Using Grounded Theory to Explain "Different and Better" Nursing Practice

Purpose: People sharing stories of their encounters with nurses in critical care environments revealed that a few nurses were perceived to have distinctive qualities that influenced a care encounter in a positive way. The care encounters with these nurses were spoken of as being somehow ‘different and better’ with these particular nurses described as being able to connect with people in a manner that transcended the combination of knowledge and competence alone. My intention in this study was to explore the nature of ‘different and better’ nursing practice with people who had engaged with critical care nurses in order to articulate an explanation of how people come to recognise this ‘different and better’ nursing practice.

Methods: Constructivist Grounded Theory methodology was used as the most appropriate way of articulating an explanation of ‘different and better’ nursing practice. Purposive and theoretical sampling processes resulted in ten participants drawn from patients’ significant others, nurses and medical colleagues in critical care environments. Data generation began with participants contributing through in-depth unstructured individual interviews and creating naïve sketches. A focused literature review conducted once the categories had formed from the participants’ contributions provided a mesh through which the emergent grounded theory became assimilated and situated. The data set was analysed using method processes of concurrent data collection and analysis, with coding through constant comparative analysis. Memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation were applied to enable the core category to emerge from but remain grounded in the participants’ data.

Results: An inductively derived explanation was formed and shaped to produce a substantive grounded theory articulating how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses. The core concern ‘being at ease’ develops through four categories, namely ‘knowing self’, ‘skilled being’, ‘connecting with intention’ and ‘anchoring’. 

Conclusion: ‘Being at ease’ speaks to a personal feeling of composure and strength that a person develops as a consequence of a trusting partnership created with a nurse; within this space a person feels able to retain their own identity, assert their power and feel in control of their life despite the chaotic or unbearable situation playing out around them. Being at Ease adds to our practice narrative through this explanation of how tacit qualities of ‘different and better’ nursing are located as discrete elements within the complex nature of specialist clinical practice.