GROUNDED THEORY - CONCEPTUAL AND OPERATI ONAL ASPECTS: A METHOD POSSI BLE
TO BE APPLI ED I N NURSI NG RESEARCH
Claudia de Car v alho Dant as1 Josét e Luzia Leit e2 Suzinar a Beat r iz Soar es de Lim a3 Mar luci Andr ade Conceição St ipp4
Dant as CC, Leit e JL, Lim a SBS, St ipp MAC. Gr ounded t heor y - concept ual and oper at ional aspect s: a m et hod possible t o be applied in nur sing r esear ch Rev Lat ino- am Enfer m agem 2009 j ulho- agost o; 17( 4) : 573- 9.
This is a descr ipt ive- r eflect ive st udy based on lit er at ur e and qualit at ive design. I t aim ed t o discuss concept ual aspect s of Gr ounded Theor y ( GT) and t o pr esent t he applicabilit y of t his m et hodology w it hin t he nur sing field. GT consist s of an int er pr et at iv e and sy st em at ic fr am ew or k t hat ex t r act s significant aspect s fr om ex per iences of social act or s and w hich enables r esear cher s t o const r uct t heor et ical fr am ew or ks and int ensify ex pansion of know ledge. I t has been show n t o be an im por t ant and consist ent fr am ew or k for obj ect s of st udy t hat inv olv e h u m an in t er act ion s an d w h ich in clu de ph en om en a con cer n in g pr of ession al pr act ice an d w h ich h av e n ot y et been pr oper ly ex am ined and under st ood accor ding t o t he r igor r equir ed for t he const r uct ion of k now ledge in qu alit at iv e design s.
DESCRI PTORS: nur sing; r esear ch nur sing; nur sing m et hodology r esear ch
TEORÍ A FUNDAMENTADA EN LOS DATOS - ASPECTOS CONCEPTUALES Y
OPERACI ONALES: METODOLOGÍ A POSI BLE DE SER APLI CADA EN LA I NVESTI GACI ÓN EN
ENFERMERÍ A
Se t r at a de est u dio de n at u r aleza descr ipt iv a r ef lex iv a, apoy ado en la lit er at u r a y de abor daj e cu alit at iv a. Tien e p or ob j et iv os d iscu t ir asp ect os con cep t u ales d e la t eor ía f u n d am en t ad a en los d at os y p r esen t ar la aplicabilidad de esa m et odología en el área de enferm ería. Consist e en m arco t eórico int erpret at ivo y sist em át ico q u e ex t r ae d e las ex p er ien cias ex p er im en t ad as p or act or es sociales asp ect os sig n if icat iv os q u e p osib ilit an const ruir bases t eóricas, pot encializando la expansión del conocim ient o. Se m uest ra una im port ant e y consist ent e m et odología par a obj et os de est udio que env uelv en int er acciones hum anas y que confor m an fenóm enos de la pr áct ica de la pr ofesión t odavía no desvelados y debidam ent e com pr endidos, m ediant e el r igor r equer ido par a la const r ucción de conocim ient os de abor daj e cualit at iv a.
DESCRI PTORES: en fer m er ía; in v est igación en en fer m er ía; in v est igación m et odológica en en fer m er ía
TEORI A FUNDAMENTADA NOS DADOS - ASPECTOS CONCEI TUAI S E OPERACI ONAI S:
METODOLOGI A POSSÍ VEL DE SER APLI CADA NA PESQUI SA EM ENFERMAGEM
Tr at a- se de est u do de n at u r eza descr it iv o- r eflex iv a, apoiado n a lit er at u r a e de abor dagem qu alit at iv a. Tem por obj et iv os discu t ir aspect os con ceit u ais da t eor ia fu n dam en t ada n os dados e apr esen t ar a aplicabilidade dessa m et odologia n a ár ea da en fer m agem . Con sist e em r efer en cial in t er pr et at iv o e sist em át ico qu e ex t r ai d as ex p er iên cias v iv en ciad as p or at or es sociais asp ect os sig n if icat iv os q u e p ossib ilit am con st r u ir alicer ces t eór icos, pot encializando a ex pansão do conhecim ent o. Most r a- se im por t ant e e consist ent e m et odologia par a obj et os de est u do qu e en v olv em in t er ações h u m an as e qu e con f or m am f en ôm en os da pr át ica da pr of issão ai n d a n ão d esv el ad o s e d ev i d am en t e co m p r een d i d o s, m ed i an t e o r i g o r r eq u er i d o p ar a a co n st r u ção d e con h ecim en t os de abor dagem qu alit at iv a.
DESCRI TORES: en fer m agem ; pesqu isa em en fer m agem ; pesqu isa m et odológica em en fer m agem
1RN, Doct oral st udent , Escola de Enferm agem Anna Nery, da Universidade Federal do Rio de Janeiro, Brazil, e- m ail: dant asclaudia@hot m ail.com ; 2RN,
Ph.D.,Em erit us Full Professor, Universidade Federal do Est ado do Rio de Janeiro, UNI RI O, Brazil, e- m ail: j oluzia@gm ail.com ; 3M.Sc. in Nursing, RN, Hospit al Universit ário de Sant a Maria, Universidade Federal de Sant a Maria, Brazil, Doct oral st udent , Escola de Enferm agem Anna Nery, da Universidade Federal do Rio de Janeiro, Brazil, e- m ail: suzibslim a@yahoo.com .br; 4RN, Adj unct Professor, Escola de Enferm agem Anna Nery, da Universidade Federal do Rio de Janeiro, Brazil, e- m ail: m arlust ipp@uol.com .br.
I NTRODUCTI ON
T
h i s st u d y i s i n cl u d e d i n t h e Nú cl e o d e Pesquisa em Gest ão em Saúde e Exercício Profissionald a En f er m ag em ( GESPEn ) [ Cen t er f or Resear ch in Man agem en t in Healt h an d Pr of ession al Ex er cise in Nu r sin g] of t h e Depar t m en t of Met h odology an d in t he Gr oup of Gr ounded Theor y St udies at t he Anna Ner y Sch ool of Nu r sin g of t h e Feder al Un iv er sit y of Rio de Janeir o.
Gr ou n d ed Th eor y ( GT) aim s t o u n d er st an d r ealit y f r om t h e con cept ion or m ean in g people h old abou t a cer t ain con t ex t or obj ect , so as t o gen er at e k n o w l ed g e, i m p r o v e u n d er st an d i n g an d p r o v i d e a m e a n i n g f u l g u i d e f o r a c t i o n( 1 ). I t c o n s i s t s o f a m e t h o d o l o g y o f q u a l i t a t i v e i n v e s t i g a t i o n t h a t e x t r a c t s m e a n i n g f u l a s p e ct s f r o m so c i a l a c t o r s ’ e x p e r i e n c e s , w h i c h p e r m i t s r e s e a r c h e r s t o l i n k t h eor et ical con st r u ct s an d in t en sif y t h e ex p an sion of k n ow led g e in n u r sin g an d ot h er f ield s, su ch as p sy ch o l o g y a n d so ci o l o g y.
Th i s s t u d y a i m e d t o d i s c u s s c o n c e p t u a l a sp e ct s o f t h e g r o u n d e d t h e o r y a n d p r e se n t i t s applicabilit y w it hin t he field of nur sing. This st udy is j u st i f i e d b y t h e o p p o r t u n i t y t o d i sse m i n a t e t h i s m et hodology, w hich can be used in nur sing r esear ch b ecau se it en ab les t h e con st r u ct ion of con cep t u al b a s e s t h a t a r e i m p o r t a n t f o r d e s i g n i n g a n d consolidat ing t he t heoret ical corpus of t his profession concer ning differ ent spher es of act iv it y.
UNDERSTANDI NG THE CONCEPTUAL BASES
OF GT AND I TS APPLI CATI ON
A i m i n g t o r e f l e c t o n a n d d i s c u s s t h e c o n c e p t u a l a n d o p e r a t i o n a l a s p e c t s o f n u r s i n g r esear ch , w e car r ied ou t a t h eor et ical r ev iew an d analyzed som e nursing st udies t hat used t he m et hod. GT consist s of “ a qualit at iv e r esear ch appr oach t hat aim s t o discov er t heor ies, concept s and hy pot heses, b a s e d o n c o l l e c t e d d a t a , r a t h e r t h a n u s i n g p r e d e t e r m i n e d o n e s”( 2 ). I t i s r o o t e d i n Sy m b o l i c I nt er act ionism ( SI ) and under st ands r ealit y as being based on k now ledge acquir ed about t he per cept ions or m ean in g s p eop le h old ab ou t a g iv en con t ex t or obj ect . St udies( 3) r ev eal t hat “ GT aim s t o discov er a concept ual m odel t hat explains t he phenom enon under st udy and which will enable t he researcher t o develop and r elat e concept s w it h one anot her ”.
Ot her aut hors( 4) explain t hat GT is one of t he v ar ian t s in side SI , sh ar in g space w it h et h n ogr aph ic st u d ies, w h ose em p h asis is on “ u n d er st an d in g t h e phenom enon as it em erges from dat a and not basing it on t he r esear cher ’s concept s and t heor ies”( 5).
Th is fr am ew or k w as dev eloped in t h e ear ly 1 9 6 0 s b y Bar n ey Glaser an d An selm St r au ss, t w o sociologist s w ho w er e fam iliar w it h t he Univ er sit y of Chicago research t radit ion and w ere influenced by SI and pragm at ism . GT em erged from t his. GT’s t echnical sy st em at izat ion an d an aly sis pr ocedu r es en able t h e r esear cher t o dev elop sociological t heor ies about t he w or ld of indiv iduals’ liv es because it per m it s one t o r each significat ion, com pat ibilit y bet w een t heor y and ob ser v at ion , cap acit y t o g en er alize an d r ep r od u ce, pr ecision, r igor and v er ificat ion( 6).
Com plem ent ing such concept ions, GT consist s of a m et hod t o const r uct t heor y based on collect ed dat a on a giv en r ealit y in an induct iv e or deduct iv e m anner, w hich, t hr ough or ganizat ion int o concept ual c a t e g o r i e s , e n a b l e s e x p l a n a t i o n o f t h e s t u d i e d phenom enon( 7). As a r esult of t he applicat ion of t his m et hod, one can also est ablish t heor et ical m odels or r ef lect ion s.
For all t h ose w h o d esir e t o w or k w it h t h is m et h odological r efer en ce, w e r ecom m en d becom in g inv olved w it h t he obj ect of st udy, m ast er ing t he GT pr ecept s, hav ing t im e av ailable, cr eat iv it y, deduct ive and induct iv e capabilit ies and t heor et ical sensit iv it y. The lat t er is specific t o GT, w hich “ is r elat ed t o t he qualit y of t he r esear cher t o per ceiv e and under st and t he m eaning of dat a and t he abilit y t o discern bet ween what is and what is not relevant t o t he st udy”( 8).
I t is im port ant t o highlight t hat GT is not based o n e x i st i n g t h e o r i e s; i t i s r a t h e r b a se d o n d a t a con t ain ed in social scen ar ios an d h as n o pr et en t ion t o r efut e or pr ov e it s r esult s but t o add ot her s/ new per spect iv es so t o clar ify t he st udied obj ect( 9).
S o m e c o n s i d e r a t i o n s , c o n c e r n i n g t h e s p e c i f i c i t i e s o f t h i s a p p r o a c h i n r e l a t i o n t o t h e r em ai n i n g q u al i t at i v e d esi g n s ar e essen t i al . Su ch con sid er at ion s ar e su ccin ct ly( 1 , 3 - 4 , 6 - 7 , 1 0 - 1 1 ) p r esen t ed b elow :
- Th e lit er at u r e r ev iew is n ot t h e in it ial st ep in t h e r esear ch p r ocess. Dat a col l ect i on an d i t s an al y si s g u i d e t h e r e s e a r c h e r i n t h e s e a r c h f o r f u r t h e r infor m at ion in t he lit er at ur e.
- Dat a ar e concom it ant ly collect ed and analy zed and t h e r esear ch er descr ibes t h e f ir st r ef lect ion s at t h e begin n in g of t h e collect ion pr ocess. Th is pr ocess is called cont inuous analy sis.
- The m et hod is circular, t hus it perm it s t he researcher t o ch a n g e t h e f o cu s o f a t t e n t i o n a n d se e k o t h e r dir ect ions, w hich ar e r ev ealed by em er gent dat a.
Th i s f r a m e w o r k e m p l o y s t h e t h e o r e t i c a l sam plin g t ech n iqu e, w h ich allow s t h e r esear ch er t o search for dat a in places or t hrough t he t est im ony of
people who hav e knowledge about t he obj ect of st udy. Ther efor e, one can car r y out r esear ch in m or e t han one dat a collect ion field t hr ough int er act ion w it h and
ob ser v at ion of ot h er p r of ession als, w h en ev er d at a collect ion is p ossib le. I n st r u m en t s can also b e r e-st ruct ured and t he focus of quee-st ions can be changed
( aim ing t o specify or ex plor e t he st udied obj ect ) , or t h e w a y q u e s t i o n s a r e a s k e d o r t h e w a y t h e r e se a r ch e r a d d r e sse s i n d i v i d u a l s w i t h a v i e w t o
ex t r act t he m ax im um infor m at ion possible.
Mem os or m em oranda are writ t en records of t h e pr ocess of t h eor y for m u lat ion an d can t ak e t h e
for m of t heor et ical, m et hodological or obser v at ional not es or a sub- variet y of t hem . These are const ruct ed du r in g t h e en t ir et y of dat a collect ion an d an aly sis.
Definit ions of each ar e pr esent ed below :
- t heoret ical not es – when t he researcher approaches t he fact s, s/ he regist ers int erpret at ion and inferences, dev elops h y pot h eses an d n ew con cept s. Th en , s/ h e est ablishes connect ion w it h ot her alr eady elabor at ed concept s, m akes int erpret at ions, inferences and ot her h y p ot h eses;
- m et h od olog ical n ot es – t h ese ar e n ot at ion s t h at r ef lect a com p let e or p lan n ed op er at ion al act : an in st r u ct ion t o on eself, a r em in der, an d a cr it iqu e of o n e ’ s o w n s t r a t e g i e s . Th e y r e f e r t o e m p l o y e d m et hodological procedures and st rat egies, t o decisions abou t t h e st u dy design , t o pr oblem s f ou n d in dat a collect ion and t o t he st r at egies used t o solve t hem ;
- observat ion not es – are descript ions of experienced ev en t s, especially t h r ou gh obser v at ion an d h ear in g. I t cont ains t he least int er pr et at ion possible.
Th e u se of lit er at u r e is lim it ed bot h bef or e and during analysis so t o avoid it s excessive influence on t he r esear cher ’s per cept ion; lit er at ur e can hinder t he discovery of new dim ensions of t he phenom enon. Th e n u m b e r o f st u d i e d i n d i v i d u a l s i s n o t pr edet er m ined in t his k ind of appr oach. I t is r at her det er m ined accor ding t o t he sat ur at ion pr inciple and
t heoret ical sam pling, not ing t hat t he lat t er is a process of dat a collect ion t o gener at e t heor ies. Ther e is dat a collect ion , cod in g an d an aly sis so as t o p oin t ou t ev en t s t h at ar e in dicat iv e of t h eor ies. Collect ion is car r ied ou t u n t il t h eor et ical sat u r at ion is ach iev ed , t hat is, unt il dat a are repeat ed or exhaust ed( 11).
We also st r ess t hat sam pling is essent ial t o init iat e t he process of generat ing a t heory because it det erm ines and cont rols where t he next dat a collect ion, co d i n g an d an al y si s t h er eo f w i l l h ap p en( 1 2 ). Th u s, t heor et ical sam pling aim s t o ident ify ev ent s t hat ar e i n d i c a t i v e o f c a t e g o r i e s . I n t e r e s t i s f o c u s e d o n collect ing dat a about w hat t he st udy par t icipant s do in t erm s of act ion and int eract ion. Then t he researcher chooses t he incident s t hat will be collect ed in t he next step and where these can be found, that is, the researcher seeks for incidents and not for people per se.
D a t a co l l e ct i o n i n GT ca n b e ca r r i e d o u t t hrough int erviews and observat ions. I nt erviews allow t he flex ibilit y t o ask t he r espondent t o clar ify issues essent ial t o t he under st anding of t he st udied r ealit y and t o ev aluat e t he v er acit y of answ er s t hr ough t he obser vat ion of individuals’ non- ver bal behavior. Thus, int erviews can be st ruct ured, sem i- st ruct ured or open, accor din g t o t h e r esear ch er ’s decision . Obser v at ion can also b e a v alu ab le r esou r ce of d at a collect ion because it allows underst anding what cannot be orally e x p r e sse d o r w h a t t h e i n d i v i d u a l i s n o t a b l e t o ex p r ess.
The num ber of individuals in t his m et hodology i s d et er m i n ed acco r d i n g t o t h eo r et i cal sat u r at i o n . Th er ef o r e, t h e n u m b er o f p ar t i ci p an t s i s n o t p r e-est ablish ed; it is r at h er det er m in ed by t h e con t en t and consist ency of dat a t hat originat e from report s( 13). Thus, as dat a ar e collect ed, t hese ar e subm it t ed t o concom it ant analysis aim ing for t heoret ical sat urat ion, w h i ch a l l o w s t h e e m e r g e n ce o f p o t e n t i a l sa m p l e g r ou p s. Th is p r oced u r e in GT is called con t in u ou s com par ison. When dat a sat ur at ion is achiev ed, t hat is, w hen no ot her infor m at ion is added or does not change t hat w hich is already exist ing, t he researcher init iat es a deeper and sy st em at ized analy sis of dat a collect ed in t he sam ple gr oups.
Th e cir cu lar m ov em en t is ch ar act er ized b y t h e c o m e - a n d - g o o f d a t a a n d a i m s t o a c h i e v e t h eor et ical sat u r at ion an d t h e elabor at ion of t h eor y t h r ou g h an an al y t i cal p r ocess. To su m m ar i ze, t h e w hole analy t ical pr ocess aim s t o const r uct t heor y, t o p r ov id e t h e n ecessar y m et h od olog ical r ig or f or t h e
d ev elop f u n d am en t als, an d t h e n ecessar y d en sit y, sensit ivit y and t he int egrat ion t o generat e a t heory( 6). D at a an al y si s w i t h i n t h i s t h eo r y p r o ceed s t hr ough t hr ee int er dependent st ages and giv en t hat t he m ovem ent is circular, t he com plet ion of one does not necessarily im pede t he researcher in ret urning t o t he previous ones. These t hree st ages are called: open coding, axial coding, and select ive coding. The coding pr ocess aim s t o r edu ce dat a, w h ich , per m eat ed by t h e cod in g p r ocess, is essen t ial t o ach iev e t h eor y. The aut hors( 4) explain t hat “ t he reduct ion of cat egories i s a m e a n s t o d e l i m i t a t e e m e r g e n t t h e o r y [ …] form ulat e t heory wit h a sm all group of a high level of abst ract ion, defining t er m inology and t ex t ”.
Th e a n a l y s i s p r o c e s s c o n s i s t s i n con cep t u alizin g collect ed d at a. I n it ially, t h ese d at a c o n s t i t u t e p r e l i m i n a r y c o d e s , w h i c h b e c o m e co n ce p t u a l co d e s a n d t h e n ca t e g o r i e s, w h e r e a s cat egor ies can conver ge int o phenom ena. A cat egor y can be a w or d or a set of w or ds t h at r ev eals h igh levels of abst ract ion, whereas codes are concept s t hat can also b e ex p r essed b y w or d s or ab b r ev iat ion s, w h ich t og et h er lead t o ab st r act ion s an d con st it u t e c a t e g o r i e s . A n d a c a t e g o r y c a n b e c o m e a p h e n o m e n o n , w h i c h c o n s t i t u t e s c o m m o n charact er ist ic r epr esent at ions t hat lead t o t heor y.
Open coding – consist s of t he fir st st age of t he dat a analy sis pr ocess. I t is m anually per for m ed t h r ou gh r eadin g in t er v iew s an d su bm it t in g t h em t o t he coding process, line by line. The lines cont ain words o r p h r a s e s t h a t e x p r e s s t h e e s s e n c e o f t h e p ar t icip an t s’ r ep or t s( 8 ). I t con sist s of an at t en t iv e r eadin g in w h ich t h e r esear ch er ex am in es, r ef lect s, com p ar es an d m ak es con cep t u alizat ion s b ased on w o r d s , p h r a s e s , p a r a g r a p h s a n d / o r g e s t u r e s gen erat ed du r in g in t er v iew s. Wor ds/ ex pr ession s ar e at t r ibu t ed t o each r aw dat a ( ex cer pt of in t er v iew ) , f or m in g p r elim in ar y cod es. I n a d id act ic w ay, t h is st age con sist s of ‘open in g’ t h e t ex t ( r aw dat a) t h at per m it s a closer int eract ion bet w een dat a- r esear cher.
Axial coding – t his is t he second st age. Aft er op en cod in g is ach iev ed , t h e g en er at ed cod es ar e r egr ouped in new w ay s and gener at e t he concept ual co d es.
The aim is to reorganize codes at a higher level o f a b st r a ct i o n . Th u s, n ew co m b i n a t i o n s a r e t h en established so as to form subcategories that, in turn, will be organized and form cat egories so t hat connect ions are established attem pting to achieve precise explanations concerning facts from the social scenario.
I n t his process, due t o t he circular m ovem ent of dat a, a prelim inary code can becom e a concept ual co d e a n d t h i s i n t u r n , ca n b eco m e ca t eg o r y a n d subcat egories according t o it s represent at iveness and occurrence in t he sam ple. I t is im port ant t o highlight t h e f act t h at ev en a cat egor y, based on su ccessiv e r eadings and analy ses, can go back t o a concept ual or p r elim in ar y cod e d ep en d in g on t h e r esear ch er ’s r ef lect ion .
As a st r at eg y t o co n st r u ct cat eg o r i es, w e suggest asking quest ions of dat a, such as: when does it occur, w here does it occur, w hy does it occur, w ho causes it , wit h what consequences? Wit h t hese sim ple quest ions, t he process of const ruct ing cat egories and phenom ena is facilit at ed.
A f t e r t h e c o n s t r u c t i o n o f c a t e g o r i e s ( concept ual codes) , t hese ar e com par ed, r elat ed and int erconnect ed according t o t he paradigm at ic m odel( 6). I n t h i s m o d e l , e l e m e n t s c a n b e d e f i n e d a s t h e follow ing: t he phenom enon is t he cent ral idea/ event / h a p p e n i n g t o w h i ch a ct i o n s a n d i n t e r a ct i o n s a r e relat ed; causal condit ions are t he elem ent s/ sit uat ions t hat per m it t he phenom enon t o em er ge; t he cont ex t
is t he specificit y t hat inv olv es t he phenom enon and w h i ch co n d i t i o n s a ct i o n / i n t e r a ct i o n ; i n t e r v e n i e n t condit ions ar e con st it u t ed b y t im e, sp ace, cu lt u r e, e c o n o m i c s i t u a t i o n a n d t e c h n o l o g y , h i s t o r y , p e r so n a l b i o g r a p h y, a m o n g o t h e r s; st r a t e g i e s o f a ct i o n / i n t e r a ct i o n a r e i d e n t i f i e d w i t h p r o ce d u r a l n a t u r e ( se q u e n ce s, m o v e m e n t , ch a n g e s, a m o n g ot h er s) , w it h a goal or aim , t h ou gh n on - act ion s ar e a l s o i m p o r t a n t ; a n d c o n s e q u e n c e s h a v e t o b e co n si d e r e d a s a r e su l t / a n sw e r, w h e t h e r t h e y a r e p o si t i v e o r n eg at i v e.
Select ive coding – t his is t he t hird st age and aim s t o refine and int egrat e cat egories, revealing t he cat egor y t hat w ill be consider ed t he cent r al one and w hich per m eat es all t he r em aining and w ill becom e t h e st u dy t h eor y. All t h e pot en t ial of abst r act ion is em p loy ed in t h e t h eor et ical scop e of in v est ig at ed / cod ed d at a, en ab lin g t h e em er g en ce of t h e st u d y t h eor y.
r e l a t i o n o f t h e se g r o u p i n g s, m a k i n g e x p l i ci t t h e experience of part icipant s in relat ion t o t he subst ant ive con cept u al/ t h eor et ical con st r u ct ion .
Cat egor ized dat a can be pr esen t ed t h r ou gh diagram s and chart s, which facilit at es reflect ion about t hem . We st ress t hat t he researcher has t o exercise/ m aint ain a cr it ical- r eflect iv e at t it ude in all st ages in w h ich su bj ect iv it y n eeds t o f low at ev er y m om en t , wit h a view t o discover point s of connect ion bet ween sev er al cat eg or ies, en ab lin g t h e in t eg r at ion of t h e r em ain in g .
All t hese st eps ar e essent ial t o achiev e t he e l a b o r a t i o n o f a so l i d t h e o r y, w i t h i n t e r - r e l a t e d concept s t hat express, wit h t he great est accuracy and f id elit y as p ossib le, t h e ob j ect of st u d y, aim in g t o cont ribut e t o t he const ruct ion of knowledge about t he st udied r ealit y.
Th i s m e t h o d o l o g y h a s b e e n i n cr e a si n g l y d i s s e m i n a t e d a n d i s u s e d b y s e v e r a l a r e a s o f k n ow led g e su ch as ed u cat ion , n u r sin g , p sy ch olog y an d sociology. Th is m et h od h as pr ov ided cou n t less cont ribut ions t o nursing. One can say it has significant ly cont ribut ed t o t he expansion of knowledge because it is an in t er p r et at iv e an d sy st em at ic ap p r oach t h at draws from t he experience and realit y of t he involved social act or s, a w ay t o ach iev e r eliable r esu lt s t h at can generat e act ions as well as t o im prove knowledge.
Ex am ple of a st udy t hat em ploy ed Gr ound Theor y
Ai m i n g t o cl a r i f y t h e co n t r i b u t i o n o f t h i s m et hodology ev en m or e, som e ex am ples of nur sing st udies t hat em ployed GT are present ed. The m aj orit y of t h ese Br azilian st u dies ar e pr odu ct s of gr adu at e pr ogr am s, m ast er ’s or doct or al pr ogr am s.
One of t he st udies( 1) w as dev eloped w it h 23 n u r ses of t w o lar ge h ospit als in Rio de Jan eir o, RJ, B r a z i l . Th e s t u d y a i m e d t o : i d e n t i f y a t t i t u d e s , e x p r e s s i o n s a n d / o r f e e l i n g s , i n d i c a t e d a n d / o r v er b alized b y n u r ses, con cer n in g t h e m an ag em en t of clien t s w it h HI V/ AI DS; u n der st an d t h e m ean in gs a t t r i b u t ed b y n u r ses t o t h e m a n a g em en t o f ca r e d eliv er ed t o clien t s w it h HI V/ AI DS; an d d ev elop a subst ant iv e t heor y t hat r epr esent ed t he ex per iences o f n u r se s, i n h e r e n t i n t h e m a n a g e m e n t o f ca r e deliv er ed t o client s w it h HI V/ AI DS.
Th e c e n t r a l p r o c e s s e x p e r i e n c e d b y p a r t i ci p a n t s w a s l a b e l e d r e - co n st r u ct i n g w a y s o f n u r sin g m an ag em en t : cop in g w it h t h e in st it u t ion al
ch allen ges an d pr ofession al v alor izat ion.
Cat egor ies t hat em er ged in t his st udy w er e: r elat ing w it h t he pat ient , gener at or of m anagem ent o f c a r e ; d i s c u s s i n g t h e s c e n a r i o w h e r e c a r e i s perform ed; seeking ways t o m anage care; living wit h bar r ier s and facilit at or s for t he m anagem ent of car e; and r eflect ing on t he r eper cussions of car e m anaged by n u r ses.
Ot her not ew ort hy aspect s refer t o t he dat a’s cont inuous analy sis and com par ison associat ed w it h t heor et ical sensit iv it y, w hich allow t he under st anding of m eanings of act ions and int er act ions t hat nur ses d e v e l o p w h i l e m a n a g i n g c a r e i n t h e h o s p i t a l en v ir on m en t . I n t u r n , t h ey sh ow t h eir ex p er ien ce b a sed i n t h e sea r ch f o r n ew w a y s t o r eco n st r u ct m a n a g e m e n t o f c a r e , w h i c h d e m a n d s f r o m pr ofessionals’ abilit ies and com pet ences, focusing t he client , inst it ut ion and t he pr ofessional funct ion it self.
Based on t h e st u d y ’s f in d in g s, t h e au t h or concludes t hat when people lose t heir organic balance t hey seek for solut ions in order t o solve t heir illnesses and t he healt h service is one of t he m eans searched. I n t h e s e i n s t i t u t i o n s , t h e n u r s e , a m o n g o t h e r professionals, is one of t he m ain ones responsible for t he recovery of t hese individuals, especially when t hey n eed h ospit alizat ion .
I n t he face of t his dem and, nur ses dev elop t h eir act iv it ies f ocu sed on t h e h osp it alized p at ien t , w h er e s/ h e u ses, con st r u ct s, d econ st r u ct s an d r e-con st r u ct s sy m bols t h at h av e m ean in gs t h at per m it init iat ing t he m anagem ent of car e. This pr ofessional, d u e t o t h e c o m p l e x i t y o f h i s / h e r a c t i o n s , u s e s st r at egies t hat per m it solv ing t he needs of pat ient s, w het her per ceiv ed by t he pat ient s or not .
The nur ses’ pr ocess of m anagem ent of car e is som et h in g dy n am ic t h at is based on a t r iad t h at values t he healt h t eam , t he inst it ut ion and t he pat ient , w h er e ev er y on e is in an on g oin g r elat ion sh ip , an d w h i c h f a v o r s t h e c o n s t r u c t i o n o f s y m b o l s a n d m e a n i n g s t h a t o r i g i n a t e f r o m i n t e r a ct i o n s. I t i s im port ant t o highlight t hat nurses are in t he cent er of t his t r iad est ablishing r elat ionships/ int er act ions.
Thus, it is wort h m ent ioning t hat nurses’ act s ar e b ased on m ean in g , w h ich is a con seq u en ce of int er act ion w it h sev er al differ ent elem ent s, and t hat t h e se a ct s su f f e r d i r e ct i n f l u e n ce f r o m r e f l e ct i v e a w a r e n e s s , w h i c h g e n e r a t e a t t r i b u t e s i n t h e m anagem ent of car e, m ainly sy m bols.
const it uent s of t he par adigm at ic m odel( 11). Aft er t he const r uct ion of codes, subcat egor ies and cat egor ies, t hese are organized according t o t he m odel m ent ioned abov e, w hich est ablishes t hat cat egor ies need t o be r e- an aly zed , com p ar ed , an d or d er ed so t o id en t if y t he following elem ent s: phenom enon, causal condit ion, con t ex t , act ion / in t er act ion st r at eg ies, in t er v en ien t con dit ion s an d con sequ en ces.
We em p h asize t h at t h e ap p licat ion of t h is m odel aim s t o ident ify t he cent ral idea t hat perm eat es t h e r e m a i n e d ca t e g o r i e s, w h i ch w i l l l e a d t o t h e e m e r g e n ce o f t h e su b st a n t i v e t h e o r y / t h e o r e t i ca l m od el b ased on t h e in t er con n ect ion of t h e sev er al cat eg or ies.
Wh en t h e au t h or sou gh t t o u n der st an d t h e n u r ses’ ex p er ien ces r elat ed t o t h e m an ag em en t of care, she verified t hat experiences consist of a dynam ic p r ocess, ex p er ien ced b y each p r of ession al, w h er e t h er e i s a n eed t o t u r n t o st r at eg i es so t h at t h e m anagem ent of car e can be dev eloped accor ding t o dem and, be it from t he inst it ut ion or pat ient .
Based on t he int eract ion est ablished wit h t his st u d y ’s in d iv id u als an d on t h e p er sist en t sear ch of t he nur ses’ m anagem ent , it w as possible t o ver ify in t he com parat ive dat a analysis, from t he beginning of t h e codin g u p t o t h e cat egor izat ion an d con n ect ion bet ween cat egories, and in each of t hese st ages, t hat nurses are concerned not only wit h t he funct ions t hey have t o develop as nursing professionals but also wit h t he funct ions of ot her professionals. Thus, nurses t ry t o re- const ruct ways t o m anage in nursing, given t he difficult ies found in t he r ealit y ex per ienced by t hem in t he inst it ut ional spher e.
I n t h is con t ex t , qu est ion s su ch as: Wh at is t he m eaning nurses at t ribut e t o t heir m anagem ent in t er m s of car e in t he or ganizat ional spher e? How do nurses conduct t his m anagem ent ? Which is t he coping process t hat st em s from t heir perform ance? How does o n e b e g i n a n d d e v e l o p t h e e x p e r i e n c e o f t h e m an agem en t of car e? Giv en t h ese in it ial r eflect ion s ab ou t t h e st u d ied r ealit y, in f or m at ion is u n cov er ed t hat originat ed t he codes t hat becam e subcat egories, w hich in t ur n becam e cat egor ies, culm inat ing in t he m a i n p h e n o m e n o n . Th i s p r o c e s s p e r m i t t e d t h e delin eat ion of t h e m ean in g at t r ibu t ed by n u r ses t o t he m anagem ent of care, which is t ranslat ed int o t he st udied indiv iduals’ ex per iences and v alidat ed by t he gr oup t o w hich t he t heor et ical m odel is applied.
I n t his way, t he elem ent s of t he paradigm at ic m o d el t h a t co m p o se t h e m a i n p h en o m en o n w er e
defined: re- const ruct ing ways of nursing m anagem ent - coping wit h inst it ut ional challenges and professional v alor izat ion.
Th u s, e l e m e n t s/ si t u a t i o n s t h a t a l l o w t h e em er gence of t he phenom enon ar e: Causal condit ion
- Relat ing wit h t he pat ient , generat or of m anagem ent of care; Cont ext - discussing t he scenario where care is per f or m ed; I n t er v en ien t con dit ion s – Liv in g w it h bar r ier s an d f acilit ies f or t h e m an agem en t of car e, i d en t i f i ed w i t h t h e p r o ced u r al n at u r e ( seq u en ces, m ovem ent , changes, am ong ot hers) , wit h an obj ect ive o r g o al , w h er eas n o n - act i o n s ar e al so i m p o r t an t ;
St r at egies of Act ion/ I nt er act ion – Seek ing new w ay s t o m a n a g e c a r e i s i d e n t i f i e d a s t h e r e s u l t s o r expect at ions of act ion/ int eract ion in relat ion t o a given p h e n o m e n o n , r e su l t / a n sw e r, w h e t h e r p o si t i v e o r n e g a t i v e ; Co n s e q u e n c e s - r e f l e c t i n g o n t h e r eper cussions of car e m anaged by nur ses.
Mu ch r ef lect ion ab ou t collect ed an d cod ed d at a i s n eed ed t o ach i ev e t h i s f r am e i n t er m s o f c a t e g o r i e s t h a t r e p r e s e n t t h e e l e m e n t s o f t h e paradigm at ic m odel. We can say t h is is a h ar d an d d if f icu lt w or k t h at d em an d s d ed icat ion , con st an cy, co n cen t r a t i o n a n d d eep a b st r a ct i o n a m i d a g r ea t v olu m e of dat a, an d t h e n eed t o t r an scen d dat a t o develop a report of t he process experienced by nurses in t he m anagem ent of t he hospit al car e.
Th e a u t h o r c o n c l u d e s t h a t t h e n o t e d cat egor ies con st it u t e st ages of n u r ses’ ex per ien ces from t he m om ent in which t hey are willing t o m anage car e. Based on t he analy sis of cat egor ies, t he bases t h a t d e n o t e c a u s e , e f f e c t a n d c o n s e q u e n c e a r e ext ract ed, which ident ify t he cent ral phenom enon. For nu r ses not t o lose t h eir pr est ige an d v isibilit y, t h ey n e e d t o d e v e l o p t h e i r f u n c t i o n s , p r e v i o u s l y est ablished, act ing in fav or of t he pr ofessional class, w or k in g assu m p t ion s ab ou t con f lict s, in t er p er son al r elat ion sh ips, defin it ion of fu n ct ion s. On e can av oid r eplacem en t of t h e n u r ses’ qu alif ied labor f or ce by o t h er p r o f essi o n al s w i t h o u t p r o p er ed u cat i o n an d t r aining pr ov ided t o t hese pr ofessionals, w hich is of gr eat v alue and im por t ance for t he pr ofession.
CONCLUSI ON
W e d e f e n d G T a s a m e t h o d o l o g i c a l f r a m e w o r k t o c a r r y o u t r e s e a r c h i n a n y f i e l d ,
esp eci a l l y i n n u r si n g , co n si d er i n g t h a t i t en a b l es
t h e c o n s t r u c t i o n o f k n o w l e d g e a b o u t l i t t l e
e x p l o r e d r e a l i t i e s . I t e n a b l e s o n e t o a c q u i r e a n e w p e r s p e c t i v e a b o u t r e a l i t y , a n d t h u s , s e e k
t h e u n d e r s t a n d i n g o f v e i l e d i s s u e s t h r o u g h t h e
m e a n i n g s s o c i a l a c t o r s a t t r i b u t e t o t h e i r o w n
a ct i o n s a n d i n t e r a ct i o n s.
Th i s m et h o d o l o g y a l so sh o w s p r o m i se f o r
a c q u i r i n g g l o b a l a n d d e e p u n d e r s t a n d i n g o f
n u r s i n g k n o w l e d g e a n d a m e a n s t o g e n e r a t e
t h eo r i es b a sed o n n u r si n g p r a ct i ce. Th i s w ay, GT i s c o n c r e t i z e d a s a n i m p o r t a n t a n d c o n s i s t e n t
m e t h o d t o c a r r y o u t r e s e a r c h , e s p e c i a l l y i n
n u r si n g , w h o se o b j e ct o f st u d y i n v o l v e s h u m a n i n t e r a c t i o n s . T h e s e i n t e r a c t i o n s i n c l u d e
p h e n o m e n a o f n u r s i n g p r a c t i c e a n d p r o f e s s i o n
n o t y e t u n v e i l e d a n d p r o p e r l y u n d e r s t o o d w i t h
t h e r i g o r r e q u i r e d f o r t h e f o r m u l a t i o n o f k n o w l e d g e i n q u a l i t a t i v e d e si g n s.
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