Issue 1, June 2021
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....Building Up
Elizabeth Kellogg, Saybrook University, USA Kara Vander Linden, Saybrook University, USA Abstract The theory of building up, developed using classic grounded theory (CGT), explains how the fit between an individual and a transformational opportunity impacts the extent to which an individual is empowered by that experience. Classic grounded theory identifies and explains human behavior patterns using an inductive, iterative process of data collection and analysis. Theoretical sampling guided data collection and constant comparative analysis of data, which yielded building up as the core pattern of behavior in negotiating challenges through transformative opportunities. Building up summarizes the potential outcomes of participation in an opportunity based on the fit of the interaction of variables in the individual and in the opportunity. An optimal fit is ideal; however, most relevant for practical applications are the variables that most frequently contribute to a good enough fit, which are deconstructing limiting beliefs, feeling supported within the experience, a sense of agency, and the timing of the opportunity. Keywords: classic grounded theory, transformation, empowerment, beliefs, agency, skills Introduction This study began as an inquiry into the sociological and psychological mechanisms contributing to the healing, empowering, and sometimes dramatically transformative effects of adaptive surfing. The benefits of participation in adaptive sport programs have been established (Arslan, 2013; Lundberg et al., 2011; Lundberg et al., 2011; Yazicioglu et al., 2012). However, there is not a substantial amount of research about adaptive surfing that identifies the specific mechanisms of these positive outcomes that might inform program development in order to maximize limited resources. Classic grounded theory (CGT) methodology is well suited for a phenomenon that is not well understood, as the theory emerges from lived experiences in the substantive area and is practically applicable (Glaser & Strauss, 1967; Glaser, 1978, 1998). As happens with CGT, the substantive area expanded as data was collected, analyzed, and abstracted, eventually encompassing transformative opportunities more generally, such as rehabilitation programs and higher education. What emerged was a mid-range theory describing the impact of the fit between the individual and the opportunity on the extent to which an individual is built up within an opportunity. Building up is empowering individuals by deconstructing limiting beliefs and developing internal and external resources within a transformative opportunity. The fit between an individual and an opportunity influences the extent to which an individual is likely to be built up. An optimal fit is ideal, but a good enough fit may be sufficient for building up. The key components of a good enough fit are deconstructing limiting beliefs and building resourceful beliefs and skills, being cared for, agency, and the timing of the opportunity. As one study participant, a motivational coach by trade, stated, “There are key components, not all of them need to be in place.” For some in the study it was “someone who believed in me,” for another it was “being able to accomplish something much bigger…as far as my physical limits, I amazed myself.” The key components of a good enough fit may be the most relevant for practical application of the theory. Methodology This classic grounded theory study was conducted in an attempt to explain the activity within a system using CGT’s iterative, systematic, six-step process (Glaser, 1978, 1998; Glaser & Strauss, 1967). These steps, often simultaneous, are preparation, data collection, analysis, memoing, sorting, and writing (Simmons, n.d.). Per CGT protocol, preparation was minimal in order not to impose preconceptions about “the patterns of behavior which are relevant” (Glaser, 1998, p. 117). The...Potentializing Wellness to Overcome Generational Trauma
Cynthia D. Stirbys, the University of Windsor Abstract The Indian residential school (IRS) system is part of Canada’s colonial history: Indigenous children who attended IRS suffered immensely at the hands of the school administrators, staff, and students. How Indigenous females cope with the intergenerational transmission of trauma was explored. Indigenous women in this classic grounded theory study aimed to resolve their main concern of kakwatakih-nipowatisiw, a Cree term used to identify learned colonial (sick) behaviours that weaken familial ties. Analysis resulted in a substantive theory of potentializing wellness, which explains the varied behaviours of how Indigenous women cope with the legacy of IRS. Discoveries suggest that effective strategies to deal with trauma can emerge when (w)holistic health is followed by, or accompanies reclaiming cultural norms grounded in community and spiritual life. With the generalizability of this substantive theory, this paper concludes with implications for future research. Keywords: Indian residential schools, Intergenerational trauma, Indigenous women, classic grounded theory, and potentializing. Introduction In Canada, when settlers first arrived, it was part of the colonial governments agenda to clear the land of all Indigenous Peoples. Part of this agenda included development of different assimilation policies aimed to eliminate Indigenous Peoples’ rights and Treaties, eliminate Indigenous governments, and cause Indigenous peoples “to cease to exist as distinct legal, social, cultural, religious, and racial entities in Canada” (TRC Summary of Final Report, 2015, p. 1). Given these on-going attacks, Indigenous Peoples have been dealing with compounding trauma at the hands of church and state for well over 150 years. When assimilation did not happen fast enough, Indian residential schools were mandated. Residential schools were part of Canada’s assimilation policy intended to civilize and convert Indigenous children towards Eurocentric ideals (Milloy, 2006). As a result, the residential schools’ grim realities and conditions of constant abuse, malnutrition, and neglect, coupled with the children’s need to survive had many children conforming to the “might makes right” (Stirbys, 2016, p. 127) mentality that subconsciously was carried into their family and community life. Underlying this study is the assumption that Indigenous peoples have an on-going unease regarding the intergenerational transmission of trauma. My interest to support Indigenous Peoples comes from my personal and professional life. I am a fourth generation descendant of three generations of Indian residential school survivors and I worked in Indigenous health where I regularly heard the (literal) cries of Indigenous Peoples wanting to address trauma from the residential school experience. Prior to starting my PhD, my mother and I attended a residential school survivors gathering in August, 2009 but we were not wholly prepared for the ways in which trauma could emerge as many felt a level of pain manifesting itself physically, emotionally, and/or spiritually. That experience never left me. During the years leading up to my thesis proposal I began to learn more about what a grounded theory was; I also began questioning what it is that Indigenous women do to overcome the traumatic legacy of Indian residential schools. More specifically, I wanted to uncover Indigenous women’s main concern regarding their experiences at IRS as a direct survivor or as a descendant of a survivor. A basic social process (BSP) conceptualized as potentializing wellness was discovered and explains the changing and evolving behaviours of what Indigenous women do to cope with intergenerational trauma. That is, Indigenous women focus on building personal competencies, moral compassing, and fostering the virtues. The three separate but interrelated phases of this social process have sub-processes and a typology that...