, quality of life, chronic illness, nursing, grounded theory. Introduction Multiple sclerosis (MS) is still an incurable and unpredictable chronic disease that is moderated by medication, and the persons’ own lifelong balancing between the illness and life evolvement. MS is challenging for the persons living with MS and the health-care personnel (Maloni, 2013). For the person with MS the challenge is how to handle (manage) the unpredictable and lifelong bodily symptoms and changes, and at the same time try to live a life as good as possible within his or her own life context. For the health care personnel, the challenge is to understand the illness, the persons’ own management strategies, rehabilitation, and health promotion in order to support and optimise the persons’ potential to live a life as good as possible with MS (Ploughman et al., 2012). In the study of factors, influencing healthy aging with MS (Ploughman et al., 2012) found resilience to be one of four fundamental factors “relating to the participants’ abilities to adapt to changes and disease symptoms, seek out and gain new knowledge, pursue self-therapy, deal with uncertainty, resolve problems on one’s own and cope with and overcome barriers” (p. 29). Thus, understanding the subjective experience of people living as well as possible with multiple sclerosis (MS) is of core importance in nursing, medical treatment, rehabilitation, and health care planning. Quantitative measurements of quality of life (QOL) have earlier indicated lower quality levels for people with MS diagnoses compared to those with other chronic illnesses (Benito-Leon, Manuel Morales, Rivera-Navarro, & Mitchell, 2003; McCabe & De Judicibus, 2005; Nortvedt & Riise, 2003).  In contrast,  a study of the relationship between QOL and coping was evaluated by McCabe, Stokes & McDonald, 2009). The study, which extended over a period of two years, revealed that people with MS increase their global quality of life over time. They experience higher psychological QOL, higher level of detachment, and are more focused on the positive coping than the general population. Studies on quality of life in MS using qualitative methods have focused...

Celebrating 50 Years of Grounded Theory: Onward and Forward Editorial...

Astrid Gynnild, University of Bergen Welcome to this very special issue of the Grounded Theory Review.  In this issue we celebrate 50 amazing years of grounded theory during which it has become one of the fastest growing methods in the global research world. Five decades after The Discovery of Grounded Theory was first published, the seminal work of founders Barney G. Glaser and Anselm Strauss is cited more than 94,000 times on Google Scholar alone. We celebrate that after 50 years of researching, teaching, defending, explicating and clarifying grounded theory as a principally inductive approach to theorizing, co-founder Barney G. Glaser still produces books on grounded theory at an incredible pace. In the last three years alone, from 2014 to 2017, Dr. Glaser has produced six new books that discuss vital aspects of doing grounded theory. We also celebrate that the Grounded Theory Review, after two years of scholarly assessment, is accepted into the Emerging Sources Citation Index (ESCI) within the Web of Science. It is a valued endorsement of the quality of the Grounded Theory Review that will improve its visibility within the academic world. We further celebrate that grounded theorists from all continents have the opportunity to participate in a growing number of troubleshooting seminars. The seminar is a productive arena for bringing emerging theories another step towards publication. While writing this editorial, I find myself once again immersed in the exciting learning space of a troubleshooting seminar led by Dr. Glaser, this time in Mill Valley, California.  At the chronological age of 87 Dr. Glaser still runs the troubleshooting seminar with methodological rigor and reversal humor. And he keeps arguing that the discovery of theory from data is a major task confronting researchers today. Interestingly, when Glaser and Strauss wrote The Discovery of Grounded Theory back in 1967, they opened the first chapter in this way: Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In this book we address ourselves to the equally important enterprise of “how the discovery of theory from data—systematically obtained and analyzed in social research—can be furthered. We believe that the discovery of theory from the data—which we call grounded theory—is a major task confronting sociology today, for, as we shall try to show, such a theory fits empirical situations, and is understandable to sociologists and layman alike. Most important it works—provides us with relevant predictions, explanations, interpretations and applications. The multitude of theories produced over the last 50 years confirm that Glaser and Strauss were right—GTs do provide us with relevant predictions, explanations, interpretations and applications. We celebrate these events by publishing a Special Issue of the Grounded Theory Review. In this issue scholars from many disciplines contribute with their ongoing research and reflections on doing grounded theory. These articles demonstrate the breadth of approaches within the global grounded theory community by providing a glimpse into the multifaceted theorizing using the procedures of classic grounded theory. Since grounded theory is a method aimed at conceptualizing patterns of human behavior, examples help us to understand the various steps in doing a grounded theory study. Thus, in this celebratory edition of the journal we follow Glaser’s predications  on the necessity of exampling, and provide more than 20 papers, short and long, from a great variety of disciplines. In his latest book, Grounded Theory: Its origins and growth, Dr Glaser invites us to share in his matured ideas on the...

Comparative Failure in Science

Barney G. Glaser, PhD This article is reprinted from Glaser, B. (1964). Comparative Failure in Science. /Science, 143/(3610), 1012-1012. A perennial problem for some scientists is their feeling of comparative failure as scientists. This problem becomes clearer if we consider two major sources of this feeling that are inherent in the vary nature of scientific work. (i) In science, strong emphasis is placed on the achievement of recognition; (ii) the typical basic scientist works in a community filled with “great men” who have made important and decisive discoveries in their respective fields; they are the acknowledge guiding lights. These esteemed scientists, who have attained honors beyond the reach of most of their colleagues, tend to become models for those who have been trained by them or who have worked under them. As Eiduson has put it in her recent psychological study of basic research scientists “Scientists: are idols-oriented.” To take these honored men as models is important for training as well as for a life of research. During training, one learns to think creatively. Emulation of these models results on the internalization of values, beliefs, and norms of the highest standard. This emulation of the great continues and guides the scientist in his research work, however individual in style his work may be. But it is precisely here that a feeling of comparative failure may arise. In emulating a great man the scientist tends to compare himself with the model. He estimates how closely he has equaled his model in ability to adhere to high standards of research, to think of relevant problems, to create “elegant” research designs, to devise new methods, to write clearly, to analyze data. In addition, because of the strong emphasis on attaining recognition for research contributions the scientist perhaps will compare his own degree of success with his model’s to gauge how he himself is doing. In using the great man’s achievements and the recognition accorded him as criteria, the scientist may be motivated to strive continually and unremittingly towards greater heights. On the other hand, he may see himself, over time, as a comparative failure for not having attained a comparable amount of recognition. Eiduson brings out the dynamics of this problem for scientists: The model, then, is the ego ideal figure who represents the ultimate position, and in fact, defines what a scientist should do, how he should think, how he should act. By comparison, everything else is inevitably of lesser worth [italics mine]. We have seen the way scientists in this group rebuke themselves as they become old, distracted, sit on committees or government advisory boards, or become administrators- and thus move away from the ideal. From this picture it is obvious that the scientist is hard on himself. He has a built-in, clearly marked scalar system, along which attitudes and kinds of performances are measured. When he moves away and deviates from the pattern, he becomes a maverick, or a person who has tossed aside the flaming torch. Average success With this basic problem in mind, I recently made a study of the organizational careers of basic research scientists, one purpose of which was to ascertain the consequences, for the scientist’s career, of receiving or not receiving an average amount of recognition: At the time of this study, these scientists were employed in a government medical research organization devoted to basic research. This was a high-prestige organization from the standpoint of scientists and was run much as though it were a series of...

Offsetting the Affective Filter

Barry Chametzky,...