Research problems can help researchers decide the most appropriate methodology for their study. Methodologies that create the structure to conduct a study and analyze its data bring new understandings of the research problem (Charmaz, 2006). This research study will use the methodology of constructivist grounded theory, which allows data to be collected from interviews and observations among other possible sources.
Grounded theory can be used to generate theory inductively by analyzing the observed actions and interactions of nurse executives in acute care settings (Charmaz, 2006). A core characteristic of all forms of grounded theory is rich (detailed) data that are gathered and analyzed (Charmaz, 2006). Data collection and analyses occur concurrently. Data are collected so that theoretical analyses can be developed and learned from the data gathered (Charmaz, 2006). Different types of data are gathered as researchers observe and interview participants. Researchers “cannot tell the data what to say” (Schatzman & Strauss, 1973, p. 120) but can develop theory from the data analyzed.
Entrée to the Field
The purpose of this research is to explore the relationship between the effect nurse executives may have on frontline staff nurses’ delivery of safe patient care and its outcomes. It is necessary to note that the theoretical framework to address this area is yet to be developed and refined. Grounded theory (GT) is the most appropriate paradigm to use to conceptualize the data that can be obtained through interviews, observations and other possible sources. GT equips the researchers with efficient tools that identify the existing themes and concepts that, in their turn, can shed light on the issue (Udod & Racine, 2017). The new theory developed within this study will identify and describe the peculiarities of the links combining three central spheres that include nurse executives, frontline’ nursing professionals’ provision of care and particular patient outcomes.
It is noteworthy that the researcher’s working environment will be explored, which has a certain advantage and disadvantages for the outcomes of the study as well as its validity and reliability (Holloway & Galvin, 2016). As for the benefits of this strategy, I am able to choose the most knowledgeable practitioners who are willing to share their experiences. It can also be easier to recruit participants as colleagues are ready to share their experiences with a person they know well enough. The atmosphere during the interview is very important as it can affect the participants’ openness. The interview run by a colleague will be characterized by a friendly atmosphere. On the other hand, it can be more difficult to avoid bias as I can select people who may have similar views and perspectives. The participants are my colleagues who know my view on the matter, and they can give answers that are expected or desired, in their opinion. Therefore, it is essential to pay considerable attention to addressing bias and try to remain neutral. To achieve this goal, it is necessary to include people who may have different views, have different backgrounds and working experience.
Two types of sampling are important to grounded theory: purposeful and theoretical sampling (Charmaz, 2006). Purposeful sampling is a common sampling strategy employed in qualitative studies. This sampling method implies the identification and selection of the most knowledgeable participants who are willing to share their knowledge and experiences (Palinkas et al., 2015). The validity of the study is enhanced as people who do not have the necessary knowledge are excluded from the research while in other types of sampling methods, people who have limited or no information on the subject matter can be included due to the random selection. However, this type of sampling is often regarded as less reliable as compared to other sampling techniques. Researchers may fail to include truly knowledgeable people, individuals sharing similar ideas can prevail, which will affect the validity and reliability of the study. Data that informs understanding about the research will be gathered by sampling a similar group of nurse executives to uncover relationships between concepts about the practice of empowerment and what that looks like in acute care hospitals.
Theoretical sampling means looking for data that cultivates emerging themes (Charmaz, 2006). This sampling method allows the researcher to generate a new theory through the identification of major themes and concepts. The use of this sampling type does not presuppose the focus on the population and its being representative, but theoretical sampling focuses on the development of theoretical data. Theoretical sampling guides researchers to fully understand themes, ideas, and concepts during data collection (Charmaz, 2006). Theoretical sampling enables researchers to “explore the range or varied conditions along which the properties or concepts vary” (Strauss & Corbin, 1998, p. 73).
For example, during my pilot study, “system issues” repeatedly emerged from the data. The data revealed that hospital systems (e.g., electronic medical record systems) could be either a facilitator or a barrier for nurse executives when implementing organizational goals or expectations. It could either increase or decrease the perception of empowerment in the nurse executive role. To fully understand how system facilitators and barriers promote or impede empowerment, I would have to further investigate this theme by re-interviewing previous participants and interviewing new ones (Bagnasco, Ghirotto, & Sasso, 2014). These steps will be instrumental in refining the obtained theoretical data. It is beneficial to re-interview participants as people have different values and tend to pay attention differently to certain areas. Thus, some aspects of practice can be omitted due to the time limits any interview has. However, it can be vital to reveal all the existing views on some areas, which makes re-interviewing necessary. Moreover, the identification of recurrent themes may affect the participant selection process as I will try to address people who are most knowledgeable or related to the concepts, areas, and spheres that emerge during interviews. Theoretical sampling is often associated with grounded theory as the sampling method is crafted to elicit concepts and themes that are used to develop a new theory. The number of interviews and participants can be quite extensive as the researcher collects data until theoretical saturation occurs. To identify the most recurrent and relevant themes, I will use different types of coding and memo analysis.
The intent of interviews in qualitative research is to understand the participants’ world and their perceptions of that world as they experience it (Kvale & Brinkmann, 2009). Interviews call for thoughtful questioning and listening to gain participants’ knowledge on the research problem under investigation (Kvale & Brinkman, 2009).
According to Kvale and Brinkmann (2009), effective qualitative research interviews should incorporate these 12 features:
- Life world. The interview revolves around the participants’ perceptions of their everyday life and how they fit into it.
- Meaning. The intent of the interview is to understand the meaning of core concepts as defined by the participant.
- Qualitative. The interview is not intended to quantify information shared.
- Descriptions. The interview encourages describing events and circumstances as lived by the participant.
- Specificity. Descriptions of events that have occurred and what the participant actually did is important as opinions are not needed.
- Deliberate naiveté. The interviewer is an open slate, there to listen and learn from the participant.
- Focused. The goal of the interview is to understand the topic being researched. Therefore the interview needs to be guided around the topic.
- Ambiguity. Information that is shared may seem inconsistent. The interviewer needs to understand if the lived experience described is reflective of the reality of the participants world with contradictions and ambivalence or miscommunication in the interview setting.
- Change. As participants share experiences, meanings can change for the participant and new revelations can be shared.
- Sensitivity. The interviewer may elicit different responses depending on their knowledge of a topic.
- Interpersonal situation. Interactive communication that develops a good rapport allows the interviewer to gain knowledge.
- Positive experience. Research interviews can benefit the participant as they learn new ideas from sharing their lived experiences. Interviews are critical to gathering data and good interviews allow for more insight into knowledge gained during the process.
A good interview gathers rich, detailed data from participants. Researchers must always be cognizant that that they are there to learn. Listening is more important than speaking. Broad, open-ended, nonjudgmental questions direct participants to share their stories and experiences about the research topic (Charmaz, 2006). Constructivist grounded theory methodology uses intensive interviewing to allow for developing, nonrestrictive, paced interviews (Charmaz, 2006). One of the strategies to use to ensure the achievement of these goals is the use of interview probes that can help in the “search of elaboration, meaning or reasons” (Holloway & Galvin, 2016, p. 93). During probe interviews, I will see people’s reactions and will understand whether the questions are clear and nonjudgmental (or biased, and so on). I will be able to refine the questions and make them more efficient (more precise and more detailed). I will also identify the most appropriate interview pace and other features. I will ask participants to provide their feedback on the questions and the overall interview. Each feedback will be taken into account, and the corresponding changes can be implemented to make interviews more effective.
Observations in the field are an additional way to gather data in grounded theory (Charmaz, 2006). Blumer (1969) argues the importance of observing participants in their natural environment as they conduct their day-to-day business. Such valuable data from the natural environment cannot be simulated in a staged laboratory environment when conducting research. Observations are important in grounded theory because one can observe participants as they interact with others and their environment, lending a fuller understanding of the phenomenon being studied. Further data can be gathered as familiarity increases during observations; this adds depth and increased understanding of the phenomenon being studied in the world it is lived (Charmaz, 2006; Schatzman & Strauss, 1973).
Observation of participants can be accomplished actively or passively (Charmaz, 2006). Active participation requires researchers to be part of the scene (Charmaz, 2006). Active participation while observing is challenging because researchers become participants, and this could jeopardize the learning to be gained (Charmaz, 2006). First, being a participant is associated with certain distractions that can prevent the researcher from noticing important behaviors, reactions, and ideas. Besides, the researcher’s actions or comments can affect the way other participants express their ideas as they can become more reserved or, vice versa, more emotional. They can follow the lead rather than share their true ideas. To address these challenges, the researcher should consider and control their every move and every utterance. It is necessary to remain active but quite neutral and use themes and concepts identified during probe and previous interviews. It is easier to make sure that all important details will be noticed if the corresponding technology is used. The researcher can video record interviews and observations. Of course, it is necessary to obtain the participants’ written consent. It is important to make field notes during the observation proper and when analyzing the video. This strategy can help the researcher elicit more details. It can also be helpful to ask a peer to implement observation and make field notes. Researchers become part of the scene in passive observation, but they must not interact with participants (Charmaz, 2006). During passive observation, researchers are being observed, which may affect data collection because their actions can have a direct impact on the scene (Schatzman & Strauss, 1973). To avoid these issues, it is possible to use the strategies mentioned above (using technology or addressing peers). Field notes are specifically relevant in this case as the researcher can note the participants verbal and non-verbal communication strategies, overall atmosphere as well as ideas concerning the participant, their answers and theoretical concepts that can be applied.
Observations are an account of social actions and interactions. Researchers observe individuals as they interact in their environment or the environment affects their actions during day-to-day activities. Researchers complete field notes as they observe the actions and processes of participants and others unfold before them, constructing an account of behaviors and interactions (Charmaz, 2006). The major documentation strategies are associated with descriptive and reflective data (Holloway & Galvin, 2016). In the former case, the researcher describes all the details associated with the interview including verbal and non-verbal communication. The latter documentation strategy involves the focus on reflection as the researcher’s ideas, comments, and reactions are noted. The benefit of the descriptive method is the thick description that can help identify the most relevant details (particular words, non-verbal cues). This information can help refine interview questions (as well as theoretical sampling) as new aspects and facets of the issue can be identified. However, the researcher’s ideas are often equally important as they can be instrumental in synthesizing and analyzing the obtained data. These notes can also help improve interview questions or the participant selection process. The use of this type of documentation will enhance the reflexivity of the research. Therefore, it is beneficial to employ both strategies.
When implementing observations, it is necessary to take into account the researcher’s influence or insider / outsider stances (Woodward, 2014). Being the insider implies sharing certain culture, values, perspective. In simple terms, the researcher and participants share the certain background that can help in setting the necessary friendly mode of interviews. The researcher and participants also speak the same language, which can help in the interpretation of the obtained data. Interviewing colleagues will be effective as people working together often have certain codes and symbols that enrich the communication and add the meaning. However, the common background can increase bias as the researcher can fail to notice or consider some of the participants’ ideas that can be relevant or even crucial. Being an outsider can ensure unbiased documentation of the participants’ accounts as no additional (the researcher’s) meanings will be applied. The researcher will not expect particular answers and reactions but will accurately document all the meaningful details. However, the participants may be less open and willing to share with an outsider. They can also be distrustful or provide socially appropriate answers. The outsider can misinterpret some verbal and non-verbal cues, which can affect the research results and validity.
Ethical considerations should also be taken into account when implementing observations. First, it is essential to obtain the participants’ consent. There are high chances that the participants’ behavior will be shaped since they would know about being observed (Holloway & Galvin, 2016). Therefore, it is possible to inform the participants that they will be observed with the help of cameras that will be turned on several (but random) times during their working hours. Thus, the participants may behave in a more natural way (at least, during a certain time). The research may involve observation of the participants’ work in the clinical setting, which may be associated with additional ethical considerations. For instance, patients’ consent should be obtained if they become a part of the study. Therefore, it can be beneficial to choose settings that do not involve patients or other healthcare professionals.
“The excellence of the research rests in large part on the excellence of the coding” (Strauss, 1987, p. 27). Coding in qualitative research refers to words or phrases that are assigned to data that summarize the symbolic meaning for a portion of data (Saldana, 2009). The purpose of coding is to organize data in a meaningful way to understand what is going on (Charmaz, 2006). Grounded theory coding consists of initial/open coding, selective/focused coding, axial coding, and theoretical coding (Charmaz, 2006; Glaser, 1978). However, before any type of coding can occur, it is important to transcribe the interviews. As has been mentioned above technology can facilitate the research. For example, interviews can be digitally recorded and (audio and video files can be created). The transcription can be carried out with the help of technology as well since certain software can transfer the data from audio files into a Microsoft Word document. Importantly, it is possible to use Microsoft Word and Excel formats as they will be helpful during coding. The use of tables can make the data analysis more efficient. To ensure the validity of the concepts and themes identified, it can be beneficial to use technology (data analysis tools). The data analysis tools will identify codes and themes if no less than 70% of themes identified coincide, it is possible to assume that the codes and themes are properly identified.
Initial/open coding. Initial/open coding refers to words or phrases that summarize the substance of data gathered during the research process (Saldana, 2009). This method will be used to categorize data collected from interviews on empowerment. I will read the transcripts several times and highlight emerging codes. I will develop tables that will help in navigating the identified codes. Remaining open to the data as it is broken down and examined in initial/open coding allows one to categorize similarities, differences, and comparisons (Charmaz, 2006). In addition, as themes emerge, open coding directs researchers to other areas that need to be explored and analyzed (Charmaz, 2006).
Selective/focused coding. Focused coding involves “more directed, selective, and conceptual” (Charmaz, 2006, p. 57) categorizing of data. It can be regarded as the further step in coding and identifying emerging themes. While open coding implies the identification of all recurrent themes and codes, focused coding entails the identification of categories associated with particular concepts (Holloway & Galvin, 2016). In this research, codes associated with empowerment, patient care, outcomes, and the like will be the core of this coding method. It is used to analyze large amounts of data into salient categories that incorporate analyzing open codes into meanings and concepts (Charmaz, 2006). Focused coding will be used to identify the most relevant codes. It requires researchers to decide which initial codes make the most analytic sense to ensure categories are fully and completely developed (Charmaz, 2006). The codes that are closely related to the concepts under analysis (empowerment, patient safety, care, patient outcomes, and the like) can be regarded as relevant and will be highlighted during this stage. Analysis of these data will allow themes and categories about empowerment and patient safety to emerge.
Axial coding. Axial coding “specifies the properties and dimensions of a category” (Charmaz, 2006, p. 60). Although Strauss and Corbin (1990) call for this coding phase to be used between open and selective coding, it is not always done. Axial coding allows researchers to bring data together as connections in the data are realized and concepts emerge (Charmaz, 2006). It systematically puts data into categories based on conditions, context, actions, and interactions extrapolated (Charmaz, 2006). Axial coding builds a frame that can be applied to the data (Charmaz, 2006). In simple terms, open codes are analyzed and the links between different codes are identified. The codes are related to each other in terms of contexts, outcomes, background, and concepts associated with them. Axial coding is very different from selective coding as the former focuses on relations between codes while the latter seeks for generalization.
Theoretical coding. After focused coding is completed, theoretical coding is the next phase. It allows researchers to identify relationships between categories developed from focused coding (Charmaz, 2006). Theoretical coding is done to identify connections within data and provides cohesiveness to the analytic story (Charmaz, 2006). Researchers can identify connections from emerging categories and themes that bring lucidity to the data gathered, moving the story into a theoretical direction (Charmaz, 2006). Researchers can apply existing theoretical codes to their data. Clearly, the categories should be properly adjusted to fit the context and purpose of the research.
Memos. Memos, an integral component of grounded theory, are the transitional steps between data collection and initial drafts of papers (Charmaz, 2006). They serve as a vital method during the research process. Memos are conversations with oneself during the research process that prompt analysis of the data as it unfolds (Charmaz, 2006). Memo writing allows researchers to capture, compare, and connect data gathered and document thoughtful insights about themselves, the process, and the data as they unfold (Charmaz, 2006). Memos are a continual process that begins when data are collected and concludes when the final paper is written (Charmaz, 2006; Glaser, 1978). Memo writing involves writing down ideas concerning theoretical and conceptual categories and ties associated with the open codes identified during the previous stages of coding. At this point, the researcher often applies theoretical frameworks and paradigms existing in the field. For example, in my research, memos will allow me to put into words my thoughts about empowerment from the data gathered. Associations and links can be made that help formulate the questions that need to be answered about empowerment and give direction to subjects such as patient safety that need pursuing (Charmaz, 2006).
Reflexivity. Reflexivity is an important component of my qualitative research on empowerment because it will allow me to scrutinize my analysis to determine how my perspectives and assumptions are influencing the investigation (Charmaz, 2006). It will also allow readers to decide how my interests, assumptions, and views influenced the research (Charmaz, 2006). My perspective on the data must be made clear to readers because it may influence how the data are understood. Reflexivity is important to implement during all stages of the study implementation including data collection and analysis. For example, my belief that empowerment is a cornerstone of patient safety needs to be shared because it will color the interpretation of data gathered. It does not obviate scientific interpretation, but my beliefs and what, if any, influence they have on my objectivity in analysis must be made clear (Charmaz, 2006).
It is possible to employ a number of strategies to ensure proper reflexivity of the research. It is important to use a mixed method of field notes documentation that implies paying equal attention to the description of observation and interview details and reflection of the researcher on the matter (Holloway & Galvin, 2016). Reflexive field notes will help the researcher to understand possible biases and contexts. Sick description of these details will be beneficial for the reader as well since the researcher’s perspective (and bias if any) will be visible. Furthermore, it is possible to have a reflexive diary that will capture all ideas, changes in perspectives, and attitudes that took place during the research. These notes are essential as the researcher and the reader will be able to understand the decision-making process and conclusions made (Houghton, Casey, Shaw, & Murphy, 2013). It is important to include the researcher’s reflection to the final paper as well. This reflection should address different stages of the research including the ideas associated with the launch of the project and ideas on the way data are interpreted and presented. The changes that occur in the researcher’s attitude and perspectives are also important to describe as they also affect the way the research is conducted.
Theoretical saturation. Theoretical saturation is reached when new data no longer contribute to theoretical understanding and/or no new knowledge about a theoretical category emerges (Charmaz, 2006). One of the ways to ensure that theoretical saturation is achieved is associated with the concept of redundancy. When it is clear that new data do not add any new concepts, ideas, perspectives, and so on, it is possible to note that the data saturation is evident. It is also possible to address the third party to ensure saturation (Holloway & Galvin, 2016). For instance, a peer researcher can be asked to identify major open codes or reveal the major theoretical codes. As has been mentioned above, it is possible to use the corresponding software that will check the relevance of codes, themes and categories identified. It can also be effective to demonstrate theoretical saturation in the final paper as it may help the reader to evaluate the validity of the research. The goal of gathering data and identifying categories allows researchers to create theory from categories.
Bagnasco, A., Ghirotto, L., & Sasso, L. (2014). Theoretical sampling. Journal of Advanced Nursing, 70(11), e6-e7.
Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. Ames, IA: John Wiley & Sons.
Houghton, C., Casey, D., Shaw, D., & Murphy, K. (2013). Rigour in qualitative case-study research. Nurse Researcher, 20(4), 12-17.
Palinkas, L., Horwitz, S., Green, C., Wisdom, J., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544.
Udod, S., & Racine, L. (2017). Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses’ practice. Journal of Clinical Nursing.
Woodward, K. (2014). Being in the field: Doing research. In C. Smart, J. Hockey, & A. James (Eds.), The craft of knowledge: Experiences of living with data (pp. 149-162). New York, NY: Springer.