About the Authors

Kari Allen-Hammer, Ph.D. serves as the Advocacy Director for LiveLifeResources, a 501(c)3 non-profit organization in the United States. Additionally, she provides wellness and performance coaching in private practice, in West Sacramento, California and through tele-health services. Emily Cashwell is the Director of Education and Research at the Institute for Research and Theory Methodologies (RTM), an organization that trains, mentors, and supports students, faculty, and researchers worldwide in qualitative, multi-method, mixed method, and grounded theory research. She received her doctoral degree in psychology with a specialization in Consciousness, Spirituality, and Integrative Health from Saybrook University in Pasadena, CA. She has also earned a master’s degree in Nutrition and Integrative Health from Maryland University of Integrative Health and a master’s degree in Special Education from George Mason University. Her research interests include authenticity, the trait of high sensitivity, and experiences of neurodiversity. Gordon Medlock, PhD, is a scholar-practitioner with over 30 years of experience as a psychotherapist, coaching psychologist, and human capital management consultant. He is currently Director of Doctoral Research at the Wright Graduate University for the Realization of Human Potential. He has been published in the areas of existential and humanistic psychology and grounded theory and has been trained and mentored by Odis Simmons and Bob Wright in classic grounded theory methodology. He earned a PhD in philosophy from Yale University and a master’s degree in clinical social work from the University of Chicago, and he is an ICF-PCC level coach. He is co-chair of the research committee of the Graduate School Alliance for Education in Coaching, clarifying academic and practice standards for graduate level coach education. Email: gordon@wrightgrad.edu Kianna McCoy graduated with her PhD from Fielding Graduate University in Infant and Early Childhood Development in 2018. In 2003, she graduated from the University of Utah with her Master’s Degree in Occupational Therapy. While attending Fielding, she was mentored by Dr. Susan Stillman to conduct her first classic grounded theory study. Kianna is a licensed occupational therapist in California and has been working with children and families for over 20 years. She has worked as a clinician in a variety of settings, in administration and as an expert training leader for ICDL. Alan Kim-Lok Oh, MCounsPsy, MBA, KB, PA is a consultant psychologist, and clinician at a private hospital. He has a practice that provides consultation, behavioral health screening and assessment, counseling and psychotherapy services to adults, elders, adolescents and children in the following formats – individual, group, family, couple or a combination of these formats based on patient and client needs. Alan is also a registered counsellor in Malaysia. He is completing his doctoral research in psychology at Universiti Malaysia Sabah. Together with his wife and daughter, Alan lives in Kota Kinabalu, Sabah. Patrick A. Palmieri, DHSc, DPhil(Hon), EdS, MBA, MSN, PGDip(Oxon), ACNP, RN, CPHRM, CPHQ, FAAN, Dr. Patrick Palmieri is director of the South American Center for Qualitative Research at the Universidad Norbert Wiener and the founding director of the EBHC South America: A JBI Affiliated Group (https://www.jbisa.org/). He completed a postdoctoral program in caring science (Watson Caring Science Institute) mentored by Dr. Jean Watson and training in evidence-based health care (University of Oxford). He also earned a doctoral degree in health sciences (A.T. Still University) and graduate degrees in nursing (Vanderbilt University), education (University of Missouri), and business administration (Saint Leo University). With extensive experience as a research methodologist and professor of nursing, Dr. Palmier has mentored many doctoral dissertations and numerous research projects. He is an...

From the Editor’s Desk

Classic Grounded Theory: What it Is and What it Is Not Grounded theory is arguably the most frequently published qualitative research method.  Yet it is often misunderstood.  Many years ago, I gave a talk on the general tenets of classic grounded theory at a large regional research conference.  After the presentation, a professor who taught PhD-level qualitative research at a large research university approached me asking: “Grounded theory doesn’t really need to result in a theory, does it?  Can’t it consist of a list of themes?”  In the same way that a pile of threads is not a shirt, a list of themes is not a theory. The purpose of this editorial is to clarify what grounded theory is and what it is not. Grounded Theory: What It Is Not Classic grounded theory as described by Glaser and Strauss (1967) and further by Glaser (1978, 1998), differs from all other research methods. The purpose of classic grounded theory, the language, procedures, analysis, and the final product are unique to the method.  It has been used, misused, misunderstood, and modified. Following are corrections to some commonly held fallacies about grounded theory. Grounded theory is not quick and easy.  As any experienced grounded theorists will affirm, the method rigorously follows a set of procedures that require humility, scholarship, attentiveness, openness, and skill.  Grounded theorists cannot rely upon previously developed instruments nor do they have the luxury of writing up narratives based upon computer generated data analysis.  The data gathering and analysis in grounded theory depends solely upon the perceptiveness, skill, and cognitive abilities of the researcher.  Stirbys’s study in this issue, Potentiating Wellness in Order to Overcome Generational Trauma reflects the rigorous nature of classic grounded theory and gives a glimpse of the procedures that assure rigor. A grounded theory is not a list of themes.  By its very definition, theory presupposes relationships between and among elements. Themes may constitute a basket of disparate findings.  A grounded theory, on the other hand, provides a focused, parsimonious explanation based upon interrelated concepts, which are developed to higher order of abstraction than raw data or themes. A classic grounded theory is not a story, nor does it represent any specific participant’s story. A grounded theory is a conceptual explanation of human process that a sample of people have in common.  It is not intended to present accurate facts.  Rather, a grounded theory is derived from participant data that is fractured, compared, and raised from the level of raw data to that of more abstract concepts. The classic grounded theory method is not based upon symbolic interactionism.  Glaser and Strauss (1967) and subsequently Glaser (1978, 1998) were silent about grounded theory’s roots.  So, through the years various authors have proposed piecemeal explanations of the method’s ontological, epistemological, and methodological underpinnings, thus promoting erosion and remodeling of the grounded theory method and creating a variety of notions about the method’s philosophical foundation. Novice researchers most often make the mistaken claim that symbolic interactionism is the basis of the method. Grounded theory is not a preliminary research step in preparation for quantitative research.  Although researchers may occasionally attempt to operationalize and quantify concepts discovered in a particular grounded theory, many grounded theories explain processes that are unique, personal, and not amenable to quantitative description or analysis.  Many grounded theory concepts cannot reasonably be transmogrified into quantifiable operational definitions.  In most cases, grounded theories provide the best explanation of the discovered processes. Grounded theory is not derived...

Getting Started

Barney G. Glaser Editor’s note: This paper addresses common questions asked by novice grounded theorists about how to avoid preconception when thinking about research problems and research questions.  This important chapter has been excerpted and lightly edited for clarity and context from chapter 4 in Glaser’s Basics of Grounded Theory Analysis (1992). 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 to 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 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 of the action in the substantive areas under study.  As categories emerge in copen 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 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 his 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 of interest with no problem.  He moves in with the abstract wonderment of what is going on that is an issue and...

Exerting Capacity: Mindsets of Bedside RNs in Keeping Patients Safe...

J. Michael Leger, University of Texas Medical Branch, School of Nursing Carolyn A. Phillips, University of Texas Medical Branch, School of Nursing and Graduate School of Biomedical Sciences Abstract This classic grounded theory (CGT) study explored the perspectives of bedside nurses about patient safety in the adult acute care environment. The theory that emerged, Exerting Capacity, explains how bedside nurses balance their own capacity against the demands of a given situation to fulfill their duty to keep their patients safe. Exerting Capacity revealed a typology of two mindsets nurses use to approach the demands of keeping patients safe: me-centric and patient-centric. Analysis of the study’s data revealed no connection between the mindset and the skill level of the nurse, unlike Benner’s (1982) “From Novice to Expert” concept. Further, no relationship could be identified between the mindset and the length of time the nurse has been in practice as a bedside nurse. Understanding the mindset nurses use to approach provision of safe care is necessary for understanding how nurses ensure patient safety in the hospital setting. Keywords: mindset, patient safety, exerting capacity, classic grounded theory Introduction The World Health Organization [WHO] (2019) estimates that adverse events occurring in the hospital are the 14th leading cause of morbidity and mortality around the globe.  The United States Institute of Medicine’s (IOM) 1999 seminal report “To Err is Human: Building a Safer Health System,” estimated, to the dismay of healthcare professionals, that between 44,000 and 98,000 people in the United States (U.S.) suffer preventable deaths annually due to medical errors. The Australian Institute of Health and Welfare [AIHW] (2018) published data indicating an age-standardized rate of 105 potentially avoidable deaths per 100,000 population and 5.4 adverse events in hospitals per 100 discharges. In 2016, Johns Hopkins Medicine in Baltimore, MD, (U.S.) reported that medical errors occurring during patient treatment in U.S. hospitals led to more than 251,000 deaths, or 9.5 percent of all U.S. deaths each year (Hopkins Medicine, 2016). This rate is significantly higher than the United Nations projected overall rate of 7.645 deaths per 1000 people (Macrotrends, n.d.) Yet despite the amount of research into patient safety ignited by the IOM report and other findings of patient error data, the numbers of adverse patient outcomes continue to be one of the most significant issues facing healthcare today. As recently as 2019, scientists estimate that more than 161,000 avoidable deaths occur annually in U.S. hospitals (Castellucci, 2019). Why then, if patient safety is deemed a “healthcare priority,” is the global healthcare system unable to make better progress in reducing these potentially preventable adverse events and deaths? A review of the literature through 2015–the time period ending this research project–related to patient safety revealed a significant gap in the current science. Despite a plethora of research focusing on the data-driven, quantitative outcomes of adverse patient events and surveys that gather information about patient safety, there is a scarcity of qualitative data about the concept of patient safety from the perspective of the bedside nurse, the healthcare worker who is closest to the patient (Author A & Author B, 2017). In an effort to close this gap in the patient safety literature, the initial study used Classic Grounded Theory (CGT) to focus on the perspectives of bedside registered nurses (RNs) in the U.S., who work primarily in adult acute care environments, as they relate to patient safety. The participants’ main concern–indemnifying duty–in keeping their patients safe and guarding them against loss or harm while...

Coming Home: A Journey Back to the Authentic Self...

Emily Cashwell, Saybrook University Abstract The theory of coming home is a three-stage classic grounded theory that details an individual’s initial exploration of the world in childhood, followed by the subsequent abandoning of their authentic self and then the life-long journey back home to their most authentic being. In the first stage of the process, individuals act and express in authentic ways and receive feedback from the environment about which aspects of themselves are acceptable and which are not. In the second stage of the process, driven by feelings of shame and lowered self-worth or the awareness that certain aspects of themselves are unacceptable, individuals engage in abandoning behaviors to fit in and avoid rejection. After months, years, or even decades of increasing awareness about these behaviors, individuals may enter the third stage of the process, during which they come to re-explore, accept, and embrace their authentic selves. Keywords: classic grounded theory, authenticity, authentic self, self-exploration, self-acceptance Introduction Authenticity has been a concept of interest to humans for centuries. To date, the body of literature on authenticity has been comprised mostly of research on state authenticity (Lenton et al., 2013; Lenton et al., 2015) and trait authenticity (Kernis & Goldman, 2006; Wood et al., 2008). There has been limited research, however, on the possibility or process of becoming more authentic throughout the course of one’s life. This research study began as an inquiry into the lived experiences of highly sensitive individuals. Following the steps of a classic grounded theory outlined by Glaser and Strauss (1967) and later by Glaser (1978, 1992, 1998, 2002), I identified the main concern of learning to be and accept oneself. Then, through constant comparison of new data with already discovered concepts, I developed the theory of coming home. This theory addresses the gap in the literature around the process of becoming more authentic across the lifespan. Methodology Classic grounded theory (CGT) is a useful method for inductively generating theories about patterns of human behavior that help individuals within a substantive area to understand their situations and take meaningful action to resolve their main concerns (Glaser, 1978). CGT is typically conducted through a series of main stages, which include preparation, data collection and analysis, memoing, sorting, creating a theoretical outline, and writing. The grounded theorist works on stages sequentially and often simultaneously, with many stages overlapping and insights from one stage informing work on another. This particular CGT was developed during my doctoral research at Saybrook University. To prepare for this research study, I identified an area of interest, which was the experience of being highly sensitive. In order to minimize preconceptions, I delayed an initial review of the literature. I then developed a grand tour question, which is a broad open-ended research question or statement, that is likely to facilitate participant sharing about the experiences and concerns most relevant to them around the substantive area of interest (Glaser, 1978). My initial research statement was “Tell me about the experience of being deeply affected by people and situations.” I began data collection and analysis while awaiting Saybrook University IRB approval by coding and memoing on four short stories written by people who self-identified as highly sensitive. Once I received IRB approval to begin data collection with human subjects, I set aside the four stories and the memos developed from them and conducted an initial interview using my grand tour statement. I open coded that interview, memoed on the emerging concepts, and then conducted another interview....