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Awareness of Dying Remains Relevant after Fifty Years
Tom Andrews, University of Cork, Ireland, Alvita Nathaniel, West Virginia University, USA Abstract This year is the fiftieth anniversary of the publication of Awareness of Dying, one of four monographs that culminated from a six-year funded research program titled Hospital Personnel, Nursing Care and Dying Patients (Glaser, 1968). Written by Barney Glaser and Anselm Strauss, Awareness of Dying (1965) was the first published study utilizing a new, groundbreaking research method. Glaser and Strauss termed this new method grounded theory because it was based upon data that was grounded in the real-live experiences of people. In this paper, we will look back at the origin of the grounded theory method and re-examine Awareness of Dying in light of more recent research in the area. Keywords: awareness of dying, dying process, end-of-life care, grounded theory Introduction Following publication Awareness of Dying, Glaser and Strauss published a detailed description of the new method that they used to discover the theory. The grounded theory method was derived from a melding of the authors’ backgrounds: Glaser’s study of quantitative and qualitative math at Columbia University under Lazarfeld, his study of explication de texte at the University of Paris, his study of theory construction under Merton, and Strauss’s study of symbolic interactionism under Blumer at the University of Chicago (Glaser, 1998; Glaser & Strauss, 1967). Their meticulous description of the method in a subsequent publication, The Discovery of Grounded Theory (1967), provided the structure for others who would subsequently use the method. It also garnered respect because it took advantage of reputable mathematic quantitative and qualitative ideas. Some would say that theory that is grounded in the experiences of people is the most important and distinctive scientific activity for human beings because theories depict a meaningful pattern. Because of this real-world orientation, grounded theories offer clear understandings of predictable processes and patterns of behavior. Grounded theories help us to understand that when certain patterns emerge, particular people respond in predictable ways and their actions produce predictable results (Nathaniel, 2007). When we understand patterns that affect people, we can work towards altering them. Thus, theories have the potential to give us more insight and control in predictable situations. Awareness of Dying 1965 Awareness of Dying is historically important because it was the first grounded theory ever published. For six years, Glaser and Strauss conducted intensive fieldwork involving a combination of observations and interviews at six hospitals. The purpose of their research was to contribute toward creating end-of-life care that was more rational and compassionate. The investigators were allowed to observe different aspects of dying within these six hospitals; death at these locations was “sometimes speedy, sometimes slow; sometimes expected, sometimes unexpected; sometimes anticipated by the patients, sometimes unanticipated” (Glaser, 1968). The researchers observed nurses and physicians at work. They sat at the nurses’ stations, attended staff meetings, and talked with patients. They also asked questions and interviewed staff. The theory that emerged from this intense investigation presented an eye-opening view of how patient care was affected by the awareness level of the dying process by nurses, physicians, and patients. Today, most people choose to die in hospitals, hospices, and nursing homes. The situation was much the same in the 1960s. When people die in institutions, nurses and physicians, who are virtual strangers, are responsible for care during the last days of life. During the course of their observations, Glaser and Strauss found that Americans hesitated to talk openly about dying and were prone to avoid telling...The system was blinking red: Awareness Contexts and Disasters
Vivian B. Martin, Central Connecticut State University, USA Abstract The awareness context has been a source of inspiration for grounded theories for more than 50 years; yet little has been done to extend the theory beyond nursing and the medical field, and a few works on identity. This paper extends the awareness context by examining its role in several high-profile disasters, natural and man-made, where gaining a clear sense of what was going on was often blocked by poor information flow and general communication failures, interpersonal and technological. Selective coding and the introduction of new concepts after analyzing hundreds of pages of documents issued by special commissions in the aftermath of the 9/11 attacks, Hurricane Katrina, the Deepwater Horizon oil spill in the Gulf, and the Sago Mine Disaster not only explain various processes around awareness in the midst of crisis, but also illuminate pre-crisis patterns that, if attended, could have mitigated the impact of the disasters. Keywords: Awareness context, crisis communication, sociology of disaster, situational awareness, 9/11 attacks, Hurricane Katrina, Deepwater Horizon explosion, Sago Mine Disaster. Introduction Whether it is in personal interactions, professional life, or community activities, we are always communicating and processing information. Some of this information is innocuous and of no immediate consequence, while other information may have direct bearing on our wellbeing, that of our families, or colleagues. In such high stakes situations, it is important to have immediate access to information that is complete and credible. Seen from this perspective, Glaser and Strauss’s awareness context (1964, 1965) addresses a fundamental communication process of everyday life. We move in and out of awareness contexts throughout daily life. The identification of a typology of awareness in which interactions among health professionals and patients are shaped by whether a patient is aware of a terminal diagnosis was a critical intervention in nursing and medical studies, and continues to be a starting point for much research (Andrews & Nathaniel, 2010). The subject—dying—and discipline in which this theory has been embedded and extended across numerous illnesses and concerns may mask the essential work of the awareness context as a theory about the managing and sharing of information, a concern throughout organizations and institutions. Of course, the awareness context has not been limited to health issues. The role of identity and the interactions that occur when people are uncertain of the identify of another is highlighted in the American Sociological Review article Glaser and Strauss (1964) published prior to the release of Awareness of Dying; Ekins’s (1997) work on cross-dressing is a successful extension of the awareness context into this realm. But awareness as a concept offers many more possibilities for explaining phenomena that impede the distribution of critical communication across many spheres. This paper extends the awareness context by examining its role in several high-profile disasters, natural and man-made, where gaining a clear sense of what was going on was often blocked by poor information flow and general communication failures, interpersonal and technological. Selective coding and the introduction of new concepts from analyzing hundreds of pages of documents issued by special commissions in the aftermath of the 9/11 attacks, Hurricane Katrina, the Deepwater Horizon oil spill in the Gulf, and the Sago Mine Disaster not only explain various processes around awareness in the midst of crisis, but also illuminate pre-crisis patterns which, if attended, could have mitigated the crises. The awareness context becomes an important contribution to crisis communication and organizational communication. Concepts such as abridging awareness, discounting...The Practical Use of Awareness Theory
(A reprint of Chapter 14 in Awareness of Dying, first published 1965) Barney G. Glaser, PhD, and Anselm L. Strauss In this chapter we shall discuss how our substantive sociological theory has been developed in order to facilitate applying it in daily situations of terminal care by sociologists, by doctors and nurses, and by family members and dying patients. The application of substantive sociological theory to practice requires developing a theory with (at least) four highly interrelated properties. (As we have demonstrated in this book and will discuss explicitly in the next chapter, a theory with these properties is also very likely to contribute to formal—i.e., general—sociological theory.) The first requisite property is that the theory must closely fit the substantive area in which it will be used. Second, it must be readily understandable by laymen concerned with this area. Third, it must be sufficiently general to be applicable to a multitude of diverse, daily situations within the substantive area, not just to a specific type of situation. Fourth, it must allow the user partial control over the structure and process of the substantive area as it changes through time. We shall discuss each of these closely related properties and briefly illustrate them from our book to show how our theory incorporates them, and therefore why and how our theory can be applied in terminal care situations.[1] Fitness That the theory must fit the substantive area to which it will be applied is the underlying basis of the theory’s four requisite properties. It may seem obvious to require that sub-stantive theory must correspond closely to the data, but actually in the current ways of developing sociological theory there are many pitfalls that may preclude good fitness.[2] Sociologists often develop a substantive theory—theory for substantive areas such as patient care, delinquency, graduate education—that embodies, without his realization, the sociologist’s ideals, the values of his occupation and social class, as well as popular views and myths, along with his deliberate efforts at making logical deductions from some formal theory to which he became committed as a graduate student (for example, a theory of organizations, stratification, communication, authority, learning, or deviant behavior). These witting and unwitting strategies typically result in theories too divorced from the everyday realities of the substantive area, so that one does not quite know how to apply them, or in what part of the social structure to begin applying them, or where they fit the data of the substantive area, or what the propositions mean in relation to the diverse problems of the area. The use of logical deduction rests on the assumption that the formal theory supplies all the necessary concepts and hypotheses; the consequences are a typical forcing and distorting of data to fit the categories of the deduced substantive theory, and the neglecting of relevant data which seem not to fit or cannot be forced into the pre-existing sociological categories.[3] In light of the paucity of sociological theories that explicitly deal with change,[4] logical deduction usually is carried out upon static theories which tends to ensure neglect, distortion, and forcing when the deduced theory is applied to an ever-changing, everyday reality. Clearly, a substantive theory that is faithful to the everyday realities of the substantive area is one that is carefully induced from diverse data gathered over a considerable period of time. This research, usually based primarily on qualitative data gathered through observations, interviews and documents and perhaps later supplemented by surveys, is directed in...Awareness of Dying Preface
This text is a reprint of the Preface of Awareness of Dying (1965) by Barney G. Glaser and Anselm L. Strauss PREFACE Once upon a time a patient died and went to heaven, but was not certain where he was. Puzzled, he asked a nurse who was standing nearby: “Nurse, am I dead?” The answer she gave him was: “Have you asked your doctor?” —Anonymous, circa 1964 Recently The New York Times reported: “VERY ILL CHILDREN TOLD OF DISEASE; Leukemia Patients at N.I.H. Not Shielded From Truth. . . . A child should always be told the truth, even when he has an incurable disease such as leukemia, according to two researchers who interviewed 51 children hospitalized at the National Cancer Institute, Bethesda, Maryland, for treat¬ment of leukemia.” This kind of news item reflects the growing concern among researchers and public about matters which touch on morality as much as on the technical aspects of medi¬cine. The rapidly increasing proportion of elderly people in the American population presents a range of personal and social questions; not the least is how they view their newly won longevity (often including anticipated years of chronic disease) as well as their attitudes toward death. In consequence, many geriatric specialists are beginning to study American attitudes toward death, while others, spurred on by what seems a sense-less prolonging of life within hospital walls by medical tech¬nology run wild, are raising questions about death and dying in American life. Our book is no exception to this trend; indeed, we would further it. We wish to contribute toward making the management of dying—by patients, families and health professionals—more rational and compassionate (and the two are far from incompatible). The chief differences between our approach and others’ can be quickly summarized. Recognizing that most Americans are now dying inside hospitals, we have focused upon what happens when people die there. We have focused on the interaction between hospital staffs and patients, rather than on the patients themselves. We have reported on contexts of action rather than merely on “attitudes toward death.” And we have been less concerned with death itself than the process of dying—a process often of considerable duration. This approach reflects our sociological perspective, for we have attempted to channel our reforming impulses into an inquiry not at all medical in character. If increasingly Americans are dying within medical establishments, surrounded more by nurses and physicians than by kinsmen, then how do these representatives of the wider society manage themselves and their patients while the latter are dying? How is the hospital’s organi¬zation capitalized upon in this process? What forms of social action, transitory or more permanent, arise while handling the dying of people? What are the social consequences for the hos¬pital and its staff, as well as for the patients and their families? To answer these kinds of questions, we did intensive fieldwork (involving a combination of observation and interviewing) at six hospitals located in the Bay area of San Francisco. We chose a number of medical services at each hospital, selected, as we shall explain later, to give us maximum exposure to dif¬ferent aspects of dying—locales where death was sometimes speedy, sometimes slow; sometimes expected, sometimes unexpected; sometimes unanticipated by the patient, sometimes anticipated; and so on. The reader who is unacquainted with this style of field research need only imagine the sociologist moving rather freely within each medical service, having announced his intention of “studying terminal patients and what happens around them”...Perpetual Betterising: A Grounded Upgrading of Disruptive Innovation Theory Resolving Co-dependent Socio-economic Main Concerns...
Brett Chulu, National University of Science and Technology, Zimbabwe Abstract Clayton Christensen’s theory of disruptive innovation has a partial ancestry in classic grounded theory (CGT), anchored in the original methodological ideas of inductive theory-building, categorisation, formal theory, and modifiability. The locus of disruptive innovation theory resides at the nexus of sociology and economics. The inescapable sociological pedigree of this theory naturally lends itself to CGT analysis. Christensen’s theory cores out with a variable of perpetual betterising recurrently resolving co-dependent main concerns held by a firm’s dominant coalition and the recipients of organisation-created value. Christensen’s theory is upgraded by employing reconstructive processes to rid it of margins of error (conceptual-descriptive syncretism) and margins of terror (unintended imposition and pre-conceiving). Perpetual betterising is a multivariatised conceptual model. The categories comprising perpetual betterising lend themselves to threading together by a biological species evolution-invasion theoretical code. Through the lenses of perpetual betterising, this paper explores long-standing and current debates around disruptive innovation. Keywords: co-dependent main concerns, perpetual betterising, socio-economic locus, CGT ancestry, biological species evolution-invasion, cycle of theory-building in management research Introduction Danneels (2004) and Markides (2006) have lamented that, despite the widespread use of the term disruptive innovation, there seems to be ambiguity over the precise meaning of the phenomenon. Clayton Christensen, the progenitor of the theory of disruptive innovation is on record: The theory explains the phenomenon by which an innovation transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation is formed in a niche market that may appear unattractive or inconsequential to industry incumbents, but eventually the new product or idea completely redefines the industry. (Christensen Institute, 2015, para. 1) Christensen, Raynor, and McDonald (2015) pinpointed the brass tacks of disruption: Disruption describes a process whereby a smaller company with fewer resources is able to successfully challenge established incumbent businesses. Specifically, as incumbents focus on improving their products and services for their most demanding (and usually most profitable) customers, they exceed the needs of some segments and ignore the needs of others. … When mainstream customers start adopting the entrants’ offerings in volume, disruption has occurred. (para. 7, parentheses are theirs) The term disruption has grown to mean two things as used by Christensen and Raynor (2003) and Christensen (2006). First, it can be used as shorthand for disruptive innovation. Second, when pre-fixed with “a”, for example, “a disruption”, it refers to a particular innovation. Background to the Study In my quest for a methodology to employ to try and solve the South African mobile money transfer non-adoption puzzle, I applied Carlile and Christensen’s (2005) cycle of theory-building approach. From pursuing this approach, I realised that Clark Gilbert’s theory of threat-opportunity framing, a variant of disruptive innovation, held the promise to unlock the non-adoption conundrum. I tested Gilbert’s (2002, 2005, 2006) model using case data from South Africa and found instances anomalous to Gilbert’s theory. Despite a careful study of Christensen’s papers, I failed to locate in his treatises a systematic procedure to generate these categories. A closer study showed that Christensen’s idea of categorisation had been directly inspired by Glaser and Strauss’s (1967) discourse (Christensen & Carlile, 2009; Christensen & Sundahl, 2001). This discovery instigated an in-depth study of Glaser’s works, thereby tracing the historical development of his ideas from 1964 to the present. Cycling back to Christensen’s cycle of theory-building, I critically evaluated the model through the lenses of CGT. With...