Staff experiences of caring for patients with extended-spectrum β-lactamase-producing bacteria: A qualitative study

BACKGROUND

Patients who become carriers of antibiotic-resistant bacteria are sometimes stigmatized by health professionals. Staff members' fears of becoming infected could affect their willingness to care for these patients.

METHODS

The purpose of this study was to increase the knowledge of what it means for staff in acute care settings and nursing homes to care for patients with extended-spectrum β-lactamase (ESBL)-producing bacteria. Assistant nurses, registered nurses, and physicians from acute care settings and nursing homes were interviewed. A modified version of Grounded Theory was used for the analysis.

RESULTS

The analysis resulted in the core category "to operate as an expert in a chaotic environment" in acute care settings. Despite a lack of resources, hospital staff try to provide the best possible care for patients with ESBL. The analysis of the interviews in the nursing homes resulted in the core category "the employee who, despite uncertainty, provides good care." Despite some fear, and a lack of knowledge, the study participants tried to provide the residents with good care.

CONCLUSION

Staff in acute care settings and nursing homes must have adequate knowledge and reasonable working conditions to be able to provide high-quality care for patients and residents who are ESBL carriers.

Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory

BACKGROUND

Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems.

OBJECTIVES

To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom.

DESIGN

Data of a longitudinal qualitative nature were collected and analysed using grounded theory.

SETTINGS

First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks.

PARTICIPANTS

A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement.

METHODS

Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained.

RESULTS

The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status.

CONCLUSIONS

Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

How parents process child health and nutrition information: A grounded theory model

The aim of the present study was to investigate low-income parents' experiences receiving, making meaning of, and applying sociocultural messages about childhood health and nutrition. Semi-structured interviews were conducted with parents from 16 low-income Early Head Start families. Verbatim interview transcripts, observations, field notes, documentary evidence, and follow-up participant checks were used during grounded theory analysis of the data. Data yielded a potential theoretical model of parental movement toward action involving (a) the culture and context influencing parents, (b) parents' sources of social and cultural messages, (c) parental values and engagement, (d) parental motivation for action, (e) intervening conditions impacting motivation and application, and (f) parent action taken on the individual and social levels. Parent characteristics greatly impacted the ways in which parents understood and applied health and nutrition information. Among other implications, it is recommended that educators and providers focus on a parent's beliefs, values, and cultural preferences regarding food and health behaviors as well as his/her personal/family definition of "health" when framing recommendations and developing interventions.

A constructivist theoretical proposition of cultural competence development in nursing

Cultural competence development in healthcare professions is considered an essential condition to promote quality and equity in healthcare. Even if cultural competence has been recognized as continuous, evolutionary, dynamic, and developmental by most researchers, current models of cultural competence fail to present developmental levels of this competence. These models have also been criticized for their essentialist perspective of culture and their limited application to competency-based approach programs. To our knowledge, there have been no published studies, from a constructivist perspective, of the processes involved in the development of cultural competence among nurses and undergraduate student nurses. The purpose of this study was to develop a theoretical proposition of cultural competence development in nursing from a constructivist perspective. We used a grounded theory design to study cultural competence development among nurses and student nurses in a healthcare center located in a culturally diverse urban area. Data collection involved participant observation and semi-structured interviews with 24 participants (13 nurses and 11 students) working in three community health settings. The core category, 'learning to bring the different realities together to provide effective care in a culturally diverse context', was constructed using inductive qualitative data analysis. This core category encompasses three dimensions of cultural competence: 'building a relationship with the other', 'working outside the usual practice framework', and 'reinventing practice in action.' The resulting model describes the concurrent evolution of these three dimensions at three different levels of cultural competence development. This study reveals that clinical experience and interactions between students or nurses and their environment both contribute significantly to cultural competence development. The resulting theoretical proposition of cultural competence development could be used not only to guide initial and continuing nursing education, but also to help redefine quality of care in a culturally diverse context.

Family Functioning as a Constituent Aspect of a Child's Chronic Illness

This study explored how family functioning may contribute to trace a child's illness trajectory. We conducted semi-structured interviews with 33 parents of children in care at a hospice in northern Italy. We also examined the medical records of the children, and interviewed the physician who cared for them. Data analysis was based on the grounded theory approach. Different illness progressions corresponded to the different ways with which families experienced the illness: possibility, focus on illness, denial, and anger. Clinical interventions should involve the whole family and take into account their role in the construction of illness trajectories.

A grounded theory study of 'turning into a strong nurse': Earthquake experiences and perspectives on disaster nursing education

BACKGROUND

While Asia has the dubious distinction of being the world's most natural disaster-prone area, disaster nursing education and training are sparse in many Asian countries, especially China where this study took place.

OBJECTIVE

To explore the earthquake disaster experiences of Chinese nurses and develop a substantive theory of earthquake disaster nursing that will help inform future development of disaster nursing education.

DESIGN

A qualitative study employing grounded theory, informed by symbolic interactionism.

PARTICIPANTS AND SETTING

Fifteen Chinese registered nurses from five hospitals in Jiangxi Province who undertook relief efforts after the 2008 Wenchuan Earthquake.

METHODS

Data were collected in 2012-2013 in digitally-recorded, semi-structured, in-depth interviews and reflective field notes, and analyzed using Glaser's grounded theory method.

RESULTS

Participants were unprepared educationally and psychologically for their disaster work. Supporting the emergent theory of "working in that terrible environment", was the core category of "turning into a strong nurse", a process of three stages: "going to the disaster"; "immersing in the disaster"; and "trying to let disaster experiences fade away". The participants found themselves thrust in "terrible" scenes of destruction, experienced personal dangers and ethical dilemmas, and tried the best they could to help survivors, communities and themselves, with limited resources and confronting professional work.

CONCLUSIONS

Our rich findings confirm those of other studies in China and elsewhere, that attention must be paid to disaster education and training for nurses, as well as the mental health of nurses who work in disaster areas. Emergent theory helps to inform nurse educators, researchers, leaders and policy makers in China, and elsewhere in developing strategies to better prepare nurses for future disasters, and assist communities to prepare for and recover after earthquake disasters.

Exploring patient perception of success and benefit in self-management of breast cancer-related arm lymphoedema

PURPOSE

The aim of this study was to identify factors influencing patient perception of success and benefit with self-management of breast cancer-related lymphoedema (BCRL) and explore how patients decide whether their swollen limb has improved or deteriorated.

METHODS

This qualitative study used a Grounded Theory approach. Twenty-one women in the BCRL self-management phase participated in one in-depth interview exploring their experience and perspective on self-managing their BCRL.

FINDINGS

Seven enablers and blocks to self-management were identified: routine, recognising benefit of self-management and consequences of non-treatment, owning treatment, knowledge and understanding, problem-solving, time required for treatment and aesthetics of hosiery. Women determined treatment outcome by monitoring size, appearance, texture and internal sensations within the affected arm.

CONCLUSIONS

Women who participated in this study showed varying degrees of acceptance and adjustment to life with lymphoedema. This appears to directly impact their ability to self-manage lymphoedema. Lymphoedema practitioners and oncology nurses have a valuable role providing knowledge and support to patients transitioning to independent self-care. A better understanding of factors facilitating patients to become experts in their condition may improve longer term outcomes and reduce cost pressures on lymphoedema services.

Using Grounded Theory Method to Capture and Analyze Health Care Experiences

OBJECTIVE

Grounded theory (GT) is an established qualitative research method, but few papers have encapsulated the benefits, limits, and basic tenets of doing GT research on user and provider experiences of health care services. GT can be used to guide the entire study method, or it can be applied at the data analysis stage only.

METHODS

We summarize key components of GT and common GT procedures used by qualitative researchers in health care research. We draw on our experience of conducting a GT study on amyotrophic lateral sclerosis patients' experiences of health care services.

FINDINGS

We discuss why some approaches in GT research may work better than others, particularly when the focus of study is hard-to-reach population groups. We highlight the flexibility of procedures in GT to build theory about how people engage with health care services.

CONCLUSION

GT enables researchers to capture and understand health care experiences. GT methods are particularly valuable when the topic of interest has not previously been studied. GT can be applied to bring structure and rigor to the analysis of qualitative data.

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories

PURPOSE

Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men's experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors.

METHODS

In-depth qualitative interviews were conducted with testicular cancer survivors over two time points approximately 6 months apart in the year following treatment completion. Interviews were analysed using a grounded theory approach.

RESULTS

The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men's ability to dismantle the present and future threats of cancer, involving the key transitions of gaining a sense of perspective and striving to get on with life and restore normality. These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented.

CONCLUSIONS

These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men's lives and have implications for the provision of support to testicular cancer survivors. Further investigation into the feasibility of one-on-one peer support interventions is warranted, as well as informal support that respects men's desire for independence.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness beliefs, encouraging emotional disclosure and facilitating peer mentoring.

Becoming the Parent of a Child With Life-Threatening Food Allergies

Food induced anaphylaxis (FIA) is a serious medical event and managing it can place tremendous mental, emotional and financial burdens on parents of children with FIA. Using grounded theory methods, the experiences of parents caring for a child with FIA and the adjustments and strategies used to effectively manage a child's diagnosis were examined. Findings revealed once a child is diagnosed with FIA, parental competency is often severely challenged, calling into question parents' ability to succeed in the parenting role. To regain parental competency, parents engage in a 3 phase process to learn how to parent a child with FIA.

Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession

BACKGROUND

The Canadian Nurses Association (CNA) estimates a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. Further compounding this crisis is the approximate 14-61% of new nursing graduates who will change nursing roles or exit the profession.

AIM

To explore the factors and basic psychosocial process involved in the decisions of newly graduated registered nurses in Western Canada who permanently exit the nursing profession within five years.

DESIGN

Data was collected through unstructured and semi-structured interviews using the Glaserian grounded theory method.

FINDINGS

Participants were found to be in a process of letting go of nursing that commenced as students and continued as they entered practice as registered nurses. Four major themes were identified. 1) Navigating constraints of the healthcare system and workplace: participants encountered difficulties adjusting to shiftwork and workload. 2) Negotiating social relationships, hierarchies, and troublesome behaviors; specifically hierarchal and horizontal violence. 3) Facing fears, traumas and challenges. 4) Weighing competing rewards and tensions which resulted in leaving the nursing profession.

CONCLUSION

Students and subsequently new nursing graduates require a variety of supports to establish a nursing identity and remain in the profession. These supports include a manageable workload; meaningful orientation; interprofessional teamwork; and engagement within transformational and authentic leadership constructs. New nurses require a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as constructive feedback, emotional support and debriefing to face workplace challenges.

A qualitative inquiry into the challenges and complexities of research supervision: viewpoints of postgraduate students and faculty members

INTRODUCTION

The supervision of academic theses at the Universities of Medical Sciences is one of the most important issues with several challenges. The aim of the present study is to discover the nature of problems and challenges of thesis supervision in Iranian universities of medical sciences.

METHODS

The study was conducted with a qualitative method using conventional content analysis approach. Nineteen faculty members, using purposive sampling, and 11 postgraduate medical sciences students (Ph.D students and residents) were selected on the basis of theoretical sampling. The data were gathered through semi-structured interviews and field observations in Shiraz and Isfahan universities of medical sciences from September 2012 to December 2014. The qualitative content analysis was used with a conventional approach to analyze the data.

RESULTS

While experiencing the nature of research supervision process, faculties and the students faced some complexities and challenges in the research supervision process. The obtained codes were categorized under 4 themes Based on the characteristics; included "contextual problem", "role ambiguity in thesis supervision", "poor reflection in supervision" and "ethical problems".

CONCLUSION

The result of this study revealed that there is a need for more attention to planning and defining the supervisory, and research supervision. Also, improvement of the quality of supervisor and students relationship must be considered behind the research context improvement in research supervisory area.

Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer

BACKGROUND

Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child.

OBJECTIVES

To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer.

DESIGN

Qualitative interview design.

SETTING

A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies.

PARTICIPANTS

Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer).

METHODS

Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework.

RESULTS

Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts.

CONCLUSIONS

Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.

Vaccination learning experiences of nursing students: a grounded theory study

PURPOSE

This study aimed to explore the experiences of nursing students being trained to perform vaccinations.

METHODS

The grounded theory method was applied to gather information through semi-structured interviews. The participants included 14 undergraduate nursing students in their fifth and eighth semesters of study in a nursing school in Iran. The information was analyzed according to Strauss and Corbin's method of grounded theory.

RESULTS

A core category of experiential learning was identified, and the following eight subcategories were extracted: students' enthusiasm, vaccination sensitivity, stress, proper educational environment, absence of prerequisites, students' responsibility for learning, providing services, and learning outcomes.

CONCLUSION

The vaccination training of nursing students was found to be in an acceptable state. However, some barriers to effective learning were identified. As such, the results of this study may provide empirical support for attempts to reform vaccination education by removing these barriers.

Understanding why people do or do not engage in activities following total joint replacement: a longitudinal qualitative study

OBJECTIVE

Numerous studies report large and significant improvements in basic mobility and activities of daily living following total hip or knee replacement (TJR). Nevertheless, quantitative research has shown minimal increase in participation in activities that benefit overall health. This study explored why people do or do not engage in activities following hip or knee TJR.

METHOD

This was a longitudinal qualitative study. Sampling was guided by constructivist grounded theory and data collected using open-ended, semi-structured interviews. Participants were recruited using maximum variation sampling based on age, sex and joint replaced (hip or knee). Data were analysed using a constant comparative approach and coded for thematic patterns and relationships from which overarching themes were constructed.

RESULTS

Twenty-nine patients participated in interviews prior to, and 8 and 18 months post following TJR. A high degree of variability with regard to participants' return to activities was found and five emergent themes were identified that accounted for this variability. These themes highlight the importance of issues beyond medical factors alone, such as socio-cultural factors that partially determine participants' participation in activity following TJR.

CONCLUSION

Findings suggest that multi-faceted experiences impact participation in activity following TJR. These experiences include changes in identity and lifestyle that preclude a 'return to normal'. There is an urgent need for supports to increase people's activity post-TJR in order to facilitate enhancement of post-surgery levels of engagement. Approaches that take into consideration more personalized interventions may be critical to promoting healthy aging in people with TJR.

Grounded theory

Grounded theory is a popular research approach in health care and the social sciences. This article provides a description of grounded theory methodology and its key components, using examples from published studies to demonstrate practical application. It aims to demystify grounded theory for novice nurse researchers, by explaining what it is, when to use it, why they would want to use it and how to use it. It should enable nurse researchers to decide if grounded theory is an appropriate approach for their research, and to determine the quality of any grounded theory research they read.

Genetically at-risk status and individual agency. A qualitative study on asymptomatic women living with genetic risk of breast/ovarian cancer

For the last 20 years, genetic tests have allowed unaffected women to determine whether they are predisposed to developing breast/ovarian cancer due to BRCA1/2 gene mutations. In the event of adverse results, women receive a specific label associated with a set of medical recommendations: the genetically at-risk status. This qualitative study adopted a life-course perspective to understand the impact of this status on women's agency. Following a grounded theory design, retrospective biographical interviews were conducted in Switzerland between 2011 and 2013 with 32 unaffected women at risk of developing genetic breast/ovarian cancer and aware of their predisposition for at least three years. The results show that the genetically at-risk status conveys an invitation to transform health into a project, i.e., into a set of planned activities realized in collaboration with the medical system in order to reduce the risk of developing cancer. This health project shapes women's agency in three ways: it enhances, constrains and questions it, thus creating a sense of disorientation about what is considered rational and appropriate in terms of genetic risk management. Based on these findings, the paper concludes by stressing the paradoxes of the genetically at-risk status and the limits of the medical system in managing women designated with it. The paper also suggests that because of the disorientation intrinsic to their situation, genetically at-risk women have to reflexively construct their own health project from a range of available options in ways that are coherent and viable for themselves and their significant others. This process of reflexive construction may be called legitimation.

An explanatory framework of teachers' perceptions of a positive mealtime environment in a preschool setting

Attending a preschool center may help preschoolers with growth and development that encourage a healthy lifestyle, including sound eating behaviors. Providing a positive mealtime environment (PME) may be one of the keys to fostering a child's healthy eating habits in the classroom. However, a specific definition of a PME, the components of a PME, or directions on how to create one have not been established. The purpose of this study, therefore, was to explore Head Start teachers' perceptions related to a PME and create a conceptual framework representing these perceptions. To achieve this purpose, researchers conducted 65 in-depth phone interviews with Head Start teachers around the US. Applying principles of grounded theory, researchers developed a conceptual framework depicting teachers' perceptions of PME, consisting of five key components: (1) the people (i.e., teachers, kitchen staff, parent volunteers, and children), (2) positive emotional tone (e.g., relaxed and happy), (3) rules, expectations, and routines (e.g., family-style mealtime), (4) operations of a PME (i.e., eating, socialization, and learning), and (5) both short- and long-term outcomes of a PME. With this PME framework, researchers may be able to enhance the effectiveness of nutrition interventions related to a PME, focusing on the factors in the conceptual framework as well as barriers associated with achieving these factors.

Perceptions of injury prevention and familial adjustment among mothers of teen parents

INTRODUCTION

Injury is a leading cause of death for infants and children. Teen mothering has been shown to put children at increased risk of injury. The mothers of teen parents often play a predominant role in the lives and caregiving of the children born to their children.

METHOD

This article presents the findings of three focus groups conducted with 21 mothers of teen parents. Grounded theory methodology was used to explore family dynamics and how they relate to injury prevention beliefs and practices regarding infants and children.

RESULTS

Our findings revealed the difficulty mothers of teen parents and the teens themselves have in adjusting to the knowledge of the pregnancy. Unique barriers to injury prevention were also uncovered.

CONCLUSIONS

Our findings provide evidence for the need of a multigenerational approach to programs aimed at improving the safety and well-being of children in this context.

Women chairs in academic medicine: engendering strategic intuition

PURPOSE

Because stereotypically masculine behaviors are required for effective leadership, examining female chairs' leadership in academic medicine can provide insight into the complex ways in which gender impacts on their leadership practices. The paper aims to discuss this issue.

DESIGN/METHODOLOGY/APPROACH

The author interviewed three female clinical chairs and compared the findings to interviews with 28 of their faculty. Grounded theory analysis of the subsequent text gathered comprehensive, systematic, and in-depth information about this case of interest at a US top-tier academic medical center.

FINDINGS

Four of five themes from the faculty were consistent with the chair's narrative with modifications: Prior Environment (Motivated by Excellence), Tough, Direct, Transparent (Developing Trust), Communal Actions (Creating Diversity of Opinion), and Building Power through Consensus (an "Artful Exercise") with an additional theme, the Significance (and Insignificance) of a Female Chair. While faculty members were acutely aware of the chair's gender, the chairs paradoxically vacillated between gender being a "non-issue" and noting that male chairs "don't do laundry." All three female chairs in this study independently and explicitly stated that gender was not a barrier, yet intuitively used successful strategies derived from the research literature.

ORIGINALITY/VALUE

This study suggests that while their gender was highlighted by faculty, these women dismissed gender as a "non-issue." The duality of gender for these three female leaders was both minimized and subtly affirmed.

Facilitating classroom based interprofessional learning: a grounded theory study of university educators' perceptions of their role adequacy as facilitators

The provision of inter professional learning (IPL) within undergraduate programmes is now well established within many Higher Education Institutions (HEIs). IPL aims to better equip nurses and other health professionals with effective collaborative working skills and knowledge to improve the quality of patient care. Although there is still ambiguity in relation to the optimum timing and method for delivering IPL, effective facilitation is seen as essential. This paper reports on a grounded theory study of university educators' perceptions of the knowledge and skills needed for their role adequacy as IPL facilitators. Data was collected using semi structured interviews with nine participants who were theoretically sampled from a range of professional backgrounds, with varied experiences of education and involvement in facilitating IPL. Constant comparative analysis was used to generate four data categories: creating and sustaining an IPL group culture through transformational IPL leadership (core category), readiness for IPL facilitation, drawing on past interprofessional learning and working experiences and role modelling an interprofessional approach. The grounded theory generated from this study, although propositional, suggests that role adequacy for IPL facilitation is dependent on facilitator engagement in a process of 'transformational interprofessional learning leadership' to create and sustain a group culture.

Australian perioperative nurses' experiences of assisting in multi-organ procurement surgery: a grounded theory study

INTRODUCTION/BACKGROUND

Multi-organ procurement surgical procedures through the generosity of deceased organ donors, have made an enormous impact on extending the lives of recipients. There is a dearth of in-depth knowledge relating to the experiences of perioperative nurses working closely with organ donors undergoing multi-organ procurement surgical procedures.

AIM

The aim of this study was to address this gap by describing the perioperative nurses experiences of participating in multi-organ procurement surgical procedures and interpreting these findings as a substantive theory.

DESIGN

This qualitative study used grounded theory methodology to generate a substantive theory of the experiences of perioperative nurses participating in multi-organ procurement surgery.

SETTING

Recruitment of participants took place after the study was advertised via a professional newsletter and journal. The study was conducted with participants from metropolitan, rural and regional areas of two Australian states; New South Wales and Western Australia.

PARTICIPANTS

Thirty five perioperative nurse participants with three to 39 years of professional nursing experience informed the study.

METHODS

Semi structured in-depth interviews were undertaken from July 2009 to April 2010 with a mean interview time of 60 min. Interview data was transcribed verbatim and analysed using the constant comparative method.

RESULTS

The study results draw attention to the complexities that exist for perioperative nurses when participating in multi-organ procurement surgical procedures reporting a basic social psychological problem articulated as hiding behind a mask and how they resolved this problem by the basic social psychological process of finding meaning.

CONCLUSION

This study provides a greater understanding of how these surgical procedures impact on perioperative nurses by providing a substantive theory of this experience. The findings have the potential to guide further research into this challenging area of nursing practice with implications for clinical initiatives, management practices and education.

Midwifery students learning experiences in labor wards: a grounded theory

BACKGROUND

The labor ward is an important and challenging learning area for midwifery students. It is there the students learn in authentic complex situations, in intimate situations, with potential risk for the life and health of mothers and their babies.

OBJECTIVE

The aim of this study was to explore the main concern expressed by midwifery students in labor wards and how they handled this concern.

DESIGN

A longitudinal study based on grounded theory methodology was used. The participants were 10 postgraduate midwifery students, from a University College in Norway. Data were gathered and analyzed throughout the 2-year postgraduate program, in the students first, third and fourth semesters. Every student was interviewed three times in a total of 15 single and three focus-group sessions.

FINDINGS

The grounded theory of "building relationships" explains how students dealt with their main concern: "how to gain access to learning experiences". This theory consisted of three strategies; a) controlling vulnerability, b) cultivating trust and c) obtaining acceptance.

CONCLUSION

Clarifying discussions involving midwives and students may facilitate the process of building relationships and contribute to confident learning. Students appreciate it when the midwives initiate discussions about acute situations and state that a novice may perceive labor and childbirth as more frightening than an experienced midwife would.

Implementation of healthy lifestyle promotion in primary care: patients as coproducers

OBJECTIVES

To explore and theorize how patients perceive, interpret, and reactin healthy lifestyle promotion situations in primary care and to investigate patients' role in implementation of lifestyle promotion illustrated by typologies.

METHODS

Grounded theory was used to assess qualitative interview data from 22 patients with varied experience of healthy lifestyle promotion. Data were analyzed by constant comparative analysis.

RESULTS

A substantive theory of being healthy emerged from the data. The theory highlights the processes that are important for implementation before, during, and after lifestyle promotion. Three interconnected categories emerged from the data: conditions for being healthy, managing being healthy, and interactions about being healthy; these formed the core category: being healthy. A typology proposed four patient trajectories on being healthy: resigned, receivers, coworkers, and leaders.

CONCLUSION

Patients coproduced the implementation of lifestyle promotion through the degree of transparency, which was a result of patients' expectations and situation appraisals.

PRACTICE IMPLICATIONS

Different approaches are needed during lifestyle promotion depending on a variety of patient-related factors. The typology could guide practitioners in their lifestyle promotion practice.

Reflecting on the challenges of choosing and using a grounded theory approach

AIM

To explore three different approaches to grounded theory and consider some of the possible philosophical assumptions underpinning them.

BACKGROUND

Grounded theory is a comprehensive yet complex methodology that offers a procedural structure that guides the researcher. However, divergent approaches to grounded theory present dilemmas for novice researchers seeking to choose a suitable research method.

REVIEW METHODS

This is a methodology paper.

DATA SOURCES

This is a reflexive paper that explores some of the challenges experienced by a PhD student when choosing and operationalising a grounded theory approach.

DISCUSSION

Before embarking on a study, novice grounded theory researchers should examine their research beliefs to assist them in selecting the most suitable approach. This requires an insight into the approaches' philosophical assumptions, such as those pertaining to ontology and epistemology. Researchers need to be clear about the philosophical assumptions underpinning their studies and the effects that different approaches will have on the research results.

CONCLUSION

This paper presents a personal account of the journey of a novice grounded theory researcher who chose a grounded theory approach and worked within its theoretical parameters.

IMPLICATIONS FOR RESEARCH/PRACTICE

Novice grounded theory researchers need to understand the different philosophical assumptions that influence the various grounded theory approaches, before choosing one particular approach.