Nurses conduct their research within the context of their distinct professional knowledge especially within a specific discipline of practice such as: administration, nursing education, informatics, surgical services, critical care, disease category, hospital or clinic based. Nurses also have a commitment to use that knowledge towards improving or supporting the health of individuals or a population. The research question should be explicitly informed by nursing’s normative direction which is to envision action and an interpretive explanation/reflection. Nursing’s pragmatic aims require a different qualitative research approach than those developed for the purposes of more theoretically grounded disciplines (Thorne, Stephens, & Truant, 2016). Therefore, as a student working towards a PhD in nursing I set out to learn how to conduct nursing qualitative research utilizing the grounded theory method.
Methods:
Grounded theory method is the study of how people resolve a problem (Charmaz, 2014). Therefore, it becomes imperative that the study states a research question to be answered. The study examined the question: How do adult children (who are identified surrogate decision makers, SDM) engage in care and decision making with and for a parent with advanced cancer? Within my own coding of five interviews related to the research question the process was to read through the interview, reflect on the data, apply labels to what was directly happening either in the line or section. It was very rough because I was being simplistic and descriptive of what was going on. Then I started understanding more about the use of gerunds for coding the action and my codes became more conceptual. I was coding and comparing codes within the other interviews and these more focused codes arose which seemed to tie together what was happening in the different interviews. Each of the SDM’s engaged in care by respecting the patient’s wishes or choices. Respecting choice became a focused code
To assist with the development of my inquiry I added the practice of memoing. Memoing is a core procedural and analytic strategy within grounded theory method which can provide the impetus to move the research from data gathering to conceptualization and development of a model (Bryant, 2017). Memos are easily accessible and written or recorded by the researcher as reflections, reasons for decisions made, and the thought processes that have guided the analysis (Charmaz, 2014). As a novice conducting qualitative research the discipline to stop the data review write ideas/thoughts or reflections on data and title, link and date the memo proved challenging.
Constant comparison is an important analytic method of grounded theory method research which produces successive abstract concepts through the inductive process of comparing data with data to identify similarities and differences within the same and/or different interviews. Then the comparison moves to comparing data with category, category with category, and category with concept. This is done with the goal of refining emerging concepts and to help bring forward emergent conceptual data (Giles, de Lacey & Muir-Cochrane, 2016). Even though the issues within the interview data are different through constant comparison of data what emerges is that the coding for these patient decisions is related on a conceptual level in that there is a commitment to respecting patient decisions.
Results:
By following the grounded theory method this novice qualitative researcher was able to identify three major categories and develop a model of how adult children engage in the care and decision making for a parent with advanced cancer. Through study and application of the grounded theory process this researcher achieved the following advanced learning outcomes based on Bloom’s model of cognitive domain (Falk, 1980) :
- application of the appropriate abstract concepts within the framework of a qualitative research process to assist in the discovery of important concerns, problems and solutions encountered by adult children caring and making decisions for parents with advanced cancer.
- analysis of entire interviews with identification and ordering of events and relationships within the very complex process of engaging in care and decision making with and for a parent with advanced cancer.
- synthesis to derive original interpretations from the data within these interviews
Conclusion:
Exploring this research question contributed to the development of my nursing research career by leading me to make more confident judgements on the accuracy, consistency and logic of my coding, comparisons and analyses following the grounded theory process. In addition, the concepts identified support nursing's commitment to use their distinct professional knowledge toward the well-being of patients with advanced cancer and their adult children who are surrogate decision makers.