Corbin - & Strauss - 2014 - Basics of Qualitative Research - Techniques and Procedures For Developing Grounded Theory

CONTENTS
Acknowledgments xii
Prefare to the Second Edition xiii
SECTION I
Introduction 1
1 The Maturation of Grounded Theory 3

Janice M. Morse, Barbara J Bowers, Adele E. Clarke, Kathy
Charmaz, Juliet Corbin, and CarolineJane Porr
SECTION II
Straussian Grounded Theory 23
2 Strauss's Grounded Theory 25

Juliet Comin
3 Exemplar: The Nurse as Advoa1te: The Sessler Branden

Advocacy Theory (SBA1) 45
Pennie Sessler Branden
x Contents
SECTION Ill
Glaserian Grounded Theory 77
4 Glaserian Grounded Theory 79

Caroline Jane Porr and Phyllis Noerager Stem
5 Exemplar: Building on "Grab," Attending to "Fit," and

Being Prepared to "Modify": How Grounded Theory
"Worl<s" to Guide a Health Intervention for Abused Women 90
Judith Wuest, Marilyn Ford-Cilboe, Marilyn Merritt-Cray,
and Colleen Vivroe
SECTION IV
Dimensional Analysis 109
6 Dimensional Analysis 111

BarlJara]. Bowers and Leonard Schatzman
7 Exemplar: Developing the Green House Nursing Care

Team: Variations on Development and Implementation 130
BarlJara]. Bowers and Kimberly Nolet
SECTIONV
Constructivist Grounded Theory 151
8 The Genesis, Grounds, and Growth of Constructivist

Grounded Theory 153
KaJJ1y Charmaz
9 Exemplar: Preserving Self: Theorizing the Social and

Psychological Processes of Living With Parkinson Disease 188
Terrie Vann-Word,Janice M. Morse, and Kathy Charmaz
SECTIONVI
Situational Analysis 221
10 From Grounded Theory to Situational Analysis: What's

New? Why? How? 223
Adele E. Clarke
Contents xl
11 Exemplar: Siruating Knowledge 267

Jennifer Ruth Fosket
SECTION VII
What's Next? 287
12 The Challenges to and Furure(s) of Grounded Theory 289

Janice M. Morse, Barbara]. Bowers, Adele E. Clarke, Kathy
Channaz,Juliet Corbin, and CarolineJane Porr
Index 321
About the Authors 334
ACKNOWLEDGMENTS
Ch2pccr 5 is reprinted from Wuc,t,j.. Ford-Cilboc, M ., Mcrrict-Cr2y, M., & V=:cc, C.

(2013). Building on "gnb," attending co "fit," 2nd being prcp,rcd co "modify": How
grounded theory "works" co guide 2 health inccrvencion for 2bwcd women. In C. T.
Beck (Ed.), Routl,dR< intmu,tfo,14/ Juzndbook of quo/i141iv, nuning r,s,om, (pp. 32-46).
New Yone Roudcdge.
Ch2pccr 9 is reprinted from Va.nn-W2RI, T., Mone, J. M., & Channaz, K. (2017). Pre-
serving self. Theorizing the ,oci:,I 2nd psycholowcal processes of living with P.ul<in-
son Disc=, QU<llitotiv, H,olth Re1<ord1, 27(1), 964-9!!2. hctp,://doi.org/10.11n/
10497323tn07494. S,gc. CopyrighcO2017, Sage. Used with !X'nni»ion.
Ch2pccr 7 is reprinted from; Uowcrs, B. J., & Nolet, K. (2014) Developing chc Green
House Nuning C>re Tom: Vari2tions on development 2nd implement2cion. 77,, C,,.
onlolO}IUI, J4(Suppl. 1), S53-S64.
PREFACE TO THE SECOND EDITION
There have been m.any developments in grounded theory research methods (yes,
plural!) since the first edition of this text appc:ircd in 2009. We have wimcssed a
flurry of changes, and much has changed, been reformulated, and been published
since then. Grounded theory is now the most frequently used qualitative method
transnationally, and in fact, most researchers typically cite the type of grounded the-
ory they arc using. That is, grounded theory itself has developed subspccialtics-
submethods, perspectives, and strategics-that within each submethod give the
results a particular stance and nuances that increase the versatility and utility ofthe
o riginal grounded theory approach to qualitative analysis.
The Back Story to this Volume

On September 24, 2007, a one-day symposium was held, sponsored by the Inter-
national Institute for Qualitative Methodology (IIQM), in conjunction with the
Advances in Qualitative Methods Conference, in Banff, Alberta, Canada. For
the first time, the major methodologists of the "second generation"-'udents
of Barney Glaser and Anselm Str.tuss--g:ithered to discuss grounded theory, its
developments, controversies, and emergent fonns.
We called this symposium the "Grounded Theory Bash," using bas/, in the
celebratory sense. The workshop met all expectations: more than 200 people
attended, and true dialogue centercd on grounded theory began. The first edition
ofthis book (Morse et al., 2009) arose as a record of the pro<tedings, supplemented
with additional dialogue among the presenters.
Our initial intent was to publish the workshop papers as presented at the
Grounded Theory Bash, as well as any dialogue and discussion from the floor. But
xiv Preface to the second EdlUon
the book grew beyond th.at as, in the months following, discussions continued
and new questions arose demanding answers. Some of these later discussions and
new introductory and closing chapters were added to provide some context for
the event. Some contributors also included research exemplars of the new types
of grounded theory that h.ave emerged.
The Second Edition

The 2007 edition was the first book that brought all of the grounded theory
developments together as a class of methods. In this second edition, these n1ethods
h.ave been further illuminated. The chapters about each of the types of grounded
theory h.ave been substantively revised. In addition, in this edition, each con-
tributor has included an exemplary research article that reffccts their "style" of
grounded theory, making similarities and differences among the styles more
apparent.
The "first generation" grounded theorists were Anselm Strauss and Barney
Glaser. The "second generation" grounded theorists--:tll former students of Gla-
ser and Strauss---<ltill lead the development of gi-ounded theory. The second gen-
ernrion includes Juliet Corbin, Phyllis Nocrager Stern and Caroline Jane Porr,
Barbara J. Bowers, Kathy Charmaz, and Adele E. Clarke. Each of the second
generation authors writes a chapter here, describing their major approach to
grounded theory.
Juliet Corbin, a student and colleague of the late Anselm Strauss for 15 years,
writes Chapter 2, Strauss's Grou11dtd '/11cory. She describes the influence ofOewey
on Strauss's early years and outlines the main tenets of his method, using her own
research as a working example. The exemplar to illustrate Straussian grounded
theory is the contribution of Pennie Sessler Branden and concerns the develop-
ment of the Sessler Branden Advocacy Theory (SBAT) and explicates the role of
a nurse advocate (Chapter 3).
Glas,rian Grounded 'I'hcory, Chapter 4, is co-authored by Phyllis Nocrager
Stern and Caroline Jane Porr. We sadly note the passing of Phyllis Noer.,ger Stern
in 2014. She was a student of Barney Glaser. Caroline Jane Porr co-authored
a basic research text in Glaserian grounded theory with Phyllis (Stern & Porr,
2011) and is therefore uniquely qualified to revise and extend this chapter. The
exemplar eh.apter for the Glaserian method, Chapter 5, was written by Judith
Wuest and colleagues. Judith was a student of Phyllis Noerager Stern at Oalhou-
sie University, and grounded theory is often still disseminated in this way from
mentor to student. This chapter describes how grounded theory "works" to for-
mulate a theory of domestic partner abuse and gener.,te healthcare interventions
for abused women.
In Chapter 6, Barbara J. Bowers and Leonard Schatzman (both students of
Strauss) describe the background of dimensional analysis and its linkages to
grounded theory and its unique contribution to knowledge. The exemplar
chapter (Chapter 7), Dn,e/opi11J1 the Grun Ho1<st Nursi11J1 Car, 1;am: Variations 011
Preface to the Secon<I Edition xv
Develop1ntnt and lmplnntntatio11, coauthorcd by Barbar., J. Bowers and Kimberly

Nolet, was first published in the Gerontologist.
The "genesis, grounds and growth" of constructivist grounded theory arc
described by Kathy Charmaz in Chapter 8. She illustrates how constructivist
grounded theory diverges from Glascrian grounded theory and how the method
has evolved and matured ovcrthe past decades. In her explanation ofthe approach,
Kathy Charrnaz also provides many examples of its use. Terrie Vann-Ward then
provides an exemplar of constructivist grounded theory (Chapter 9), exploring
the ramifications of living with Parltinson's disease.
Adele E. Clarke extended grounded theory as situational analysis, derailing its
latest developments in Chapter 10, Fro1n Cro,mdtd Theory to Situational Analysis:
What's Ntw? W11y? How? Her chapter is extensive and detailed. Her former stu-
dent, Jennifer Ruth Foskct, illustrates the usefulness of Clarke's methodological
innovation for empirically studying situated knowledges by presenting her own
experiences of studying a large-scale, multi-sited clinical trial.
The final chapter, Chapter 12, offers an extended discussion of the processes
and problems that have arisen due to myths associated with the various grounded
theory methods and how to strengthen each of them. Sage advice from each
author will put both new and more experienced grounded theorists in good stead
into the future.
Additional readinF;$ in both grounded theory methods and substantive exam-
ples may be found following the biographies of the authors in the next section
of this book.
Acknowledgments
We th•nk the lntcm•tional Institute of Qualitative Methodology, University of
Alberta, for their support of the original 2007 symposium, and Mitch AUcn, Left
Coast Press, for his support in bringing the first edition to reality. We thank Hon-
nah Shakespeare, Senior Commissioning Editor al Routledge, for her support of
both editions, and arc grateful for the research assistance of Eileen Eng ond Laney
Wrutncy, University of Utah. We also thank Sage Publications, Routledge Pub-
lications, •nd Oxford Academic for their permission 10 reproduced previously
published articles. These include:
Bow=, B., & Nolet, K. (2014). Developing the Green Hou.c Nuning C:ut: Tcarn: Vari-
ations on development and implementation. 77,, Cmntol,ws~ S4 (Suppl. I), SS3-S64.
http,://doi.org/10.1093/gcront/gnt109
Fookct, J. R. (2015). Sit,.,tin.11 i.,,ow/,d.11<. In A. E. Clarke, C. Fric,c, & R. W:uhbum
(Eds.), Situotio,..t a,..Jysis in pro<ti«: Moppin.11 Jl'OU1tdtd t/i,ory (pp. 195-233). London:
Routledge.
Vann-Ward, T,Monc,J., & Clwmaz, K. (2017). Prc,crving,df:Thcorizingthesocialand
psychologjcol proc= ofliving with Parlcimon Disczc. Qw,/il4Jivc H,,,/th R.,s,ard,, 27(1),
964-982. Copyrigj,102017 (Sage publications). http,://doi.JmrLI0.I 1n1104973231n
07494. Reprinted with pcrmi>Sion.
xvi Preface to the Second Edition
Wuest,)., Ford-Gilboc, M., Mcnitt-Cr.ay, M., & V=, C. (2013). Building on "gr.ab,"
attending to "fit," and being prepared to "modify": How grounded theory "work>" to
b'Uide he.Jth interventions of abwcd women. In C. T. Beck (Ed.), Ro11tltdJI' in1,mational
J..,idbook ofq11"1i141iv, ,..,.;,.X ttscorcl, (pp. 62-76). New York: Roudcdgc.
References
Morse, J. M ., Stem. P. N., Corbin, ].. Bowers, B. J.. Cham=, K.• & Clarke, A. E.
(2009). l:>n,,/opinx x,ou11d,d t/i,ory: 111t s«ond ll''"'•ticr1. W.Jnut Creek. CA: Left Coa,t
PrcwRoudcdb"·
Stem, P. N., & Porr, C.J. (2011). Essn,tiols ofatmSiblcJ11u11ndcd t/1<ory. London: Roudcdgc.
SECTION I
Introduction
1
THE MATURATION OF GROUNDED
THEORY
Janice M. Morse, Barbara J. Bowers, Adele E. darke,
Kathy Charmaz, Juliet Corbin, and Caroline Jane Porr
Grounded theory consists of a systematic approach to inquiry for the purpose of

theory construction (Charrnaz, 2012) and is now the most frequently used qualita-
tive research method in the social sciences transnationally. It is an excellent tool for
accessing and developing knowledge most useful to the social sciences: it provides
description (as detailed as the research question demands); it enables interpreta-
tion (to demonstrate how meaning is implied and how meanings are attributed to
phenomena); it allows for individual and group experiences to be explicated and
analyzcd; and it facilitates developing the analysis conceptually and theoretically.
The syntheses and theoretical franung of individual and group experiences pemut
these models to be applied externally- that is, to be generalized and applied to
other similar settings and situations. They may also be linked to and expand other
theories. In this way, grounded theory both builds and extends knowledge.
In the process of conceptual development, grounded theory considers both
the static and the stagnant but can also encompass rapid changes that may occur
within a person, group or situation. It considers the concrete and the objective,
and importantly, it also includes the subjective and the inferential, throughout
data interpretation and abstraction. Moreover. while creating theory that fits these
data, it also enables explanation and incorporation of those data (negative cases)
that do not fit.
From this broad description, we highlight here the three most important fea-
tures that arc unique to grounded theory. Grounded theory allows for.
• Description, understanding, and analysis of both action and change

• Generalization through theoretical development and abstraction
• Broad application that is also applied, usej"I a11d widely used.
These three characteristics make grounded theory distinctly powerful.

4 Janice M. Mo™! et al.
The documentation and understanding of patterns of action and change lift

grounded theory research beyond the immediate context; abstraction, theoriz-
ing, and generalizing permit application to other contexts, situations, and groups.
Schwalbe and colleagues (2000) call such patterns "generic social processes," not
unique but repeating across a range of situations. Thus results arc not bound to
isolated individuals or groups but arc applicable to others who arc experiencing
similar events or problems.
Using grounded theory involves documenting and acknowledging the con-
texts and situatcdncss of research participants' lives and the research situation. Fur-
ther, the specific conditions under which the analysis holds must be explicated.
Thus, other researchers can test and refine a published grounded theory (sec,
for example, the elaboration of the concept of"awarcncss contexts" in Glaser &
Strauss, 1965, 1967; Mamo, 1999).
As no social science theory exists in isolation, a grounded theory may also be
linked to the concepts and theories as described by others. This feature may verify
its validity and application and vice versa. In these ways, a single grounded theory
project may be powerful, impactful, and even change the direction ofinquiry fur
beyond the usual disciplinary and contextual boundaries.
The Strategies of Grounded Theory

Grounded theory is a research method that enables the description and identifica-
tion of the significant social processes and generates concepts used to document
and explain the changes, or "what is going on" in a setting. It is the "discovery of
theory from dat:>--systcmatically obtained and analyzcd in social research" (Gla-
ser & Strauss, 1967, p. t). More recent elaborations of grounded theory (Strauss,
1987, pp. 33-34, 1993, pp. 27-29; Chamiaz, 1995, 2000, 2006, 2014a; Clarke,
2005; Clarke, Friese, & Washburn, 2015, 2018) argue that theory is "constructed"
rather than °discovercd.''
To achieve theory construction, grounded theory consists in pursuing distinct
strategics that characterize the method and permit the researcher to focus on
certain processes, verify those processes, identify negative cases, develop and link
pertinent concepts, describe the conditions involved in the transitions between
concepts, and ultimately develop a substantive theory linked both to the setting
and to others' extant research.
Initially the research process is primarily inductive, with distinctive strategics
used to facilitate the researcher's locating, identifying, and sorting relevant data,
exploring and asking questions of those data in context, and comparing and con-
trasting important features as they arc identified, in accordance with the purpose
of the study. As the researcher's understanding develops, abductivc reasoning is
then used to generate and confirm emerging concepts; the research question may
subsequently be "corrected" modified or changed to focus more precisely on
areas of interest as these arc refined.
The MaturaUon of Grounded Theory s
Abductivc reasoning involves (I) analyzing :m interesting or puzzling finding;

(2) considering all possible theoretical explanations of this finding; (3) choosing
the strongest theoretical explanation for it, which may be a new or extant theory;
and (4) testing this tcnt1tivc explanation through analyzing new data.
Codes and categories should then be developed into concepts, which arc
described, bounded and labeled. They may also be linked with concepts in
the ext:mt literature. A core category (Strauss, 1987, pp. 34--36; Glaser, 1978,
pp. 98-100) or a basic social process (BSP) (Glaser, 1978, pp. 1~101) may
be identified that may primarily hold phases of the process together. Mature
grounded theory research results arc explanatory, generalizable, and applicable
to multiple settings and situations. While Glaserian grounded theorists seek gen-
eralizations that arc abstracted from persons, time, and place, in contrast, recent
versions of grounded theory argue against erasing differences, and situatedncss,
instead of urging their specification and elaboration.
It is not the intention of this book to serve as a manual for doing grounded
theory. Even reading this book in its entirety would provide only scant infor-
mation on how to become a strong grounded theorist. Rather, grounded
theory method is first and foremost a way of thinking about and acting toward
a research question or problem (e.g., Star, 2007). The cognitive effort involves
(1) seeing, hearing, and making sense of your research problem; (2) deciding
where to conduct the study; (3) identifying the initial participants and/ or
sources of data; (4) selecting the type of data to use; and (5) determining how
to approach your data. Such efforts arc often overwhelming, yet arc only the
first steps.
Although most datl consist of interviews, grounded theorists also use other
empirical sources such as documents, written policies, Internet materials, and
visual materials. The researcher must decide how to analyzc and integrate all the
materials selected for the research project.
Remember that grounded theory is especially interested in processes and
change; start there, continually looking and listening, transcribing, coding, and
mcmoing to sec Hwhat is going on" in your data. But 0 what is going on" is not
usually obvious, superficial, or self-evident. It may well be hidden, intuitive,
and interpretative. But once you develop and conceptualize your findings and
report them to others, people will light up and say "Oh, yes! That's just how
it is!" Thus, analysis involves working consciously and deliberately, thinking
about and figuring out what your data arc telling you by using grounded theory
strategics.
What arc these significant strategics that make a grounded thtory into agrou11ded
theory? The major distinctive strategics of grounded theory arc the following:
Coding data: word by word, line by line, clump by clump, with codes that
concept11ally capture what is happening in the data-what the action is and
where it is happening.
6 Janice M. Morse et al.
Mttnoint"- the generation and recording of the codes and researcher's ideas
about them; writing about the research project and processes, done con-
currently with research design; and the gathering, coding, and analysis of
data.
·n,eoretiail sa111pli11K"- seeking further data according to the analytic 11uds of the
study, rather than the use of random selection or recruitment according to
the researcher's convenience. Pursuing theoretical sampling also involves
abductive reasoning.
Co,istm,t ,ompariso11: comparing data pieces with other relevant data pieces,
comparing new data with already constructed categories, comparing cat-
egories with other categories and new categories with those in the ext.1nt
research and theoretical literatures.
Exploration of 11tgativt <asts: the analysis of inst.1nces or participants that do not
fit the emerging pattern or theory currently "covering" or encompassing
the bulk ofthe data. Determining w/1y and how they do not fit adds analytic
depth and insight.
Saturatio11: the continuing collection and analysis of data (with continued use
of theoretical sampling) until no new characteristics of the constructed ana-
lytic categories emerge and a good range of differing examples of concepts
and phenomena is fully evident.
Developtntnt of ,odes into aitego~s, stages a11d, ultimately, into an in~rated theortti-
ail explanation linki11g these <at<gorits and pl1ases, is the goal. The verification
of categories and the development and linking of concepts through theo-
rizing arc requisite for the development ofa fully developed grou11dtd theory.
How do you know when you have finished a grounded theory research pro-
ject? The completed grounded theory must be coherent and must have "theo-
retical purpose and relevance" (Glaser & Strauss, 1967, p 48). Glaser and Strauss
(1967, p. 238; also Glaser, 1978) suggest that the completed theory must "fit,"so
that it is not "divorced from subst.1ntive areas so that one does not know how to
apply them." The theory generated must be relevant to the problem, must work
when made modifiable, and must be applied 10 adapt to changes.
The Emergence of Grounded Theory Methods

Grounded theory methods have been greatly elaborated over the last 60 years.
They arc best described by their shared objective of constructing fresh conceptual
analyses that offer abstract understandings of the empirical problem or phenom-
enon under study.
The Origins of Grounded Theory

The originality of the contribution of Barney Glaser and Anselm Strauss (1967)
in their development of grounded theory cannot be overestimated (Charmaz,
The Maturauon of Grounded Theory 7
2008, 2014b, p. 1080}. The Discov,ry book was the lint manifesto for qualit:11ive
inquiry in a series that hos Jed to the renaissance of qualitative inquiry we sec
today. Jn 1960, Srrauss was recruited by University of California, San Francisco
(UCSF) Dean of Nursing Helen Nahm to train nursing faculty and students in
research methods, offer courses on social aspects of health and illness, and help
organize doctoral programs. Srrauss was soon joined by other sociologists, includ-
ing Virginia Olesen, Fred Davis, Barney Closer, Leonard Schatzman, and Egon
Bitmer. They obtained several NIH grants to examine the socialization of nurs-
ing students and created a research unit at the School of Nursing, UCSF. The
Doctoral Program in Sociology was established in 1%8, including students from
both nursing and sociology (Schwartz, 2009). The unit, organized as the Depart-
ment of Social and Bchavioral Sciences in 1972, was distinguished by intense
faculty mentorship of students, Strauss's leadership of team research (including
co-authorship), and intense productivity. From this small program, an exception-
ally innovative approach to qualitative inquiry was developed into a method that
became highly applicable across social science disciplines and across professional
rraining and is now used globally.
The Landscape of Grounded Theory Methods

The varied range of grounded theory literature that hos emerged since the Dis-
covtry book in I %7 can be described as the /0111/scap, ofgrou11ded theory m,tl,ods.
We have divided it into four segments: (I} books authored by the originators of
grounded theory, their collaborators, and their students--both research mono-
graphs and methods texts; (2) methods texts authored by other researchers expli-
cating grounded theory methods; {3} articles and handbooks addressing special
topics within grounded theory methods; and (4) articles and chapters that sum-
marize, clarify, and simplify grounded theory methods (sec Figure 1.1).
1. AulhONld by Ulo origlnato~ of grounded

u,eo,y and their students:
a. Methods texts
b. Texts report;ng on $<lb$tarltive research
mustrating the use of grounded thoofy
! l !
2. Me1hods texts 3. Ar1Jcles and handbook$ 4. Art<:~ end boolc
authored by olhet" that edd'"4 epecfflc chapters that aummarlz•,
researchers explk:aU~ topics within gtounded clarify and/o, slmplily
grounded theo<y methods theory methods g,ouoded theory methods
FIGURE 1.1 The Landscipe ofCroundod Thoory Methods

Texts Authored by the Originators of Grounded Theory

and Their Students
Initially Barney Glaser and Anselm SIT3uss, along with a doctoral nursing student,
Jeanne Quint (later Benoliel), commenced a research study of dying in hospi-
t>.ls. This resulted in several rcs=ch monographs: Awareness of Dying (Glaser &
SIT3uss, 1965), A Timt for Dying (Glaser & SIT3uss, 1968), and ·n ,t Nurst and the
Dyillg Patinit (Quint, 1967) (see Table 1.1).
T he first grounded theory methods book emerged from this collabora-
tion: Glaser and Strauss's (1967) ·11,e Discovery of Groundtd 'I11tory: St,altgks for
TABLE 1.1 A List of Grounded Theory Methods Texts (Column A) and Substantive
Research Monographs (Column B) Published by the Different Gbscr and
St111= Rc,car<:h Group>, 1964-Prcocnt'
A. Origi,10/ M<1Ws "lixrs B. R,s,,mh MonOJ('aphs
Do~ Author(s) 1i1k o.,, Aul/10,(s) 1i1t,
1967 Gbscr& TI1t Dis<OfltT)' of 1964 Strauss, Psyd,i,,1ri,

St111 .... Cr,nrndtd Tlrto,y: Schat:znun, /d,o/Oj/ia and
St,autits fa, Bucher, lnstitutio11s
Quali1ati11t Ehrlich &
Ra,orrh Sabshin
1973 Schat:znun & Fitld Rtst,mh: 1965 Gbscr& Awam,,., of
St111= Strat,xj,s for a St111uss DyinJI
No111,al S«io/0/()'
1978 Gbscr 'l11ton:lital 1967 Quint "11st Nurst a11d
Snisitivity: lht Dyi"!(
Advan«s ;,, tl~ P4timt
Mtlhodo/OflY of
Croundtd T/r,o,y
1986 Chcnitz &. From Proai,~ to 1970 Gbscr& AnJ1Uish: A Cut
Swanson Cr,nrndtd Tlrto,y: St111= Hislo,y of
Qualitativt a Dyi11J1
Ra,arrh in Nursit1t Trojtdo,y
1987 St111uss Qualilotiw A11alysis 1971 Gbscr& S1a1,u P ~
far S«ial Sat1~is/S St111uss
1990 St111uss & &,ia of Qualitotivt 1971 Gbscr &ptrts Vm,u
Corbin R<Statm: Lzyrr,,,.,
Croundtd Tlr,o,y A Study of lht
Prottdur,s and Paisy mu/ 1/1t
Ttdi,,iques SJ1b«mlrador
1990 Corbin& Cr,n1ndtd 1/1to,y 1975 St111uss &. C/,ronit il/n,ss
St111= Tt:H4flll: Gbscr a"d tl~ qmJ/ity
Pro«durrs, '41'UmS, of lift
and n,a/uati~
crikria.
The MaturaUon of Grounded Theory 9
A. OriJ1i,,a/ M<11"'4s Texts B. Ra,arm Morwf(faplrs

Aut/,o,(s) T,1/, Author(,) 1itk
Dou:
1992 Cwcr Basks of Crou,ui,d
°"''
19n Fagcrluugh & Politia of Pai11
·11,,ory Analysis: S1nws M(l1~1mt:
En,,_ vs. St,iff-Paomt
r-om,,x lntmxtior,
19<)4 Slnws& Cround,d t/i,ory
Corbin n,ct/wdolOJIY: An
ovm,kw
1998 Sa,..,. & &it, cfQralif41iw 1980 Cwcr& 7;,,,,for Dyinj/
Corbin Res,a,d,: Cn,wui,d S1nu.n
11,,o,y/>roadu,u
mu/ Ttdllliqua
(2nd ed.)
2001 Cwcr Tit, J/!Oun<kd 1983 Fagcrhaugh & Politia of Pai11
t/r,ory pmptttiw: Stnuss Mat14tnJiml:
0,1,aptualization Steff-Patimt
,01,traskd ivit/1 /11/trattion
k«riptfon
2003 Cwcr 77,, J1ro11n,kd t/r,ory 1984 S/ro,w et al. Om»UC illn<u
pmp,ttivt II: (1984) m,d tht quality
Dtsaiptiou 1s oflife
tmwd,linJI of
Jl'Ofllui,d thtory
=tlwdolOJIY.
2005 Cwcr 77,, Jl'Ol"'<kd tlr,ory 1987 Fagcrluugh HuMd.s in
pmp,ttiv, Ill: Hotpital Gm:
11~orrtital ,odfox EnsurinJI PalimJ
Saftty
2005 Clarice Situational A,udysis: 1989 Star Regions of tht
Cro,1ndtd Mind: Btain
11i,ory Afitr lht R.a<art/1 and
Postmodmr T11m ,,,, Qut,t
for Samti{ll
Crtainty
2006 Chamuz Oms/rudinj/ 1991 Maines (Ed.) Soda/
C1'17U1ukd 11r,ory: D,xanization
A Pr,,a;,,,J and Soda/
Cuidt '11110UJII, />,,,,a,: Essays
QialitaJiw Analysis ;,. rlonor<f
Am,lnr Strmus
2007 Glaser Doi,ig Fonnal 1991 Charmaz C-1Doys, Bad
Cro,1ndtd 11,,ory: Doys: 71,,
A Propo<al Stlfin Cliro1Ul
Illness and
"limt
(Omtin11<d)
TABLE 1.1 (Conrinucd)
A. Origj,,.J Mtdwds Tetts B. R,s,,um MonOJlT•phs

Dok Author(s) "fi1k Dolt Aul/10,(s) 1i1k
2007 Bryant & Hondbookof 1993 Gwer(Ed.) Exo1t1p/,s of

Ch:urnu C,"""dtd 11w,,y Croundtd
(Eds.) 11,,o,y:
A Rtodtr
2008 Corbin & &sia of QuoliloJiV< 1993 Stnws Co,,ti,ruol
Straw. R..torrl, {3rd ed.) Ptnnutations
of Adior,
2009 Mor:scet:aJ.0,,,,/opi,,g 1994 Gwer(Ed.) Mor, Croundtd
Crorrndtd 11rto,y: 11rto,y
•n,,&,ond MtthodolOJlY:
Cn1«a1ion A R,odtr
2011 Stem & Pore Essmtiols ofo,msiblt 1995a, Cwer(ed.) Ct01,ndtd Thto,y
Jl"'frndtd 1/1to,y. 1995b 1984-1994.
Vols. 1 oruJ 2
2014a Chan,w: ConslNdi~, 1997 Stnw.& Ct01,ndtd 17,,o,y
Crorrndtd 11,,o,y Corbin in Pradi«
(2nded.) (Eds.)
2014 Gl=r Applyill/1 Crou,ultd 1998 Clarke Dis,iplininJI R,.
111to,y: produdior,: 77"
A N<J1ltdtd Amni<on /Jft
Op1ion S,itn(,s
01td "tht
Produditm
ofSec"
2015 Corbin & &sia of Quolilalive 2014 Clarke & Ct01,ndtd
Stnw. R..tortl, (4th ed.) Chamuz 11,,o,y ond
(Eds.) Situ.aliotuJI
Anolysis
(4 vob.)
2015 Clarke et :,I. Sit11oliot1al Analysis 2015 Clarke et :,I. s;,..,;.,..,
(Eds.) in Pradi«: (Eds.) Analysis
MappinJI Wi1/, in Prattia:
Crorrndtd 11rto,y MappirlJ(
R..torrl, Wilh
Croundtd
"flrto,y
2015 Gwer(Ed.) a,001;,,g
Croundtd
·11,,0,y: A CT
Rtadtr of Exp,rt
Advitr
/)at, A utlw,(s) Oat, 1itl,
2016 Closer Cround,d n~ry

Pmpmiw:
Its 0rixi11 o,ul
Crm"1/1
2018 Clarice et al. Si111atio,ia/ A,ialysis:
Crtn1nd,d
11i,ory Afi,r th,
lntnprrtive li,m
2019 Bryant & 1k So~ Handbook
Clumw: ofCurrrnl
(Eds.) 0,,,,/opmmts i11
Crtnrnd,d Th,ory
(2nd ed.)
Note Ans,lm S1nws died in 1996.
Qualitative Researdt. This text became one of the most influential and highly cited
books in qualitative research and remains in print today. The book directly chal-
lenged the then dominant "theory-methods package" {Star, 1989) of positivism
and quantitative survey research in the U.S. Jntcreslingly, the Discovery book was
Glaser and Strauss's final methods publication together.
Jn tandem with their substantive research, Glaser and Strauss, and also
Leonard Schatzman, continued their interests in methodological development.
Jn the collaborative and interactive research unit al UCSF, "the discovery of
grounded theory" was applied as various research programs addressed different
topics. Substantive research publications that used grounded theory began to
emerge.
New methods texts were also written from within the research unit at UCSF,
revising, expanding, and modifying the 1967 Distovery text. Schatzman and
Strauss offered Field Rtstarc/,: Stratt11ies for a Natural SodolOJIY in 1973; Glaser
published T/rtoretical Sensitivity in 1978; and Strauss published Qualitative Analy-
sis for Social Scientists in 1987. Both through these methods texts and through
an array of research publications, the sociology program Strauss established at
USCF has an unprecedented influence on social science communities. Col-
league Virginia Olesen later commented, "J like 10 refer 10 this program as 'The
mouse that roared.' This has always been a tiny program-never more than six
or seven faculty. But my gosh, the contributions" {Virginia Olesen, cited in
Schwanz, 2009).
Using symbolic interactionist theory and grounded theory method, research
that emanated from this cenlcr provided the foundations of social scientific studies
12 fanlce M. Morse et al.
of health and illness. Over the years, at UCSF, these areas developed from the
early studies of dying to examining nursing work to studies of hospitals, patient
work, studies of women and health, aging and health, chronic illness, and health
policy. Emphasis was on publication: doctoral students were encouraged to pub-
lish their dissertations as books or journal articles. Strauss, in particular, formed
rcscorch teams that included his students and former students as co-authors. (Sec,
for example, the ground-breaking book by Strauss, Fagerhaugh, Suczek, & Wie-
ner (1984/1997), The Seda/ Org011izalion of Medical Worl<.) These iterations of
methods and substantive texts :ire detailed in Table 1. 1.
The methods-focused collaboration between Barney Glaser and Anselm
Strauss ended after the Discovery text. T\\O modes of doing grounded theory
rcscorch gradually emerged, referred to as "Glaserian grounded theory" and
"Straussian grounded theory" (Stem, 1994), something that was not surprising.
Glaser and Strauss had both acquired sociology degrees but from very different
academic institutions representing diverse approaches to social science research.
It was the synergy of the two minds focused on understanding the dying process
in California hospitals that resulted in the grounded theory method. As Glaser
learned, under Straus' mentorship, how written text, documents, and memoirs
could serve as data and the basis for theory generation (as opposed to relying on
abstract theoretical systems), Strauss learned from Glaser the line-by-line com-
parison technique that enabled Strauss to refine the process necessary for data
abstraction and emergence of concepts. However, over time Strauss, steeped in
academia, contributed to the evolution of grounded theory about which Glaser,
who had left academia, perceived as a departure from, and an erosion of, the
original method. The basic differences between Glaser and Strauss were described
by Stem (1994), herself a Glaserian researcher.
Glaser and Strauss :ire two brilliant men and both do important work, but
they go about it in different ways. The crux of the dichotomy is, I think,
that Strauss, as he examines the data, stops at each word to ask, "What if?"
Glaser keeps his attention focused on the data and asks, "What do we have
here?" ... Glaser focuses his attention on the data to allow the data to tell
their own story.
(pp. 220-221)
Glaser left UCSF in the late 1970s, setting up the Grounded Theory Institute in
nearby Marin. He has continued to offer grounded theory workshops and present
internationally. Strauss remained on the UCSF faculty until retiring in 1987, then
serving as professor emeritus until his death in 1996. In 1989, his fomier student
Adele E. Clarke was hired into the UCSF Doctoral Program in Sociology in the
School of Nursing.
Both Glaser and Strauss continued their mentorship ofstudents and collab-
orations with their former students. Significantly, their differing perspectives
on grounded theory were then also incorporated into their students' method-
ological approaches as they learned and used grounded theory. As these for-
mer students became researchers in their own right, they adopted, developed,
and adapted some (or all) of the perspectives and strategics of Glaser, Strauss,
and/or Schatzman. For example, an important early nursing research text
was written by students from Glaser and Strauss's seminars. Edited by Chcn-
itz and Swanson (1986), it contained specific details about coding, mcmo-
ing, developing categories, and abstracting data that these former students of
the "first generation" grounded theorists perceived were poorly described in
other texts.
Over time, further changes in grounded theory have occurred. Several students
of Glaser and/or Strauss have emerged as leading methodologists in grounded
theory, with their own expertise, interests, cadres of students, and colleagues.
These researchers were referred to as the "Second Generation of Grounded The-
orists" in the first edition of this book (Morse et al., 2009). They arc developing
new and innovative grounded theory methods and expanding the repertoire of
grounded theory.
Thus, in this text, we follow the development of Juliet Corbin's continued
collaboration with Anselm Strauss, clarifying Straussian grounded theory (1990-
2015); Barbara J. Bowers' collaboration with Leonard Scha12rnan's dimensional
analysis (1987-2009); Kathy Charrnaz's further integration of pragmatism and
constructivism with grounded theory (2000-present); and Adele E. Clarke's
development of situational analysis (200>-present), more recently in collabora-
tion with Carrie Friese and Rachel Washburn (2007-present). Glaser has contin-
ued to publish texts explicating grounded theory, while at the same time, Phyllis
Noeragcr Stem (later in collaboration with Caroline Jane Porr) further developed
Glaserian grounded theory (I 994-201 I).
Figure 1.2 offers a broad overview of these initial developments in grounded
theory and provides an interesting landscape of works that Glaser and Strauss
provoked.
Later Uterature ContribuUng to Glaser's and/or Strauss's

Grounded Theory TradiUons
Of importance, over the years other grounded theory texts emerged that were
not written by authors who were a part of the original UCSF Center. These
authors included attendees at the numerous workshops, others who had carefully
studied available articles and texts, and researchers who had conducted grounded
theory studies. The first of these texts was written in Great Britain (Dey, 1999),
and this has been followed internationally by many others internationally. As
grounded theory became increasingly utilized in other disciplines, books were
written specifically for those disciplines, using appropriate research examples (sec
Table 1.2).
14 1anlce M. Morse et al.
Cllao«&S1roul0
The Olacov.ry of Grounded
Thoo,y (1987)
I I
I Schatzman (1991) Strause

I Glastr
I
I
Schalzffl8n Dimensional
I I
Anolytls GlaNrlan GT
StrauNlen GT
Sdlatzman& SIJauss (1W3) Thtoretieal Sensltivi1y (1978)
OW/d4r~ AMJys;s (1987)
Bow.,.I1987. 2009) Suauss & COrt>in (1990-1998) 1992-2018
caron& -12000> Cort>in &Strouss (2008·20IS) S1ern (1994)
-&Sdlalzman(200G) Stem & Poo (2011)
Koolsetal (11196)
I
I Ctari<♦
I I Charmaz
I
I I
Sltu.atJonal Anatyals
Cont11'Vct"'11t OT
Clatl<e (20t)S·)
Clal'ke, Fries,o & Wa&hbum - Cham>az tz()06-2014)
B,yanr &Chatmaz (2007. 20171
(2015. 2017)
FIGURE 1.2 The Maturation of Grounded Theory Methods
TABLE 1.2 Examples ofTexts Explicating Grounded Theory u a Method by Authors Who
Were Not Mcmbcn of the lnitw Grounded Theory Rc,carch Collabontion
at UCSF, Genenl and Discipline Specific
Cmnal C,ound,d 11u:ory Tcxts DisapN,u:-Sp,afr Cround,d 11,,ory T cxts

y,,,,. Authors T,1/, Y,cr Aullum 1itl,
1999 Dey Crou,u/inJI Cround,d 2001 Locke Crourukd

11u:ory: Cuid,lin,sfar 11m,ry in
Qu,,litativ, l,,quiry ManaJl<fflffll
R,s,a,d,
2011 Birl<s&Mills Crou,u/,d Th,ory: 2001 Schreiber& UsinJI
A Pradital Cuid, Stem C,ound,d
~11,~<>ry in
Nursin_x
2011 Martin & Crou,,d,d 11,,ory: Th, 2002 Goulding Cround<d
Cynnild Pl,i/osopliy, M,i!wd, and 11i,ory:
Worn ef Bam,y Clas,, A Pranital
Cuid,far
MaM~I,
B"sinas
mu/ Marlw
R<s,arrhm
The MaturaUon of Grounded Theory 1S
CmnoJ Cround,d Tirco,y 1cas DiJ<ipNt1t-Sprofa C=n<kd 1'ko,y 1C<t<

y,.,. Author, 1itk Yau Authors
0
Ti1k
2013 Urquhart Crou,ultd Tirco,yfor 2009 An::inia.n. Cl=rian

Quali1a1i11< &s<D1Ch: Ci,kc & Croundtd
A PrlJ(U(Jl/ Cnidt Cone 17,,o,yin
Nursi,~
Ra~ardt:
Trw1;,,_,
E,,.,_
2014 Gibson & R,diKovm1111 Cronnikd 2012 Oktay Cround,d
Hartman 11i,o,y 17,,o,y
(PO<ktt
Cuide to
S«ial WCHI:
&.its)
2015 Birks & Mills Crou,ultd Tii,o,y: 2015 O"Connor S«ial WCHI:
A Prati@/ Cnid, O,.,utn1divi.st
(2nd ed.) Rtstarm
2016 Hanzel Tu Cronnd,d T yp, of 2016 Padgett Qi,alitativ,
S«iol,wcal "f11to,y Mtthods in
Soaal WCHI:
Ra,arm
2017 Bryant Crou,ultd Tii,o,y and
Cromukd ·11r~oriz i11,R:
PrtJK11ialism in ~arrlt
Pra<ii<t
2017 Holton& Classi, Cro11nd,d
W:wh "l1i,o,y: ApplicaJions
W,1/1 QualilaJiv, and
Qua11tita1i~ Data
2018 Aick Doin1111rou1ultd 1/1<0,y.
2019 Bryant Varictia of Croundtd
111<0,y
With these elabor:11ions of grounded theory, changes inevitably occurred.

In 1996, a special issue of Qualitative Health Research (Vol. 3, No. 3) featured
Kathryn May as guest editor. In reviewing grounded theory's contributions to
nursing knowledge, Benoliel (1996) noted that observational methods, initially
integral to grounded theory, were now seldom used in nursing. Moreover,
grounded theory data were originally primarily obtained from open-ended
interviews and were now often derived from guided or semi-structured
interviews.
Short Articles and Handbook Chapters Addressing Specific

Topics Within Grounded Theory
The third type of literature we consider here consists of articles and book chap-
ters that review, explain, interpret. and apply established grounded theory strate-
gics. By strallJl}ts, we mean particular actions (or components of the method)
that researchers use to facilitate the conduct of grounded theory research. These
articles nuy address such topics as theoretical sampling, coding and mcmoing,
constant comparison, and so forth.
This literature began to emerge from the originators themselves with the
introduction of qualitative research handbooks. In 1994, Denzin and Lincoln's
pioneering Ha,idbo,,k of Qualitalive Resear(/1 contained a chapter titled "Grounded
Theory Methodology: An Overview" written by Strauss and Corbin (pp. 273-
285). Since then, nuny articles have been written, addressing such topics as theo-
retical sampling, interviewing, coding, mcmoing, and so forth. T\\O ambitious
Grounded "I1ttory Hat1dbooks appeared (in 2007 and 2019), both edited by Antony
Bryant and Kathy Charmaz. They provide rich arrays of articles on special topics
in grounded theory methods, but their intent is not to teach grounded theory.
Therefore, these articles and handbooks do not replace the text-length books
written by the originators of grounded theory or other authors. Instead they offer
excellent supplementary materials that endorse or explain various aspects and
strategics of grounded theory research. In short, they arc intended to supplement
methodological texts, not to replace them.
Articles and Book Chapters That Summarize, Clarify,

and Simplify Grounded Theory Methods
T he last grouping of the grounded theory literature includes articles and chapters
that summarize and seek to clarify and/or simplify grounded theory methods
for researchers who have little or no knowledge of how to do grounded theory
research. These authors do intend to provide basic information about how to do
grounded theory work. Unfortunately, too often these arc the only resources used
by some researchers who want to dodge reading entire original texts. Sadly, this
information is typically applied in a stepwise fashion, leading to results that arc
simplistic and obvious, offering very poor and inadequate examples of grounded
theory research.
Other sources for abbreviated grounded theory methods include the use of
methods section of research articles that used grounded theory. These have also
been used by subsequent researchers. Alternatively, the researcher nuy rely on a
single chapter of a grounded theory text and provide a drastically limited under-
standing of the method in the methods section.
The major problem here is that such abbreviated sources and descriptions
of methods do not effectively communicate the nuances of grounded theory
methods, much less dcmonsl'l':llc the researcher's competence in its use. Research
emanating from the briefest instructions is inevitibly lacking in description, depth,
and 1heorctic3.I development. Study samples arc frequently inadequate, and the
research typically offers little beyond an isolated and rather obvious description
of everyday events, a few themes, or a typology. Integrated conceptual grounded
theorizing is generally wholly absent.
Perhaps the first example ofthis literature was a detailed book review ofClascr
and Strauss's Dislov,ry of Grotmdd Thtory, published by Struttcl (1968) in a nursing
journal, NursinJI Rtstart/1. The author's intention in the review was to bring the
interesting and innovative new sl'l':ltcgies of the grounded theory method to the
attention of nurse researchers. But sadly. the article was used as a resource per sc for
the conduct of grounded theory research. Moreover, 1hc article is cited in Cooglc
Scholar as though it was a direct resource for conducting the research, with Claser
and Strauss actually listed as co-authors of the article along with Struttcl!
Because the interpretation of data is a key research process in grounded theory
work, inadequacy in this skill is not superficially evident without deep knowl-
edge ofbo1h the methodological expertise and the receptivity of insight into the
process of inquiry. Both qualititivc craft 011d theoretical thinking must be present.
These require time, thoughtful inquiry, a deep understanding of the data, and
1hc patience to carefully conceptualize and theorize those data to produce and
document an integrated conceptual grounded theory. As with most if not all
research methods today (e.g., Lynch, 2012), there arc many problematic examples
ofgrounded theory research in print. r,1/e discuss some of the related issues in the
concluding chapter of this volume.)
The Global Dissemination of Grounded Theory Methods

Today, grounded theory articles and books also appear in foreign journals and in
many other languages across the social science and professions disciplines, indicat-
ing its global spread and international influence. It is widely accepted as a strong
qualitative method, and again, it is the most commonly used qualitative method.
Translations of texts by the originators of grounded theory arc widely available
and arc listed al lhc end of this book.
The Internet has also greatly assisted international dissemination. Both Clascr
and Charmaz have several video presentations from the UK available on You-
Tubc, 1 and Clarke offers one from Ccrmany (with her presentation in English).2
We urge you to read, and be guided by. the texts and articles written by lhc origi-
nators of grounded theory and their "second generation" students.
Significantly, the chapters in this book do not rcplicalc the original grounded
theory as described in 1967 but reflect the varied developments in quali1a1ive
research methods as now practiced in 2020. These developments have come about
because of these scholars' responsiveness to many difficult challenges and changes
in the broader landscape of social science research, especially qualitative inquiry,
!T:lnsnatiorully over recent yem. These include C hamuz's (2000, 2006, 2014a)
deep eng:igement with pragmatist constructivism, Cotbin's (Corbin & S!T:luss,
2008, 2015) explications ofStraussian grounded theory, and Clarke's (2003, 2005;
C larice et al. 2015, 2018) incorporation of discourse materials (narrative, visual,
and historical) as data sources in addition to interviews and documents, along
with new theoretical perspectives and situational mapping s!T:ltegies. This volume
also offers clarifications ofSchatzman's dimensional analysis by Bowers and con-
tinuations of the work of Stem with Glaserian grounded theory by Porr.
Notes
1. Videos 6-om the UK, avaibbleon YouTubc:
Clasn-: "The literarurc review in gJ<>undcd theory."
www.yourubc.com/watch?v=7Sl kJOk3yHk&list=PLNCas4ucmlWPODcKroQJ
POL_FIQjv.zFmp&indcx=2&t=Os
''.Jargonizing-: Using the gJOUndcd theory vocabulary."
www.yourubc.com/watch?v=r6RpQclvS1k&lin=PLNCas4ucrnlWPDDcKroQJ
POL_FIQjv.zFmp&index=2
'"Higl, impact dependent vari.bb."
www.yourubc.com/watch?v=WwR9K17kulO&li>t= PLNCas4ucmlWPDDcKroQJ
POL_ FIQjv.zFmp&index=3
"Impact variable,: Grounded theory is a ,rudy of a conccp~"
www.yourubc.com/watch?v= OcpxaLQDnLk&list=PLNCas4ucmlWPDDcKr6QJ
POL_FIQjv.zFmp&index=4
C/u,m,az: "Description ofgJ<>Unded theory." www.yourubc.com/watch?v=&-PHU
S2qEE
"A discw,ion with Kathy Chamuz on gJ<>unded theory" (interviewed by Graham
G ibbs).
www.yourubc.com/watch?v=D5AHmHQS6WQ
''The power and potential ofgJ<>unded theory" (keynote for the British Sociological
A>sociation, 2013). www.yourubc.com/watch?v=zY1h3387txo
2. Videos avail.able on YouTubc:
Clark,: Video of talk tided "Qualitative Rc,carch and Postrnodemism: The Exam-
ple, of Grounded Theory and Situational Analy,is," given in EnJl)i:lh by Adele E. Cbrke
at the Berlin Qualitative Wooohops in 2011. There is a long introduction in German by
Prof. Dr. Reiner Keller (Univcr,ity of Aug,bu'l!), who arranged for the German traru-
lation of Situalionol Anoly,is: C,01,n,kd Th,ory Afur ,1,, Postmodtm Tum (Cbrke, 2012).
www.bcrliner-methodcntrdfcn.de/ archiv/vidco/closinglccturc_201 1/ index.html
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https://doi.org/10.4135/9781526402196
SECTION II
Straussian Grounded
Theory
2
STRAUSS'S GROUNDED THEORY
Juliet Corbin
I was asked to write about Anselm Strauss's version of grounded theory in this
chapter. What qualifies me to attempt this task? I worked with Dr. Strauss for
15 years, first as a postdoctoral student and then as a co-researcher. We met twice
a week at coffee shops in and around San Francisco or at the University of Cali-
fornia, San Francisco. In our working sessions we compared notes, shared memos,
discussed the progress ofour research projects, and analyzcd data. We talked about
methodology. In the later years of Dr. Strauss's life I often sat in his doctora.1
seminars. Together we held research sessions for students no longer attending
university classes but who were still working on their dissertations. Over the years
l leamed a lot about how his mind worked. I also grew as a researcher.
I have fond memories of those times and cherish the opportunity 1 was given.
As such, I take the task of writing his chapter seriously. Although I find it is dif-
ficult to enter the mind of another person, I will try to represent Dr. Strauss',
approach to analysis. However, before going into the details of his approach it is
important to examine Anselm's worldview and philosophical beliefs. These not
only formed the foundation for how he lived his life but also how he thought
about and did research .
Background Years
Anselm Strauss's worldview had its foundation in his early college years. He com-
pleted his undergraduate studies at the University of Virginia {1935-1939). There
he was introduced to the pragmatist philosophers such as John Dewey (1929,
1934, 1938), William Jan1es {1968), and C. S. Peirce {1877). Although all were
important in shaping Strauss's worldview, the philosopher that I believe had the
greatest influence upon him was John Dewey. The following arc just some of
26 JuUet Corbin
features of Dcwcy's philosophy that stand out as having a significant impact on

Strauss's approach to research. These arc:
1. The individual is a thoughtful being who responds to events and problems

through reflective action based on reason and w ith the desire of achieving
certain outcomes.
2. There is no split between thinking and action, both being part of a continu-
ous stream of activity.
3. Thought and action occur within a context of multiple and varied internal
(personal) and external conditions.
4. As conditions change, action has to be adjusted to respond to that change.
5. Action has consequences, and these arc taken into account when making
those adj usm,cnts.
After graduating from the University of Virginia in 1939, Strauss attended

graduate school in the Deparm1cnt of Sociology at the University of Chicago,
receiving his MA in sociology in 1942 and his PhD in 1945. There he encoun-
tered men such as WiUiam I. Thomas (1966), Robert Park (1967), Herbert
Blumer (1969), and Everett Hughes (1971). Strauss says he was dr.iwn to the
University of Chicago by the rcfonnist mentality of the faculty and their aim of
making research more relevant to the problems of the community. This meant
leaving the halls of the university and going out into the "field," to hear and sec
what is "going on." Also in Chicago, Strauss was introduced to the writings of
George Herbert Mead (1956, 1959, 1962, 1972), another pragmatist (Strauss,
1991) whose views on the development ofself offered an alternative to the deter-
ministic way of thinking of development that was prevalent at the time. Among
the many of Mead's notions adopted by Strauss were:
1. The role of interaction within self and with others in the development ofthe
self.
2. Persons act on the basis ofthe meanings that they give to events and problems.
3. A broad view of time that brings past and future together into present action/
interaction.
Herbert Blumer (1969) also had a great influence on Strauss's thinking. Blumer
took Mead's idea of interaction further by emphasizing its symbolic nature. That
is, concepts serve as the basis for interaction among and between persons. At the
same time it can be said that the shared meaning of concepts is derived through
and from interaction. For example, a chair is a symbol or concept that describes
what persons sit on. When someone speaks of a chair, other persons have some
conception ofwhat the object is. At the same time, the very fact th•t persons have
come to call what one sits on • "ch•ir" has to come about through interaction.
Having symbols or concepts is important bec•use these give persons common
Strauss's Grounded Theo,y 27
ways of thinking 3nd 13llcing 3bout issues and problems 3nd m3king use of objects.
Although Blwner 3rticulated the need for greater development and refinement of
concepts, he never developed 3 methodology for doing so. This 13Sk was left to
other researchers to accomplish.
By the time Strauss completed his cduC3tion, one might say th3t he carried
within him two major philosophic traditions, pragmatism and intcractionism. He
had developed a reformist mcnt31ity and wanted to spend his life doing research-
not the type of research th3t was based on preconceived theories or completed in
3 laboratory, but research based on dat3 gathered in the field and aimed at devel-
oping theory. It is interesting to note that it was not until almost the end of his
life t.h3t Strauss fully articulated his worldvicw, published in the book Co11ti11ual
Ptnnutatio,is of Allio11 (1993).
A Synopsis of Strauss's Method

Because this is not a mcthodologiC3l textbook but an overview of the vari-
ous approaches to doing grounded theory, it is impossible to provide a detailed
description ofStrauss's method (sec Strauss, 1987). The following statements pro-
vide a synopsis of the method and arc adapted from Basics of Qualitative Resea"h
(Corbin & Strauss, 2015, pp. 216--219).
I. Rtstar(h using this method involves going out into the field and obtaining
data by means of observations, interviews, videos, and other similar means.
2. Data arc broken down, examined closely, and given conceptual names based
on participants' implied meanin~.
3. Concepts serve as the major foundation or structure of the theory grounding
it.
4. Strauss did not advocate beginning the research with prcidcntified concepts
or a theoretical framework. Rather concepts a11d t/1tory are developed over the
course of the research.
5. Analyzing data for concepts is called a,di11g.
6. Coding is an i11terprttive pr«~s. It involves an interaction between the
researcher and the data; therefore the concepts derived arc a combination of
participants' data and researchers' ability to discern the meaning implied in
those data.
7. Coding for concepts requires thinking abstracdy. It is not just taking a phrase
or section of "raw" data and using the phrase as a label to describe some-
thing. Rather, coding requires that a rescarchcr carefully scrutinize, check,
and recheck data for meaning. Sometimes participants provide the researcher
with a useful concept. These arc called "in vivo concepts." For example, if
a person who was is injured in an accident st.ites that he or she is making a
"comeback," the word "comeback" can be a useful concept for describing
the hard work involved in regaining some degree of functional ability.
28 Juliet Corbin
8. When an:tlyzing data or coding, the researcher makes use of two basic ana-
lytic strategics. These arc making comparisotis and asking q11tstions of tl~ data.
9. Making compariso,is involves taking two or more sections of data and compar-
ing them for similarities and differences at a conccptu:tl level. That is, it is
not so much that the specifics of data have to be the same, but if one thinks
about the data at an abstract level, the idea contained within them is similar.
What the researcher is actu:tlly comparing arc two things at a property and
dimcnsion:tl level. Take for example a flower. An object is classified as a
flower because of its properties such as size, shape, the presence of pct:tls and
a ccnter, and odor. If coming across another object that might be called a
flower, a person can compare the two flowers according to the same proper-
ties such as size, shape, and so on. If the next object being examined has dif-
ferent properties in terms of color, size, and shape and lacks pet:tls or a ccnter,
it is given a different conceptual nan1c, perhaps a tree.
10. As indicated, making comparisons is also applied to data to differentiate them
but also to develop data given the same conccptu:tl name in order to develop
its properties and dimensions. For example, two flowers of the same and dif-
ferent species can be compared to sec how they differ in tcm,s of their prop-
erties such as shape, color, odor, and type of stem. The different dimensional
ranges of properties enable further classification of flowers and show their
variation.
11. AskitlJI q1ttstions is another way of trying to elicit meaning implied in data.
All kinds of questions can be asked. One of the most common is "What is
going on here?" To open up data, especially in the early phases of analysis,
the more questions a researcher asks, the more likely he or she is to generate
different mc."lnings. These arc then either verified against data or discarded if
the mc."lnings don't apply.
12. AskitlJI q11estions not only helps keep the mind open to :tltcmativc interpreta-
tions but also enables rcsc."lrchers to think about where to go next to gather
data in order to verify interpretations and further develop properties and
dimensions of concepts. Going back to the field to gather more data based
on the results of analysis is a process referred to as "thcorctic:tl sampling."
13. There arc times when the meaning of data is not evident even after making
careful comparisons and asking a lot of questions. Perhaps the researcher
is being blocked by profcssion:tl and personal biases or is having difficulty
identifying properties and dimensions of a concept. Sometimes a researcher
discovers upon further analysis that what he or she thought "what is going
on" doesn't seem to fit when compared to further data. Strauss borrowing
from Wicker (1985} has provided researchers with several heuristic devices
to get us to get us out of our "conceptu:tl ruts" and to think about data dif-
ferently. Among these devices arc thinking about the various meaning of a
word, turning a situation upside down, and making fur-out comparisons (sec
Chapter 4, Corbin and Strauss, 4th ed. (20151).
Sttauss's Grounded Theory 29
14. Not all ,on«pts derived through onolysis ore of the same level. There ore lower-
level concepts. These often tum out to be the properties 3lld dimensions of a
,attfl.O,Y, thot is a concept that at 311 abstract level brings out o similar idea or
theme within a group. In gi-oundcd theory research, categories represent the
major themes derived from data. Depending upon the size of the research
project there may be as few as five or six themes or as m311y as 10 or even
more. Each category will have its own properties and dimensions, giving it
specificity 3lld differentiating it from other themes or categories
15. Then there is the tort cattfl.Ory. It is the highest-level, most abstract concept.
It describes what the research taken as a whole is all about. For example,
using the term "protective governing" to describe the action ond interaction
taken by a woman in a high-risk pregn311cy to ochieve her goal of hoving a
healthy baby (see Chapter 10 of Corbin & Str.luss, 2015, pp. 191-194 and
also Corbin, 1987). A researcher may have many categories but only one
core category. Once a researcher has the core category, he or she C3ll go
about integrating all the categories and their various properties and dimen-
sions around it to form theory.
16. Strauss believed that theory was meant to be explanatory 3lld give direction
for practice or change. This means locatinJl. ,,,,uq,ts in context. He breaks con-
text down into tonditio,is, action !process, and ,o,istq11ttllt'S, which for brevity's
sake he referred to as the "paradigi-n."
17 . Conditi"',s refcrto the cxpl311ations that persons give fortheir own or another's
actions or interactions. They answer to why, when, and where and often pre-
sent as "I did such and such becouse . . ."; "This or that hoppened because . . .";
or "I was here or there when this happened." Locating explains behavior
using the explanotions porticipants give. The researcher refers to them ana-
lytically as conditions, but porticipants usually don't. The range of condi-
tions derived from dato con be broken down into personal, so<ial, ttonomic,
historical, and other. While context is derived from participants' explanations,
a researcher might have to do further rcseorch {S"/f'/, on historical factors) to
understand the brooder implications of what participants arc saying. Condi-
tions ore subject to change over time.
18. Attionslintnadions refer to the things that persons say and do in response
to evenrs or problems. They arc goo! directed and answer to the "how" or
"what" that was done in response to a problem or a happening. Action/inter-
action may be strattfl.il or routine. Action/interaction thot ch3llgcs over time
in response to changing conditions is referred to as "process." l'rocess denotes
the continual adjustments in action and interaction necessary to alter. allevi-
ate, manage, or climinote conditions thot might stond in the way of achiev-
ing a desired goal or solving a problem. Process docs not necessarily have to
be described as progi-css or steps or stoges. It can refer to sequences or small
adjusnnenrs in action/interaction. Action/interaction takes into considera-
tion persons' reflections and evaluations of the results of previous action/
30 Juliet Corbin
interaction. For example if a woman who continues to work during her

pregnancy (because the risks of problems were low) finds that she is having
contractions too early in the pregnancy (a problem denoting an adjustment
in her action), she might take a leave from her job and rest more in order to
be able to carry the child to term and have a healthy baby (desired outcome).
Or, to we another example, think about two people having a conversation.
Over the course of the conversation, each person will respond to the other
person based on how the conversation is going. Or think of a symphony
conductor and the changes he or she has to make in order to move the music
along. All of these arc examples of process.
19. Consequenm. Action and interaction have consequences or outcomes. These
can be positive or negative, overt or covert, and reflections upon these feed
into decisions regarding the next set of action/interactions.
20. T/u:qretical muitivity denotes insight into implied meaning contained in the
words or actions ofparticipants. Sensitivity usually grows as a researcher moves
along with his or her analysis. It is noted by having that "aha" experience.
21. T/u:qrttital satnpli1111 refers to data gathering taken with the aim of develop-
ing the properties and dimensions of categories. It means looking for how a
category is expressed under different sets of conditions. It requires following
the leads in the data. going to persons or places that will help the researcher
find answers to questions such as who, what, when, where, how, and why
something happens or is said. Researcher can theoretically sample different
siruations within a document or make compari.sons between different docu-
ments with different people.
22. Saturatibn is a widely misunderstood concept and is often used as an excuse to
tem1inate data collection early. Researchers can't say that they have achieved
saruration until all categories show differentiation, specificity and varia-
tion. This means well-developed categories in terms of their propenies and
dimensions
23. lnte11ration can only be achieved once a core category has been identified.
One can think of the core category as the main or general theme of the
research. For example, in Corbin's pregnancy study (1987) that focused on
women with chronic conditions, the core category was denoted as "protec-
tive governing." a term that explained the actions/interactions taken by a
woman to achieve her goal of having a healthy baby under different condi-
tions of risks that arose over the course of her pregnancy. The core category
not only helps the researcher to explain what is going on in the researcher
but provides the strucrurc around which researcher can tic together all the
other categories developed during the course of the research. It is tlu: linkinJI
of cate11ories around a core calt!(O,Y that raise fi11din11s ftom description to theory.
24. Memos and duzJ11ams arc the repositories of analysis. Doing memos and
diagrams might take time and effort. However, a grounded theory srudy
that is lacking in memos results in a sparse theory because categories lack
Strauss', Grounded Theory 31
development in terms of their properties and dimensions. Memos should

be written following every period of analysis. Sometimes many memos arc
written off of one small piece of data. Although field researchers often try to
get away with doing written notes on the side of field notes, these arc mostly
too superficial and easily lost as time goes on.
25. Diagra111s arc also important to analysis. They arc used to show relationships
between concepts and also to point out the holes in one's theory.
26. linking refers to cxplic:iting the rcbtionships between categories and of the
rebtionship of c:itcgorics to the core category.
27. Validati0t1 is a process that occurs along the way in grounded theory. It occurs
in several ways. One way is by comparing one piece of data against another,
always checking to sec if the meaning assigned by the researcher corresponds
with what is being said in these data. Another way is to follow up each data
collection with analysis and ask questions about implied meaning with the
same and with different participants. A researcher might bring the whole
theory back to participants and to colleagues to obtain their feedback on the
theory. Another way to validate is to compare findin~ with other literature
related to the same conceptual topic.
Doing Analysis
Before doing analysis a researcher must have some data. Data c:in take many
fom1S, but the most common arc interviews, observations, and videos. Stepping
back a moment, before collecting data a researcher must first have a general focus
or question. The question may be revised as the research goes along, but there
has to be some initial statement in order to write a proposal. Also, for a proposal a
researcher may have put together a preliminary interview or observational guide.
However, Strauss generally advised doing open-ended interviews bcc:iuse they
produced denser and richer data. Bear in mind that in a grounded theory study,
bec:iusc of theoretical sampling a researcher may have to leave that original guide
behind to let the data lead the data gathering.
Analysis should begin after the first data collection. The reason for this is that
concepts from the initial analysis guide data collection during the next inter-
view and/or observation and so on. Having concepts when going into the next
interview or observation docs not always mean using the concepts to pose direct
questions to participants. Rather, when conducting open-ended interviews the
researcher keeps the concepts in the mind when collecting data and only brin~
them out if examples of the concept arc not brought out in an interview. (For a
more in-depth discussion of how to conduct unstructured interviews sec Cor-
bin & Morse, 2003). For example, usually an interview or observation is focused
on a certain topic, say on chronically ill pregnant women, putting the pregnancy
at high risk. As a woman tells her story, usually there arc similarities as well as dif-
ferences in the topics or situations that arise among the women. Having concepts
32 JuUet Corbin
in mind m:ikes the researcher more se11sitive to these similarities and diffetetl{tS when
they arc discussed or observed. Also, a researcher can ask questions at the end of
an interview or observation about concepts that were brought out. To the novice
researcher, doing grounded theory analysis may seem to be a very complicated
process. Reading about it is more complicated than actually doing it. How did
Strauss teach analysis? Before beginning analysis, students were advised to read a
document in its entirety to get a general sense of the topic and how the interview
or observation proceeded. However, they were advised to resist the urge to write
anything in the margins because reading is not doing analysis. Once the docu-
ment is read, it is time to begin the analysis.
In the beginning, analysis is unstructured aimed at breaking down data, gen-
erating possibilities, testing out those possibilities against data, and delineating
concepts to stand for that data. Lots of questions arc raised, and lots of compari-
sons arc nude. To facilitate analysis the researcher looks for natural breaks in the
flow of the data. It might be a word, a sentence. or a paragraph. Then it is time
to ask a series of questions about the data, such as "What seems to be going on
here?" "What is this section of data all about?" "What is the main idea being
expressed?" The analyst tries out different interpretations and checks them out
against the data. Once a researcher has some notion of the meaning implied in
the data, that meaning is denoted as a "potential" concept. Potentia~ yes, because
as a researcher progresses further into the data he or she might discover that his
or her initial interpretations were wrong. One of the great things about doing a
grounded theory is that it is possible to discard initial interpretations and arrive at
interpretations that arc a more likely fit with data.
Usually when persons arc describing an event or problem they locate it for us,
they tell us what the problem or happening was, what they did or did not do, why
it happened. who was involved. and what they said, felt, or did about it. In other
words they contextualize the situation for us. Therefore, once we have an idea of
the main concept being expressed in a section of data, a researcher can analyzc
the data around it for related concepts. These concepts become the properties
and dimensions of the concept and arc added to every time another example of
the concept is encountered in data. This is why grounded theory is sometimes
referred to as the constant comparative method because data arc constantly being
compared. Ifdata arc found to be conceptually similar, they arc categorized under
the same concept. Data that arc determined to be conceptually different data arc
placed under a different concept.
Sometimes when analyzing data Strauss and I did what is called /i11e-lry-li11e
a11alysis, where we focused on a sentence or even a word. We did this when we
wanted to get a better understanding of what might be going on in this particular
situation and when we might be having difficulty identifying the possible mean-
ing contained in data. In doing line-by-line analysis, we not only asked a lot of
questions of the data but we also turned to "theoretical games." These included
thinking through all the possible meanings of a word and then discarding those
tlut seemed far-fetched, or turning the situation upside down and asking "Wlut
if?" It also included drawing upon conceptually similar but situationally differ-
ent circumstances. For example, if a researcher was studying persons who lost
a spouse through death, he or she might think about persons who lost a spouse
through divorce, looking at these rwo situations of loss for similarities and differ-
ences. Thinking in this way sometimes brings out properties of loss that arc pre-
sent in the dab but that were not obvious to the researcher until the comparison
was made. To jump ahead, making these types of comparisons can also provide
direction for theoretical sampling.
Let me be clear: a researcher docs not luvc to do line-by-line analysis on each
line of every document (Corbin & Strauss, 2015). Doing line-by- line analysis on
every document would take forever and no one would do it. However, line-by-
line analysis docs luvc an important place in the analytic process. It is a good way
to begin analysis because it enables the analyst to "open up" the data. The analyst
sbrts by asking questions and opens up the mind to possibilities w ithin the dab.
The idea is to let the dab guide the analysis and rruly make the analysis grounded.
Line-by-line analysis is also helpful when a researcher is "blocked" and luving a
hard time getting past standard ways of thinking about dab. Asking a lot of ques-
tions about small pieces of data can often point in new directions.
Sometimes when we analy.zed dab, Srrauss and I worked with a paragraph
taking it as a whole. This is another way of approaching analysis, especially after
doing some line-by- line analysis. It involves taking a paragraph and looking for
the general theme and giving it a conceptual nan1e. Then code around the new
concept by asking questions and making comparisons. There arc times when
doing analysis that a researcher comes upon data tlut contradicts previous cod-
ing. When this happens, the analyst has to go back to the original code and do
a comparative line-by-line analysis of the new with the old to find the source of
the conrradiction. Doing analysis is a process. It requires that a researcher go back
and forth berwccn documents and amend errors and look for conrradictions. The
beauty ofgrounded theory is that it allows for amending initial analysis because of
the focus on checking and rechecking analysis and even revising analysis through-
out the analytic process. It is possible to nuke errors, but mistakes in analysis have
a way of making themselves known because the analysis doesn't fit when applied
to the next sets of dab.
A researcher draws upon the tools in his or her analytic tool box as the analytic
situation demands. However, there arc no shortcuts that can be taken when doing
qualitative analysis. One either takes the time to do it correctly or ends up with
at best a thin and poorly developed description that contributes little to the body
of professional knowledge.
A mistake often made by beginning analysts is to come to the end of their data
analysis with pages and pages worth of concepts and not know what to do with
these. I know because I did the very same thing with my first grounded theory
study when writing my dissertation. One day I showed up at Dr. Strauss's office
34 Juliet Corbin
with two huge and heavy binders with page after page of memos, each one about
a different concept. He just looked at me and said, "Oh dear, I guess you missed
the class on categories."
It seems that concepts have to be grouped around the major themes, or what
we call categories. So Dr. Smuss told me to sit down and put my binders aside
and said: "What arc the major ideas that have come out of your study?'' This was
my study of pregnant women with chronic illness (Corbin, 1987). I said, "Well
there is the notion of 'risk.' It seems important because it comes up in every
interview though women may perceive the level of risk to differ at different rimes
during a prcgnancy.""Aha," he said. "Risk is probably one of your categories. Do
other concepts seem to relate to it?" "Oh yes," I said. "There arc different levels
of risks and risk management strategies," among others. He said,
The main ideas that you have expressed arc concepts but they arc broader
and seem important and arc probably your categories. Now go home, read
your memos, and look to sec if there arc other main ideas and how all the
other concepts you have come up with relate to these main ideas.
With that I had some sense of direction, and after several more weeks of work
I was able to pull out my categories and begin to build these in terms of the dif-
ferent properties and dimensions that I had already delineated as concepts.
Later, when I finished my dissertation and was working as a researcher with
Dr. Strauss, 1 found out we didn't wait until the end of our research to iden-
tify preliminary categories. After analyzing five or six interviews and observa-
tions, we began to notice that some concepts were more important than others
because they came up in each interview. At first, the designation of certain
concepts as categories was tentative. However, as we went through more data
and found that these concepts existed in some form in almost every interview,
we began to feel more comfortable designating them as categories and we
began to organize our lower-level concepts around them. For example, in my
pregnancy study, once I had some idea that "perception ofrisk"was a category,
I linked to that category concepts such as "level of risk," "change in percep-
tion of risk level," and "conditions that brought about a woman's perception
of risk level."
Each time Anselm Str.luss and I met to analyze data, one of us took notes and
wrote memos. We brought the memos to our next meeting where we shared
and discussed them, often writing more memos off the original memos. Writing
memos is an essential part of doing grounded thoory. There is no other way of
keeping track of one's thoughts during analysis. Just a list of codes tells you noth-
ing. Now with computer programs malting it so easy to write memos, there is
no excuse for a researcher to not do so. Diagrams arc also essential, because it is
through diagrams that a researcher begins to sort out categories, sec their connec-
tions, notice breaks in logic, and identify poorly developed categories.
Slr.!uss's Grounded Theory 35
Analysis is not complete until the analyst has linkod the categories with all their
properties and dimensions around a "core c:itcgory." A central category explains
the main action/interaction of the study. Going back to my pregnancy study, by
the time I finished identifying and building my categories, I was still uncertain
about how to identify the core category and how to link all those categories
around it. In the meantime, Strauss had travcled, become ill, and was hospital-
ized. Fortunately, I had other committee members I could turn to for support,
one of whom was Phyllis Nocragcr Stem. Although Phyllis had taken a teaching
position in another state, I was able to talk with her by phone. Her question was
"What is it your women arc telling you that they want out of their prcgi,ancy?"
I answered that "each of the women in my study stated that they wanted a hcalthy
baby." I also noted that everything that they s,ud and did was protective in nature
and related to this end goal. She suggested that based on what I told her, my core
concept should be something like "protective governing." That tern, secmod to
say it all and could serve as a starting point for building all my categories around it.
I ended up calling the dissertation "Protective Governing: Strategics for Manag-
ing an at- Risk Pregnancy" Corbin, 1987).
Once a researcher has a core category, the end is near, but the process ofanaly-
sis is not quite finished until all categories arc saturated and there is some degree
of validation of the theory. This may mean going back and filling in underde-
veloped categories, reviewing relationships between categories, and if possible,
bringing the theory back to participants and colleagues for review. It is important
to remember that a theory is an abstraction derived from many cases and not a
representation of one or two cases, therefore a participant may agree that the
theory fits them in a general sense but that not every little detail applies to them.
It is impossible to conclude a discussion about analysis without talking about
theoretical sampling. A researcher uses theoretical sampling to develop a promis-
ing category further in terms of its properties and dimensions. He or she docs
so by exploring a category under different sets of conditions. For example, a
researcher notes that a certain sequence of action/interaction/emotion occurs
when one set of conditions exists. In the pregnancy study, when women per-
ceived the level of risk to be low, they acted in a certain manner. I then theoreti-
cally sampled to sec what would happen to action/interaction when they perceive
the risk level to be higher. This allows a researcher not only to bring variation
into the research but also to identify process.
An Analytic Example
In the next section I'll utilize aspects of the analysis I did on interviews with Viet-
nam veterans as part of both the third and fourth editions of Basils of Qualitative
Analylis (1998, 2015). I had no specific research qucstion(s) when I began the
analysis. I just had a general topic and was going to let the data lead me. I picked
up the first interview, read through it, and then broke it down into sections
36 Juliet Corbin
according to topic and the flow of conversation. Once I had defined my unit of
3113Jysis, I beg.In to scrutinize the data. I could sec the words, but I wanted to
get beneath the surface in order to find out what those words were telling me.
I began by asking a lot of questions. I compared one piece of data against another.
I tried out various interpretations and discarded those that were not supported
by data. I came up with concepts that I felt captured my interpretations. Once
I had some concepts, I further scrutinized each section of data for properties and
dimensions--0r said another way. for descriptors or qualifiers of those concepts.
For example, Participant #1 bcg:in the interview by explaining something
about himself before going to war. He went on to say • little about why he
decided to volunteer for military service as an army nurse. A concept I came up
to describe those words was the "prcwar self." I coined that concept because I felt
the participant was trying to explain who he was before going off to war. Some
ofthe properties I found in the data pertaining to that "prewar self" were "youth,
idealism, • sense ofpatriotism, innocence about war, training as• nurse, and hav-
ing a family that supported the war effort and his joining the military."
The significance of the concept "prcwar self" was not evident to me at this
early stage of analysis. However, I did write • memo about the concept and
included in it the properties I had identified from this particular interview. Writ-
ing the memo increased my sensitivity to the notion that all of the participants in
the study will have a prcwar self, although how they describe it may be different,
and that I should kocp my cars open to mention of this in subsequent interviews.
Of course, I knew I could discard the concept if it should prove irrelevant as
the analysis progressed. If other participants also brought it up, it would verify
its importance as a concept, and I could examine their data to determine if they
described themselves as being before the war in the same or a different way, add-
ing to my list of properties and dimensions. If the notion of a prewar self did not
reappear, I would then discard it or put it aside.
A =jor point about grounded theory analysis is that all concepts arc tentative
and might be discarded later if they don't prove useful. Sometimes a researcher
just knows intuitively that something is important but should never become
"married"to a concept and continue to impose it on data if it is not supported by
further data. Although I thought it might be important to know something about
how a person thought of himself or herself before going to war, it was not until
I got deeper into the analysis that I discovered that the concept "prewar self' was
part ofa higher-level concept or category I termed the "changing self."This con-
cept was derived from data after noting that the manner in which the men in my
study described themselves before going to Vietnam was considerably different
from how they spoke of themselves while in Vietnam, and even more different
was the way they talked about themselves after leaving Vietnam.
I derived many concepts while coding the first interview. Only a few struck
me as being especially noteworthy. This man described his "war experience"
(another concept} in Vietnam as being "not so b:id." In fact, he described it as a
Strauss's Grounded Theory 37
"very maturing" experience. His description of the experience was interesting to

me because I grew up during the Viernam War and "not so bad" was not the way
I heard nuny other veterans talk about it. They were more likely to describe it the
experience in ncg:itive terms or not talk about it. Methodologically, by saying the
experience was not so bad, the participant was providing me with one dimension
of the nature of the "war experience" for him. I went back to the interview to
try and determine what was it about the "war experience" that nude it not so
bad. I felt it was important to note he was a nurse and a "noncombatant" (a new
concept), and although he flew into war zones in helicopters to pick up wounded
soldiers, he never engaged in banle. I asked myself, "I wonder what it was like for
persons who were on the front lines and who had participated in battle."
Toward the end of the interview, it struck me that although the participant
described his experience as "not so bad," he seemed to have some anger about
the war and how it was conducted. It appeared that his perspective about the
war changed when he got home and saw the war through the eyes of those who
remained at home and were protesting against it. I conceptualized the anger as
"residual anger" because it seemed to have lingered for more than 30 years. The
participant went on to say that until this interview he had never talked about the
war or told anyone he had been in Viernam. He had never talked about it even
with his two brothers who had also been there. The "not talking" I conceptualize
as uthc wall of silence. 0
I thought about this interview and what I had read for a while and came up
with two questions that would guide the next steps of the research. T he first
question was, Would the war experience be different for "combatlnts." that is,
persons who went to Vietnam and participated in combat? The second question
was, Why is there still the wall of silence and so much residual anger? In following
up on those threads in the data, I was doing theoretical sampling or directing datl
collection on the basis of the concepts "combatant" and "noncombatant," "wall
ofsilence," and "residual anger." In addition to analyzing datl with these concepts
in mind, I also followed up on other concepts such as "prewar self' that derived
from that first analysis of data.
At this early stage of the rcscarch, I couldn't be certain that I was going in
the right direction with the research. I had to trust my instincts. I let my inter-
pretation of what I perceived to be significant guide me to the next phase of
research. I still didn't have a well-formulated ovcrall research question. I didn't
know exactly what I was looking for. Up to this point in my research career,
I had never trusted my own intuitive responses to data to such an extent. Usually
I had some vague research question in mind when I began a research project. This
time, rather than a specific question directing the rcscorch from the outset, the
questions that evolved during my interaction with the data shaped the direction
the research would tlke.
I was ready to move on with the study, following up on the concepts of"com-
batant" versus "noncombatant," when I realized I didn't have another participant
38 Juliet Corbin
to interview. I didn't know anyone else who h3d been a comb313nt in the Viet-
nam War well enough to 3pproach him or her for an interview. My next meth-
odologiC31 problem W:IS to figure out where I could I find a group of Vietnam
War combatants to interview. I rumcd to the Internet, where so many people
go these days go for help, and put out a request for p3rticipants. Oh my, wluit a
dis,wery that was! After several days, I received a reply to my request. I mC3n just
011e response, whereas I had expected to be overloaded with willing participants.
The responder, a Vietnam veteran, stated that he would be happy to answer my

questions about his time in Victn3ffi. He was willing to talk because he W:IS inter-
ested in eduC3ting people about the Vietnam War. However, he wanted to warn
me that I shouldn't expect a response from other veterans because even though
30 years had passed since the war, many vets were still having difficulty coping
with their experience in Vietnam. I was rather astounded that the Vietnam War
W:1S still e3using so much suffering.
I did receive another email ftom someone in the same chat group. It said. "If
I can't even tell my wife about the war, what makes you think I C3n talk to you."
Ouch. I thought at this point that maybe it was not such a good idC3 to do a srudy
on Vietnam War veterans. Eventually, I did get another response, and the third
responder was willing to talk about his experience. I had two more participants
for my study, and I felt that I could continue with the analysis begun months
earlier.
I asked Participant #2 what it was like to fight in a war. I wanted to compare
the first two interviews for similarities and differences. I still had no general
question in mind or sense of where I was going with the study, but I was push-
ing forward. Participant #2 was not overly verbose, but what he said was quite
startling, at least to me. At first, I wasn't certain that I should put his interview
in my book. I was concerned that readers might be frightened by such graphic
words about war. Participant #2 told me that war is about killing. You kill the
enemy before he kills you. He also said that although a soldier goes into war
with sense of idealism and patriotism, these virtues become lost at the time of
the first battle, "the changing self." When you arc in a war zone being shot at
day after d3y, it all comes down to your own "survival" and the survival of your
marine brothers.
Then I asked him about the anger that I picked up in the first interview and
fiom the person who refused to talk to me. He said there were several things that
made him angry. The first thing W:IS that the AmeriC3ns lost the war, the first
war they had ever lost. He believed that the hands of those who actually did the
fighting in the war were constr.iined by the many "rules of engagement" put on
them by the policy-makers in Washington. Second, he said that he was angry
beC3usc 58,000 men lost their lives in a war "that had no purpose." Third, he was
angry because of the reception veterans received on their "homecoming." The
arguments about whether the Vietnam War W:IS a just war didn't filter down to
the combatants in the field. They believed they were fighting for their country.
Moreover, combabnts cm't easily leave the wor behind just because they leave
the battlefield and return home. They "bring the wa:r home" with them in the
forn1 of "memories" and "nightmares" that this panicipant conceptualized as "the
ghost within."
After analyzing interview #2, 1 knew that I had to learn more about the "wa:r
experience" per sc and about "survival." I realized something occurred during
combat that made the difference between how "combabnts" and "noncombat-
ants" experienced the wa:r.
At this point, the research project began to take on a life of its own outside of
the book on methodology that I was writing. I had been touched by the stories
that I heard, and as a researcher I was emotionally invested in retelling that story.
At the same time, I realized that I couldn't become too emotionally invested or
I would not be able to complete the book. I also realized that this research would
require a lot more investigative work because there were still so many unanswered
questions. I was a little frightened because I still wasn't sure where I was going
with this research. 1 would have 10 continue to trust in myself and in the research
process.
I turned to the interview with Pmicipant #3, the only other veteran who
responded to my request for participants. I wanted to explore with him the con-
cept of "anger" in greater depth. I wondered if he had a different explanation
for why anger seemed so much a part of each of these interviews. I asked him:
"Could he explain why, after all these years, so many vets have not let go of the
anger and 'healed."'
Pmicipant #3 told me that the anger begins in boot camp, where the drill
instructors demean you and wear you down. The purpose of their bctics, from
his perspective, was to generate anger, and thereby tum raw recruits into a team
that sticks together and that sees the outsider as an enemy. Then, once a soldier
gets to wa:r, the anger increases because a soldier realizes that he or she is simply
being shot at because they a:rc there: "You don't even know the people who a:rc
shooting at you." If you a:re lucky enough to survive the experience and return
home, you then discover that those who remained at home were going on with
their lives as usual. They went to college, got married, and had good jobs. The
vets thought that family, friends, and non-vets just couldn't relate to what a com-
batant has been through, nor could they undersbnd the nightmares and the dif-
ficulties of readjustment to civilian life.
With the analysis of three interviews behind me, I still had many more ques-
tions about the research than I had answers. I didn't know much about the actual
experience of combat. Furthermore, I needed to put the wor experience into
a larger historical and political context to better understand it. I realized that
I would have to know more about the "rules of engagement" and the policies
that brought the U.S. and Vietnam into wa:r. I also needed to know more about
the "enemy," the North Vietnamese and the Viet Cong, and why they "fought"
so "fiercely." I needed to exa:rnine "combat situations" and analyze them so that
40 Juliet Corbin
I could understand more about the pr«ess of "surviving" and why, although
58,000 men died (a large number), many more survived to return home.
Because I had no more participants, I wondered how I was going to acquire
that data. I turned to the Internet once more, this time going to Amazon.com.
Here I made an interesting discovery. Although the Viemarn veterans in the chat
room I connected with had difficulty talking about the war, apparently there were
many other veterans who were willing to put their stories in print. I had found a
fountain of data in the form of memoirs. I ordered as many books as I could from
Amazon, some written by combatants, others written by nurses, helicopter, and
fighter pilots, and some written by prisoners of war and journalists. I even found
a couple of books written by Viet Cong soldiers, because in qualit1tive research
it is important to get those multiple perspectives. I also ordered several historical
books about the war and about Vietnam to find data about co11textua/ q11estions,
like the events that led up to this war; further, I read about the profiles of the men
in Washington who directed the war from afar and set the rules of engagement.
Their perspective was important, too.
I soon found myself overloaded with dat1. I learned more about war than I
ever wanted to know. I had trouble sleeping. I became srresscd every time I looked
at the materials. I decided that I needed to distance myself from these war materi-
als for a while so that I could return and do a proper analysis.
When I did return to the study, I analyzcd the memoirs in the same way as
I did the interviews. I built on the concepts and questions derived from each
previous analysis continuing on with theoretical sampling. In the memoirs, I dis-
covered that surviving in war is situational and proportional to the risks associ-
ated with those situations. I learned that the greatest death rates occurred in men
inexperienced with war and that survival is enhanced when one becomes "a
seasoned soldier." However, with time and exposure to conflict, even seasoned
soldiers tend to "wear down," which in turn increases thcir chances of being
killed or wounded. I discovered that the men fighting the war saw it as a war that
seemed to go nowhere. There was no attempt to gain or hold territory. Rather,
success was based on body counts. The soldiers would fight the enemy and take
over a piece of territory, only to walk away after the battle, leaving the enemy free
to retake that territory. When pushed, the enemy would rerreat above the 17th
parallel (the dividing line between North and South Vietnam) or go into Cam-
bodia or Laos, also supposedly out-of-bounds according to the rules of engage-
ment. There was a high mortality and morbidity rate on both sides, although the
main concern for U.S. soldiers was for their own lost comrades. Then, especially
relevant for the soldiers, was the lack of support for the war at home, which was
demoralizing.
Most soldiers served their country with honor. But a few soldiers commit-
ted what might be called "atrocities," and often it was the "arrocities" and not
the good things that soldiers did-like working in the orphanages or with the
poor-<hat made the news. Some "arrocities" occurred because soldiers were
Strauss's Grounded Theory 41
worn down by the stress of being in a war zone and not knowing who among the
civilian population was enemy and who w:is friend. As a consequence, combat-
ants sometimes fired at anyone who acted SU$piciously. This is understandable, as
the enemy often hid within the civilian populations, or persons were farmers by
day and Viet Cong by night. I am not excusing soldiers' bad bchavior. It turns
out that some soldiers were just bad people who happened to be in the military.
Others were young men who were easily influenced and lacking in the kind of
leadership that sets moral standards. Sometimes soldiers were just plain angry
about seeing comrades die before their eyes. They wanted to avenge their broth-
ers' deaths by going after the enemy and they unfortunately hurt civilians who got
in the way. But anger also had a positive side, in that it could also keep soldiers
alive and fighting on even when they were fatigued and disillU$ioned with war.
The problem was not being able to let go of that anger once a soldier returned
home and back to civilian life.
These findings led me to another question and more theoretical sampling. If
the risk of wearing down was so high, I wondered why some men were able to
survive without injury and at the same time maintain their moral integrity? Why
is it that, despite the terrible things that occur in any war, there arc heroes and
men and women who did very good deeds for civilian populations? I returned to
these data to look at specific situations of risks and analyzed them. I looked at the
personal and social psychological conditions that enable soldiers to survive and
overcome the physical, psychological, and moral risks associated with war. later,
I examined these data to determine why some individuals were able to heal after
the war whereas others suffered from posttraumatic stress disorder. What I discov-
ered was that to survive physically and psychologically, combatants had to be able
to put aside their prewar civilian selves, adjust to the "realities of war," and then,
when they returned home, readjU$1 once again by constantly shifting their images
of"sclf'' and the "meanings of war." I ternted the ability to make these transitions
"surviving: reconciling multiple realities," and it became the core concept of my
study (Corbin & Strauss, 1998, 2015). The study was more complicated than this,
but this gives you some idea of how I proceeded with the study and why I went
in the directions that I did.
I want to emphasize that although in methodology texts we talk about pro-
cedures, these analytic techniques arc just broad guidelines that arc used in very
dynamic and flexible ways to stimulate the mind and move the analysi.s along.
Whenever a writer tries to put into words what he or she docs when doing
analytic work, it becomes rigidificd and open to unintended U$es. Ytt the actual
research process is fluid, dynamic, and evolving. Notice that I had no idea where
I was going at the beginning of the study. I let my interpretations, in the form
of concepts and the questions I asked about those concepts, guide each step of
the research process. Throughout the analysis, I felt like a detective following up
on one lead after another until I could piece together a whole story. I marvcled
at the inforntation that a researcher can obtain from data if he or she asks the
42 JuUet Corbin
right questions and takes the rime to write memos. In memos, it's not just the
researcher and not just the data that arc talking but a combination of researcher
and the dat:1 interacting together 10 come up with an explanation of what is
going on. Memos arc a reflection, the records of that interaction. There is no
possibility of omitting the writing of memos as a way ofshoncutting the research
process. Not having those memos 10 refer back 10 shows up in the quality of the
product that is produced. The density and variation are missing from the final
product because there is no way that a researcher can remember all the details of
the analysis.
The usual way of explaining when to terminate the research is 10 say "no
new categories are emerging," or saturarion has occurred.,, However, there arc
0
practical matters that influence the decision 10 continue with a research project
or 10 terminate it. Although inexperience, rime, and a lack of grant money often
influence decisions, a researcher should keep in mind t.hal the research should not
be terminated until every category is fully developed in terms of its properties and
dimensions. There can't be some categories that arc fully developed while others
remain sparse. Funhcnnore, linkages between categories should be clearly spelled
out. When it comes to writing, the final theory should be placod into the larger
framework of other pertinent theories and the relevant literature.
Concluding Remarks
Strauss's approach to quolit1rivc research analysis encourages researchers to enter
an investigation with an open mind, ready to hear what panicipants arc saying,
and advocates Jetting the questions that emerge from analysis guide the next steps
in data collection and analysis. It is a method that rejects a dogmatic and rigid
approach to doing research and embraces taking the role of the other, giving
voice to panicipants, all the while noting how the researcher himself or herself is
responding and shaping the research. It is a highly conceptual and creative activity.
The researcher formulates new questions as the research evolves, chooses
among a variety of data sources and analytic strategics, and may even change the
course of the research midway if the analysis indicates that it should. As in other
qualitative research, the self is the instrument of the research. It requires that
a researcher trust his or her instincts about where to go, what kinds of data 10
collect, when 10 let go, and when to move on. Strauss's method is truly an inter-
action between the researcher and the panicipant in the sense that it is the par-
ticipant's words or actions as captured in interviews and observations that guides
the research.
Although grounded theorists today come from different perspectives and have
their own approaches 10 analyzing datl, I think ccnain threads run through all
our methods, for example, doing comparative analysis and asking questions of
the data, theoretical sampling, and writing memos. Concepts remain the foun-
dation of research, along with the development of concepts in terms of their
Sttauss's Crounded Theory 4 3
properties and dimensions. Other common threads arc saturation and theoretical
sampling, two concepts often misunderstood and misused by novices to quali-
tative research. For me, the imponancc of method is not whose approach one
chooses but the "quality" of the research findings produced by any approach.
Each of the methods presented in this book has the potential to produce quality
findings. In fact, looking at the list of evaluative criteria provided by C har maz
(2006) 1 find that any of the criteria could be applied to the method described in
this chapter. Findings have a way of speaking for themselves. They either do or
don't resonate with participants and colleagues, offer new insights into bchavior,
add to a body of knowledge base, and/or make you stand up and listen. 1 don't
sec the purpose of all the disagreements and arguments about method. One
could argue the pros and cons of each all day. In the end, it doesn't matter. People
will choose the method that most speaks to them and they will use it in ways that
make sense to them.
One last thought: I'm sure that if Anselm Strauss were alive today, he would
say that his goal was to teach students how to think. He wanted to provide
researchers with a methodology that wou.ld enable them to capture some of the
complexity and variation in this world. He wanted to give researchers the tools to
produce findings that could be used to make the world a better place. He would
be pleased to sec the different methodological branches of grounded theory that
have emerged from the second- and third-generation grounded theorists based
upon the original work done by him and Barney Glaser (Glaser & Strauss, 1967).
Although each of the contemporary and descendant methodologies is some-
what different, all have the capacity, if carried out properly, to do just what was
intended: to develop useful theory that is grounded in data.
References
Blumer, H. (1969). Symbolic inJ,radionism. Englewood Cliffs, NJ: Prentice Hall.
Clumuz, K. (2006). Corulnit1ir1J1 Jlf"llndtd tlwry. Thousand Oalcs, CA: S.b"'·
Corbin, J. (1987). Womt:n's pcrceplion.s and management of a pregnancy complicated by
chronic illness. H,al1l1 C,rr:far Woma11"Jm11J1ional, 8(5 & 6), 317-337.
Corbin,].. & Morse, J. (2003). The unstrucrurcd interactive interview: Issues of rcciproe-
ity and risks when dc:aling with scn.silive 1opics. Qu,,lilaliu, Inquiry, 9(3), 335--354.
Corbin, J., & Strauss, A. (Eds.). (1998, 2015). Basics of qualilativc m,a,c/1 (3rd & 4th eds.).
Thousand Oaks: Sall".
Dcwcy,J. (1929). Human natur, ir, ,ondrld. New Yolk: Henry Holt.
Dcwcy,J. (1934). Arl as <xpmm«. New York: Minton Blach.
Dewey,]. (1938). f.oiliLll1< lhtory ofinquiry. New Yolk: Henry Holt.
Glaser, B., & Strauss, A. (1967). 11u:dis<""")' ofJl'oundtd 1h,ory. Chicago: Aldine de Gruyu:r.
Hughes, E. C (1971). '/1u: SO<iolOJli<al cy,: StltMd pap,r,. Chicigo: Aldine de Gruyter.
James, W. (1968). '/7., philosophy of WilliamJama 0- McDermott, Ed.). New York: M odem
Libra,y.
Mead, G. H. (1956). ln A. Strauss (Ed.), On s«ialpsyd1o/OJIY: S,l,,1,d papm. Chicago: Uni-
vcnity ofChicago Press. (Original work published in 1938).
44 Juliet Corbin
Mcod, C. H. (1959). In A. E. Murphy (Ed.), Plulosopl,y of tk ,,,..m1. i...s.J.lc, IL: Open

Court Pr=. (Original work publi.hcd 1932).
Mead, C. H. (1962). Mind, self. and ,ociety. In C. W. Morro (Ed.), Works of Oo,x< Hrrl,,rt
m«1J (Vol I}. Chicago: University of Chicago Pr=. (Original work published 1934).
Mead, C. H. (1972), The philo,ophy of the act. In C. W. Morris (Ed.), Works 'lfC""ll'
Hnbm ,,.,a,1
(Vol. 3). Chicago: Univecity of Chicai,'<> Pr=. (Original work published
in 1938).
Park, R. E. (1967). On s,xia/ """"' and tolkaivt: bclurvior (R. H. Turn<:r, Ed.). Chicago:
University of Chicago Pr=.
Peirce, C. (1877). The fixation of belief. Populor Sama: Mo,uJJy, 12(1), 1- 15.
Strauss, A. (1987). Q,,o/itoJiw: onalysis for sO<ial sri<ntists. C2mbridgc: Cambridge University
Pre».
Strauss, A. (1991). The Chicago tradition's ongoing theory of action/interaction. In A.
Strauss (Ed.), Crratin_~ soaol,xical """'"""' (pp. >-32). New Brunswick: Transaction
Publications.
Strauss, A. (1993). Con1im1al p,mouJatiom of odion. New York: Adinc De Cruycr.
Thomas, W. I. (1966). On slXial OfJIDfUXolion ond sotial pmonality: S,ktt,J p<1p,ts (M.Janow-
i12, Ed.). Chicago: University of Chicago Pre».
Wicker, A. (1985). Getting out of our conceptual rut>: Strategics for expanding concep-
tual frameworks. Am,rican Psydu,/ogis~ 40(10), 109+-1103.
3
EXEMPLAR
The Nurse as Advocate: The Sessler Branden
Advocacy Theory (SBAl)
Pennie Sessler Branden
The Phenomenon and Study Findings
Introduction
This investigation was intended to identify and delineate the nurse advocate role
using grounded theory (GT) methodology. Here the researcher will describe
the participants, provide the story line, and discuss the research paradigm. The
higher-level concepts (major categories) will be presented including their sub-
categories (concepts) and relationships to each other and the context. Grounded
theory methods, participant demographics, and the emergence of the major phe-
nomenon, categories, and concepts from the dati that lead to the Sessler Branden
Advocacy Theory (SBAT) arc explicated as well.
The Sessler Branden Advocacy Matrix diagram (SBAM) will be depicted,
explained, and related to the core phenomenon of advocacy. The Advocacy
Matrix and its story line clarify the dynamic and complex process of advocacy
that emerged from the datl. It is to be used to assist the nurse to advocate using
this advocacy process that includes components that fonn a series of actions,
strategics, and outcomes.
Study Participants
The participants were 13 nurse leader/advocates from multiple regions of the
U.S. including the Northeast, Midwest, Southwest, and Northwest. There were
12 fcnule participants and one male participant. Race and age were not discerned
because the interviewer met these nurses via a telephone call and this information
46 Pennie Sessler Branden
was not elicited. All of the nurses interviewed were actively engaged in work
and volunteer activities at the times of their interviews. The specific examples
of advocacy that were recorded and analyzcd were chosen by the participants.
The participants represented nurses from academia, administration, organizations,
policy work, research, and clinical practice. Many of them crossed over areas
of specialization. For example, 3 nurse educator may be an administrator and
be involved in professional organizations. The sample represented a wide range
of experiences, publications, and connections to or membership in professional
organizations.
The demographic infomiation, reported for this research in Table 3.1, was
gleaned from CVs and the participant interviews. However, some participants
did not report all of their activities on their CVs but instead gave summaries or
highlights of their activities.
TA8l£ 3.1 Participant Dcmognphia
Partidp<1nl Drniopap/,ia TOia/ N,,n,l,u of

Partidpanls
Education:
Diploma 4 4
AON 1 I
BSN/UA 12/1 13
MSN/MA/MPH 10/1/2 13
PhD/EdD/DNP 6/3/1 10
Other degrees before nursing 2 2
# Other degr=/certifications 12 8
Employment
ClinicaJ pncticc in yC2n 182 13 14
AadcnU in years 264 11 24
Policy in yc-.rs• 85 5 17
Adminutntivc/O~ involvement• 145 8 11.2
Mentor: Ycs/No 12/1 13
Men tee: Ycs/No 12/1 13
Publications
Articles (pcer-.rcvicwed) 716 13 SS
Textbooks/book., (includes chapter authorship)" 232 II 21
Speaker/presenter' 2,638 13 202.9
Ori!anization membership 145 13 11.2
Committee work for profC$$ion: Ycs/No 12/1 13
Other volunteer worlc: Ycs/No 10/3 13
Consulting: Ycs/No 8/S 13
Grants awarded 169 8 21
Honors/awards 304 13 23.4
• Indi.c:ncs lncompletc numbers ttp0rtcd ptr some puticipanrs.
Exemplar 47
These findings as described in the table arc important because they suggest
that the participant nurse leaders/advocates arc committed to dissemination
of nursing information to the profession and community at large. Therefore
the participants have a podium for advocacy, and these data support that they
use it to advance nursing and healthcare. This recognition also gives the par-
ticipants more visibility with the potential to facilitate further and ongoing
advocacy.
The Story Line

The story line is a nanativc description of the process and theory. It provides a
detailed overview of the core phenomenon, the major categories and their sub-
categories, and the internal and environmental characteristics that shape the con-
text of the advocacy activity. The story explicates the complexity of the theory
but simplifies it through a narrative so that one is able to understand and apply it.
Sandclowski (2004) stated that "a story by itself, with no interpretation, may not
be considered a research finding" (p. 1375). Therefore, the story line must move
beyond a presentation of data to a higher level of thinking about the raw data and
also be pragmatic.
The process of advocacy that emerged from the data is dynamic and complex
across all stigcs and levels of the matrix, and each component action leads to
ongoing reassessment and rccvaluation by the nurse advocate. The entire process
is within what the researcher has named the Sessler Branden Advocacy The-
ory (SBAT), and is depicted in the Sessler Branden Advocacy Matrix diagram
(SBAM) seen in Figure 3.1. This diagram, hereinafter referred to as the Advocacy
Matrix or SBAM, is a representation of the process that includes a series of strat-
egics, actions, and outcomes with stitcd goals to bring about changes that will
assist the nurse to advocate. 7i, ad=tt is the main process and is found in the
ccntcr of the Advocacy Matrix.
After constant comparative analysis of the 13 semi-structured interview tran-
scripts and the researcher's field notes, there emerged the following concepts,
which form the basis of the SBAT: (1) internal and environmental characteristics
which constitute the conditions; (2) conditions lead to the formation of the con-
ditional context for the advocacy event; and (3) five categories of interactions,
which arc to identify, to stratcgizc, to fucilititc, to empower, and to promote. All
interactions arc the stages that the nurse navigates leading to the main action to
advocate. Each interaction category has subconccpts describing it in more depth
with properties and dimensions. The complexity of the nurse advocate role is
shown through the interrelationships of the concepts because each of the actions/
interactions is tied into other actions/interactions. The levels that the nurse trav-
erses during the advocacy action arc represented by the arcs above the main tri-
angle in the SBAM diagram.
TO ADVOCATE
Pf/OCESS
Strateglze
ldentlfY
Dedslon to Advocate
Conditional Context
i I
Internal Olaracterlstlcs Environmental Olaracteristlcs
FIGURE 3.1 The Scs.sler Branden Advocacy Matrix Di:igr:un

Exemplar 49
As one becomes familior with the SBAT, the reoder needs to undersl3nd thot •
limitotion of this Advoc,cy Motrix diagram on paper may make it appear to be a
purely linear process, when in fact, upon closer inspection, it is a dynamic process
containing intrinsic feedback loops. It visually reflects the inductive nature of the
process from the "ground up."
Referring to the SBAT, the process of advocacy by the nurse begins with iden-
tifying or recognizing internal choracteristics of the nurse ond the environmental
choractcristics around the nurse thus forming the conditions. These C3ll be found
31 the base of the diogr,m. The internal characteristics that emerged from these
data include malting one's opportunities; willingness to take a stond; being a risk-
taker; experience and/or upbringing; desire to make a difference; desire to do
what is right; knowledge of health, business, ond culture; identifying one's pas-
sion; being• good comrnunicotor, both verbally ond in writing; having persever-
ance; looking at the big picture and having a willingness to look outward (outside
ofoneself); and having the desire to be an advocate. The external or environmen-
tal characteristics that emerged and which con affect the nurse's course of action
include opportunity, mentor relationship(s}, incentive, and having role models.
As these characteristics come together in multiple combinations, they crc:ite the
context within which there exists the potential for successful odvoc,cy. They arc
referTed to as the tonditibns needed for the advococy process making up the tondi-
tio11al context. This conditional context may change with a different combination
ofconditions, thus changing the subconcepts that might be chosen from each e:tl-
cgory and then acted upon. According to Corbin and Strauss (2008), the context
doesn't determine the experience or set the course of action, but it docs
identify the set of conditions in which the problems and/or situations arise
and to which persons respond through some form of action/interaction
and emotion (process), and in so doing it brings about the consequences
that in tum might go back to impact upon conditions.
(p. 88)
A conditional context must be identified before the nurse can decide to odvOC3tc,
and it needs to be present at each level as the nurse 1r.1vcrscs the Advoc,cy Matrix.
This context will shape and reshape the nurse's interactions as one moves within
the SBAM stages and across its levels. After ascertaining the conditionol context,
the nurse decides to proceed with 3JI advoc,cy act. These, the earliest steps, are
represented by the three boxes at the bottom of the SBAM and form the founda-
tion of the advoc,cy action.
After deciding to odvocatc, the nurse initiates the main action "to advoc,te,"
which occupies the triangle in the center of the SBAM, by engaging in its neces-
sary components of process and goals, which collectively arc rcfcrTed to as stages.
The Process, comprising the interactions to identify and to strategize, can be seen
near the base of the large central triangle. The Coals, as they emerge from the
data, arc to fucilit.ttc, to empower, and to promote, and arc grouped in a smaller
triangle within the apex of the large triangle. Advocacy has been defined by
this researcher as a dynamic process through which the nurse engages in a set of
actions with stated goals. The Process leads to the Coals. Advocacy is the ultimate
product of the nurse engaging in these interactional stages.
While all categories arc contingent on the conditional context, once the nurse
pinpoints the context of the advocacy action, the process to identify and strate-
gize in order to advocate must be followed. Within the advocacy concept, to
ide111ify and strattgi:u include various actions and concepts that emerged from the
data as listed next. The interaction to idtntify includes interactions/actions when
the nurse can
t. Recognize a need
2. Analyzc the system first/gather infom12tion
3. Understand the issues, systems, community.
As the nurse identifies any or all of these things the next step would be to strak-
gizt. To achieve this, the nurse can:
t. Partner/build coalitions
2. Examine the context
3. Determine means and relationships to accomplish the ultimate goal(s) by
planning, organizing, negotiating, and/or persuading.
In order for the nurse to identify and strategize, one or more concepts from
each of these categories can be used, in any combination as the situation allows,
moving forward toward the goals. Jfthe nurse progresses to the strategize step and
finds that there is not enough information with which to put together a strategic
plan to achieve one or more of the goals, then the nurse may need to return to
the identify step to reassess and reevaluote before returning to the strategizc step,
as indicated by the arrows in the SBAM diagram. This dynamic process between
the interactions to identify and stratcgizc fonns the initial component of the main
action of advocating.
As the nurse moves from Process to Coals, the goals themselves will be specific
to the conditional context of the issue and must be kept in mind by the advocate.
Each goal may not be realized with each advocacy action and may need to be
reassessed and rccvaluated in an ongoing basis throughout the actions and inter-
actions in the Advocacy Matrix. As represented by the Venn diagram, one, two,
or all three goals n12y be realized in a given act of advocacy. These Coals have
subconccpts that were discovered through the data analysis and arc listed here.
Facilitate:
1. Relationship/coalition builder
2. Communicator
Exemplar Sl
3. Liaison
4. Establish mcntor/mcntcc rel3tionship(s).
Empower:
I. T:ikc responsibility for one's own 3ctions (includes to transfer responsibility

to individual or group)
2. Be an active member in professional nursing organization(s)
3. Give voice to
4. Educate.
Promote:
I. Engage in issues
2. Work for social justice
3. Disseminate information
4. Effect change.
As the nur.;c attempts to advocate, the 3Ctions and interactions, as seen in the
respective areas in the Advocacy Matrix, remain the same no matter what matrix
level the advocate is on. One must remember that all actions of the advocate arc
dependent on the context in which the advocacy occurs. As stated earlier, this con-
text is any combination of the conditions (internal and environmental characteris-
tics) that arc necessary for there to be the potential for successful advocacy to occur.
If conditions for advocacy do not exist, the nurse must create them and know
how to use them. For example, if the nurse docs not have knowledge of a system
that could affect the outcome of the advocacy action, the next step would be to
learn about the system by reading, speaking with other players within the system,
or comparing it to other systems. Once the nurse has acquired this knowledge
about the system, it can be used to better understand how to approach the issue
strategically by activities such as organizing, planning, and building relationships.
Another example is the identify stage of the Advocacy process, in which the
nurse will recognize a need, gather the necessary information, 3nd know the
community in which work is needed for the advocacy to be effective and suc-
cessful. However, if the nurse is not able to effectively make the case for the
advocacy action to the community, the possibility of a successful advocacy action
is decreased. As can be seen through these small examples, the nurse needs to
be aware of the Advocacy stages and how best to maximize the efforts of these
actions. These steps may be sequential, simultaneous, or free-flowing between
the two but continue to be dynamic with each issue, opportunity, and advocacy
case. Depending upon the issue, all of the concepts under "identify" and "stratc-
gizc" may not be needed every time the nurse is advocating for an issue, patient,
or policy. These arc guides to assist the nurse in working through the stages of
Advocacy within each level of the matrix.
The levels of the SBAT in which the advocacy action occurs comprise
individuals, groups, organizations, communities, and national, international,
and global arenas, as represented in the SBAM in Figure 3.1 as the concentric
arcs above the large triangle. Acts of advocacy may be effected upon individu-
als, groups, or multiple groups, as indicated by the arrows pointing from the
advocacy triangle into every arc level, and may subsequently be directed to
successively larger groups or even smaller groups, as represented by the arrows
radially traversing the arc's components in outward and inward directions,
respectively. The data suggest that as one goes further out into the levels of the
SBAM, the advocacy may become more difficult and/or complicated reflect-
ing more layers of understanding that arc needed for the larger, more complex
systems and the larger number of people with whom to build relationships.
Conversely, earlier successes in the matrix may accelerate the Advocacy pro-
cess because the nurse has more relationships built and information learned on
which to base the next advocacy action. This is why building relationships and
knowledge, combined with planning, are integral to a nurse's success across
the Advocacy Marrix.
Success on one level of the Advocacy Matrix prepares the nurse for success
on the next level. However, if the nurse moves across levels and does not achieve
success in a higher, subsequent level(s), there may be a need to return to the pre-
vious level of success with reassessment of what was successful and what could
be changed. The data suggest that this may lead to future success in those higher,
more complex Advocacy Matrix levels. Success, as evidenced by goals achieved,
can increase motivation to be more involved in advocacy. In this dynamic process
the actions and interactions will overlap and move in a fluid manner as the con-
ditional context requires.
As the nurse advocate traverses each Advocacy Matrix level, negative and/or
positive influences may change the nurse's direction of traversing the levels and
stages of the SBAT. As the construct emerged from the data, negative influences
were generally perceived as barriers by the participants. They may prevent the
nurse advocate from getting to the next stage and/or level, whereas positive influ-
ences were perceived by the participants as helpful to the advocacy process and
having the capacity to f.icilitate the nurse advocate's movement forward within
the Advocacy Matrix. We will call these negative and positive influences i11tcrven-
ing "'nditio,is. The nurse needs to constantly reassess, reevaluate, strategizc, iden-
tify, and establish support, relationships, and coalitions in order to move outward
or through more complex levels on the Advocacy Matrix. With the influence of
intervening conditions, which can happen between any two stages or levels ofthe
SBAM, the nurse may need to remain in a matrix level or drop back a level to
achieve the advocacy step, as indicated by arrows that point forward and backward
or outward and inward on each Advocacy Matrix level. The level of negativity a
nurse encounters may be decreased through interactions with or interventions by
Exemplar 53
peers/team support, mentors, and others. The ncg.,tive versus positive influences
that emerged from these data arc:
1. Lack of professional/system support vs. presence of professional support.

2. Ncg.,tivc nursing culture vs. encouraging nursing culture.
3. Lack of time vs. sufficient time.
4. Lack of energy vs. sufficient energy.
5. EduC:ltional system that discourages advocacy vs. educational system that
encourages advocacy.
6. Lack of eduC:ltion and knowledge vs. adequate education and knowledge.
7. Lack of communication skills vs. adequate communication skills.
Movement across the SBAM levels requires engagement in the process and
working toward the goals in order to achieve the advocacy action. The advocacy
process in the matrix is the same at all levels of the Advocacy Matrix but may
change due to the complexity of a system, larger numbers of people involved,
previous relationships, knowledge acquired, or intervening conditions. The
innermost levels of the matrix support the multiple outer levels as one works
toward them. One must remember that patient advOC3cy, which may lead to
policy advocacy, will ultimately return to and benefit the patient. Success in advo-
cacy is seen as moving through levels with the end point being transference of
advocacy on each level to the patient or group identified on the SBAM levels.
These data suggest that the "timelinc" for the nurse to become an advocate is
not measured in units of time but rather by the experiences across one's career. As
evidenced by the data analysis, the advocacy action, encompassing the five stated
categories and the nurse's success across the SBAM, is an evolutionary process that
occurs throughout the nurse's professional life.
The Paradigm Model

The paradigm model is "an analytic strategy for integrating structure with pro-
cess" (Corbin & Strauss, 2008, p. 87) that assists the researcher to think about
relationships within the data in order to identify the context and to link it to
the process. The analyst uses the paradigm to gain a deeper understanding of the
data, especially the situation or circumstances that surround an event or response
to it, in order to enrich and deepen the analysis. It is a set of questions that "can
be applied to data to help the analyst draw out the contextual factors and identify
relationships between context and process" (Corbin & Strauss, 2008, p. 89}. It
consists of conditions, actions, interactions, and/or emotions, and consequences,
a.II of which can be referred to as classifications of the data. The three main ques-
tions include: (1) What arc the conditions or circumstances that elicit a response?
(2) What arc the actions/interactions/emotions that the person responds with?
(3) What were the consequences to the person's response to the condition? (Cor-
bin & Strauss, 2008, p. 89). Therefore, this assists the researcher to look for cues
in the dat:1 that will answer these questions, be able to code the dat:1 as concepts,
and place them in the identified classificitions.
Open, focused, and axial coding, which is the act ofrelating concepts and cit-
egories to each other, were used to determine codes or concepts and to ultimately
sort them into categories. This sorting was a dynan1ic process that occurred
throughout the analysis ofeach interview transcript and the constant comparisons
that were applied to these data. In the early part of the investig:ition, codes that
were used were expanded and then contracted as guided by the data. A total of
10 citegories and 89 codes emerged and cin be seen in Table 3.2. The researcher
managed the data manually in order to g:iin a deeper understanding of the process
TABLE 3.2 Initial Catcgorics and Codes
Coda
burnout, educational sy>tem may discour,i;e advocxy (also

under Edu,atitm), fear, inability to form coalitions, bck of
autonomy, lack of commioncnt. bck ofcommunicarion
skills, bck of desire, bck of education, b.ck of interest, bck of
knowledge, bck ofpreparedness, bck of professional support,
bck ofself-confidence, bck of sclf...,.tecm, lack of time and/
or energy, bck of willingnC$S to sec big pictwc, negative
nursing culture, perception vs. rc:ality, potential for not being
appreciated, rescuer vs. advocate, shame, wanting to ''keep
the pcacc;'unsafc profem.onal environment, unwillingness to
accept responsibility for one's own actions, unwillingness to
take a sw,d, lack of cb.rity
EJ""'ti"" educator, role iJ intrinsic to nuning. knowledge vs. bck of
knowledge, >Ocialization of role, educational system may
discounge advocacy, education vs. bck of education
Know/dg< know community/audience, opponunity and being able to
recognize it, knowing when to take advantage of opportunity,
bck of clarity vs. undersw,ding based on knowledge
u,,Jn,J,ip vol11a, lead from behind, to give voice to, c:i:tal)'3t to push an Wue,
uamingef opportunity recognition and what to do with it, position, role
leuership models. suppon from others/mentors vs. lack of3upport from
others, mentor/mentcc relatioruhip (also under Oukon1a), bck
ofprofe1tional system support
o..,,,,,,,,. empowcm1cnt vs. powcrlcssncs.s, «nurse advocate is the
patient's safety net." desire for social justice. effect change,
form coalitions, learn through successes 2nd failures. trust,
financial implications. mcntor/mcntcc rebtioNhip (also under
L,admlup Vaiua, 1,odrinx of uadmlup)
Exemplar ss
Pnso,w/ confidence, courage, deliberate manner, fear, persistence/

dumutnistics perscvcrmce, political will, questioning lhe starus quo, risk-
taker vs. unwilling to blcc a risk or stand out, willingncs.s to
take rcspomibiliry for one's own actions vs. unwillingncs:s to
accept responsibility for one's own actions. having a vision/
nus,ion/goal, desire to do what is right, desire to make a
d.ifrcrcncc, listener, opcn-mindcdnc:s.s, passion, desire for social
jwticc (also under Ou/tomes), ability to ,clf-reAcct rqi;,rding
penonal strengths, etc., willingness to take a stand, value
system, trust, fear, shame, lack of ,elf-confidence, lack of sclf-
cstccm, lack of willingness to sec big picrurc vs. ability to sec
big picture/look outside ofonesclf, lack of interest, having
in,cg,;iy, lack of commitment, lack of desire
Pn,Jcssio,w/ w,,n negative nursing culture vs. p05itivc nursing culture, '"u.n.ufc''
profouional environment~ lack of autonomy, lack of
prcparcdn~ unsupportivc nursing environment. wanting to
11
kccp the peace"
facilitator, game changer, sy3,tcn» anal)')t, actiVUt, coalition
builder vs. inability to fonn coalitions, liaison, identifier
(recognize a need), innovator, partnering, prob1cm solver,
stntcgic thinker, systems analy,t, desire to be an advocate,
rescuer vs. advocate
SnniMl ind4mt ..aha" moment, "tipping point"
Tl,Jngs "-• wldle engagement in is.sues, cle2r communicator vs. lack of clarity
in rola (tu:ti<nt.S) in communications, need to analyze system first, having
autonomy, partnering (also under Ro/«), perception
vs. reality, power relations, questioning the status quo
(also under Ptrson.al CJUJrattuistia). understanding social
re5.ponsibility. undcnunding the system, being in,spircd.
having experience, grounded due to having pcnpcctivc
on a situation, listener (also under Ptmmol Chttra<ttristia),
perception of being able to influence someone, perception
of being in a "s.afc" environment, understanding
the context, lack of communication skills vs. good
communia.tion skills
NB. Jtlliclud wordsl•xprcsslons ar• ca«-gories. Each <><,gory Is fullow,d by ,,,. cod,(s) llut it con-
tains.. Expressions shown in quotltion rrwks rtprese-nt the words chosen by the interviewee-.
ofgrounded theory analysis. Although the p3r3digm was a useful tool in this stage
of the research, it became apparent to the investigator that infonnation that was
emerging from the data was much richer, deeper, and more dynamic than the
linear paradigm model could depict. This Jed the «:searcher to utilize the condi-
tional matrix as it applied to advoc:1cy.
56 Pennie sessler Branden
The Conditional Matrix

The conditional matrix, as explained by Corbin and Str.1uss (2008), can be used
to explain the complexity of a topic by enriching the analysis and helping the
researcher sort through the r.1nge of conditions and consequences associated with
location of and response to events (p. 91), especially as they can change in relation
to the context. In addition to using the paradigm model, the conditional matrix,
as specified by Corbin and Str.luss, allowed the researcher to compare the data
and gain a better understanding of it through a deeper, more substantive analysis.
Through ongoing constant comparison, theoretical sampling, discussions with
Dr. Corbin, and fiinher data diagramming to ascertain relationships of codes, the
coding process described earlier and shown in Table 3.2 had some categories and
concepts subsumed under a smaller number of categories with their respective
subconccpts. These six categories and 55 codes can be seen in Table 3.3.
Using the codes fiom Table 3.3, the researcher sought to construct a visual rep-
resentation of the codes' interrelationships by constructing a diagram. Drawing
this initial diagram was the first stage toward the creation of the Sessler Branden
TABLE 3.3 Refined Coding Sy,ten,
Coda
Slrotegize identifier ofissues. need(s), etc.; sttatcgic thinker; risk

taker; "'systems anal)"'t"': undcntanding of i$S\lcs, system,
and community; waly:zc system first; know audience/
community
take rC$poruibility for one's own actions; give voice to;
lead fiom behind; tnrufcr rcsponsibilily to individual or
group; cduc.1.tc; understanding issue and system; form
coalitions
Fotilitotc ffl41'Jlt: undcnt3Jlding systems, i.uucs, community; have pcnistcncc;
rcbtionship/coalition builder; communicator; focused,
deliberate manner; courageous; &cilitator/liaison; fom1
coalitions
l'rtmu,te sot:LJ j,utice activist; engagement in is.1ucs: big picturc/willingnc:s.s to
look outward; political will; couragcow; health
lntffflDl draroc.taistics ma.king one's opportunities; experience/upbringing; desire
to n>akc • dilfcrencc; knowledge of health, bwinCM, and/
or culture; motivation; identifying onc"s pas.1-ion; good
communicator. in verbal and written fomu; persistence;
self-reflective; sclf~warc
Ext,mal mara,;tmstia opportunity with current s-ituation; context; mentor;
socialization: educational. professional, infomul;
stimulation/motivation/incentive
NB: ltallciud words/txpr...tons att cattgorit<. Each mogory Is followtd by tht codt(s) that It con-
tlins. Express.ions shown in quotation marks represent lhe words ch~n by the interviewee.
Exemplar 57
Advocacy Matrix (SBAM). Through ongoing analysis of the data, rethinking the
carcgorical connections of the concepts, diagnmming the data multiple times, and
discussing all of this with Or. Corbin, it became clear that the concepts and catego-
ries as seen in Table 3.3 needed to be expanded. For ex.ample, in Table 3.3, the code
of identifier was under the category "stratcgizc." Alier recxamining the data, this
code needed to become a categorical assessment component as seen in Table 3.4.
Upon closer analysis, "identify" and "stratcgizc" were two =nent components of
the advocacy process. Therefore. they were placed in Table 3.4 under Categories as
the two 3SSCSSlllent components of the advocacy process with their respective codes.
TABlE 3.4 Final Coding Sy,<em
Q,d,s
PROCESS
IJmtify recognizing a need; initially analyzing the
sy,<em; understanding the issues, :systems,
community
partnering; W1dcrscanding the context; and
working out means and rclatiomhips to
accomplish the ultimate goal(s) including
to plan. organize. negotiate, persuade
GOALS/OUTCOMES
F'1<ilililte be a rclatioruhip/coalition builder;
communicating; being a liaison;
CKablishing mcntor/mcntcc rclatioruhip:s
Empotva raporu:ibility: to l'akc for one"s own actions
as well as transferring responsibility to
individual or group; giving voice to;
educating; and being an active member in
professional nursing organization(s)
Prrnrwte engage in h.suC$; work for social jwticc;
disseminate infomu.tion; effect change
CONDmONS
Int<m11/ diortldnistia nuking one's opportunities; willingness
to take a .stand; being a ri.sk-takcr;
experience and/or upbringjng; desire to
make a difference; dell.re to do what is
right; knowledge of health, bwincss and
culture; identifying one's passion; being
a good communicator, both verbally and
written; ~ving pcncvcrancc; looking at
the big picrurc and a willingness to look
outwanl (outside of oncscU); and having
the desire to be :an 2dvocatc
(Omrinut<f)
TABLE 3.4 (Continued)
En,inmmmJ41 (atnnal) dr11radnistia opportunity; mentor rclatioruhip(s);

incentive; having role modcb
Inlavm;ng wru1;,ums • lack of profa,ional/sy,tA:m ,upport vs.
(Nrrins r.s. positive ir,fo<mus) presence of professional support
• Negative nursing culture vs. encouraging
nuning culture
• Lac,k of time vs. having sufficient time
• Lack of energy vs. having sufficient
energy
• Eduat:ional system that discow.b,cs
advoacy vs. educational ,ystcm that
encourages advocacy
• lack of education and knowlcdw, vs.
adequate education and knowlcdw,
• Lack of communication $kills vs. adequate
communication skills
NB: Jtilldud worck/txp.-.sslons arc cat,gories. Each cat,gory Is fotlowtd by th• cod•(•) that It
contains.
111• Sessin Brandtn Advocacy Theory (SBA"I) Is • unique. mld-.-.ng,, ground,<! thtory that otftr>
cv,ry professional the took and guld>nc, to bt<ttr undmtand advocacy md Its op,ratlonalizadon.
AdvOC1cy ~ a topic that mOSl h,alth profeuional, have heard of and m1y hav, Ironed about liom a
mffltor. However, rmny do not undencand how to execute and apply 2dvoacy, which c.an be over-
whtlming and lndmidating to any pro(tssioruJ. The SBAT NU.bits any professional to be a successful
advocate. Using tht specific ~ps. b,giMing at the b2Se of tht SBAT Matrix md moving upward 10
each section 200 category, the pro(esslonal who Is: commluied to r.hc process an learn to advocate
for patients. groups, and communities. Funhtr, succ~ :u an advocate is not a lin~ progression but
rather a dynamic 2nd ftWd process across one's career. Through advocacy, nurses, and other profcs--
sionals can :assist and stand up for those who are ltsS :able ro do $0 for themstlves, all the rime being
culturally Sft't:Sltive to whether or nor a person or group wants a profts:donal's awSbnee or guidance.
111es, points, 1S txpllcattd throus)l this thtoty, are lntqval to tlftcdve and succ..,ful advocacy whll,
bringing theory to pracdc,.
As constant comparison continued, it became clear to the researcher that in

Table 3.4 the main categories that emerged were actions with subconcepts rep-
resenting actions, interactions, skills, and knowledge. The final coding system
yielded three categories, eight subcategories, and 41 codes. This process brought
deeper meaning to the data while clarifying the findings and led to the discov-
ery of the SBAT. All of this is diagrammed in the SBAM (Figure 3.1) which
comprises the central phenomenon of the advocacy process. the five categorical
components made up of two assessment components and three goal components.
T he conditions. as seen in the SBAM in Figure 3. I, arc composed ofintemal and
environmental characteristics, hereinafter called the foundational characteristics,
the intervening conditions. and the context.
Exemplar 59
The SBAT allows for the dynamic nature of advocacy to be shown as it rcbtes
to the advocacy process, including the 3SSCSSment and goal components, and con-
ditions as they emerged from the data. The Advocacy Matrix is not a procedure
but rather a representation of the categories that have emerged from the data
regarding the advocacy action by the nurse.
If one envisions the matrix structure built upon the conditions, the condi-
tional context and the decision to advocate boxes form the fau,idatio11al co11ditilms
for the central- most portion of the diagram, represented by a large triangle. This
brge triangle representing the advocacy process comprises the two sections that
make up the asstssmt11I compontnls of identification and strategy in the lower box
within the triangle, and three ~•/ compontnts including facilitation. empower-
ment, and promotion arc represented by the Venn diagram arc in the upper por-
tion of the triangle. The 3SSessment leads to the goals and all of those constitute
the advocacy llltio11 process. These five components, in various combinations, make
up the advocacy action and can be considered an infrastructure upon which all
advocacy actions arc built and/or arc supported.
These component categories within the triangle arc surrounded by the upper
semi-circular arcs representing levels of cvcr-incr=ing magnitude and complex-
ity including the individual, group, organization, community, national, and inter-
national and global arenas. These arc the forums in which the nurse can advocate.
The dynamic process of advocacy is represented by arrows that go bidirection-
ally between these levels. The advocate can traverse the levels of the Advocacy
Matrix in a sequential or non-sequential manner. However, as evidenced by what
emerged from the data, successful advocacy in one level docs support the further
success of the advocate in other levels of the matrix.
Theoretical sampling allowed for saturation of categories, and the develop-
ment of concepts in the expression of their properties, variations, relationships,
and dimensions. This brought about the emergence of theoretical categories.
Theoretical Categories
Higher-level concepts or categories arc derived from the concepts emerging from
the data and arc the theoretical categories that constitute the theoretical model.
They possess properties or characteristics giving specificity to an action, event,
or object and that define and describe the concepts (Corbin & Strauss, 2008).
Dimensions are what explain the variation within properties (Corbin & Strauss).
I will now explain the theoretical categories and then move on to the relation-
ships found within and between these categories. PIC3Sc note that the participants
were de-identified before the data were analyzcd. Each participant was given an
ID number that was used to identify statements recorded in the interviews and
the subsequent transcripts.
These data support that the core phenomenon to advocate is a dynamic pro-
cess, thus made up of actions and interactions by the advocate, and interactions
between the advOCltc, the proposed goals, and the actual outcomes, as well as the
venue/community that the advocacy act occurs in. These data suggest that there
arc five major theoretical categories that nuke up this dynamic process of advo-
cacy by the nurse. These categories arc to identify, stratcgizc, fucilibtc, empower,
and promote, and arc referred to herein as stages.
Identify and stratcgize form the early process in advOC1cy. A process is an ongo-
ing action/interaction that responds to situations or problems so that the advOCltc
C3ll reach a goal. The purpose of the process is to achieve a goal or outcome. The
process and context arc interrelated because if the context condition(s) changc(s},
the process of action/interaction will need to be altered or adjusted to achieve
the goal. This dynamic process is integral to the advOClcy action because there
will frequently be intervening conditions, causing the context to change that will
force the process to shift in how it will be applied.
Identify
To idtnlify is defined as being able to ascertain, recognize, or discover an issue,
object, event, or person. Nurses identify issues, problems, and ways to communi-
cate in everything that they do, including advOC1cy. The subconccpts of recogniz-
ing a need, initially analyzing the system, and unders131lding the issues, systems,
and community arc used to identify an issue that needs to be advocated for. The
Advocacy process, as suggested by the data, begins with the stage to identify.
RttOJlnize a nttd. This is the point at which the nurse must ascertain the spe-
cific need that has been observed in the context. One participant describes this
quite aptly:
You come across a problem and you could let the problem go and not even
pay attention to it or you can think about what is this problem and start
analyzing the problem and coming up with solutions and collaborating
with people to sec how you could p05Sibly make change.
The participant spealcs to the nurse's recognition of a need or a problem and the
choice to address it or ignore it. This is critical to the process of advocating and
one that is supported by the dab in this research.
Initially analyzit1J! tire sysltm. Once the nurse has identified the need for the
advocacy action, analyzing the system within which the nurse needs to advOClte
is crucial to moving forward with the process. Many of the participants pointed
to this step as a method of beginning to learn the overall process of advocacy.
Another participant described its importance like this:
The other that it (advocacy) means to me is that it's a gateway to a more

analytical process about utilizing data to determine sort of appropriate
options ... to intervene in health problems.... the analysis role I think is
Exemplar 61
cqu'1ily exciting. 11,at's rc'1ily the analytical and sort of the, kind of policy-
option side of the business, and I think advocacy is a doorway for that that
some nurses can take and wanna take.
Undmtat1ding dzt issues, systtms, mmmunity. Third, an important aspect in the iden-
tify sugc for the nurse to advOC3tc is to understand the issuc(s), systcm(s), and
community. This undemanding not only gives the nurse the sensitivity toward
the issue but also the people, system, and community that arc affected by the
issue. A participant spoke to understanding the issue as it applied to the people/
community by saying: "You still want to do an analysis of the situation. You want
to think about who are the players, who can make the decisions. What arc their
values? How do I influence those values? That kind of thing."
Another participant put issue identification into a specific context:
And then of course there is the abortion issue. Some nurses view it as a
women's health issue and that nurses' views have no place in providing
health to women. Others foci that this is not a women's health issue. It's
a personal belief issue, but that has not been argued as much in the nurs-
ing literature. There's been some ~y rights issues that have been back and
forth. I think some of the issues have been around-the issues 1--thc times
I recall it's been around issues that society as a whole struggles with.
Both quotes point to the importance of issue identification as integral to the

advocacy process. Second, the nurse must understand the system and community
within which the nurse will advOC3te. This sensitivity will support the actions
of the nurse. As a participant stated "So you have to look at, 'What is their way
ofunderstanding? How will they best learn this?' So you have to understand the
patient population that you're taking care of."
As one participant stated to illustrate how the lack of this understanding is
critical to advocacy success:
They understand the organizational culture of the (community) arena, they

understand the incentives, the motives, don' t know how to talk (within that
community), don't know the jargon, don't know tho-cvcn some things as
basic as knowing the (system) process. And knowing it, not just writing it
3nd don't know who's in power and who's not, don't know how informal
power works in these arenas, don't know deals arc made behind the scenes,
don't know the role of staff (in the system).
Strategize
The second stage of the advocacy process is to stratcgizc. To stratcgizc means to
make a plan. In order to do this one would consider the associated subconccpts
of pannering, examining the context, and working out means and relationships
to accomplish the ultinutc goal(s) to str:ltcgize for an issue that the advocate is
working on.
Part11erinR. Partnering with other nurses, people, professionals, and groups ena-
bles the nurse to form relationships that can lead to coalition building. To partner
is to :issociatc or affiliate with, to connect, to unite, or to team up. Nursing has
always valued the team approach to issues and problems within nursing but has
been less willing to work outside of the profession with others to get to the same
goals. Many panicipants emphasized the imponancc of intcrprofcssional partner-
ing to increase the effectiveness of nursing efforts. Another participant spoke to
working on forming relationships and partnering in a deliberate or inadvcnent
nunncr by telling a story of a nurse advocate. She stated:
And so, she (colleague) needs basically to say, "I can make things work
together." And so, one of the things that she's done is to align herself
with other people who have expertise and arc well-known on that topic.
And I think I've done the same thing, although not deliberately, in the
(nurse's spccialty). I know thc--many of folks who arc out there in
front-certainly not everybody, but out there in front related to (issue
in specialty).
This was emphasized in what this panicipant stated:
So now when I think of the nurse as advocate, I feel in (system) arena, I feel
very strongly that it needs to entail partnering. Partnering with communi-
ties and not being the ones who go up and speak for-have any, have any
basc--havc any illusion of feeling that they're spe•king for others. Even
speaking for other nurses so that-o the other thing about being a nurse
advocate is that we don't speak for ourselves.
To put it more succinctly and poignantly, another panicipant said: "I mean that's
part of the method of being an advocate because you can't-you have to do
things collectively if you're going to make change." And later, "You can't do it on
your own. Can't change the world by yourself."
Undmt,mdinR tht context. To understand the context is to understand the con-
ditions surrounding a situation or issue and is signific•nt in the •dvocacy process.
Another participant related this to a context of patient illness and the nurse's
response to that situation:
It continues to be in providing care, they-what they want. So it's prob-

ably going to be, in the case of that, where say somebody has Stage 4 breast
cancer but doesn't want chcmo, it's what other types of quote-unquote
"treatment" for pat.icnt care management. use that word, that you're going
Exemplar 63
to be with them. So it's providing, you know, a different kind of care, it's
just care-based on what they want, and/or (the specific context).
A panicipant related it to the nurse being at the bedside:
the nurse's role is initially at the bedside to inform and take action, to
inform the patient and take appropriate action as necessary but to go fur-
ther and all the way 10 potentially effecting policy changes basod on what
the situation is.
Nurses frequently assess the context of a situation in order to best approach an

issue as is done when the context is identified as seen in the matrix. This is done
after the nurse recognizes that context and through the advocacy process the
nurse will realize a deeper understanding ofit as well.
Woiki1,x out mta11s a11d r,/atiomhips to auomplish the ultimate J!O•l(s). Worklng
out the means to accomplish the ultimate goal(s) include interactions 10 plan,
organize, negotiate, and persuade. II is through these actions that the advocate
can panner and establish support across various venues and levels in order to
strengthen the potential for success. As stated by another participant: "I think
the most important thing is that you have to have ground to stand on if you're
gonna stand for anything. So you have to know what you arc talking about." Or
to persuade by "bringing to the attention of people who can do something about
it is a lot of what advocacy is."
Facilitate
As the nurse interacts within the Advocacy Matrix, the advocacy act should be
simplified as the nurse fu.cilitates. The nurse as a fucilitator can speak for people
initially to ensure it is for the benefit of the patient, group, or community. This
can be done by being a relationship/coalition builder, communicating, being a
liaison, and establishing mcntor/mcntcc relationships.
& a rtla!ioml,iplcoalition builder. Nurses have always built relationships with
their peers and colleagues within the work setting. The data from this research
show that nurses do not build other relationships, outside of nursing, on a regular
basis. Participants frequently statod that to build relationships is essential to suc-
cessfully advocating for a case or cause. Once these relationships arc established
they arc a stepping stone to building coalitions around an issue. As a participant,
who had ongoing successes in advocacy work related to their work and research,
put it "But I think it's been more the fu.ct that I happened to know somebody. So,
I think I've been lucky from that standpoint, is that I've either known somebody;
and I think that's what it was. And my associations."
Further, another participant speaks to the importance of building these rela-
tionships: "but a lot of it just has to do with relationships that you have with
people that develop over yC31'S. And you have different relationships depending
on where you arc in your career. .,
Many participants described the key step of utilizing relationships in order 10
build coalitions within and outside of one's institution. The data support that this
is a step many nurses arc very uncomfortable with and/or do not have the skills,
education, or wherewithal to undertake. This participant pointed out the advan-
tages of building coalitions:
I think it can't be just a nurse, I think it has 10 be multi-disciplinary; because

sometimes, 10 be honest with you, ii takes more than a nurse. And I think
when you have a multidisciplinary team-at least that's what I've seen in
(my work)-that you can get a lot more done and accomplish a lot more
when it's a team. Not saying that nurses can't do it alone; we can. But
I think you do it better when it's multidisciplinary.
To confirm this as well, another participant said:
And so that's why I think advocates also need a community of colleagues,

peers, coaches, support people, supervisors, or networks so 1ha1 they can
engage in strategic dialogue about when their stuff gets in 1hc way and
when it is too much or maybe not enough in regards to certain situations.
Historically, nurses have seen that there have been advocates within the profes-
sion who have accomplished many things. They too recognized 1hc importance
of building relationships outside the profession. One participant discussed this
context while describing what Lillian Wald did 10 move her agenda forward:
I mean she (Lillian Wald) invited the Metropolitan Life Insurance president
10 dinner and told him she could reducc--help him save money-by open-
ing TB clinics and having nurses go. I mean, a lot of this stuff was through
connections, and that's how the good ol' boys worlc, and I think nurses
need to get a little bit smarter. I think nurses arc getting smarter with that,
but I think most nurses aren't there (yet).
Comm,micatin~. Nurses learn communication skills in their nursing programs and

frequently believe they have good communication skills in their workplaces. How-
ever, these data show that when having to communicate with others outside of the
nursing team and/or worlc setting, nurses flounder in their ability and skill to com-
municate clearly. This is exemplified through this statement by another participant:
We have to be able to communicate the issue clearly and it has 10 be

focused on the issue at hand. It can't be made to appear to be about nursing
Exemplar 65
as nurses frequently do. Because then society sees nursing as only caring
about their own and not society in general. If we can't communicate all of
this, we can't advocate.
L3ter, a participant focused on having to be outspoken and articulate:
I think it has to do also with seeing- well it has to do with value. I think
it has to do with having a mission, a passion, being somewhat outspoken
about those things, because I think you have to be, particularly if you're
going against the tide. And articulate about those issues. I guess that son of
sums it up for me.
A third participant summed it up by saying:
So that expertise and knowledge become very important. In both arenas,

it's very important to articulate facts, but it's also important at both levels
to be able to take it down to that personal level. Those narratives arc really
important.
&i11g a liaison. To be a liaison, the nurse must make a connection or a link between
the people or communities that the advocacy act is occurring in. This liaison
association will bridge some gaps because the nurse advocate will strengthen the
link with advocacy across the groups and levels within the matrix. As another
participant stltcd:
but someone needs to help with the connections. It doesn't happen auto-
matically. If one learns the skills ofdeveloping and implementing workplace
(issues) one can use those skills in the larger community and government
arena. But it is hard and one person cannot do it alone. Pait of the skills is
learning how to organize others for a common purpose.
Establishing mentorlmtnt,e rtlatibns/1ips. Every participant spoke to the key role that
having a mentor played in moving them forward in their careers and assisting
them to sec what they were unable to sec in a situation, research investigation,
or workplace issue. The mentors were fondly referred to by the participants as
evidenced by the frequent mentions of their positive feedback from and regard
for their mentors. All of the participants, who spoke to the fact that they have had
more than one mentor, were shaped by these mentor/mentce relationships that
continue to this day for many of them. Each of them found someone who they
could confide in and know from whom they would get an honest assessment of
a given situation. Once the nurse has had a positive mentor relationship, these
relationships become reciprocal ones where each person offers similar support to
the mentor. One participant spoke of three mentors who she has had through the
course of her career. She stated:
My mentors were instrumental in helping rein me in, so a really, really close

friend, (name) was my mentor through my early days. I met her through (a
professional organization). She's the exact age of my mother, but she really
loved my work and advocacy work with clients with (disease process), so
she was my huge support. We trnvcled together. She lives in (city) and
I visit her all the time, but I never get an idea that I wouldn't bounce off
(person's name), and just bouncing off of (name) helped me rein myself in.
In another interview, a participant's statement brought to light the issue of nurses

in the clinical setting needing a mentor as weU. This participant stated:
I'm not sure that they'd even call it that (advocacy), but we do have this
term patient advocacy, and I think that helping people with a mentor who
kind of walks with you is important to gain the confidence and those skills.
One participant spoke of a mentor who was a significant force in her life. This
mentor saw strengths in the nurse that the nurse did not and encouraged this
nurse to try new and exciting things that might be of interest. The participant
stated:
And I don't think she would ever want that woni used knowing (person's
name). But she did--and she was not an advocate herself. Not in the way
she encouraged me to be, and she encouraged me and believed in me....
we had a conversation about how our styles were different. So she would
be in my mind a great mentor because it wasn't this imposed, intrusive rela-
tionship that we now sometimes sec as mcntoring in my opinion. But yes,
she was and has been one of the most influential nurses in my life.
Finally, many of the participants continue their mcntor/mcntcc relationships as

needed but they also became mentors to nurses as they recognized another nurse's
need to have this type of connection. T hese relationships do not need to be nurse
to nurse but C3n be another professional to nurse and vice versa. A participant
stated:
I do mentor. Actually, I'm mcntoring three (identifying factors removed)

nurses right now because I think they in particular-these arc nurses who
arc in (sctting)-And they have I think a particularly difficult lime finding
people who will mentor them from junior positions to opening doors for
them and helping them to really grow and have a smashing career in (spo-
cialty), so I've taken on these three nurses and just love it.
Exemplar 67
The participants described this mcntor/mcntcc relationship as a reciprocal pro-

cess where both sides benefited in multiple ways. On the whole, aJl ofthe partici-
pants have been shaped by mentors and each of them is actively mcntoring other
nurses to help those mentces progress in their individuaJ careers.
Empower
The temt to empower has developed positive and negative connotations over the
years. Ncg;itively, being empowered has been seen as being aggressive in an action
and has been linked to various movements (e.g.• the Women's Movement} where
there have been other negative associations. However, the positive aspect of to
empower is seen as giving somebody confidence and authority over a situation
(Encarta Dictionary). In this invcstig.ition, the category to "empower'' had sub-
concepts emerge from the data which include taking responsibility for one's own
actions as well as transferring responsibility to an individual or group, giving voice
to, educating, and being an active member in professional nursing org.inization(s).
One nurse participant referred to empowerment and aptly stated this:
I think it's critically important that you feel empowered in terms of your
practice. And when nurses don't. that makes me feel very frustrated with
the system, but it also makes me sad for the nurse because they're not
experiencing what they should in terms of the difference that they make
for the patient.
1ilkit,g responsibility for one's """' adions as wt/I as lra1isferrir1g responsibility to i11di-
llidual or group. The issue of taking responsibility was highlighted by a number
of the participants as they spoke to the fact that while there arc nurses who
take responsibility, there arc nurses who do not want to take responsibility for
their actions, inactions, or decisions. This to them, the study participants, is an
important aspect that nurse advocates must be able to do. As this participant so
accurately stated: "So, that was a pretty instrumental situation, realizing that you
got a problem.... You gotta own up to it and fix it"
One nurse participant described how this was learned in nursing school. This
quote points to the fact that nursing education can be instrumental in teaching
the nursing student the value of taking responsibility for one's own actions. The
participant stated:
I went to college during Vietnam so I started seeing that everybody was

advocating for things. I think I became an advocate because I took to heart
what I was taught in nursing school, that the buck stops with you.
Taking responsibility is aJso important for the person or group that the nurse
advocates for. Therefore, the nurse can tr.1nsfer this responsibility which makes
the person or group more self- confident and may lead to their advocating for
themselves. As another participant stated:
And to rescue people who might be in a vulnerable population and some-

times I see that you could overdo that, because you don't then help the
individual's develop their own sense of responsibility about how they can
be empowered to make decisions for themselves.
CivinJI voia: to. A large part of advocating, as seen in the data, is for the nurse not
to speak for the person or group, but rather to assist the person or group that one
is advocating for, to be able to speak for themselves in a manner that is effective.
A participant stated:
for the population for whom they're advocating. Do those people want
and need advocacy? That's probably one of the things I've learned the most
here. Some people don't want us speaking for them. And I'm sensitive to
that having done (programs about this} . .. . that I see a lot more people
encouraging people to give a voice in their relationships with practitioners
and other people in the healthcare system and if that's an advocate then
that's an interesting twist on it. But-so that would allow people to be able
to advocate for themselves.
Another participant spoke to this in a somewhat different manner:
But I guess the nurse should ask for what the patients want, in terms of
their own healthcare. The other thing is to be a practice nurse, and I can
really see somo--around the whole arena of advocating, to make sure that
patients know that they can be involvod in their own healthcare: that they
can say "no" to things that providers recommend. That they're a part ofthe
team .. .. So maybe to make sure patients know they have a voice.
Edu,atinJI. Nurses need to be educated in any new skill, technique, or procedure

that is needed in clinical practice and education. This holds true for learning to be
an advocate as well. Once the nurse has been educated to the role ofadvocate and
its fundamental skills, educating the public is the next step to being an advocate.
One participant spoke to the education of nursing students:
They (faculty) may talk about the fact that the nurse is supposed to be
an advocate: they're supposed to be this, this and this, but I don't think
that they really talk about what that means. I don't think that we do-we
do simulations for everything under the sun today, but we don't do those
kinds. So, I think that probably there's a place in nursing education and
Exemplar 69
probably in a lot of fields for mcntoring people in advoe:tcy and in lcadcr~

ship bchaviors in w:iys that we are not doing right now.
It is also import:mt that the nurse advocate edue:ttcs other players while in the
advocacy act. This edue:ttion e:tn enhance what the nurse advocate docs, make it
c.,sicr to move forward and lay the groundwork for the nurse advocate in other
situations and venues. Another participant described it this way:
And those skill sets include what arc the kinds of data you're going to need
to sustain this program and to influence policymalccrs to support it? You're
going to need financial data. What kind of financial data? What's the intn-
structure you're going to need to gather that data? How wiU you analyze it?
What arc some of the problems in analyzing the data, that kind of thing?
And then how do you communie:tte that? Through journalists? We've got
to do much better in terms of (education for and of} media and as well as
the policymakers and other key stakeholders, so I think we're on the preci-
pice of doing much better.
&it1J1 an a,tivt memberit1 professional niming O'Jlanization(s). Over and over, the study
participants emphasized the signifie:tnce of every nurse being active, in one w:iy
or another, with one or more professional nursing organizations. One nurse par-
ticipant told about the importance ofjoining professional nursing organizations,
and why she did it:
Well I'm a joiner. It's another characteristic. You gotta get yourself out
there. I'm a joiner. I join organizations in which I think I can make a differ-
ence. I learned a long time ago you e:tn't change anything from the outside.
You have to be on the inside, and so I joined organizations.
A participant spoke to getting involved and how it was the key to being a profes-
sional and an advocate:
Again, I have to go back to the association and finding out. I mean most
associations like (professional organization). I'm involved in that, and we
have a policy (section ofthe association). Getting involved in those kinds of
things. Making sure you're on a LISTSERV, so you know what the issues
arc. Staying current with those. I think it's rcally important. So I think that's
how to get involved (in advocacy).
A third participant spoke to how a professional organization can do work for the
larger professional group and the greater good when the individual nurse may
not be able to do that as efficiently or effectively. This nurse participant stated:
"That's why I think it's impol'l3nt, you know, every nurse should be 3 member
of the American Nurses' Association because you can't be everywhere." And later
p3rticipant st3ted, "Even if the nurse can't do 3dvocacy work, it is imperative for
every nurse to support the (nursing) organizations who arc actively advocating for
them and the profession."
Promote
The fifth category th3t is specified in the SBAT is to promote. When a nurse
promotes an issue that has been 3dvocated for, the nurse will support, advance,
3nd/or encourage that issue. There arc a number of actions/interactions that
can be used to achieve this that emerged from the data as subconccpts. These
include engaging in issues, working for social justice, disseminating information,
and effecting change. The nurse may use all or any combination of these in order
to promote whatever is in need of other support and sponsorship.
Engage in issues. Being engaged in issues by the nurse advocate and by those
affected by the advocacy issue is an expect3tion and is vital to being able to advo-
cate for one issue or multiple issues across the levels of the Advocacy Matrix that
have greater societal impact. One participant st3ted:
So when I think about advocacy, I think that it's certainly important that
we advocate for the individual patient, but I think it's just as, if not more,
important that we think about the broader societal/political factors that
really call nurses to advocate on that level for a much more substantial and
expansive change to occur within the broader society.
Another participant spoke to the impol'l3nce of becoming engaged in an issue

and a way in which to operationalize that. This nurse participant stated:
As a young nurse you have to be willing to t3ke some committee work

home. You'd have to be wiUing to join the Nurses Association and go to
the meetings. You might have to be willing to start writing letters to legisla-
tors, getting involved in a legislative committee or task force.
A third participant states that "A major aspect in (type) engagement is advocacy
for issues and concerns that one cares about. " The dat3 support that all of the
advocates who were interviewed spoke of having a passion for or a vision of
something that could make a situation better. This is what drives them every day
as they advocate. Many of the study participants spoke to the point that nurses
generally want to help with ccl'l3in issues. However, how to engage in these issues
is not always clear. It was posited earlier that if a nurse is able to work for some-
thing that is apparent to her/him, such as social justice, the nurse may be more
willing to learn how to advocate for that.
Exemplar 71
Wurk for social justice. Social justice or the equal distribution of benefits to
all within a community is something every nurse can understand. The nurse
wants each patient to have access to the best possible healthcare available and
to be able to offer the best treatments. This form of social justice was referred
to by a number of the participants. Additionally, the participants had a num-
ber of things to say about the nurse role in looking at the broader societal
picture of social justice. The researcher also sees how this can be applied to
the stages and levels across the Advocacy Matrix. One participant explained
ii like this:
The nurse advocate is someone who-I think advocicy comes from Latin
right?- giving voice to. So, I think of a nurse advocate as someone who
can evoke responses to people as well as provoke systems in regards to
responding to injustice and imbalance 311d perhaps maybe fairness and
equity issues. And so a part of advocacy is helping people give voice to
what they're thinking, feeling and wanting in a situation especially in situa-
lion.s where there is perhaps maybe an imbalance of power.
This is something that most nurses arc able 10 understand and may want to be a
part 10 improve the systems within a group or community. Another nurse pre-
sented it in a slightly different manner while being especially concerned with
social justice regarding healthcare access and availability for all people in our
society:
And they (mentors) were just really inRucntial in my life in terms of really
understanding that there was a social responsibility to advocate for those
who society doesn't really pay attention to in particular but also for all of
society in terms of how to create health.
Disstminale infom1alio11. One can undcrsta.nd that ifinformation is not shared, or

disseminated, then that information cannot benefit a patient, a group, or society
at large. Therefore, as pointed out by the participants, the nurse must be the per-
son to broadcast the issues and what one can do about them. Again we hear from
a participant who pointed to a specific example:
The other is this Raise the Voice campaign, and here arc nurses that have
great models of care that nobody knows about, so that's a whol()--that
whole program working to learn with each other, to make their work vis-
ible, looking at what do they need to strengthen them, that kind of thing.
Another way to disseminate information is to share it with other professionals

through joint conferences, publications, or presentations. Many of the partici-
pants alluded to this in their interviews.
E.ff,ct changt. For a nurse advOC3te to effect change, promoting the issue is very
import:lnt as is pcrscver:incc and moving forward for an issue that one had identi-
fied as imponant. A participant stated:
I don't know if it's a char:ictcristic of advocacy. I know it is something that

I have, and that is persistence. I will persist. You don't always get what
you think you want or you reach your goal and you don't always get there
quickly, and sometimes you don't get it period, but I will keep working
at it. I will refuse to give up if I think that the possibility exists and it's for
a good cause, not for personal gain. I don't mean that, but it's for a cause
that's impona.nt.
Intervening Conditions
lntnvming conditiow: arc those conditions that can change the course of the advo-
cacy act. They can influence the nurse in a positive way or can erect a roadblock
that the nurse will need to navigate in order to be successful in the advocacy act.
Because all intervening conditions change the context in which the nurse advo-
cate is working, the nurse advOC3te must rc3SSCSS and rcevaluate what has been
successful and what may need to change in the str:itcgy to achieve the previously
set goals.
The participants recognized that these intervening conditions can happen at any
time within the advocacy act. The participants were specifically asked to identify
barriers they thought were reasons for unsuccessful or not attempted advocacy.
Additionally, with constant comparison it became clear to the researcher that they
referred to positive intervening conditions as well. One participant discussed the
lack and presence ofsystem support as an intervening condition:
If I foci like I'm kind of-that there arc barriers at every tum in terms of
my ability to impact a patient's database experience and rcally get them
what they need; at some point, I'm going to stop trying. So if that's, indeed,
the prior experience of the advOC3te, I think that kind of skcptical kind
of-that, perhaps, sense of not having the ability or the power within the
system. That can be an issue.
On the other hand, for nurses who--thcrc arc some nurses who con-
tinue on a consistent basis to advOC3te for their patients. It doesn't mean
you're always successful. Anyone who has experience in terms of pr:icticc,
knows that, that you're not always going to be effective in term-and it's
not always about you; it's about t.hc system and understanding, having that
perspective is probably the most valuable part of the experience so that you
don't internalize it in a way that prevents you on other occasions, advocat-
ing for your patients.
Exemplar 73
Another participant spC3ks to the condition of knowledge deficit of advocacy

skills secondary to an unsupportive educational program:
I think also that some nurses arc not educated enough. and that is still a
problem. We don't have a level playing field, and so if they don't have the
adequate education so that they know how to, let's 'i:.r/, write a resolution--
that's in a more formal senso-or they haven't had the education that will
help stimulate their being able to approach some kind of a challenge in
a strategic way rather than just arguing, I think education has a lot to do
with it. And, ag:,in, I mean, I'm a big advocate for-my friends will tell
you-verbal skills.
As can be seen, intervening conditions can be both negative and positive. The
nurse advocate must understand that these intervening conditions, although alter-
ing the initial advocacy course, can be navigated and at times strengthen a nurse's
skills and/or resolve to effectively advocate for the desired goals. One participant
stated:
It was during the Vietnam War and some of us were going to go to a

march in Washington, DC to protest the war and that the USA pull out
of it. The director of our nursing program came to one of our classes,
stood in front of the class and pounded her fist on a table saying that if
any of us went to the protest march we would be failed out of the nurs-
ing program. So, a group of us, decided that this was wrong, we were
in the right, and we went to DC without telling anyone. When we got
back, nothing was said by the faculty or the director .. . and clearly we
weren't kicked out of the program. But this set my resolve about doing
the right thing.
This nurse had a goal to go to the protest march in Washington, DC. The inter-
vening condition of a non-supportive nursing program diroctor entered into the
context necessitating the nursing students' original plan to shift a little by "not
telling anyone (in the program)" and as they negotiated the situation they were
successful in getting to the march, their goal. Another outcome that occurred
serendipitously was that of setting "my resolve" to do advocacy as guided by
doing what is right.
Ultimately, what is important is that the nurse forges ahead to achieve the set
goals by reassessing and rccvaluating the situation. This may cause the nurse to
navig:,tc the situation somewhat differently than originally planned, but this will
also contribute to a successful outcome. It may be necessary to retreat to a previ-
ously successful level to discern what works and what doesn't work and/or to
learn skills that had not been previously learned before forging ahead.
Categorical Relationships
One of the main steps in grounded theory is to describe the rc'3tionships that
exist between categories. The categories, as specified c:irlier and as seen in
Table 3.4, emerged from the data. The relationships that became apparent arc
presented here. Each of the categories is interrelated with the over.ill advocacy
phenomenon. That is, a succ=ful advocacy act/event depends on the successful
navigation of c:ich category individu.ally and as a whole. The core concept was
to advocate. This core concept was the anchor that held its subsidiary categories,
made up of actions and interactions, in place in the SBAT.
Therefore, the concept to adVO<ale is the core phenomenon of the Advocacy
Theory around which all categories arc built and which works as part of the
dynamic process discussed earlier. To idmtify and to stra~ze created the pro-
cess beginning the advocacy action. In order to identify, the nurse must have
established the context within which the advocacy act will take place. Once the
nurse recognizes the need, analyzcs the system before moving forward, and has
an understanding of the community, systems, and issues, the next stage to stratc.-
gizc can begin. To strategize, the nurse wiU partner w ith those people or groups
affected by the advOC1cy act, necessitating that the nurse understand the system if
that has not been achieved in the previous stage. Further, as a plan is constructed
by the nurse, relationships and actions/means need to be made to achieve the
desired goals. Goals or outcomes arc ascertained during these two process steps.
AU five of these interactions arc referred to as stages of the advocacy act.
Once the process is underway, the nurse will be able to advocate, which is
the core action in the SBAT, to move toward the previously detcmlincd goals.
The outcomes as seen in the matrix arc to fucilitatc, empower, and promote and
were discussed at length c:irlicr. As the nurse works toward the goals, it must be
remembered that the core phenomenon to advocate is a product of the interac-
tions. Further, the nurse advocate must appreciate that all of these five categories
arc interrelated in how they work inside the Advocacy Matrix. These categorical
relationships strengthen the infrastructure of the SBAM, thereby supporting the
advocatc's movement across the matrix.
The Substantive Theory

Through fastidious development of the concepts and categories and their re'3tion-
ships to each other based on the data from the 13 participants' interviews, theo-
retical sensitivity, and meticulous analysis of the participants' words, a substantive
theoretical model emerged and continued to evolve throughout the grounded
theory rcsc:irch process. The end product was the SBAT, which can be seen
in Figure 3.1. Using the paradigm suggestions from Corbin and Strauss (2008),
answering those questions and moving into the conditional matrix model that
Corbin and Strauss explicated in their text, a theoretical model was developed
Exemplar 75
1lu1 will add 10 the current knowledge of the nurse as advocate topic. This Advo-
cacy Theory and its story line explicate the nurse advOC31e role in a step-by-step
manner so that the nurse is able 10 follow it and apply it in any circumstance.
Althoug)I the panicipants of this research investigation were known leaders and
advocates in the nursing profession, their experiences arc directly rclatablc to any
nurse experience through the SBAT.
This theory suggests tlut a combination of internal and environmental charac-
teristics of and around the nurse set forth the context in which an advocacy event
will take place. Upon discovery of the context and the nurse's decision to advo-
cate, the nurse will engage in the advocacy process 10 identify and to strategizc,
which leads to the goals, all ofwhich brings the nurse to the central phenomenon
to advocate. Once the nurse is in the main lria.nglc in the Advocacy Matrix, the
categories to identify and strategize will work together in a dynamic manner to
bring the nurse to the outcomes or goals that were identified early in the process.
These goals will fall under the three categories to fucilitale, empower, and pro-
mote. This dynamic process will continue to move between these five categories
resulting in the main action to advocate as the nurse advocate traverses the SBAM
levels, appreciating that the knowledge learned along the way will support further
success in the advocacy process. The procedure is the same no matter what con-
text or Advocacy Matrix level the nurse advocate is in.
As the nurse progresses across the Advocacy Matrix, the journey is not neces-
sarily direct or linear; rather, the dynamic nature of it allows the nurse 10 retreat
or advance throug)I the matrix as needed. Upon retreat or advance through the
matrix, the nurse advocate will reassess and reevaluate at each level and step of
advOC3cy. Whal determines the direction of the advocacy is the success of an
advocacy act or the need 10 acquire more information or knowledge 10 move
forward. Knowledge, acquisition or maintenance, was a concept that was sub-
sumed under each of the categories as a basic imperative within each interaction.
This dynamic and active role that the nurse advocate takes is progressive but not
a unidirectional movement through the AdvOC3cy M atrix.
The Sessler Branden Advocacy Theory posits llut the nurse advOC31e role
can be acquired by any nurse willing 10 be engaged in the process. This suggests
that the role can be taught and modclcd. It follows 1ha1 there can be educational
courses fashionod to teach these skills. To advOC3te, as described in the SBAT,
is an attainable skill; once the nurse experiences success with ii, the nurse can
continue to move within the matrix and its levels with relative certainty and case.
Summary
In this discussion, all characteristics, categories and subconccpts of the Sessler
Branden Advocacy Theory for use by the nurse advOC3tc luvc been explicated
and supportod by the paniciponts' words from their individual interviews, 1hco-
re1ical sampling and sensitivity, and in-depth analyses using the iterative process of
constant comparison. Explanations have been given for the development of cat-
egories and subconcepts, properties and dimensions and their placement within
the p31:1digm, and later the conditional matrix as classified by Corbin and Strauss
(2008). The relationships between the categories have been explained as they
relate to the SBAT, a mid-range nursing grounded theory. Finally, a story line has
been presented and a matrix diagram of this dynamic process in the SBAT has
been shown.
References
Corbin,)., & SD"auss, A. (2008). Basics ofqualitatiw r,s,arcl, (3rd ed.). Los Angele.: S.b"'·
Sandclowski, M. (2004). Using qualitative research. Qu,,IitaJiw Health Rts,arc/1, 14(10),
1366--138S. http,://doi.org/10.1 tn/1049732304269672
SECTION Ill
Glaserian Grounded
Theory
4
GLASERIAN GROUNDED THEORY
Caroline Jane Porr and Phyllis Noerager Stern
Phyllis No,ra,.er Sttm, au txpttt in tlassit (Clastrian) grou11dtd tliM,y, died May 4,
2014. 11,e s«tmd edition of this chapter is i11tmdtd to h0110< her voitt and wrili11g style.'
Caroline: What is the backstory, Phyllis, as to how Glaser and Strauss met?
Phyllis: Anselm Strauss, a well-known sociologist, was recruited in I 960 by
Helen Nahm, dean of the School ofNursing at the University of Cali-
fornia, San Francisco, in order to strengthen the research component
of the Doctoral Nursing Program. Strauss looked forw.ud to working
with nurses whom he reasoned would be unencumbered by a quantitl-
tive research background like most sociologists. Barney Glaser, a native
of California, was a new PhD in sociology, fresh out ofColumbia Uni-
versity. Upon returning to California, Glaser met Strauss ata gathering.
The two men fell to discussing a research grant awarded to Strauss to
explain the everyday realities of temtinal care in California hospitals.
Both Glaser and Strauss had unsatisfactory experiences with relatives
dying in hospitals; therefore, it seemed fated that the two should work
on the r=rch together. Indeed, Strauss recruited Glaser to the project
and Glaser, steeped in the q113ntit11ive research tradition, aspired to
develop with Strauss sociological theory based on real-life sitll3tions.
Caroline: I am curious, Phyllis, what were these two men like? And how did
they work together?
Phyllis: Each was different in terms of personality, academic tradition, and
research training; they developed a mentor-protcgce relationship,
with Strauss taking on the role of established older scholar. Both were
bothered by the tendency among social science researchers to test
prcexisting and often irrelevant theories about social situations rather
80 Caroline Jane Porr et al.
than gcncrntc theoretical knowledge from the very actors and cir-
cumstances within the social setting itself.
Strnuss recruited a number of prominent sociologists to teach in the
Doctoral Nursing Program, and they all looked up to Strnuss as the
learned mentor who could do no wrong-<hat is, until he imported
this youngster, Glaser, to work with him on an important research
project. Resentment may be too soft a word to describe the reac-
tion of the sociology group; in fact, one by one, many of them left
for venues where they could enjoy the respect they thought they
deserved. Time, fame, and a happy marriage have softened Glaser,
but at the time (during the '60s and '70s) he employed a number of
defensive strntcgies that colleagues and sometimes students found dif-
ficult to deal with. Those students through the ycan who were able
to realize Glascr's brilliance remained loyal followers.
Caro/i11e: How was grounded theory "discovered"?
Phyllis: Several books came out of the dying research project, beginning
with Awartt= of Dyi11g (Glaser & Stl':luss, 1965). Their Awareness
theory became popular and caused scholars in sociology to ask the
authors about the methods they had used to develop their substantive
theory because the concepts were spot on and well understood by
medical and nursing personnel. These queries caused the authors to
take stock and to ask themselves. "What arc we doing exactly?" (Or.
Barney G. Glaser, personal communication, April 6, 2007). They
concluded that their theory was applicable because they hadn't used
logical deduction. That is, they hadn't tried to reason from an extant
theory how healthcare providers, patients, and fumily members man-
age the dying process. Instead, the two researchers came up with their
theory through inductive reasoning. Their inferences were built on
data obtained from interviews, observations, and documents from the
actual social setting, from the hospital. In short, Glaser and Smuss
realized that, together, they had discovered a systematic process for
gcnernting theory that was grounded in everyday real-life data.
Caro/i11e: After the discovery of grounded theory, Glaser and Smuss took dif-
ferent pathways methodologically and their differences arc made
explicit in some of Glascr's publications. Would you share your views
as to why Glaser would be so upset with Strauss's explanation of the
how-tos of grounded theory?
Phyllis: Glaser invented the term grounded theory, and I might add, is
responsible for its lexicon of esoteric terms. In fuct, he wrote most
of the Discovtry book. Glaser contributed the constant comparntivc
method of analysis (constant comparison) that enables the researcher
to create concepts while remaining fuithful to the data. Imagine, if
you will, that the grounded theorist is liken unto a detective work-
ing on a case-looking for clues (data), fact-checking (constant
Claser1an Grounded Theory 81
comparison), ond solving (theorizing). Closer hod difficulty getting

his methodological head around Strauss's need to use certain strate-
gics to generate theoretic:tl ideas, ideas that should come exclusively
from the data without outside interference. In Claser's mind, Strauss
hod missed looking for clues and was risking his detective's license
by imposing pteconccived notions. Glaser found the techniques and
procedures book that Smuss co-authored with his protcgc Juliet
Corbin too prescriptive, irksome, and in violation of the quintes-
sential nature of grounded theory. It's important to note that this was
an academic argument rather than a personal one; Glaser continued
to have immense respect and appreciation for Strauss, as evidenced by
his published tribute to Strauss in 1991.
In this chapter, we will explore the "architecture" ofa Clascrian grounded theory
study, including the principles and procedures, by analyzing the fire study con-
ducted in the 1990s by Stern and her graduate student, June Kerry (Stern &
Kerry, 1996). Although home fires were not uncommon, little was known about
appropriate interventions in the lives of victims following fire disasters. Stem set
out 10 conduct a grounded theory study to determine how victims process losing
their homes to fire (Stem & Kerry, 1996). As we arc not moving through the
study sequentially but rather analyzing key tenets, the reader must also carefully
read the study; only excerpts from Rtstnuturi11g LJfe After Hom, Loss by Fir,: arc
provided within this chapter.
Data: A// ls Data

"All is data" is very much the lexicon of Clascrian grounded theory, but data
sources must be guided by the study phenomenon. Stem advised, though, that
the researcher should first begin with conglomerate data to gain a clearer "pic-
ture" of the phenomenon (Stern, 1980). Today that may mean viewing social
media. YouTubc, biogs, and glancing ot newsletters, for example, before decisions
arc made about dota sources and collection methods. Data collection con include
a single case study, which is what Stern started with in her study of home fires. It
was the experience of a "painful sociopsychological scquelac" shared by the case
study participant that led Stem and her student to dcternune that both a study
is warranted and that data sources must be the fire victims themselves and their
rich experiences gathered through face-to-face interviews. To that end, data was
collected through interviews with 113 victims of home fires.
On the other hand, when Glaser (1972/1976) explored the "expert-layman"
relationship, he based his discovery of the social processes of private home con-
struction (i.e., the power dynamics involved when laypersons hire experts or sub-
contr.1clors) on his own pmor,a/ interactions with 200 subcontr.lctors and on his
detailed field notes. When Strauss wanted to understand how organizations func-
tion by identifying how employee behaviors arc influenced by soci:tl interaction
within the workplace, observations became the data source. Stem remarks how
Strnuss relied on his observations at the scene and then recorded those observa-
tions into a tape recorder as he departed. When Stem {1982a; 1982b) explored
stepfather families to determine processes involved in stepfather family integra-
tion success, the whole family unit was the data source, and when that was not
possible, individual "intensive" interviews were conducted (given the sensitive
and confidential nature of the phenomenon) with stepf.athers and with stepchil-
dren. Stem reported that she interviewed 62 participants, totaling 85 hours. She
obtained data about 132 persons living in stepfather families, enabling conceptu-
alization and theoretical understanding of the strategics employed by stepfathers
and stepchildren to establish "affectional ties" (p. 78). We can aU agree with the
truism "AU or everything is data." And Glaser (2007) insists that any kind of data
can be collected in a grounded theory study.
Core Variable: Solving the Puzzle

Detennining data sources and sampling procedures continue as the researcher's
knowledge about how participants respond to a phenomenon grows and inter-
pretation of behavior patterns produces conceptual categories. Stem could not
emphasize enough that initial interviews in a grounded theory study must pro-
vide space for the participants to fully describe the experience, circumstances, or
situation surrounding the phenomenon of interest and explain how they reacted.
Researcher comprehension is key, and sampling for suitable participants and other
data sources ensures this initial rich description. In the fire study, Stern knew how
to select the most suitable participants; she even sought variation, broadening
sampling procedures to include participants internationally to obtain diverse cul-
tural experiences. Her successful mentor-mentee relationship with Glaser (and
Strnuss) and her vast research accomplishments taught her that she must have ade-
quate da/4; the greatest mistake is to have too few participants and too little data.
Stem began by asking participants to tell her about their experiences losing all
of one's possessions in a home fire, but in subsequent interviews her focus shifted
to the associated cultural and symbolic meaning as the common issue, concern,
or problem became more apparent. The common concern of victims, or the core
variable, was processing the problem of recovering from a home fire when cultur-
ally a comforting soci.11 ritual support did not exist. Stem was now sampling for
participants who could assist in solving this "punle."
To be true to the method, we selected participants on the basis of their abil-

ity to help us solve the puzzle of what surviving a fire symbolized for them.
That is, we used a purposive sample: participants who suited our purpose
of solving the mystery. For exan1ple, as we fom1ed hypotheses about recent
fire victims, we looked for survivors whose personal disaster occurred ear-
lier in their lives. When we were told, "Folks in the counrry help out each
other/" we concentrated for a time on victims whose fire occurred in rural
Glasertan Grounded Theory 83
settings. As the ritual-suppon connection category became apparent, we

investigated home loss by fire in other cultures, talking with individuals of
diverse cultures whenever the opponunity arose.
(Sttrn & Kerry, 1996, p. 12)
Abstraction, Not Accurate Description

It is imponant that this stage ofdescription, drawing the picture, is not cut shon
because in-depth knowledge and comprehension precedes interpretation and
enables interpretation. However, many qualitative researchers tcm1inatc their
inquiry at this point and their findings, albeit "saturated," do not present new or
nuanced facets of the phenomenon of interest but merely patterns ofbehaviors
with which we all arc familiar. Moreover, if the researcher is not intentional
about searching for clues to the puzzle, discerning how the recurring problem
is processed-the core variable-and then emergence of conceptual categories
and development of rich, relevant, dense theory arc put in jeopardy. Notice
how Stem focuses her attention on the core variable in the fire study:
We found that the victims' difficulty in recovering from home fires was
exacerbated because, generally, no comfoning social ritual supponed them
in working through their difficulty. A typic31 comment leading to this
conclusion was, "It's like people want to do something, but they don't
know what to do." Once developed, the analysis was presented to selected
fire victims in the United States and Canada who had been panicularly
informative (11 • 20) for checks on accuracy and fit with their perceptions
of the problem of restructuring their lives after a home fire and how they
processed it. Then we conm1trated 011 the importa/lCe of rit11a/-tha1 is, on pre-
scribed symbolic bchavior of the recovery process in home fires.
(Sttrn & Kerry, 1996, p. 12}
But we arc not out of the woods yet. What about the propensity to dwell on the
accuracy of the description of the data that occupies the minds, time, and cffons
of some researchers? Silverman and Marvasti (2008) criticize researchers who
do not meticulously record the rescarchcr- panicipant dialogue, but like Stern
and her mentors, they prefer to talcc handwritten notes, filtering on the spot the
useful data that arc relevant to the research aims. The aim is conceptualization.
That is, the grounded theorist should be focused on abstr.acting up from the
data to reach theoretical interpretation and explanation as opposed to pursuing
lengthy descriptions of people, place, events, and time. During the stepfather
study, Stern thought that audiotape recording (which was new) might be off-
putting to her participants, so she wrote field notes instead. Stern got pretty
good at writing while maintaining eye contact. Then she typed up the inter-
view as soon as possible. Were these data inaccurate? Possibly, but as she typed
up the notes, she could hear their voices, sec their nonvcrbal movements, see
how their living room or their kitchen was arranged. If she imagined distress,
she felt distressed for days.
Stem and her colleague (2001) shared how she learned firsthand how to trust
her memory and allow the 'cream to rise to the top' and prevent worrisome
accuracy:
Tape recorders were available to us, but they were bulky pieces of equip-
ment; therefore most of us relied on field notes written during an inter-
view or observation, and formalized as typed data soon after-ward. Srr:iuss
once said that the only reason to use a tape recorder was to record ideas
if they came quicker than we could type. Glaser assured us that we would
remember what was important, that cream flows to the top, and "The mind
is a good filter." Typing up interviews immediately after collecting them
allowed us to analyze data as we recorded it.
(p. 24}
Admittedly, srudcnts and new researchers will want to rely on audiotaping and
transcribing interviews, but expert researchers like Stem acquire skills to listen, take
notes, and conceptualize data during the acrual interview. The precise words of the
participant arc often less important than what the participant is essentially imply-
ing. Participants in the fire srudy explained how after the fire they "went through
a period of being disoriented and disorganized; some even hallucinated.... The
strongest memory that victims had was of disorientation because of the loss of the
place where griefwork is usually donc----their home" (Stem & Kerry, 1996, p. 13).
Stem labeled this stage "wandering aimlessly," and "in spite of their helplessness,
victinu were forced to take on the task of restoration and restructuring" (p. 13).
The extensive psychological pain and suffering were caprured in the study findings
but it was the reference to restoration and restructuring that spoke to the process-
ing of the problem, and "restrucruring life" emerged as the basic social process
enacted by victims of home fires to resolve the recurring problem. Stem verified
her analysis with "selected fire victims in the U.S. and Canada for accuracy and fit"
(p. 12). Notice how this core variable is reflected in the data:
Victims, while working through the grief of loss, needed to find a place
to sleep, something to sleep on, and clothes to wear. Shopping became
an arduous task. Uninsured victims suffered terrible financial problems--
sometimes never recouping the losses. When a victim was insured, endless
lists of home contents needed to be compilcd----oftcn from memory. Fur-
thermore, victims needed to continue to fulfill obligations of employment.
(Stem & Kerry, 1996, p. 13)
"Restructuring life" addressed the problems of victims having to replace home

contents and return to their jobs, but of greatest importance for victims of home
fires, Stern interpreted, is dealing with the loss of "possessions of worth," 3S cap-
tured here:
Material possessions hold symbolic meaning for us. Acquisitions, in addi-

tion to their m:trket v:tlue, cll up memories of when and where they were
purch3Sed, who was involved, and who found the possessions of worth.
We value things we own for their beauty, their connection to ancestors,
or because they :tre necessary to our survival. When our possessions are
reduced to rubble by flames, parts of our lives are destroyed as well.
{Sinn & Kerry, 1996, p. 11)
Advandng Abstraction to Theoretical Codes

Although not specified, Stem and Kerry (1996) would have repeated the
collection-coding-analytic process of building substantive codes through open
and selective coding, constant comparison and memoing, and then advancing
abstraction to theoretical codes (Glaser, 2005) by assembling substantive codes
theoretically by using Gbser's (I 978) families of theoretical codes (e.g., causes,
contexts, contingencies, consequences, covariances, and conditions) as analytic
str:itegies to enhance abstraction. Conceptual categories relevant 10 restructuring
life represented fom,s ofsupport, culture, and rituals. An essential step undertaken
to explicate and expand conceptual categories and 10 determine the interrelations
of conceptual categories was Stem's theoretical sampling of comparison groups
from different geographic regions for similarities and differences and through
consultation with relevant literature.
Stern integrated the literature during theoretical sampling to achieve robust
theoretical interpretation and by comparing her grounded theory constructs with
extant theories. Notice how she compares "wandering aimlessly" with the theo-
retical literature:
Vic.tin,s went through a period of being disoriented and disorganized; some

even hallucinated.... Kerry (1991) called this "wandering," and Northrup
(1989) nan1ed it "stepping in and out of reality." In his study of the fire in
Coconut Grove California, Lindemann (1944/1965) described survivors'
grief reactions 3S anger, loss of energy, and guilt. In the present study, the
strongest memory that victims had was of disorientation because of the loss
of the place where grief is usually expressed-their home.
{Sinn & Kerry, 1996, p. tJ)
Conceptual categories were further elaborated through cross-tabulation to con-

struct typologies from which Stern was able to distinguish the dimensions of
"ritual-support connection" (Stern & Kerry, 1996) that is determined not by the
needs of the victims but by social ritual. "Despite the seriousness of the problems
86 Caroline Jane Porr etal.
victims fuce, social ritual guides support. In many instances, this ritual dictates
support that is short tenn and only loosely related to the actual needs of victims"
(p. 11). Stem generated three dimensions: (1) connected support, (2) uncon-
nected support, and (3) disconnected support (p. 13), which she explicates as
follows:
(!) connected, where support is connected to need; (2) unconnected, in

which ritual fuils to bring about comforting support; and (3) disconnected,
where comforting ritual is withheld from victims thought to be unworthy
of support. Although support may be absent, there is never a total absence
of ritual for a given situation. The ritual may be to ignore the victim, an
uit>s-not-my-busincss.., response.
(Sttm & Knry, 1996, p. 13)
Stern sought underst:inding, interpretation, and explanation, far beyond accurate

description. Similarly, Glaser and Strauss (t 965) did not merely describe their
observations of the behaviors of patients, family members, and hospital staff in
California hospitals in response to death and dying, but applied their sociological
knowledge and insights to interpret theoretically and to write theoretically. Stem
applied sociological knowledge associated with rituals to write theoretically about
the social responses to victims of home fires-what people in society do or do not
do-along with the processes enacted by victims themselves:
Furthem1orc, over time it became clear to victims that the rebuilding

(restructuring) must t:ikc place within a society where the rules of conduct
(social structural process) arc governed by "ritual support connection";
that is, for victims who received connected support, the restructuring-
though painful-was undertaken within a milieu of appropriate comfort-
ing measures. Those people who restructured their lives where there was
unconnected or disconnected ritual""upport received less or no comfort-
ing. Participants with stamina and relevant life experiences seemed able to
regroup more quickly and with less lasting trauma.
(Stm, & Knry, 1996, p. 15)
The Myth of Emergence

Some people object to the use of the term "emergence" (Glaser, 2009) as
the way one finally discovers theory from data. "Well," Stem contends, "the
theory certainly doesn't rise up off the page as the term implies, but after weeks
or months of painstaking analysis and when you finally get it, it seems like a
second coming." And she rather likes the phrase "trust in emergence," which
is a warning to new and seasoned researchers alike to avoid imposing presup-
posed interpretations on the data. And yes, it is theory and theory construction
(emergence!) that arc the goals of grounded theorists. Strauss (1995) W3S di.s-
turbcd that most of the authors of Denzin and Lincoln's (1994) Hot1dbook of
Quolitotive Reseorch did not talk about theory. Strauss (1995) had commented
that there has been a "long tradition of describing how data (materials) arc dis-
covered, noted, and elicited but arc little interested in analytic scrutiny of how
these arc interpreted" (p. 9).
Honoring the Originators of Grounded Theory

Why arc Glascr's protcgcs so loyal, Stern being one of them? Because he is so
there. If you think you arc stumbling, you can still call him or email him and
get his advice. (Strauss was like that as well.) The Grounded Theory Institute
(http://groundcdthcory.com/) maintains the official site of Or. Barney Gla-
ser, where one can find books, articles, seminars, and other resources about
classic grounded theory. Students, novices, and seasoned researchers can join
and engage in discussion with other grounded theorists from all over the world
Glaser & Holton (2007). Stem thought Glaser W3S a genius who talks like a
geniur-too intellectual for us regular people to understand. Stem did work-
shops with Glaser as his mentee, where she acted as interpreter to help a bewil-
dered audience make sense of what he was saying. His main occupation remains,
other than writing books, conducting troubleshooting workshops, mainly for
PhO students. The Grounded Theory Institute troubleshooting seminars have
become world renowned. Glaser and other grounded theory scholars work with
PhO candidates during these seminars to navigate the classic grounded theory
method. Graduate students can ask questions, and after a session with Glaser we
arc sure they leave inspired!
Glaser also offers to the world access to DVDs, an open accessjournal (Crour,ded
'I11tory Review), a website (Grounded Theory Online), and new book publica-
tions (available for purchase from Sociology Press). Novice grounded theorists
would be interested in reading his books, especially the newest that arc dedicated
to clarifying and preserving "authentic" grounded theory:
• Cttting Out of the Doto: Cro,mdtd Theory Conuptuolizotio,, (201 t) https://

www.amazon.com/Gctting-Out-Data-Groundcd-Conccptualization/
dp/1884 t 56223.
• Slop, Write!: Writir,g Grounded Theory (2012) http://groundedtheoryrcvicw.
com/2012/06/0 t /stop-write-writing-grounded-theory/.
• No Prtconceplions: Tht Grounded Theory Dictum (2014) https://www.rescarch
gate. nct/publication/26 t 554802_No_Prcconccption_ Thc_Oictum.
• Mtmoir,g: A Vito/ Grour,ded Theory Prottdure (2014) https://www.amazon.
com/Mcmoing-Vital-Grounded-Thcory-Procedurc/dp/ 162209834X.
• Applying Grour,dtd Theory: A Negledtd Option (2014) https://www.amazon.
com/Applying•Grounded-Thcory-Ncglcctcd-Option/dp/ 1633154998.
• C/roosirtg Grourtded T/1tory: A GT Reader ofExpert Advite (2015) https://www.

anuzon.com/Choosing-Cl.mic-Croundcd-Theory-Rcadcr/dp/1942749295.
• T/u, Cry for Help: Preserving Au1011omy Doing GT Researc/r {2016) https://
www .amazon.com/Cry-Hclp- Prcscrving-Autonomy-RC3Scarch/ dp/19451
7207X.
• Gro,mded 111tory Pmpedive: Its Origin and Grl>Wlh (2016). http:!/grounded
theoryrevicw.com/2016/06/19/thc-groundcd-theory-penpcctivc-its-origins-
and-growth/.
Fi.n311y, how have we evolvod as interpreten of grounded theory? In every

article we write, we think we add more clarity how to conduct good grounded
theory. In fact, after insistence from colleagues and students, we actually wrote
a how-to book titled EsstPJlials of A«mible Grounded Tiieory in 2011 to assist
researchen and students how to 113viga1e the sometimes murky waten ofgrounded
theory. Essentials is not intended as the A, B, C formula, but rather as a compass
to guide rcaden through fundamental principles and procedures (Stern & Porr,
2011). We wantod to talk about grounded theory as a method (and a methodol-
ogy with philosophical and theoretical underpinnings) in addition to illustrating
the steps of conceptualization and theory generation by using real-life dati. We
did our best to adhere to the tenets of Clascrian grounded theory (the Juilliard of
solid qualitative research) and our little book has been well received!
Note
1. Dr. Janice M. Mone wrote a tribute 10 Phyllis in the Q,1ali1atiw: Heall/1 Rtscarc/1 journal
that highlights Phyllis', many contributions 10 the advancement of quali12tivc inquiry,
in panicubr grounded theory. Especially poiw>ant arc qu012tions capturing her witty
reflections on aging. Sec Monc,J. M. (2014). Remembering Phyllis Nocrager Stem,
1925-2014. Qualitativt Healt/1 ~,ard~ 24(10), 1356-1359.
References
Denzin, N. K., & Lincoln, Y. S. (Eds.). (1994). Handbook of q"4litaJiw mcard,. Thousand
Ow, CA: Sage Publications.
Cla,cr, B. C. (1972/1976). F.xpnu """'' laymm: A study of the pauy a11d the sulxonJl11/tor.
Mill Valley, CA: Sociology Pre,..
Cla,cr, B. C. (1978). '11i,orrti<al S<tuitivity. Mill Valley, CA: Sociology PrC:1$
Cla,cr, B. C. (2005). 7k XfOtmdcd theory pmp,ttiw llf: 1'hcorrtital todinl(. Mill Valley, CA:
Sociology Pr=.
Cla,cr, B. C. (2009).J•1RD11izinl(: Usin.f th<l(<o11ndcd t/i,ory _,,bulary. Mill Valley, CA: Soci-
ology Pre,,_
Cla,cr, B. C., & Holton, J. A. (2007). TheJl'•••ufcd theory scmi,iar rtadcr. Mill V.Jley, CA:
Sociology Pr=.
Cla,cr, B. C., & Str.1ws, A. L. (1965). A""""""-' of dyinl(. Chicago, IL: Aldinc de Cruytcr.
Cbscr, B. C., & S1r.1u.ss, A. L. (1967). The dis,owry o/Jlr011nd,d 1/.,ory. Chicago: Aldine de
Cruytcr.
Glaserlan Grounded Theory 89
Silvennan, D., & Marva>ti, A. (2008). DoinJl q,,oli'4JM r=atdi: A wrrprrhmsi,,, J(Uid,.
Thowand Oak>, CA: 5.gc.
Stem, P. N . (1980). Grounded theory methodology: Its uses and processes. /mall': ThL
Jo,,n14/ ofNuni,IJI. Stholanhip, 12, 2(}-23.
Stem, P. N. (1982.a). Confticting funily culture: An impediment to inteb.,..tion in stepfa-
ther funilics. Jo,,n,,,J ofP,ydw,oaa/ Nursinfl, 20, 27-33.
Stem, P. N. (1982b). Affiliating in stepfather families: Tcachablc strategics lead-
ing to stepfalher-child mcndship. Watnn Jo11n"'1 of N11mn11 Ra<atd,, 4(1), 7S-89.
Retrieved from https://joumals-sab>epub-com.qe2a-proxy.mun.ca/doi/pdf/10.1177 /
019394598200400107.
Stem, P. N., & Kerry,). (1996). Rcsttucturing life 2fter home lo» by ftrc.Jo,,n14/ ofNumnJl
S,/,o/anhip, 28(1), 11- 16.
Stem, P.N. & Covan, E.K. (2001). Early grounded theory: Its processes and products
(pp. 17-34). In R.S. Schreiber & PN. Stem (Eds.). Using grounded theory in nuning.
Springer Publishing.
Stem, P. N., & Porr, C. J. (201 I). Esm,tials of a««sibl, pou,ul,d th,ory. Thousand Oak>,
CA: Sage Publications, Inc.
5
EXEMPLAR
Building on "Grab," Attending to "Fit,"
and Being Prepared to "Modify": How
Grounded Theory "Works" to Guide a
Health Intervention for Abused Women
Judith Wuest, Marilyn Ford-Gi/boe,

Marilyn Merritt-Gray, and Colleen Varcoe
Grounded theories have unique potential for influencing clinical practice. The
theory has grab (Glaser, 1978); it resonates for those who have experienced the
situation that the theory explains, or know or practice with those who have.
Because grounded theories can explain, interpret, and predict human bchavior
in specific social contexts, they work and have practical utility (Glaser, 1978).
A fundamental premise of grounded theory research is that people actively shape
the worlds they live in through the process of symbolic interaction and that their
viewpoints arc vital to generating useful knowledge of process, interaction and
social change (Glaser, 1992; Strauss, 1987). "Nursing is a practice discipline
whose essence lies in processes" (Stem & Pyles, 1986, p. 1). For clinicians, the
theoretical rendering of what is most problematic in the study situation and how
it is processed by participants offers insights into how and when a clinician might
intervene. Thus grounded theory lends itself to conceptual utilization, that is, a
rethinking ofsituational phenomena that may or may not lead to change in action
(Estabrooks, 2001). Indeed, the effects of grounded theories on nursing practice
appear to have been minor (Hall & May, 2001; Morse, Penrod, & Hupccy, 2000).
Poor uptake is not a problem specific to research evidence with qualitative ori-
gin (Estabrooks, 2001). However, translation of grounded theories by rescarchcrs
is essential to facilitate their utilization in concrete applications such as clinical
protocols, decision trees, or practice guidelines (Estabrooks, 2001; Sandclowski,
2004). Little has been written about how such purposeful translation takes place.
Yet, as Thome (2011) reminds us, nurses need to understand phenomena "in
a way that will be applicable to the diversity of context and complexity within
the actual real-time setting" (p. 449). Thome calls upon rescarchers to mobilize
research toward "meaningful social and pragmatic action" (p. 450). Importantly,
with grounded theory, the work of knowledge translation not only makes the
Exemplar 91
theory more accessible 10 practitioners; it also has potential 10 add breadth and
depth 10 the original theory through the constant comparative process with mul-
tiple sources of new data. In this chapter, we discuss the processes, challenges,
and advantages of 1ransla1ing our theory Strengthening Capacity to Limit Intru-
sion (SCLI) (Ford-Gilboc, Wuest, & Merritt- Gray, 2005; Wuest, Ford-Gilboc,
Merritt-Gray, & Berman, 2003) into a primary healthcare intervention, the
Intervention for Health Enhancement After Leaving (iHEAL) (Ford-Gilboc,
Merritt-Gray, Varcoe, & W uest, 2011), and conducting initial feasibility studies
using the iHEAL with women who have left their abusive partners in the past
three Y=·
Backg round
Grounded theory is distinctive among qualitative research methods in that its goal
is the development ofsubstantive theory, that is, theory that accounts for a human
bchavior within a particular social context (Glaser, 1978; Glaser & Strauss, 1967).1
Through constant comparative analysis of data from interviews, observations, doc-
uments, and/or images, researchers conceptually construct what is most problem-
atic and the social-psychological process by which the problem is addressed. The
analytic outcome goes beyond descriptive themes or the recounting of individual
narratives lo the articulation of a theoretical scheme in which key concepts arc
identified and defined and the relationships among !hem delineated. While some
grounded theories arc reported in terms of a core category, more commonly they
arc written as basic social psychological processes (BSP), that is, a core category
with at least two sequential stages. Vita.I to their usefulness is the naming of fuclors
or conditions that influence variation in !he core category or BSP, not just by their
presence or absence but also by their degree or intensity (WUC$1, 2012). Condi-
tions that influence variation arc diverse and may include individual attributes such
as age or fum.ily history; relational factors such as conflict, support, services, and
resource$; and/or structural influences such as poverty or discrimination. T hus
a grounded theory is a substantive theory that accounts for !he heterogeneity in
how a basic social process unfolds for individual people in different contexts and
suggests possibilities for action that previously may have been invisible (Glaser,
1978; Swanson, 2001). Substantive theory helps us transcend our finite grasp of
!he specific through its potential transferability 10 other situations (Glaser, 1978).
"Analytic generalization and theoretical transferability arc the bascs for utility in
grounded theory research" (Sandelowski, 2004, p. 1371).
The Theory of Strengthe ning Capacity t o li mit

Intrusion (SCLI)
In our program of research focusing on women's health after leaving an abusive
partner, we conducted a grounded theory study of fumily health promotion after
92 Judith Wuest et al.
scpar:ation from an abusive partner and developed the theory of Strengthening

Capacity to Limit Intrusion (SCLI) (Ford- Cilboc et al., 2005; Wuest et al., 2003).
We used a feminist grounded theory approach (Wuest, 1995; Wuest & Merritt-
Cr:ay, 2001) and analyzcd repeat interview data from 40 mothers, ages 22-48
(M • 36) and 11 of their children. The families had been living scpar:ately from
the abusive partners on average just under four years (range 1-20). As we coded
and constructed provisional conceptual categories and the relationships among
them, we shared our findings with the women during their second or third inter-
views, seeking their feedback for modification and confirmation of our emerg-
ing theoretical schema. In this way, we identified that the core problem related
to hc:tlth promotion for the fumilies under study was inrrusion, that is "external
control or interference that demands attention, diverts energy away from fam-
ily priorities and limits choices" (Ford-Cilboe et al., 2005, p. 482). Intrusion
stems from ongoing abuse and harassment from the ex-partner (frequently exac-
erbated by child custody and access issues) , physical and mental health problems
ofwomen and their children, the "coSts" of seeking help (for example, measuring
up to criteria imposed by policies, increased surveillance by income assistance
workers or family members), and negative changes to daily life (Wuest et al.,
2003). Leaving an abusive partner is a risk- taking act to position the family for a
better future. However, increasing intrusion after building on "gµb," attending
to "fit" leaving forces families to focus on promoting hc:tlth by creating stability
in day-to-day survival. As stability is achieved, women arc able to focus again on
positioning for the future, an act which may lead in tum to increased intrusion.
Families spontaneously engaged in the process ofSCLI in four ways: (I) pro-
viding, (2) rebuilding security, (3) renewing self, and (4) regcner:ating family
(Ford-Cilboc et al ., 2005). Providing involves meeting basic needs of income,
housing, personal energy, food, childcare, recreation, transportation, medication,
and relief from symptoms. Rebuilding security includes safeguarding from threats
to physical and emotional safety and cautious connecting with family, friends,
services, and the larger community. Renewing self refers to the process of devel-
oping personal capacity to make their personal needs a priority, make sense ofthe
past, consider who they arc and who they want to be, and find comfort and relief
from day- to-day intrusions and distress. Regencr:ating family entails developing a
family story line to explain their past, increasing predictability in day-to-day life,
and naming and using new standards for relationships. Within these subproccsses,
the hc:tlth promotion focus for women shifts from positioning for the future
to surviving and back again according to the degree of intrusion the family is
experiencing.
Sigl'lificantly, when we shared the emerging theory with women, they readily
connected with the grounded theory conccptualiution and offered further data
to help refine the theory. Similarly, the theory had gr:ab for other researchers,
clinicians, and other helpers. As we presented our work in the community, at pro-
fessional conferences, and in peer-reviewed papers, we discussed the implications
Exemplar 93
of the theory for practice, largely at a level of "conceptual utilization" (Esta-

brooks, 2001). T he theory shaped how we understood women's experiences of
leaving and how we individually interacted with women with abuse histories. At
the same time, the identification of intrusion from ongoing physical and mental
health problems related to abuse helped us to recognize that, despite the dominant
belief that leaving an abusive partner is the solution for abused women, little was
known about the trajectory of women's health after leaving abusive partners. To
address this gap, we conducted a four-year longitudinal study examining changes
in women's resources and health after separation from an abusive partner, the
Women's Health Effects Study (WHES). Annually, 309 Canadian women who
had left abusive partners in the previous three years took part in structured inter-
views and health assessments (Ford-Cilboc et al., 2009). Baseline data revealed
that the women (who had been separated on average 20 months) had significantly
poorer physical and mental health and higher rates of service use than Canadian
women of similar age with little relief from their symptoms, and that the annual
health system costs attributable to violence were approximately $4,969.79 per
woman {Ford-Gilboe et al., 2009; Scott-Storey, Wuest, & Ford-Gilboe, 2009;
Varcoe et al., 2011; Wuest et al., 2007, 2008, 2009, 2010).
These quantitative results were useful as comparative data for further develop-
ment of our grounded theory, particularly to expand the concept of intrusion
from physical and mental health problems, "costs" of seeking help, ongoing abuse
and harassment, and changes in lifestyle (for example, forced moves, income dis-
ruption). Despite the lack of attention to constant comparison with quantitative
data in gtounded theory scholarship today, Glaser and Strauss {1 %7) asserted that
both quantitative and qualitative data arc useful, and sometimes necessary, for the
generation of gtoundcd theory through constant comparative analysis. Although
the WHES was not a grounded theory study, we found the WHES data to be
an important source of secondary data for theoretical sampling, that is, purpose-
fully choosing data for comparison in order lo augtnent the original SCLI theory
through the refinement ofthe properties of concepts and the relationships among
them (Glaser, 1978).
Our grounded theory and the WHES findin~. along with the dearth of exist-
ing health interventions for women after leaving, demonstrated the urgent need
to develop a community health intervention specifically designed to assist women
who had experienced the trauma of abuse to promote their health (Ford-Cilboc
et al., 201 t). This compelling evidence also helped us to gamer financial sup-
port and partnerships from funding agencies and decision-makers to develop and
examine the feasibility of a health intervention for women after leaving. The
theory of Strengthening Capacity to Limit Intrusion was the logical starting point
for health intervention development. 2 The scope of the theory provides evi-
dence that survivor health is socially detcnnined. Thus, we decided to design the
iHEAL to be delivered collaboratively by a nurse and a domestic violence worker.
Based on the SCLI theory, we agtced that the aims of the intervention would be
to improve women's health and quality oflifo after leaving an abusive partner (1)
by reducing intrusion and (2) by enhancing women's capacity (knowledge, skills,
and resources) to limit intrusion (Ford-Cilboc et al., 2011).
Processes and Challenges in Developing the Intervention

Our theory captures the central pattern of health promotion bchavior in mother-
headed, single- parent f:imilies after leaving an abusive male partner and its con-
sequences (Ford-Cilboe et al., 2005). Importantly, this theoretical rendering
captures the naturally occurring and intuitive actions taken by diverse women
and their children to strengthen their capacity to manage intrusion at different
points in time after leaving and consolidates the lessons learned from them. A key
intervention principle of the iHEAL is that
women's own experiences ofleaving an abusive partner and those of other

women, as reflected in the theory ofstrengthening capacity to limit intru-
sion, will be a key source of knowledge to help women reflect on, rcframe,
and name their experiences, concerns, and priorities.
(Ford-Cilbot tl al., 2011, p. 203)
This principle draws on what Estabrooks (2001) called the persuasive power
of research evidence, which is akin to Clascr's (1978) grab. Stories of others'
experiences are important "in evoking, persuading, and provoking; in promoting
empathetic, feeling or visceral understandings of the people and events; in mov-
ing listeners and readers to act" (Sandclowski, 2004, p. 1373). Grounded theories,
because they frequently focus on aspects of human experience that have received
little attention, can help to mitigate feelings of isolation and alienation.
The theory, however, is more than individual stories; it captures a pattern of
survivors' personal and social bchaviors in terms of antecedents, consequences,
and influencing factors. The theory then has potential to resonate with wom-
en's disparate experiences in different contexts and to permit diverse women to
name their experiences and sec new possibilities for limiting intrusion, leading
to better health. The SCLJ theory presents what women do, with and without
help from others, highlighting how contextual f:ictors limit or enable women's
growth. Although this theoretical scaffold directs clinicians to draw upon and
augment women's expert knowledge and skills in supporting them to strengthen
their capacity to limit intrusion, a limitation of the SCLI theory is that it docs
not explicitly explain how clinicians might do this. In short, it is not a theoretical
construction of how to practice. However, the theory's concepts and the relation-
ships among them can shape the underlying philosophical assumptions and prac-
tice principles for an intervention. Further, the process ofStrengthening Capacity
to Limit Intrusion provides direction for the intervention's structure. Just as the
original grounded theory was generated, so the iHEAL was constructed in a
Exemplar 95
series of reflective, str:itegic, iter:itive choices about which aspects of the theory
should be highlighted in the context of our agenda to improve women's health.
The building on "grab," attending to "fit" discussion that follows is a reconstruc-
tion of key challenges and processes in moving from theory to intervention, from
our initial attempts to create a rough outline of goals, components, and poten-
tial outcomes of the intervention (Ford-Gilboc, Wuest, V:ircoc, & Mcrritt-Cr:iy,
2006) to a more complete rendering some four years later (Ford-Gilboc et al.,
2011). As with most retrospective accounts, our discussion reflects a more organ-
ized, conscious, and polished process of intervention development than was actu-
ally the case. It docs not fully capture our false starts, dead ends, and stumbling
steps in developing the iHEAL.
Theoretical Sensitivity, Constant Comparison, and

Emergent Fit: Naming Underlying Philosophical
Assumptions and Principles of Practice
Grounded theory analysis is informed by theoretical sensitivity, that is, the
researcher's capacity to use knowledge of theoretical constructions from many
disciplines as well as personal and vicarious experiences as a basis for constructing
concepts and the relationships between them (Glaser, 1978). Theoretical sen-
sitivity docs not drive theory construction, but it docs open the rcscarcher to
theoretical possibilities that arc then checked out and refined through theoretical
sampling and constant comparison (Wuest, 2012). The philosophical assump-
tions delineated for the iHEAL reflect the shared perspectives and values that
underpinned our program ofrcscarch (Ford-Gilboc et al., 2011). Our theoretical
sensitivity in the grounded theory research that gcner:ited the SCLI theory was
informed by diverse philosophical assumptions, including a feminist viewpoint
of intimate partner violence 0farcoc, 1996), health promotion as a process of
enabling people to increase control over and improve their health (World Health
Organization (WHO), 1986), health as socially detcmlincd (Health Canada,
n.d.), and primary healthcare (WHO, 1978). This sensitivity influenced our the-
ory construction; for example, it enhanced our ability to sec women's agency;
our recognition of women's health promotion taking place on social, relational,
and individual levels; and how we theorized "costs" of seeking help. As we scru-
tinized the theory with pr:ictice in view, we quickly identified the applicability of
these assumptions for our health intervention, with women's health being socially
determined and primary healthcare being key (Ford-Gilboe et al., 2011).
Some other key assumptions were named much later when the structure
of the intervention and activities for the interventionists were under develop-
ment. Dr:iwing on our theoretical sensitivity, we progressively became aware
that some existing expert practice philosophies fit with the theoretical scaffold
of the iHEAL, such as harm reduction (Pauly, 2008) , cultural safety (Browne
et al., 2009), and tr:iuma-informed care (Elliot, Bjelajac, Fallot, Markoff, &
Reed, 2005). In grounded theory, categories arc inductively developed

through substantive coding and constant comparison such that the category
fits the data (Glaser, 1978). But not all categories must be new. Emergent
fit refers to using constant comparison between preexisting categories and
the data to determine whether it fits the data (Glaser, 1978; Wuest, 2000).
Using a process of emergent fit between the practice implications of data
from both the SCLI theory as well as the WHES findings and expert practice
philosophies, we identified philosophical assumptions true to our theoretical
conceptualization and reflective of expert practice beliefs. One example of
emergent fit is incorporation of harm reduction (Pauly, 2008) as an under-
lying philosophical assumption that aligned well with the processes in the
theory of SCLI.
Our grounded theory process of renewing self conceptualizes how women,
relieved from the oppression of abuse, initially relished living free, that is, find-
ing release in a wide range of activities, some of which were potentially harm-
ful such as substance use, extensive partying, overinvestment in children or
work, and hasty connecting in new relationships (Ford-Gilboc et al., 2005).
Most also continued to use some previously learned strategies to find comfort
from the trauma of abuse, such as smoking, working long hours, eating, sleep-
ing, or using drugs and alcohol. These theoretical findings were supported by
the WHES study's findings: of 309 women, at baseline, 44% smoked and 53%
were overweight or obese. In the previous 12 months, 27% had used street
drugs, 16% overused prescription medication (Wuest et al., 2008), and 26%
screened positive for potential high-risk drinking. Just over 3% reported hav-
ing a sexually transmitted infection in the past month. However, our grounded
theory findings also showed that as intrusion levels settled, women found that
despite living free, they did not feel happy or satisfied and began to position for
the future by engaging in the work associated with living better (Ford-Gilboc
et al., 2005). One way of living better was to begin intentionally to take better
care of themselves. The process of living better was facilitated by fomtal and
informal support that focused on fortifying women and avoided undermining
their dreorns. Harm reduction is an intervention philosophy that focuses on
engaging non-judgmentally and respectfully with people to help them find
ways that they can be safer, healthier, and more in control while risk-taking
(Pauly, 2008). Our theoretical sensitivity to harm reduction initiated constant
comparison with our data for emergent fit. Through constant comparison,
we identified harm reduction to be a congruent and important philosophical
orientation for supporting women whether they were living free or working
on living better. By making the assumption that risky bchaviors arc a rational
and purposeful response to the trauma and aftermath of abuse, and focusing on
supporting women to reduce the health and social harms of such behaviors,
we incorporated harm reduction as a key philosophical underpinning of the
iHEAL (Ford-Gilboe et al., 2011).
Exemplar 97
Principles of Practice
We also developed intervention principles for the iHEAL, that is, key guidelines
to ensure that the intervention built on the practice implications of the theory.
For each previous publication and prescnt:ltion of the theory, we had carefully
scrutinized and reflected on the theory, considering particularly how practicing
from this theoretical base might differ from "usual" nursing practice. Collec-
tively, we reflected and discussed and argued about meaning for practice over
time as we did this scholarly work together and used it to inform our policy work
related to the grounded theory and the Women's Health Effects Study. Develop-
ing the iHEAL, however, pushed our thinking to another level as we considered
how we might articulate interventionist approaches based on the SCLI theory.
Although we had worked together successfully for more than 10 years, and shared
many common values, this exercise made visible differing viewpoints. NOt:lbly,
individual commitments to the Development:11 Model of Hea1th and Nursing
(Allen & Warner, 2002) and relational inquiry (Doane &Varcoe, 2005) required
intense and lengthy discussion regarding how these nursing approaches might
fit with the SCLI theory. As well, because the intervention was being devel-
oped for delivery by nurses and domestic violence advocates, current best prac-
tices in domestic violence advocacy also were considered. Gradually we realized
that rather than choosing an existing practice model or philosophy to guide the
iHEAL, we needed a set of general practice principles that would fit with our
shared assumptions and the theory of SCLI and would guide practice by both
nurses and advocates.
Some principles were identified readily. Principles such as the intervention
being women centered, that is "women will direct the pace, what is given pri-
ority and who is involved," and strengths based, that is "women's strengths and
capacities will be recognized, drawn upon, and further developed" (Ford-Cilboe
et al., 2011, p. 203) reflected not only our own philosophies of nursing prac-
tice but also best practices in the domestic violence intervention sector. Other
support for the latter principle stemmed from the SCLI theory demonstrating
that survivors habitua11y had their deficits reinforced by ex-partners, other family
members, and helping building on "grab," attending to "fit" agencies, yet were
consistently demonstrating creative resourcefulness and successful management
of complex day-to-day challenges. WHES study findin~ reinforced this finding,
showing that after leaving, women's scores on st:lndard measures of resilience,
mastery, and fumily functioning were comparable to those of other women of
the same age.
Some principles of the iHEAL arc a direct bridge from philosophical assump-
tions to a practice approach such as the principle of advocacy, St:lting "the
interventionists will work to reduce intrusion from community services and to
advocate for improved system responses to women who arc situated in varied
contexts of social inequity" (Ford-Cilboc et al., 2011, p. 203). The principle
of advocacy translates our stated assumption that intimate partner violence "is
sanctioned and enabled by broader social, cultural. and political structures that
systematically oppress women, the poor, and those from non-traditional cultural
backgrounds" (p. 200). However, funher suppon for this principle was derived
through constant comparative analysis with our theoretical findings of intrusion
experienced by women who seek help, including having to measure up to criteria
to access services by repeatedly recounting stories of abuse, submit to ongoing
surveillance as a condition of receiving help, or settle for services that do not
match their needs (Wuest et al., 2003), and our WHES findings that services
accessed commonly meet women's needs poorly.
Other principles came primarily from scrutiny of the theory and constant
comparison to develop a more generalized principle. For example, another prac-
tice principle is: "Women will be supported to assess, judge, and take calculated
risks necessary for moving forward" (Ford-Cilboe et al. , 2011, p. 203). Risk-
taking is inherent in the act ofleaving an abusive partner in that abuse and harass-
ment intensify after leaving (Canadian Centre for Justice Statistics, 1993; Wuest &
Merritt- Gray, 1999). Indeed, 83% of women in the WHES reported ongoing
harassment an average of 21 months after leaving (Wuest et al .• 2007). Women
who left their partners took the risk of experiencing more violence because they
wanted a better future for themselves and their children. Thus leaving is an act of
positioning for the future, that is "promoting health through proactive. strategic
efforts to develop the skills, assets, and strengths needed to realize their family's
dreams in the long term" (Ford-Cilboc et al., 2005, p. 483). However, within
our data, we found countless examples of women taking diverse risks to position
for the future; for example, leaving a stable low- payingjob in order to go back
to school to gain needed credentials for a career that promised more financial
security and fulfillment, buying a house using non-conventional or under-the-
table financing in order to build equity for children, or involving children in
family decision- making about safety strategics, money, and relationships. In usual
practice, clinicians may encourage women to maintain stability through the status
quo and discourage taking calculated risks that might lead to further intrusion.
However, the SCLI theory suggests the imponance ofinterventionists reinforcing
the legitimacy of survivors continuing to take calculated ri.sks in order to build
capacity and helping women to contain the potential costs of doing so.
Our initial assumptions and principles offered direction for the subsequent
development of the iHEAL, a six-month community-based primary healthcare
intervention to be delivered in 12-14 one-to-one meetings, with the majority of
client contact with the nurse (Ford-Cilboe et al., 201 t) but were, in turn, refined
and expanded in response to our further work. We decided that the theoretical
processes of strengthening capacity (rebuilding security, providing, renewing self,
and regenerating family) would structure the content of the intervention, which
we named as components. However, as we began our translation work to develop
the components, the need for theory modification became apparent.
Exemplar 99
Modifying the Theory in the Process of Developing the

Intervention Components
Our work on developing the intervention components began with a review of
the original SCLI theory. Often this included returning to the original coded
interviews, process tibles, and memos, particubrly to support our choice oflan-
guage and illuslr.ltive ex.1mplcs. Although the WHES study provided additional
data for consbnt comparison, our modification of the theory in response to that
data had been largely inforn1al as our common underst:indings evolved. Thus as
we began our work on the iHEAL, we found ourselves in a process of conscious
theory modification in response to theoretical sampling of our WHES findings as
well as the original grounded theory data. Modifiability is a key characteristic of
grounded theory (Cbser, 1978) and also an aspect of grounded theory applica-
tion. Glaser and Strauss (1967) noted:
The person who applies the theory must be enabled to understind and ana-
lyzc ongoing situational realities, to produce and predict changes in them,
and to predict and control consequences.... As changes occur, his (sit)
theory must allow him [sic) to be flexible in revising his (sic) tactics ofappli-
cation and in revising the theory itself if necessary.
{p. 245)
Although the original theory had been developed with a sample of women
with dependent children who had been separated from abusive partners as long
as 20 years, 40% of the WHES sample did not have dependent children (Wuest
et al., 2008) and had been separated between three months and three years from
their abusive partners. Although women who were mothers were more likely
to experience some types of intrusions such as harassment and disabling chronic
pain, mothering generally did not account for differences in resources or health
patterns found in the WHES. We intend the iHEAL for all women in the early
years after leaving abusive partners, believing that early intervention has the
potential to prevent or ameliorate many health problems identified in the WHES
sample. Thus data from the WHES helped us to modify the grounded theory for
wider applicability.
The original theory has four health promotion subprocesscs: providing,
rebuilding security, renewing self, and regenerating family (Ford-Cilboe et al.,
2005). Providing addressed meeting basic needs including those usually identified
such as food, money, housing, and childcare, and also ones not usually named
such as medication, energy, leisure, and relief from symptoms. However, the
WHES findings related to women's health problems and health service use greatly
expanded our conceptual understanding ofintrusion related to physical and men-
tal health problems. We learned that women on average reported three current
diagnoses by a health professional and 12 current health problems or symptoms,
with more than 60% reporting fatigue, difficulty sleeping, back pain, headaches,
and difficulty concentrating. Rates of high disability chronic pain (35%) (Wuest
et al., 2008) and prchypcrtcnsion (42%) (Scott-Storey et al., 2009) were twice as
high as those for Canadian women in general in a similar age group. As well, 73%
of women had symptoms consistent with clinical depression and 48"/4 reported
symptoms consistent with posttraumatic stress disorder (Wuest et al., 2010). Visits
in the past month to a physician doctor were more than five times higher than
Canadion women in general, and visits to emergency departments were 20 times
higher (V:u-coc et al., 2011). Despite such high levels of service use, women in
the WHES appeared to have little relief from their health symptoms. These data
enhanced our theoretical understanding of symptom management in the context
ofinrrusion from health problems and increased its primacy in the theory. It also
led to our explicitly identifying the principle, "Women's physical, mental, emo-
tional, and spirirual health will be prioritized" (Ford-Gilboc et al., 2011, p. 203),
building on "grab," attending to "fit."
Consequently, we divided the process of providing into two components:
managing symptoms and managing basics. Managing symptoms focuses on
supporting women to build confidence in preventing and monaging intrusive
symptoms through self-management and support from health professionals (Ford-
Gilboc et al., 2011). Managing basics focuses on "assisting women to build the
economic, moterial, ond personal energy resources needed to estoblish and s=
tain herself separate from the abuser over time" (p. 207). Using similar processes
of comparative analysis with WHES data, we also divided rebuilding security
into two components: safeguarding and cautious connecting (Ford-Gilboc et al.,
2011). We retained the two processes, renewing self and regenerating family, as
individual components. Thus the theoretical model used to guide the interven-
tion included six components or ways ofstrengthening copacity to limit intrusion
(sec Figure 5.1).
From Theoretical Process to Practice Component

Our next challenge was the translotion from theoretical process to practice com-
ponent. Grounded theory processes arc very rccogni2.1blc to those who took
part in the srudy either as participant or investigator becouse they can sec the fit
between the theoretical concepts and the data or their own experiences (Glaser,
1978). However, these processes may be dense and complex for the interven-
tionist who tries to use them, especially if she/he is not familiar with the srudy
domain or, on the other hand, is an expert in the field with an entrenched prac-
tice approach. The conccprualization may be contrary to previous undcrstand-
in~ and the language may feel awkward, at least initially. Thus it was important
to identify and explain what was unique or different about each component
for this popu13tion of abused women based on our qualitotivc data. For exam-
ple, while the concept of managing basics in terms of housing, jobs, childcare,
Exemplar 101
INTRUSION
Stttngthenlng
C.padty
FIGURE S.1 Theory of Strengthening Capacity to Limit Intrusion (SCIL)

SOwt: Ford GUboe et ,J. (2011, p. 203).
and transport3tion was easily grasped, aspects such as recreation and energy were
more unusual. The conceptual understanding that women face the challenge of
managing basics while feeling undeserving and often with their energy levels "on
empty" is new.
Funher, the theoretical construction, not the conceptual indicators from the
women's stories, h:i.s the broadest applicability clinic:tlly. For example, all women
struggled with managing basics related to intrusion from negative changes to daily
life after leaving, such as those related to financial losses. However, a concep-
tual indicator of how a woman managed her current difficulty in paying hockey
registration fees for her teenage son may have little meaning for many women,
including those who have no sons of hockey age, or those whose economic
circumstances have always precluded children taking part in such activities. How-
ever, the broader concepts of determining what is basic currently and the process
of managing without are recognizable for all. This is not to say that specific
examples of women's experiences (conceptual indicators) arc inappropriate for
illustrating ways of managing particular situations. However, the experience used
must be matched to the needs and context of the woman, requiring the interven-
tionist to have a range ofdiverse examples from which to draw. T hose who devel-
oped the theory will have in their minds a range of indicators of the concepts
from the original data. Altcmatively, interventionists attempting to practice from
this new theoretical lens will take time to amass a collection of diverse indicators
that capture the variation in inrrusion and the six components (health promotion
processes). Hall and May (2001) asserted that because substantive theory is more
specific and complex than practice theory, "more mental agility, and a ccruin
amount of experience and knowledge of the substantive area" may be required
for its application (p. 214).
As well, grounded theories often include multiple subproccsscs and strate-
gics that may be too layered or complex to be readily useful for an interven-
tionist, especially one who has a novice understanding of the theory. Thus, a
rccxamination of each of the theoretical processes was necessary to asccruin
which elements were core to the process and gem1ane to directing practice to
improve health outcomes. We drew on our presentations and publications in our
deliberations, particularly the papers focusing on intrusion (Wuest et al., 2003)
and the theory overview (Ford-Cilboe et al., 2005). The process of regenerat-
ing family had been published as a separate paper detailing the varied strategics
used by families (Wuest, Merritt-Cray, & Ford-Cilboe, 2004). Interestingly, we
had the most difficulty in developing the core elements of the regenerating fam-
ily component, partially because it required modification to apply to women
without children but also because once the detail of variation in process or
concept has been explicated, it is difficult to set it aside. This latter issue had
similarly challenged Wuest and Merritt-Cray in their work developing measures
of carcgiving concepts from a grounded theory of women's caring, where they
learned, for example, that the concept of dependency in the care recipient as
reason to take on caregiving had broad application, but the conceptual indicators
of dependency such as cognitive difficulties or inability to speak English did not
(Wuest et al., 2006). The caveat, then, was to use the more abstract concepts, not
the conceptual indicators, so that the interventionist would be free to identify a
wide range of indicators for each concept, based on personal experience as well
as our original work. Over time, as the interventionist delivers the iHEAL, the
repertoire of exemplars grows and provides further data for the ongoing refine-
ment of the SCLI theory. In regenerating family, we ultimately focused on three
core elements that we believed could be most helpful to women: (1) the story
line, or how women construct how they have come to be in their current situa-
tions; (2) using routines, new roles, and rules in working with others to increase
predictability in daily life; and (3) purposefully naming and using new standards
for relationships with others.
For each component, the next step was to determine how these core elements
could be best translated as a clear guide to practice while staying true to the origi-
nal conceptualization. We developed a standard template for developing practice
modules for each component that included (t) defining the component; (2) nam-
ing expected outcomes; (3) identifying the theoretical and empirical grounding
by linking it to the theory of strengthening capacity to limit intrusion but also to
existing related research; (4) developing standard required and optional tools to
facilitate exploring intrusion, or sharing options; (5) writing an illustrative script
Exemplar t 03
for the interventionist lo demonstrate an approach for exploring intrusion and

sharing options; and (6) identifying potential actions for strengthening capacity.
In doing this work, we guarded against conceptual drift. Despite efforts on the
part of grounded theorists to choose conceptual labels that fit, the meaning given
to words varies widely according to individual contexts and experiences. As we
worked together on components, we found that among ourselves our understand-
ings of concepts were sometimes different, and we needed to revisit our analysis
of the original data. As well, common disciplinary undcrstandin~ can intrude.
The component of cautious connecting, for example, on first glance seems to
focus on women's needs for support from fumily, friends, community, and formal
services, and the interventionist could sec the principal focus on helping women
make the needed connections. But the theory shows that when women seek sup-
port, especially when they have an urgent need for help and few connections, the
consequence is often increased intrusion from having to retell their story to justify
their need for help, ongoing surveillance from people or agencies, and help that
does not match needs well. Thus some key elements of cautious connecting arc
that it is healthy and important for women to withhold trust from potential help-
ers until they feel ready, and that agencies and individuals may misinterpret and
try to violate the woman's limits. The focus of cautious connecting then is sup-
porting women to evaluate the costs and benefits of the connections they have or
arc thinking of making, with the goal of decreasing conflict and increasing their
sense of belonging, emotional support, social interaction, and practical aid. This
conceptual focus goes well beyond making referrals. Thus the illustrative script
for cautious connecting and the tools developed needed to elaborate and detail
this conceptual focus. An information sheet oflessons learned from other women
about connecting with others after leaving was developed for exploring intrusion
related to cautious connecting. Large print showing various reasons women want
to connect to others after leaving and a colored table of "costs" of seeking help
provide a useful tool to facilitate women exploring the range of possible intru-
sions from connecting with others. A second tool, a Rcl3tionship Map, which
is similar to an ecomap, was developed to help women look at the strength and
quality of their relationships with people and/or resources that they identify as
important to them, first in their "inner circle" and then in the brgcr community.
The illustrative script directs the interventionist to support women to discuss the
quality and nature of each relationship and identify which connections arc most
helpful and which are more intrusive. This sets the stage for a discussion regarding
what women might like to change with respect to their connections. A third tool
called Options, Tradcolfs, and Choices f.icilitates women's consideration of their
options for taking actions to change connections that arc most intrusive. Once
women determine the action to take, the interventionist then focuses on help-
ing them build capacity. Seven strategies for supporting women to build capacity
regardless of the component arc pacing, infom1ing/ educating, acknowledging
strengths, coaching/guiding, monitoring change or progress, connecting with
services or resources. and advocating (Ford-Cilboc et al., 2011). The modules

that we developed for each component became the core materials for a training
manual for interventionists.
Putting the Intervention Into Practice

We currently arc conducting two studies to gain information regarding the fea-
sibility of implementing the iHEAL in diverse community contexts. A key step
in moving forward with the feasibility studies was training the interventionists to
practice from the theoretical base and use its language and conceptual render-
ing in a meaningful way. The grab of grounded theory is helpful here, but it is
also easy to fr.imc parts of the intervention in usual practice. During the initial
training, we oriented interventionists to the SCLI theory and to the assumptions,
principles, structures, and activities of the intervention. Mindful discussions
about our mutual understandings of abuse and trauma, resources and services,
and practice philosophies and strengths set the stage for more specific iHEAL
preparation sessions. Differences between the iHEAL and usual practice, as well
as potential gaps, were identified and salient clinician expertise was useful for fur-
ther refinement of the therapeutic approach to fit particular contexts. We found
that clinical coaching in regular, scheduled meetings was essential for safe case
management and to review, highlight, and ensure consistent application of the
theory. Interventionist perspectives arc particularly useful for helping us to attend
to pragmatic obligation (Thome, 2011), the interrogation of theoretical find-
ings for their potential to cause harm in practice, by bringing potential problem
orcas to the surface. Periodic ongoing interventionist development sessions were
necessary to uncover problem areas, reflect particular challenges with various
components, provide further training, identify issues with services and resources
that called for advocacy with decision-makers, and gather data to inform further
theory development. The strength of a grounded theory-based intervention is
the openness to modification using constant comparative analysis with new data
to improve fit.
Within the feasibility studies, we have formally collected data. not just
through pre- and posttcst measures of quality oflife, health, capacity, and intru-
sion but also through qualitative indicators of the intervention process. The
latter include interviews with interventionists early in the intervention pro-
cess and after the intervention study is completed, interviews with participants
about their experiences, and notes reflecting salient points from regular admin-
istrative and process-focused meetings with interventionists and/or the research
team. further, clinical building on "grab," attending to "fit" file reviews and
constant comparative analysis considering the quantitative and qualitative data
collected on the corresponding participant arc a rich source of insights on the
client trajectory and how the theory was opcrationalized in the intervention.
Together these analyses will lead to further modification of both the interven-
tion and the thcorv.
Exemplar 105
Final Thoughts
The process of translating the SCLI theory to the iHEAL intervention and
conducting two feasibility studies focusing on implcmcnt:ttion is complex and
demanding. Although our feasibility studies arc ongoing, preliminary qU.11it:ttivc
and quantitative finding,; are promising. In particular, the grab of the SCLI theory,
particularly the concept of intrusion, for both the interventionists and the women
taking part is convincing evidence that grounded theories arc an important start-
ing point for clinical interventions that arc useful. The complexity of ensuring
conceptual correspondence among the original theory, the iHEAL as written,
and the iHEAL as implemented requires detailed knowlodgc of theory and of the
practice field. We have come to undcrst:tnd that intervention development, like
grounded theory itself, is an ongoing process open to constant modification. The
process of developing and implementing an intervention based on a grounded
theory docs not result in a fixed intervention. Rather, continuing constant com-
parison, refinement of fit, and emergent fit lead to modification not only of the
intervention but also the theory itself, which in tum has implications for the
intervention. Feedback from interventionists and from women combined with
outcomes and chart review all contribute to identify aspects of the intervention
and theory that need to be rethought or further refined and confinn the usefulness
of others. As we move forward, we arc challenged to understand how and why
this theory-based intervention works or docs not work for women with particular
health, abuse, or demographic charnctcristics in order to sharpen its therapeutic
focus for diverse groups of women. Thus our worlc, it appears, has barely begun!
Acknowledgments
The research that supported the work described in this chapter was funded by
the Canadian Institutes of Health Research (CIHR) New Emerging Team gr.,nt
106054 (PI: M. Ford-Cilboe) and Partnership for Health System Improvement
Cr:mt #101529, co-funded by the New Brunswick Health Research Foundation
(PI: J. Wuest). We also thank the many women who have supported our program
of research focusing on women's health after leaving an abusive partner by taking
part in our research studies.
Notes
I. Fora full discwsion of wounded theory as a research mechod, sec Wuest (2012).
2. For a full description of the Intervention for Health Enhancement Alier Leaving
(iHEAL), sec Ford-Cilboc et al. (2011).
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SECTION IV
Dimensional Analysis
6
DIMENSIONAL ANALYSIS
Barbara J. Bowers and Leonard Schatzman
Dimensional analysis is an approach to research developed by Leonard Schatz-

man, a student and later colleague of Anselm Strauss. This chapter provides an
introduction and historical context 10 dimensional analysis.
This chapter provides an overview of:
t. The context and development of dimensional analysis. including personal

biographical information about Dr. Leonard Schatzman. specifically as it has
influenced the development of dimensional analysis.
2. The relationship between dimensional analysis and grounded theory as ini-
tially endorsed by Anselm Strauss.
3. The contributions of dimensional analysis in rcg:inl to teaching analysis and
learning to conduct analysis.
4. A discussion of natural analysis as a universal form of human reasoning.
5. A statement on the relationship between natural analysis and dimensional
analysis.
At the initial writing of this chapter (2006). dimensional analysis {DA) was
continuing to be passed on by a few fonner students ofSchatzman to new gener-
ations of researchers, primarily through an oral tradition. At that rime. published
research reports using dimensional analysis were mostly authored by Schatzman's
former students, communicated largely from teacher to student and colleague to
colleague. Since then. dimensional analysis has expanded both to new generations
of researchers mentored by Schatzman's fonner students and beyond this direct
lineage to researchers learning the method through written reports and published
materials describing the methodology.
112 Barbara J. Bowers and Leonard SChatzman
Although Schatzman published linlc on dimensional analysis, his 1991 chapter

on dimensional analysis (Schatzman, 1991} and several articles published by for-
mer students (Caron & Bowers, 2000; Kools, McCanhy, Durham, & Robrccht,
1996) provide some introduction to the method. Studies using dimensional analy-
sis have now been wrinen and widely published by Schatzman's students (Bowers,
1987, 1988, 1989, 1996; Bowers & Becker, 1992; Bowers, Esmond, & Canales,
1999; Bowers, Esmond, & Jacobson, 2000, 2003; Bowers, fibich, & Jacobson,
2001; Bowers, Lauring, & J acobson, 2001; Bowers, Esmond, Norton, & Hol-
loway, 2006; Bowers & Nolet, 2014; Brown & Olshansky, 1997; Hatton, 1992,
2001; Kools, 1997, 1999; Kools, Gilliss, & Tong. 1999; Kools & Kennedy, 2002;
Kools & Spiers, 2002; Kools et al., 1996; Kools, et al., 2002; M cCarthy, 2003a,
2003b; McCarthy, Ruiz, Gale, Moore, & Ka.rem, 2004; Liang & Olshansky, 2005;
Olshansky, 1987a, 1987b, 1993a, 1993b, 2005; Robrecht, 1995; Watson, Kieck-
hefcr, & Olshansky, 2006), and in tum by their students (Caron & Bowers, 2003;
Creasy, Lutz. Young. Ford, & Martz, 2013; DeVore & Bowers, 2006; Hamilton &
Bowers, 2005; Hamilton & Kopin, 2013;Jacobson, 2009; King et al., 2013; Lutz,
Bowers, Esmond, & Jacobson, 2003; Lutz & Bowers, 2005; Mohr & Hamilton,
2016; Norton & Bowers, 2001; Oycsanya & Bowers, 2017; Roll & Bowers, 2019;
Roberts & Bowers, 2015; Yu & Bowers, 2020).
Strauss-Schatzman Collaboration
As with all intellectual traditions, personal biography and social circumstances
played an important role in the development of dimensional analysis. Specifically,
Schatzman's long association with Anselm Strauss is clearly reflected in the devel-
opment of dimensional analysis. Schatzman began his association with Strauss
when he became Strauss's first graduate student at Indiana University in 1946.
from Anselm Strauss, Schatzman learned about research and developed both a
passion for Chicago School Sociology and a strong sociological worldview. As he
watched Strauss collect data and write monographs, he began to wonder what
actually happened between the selection of a research question and the final mon-
ograph. What was involved in the analysis? How did the researcher actually "do"
analysis? How did researchers actually learn to conduct research? How did per-
spectives and conceptual commitments held by researchers influence their analy-
sis? How did a sociological perspective, or the particular sociological worldview
of Chicago School Sociology, inform the analysis? Indeed, how docs someone
come to do analysis in a way that is similar to colleagues in the same discipline yet
different from those in other disciplines? What difference did it make whether the
researcher was a psychologist, sociologist, educator, or nurse? At this point in his
career, analysis was a profoundly mysterious process.
As Schatzman recalled, during his early graduate years he asked Strauss for a
description or definition ofanalysis, an explanation of what analysis was, and how
analysis was done. Strauss responded to Schatzman as many mentors conducting
Dlmen{lonalAnalysls 113
research in the social sciences did then and still do today. He said, "Watch me.
Worlc with me. Read monographs extensively and you will sec." Like most stu-
dents, Schatzman followed that advice and eventually did "sec" and was able to
conduct sophisticated analysis on his own. By the end of his graduate program,
he saw and understood ,u a sodologut, with a sociological eye (Hughes, 1984).
Although he was largely satisfied with this new ability, he did not then realize that
Chicago School Sociology was the perspective that guided his understanding and
framed his analyses (i.e., that he was "theory driven" although not explicitly so,
not yet identifying the theoretical fi:uncworlc his work was embedded in). And
despite being able to conduct research, to do analysis (through the lens of Chi-
cago School sociology), he was still unable to explicate the steps he was using as
he engaged in analysis. The process of analysis continued to be mysterious despite
his ongoing engagement in it. This continuing mystery remained a significant
force in the development of dimensional analysis, driving SchatW1an to explore
and eventually describe how grounded theory analysis is actually done, while at
the same time arguing for a shift to a more constructivist approach and a more
robust integration of perspective and context in the data collection and analysis
process. Schatzman spoke about this as a shift from focus on the basic social pro-
cess to one that asks "what all is going on."
From this early time, Schatzman continued his interest in the nature ofanalysis
done for research purposes but also in general everyday use. Following comple-
tion of his doctoral worlc in sociology, Schatzman spent three years working with
Anselm Strauss and Rue Bucher, another former student of Strauss, on a study
of psychiatry, psychiarric professions, treatment philosophies, and psychiarric
institutions (Strauss, Schatzman, Bucher, Ehrlich, & Sabshin, 1964). In retro-
spect, Schatzman was intrigued that the psychiatric study, including the analysis,
had gone so smoothly, without any explicit plan for analysis and without in fact
understanding what analysis actually was. What the researchers shared, implicitly
of course, was a sociological perspective of the world (specifically one aligned
with Chicago School Sociology) and an accessible (received) set of sociological
concepts to use in their analysis. So although their analysis continued quite nicely,
quite intuitively, without ever having to figure out what analysis was, Schatzman
continued to puzzle over the nature of analysis.
In 1960, Strauss was invited by Helen Nahm, dean of nursing at the University
ofCalifornia, San Francisco (UCSF), to join the faculty for the purpose of devel-
oping research skills among the &culty, to support f.iculty to conduct research and
publish. Strauss negotiated an agreement that allowed him to bring a small cadre
of colleagues with him. This eventually led to the development of a doctora.l
education progran1 in sociology embedded within a doctoral program in nurs-
ing at UCSF. Not surprisingly, many ofStrauss's (and Schatzman's) students were
initially and continued to be nurse researchers and academics. This has created a
generation ofnurse researchers who spent their formative years at UCSF, working
closely with sociologists and conducting grounded theory studies.
Schat2man recalls the "bright and cager nursing students" coming to UCSF
to learn to do research who would invariably ask the question that Schatzman
had asked when he began hls work at Indiana, and about which he continued
to wonder: how docs one actually "do" analysis? The students were asking him
questions such as "What exactly happens in analysis?" "What is analysis and how
is it done?" "How can I learn to do analysis?" and "How do I know when I ant
doing analysis? Or doing it correctly?" Schatzman found himself giving the same
response that he had been given by his mentor Strauss, which that so many stu-
dents learning qualitative analysis still hear today: "Work with me for a while and
you will see." He found this answer unsatisfying, but it had worked for him and
he reasoned that it would likely work for his stude.n ts as well. But the mystery of
analysis remained and continued to occupy him.
Although Strauss and Schatzman continued to work together, their research
panncrship lasted primarily into the mid-1960s, when Strauss began to work
much more closely with Barney Glaser. After that, the collaboration between
Strauss and Schatzman was primarily in relation to students for whom they served
jointly on dissertation committees, although they also continued to read and dis--
cuss each other's work and remained friends.
Strauss's work with Glaser on ·11,, Discovery of Grounded 11ttory in 1967 (Gla-
ser & Strauss, 1967) and his 1987 publication Qualitative Analysis for Soci41 Samtists
reflected Strauss's going devotion to developing the grounded theory method,
leading them in somewhat different directions, intellectually. During this time,
Schatzman was becoming increasingly interested in understanding analysis in
general, in developing a general theory of analysis, and by extension, to under-
stand how research analysis was done and whether/how it differed from analysis
in general. At the same time, around the late 1970s and early 1980s, Strauss
was being pressured from many comers to explain what he did, in particular to
explain how he did analysis. While many students and experienced researchers
found his work theoretically rich and compelling, clearly reflecting the social
world or phenomenon that was the object of study, they were unclear about how
to actually conduct grounded theory analysis, or for that matter, any qualita-
tive analysis. His initial response to these queries was in the form of Qualitative
Analysisfor Solial Samtists (1987). Widespread feedback that this 1987 treatise had
not sufficiently addressed the mystery of analysis led to the 1990 book with Juliet
Corbin. Ironically, this latter text has been and continues to be criticized for its
overemphasis on operations, techniques, or procedures and its overdetcnninacy,
particularly in reaction to discussions of axial coding. Schatzman, on the other
hand, was increasingly focused on understanding analysis in general, in develop-
ing a "general theory of analysis."
Strauss and Schatzman had many conversations about the direction that
grounded theory was taking. Schatzman was mostly interested in the possibil-
ity that grounded theory might lead to an understanding of analysis in general
and could also provide a theory of analysis that could be used to understand the
DlmenslonalAnalysls 115
distinctions among types of qualitative research. He and Str.luss had many con-
versations about grounded theory during this time. Stnuss acknowledged Schatz-
man's influence on the development of his thinking about analysis, in particular
about dimensionalizing, that Strauss describes in Qualitalivt Analysis for Sc<ial Sci-
mtisls, as an important aspect of open coding, and about the early ve1$ions of the
conditional matrix. The relevant point here is that Schatzman's ideas about analy-
sis were largely generated out of these discussions with Strauss in the late 1%0s
to mid-1970s. After that there was little interaction between them about analysis.
Dimensional Analysis: Convergences With

Grounded Theory
Althoug)I dimensional analysis developed at least in part as a response to what
Schatzman saw as limitations of early grounded theory, there is considerable over-
lap between them. The nature and extent of the similarities between dimensional
analysis and grounded theory depend on which VC1$ion of grounded theory is
considered. The following discussion is based on Stnussian grounded theory as
best reflected in Qualitative Analysisfar Sc<ial Scitntists (Strauss, 1987).
Grounded theory (a la Stnuss) and dimensional analysis have similar intellectual
foundations and commitments. That is, they arc both firmly rooted in the Chi-
cago School of Sociology, informed by symbolic interaction, and initially devel-
oped by sociologists with clear commitments to both an interactioni.st worldvicw
and the questions generally addressed by sociologists, and with a particular focus
on social process. At different times, Schatzman describes dimensional analysis as
developed "in the wake of grounded theory," as "generally informed by the core
ideas and practices of grounded thoory," as "an alternative approach to grounding
theory in data," and as "philosophically, following the work ofStt:luss." Dimen-
sional an:tlysis, like grounded theory, was designed for the generation of theory
directly from data. This contnsts sharply with much research, both qualitative and
quantitative, that is directed (implicitly or explicitly) by substantive theory or is
implicitly theory testing.
Dimensional Analysis: Schatzman's Response

to Grounded Theory
Schatzm30 was initi:tlly quite excited about the power of comparative analysis
that the grounded theory method offered, seeing grounded theory as having
distinct advantages over theory-controlled analysis, consistent with the primary
message in T~ Distovtry of Grou11dtd Theory. However, he felt that something
was missing. Specifically, as he watched the development of the grounded theory
method and worked with students using the method to conduct their research, he
began to sec that, despite the usefulness of comparison, the focus on comparative
analysis seemed to minimize the complexity and the subtlety of analytic reasoning
116 Barbara J. Bowers and Leonard Schatzman
required in analysis and failed to acknowledge the wider range of analytic pro-
cesses that, in addition to comparison, were involved in analysis. So while appre-
ciating the power of constant comparison, Schatzman began searching for an
understanding of analysis that was broader than grounded theory acknowledged
and could accommodate both the wider range of analytic processes and greater
complexity of analytic operations required to conduct analysis of any sort.
Scha12man first began to realize why comparative analysis as a focus for oper-
ations was not adequate to describe, and in particular to teach, analysis as he
worked with students who were trying to do qualititive analysis using grounded
theory. As he listened to students describe what they were doing, he was hearing
clear and repeated descriptions of many other analytic processes that were integral
to their analysis.
In 1973, Schatzman wrote his field research text, which included a chapter
devoted to analysis. The text was intended to be a collaboration with Strnuss.
However, as Schatzman completed the first draft, it became clear to both Strnuss
and Schatzman that this work reflected a clear departure from grounded theory.
Continuing to puzzle over the nature of analysis, Schatzman hoped that explor-
ing analysis in the field research text might assist him to develop a position or
perspective on analysis that would be suitable to any qualitative research prob-
lem. Initially believing he had failed in this effort, Strnuss urged him to publish
the book (Schatzman & Strnuss, 1973). Still without a theory of analysis, he
continued until 1975 to advise individual doctoral students who were using the
grounded theory method. Returning later to this text, Schatzman saw clearly the
beginnings of dimensional analysis.
In 1975, the dean of the School of Nursing asked Schatzman to teach a course
on qualititive research for a dozen or so students in the master's program who
needed research credits. He was told that the students were clinically focused and
not really interested in research and that on graduation, they would be seeking
clinical positions. Faced with the task of teaching qualitative research, including
describing analysis to students who did not have a clear understanding of analysis
in general and were not particularly interested in research, he asked them to dis-
cuss what considerations they would use to decide from among several job offers,
which one they would select, and how they would make the selection.
The students indicated a number of considerations in lay terms bearing prin-
cipally on a professional perspective. Schatzman interpreted these as expressing
clinical spccialty, philosophical compatibility, and role autonomy.
As Schatzman encouraged students to identify the criteria they would use to
consider and ultimately select their first nursing p06ition, he noticed how they
were selecting some dimensions while ignoring others. He observed the nurs-
ing students as they conjured dimensions, seeing some as highly valued whereas
others were seen as of little relevance. For exaniple, they identified model of care
as very important; type of care or the particular unit as much less important.
The students described patient population as somewhat important, but size and
3ppc3rancc of the building as not import3nt 31 311. Schawnan then asked for
3dditional considerations 3nd when none was forthcoming, he volunteered such
considerations as salary, workload, and work shift. The students responded with
exclamations of 41 Naturally." 410bviously." or "Sure."
As Sch3tzman considered how the students were conjuring dimensions, he
offered 3 few th3t might have been relevant to other similar analytic process such
3S selecting 3n apartment or selecting a part-time position before gradu3tion.
These dimensions were summarily dismissed by students as irrelevant. For exam-
ple, working with a friend might have been one of the most import3nt considera-
tions for a part-time position during graduate school. Geographic location might
be one of the mon import3nt dimensions of selecting an 3partment, especially
for students with limited time and transport3tion alternatives, but might be only
somewhat relevant for tatting 3 first nursing position.
Students were obviously attributing greater value to some dimensions than to
others. So although they were clearly engaged in comparative 3nalysis of nursing
positions, comparison alone could not account for the positions they might con-
sider or accept. Their comparisons proceeded on the basis of prior assumptions
3nd understandings 3bout the n3turc and variable importance of these considera-
tions. The possibility of comparison and the n3ture of the comparison relied on
their ability to c3ll out and evaluate dimensions. Dimensions not known or not
identified were obviously not included in their comparative analysis. Sch3tzman
concluded th3t 3lthough the ability to c3ll out or design3tc and 3ttributc value to
dimensions is implicit in comparative 3nalysis, these other analytic processes were
also necessary for comparative 3nalysis but had not 3ctually been identified as part
of or necessary for comp3rativc 3nalysis in descriptions of grounded theory or
other qualitative research. The failure to explicitly recognize these other cogni-
tive processes made teaching or learning qualitative research, including grounded
thoory, much more difficult th3n it needed to be. In 3ddition, the &ilure to
acknowledge these other analytic processes was at least a partial explanation for
the mysterious nature of analysis.
It was then that Schatzman "discovered" dimensional analysis. He concluded
that he had tapped an important aspect of n3tural analysis 3nd that considera-
tions arc, in fact, dimensions of experience-in this case nurses' experiences--
that constitute the wherewithal to construct, analyzc, and define situations (sec
Schatzm3n, 1991).
Enjoying 3 rcput3tion 3S 3 master tc3chcr and storyteller, and someone alw:iys
3cccssiblc to students, many students visited Schatzman to gain insight into what
Strauss (3nd other faculty) was telling them to do and how to proceed with
their analysis. As Schatzman helped students learn to conduct a grounded the-
ory analysis, it became increasingly clear that many other analytic processes were
involved in analysis. As Schatzman interacted with these students, many of whom
he advised jointly with Strauss, he became increasingly diss3tisfied with the
"procedures" or operations of grounded theory and the limitations of constant
comp=tivc analysis. So while appreciating the power of comparative analysis,

Schatzman continued to develop his ideas about dimensional analysis.
Schatzman's thoughts about the importance of these other analytic processes
were also supponed by his encounters with students who were working with
Str.1uss and others and who were having great difficulty learning to do grounded
theory. These students would sometimes come to Schatzman for help in cluify-
ing the operations involved in grounded theory analysis. They sought assistance
in figuring out how to proceed with their analyses, having great difficulty under-
standing the process, how 10 get stancd, and how conceptual categories were
generated. The students were focused on comparing and comparative analysis but
were finding it difficult to proceed with their analysis using that single analytic
tool. This operation, comparison, was simply not sufficient.
Schatzman concluded that research analysis involves a range of analytic pro-
cesses, only one of which is comparative analysis. Some of the other analytic
processes, necessary in conducting research analysis, include:
• Conjuring, calling up dimensions (characteristics}. This conjuring process

often proceeds unproblematically and invisibly in qualitative analysis. The
impact of other analytic procedures on the conjuring process is generally not
taken account of, proceeding as if the identified dimensions were the only
possible dimensions.
• Assigning relative value to each of the dimensions considered. This is the
process of deterniining which dimensions to include and which to discard,
determining which dimensions arc "nothing and nonsense." and which rise
to the level of relevance or even salience. Although his analytic process is
engaged in by analysts in all types of qualitative research, it is not visible
to others or even to the researchers themselves. Attributions of value arc
embedded {albeit often without acknowledgmcnt) in personal and profes-
sional biography and operate to screen and select dimensions that arc con-
sidered or "identified" as inherent in the situation. This professional and
personal lens generally remains unacknowledged.
• Inferring, making inferences about dimensions conjured. Although com-
parison f.icilitatcs analysis of dimensions conjured and selected, comparison
relics on the rcseucher assuming relationships among dimensions and assum-
ing relevance or irrelevance of those dimensions.
Perspective determines which dimensions arc irrelevant, relevant, and salient. As

perspective V3rics. so too the relevance of dimensions varies.
A second observation Schatzman made was that identifying a basic social pro-
cess, particularly when doing so early in the process of analysis, led to premature
focus on logically deduced or logically conjured comparisons, taking the researcher
outside the data, developing theory from dimensions that were external to the
data, and ultimately limiting the researcher's understanding of the phenomenon
being studied. Using comparative analysis, which fucilitated or stimulated con-

ceptualizing at this early point, increased the distance between the researcher and
the data. This was inconsistent with grounded theory's explicit purpose of devel-
oping theory from empirically generated data. Schatzman reasoned that focusing
on "what all is involved" in the data, as presented by informants, rather than a
single, basic social process, would prevent the premature closure that would result
from early comparisons and would ultimately minimize the distancing between
researcher and the data.
So, Schatzman r=oned, taking a broader approach to analysis, asking "what
a// is involved," rather than identifying a basic social process, would likely generate
a wider range of dimensions related to the phenomenon under study, avoiding
early theoretical closure, leading the researcher to a much fuUer and more com-
plex range ofdimensions and properties. This broader approach to dimensionaliz-
ing, he believed, was necessary to handle the complexity of social life. FoUowing
th.is logic, conceptualizing too early would result in a much narrower, less rich
view of the phenomenon. This meant that staying open to "what all is involved"
would lead to a richer and more grounded understanding of a phenomenon .
Consequently, it is the job of the researcher to encourage infom1ants to designate
concepts, to caU out dimensions and their properties, to develop a rich and com-
prehensive bank of dimensions generated from the informant whose experience
is the focus of study.
This view of analysis is reflected in the advice that Strauss and Schatzman
gave to their students when asked, "How long do I stay focused on my data
before I begin to compare, to logically deduce possibilities?" (Strauss, 1987). Stu-
dents working with Strauss were generaUy directed to begin comparative analysis
immediately (Strauss, 1987); the analyst was engaged in comparative analysis right
from the beginning. Schatzman took a different approach, suggesting that com-
parative analysis should be delayed until a larger bank of dimensions had been
generated from the dab.
Dimensional Analysis: A New Path

Dimensional analysis is committed to an expansive, early process of identifying
and designating dimensions and their properties to expand the analyst's under-
sbnding of the object of study; the relevance and complexity of any dimen-
sions and their relationships to each other can generally only be determined by
understanding the perspective from which it is viewed. Perspective both limits
and directs analysis, whether everyday analysis or research analysis. Perspective
not only determines the selection and designation of dimensions: it also directs
their organization or their relationships to one another. Left relatively unad-
dressed in grounded theory as well as in most other qualibtive research, were
questions about researcher and informant perspectives (thereby integr;,ting social
and historical context) and how perspective (commitment, discipline, or personal
biography) is embedded in the analysis, guiding the identification and designation

ofdimensions, the direction of comparative analysis (and consequently conceptu-
alizing), and the eventual organization of dimensions (theory development) into
a dimensional matrix (Schawnan, 1991).
Much of published qualitative research identifies neither the perspective ofthe
researcher nor that of the informants. Thus a more sophisticated understanding
of how both operate in analysis is vital. As Schatzman noted at the time, there
continues to be a pervasive insufficient recognition of the role that perspective
plays in analysis, either the researcher's analysis of the data or the informants'
representation (analysis) of the phenomenon being studied. That is, researchers
often fail to recognize the role that perspective plays in the informants' conjuring
and organizing of dimensions, and fail to recognize how their own perspectives,
personal or as content cxpens, operate in considering, valuing, and selecting con-
cepts they determine to be relevant. This is often reflected in erroneous descrip-
tions of concepts "emerging from the data." Schawnan also reasoned that there
were multiple perspectives to consider during analysis; that informants might,
and often did, take different perspectives depending on the context or conditions
being considered at the time; that a "good" analysis would include more than a
single perspective; and that it would, in fact, seek to identify multiple perspectives
and explain how those perspectives influenced the stories they told. Schatzrnan's
description of nursing students considering offers of employment illustrates how
perspect.ive operates in analysis, how it guides the conjuring of dimensions and
the determination of their explanatory value.
The example ofstudent nurses responding to questions about how they would
select employment after graduation provides an example of how this operates.
Identification of the "best" job and the considerations used to make that deter-
mination varied depending on the perspective from which they were responding.
When viewed through a professional perspective, with the professor as primary
audience, they focused on vision and philosophy. In contrast, when asked about
dimensions of work unrelated to a professional perspective, students were able
to switch to a more personal perspective in which work routine, l"'Y• work shift
and shift rotation, modes oftransponation, safety of setting, distance, and parking
were salient. Each perspective brings limitations in temts of dimensions included
and in their relative value.
Limited income would likely be a condition influencing perspective taken in
the selection of dimensions relevant to job selection; making pay, transponation
costs, and opponunity for ovenime more central dimensions in their analysis.
This simple example begins to illustrate the coexistence of multiple perspec-
tives, the emerging and shifting salience of a particular perspective in response to
context or condition, and the resulting consequences of perspective for selection,
designation, and organization of dimensions.
When students were offered a new perspectiv~practical rather than
professional-{hey were led to a new set of dimensions to consider and responded
to the question from that new perspective. For at l=t some, this led to a new
conclusion about the job they would select. Schatzman recognized that initially
they had answered his question from the perspective of a professional in an aca-
demic setting (and considering a patticular audience), and their responses were
crafted from that perspective. However, when they adopted another perspective,
one that was just as real, the response or conclusion was quite different. What was
important both for understanding analysis and the development of research oper-
ations or methods was the realization that "humans arc doomed to be selective,"
to take a perspective on problems, to sec from a standpoint. In fact, inforn1ants in
a research project can only tell their story from a perspective, granted at different
times or when considering different conditions, possibly from different perspec-
tives, but never without a perspective. The relevance for research analysis is that
researchers can only conduct an analysis from a perspective and that perspective is
always operating. Analysis cannot be done without a perspective.
Perspective, and how (or even whether) it operates in analysis, has still rcccived
little attention in discussions of qualitative research, including grounded theory
studies, although somejournals/ intellectual traditions continue to include author
biographies to provide some context for published work, believing this provides
at least some insight into perspective. And certainly Clarke and Chamuz's work
on situational analysis recognizes and incorporates analytic strategics bearing on
perspective. However, in much of the current qualitative research, awareness of
the power of perspective docs not extend to questions about how disciplines and
individual perspectives (unproblematically) operate to select and limit the dimen-
sions included in any analysis, to determine which dimensions were deemed to be
of some value or "of interest" to the researcher. This is often seen in descriptions
of analysis that suggest "key" concepts or codes "emerge" from the data, with
rarely ever any discussion on what nukes something "key."
Schatzman saw the influence of perspective most clearly in the differences
between analyses of nursing students and students in sociology. Students in soci-
ology came to analysis with sociological concepts; nursing students can1e with
concerns about clinical questions. Their lenses (perspectives) were different. The
dimensions conjured by nursing students differed from those of their sociological-
minded colleagues. This difference was often understood by sociology faculty as
being less sophisticated analysis rather than as analysis generated from a different
perspective. Failing to tease out how perspective was directing the gaze of student
researchers made it difficult for students to understand how to improve their
analysis or even why it might be seen as lacking.
The recognition that perspective is always operating also raised questions
about the notion of emergence in qualitative research. Recognizing that what
"emerges" from data is dependent on both the perspective of the informant and
the perspective of the researcher, the notion of emergence as unproblematic dis-
covery in much qualitative research, continuing today, is an insufficient, even
misleading explanation of analysis as it f.iils to account for the range of analytic
processes that lead to selection and organization of dimensions. Schatzman was

concerned that the failure to take perspective into account was responsible for the
common mistaking of "received" interpretations (including salient dimensions
and their relationships) for discovered or emergent "truth." Schatzman described
this recognition/recall process as frequently guiding analysis that purports to be
engaging in discovery.
Recognition/Recall
Recognition/recall involves the use of prior/received theory, often unwittingly.
to conceptualize data while mistakenly attributing that conceptualization to anal-
ysis of the object of interest. The designation of dimensions in data is guided
or determined by prior assumptions of the analyst. Recognition/recall extends
analytic "discovery" beyond a general understanding of dimensional relevance.
It also guides the selection and organization of dimensions and subdimensions.
Thus emergence can be better understood as an interaction between what the
analyst brings to the analysis and the data available to work with. Anthropologists
will find culture in their data; psychologists will find internal cognitive and emo-
tional categories; more ideologically informed analysts will find inequality and
oppression. Researchers learn theories, conceptual frameworks, and core discipli-
nary concepts and acquire the vocabularies that these concepts arc embedded in.
These concepts suggest to students and other members of the discipline what they
should be observing in the field, distinguishing between significant dimensions
and concepts and those that arc unimportant, directing their cndcavors and their
discoveries. Once novices take on the perspective of the discipline (as Schatzman
described in his own experience of becoming a sociologist), they arc able to bring
this perspective to their analysis, no longer needing a definition of analysis. They
have the concepts they need to find what is relevant in their data. This is often
mistaken for emergence, seen as not beholden to any theoretical perspective, as
pure discovery. In the instance described here, discovery is more an organizational
or labeling problem than a conceptual one.
In Schattman's view, scientific research and analysis arc taught in academic
institutions by experts in the various disciplines, both quantitative and qualitative,
using analytic tools that arc grounded in a perspective, using their professions'
vocabularies. In other words, the processes for analyzing substance arc hidden in
the vocabulary and knowledge of each science, discipline, or perspective.
Analysis, Schatzman suggested, is different. Analysis occurs when a problem-
atic situation is encountered, when recognition and recall arc not sufficient to
understand what is going on. Analysis, at least theory-generating work, allows
for competing explanations or dcfinition.s and must always be carried out and
identified as from a perspective or from multiple perspectives. An important ques-
tion for researchers wanting to learn the experiences of research informants is
whether the perspective operating to select and organize dimensions is that ofthe
Dimensional Analy$1s 123
infom1ants or that of the researcher (or the researcher's discipline). In daily life,
recognition/recall is an appropriate and efficient way to understand the world
and the things around us. In research, recognition/recall can block analysis, stop-
ping the conjuring of dimensions or the seeking of new dimensions and proper-
ties. This view resonates with Schattman's caution about beginning comparative
analysis too early. Recognition/recall essentially precludes transparency in the
conjuring, valuing, and selecting of dimensions to include in the analysis as well
as the determination of importance.
Leaming to Do Analysis
One of the most intriguing aspects of Schattman's work is his proposal that
the operations involved in research analysis and the analysis we all engage in
every day to solve mundane problems, to figure things out, and to explain and
evaluate the things in our daily lives arc essentially the same. Schatzman believed
that the failure to understand this, to perpetuate a belief that research analysis
is fundamentally different than natural analysis, leads students to believe, inac-
curately, that they arc analytic novices. This belief is a major source of difficulty
for students learning to become researchers, particularly when engaged in quali-
tative research. Descriptions of analysis in qualitative research texts, including
grounded theory, fail to rcbtc the analytic strategics used by researchers to those
used naturally.
According to Schatzman, research analysis was and is discussed by most teach-
ers of qualitative research as requiring an order of thinking, a quality of thinking
that is quite different from the thinking we engage in during more mundane
activities. Although there arc few descriptions of how to do analysis, there seems
to be a general belief that analysis is something that novices need to be taught.
T hat is, students do not come to rese3rch progrants with a sophisticated knowl-
edge of how to do analysis.
In reviewing texts on qualitative research, Schattman observed that many
of these texts, especially those written within a discipline, offered the novice
researcher concepts that were core to that discipline, as sufficient components
or structures for analysis; that is, providing theory or perspective relevant to the
discipline was offered as the tool to conduct analysis. This meant that the con-
cepts of the discipline would be brought to the data, not derived from data, but
presented as analysis.
This observation becan1e important for Schatzman's ideas about analysis, as
it suggested that the researcher's prior perspective leads to "recognition" of the
dimensions relevant to that perspective, and that the process is experienced as
"discovery." That is, researchers use what Schatzman calls recognition/recall
rather than any formal analysis grounded in the data, to derive theory from data
or to "discover" what is in the data. So, when looking at how theorizing is
actually done, he realized that sociologists generally theorized by bringing the
concepts of sociology to the interpretation, a process similar to that which occurs

across disciplines.
Other texts on qualitative research, those that did not offer theory or concep-
tual frameworks from a panicular perspective, generally provided little to guide
the novice about how to actually do analysis, what to actually do with their dtta.
When guidtnce was offered about the analysis or interpreting process, it was
largely procedural rather than analytic. For cxan1plc, readers might be instructed
to read and reread their notes, to immerse themselves in the dtta or the field. This
is similar to the advice Schatzman had received from his advisor: watch, listen, read
monographs, and immerse yourself. The lack of attention to what is occurring
a11alytically often reflects recognition/recall, when researchers bring concepts to the
analysis, use them to dctcrnunc relevance of dimensions, org:inize the dimensions
according to the discipline's perspective, and experience the process as discovery.
In either case, the actual process of analysis or interpretation is invisible, even to
the researchers. Without understanding the processes by which an interpretation is
actually made, the experience will continue to be inaccessible and mysterious. The
same process can be seen in the development of interview questions.
Variations in analysis and findings occur as a consequence of who is doing the
analysis, as people have private commitments, interests, sensitivities and toler-
ances, and ways of seeing, weighing, and choosing options. Ideas and findings arc
competitive. Every analyst conjures and gathers his or her own considerations,
weighs and values each, a.n d configures them into a pattern or story that expresses
a logic and sequence, often with little insight or transparency.
Making perspectives and their operation in the "emergent" theory trans-
parent would require that perspectives be recognized, disclosed, and tracked.
Acknowledging the limitations and procedures involved in carrying this out
(sec Chapter 10). Greater awareness of how perspectives operate in dtta analysis
would result in greater of researcher self- consciousness about and acceptance of
greater responsibility for the substance of the analysis than is generally the case.
Natural Analysis
Schatzman's long-standing question about the nature of analysis led to his close
observation of how we all analyze every day, solving mundtne problems and fig-
uring things out. Schatzman observed that all analysis, not just research analysis,
requires a property of thinking that he refers to as "dimensionality." He sug-
gests that humans dimcnsionalize experience and construct and define situations
dimensionally, which is necessary to understand complexity. Dimensionalizing
allows us to sec things in their complexity, to discrinunatc among them, and to
compare one thing to another. Any description of something involves an identi-
fication of its dimensions and propcnies.
Schatzman sees analysis as basic to all human understanding and interaction.
Analysis is "natural," learned early in life, and practiccd "constantly in experience."
As he pointed out to students he worked with, everyone arrives in graduate school

with a sophisticated ability to cng:igc in analysis. The nursing students looking
for jobs were analyzing the options, attributing value, and selecting from among
the possibilities. They were dimcnsionalizing the situation and analyzing from a
perspective. Humans born into a social system learn its language and culture and
become socialized. In that process, children begin to develop a conception of self.
The child learns many designations and evaluates them as good, bad, and irrel-
evant, learning to designate and to organize behavior around designations. The
child is then expected to continue both explaining actions and organizing actions
around designations and their evaluations. As this ability becomes more sophis-
ticated, the child begins to conjure, sort, and select considerations for inclu-
sion in their "definitions of the situation."Thcsc understandings arc informed, in
increasingly complex ways, by perspective. The child learns to take into account
the perspectives and the logic of the audience to which the interaction is directed,
to take the role of the other, to create an explanation that will be plausible to "the
other." In any event, the scholar (or anyone) who expresses an understanding to
others on any topic must speak to the logic of others as audience and then await
the others' acceptance or rejection of the assertion. Validity is in the eye of the
beholder and is inherent in the vocabulary and logic applied to the explanation.
These observations led to Schatzrnan's exploration of the similarities between
natural analysis, what we all do every dty, and research analysis. This aspect of his
work is significant for the teaching and learning of research analysis in particular.
His conclusion was that research analysis is similar in kind to natural analysis.
They arc simply informed by different perspectives, guided by attention to dif-
ferent audiences, but in terms of the analytic tools and the logic used, they arc
essentially the same.
The example he often used to illustrate this is the problem of explaining the
actions of a woman sitting all day in front of a bank of slot machines. An evange-
list tells us that the devil made her gamble; a Marxist would say it was the capitalist
system that enticed and exploited the woman; a geneticist might hypothesize the
existence of a gene related to addiction. All three positions adhere to a logic of
cause and provide internally consistent logics, verbalizing their explanations in
different languages, from different perspectives, using different a priori logics and
vocabularies. Thus depending on who is listening, each explanation will or will
not be sensible, rational, or ridiculous.
Being impressed by what he saw as the universality of analysis in human rea-
soning and the tools to engage in analysis, Schatzman concluded that it would be
quite useful, in teaching analysis to novices, to disabuse them of the beliefs that:
t. lay capacity for analysis is different from and inferior to scientific analysis.
Rather, Schatzman sees research analysis as itself a natural development, a
subtype of ordinary human reasoning, suggesting that scientific research is a
modified fomi of lay analysis, not different in kind.
126 Barbara). Bowers and Leonard Schatzman
2. Qualitative analysis is generally quite independent of theory, that something

can be discovered without a theory or per..pective to guide the inquiry. As
Schatzman concluded, researcher.. and audiences barely see--<>r don't sec--
the relationship between "knowledge," their disciplinary per..pective, and
their "discoveries. 0
Making visible the link between analysis involved in research and that involved
in common interpretative acts, Schatzman believed, could have the effect of
demystifying research analysis, making analysis of any kind more transparent and
more amenable to instruction than "watch me and you will pick it up."This view
essentially render.. analysis not only transparent but also recognizable as a com-
mon human skill, and therefore comfortably familiar to students "learning to do
analysis."
Dimensional analysis, then, is a fundamental component of natural, everyday
analysis as well as research analysis. It is concerned with how someone comes
to "define the situ3rion" (be it researcher or infornunt), with making explicit
the analytic processes involved in the interpreting, discovering, or construct-
ing processes. It keeps the question of per..pective in the forefront and seeks to
make transparent the things that arc often, in qualitative research, not considered
explicitly or at all by the analysts engaged in analysis or by the audiences.
Dimensional analysis shares with grounded theory a commitment to gen-
er:iring theory directly from data. It recognizes and deliberately integrates the
perspectives of the researcher as well as those of the inforn1ants or subjects of
research. Dimensional analysis seeks to make tr:insparent the analytic processes
used by researchers as they conduct their analysis. The methodology directs the
researcher to remain open to what inforn1ants have to say, seeking to identify both
the per..pcctivc through which an account is offered and a rich bank of dimen-
sions prior to beginning analysis (comparison), preventing early conceptual clo-
sure. As a research method, dimensional analysis interferes with the tendency for
qualitative researcher.. to bbcl concepts early in analysis, or engage in recognition
recall, thereby blocking the development of rich and grounded thoory. Although
dimensional analysis shares much with the other grounded theory methods, and
is gener:illy considered a variant of grounded theory, it differs in its assumptions
about the centrality and timing of comparative analysis and differs from some
of the grounded theory methods in not supporting the search for a single, basic
social process, rather seeking to learn "what all is involved," thus recognizing the
complexity of social life. Finally, dimensional analysis explicitly recognizes and
embraces the sophisticated analytic skills that are used by all of us in our daily
lives, adapting these skills to the research enterprise.
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7
EXEMPLAR
Developing the Green House Nursing Care
Team: Variations on Development and
Imp lementation
Barbara J. Bowers and Kimberly Nolet
Purpose of Study
A core component of the Green House nursing home model is an altered supervi-
sory relationship between the nurse and direct care workers. Some have exp=ed
concern that the Green House nursing model might weaken professional nursing
oversight, threatening the quality of clinical care. This qualitative research study
explores the role of the nurse as implemented in the Green House model, focus-
ing on how variations in the nursing team influence clinical care practices.
Design and Methods

Dimensional analysis, a "second-generation" grounded theory methodology, was
used to conduct this study. Data were collected through observations and indi-
vidual interviews with 37 nurses, 68 Certified Nursing Assistant (CNA}, and 11
Guides working at 11 Green House sites.
Results
Implementation of the nursing role within the Green House model varied both
within and across sites. Four nursing model types were identified: Traditional,
Visitor, Parallel and Integrated. Care processes, CNA/Shahbazskill development,
and worker stress varied with each nursing model.
Implications
Government policies have been enacted to support culture change. However,
there is currently little guidance for regulators, providers, or consumers regarding
Exemplar 131
variability in how culture change practices arc implemented and consequences

of these variations. This chapter outlines the importance of understanding these
practices at a level of detail that distinguishes and supports those that a.re most
promising.
Background
Beginning in the 1970s, fucled by widespread published accounts of abuse,

neglect, and fraud in nursing homes, federal and state governments began rais-
ing questions about the quality of care in nursing homes. After a dismal Institute
of Medicine report {1986), the federal government enacted the Nursing Home
Reform Act of 1987. The Act prompted an unprecedented focus on quality of
life for nursing home residents by establishing a resident bill of rights and requir-
ing a spectrum of services that equally promoted psychosocial and mental well-
being alongside physical well-being.
Culture Change
By 1997, a movement to transforn1 nursing homes to more home-like environ-
ments for residents and to improve quality of work life for direct care stalf was
taking shape (Koren, 2010) Since that time, several "culture change" initiatives
have emerged, all sharing a vision of improved quality of life for residents along
with greater autonomy and work life quality for stalf. There arc generally agreed
on basic principles guiding the nursing home culture change movement (Koren,
2010), including "de-medicalizing" the look, feel, and care delivery in nursing
homes through environmental redesign, staff empowerment, relationship build-
ing, and resident-directed care (White-Chu, Graves, Godfrey, Bonner, & Sloane,
2009).
Staff Empowerment
Culture change innovators often implement modified CNA roles such as empow-
ered workers, universal worker roles, o r "self-managed work teams" designed to
promote both resident quality of life and improved quality of work life. CNA
cmpowcrn1cnt initiatives and self-managed work teams have been linked to mod-
est positive outcomes for CNAs and residents (Bowers & Nolet, 2011; Yeatts &
Crcady, 2007).
Direct care worker empowerment initiatives have sometimes created challenges
for nurses. For example, nurses often struggled to adjust medication administra-
tion and treatments as CNAs allowed residents to wake at different times. They
began to vocalize concerns about resident care quality and being left out of culture
change efforts (Bcllot, 2012; Scalzi, Evans, Barstow, & Hostvedt, 2006). Indeed,
there is often little guidance to homes about how to successfully integrate nurses
132 Barbara J. Bowers and Kimberly Nolet
into culture change initiatives (Hill, Kolanowski, Milone-Nuzzo, & Ycvch3k,

2011; White-Chu, et al., 2009). The consequence has often been to marginalize
nurses (Greene-Burger et al., 2009}.
The Green House Project Homes
Possibly the most comprehensive nursing home culture change is the Green
House model, an evolution of the Eden Alternative (Rabig, Thomas, Kane, Cut-
ler, & McAlilly, 2006). The model provides a home-like environment, including
the physical environment that resembles a family home (usually 8-12 people),
with significantly transformed care staff roles (Table 7. I) (The Green House Pro-
ject, 2013). Most Green House homes arc in clusters of two or three, sited on a
campus with a larger, traditional nursing home. Direct care staff, referred to as
"Shahbazim" (singulor: "Shahbaz"}, work in sclf-nunaged teams and are respon-
sible for direct resident care, cleaning, laundry, meal preparation, staff scheduling,
and activities, simulating how families might organize work (Rabig et al., 2006;
Sharkey, Hudak, Horn, James & Howes, 2011). There arc two Shahbazim for
each house on the first and second shifts, and one on third shift. Green House
nurses generally cover two or three homes during first and second shifts, often
covering additional homes on third shift. The description of the nurse's role in
Green House homes (Table 7.1) is sirnil.arto that of more traditional homes, add-
ing emphasis on coaching and pcrson-centered care while omitting management
ofnon-dircct care activities (e.g., scheduling and conflict management).
A significant Green House innovation is the Guide role. The Guide, rather
than the nurse, supervises all non-clinical Shahbazim work and provides general
oversight of the homes. Clinical care oversight remains the responsibility of the
nurse. How these supervisory responsibilities are shared between Guide and nurse
is less well defined as the distinction between clinical and non-clinical may not be
interpreted consistently. One Guide generally oversees all Green House homes at
a site. Where there are only one or two Green House homes, Guides often have
an additional role (e.g., administrator, social worker). Extensive training is pro-
vided for new Green House homes including general principles, architecture, and
roles of the Guide and Shahbazim (Table 7.2). The details of how the other areas
should be implemented (including the nurses' role) have had less formal guidance.
Research on the Green House Project

Early research on the Eden Alternative showed mixed results. Coleman and
colleagues (2002} found a higher incidence of falls, more nutritional problems,
higher rates of hypnotic prescriptions, and higher staff turnover, while Bergman-
Evans (2004) found higher family satisfaction, lower resident depression rates,
and lower levels of helplessness. Other studies found higher quality of life,
TABLE 7.1 Common Swf Responsibilities and Role Sharing With Legacy• Home
91.J,""1: N,.,,, Cuid, Dirtdor cf N,.,,it,g 01/1tr Cli11i"'t S..ppo,t

(Pf,ysiaans, Th,11pies,
Dittary)
• Nu,sing assistant direct care (e.g., • Oversig)u of direet care • Coach Shahbazim • Oversight of all • Consult on care as
bathing. mobility assistan~ check provided byShahbazim • 0.-.rsight of house clinical care and needed/requested
vitals) • Skilled nuning direet • D~et supervision elder safety • Contr ib.ue to care
• Organize and conduet aetvities for care (e.g., assessment, of Shahbazim • Direet supervision plans
dde,s medic><ions, trewnen1) • Full-time vs. part• of n.ines • Serves both Green
• Organize and lead care plan • Care planning. physician time depending on • Serves both Green House and Legacy
meetin~ calls, rounds, charting n.imber of homes House and Legacy
• Commmicare with nurses to • Communicire with • If pan time, often
provide optimal dder care Shahbaz and clinical support has another role
• Scheduling ofShahbazim and shift team to provide optimal inLegacy (e.g.,
CO\uage dder care administrator,
• Household supply and food • Educate and mentor actilities assistant);
ordering and stocking Shahbazim should no, be a
• Men.i plaming and meal • Only assigned 10 "orl< OJISC
preparation in Green House homes,
• Daily cleaning although this sometimes
• Laundry varies
• Maintenance calls • °Fill in" nuses from Legacy
• Organizing and condueting Shahbaz are often not Green House
"house" mcc<ing5: ttained
• Only worl< in Green House i
~
....
·"'ore: Thu tablconl)' docribes whac U most commonly seen in Green Hou.1c Homes. Varullces do occw. ~
a Commonl). the "'Lcpq homc''U the more tnclitional nun.ing home on the same site a$ the Green Howe homa. The Lepcy -and Green Howe homes share a nursing
home license, The Lcpcy provides shaa:d urviccs to the Green Howe homes, wch » dietary and then.pi a. Green Howe homes commonly ..ordet'' wpplics and (ood
from the Lcpcy home
134 Barbara J. Bowers and KJmberly Nolet
TABLE 7.2 Education and Support Provided to Adopters by the National Green Howe
Organization
Pluu<
Oi,covery Financial fo..ibiliry

Introductory workshop for community and organization
Adoption Architectw21 planning
Kickoff meeting for lcadership
Organizational elunb'C worbhop
Educator worbhop
Guide worlahop
St>rt Up On..$itc training s:upport to educators
Ad hoe eonsult>tion
Shahbazim worbhop and practicum
Role ofnurse worbhop'
Clinie:al support team workshop,'
Ongoing Peer network
ConfcrcnCC$
Ad hoe eonsult>tion
a Newer prognms. Not all org:u,.izadons have recclved this tducad.on.
higher family satisfaction, less late loss of activities of daily living (ADL), and
higher levels ofincontinence in Green Home homes than in comparison nurs-
ing homes (Kane, Lum, Cutler, Dcgcnholtz, & Yu, 2007; Lum, Kane, Cutler &
Yu, 2008). A study of work processes found that Shahbazim spent more time on
direct resident care and engaging with residents, despite the expanded respon-
sibilities of their universal role (Sharkey et al., 2011). Zimmcm1an and Cohen
(2010) examined evidence regarding Green House elements, finding support
for many elements, but suggesting that more evidence is needed regarding ele-
ments such as building design and use of outdoor spaces. The Green House
elements of a new physical plant and empowered workers arc strategics consist-
ent with the characteristics of high pcrfomuncc work systems, although ques-
tions rcnuin about their applicability to long-term care culture change (Bishop,
2014).
Green House Nurses and Shahbazim

Green House nurses arc described as "clinical support team" members who
"visit on a schedule dictated by the clinical assessment and treatment needs of
the cider and regulatory compliance mandates" (Rabig et al., 2006, p. 535).
Moving oversight of direct care workers from a nurse to a Guide was intended
to strengthen the focus on quality of life and diminish the mcdicalization of
ciders' lives. Not surprisingly, nurses in the early Green House homes were
Exemplar 135
resistant to the model, particularly to moving supervision of direct care work-

ers from nurses to the Guide (Rabig et al., 2006). The Green House vision
of empowered front-line workers no longer supervised by the nurse raised
concerns in the nursing community that the Green House model might result
in a weakening of professional nursing oversight, threatening clinical care qual-
ity (Greene-Burger et al., 2009; Zimmerman & Cohen, 2010). The purpose
of this study was to describe the role of the nurse in the Green House model
and to analyze variations in the nursing role as implemented in Green House
homes.
Methodology
In this study, dimensional analysis, a "second-generation" grounded theory, was
used (Bowers & Schatzman, 2009). Dimensional analysis follows the grounded
theory framework, is embedded in the social-psychological tradition of sym-
bolic interaction (Blumer, 1969), and is suited to the analysis of complex social
processes in which actors may hold varying perspectives. The strength of this
methodology is in defining a phenomenon from the perspective of the respond-
ent, promoting an understanding of the phenomenon as it is experienced and
understood by the respondent(s) and eliciting the social processes involved in
creating and sustaining the phenomenon under study.
Recruiting
Following institutional review board approval, the national Green House office
provided the research team with a list of all 14 skilled nursing care Green House
sites operating for at least six months. The research team sent an email, followed
by a phone call, to invite the Green House Guides (supervisors of the homes) at
each of the 14 sites 10 participate in the study. Eleven of the 14 Guides agreed to
participate.
Data Collection Phase I

Data were collected in two phases. Phase I consisted of telephone interviews
with Guides in all 11 participating sites to assist in general model understanding,
interview question development, and san1ple selection for site visits. Interview
questions evolved from less to more structured, both within each interview and
as the study progressed (Bowers & Schatzman, 2009). Guides were first asked to
"talk about their experience with being part of the Green House model." Inter-
viewers used probes to g:iin detailed descriptions of topics raised by the Guides,
encouraging participants to provide explicit examples of their genernl impressions
of the model and to provide specific examples of their experiences, including the
pro= used currently and over time, to implement the model. This participant-
guided exploration was followed by researcher-generated questions related to
specific issues (e.g., reporting relationships between the Shahbazim and nurses)
identified prior to the interview. The researchers, experienced interviewers,
and qualitative researchers conducted the telephone interviews. Interviews were
recorded and transcribed.
Data Analysis Phase I

Analysis of Guide interviews provided insights into significant differences
among the sites as well as common implementation strategics and challenges.
Areas of difference and similarity identified during phase I included chal-
lenges implementing the program, the selection and role of the Guide, and the
number of individual homes on a single site the Guides were responsible for
supervising.
Data Collection Phase II

Based on analysis of these initial interviews, eight Green House sites were selected
for follow-up site visits. The decision about which sites to visit was made to
maximize the variation in size of the Green House site, strategics for model
implementation (particularly around the nurse/Shahbazim relationship), apparent
difficulty implementing the model, and degree of change in the model since ini-
tial implementation. A two-member research team went to all eight sites. Guides
posted study information sheets in Green House homes and distributed volunteer
sign-up sheets. Guides did not engage in recruitment.
Observation was used to direct the research team to relevant additional topics
that were included in the interviews and to valid.ate interview data (e.g., if shift
change activities were described in interviews, researchers were able to compare
this to what they observed). Observation was also used to valid.ate nursing model
differences such as nurses engaged in direct care or interacting with Shahbazim.
Researchers had meals with residents and staff and participated in house activities.
No personal care was observed.
Interviews were conducted with administrators, directors of nursing, and die-
tary and therapy staff. These interviews were used primarily to learn how Green
House homes related to the larger organization and how support services were
integrated into the Green House homes. The interviews and observation were
useful in determining additional relevant areas to include in interviews with direct
care staff.
Consistent with the grounded theory methodology, the researchers met
each day to conduct analysis, revise interview questions, and determine subse-
quent theoretical sampling, seeking staff with experiences that would provide
comparative sampling opportunities. The Guides served as the primary source
Exemplar 137
of information for theoretic.ii sampling options. Site visits took place over six
months, each lasting two to three days.
Data Analysis Phase II

All interviews from site visits were recorded and transcribed. Field notes were
typed and made available for data analysis sessions. Transcripts were analyzcd
using dimensional analysis (Bowers & Schatzman, 2009; Strauss, 1987), a
line-by-line analysis that assists in maintaining the researchers' focus on how
participants describe their experiences and identify what is salient in their
experience. Comparisons across sites, homes within each site, and shifts within
each cottage led to insights into the consequences of differing implementa-
tion strategics. Participant observation, specifically the ability to compare staff
descriptions to researcher observations, was particularly useful in guiding the
analysis.
Saturation
In grounded theory, saturation is achieved when there arc no additional concep-
tual discoveries within the core categories or in the link between core c.itcgories
and salient conditions. In this study, saturation of core categories was achieved
when no new care team implementation strategics and no new conditions influ-
encing implementation were identified in ongoing interviews.
Rigor
Analysis sessions were conducted in a team setting with researchers who had
varying levels of familiarity with the Crccn House model and with long-temt
care. Particularly important during early analysis, the addition of outsiders facili-
tates the elimination of interpretations that c.innot be supported by data. Second,
as analysis evolved, analytic matrices of concepts and conditions were shown to
subsequent participants. These 13tcr participants were asked to comment on the
emerging matrix, noting where it might confirm or diverge from their experi-
ence. Divergent examples were followed up by rccxamining the data, rccontact-
ing prior participants, and/or altering the developing matrix.
Setting
Data were collected at eight Crccn House sites, most with multiple Crccn
House homes on site, totaling 20 Crccn House individual homes. All were
skilled facilities. Each home had 10-12 ciders. Administrative staff, including
the Cuidc, had offices in other buildings on the same site. Site descriptions arc
listed in Table 7.3.
TABLE 7.3 Phase II: Number of Homes on Each Site, Interviews and Observations
Numb,, U.S. Dirttton Nunes Shahl,,irin, C11ul, Oth<r Approximat~

of Crrm R,xio11 of (<.,e., Huma11 Numb,, of
1-1,,..,, Nursi,,,t Raourta, PtJditipaul
Homes Di<lary) Obs,rvations
on Site"
Site A g South 4 10 1 1 20
Site B ~ South 3 9 1 1 40
SiteC ,2:4 East s s 1 18
SitcD g Midw<>t t 4 12 1 2S
Site E g Midw<>t 2 10 t 3S
Site F ,2:4 Wc,1. 6 6 t 20
SitcC _2:4 South 8 IS t 1 28
Site H g Midw~ s 2 20
Toal 22 8 37 68 8• 3 200
a The nwnber of homes on .., .h site is notpr- In this uble to prottct the ldtntity of the homes.
b 'J'hrtt additional guides were interviewtd in Phase I. This '2.ble only rdfects sites tlu.t were pan of
Phase II,
Sample
Participants included Shahbazjm and Green House nunes across shifts and from
multiple homes, as well as Guides, as.<istant directors of nursing, directors of nurs-
ing (DoNs), and administrators (Table 7.3). At some sites social workers, thera-
pists and dieticians were also interviewed, depending on their involvement in the
Green House in relation to the nursing role. These other interviews provided
both specific areas to probe during Shahba2im and nurse interviews and a source
of confirmation for Shahba2im and nurse interview data.
Findings
This study revealed significant differences across Green House sites in how nurses
and Shahbaum understood their roles, the boundaries between nurse and Shah-
baz work, responsibility for initiating contacts with family members, responsi-
bility for making refcmls to professionals, the range of decision authority over
residents' daily lives, and oversight of Shahbaz activities. Based on these differ-
ences, a typology of four nursing care implementation models was developed:
Traditional, Parallel, Integrated, and Visitor. Significantly, differing nursing care
models were found not only across sites but also across homes at a single site and
Exemplar 139
even within the S3ntC homes across individual nurses and Shahbazim. Therefore,
the typology provides a heuristic to better undcrsbnd variations in implementation
strategics and their consequences rather than a comprehensive description of indi-
vidual sites or a description of how the various models arc distributed across Green
House homes. Interviews with staff who had long tenures in the Green House
homes suggested that the model had generally changed over time. For example,
although the Visitor model might have been dominant initially at one site, it was
now uncommon. Table 7.4 outlines the characteristics of the four models.
TABlE 7,4 Green Howe Homes Nuning Model Typology
N1mini Nu=. Collaboratio,1 and Nm~ Wod!uf,

Model S/,a/J,az Communialtio11 0vmw111 of Q11olity
&11ndariesl No,M1uninx
Wori, Shati1111 Wori.,
Tnditional Cl=/ Nunes make most Yo Nunc: high, Nurse

minimal decisions about with high directed
overlap arc and home work load
operations Shahbaz:
Frequent unchanged
communication
Parallel Cl=/ Shahbaz reports to No Nw,c: Nurse
minimal nunc on ~idcnt high directed
overlap arc Shahbaz: high
Shahbaz nunagc
opcntions of the
home/unit
Modcr21c
communia.tion
ln1cgr21cd Blurred/ Collabor2tion o n No Nunc:high, CoU.bor2tive
con.1idcrablc many il.luc, with high
overlap Highot level work load
of reciprocal Shahbaz: high
communication
Vuitor Cl=I Communication No Nw-.c: Shahbazim
no overlap only when seen low directed
as ncces.ury 6-om Shahbaz: high
Shahbaz to
nunc
l.owcst level of
communication;
primarily
through Guide
Traditional Nursing Model

lnltr11it1vtr: Is working with the nurses any different than working with nurses
in the nursing home?
Shahbaz: Not a whole lot. We're the main caregivers, you know. We have a
nurse who goes back and forth and she's still the nurse, and who still
oversees everything.
The Traditional model was found where nurses had not been well oriented to the
Green House model and in sites that implemented the model prior to develop-
ment of the extensive nurse education program. Nurse oversight ofShahbn work
encompassed both delegated nursing tasks (ambulation, symptom monitoring,
and vital sig,is) and non-nursing activities (cleaning rooms and stocking linen
shelves), as wcll as resolving conflicts among Shahba:zim. Overlap in responsibili-
ties occurred in delegated tasks as nurses continued to monitor these activities
closely. Nurses tended to give direction to Shahbnim, check up at the end of
each shift to make sure the work had been completed, referee conflicts between
Shahba:zim, and comment on the quality of the housekeeping.
Shahbaz: If they [nurses] go in and sec a spill or something, they ask,

'Can you go clean that up?"
Although there was overlap in responsibility, there was minimal sharing of

work. As in traditional skilled nursing facilities, nurses rarely answered resi-
dent lights. Instead, they responded to a light by indicating to Shahbazim that a
resident light needed to be answered. If there was no Shahbaz available, nurses
either sought out a Shahbaz or asked what the resident wanted, and then found
a Shahbaz to do the work, unless the request required a nurse. When Shahbazim
observed a change in resident condition, the nurse was summoned to determine
what needed to be done and whether a referral needed to be made. Resident care
problems were referred to the nurses who integrated changes into the care plan,
often with minimal input from Shahba:zim.
Nurses were responsible for initiating family contacts. Shahbazim might sug-
gest to a nurse that a family member would want to be notified about something
but did not make the contact. This is consistent with traditional settings where
CNAs interact with families during visits to the home but rarely initiate contact
with families outside visits.
Nurses and Shahbazim generally agreed that nurses were "in charge" of the
homes and the care. The nurses viewed themselves as ultimately responsible for
both their own and Shahbaz work. These nurses consistently expressed the belief
that it was their responsibility to oversoc all Shahbaz work, to make sure Shahba-
zim completed their work.
Nursi1111 slajf rep!Olttnmts-. In this model, selection of new Green House nurses
was primarily based on past attendance record, clinical skills, ability to multitask,
Exemplar 141
and ability to work independently as they often worked alone, particularly at

sites with only a single Green House home. In the Green House homes using a
Tradition:il model, past team collaboration, quality of relationships with CNAs,
and views about the Green House philosophy were not prioritized as new nurses
were selected. In these homes, those in charge of hiring nurses could not identify
any differences between the nurses' they would hire into the Green Houses and
those they would hire into their nursing home.
Worli life quality. Most nurses practicing within this model were comfort-
able with their role, describing relationships with Shahbazim as quite positive.
These nurses described their workload as greater than in nursing homes where
they had previously worked, attributing the heavier load to being (often) the
only nurse, with no one to back them up in an emergency. Shahbazim working
in this model were mixed regarding work life quality. They were less excited
about their work than were Shahbazim working in the other nursing models,
expressing disappointment that the Green House had not turned out as they
had expected. In particular, they noted the failure to achieve greater autonomy,
objecting (not openly) that nurses continued to be authoritarian and "bossy," and
that much of the oversight from nurses was unnecessary or even demeaning. As
one Shahbaz said,
I don't think it's right that a nurse asks me at the end of the shift whether
I have gotten my vitals. I have been doing this for I 5 years. I have gotten
vitals every day. Why wouldn't I get vitals? Why docs she have to ask me
that?
Rtsidmt a,re procmts: The care processes, decision authority, lines of commu-
nication, and accountability were much like those generally operating in nursing
homes. Shahbazim reported to nurses and nurses took responsibility for respond-
ing. Green Houso-rebted improvements in quality oflifc were described anecdo-
tally by staff, mainly in terms of physical environment, residents' ability to make
choices about daily activities, and the belief that families were more comfortable
and visited more often.
The role of the Guide in the Traditional model was to support a shift in bal-
ance between medical and social aspects of residents' lives. Guides felt unsure of
their role or reported bcking the necessary skills. At these sites, Shahbazim were
left to determine how cider care and home operations would be managed and
how the nurses and Shahbazim would relate to each other, including resolving
conflicts, filling gaps in staffing, and dividing the bbor. Under these conditions,
the approach ofthe nurse working at the time largely determined how the model
would be implemented on that shift. As nurses were often not familiar with the
Green House model, approached their work as they would in a traditional nurs-
ing home, creating a Traditional model in the Green House. These homes had
the widest variation in model implementation, often varying across shifts as the
nurses changed.
142 Barbara 1- Bowers and Klmberly Nolet
Visitor Model
He !uzd aftOllur,d hip so /r,: sl101dd'w bmr 111rn,d or r,posirwn,d b«aw, he's i11 /1is
rooni tJnd M uw: likt, "I don'l Wd1J/ to," and nobody {SJushhdzim) 1w:s tllki"R ta" ofit.
Ar r/ral rinu:, I (nun,) ta/led 1h, C11id, lo come down arul taL., car, of ir.
The Visitor model was found at only one site. This model has the clearest bound-
aries between Shahbaz and nurse work. In this model, Shahbazim arc responsible
for resident quality of life whereas nurses arc responsible for responding to "medi-
cal/clinical nccds." Thcrc is little interaction between them. Shahbazim described
themselves as "empowered" to determine whether a resident condition required
nursing intervention or referral to other professional. Shahbazim viewed them-
selves as "in charge" of the home, using nurses as consultants when they chose to.
Shahbazim saw nurses as having no authority over Shahbazim work.
Shahbaz: Basically, I just sec her (nurse) pass pills and if somebody wants, pain
mcds, or some thing, then we'll call her.
Nurse: They {Shahbazim) made a referral to the speech therapist. No one
told me anything. I was the last one to know.
Nurses were discouraged from. and were not comfortable with, directing Shah-
bazim in these homes. The Guide did not bring nurses and Shahbazim together
to discuss either resident care or interpersonal issues. Nurses who observed care
quality problems with Shahbazim, either said nothing, corrected the problem
themselves or biked to the Guide, rarely approaching Shahbazim directly.
Nurse: I kind of stepped on people's feet because I went directly to the Shahbaz
on certain occasions and was met with a bit ofresistance. I was told, "If
you arc having problems with so and so, please go through the Guide."
Niming stojf repfluements: New nurses were selected primarily for their clinical
ability and experience. Team collaboration and quality of past relationships with
CNAs was not considered central when hiring new Green House nurses. Nurses
who were "able to make decisions on their own" we.re seen as desirable.
Worl< life q11ality: Shahbazim and nurses had very different perceptions of how
well the model was working. Shahbazim were quite positive, particularly about
their independence. However, some were dissatisfied with the expansiveness of
their work (e.g., shopping, scheduling). In sharp contrast, the nurses described
work life quality as poor, as feeling like visitors rather than integral to resident
care. They felt marginalized and unappreciated, providing many examples ofresi-
dent care decisions that had been made without their input, leaving them gener-
ally uninformed, feeling unwelcome in the homes, and as "often the bst ones to
know" what was going on.
Exemplar 143
Resident tare proussts: In addition to being generally unhappy and feeling

unappreciated, nurses working in the Visitor model were concerned about
the quality of care in the homes, describing themselves as having no author-
ity to direct or intervene in Shahbazim work and as often being "out of the
loop on what was going on with residents." Nurses offered several examples
of clinical problems that had not been brought to their attention, and were
consequently not addressed in a timely manner. During both interviews and
field work with Shahbazim, the nurse on the research team identified clinical
situations that were clearly in the domain of nursing care that were not shared
with the nurses.
Parallel Nursing Model

A midttll ""' Wnx diffe,,/Jy. . • . yo11 rqx,rt it ,. ,,., tn<M o,ul your t<Sp<>nSibility
is dont.
In this model, nurses and Shahbazim worked in par:illcl, each having clear tasks,
with minimal overlap in their work. However, both groups were invested in
resident care issues and communicated frequently about what and how residents
were doing. In this model, nurses had very little, or no, involvement in the daily
opcr:ition of the homes or how the Shahbaz worked. Nurses did not check up
on Shahbazim to be sure they were doing their work (weights and vitals) and
did not intervene in conflicts between Shahbazim. They provided direction to
Shahbazim only when it involved a resident safety issue. Nurses indicated that all
other issues were addressed either among the Shahbazim or between them and
their Guide.
Nt,rst: We do our nursing duties and don't pay a whole of attention to what the
Shahbazim arc doing care-wise. I mean, we do, in a sense that ifl sec that
there is a safety issue or I'm concerned about pressure relief or things like
that, but for the most pan their Guide is responsible for discipline.
Generally, nurses working within a Parallel model maintained responsibility

for contacting fumilies about resident concerns, although this was not univer-
sal. In some homes, Shahbazim were comfonablc cont:icting families and nurses
sometimes made that suggestion if the Shahbaz had a particularly close relation-
ship with the fumily. Nurses also took responsibility for making referrals and
cont:icting physicians. Both nurses and Shahbazim agreed that clinical problems
should be immediately referred to the nurse and that nurses were responsible for
informing Shahbazim about resulting changes in c:ire. Shahbazim did not expect
nurses to inform them about the outcome unless it had relevance for Shahbaz
work. In general, the Shahbazim and nurses felt their relationships were quite
positive. However, some Shahb:izim were disappointod that nurses did not share
any of the work.
Shahbaz: They're just like "we give the mods." Sometimes they're right in front
of a light and the resident just needs like water. I mean, something
really basic.
Nursi1111 staff replai:ttnmts-. When selecting nurses for work in the Green House,
nurses who were familiar with the Green House philosophy and approach and
who were known to "get along" with CNAs were preferred. A calm dcmcanor
was seen as helpful to managing relationships with the Shahbazim and fitting the
tenor of the house.
Worll /if, quality: Nurses practicing within the Parallel nursing model were
generally extremely positive about the work and felt quality of life for the resi-
dents was superior to that in the more tr:lditional settings where they had workod.
They panicularly appreciated no longer having to monitor direct care workers,
spending more time doing "nursing" work and having more direct resident con-
tact. Some nurses working w ithin this model described the workload as greater
than in a traditional nursing home, if they covered more than one home or cov-
ered both the Green House {or two) and units in the nursing home at the site,
and were frequently paged to another home to assess a resident or answer ques-
tions from families or physicians. This was panicularly the case when nurses were
responsible for multiple homes and described difficulty completing their work as
they were frequently called to another home.
Shahb:izim working in the Parallel model were also generally positive about
their work life. They described themselves as empowered to make decisions about
their work, identified many new skills they had developed, felt the work was more
rewarding than previous CNA work had been, and could "not imagine going
back." There was a high level of excitement about the work and the ability to
provide high-quality care and a more satisfying life for residents. They felt positive
about being responsible for completing their daily work without oversight from
the nurses. Like Shahb:izim working in the other nursing models, they sometimes
felt challenged to complete all their work with their added responsibilities.
Rtside,1t a1r, pr0<,ss,s: Shahbazim saw themselves as responsible for identifying
changes in residents' conditions and notifying the nurse. They were comfonablc
communicating directly with nurses about residents' conditions and saw it as an
imponant pan of their role. Although there was minimal nurse-to-Shahbaz or
Shahbaz-to-nurse shift change reponing, researchers observed many instances of
Shahbazim a.n d nurses communicating about residents during the shift.
Integrated Nursing Model

Shahbaz: "We have a resident that has been declining and falling. So we {nurses
and Shahbazim) talked about how we arc going to stop this and try
Exemplar 145
to get her out more.... we staned drawing up papers to get check

on her every 30 minutes, bring her out to watch TV more with eve-
rybody else, and we're getting the family to come in more. So we've
been communicating on that and getting ideas back and fonh. We
stancd finding a pattern. The nurse and us called the family up and
biked to them to get idc:is."
The Integrated model represents the highest level of collaboration between nurses
and Shahbazim and is characterized by a high level ofongoing interaction and con-
siderable shared responsibility. For example, the nurses were generally quite willing
to do "Shahbaz" work. Nurses were seen assisting with feeding and toileting. If a
resident asked for assistance and the Shahbaz was not present, they often responded
to the resident's request. Sometimes nurses and Shahbazim engaged in resident
care together. For example, nurses and Shahbazim were observed walking ciders
together and then later discussing what they had noticed, what assessments might
be needed, referrals made, and care plan alterations needed. This was the only
model where nurses were observed actively teaching Shahbazim. As in the other
models, Shahbazim viewed nurses as responsible for most clinical decision-making.
This model differed from the others in that both nurses and Shahbazim initi-
ated contacts with family members. Similar to the other models, nurses always
initiated contacts to discuss serious clinical events.
NursirlJI stojf rtp/(l(emer,ts: Shahbazim and nurses expressed a strong preference
for nurses with Green House experience, insisting that only Green House-trained
staff could fill even temporary positions, and were not accepting of nurses who
took a hierarchical approach to working with Shahbazim. While the DoN was
always concerned about nurses' clinical skills, sites that were careful about select-
ing nurses who supponed the philosophy and were known to be respectful and
good "teachers" of CNAs had more consistent opponunities to use an Integrated
model than when nurses were not selected this way.
Worll life quality: Work life quality and job satisfaction were high for both
nurses and Shahbazim. Nurses liked the greater resident contact and felt the
shared work led to higher-quality care. For example, one nurse described how
she answers lights, takes residents to the toilet, gets them food and drink, and
walks with them. In the process, she has been able to conduct much better assess-
ments, identify subtle (earlier) changes in condition. and teach Shahbazim thin~
that make them better observers and care panners.
Although nurses working in the Integrated model were satisfied, many believed
that the model resulted in a significantly increased workload. The workload
increased because nurses (willingly) shared in some of the Shahbaz work, either
instead of Shahbazim (in the spirit of partnership) or along with them (to teach
or to gather clinical information about the resident). At the same time, nurses in
the Integrated model felt more comfortable with less nurse suffing on the night
shift. as they highly trusted Shahbazim to quickly summon a nurse when needed.
They also described rarely being called to a home for "trivial" issues.
Residtt1t t:4re proussts: The Integrated model fucilitatcd the timely identification
of ch311ges in resident condition, resulted in the greatest collabor:ition between
Shahbazim and nurses, and provided important embedded learning opportunities
for Shahbazim. Shahbazim saw it as their role to participate actively in identifying
resident clinical needs and were more likely than in the other models to offer their
opinions. For CX3mple, in one home with • predomin3Jltly lntcgr:itcd model,
a Shahbaz was observing 3 resident as the nurse was helping the resident take a
medication. The Shahbaz observed that the resident seemed to be "leaning to the
right" while taking the medication, and that this was unusual for this resident. She
continued to observe the resident as the nurse escorted the resident back to her
room, and then went to share her observations with the nurse. This led to very
early identification and treatment ofan infection.
Several, but not all, of the nurses in this model engaged in some teaching of
the Shahbazim as they worked together. Although the nurses did not sec them-
selves as responsible for educating the Shahbazim, they often explained what they
were doing and why, described new treatments, and demonstr:ited techniques for
lifting, moving, and tr:insporting.
Shahbaz: When I worked up at (Legacy home), I never did the glucose scans
and she kind of expects that here, you know, like at 4:00 two of
them might need a glucose scan and she's over at the other house.
lnttn1iewer: Do you foci comfortable doing that?
Shahbaz: It's no big deal.
lnltn1iewer: So how did you learn to do those?
Shahbaz: The nurse showed me.
Some of the Shahbazim talked about how they were taking on increasing
responsibility for learning about clinical conditions and becoming better collabo-
r:itors with the nurses, describing their skiU levels as increasing over time.
Shahbaz: We know when she's (cider) starting to act a little restless, and she's
on the light all the time, we quickly check her blood sugar or her
oxygen, because we know that's 3 sign of ... maybe blood sugar or
an oxygen issue.
lntmieiver: How did you learn that might be • sign of that?
Shahbaz: The nurse, actually. We work very, very closely with the nurses ....
so if someone just isn't acting normally, I'll say, "Hey (nurse), this
person over here has been crying a lot lately, or they're very restless"
and the nurse will come over and say, "Well. hey, this is usually the
case when this happens." Especially when you work so closely with
the nurses, you learn.
A nurse working in this model described how taking a resident to the toilet
with one of the Shahbazim allows her to observe the clinical skills of the Shahbaz
Exemplar 147
3nd to tc.,.ch the Sh3hbaz about more effective strategics. It 31so gives the nurse 30
opportunity to tc.,.ch the Shahbazim about new trc.1tments 3nd clinical problems
with a specific eye to clarifying wh3t the nurse should be informed about.
Discussion
This study describes licensed nurse oversight Green House homes in a way that
has not been previously understood. The Green House program offices provided
general guidance to early Green House adopters, lc3ding to variation in how the
nurse's role was implemented and evolved in c.,.ch organiZ3tion. E:ich nursing
model identified in this study has differing implications for dimensions of work
life 3nd care quality. The Integrated and Parallel nursing models in this study arc
promising in tcm1s of quality of work life, communication, collaboration, and
care processes, but balancing workloads remains a challenge to nurses. The Inte-
grated model was the only model where the staff were able to provide frequent
examples of nurses teaching Shahbazim, thereby increasing the skill capacity of
Shahbazim and increasing the likelihood of improved resident outcomes. For
example, nurses taught Shahbazim to test glucose levels, described by both as
30 example of collaborative problem solving, while appropriately man3ging the
division oflabor between them. The Visitor model identified in this study raised
concerns about resident safety 3nd care quality but was described as a "past pra~
ticc," and changes toward appropriate oversight were found in interviews and
observation.
The Green House model promotes staff familiarity with ciders and presents an
opportunity for a high level of collaboration in providing social and clinical care.
This could potentially lc.,.d to earlier identification of change in condition and
possibly reductions in preventable hospitaliZ3tions. If these associations were con-
fim1cd, the financial gains may outweigh any additional costs of implementation.
However, given the variations observed in this "single model" of culture change
and variations reported across other culture change homes (Elliot, Cohen, Reed,
Nolet, & Zimmem1an, 2014}, caution is needed in linking resident 3nd staff out-
comes to any model without carefully exploring internal variations (e.g., lines of
3Uthority and flow of communication). Resc.,.rchcrs arc cautioned to attend to
such variations when making cross-model comparisons.
Replication of nursing home culture change initiatives continues to be a
challenge to providers. Even where innovations have documented impressive
improvements, innovators have had difficulty describing what they actually did
and how it might be replicated somewhere else. The level of guidance available to
culture change adopters is evolving. For example, the Green House program has
implemented a "Role of the Nurse" education program and is developing more
guidance for directors of nursing. This study suggests that improved implementa-
tion guidance about the role of nurses may lc.,.d to greater consistency in out-
comes. However, it remains unclear how much stringent guidance is feasible or
dcsir:ible. Future rCSC31'ch may 3SSist with understanding the fe:isibility of fidelity
to rigorous culture change guidelines.
The findings of this study are useful for states developing pay-for-performance
incentive systems. Clearly, it cannot be assumed that "the same" culture change
progr:im will always result in the same outcomes. Greater attention to spe-
cific replication guidance and implementation fidelity are vital in determining
whether a particular culture change progran1 is elfective and an appropriate pay-
for-performancc investment.
Limitations
Participation in the study was voluntary and the sample size was small, limit-
ing the generalizability of findings. Although it is possible an organization may
have encouraged "positive" stalf to participate in interviews, the data docs not
reflect such a practice occurring. As the focus of the study was on implementa-
tion proccsscs, and there w:is no elfort to identify the frequency of perspectives
held by either Shahbazim or nurses, the relevance of findings for any particular
shift, home, or site cannot be determined. Observational data did not confim1 all
self- reported practices, although findings arc supported via observation or asking
other stalf about examples and comparing their "stories." These findings, how-
ever, should be treated as preliminary. More extensive and formal observations
arc necessary to confirm study conclusions. Finally, the Green House model con-
tinues to evolve as educational and support progr:ims arc updated and expanded.
Continuing relevance of the models cannot be anticipated as the context contin-
ues to evolve.
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ahe.10.66
SECTIONV
Constructivist Grounded
Theory
8
THE GENESIS, GROUNDS, AND
GROWTH OF CONSTRUCTIVIST
GROUNDED THEORY
Kathy Charmaz
Over the past decade, the roots of constructivist grounded theory have deepened
and its reach has grown. Constructivist grounded theory began through critique
and revisions of earlier versions of the method (Glaser, 1978, 1998; Glaser &
Strauss, 1967; Strauss & Corbin, 1990, 1994, 1998). This revision adopts and
develops the useful methodological strategics of earlier versions but places the
method on contrasting ontological and epistemological grounds (Charn1az, 2000,
2007, 2014a; Mills, Bonner, & Francis, 2006a. 2006b). Adopting constructivist
grounded theory leads to recxamining what data are and what they can mean,
changing researcher-participant relationships, repositioning our studies, and
asking critical questions about the research process, products, and ourselves as
researchers. As interest in qualitative research expands throughout academic dis-
ciplines and professional fields, many researchers resonate with the philosophical
underpinnings and practical guidelines of constructivist grounded theory.
Since the publication of the first edition of this book in 2006, increasingly
diverse researchers have adopted constructivist grounded theory.' Beyond its
beginnings in sociology and infomution systems (e.g., Bryant, 2002; Charmaz,
2000, 2002, 2006), constructivist grounded theory continues to be developed in
the social sciences (Charmaz, 2011, 2015, 2017a; Charmaz & Belgrave, 2019),
information systems (Bryant, 2014, 2017), nursing (Butler, Copnell, & Hall,
2019; Higginbottom & Lauridsen, 2014; Willian,s & Keady, 2012), education
(Dunne, 2011; Keane, 2015; Nelson, 2017; Thornberg, 2012; Thornberg &
Dunne, 2019; Thornberg, Halldin, Bolmsjo, & Petersson , 2013; Thornberg,
Perhamus, & Channaz, 2014), Indigenous research (Bainbridge, Whiteside, &
Mccalman, 2013; Schreiber & Thomm-Bonde, 2015), applied linguistics (Had-
ley, 2017), psychology (Arczynski & Morrow, 2017; Chamuz & Henwood,
2017; Priya, 2010; Tweed & Channaz, 2012; Viswambharan & Priya, 2016),
154 Kathy Charmaz
participatory action research (Duckies, Moses, & Moses, 2019; Hense & McFer-
ran, 2016), business (Carmichael & Cunningham, 2017), and tourism research
(Matteucci & Cnoth, 2017).
In addition to its strong presence in sociology, nursing, psychology, edu-
cation, business, and gender studies, constructivist grounded theory extends
across such diverse areas as international policies and politics (Richards & Far-
rokhnia, 2016; Saleh, 2016), urban planning and architecture (Allen & Davey,
2018; Leick, 2015), environmental studies (Benhou, 2013; Fleming, Dowd,
Gaillard, Park, & Howden, 2015; Hargreaves, 2011), software development
(Sedano, 2017; Sedano, Ralph, & Pcraire, 2017), criminal justice (Carot, 2009;
Lopez-Aguado, 2012), social work (Bryson, 2016; Perez, 2017), race and
ethnicity (Hordge-Freeman, 2013, 2015; Philbin & Ayon, 2016), kinesiol-
ogy (Wilson, 2009), construction management (Rahmani & Lcifcls, 2018),
engineering education (Khiat, 2010; Simmons & Manin, 2017), and travel
and tourism (Everett, 2012; Yang, Khoo-Lattimore, & Arcodia, 2018; Zhang,
Tucker, Morrison, & Wu, 2017). Researchers have often used constructiv-
ist grounded theory with situational analysis (Clarke, 2005; Clarke, Friese, &
Washburn, 2015, 2018). More researchers arc combining constructivist
grounded theory with Juliet Corbin and Anselm Strauss's (2008, 2015) later
approach, and a few complement it with dimensional analysis (Bowers, this
volume; Schatzman, 1991 ).
Constructivist grounded theory has become recognized for advancing
grounded theory,' and it is recognized as a major method of conducting qualita-
tive analysis. This method has increased the transparency of grounded theory
strategics. Hence constructivist grounded theory has clarified differences between
how grounded theorists use these strategics compared with other qualitative
researchers who construct thematic syntheses rather than integrated conceptual
analyses that arc theorized.
This chapter begins with a brief recap of the origins of constructiv-
ist grounded theory and the points of convergence and divergence between
versions of grounded theory. To show how these points of divergence have
contributed to the continuing evolution of constructivist grounded theory,
I highlight methodological developments occurring over the past decade.
This approach expands my earlier argument that Clascr's (1978, 1998, 2013)
notion of preconceptions in grounded theory not only assumes an uncritical
researcher but also overlooks addressing researchers' preconceptions rooted in
their respective worldvicws and social positions. Therefore, I advocate strong
reflexivity (Harding, 1991) to excavate our preconceptions, encourage devel-
oping methodological self-consciousness, and expand our knowledge of our
place in the research and of the research process. I then move on to show
how constructivist grounded theory works in practice. Throughout the chap-
ter I bring in examples and contributions from researchers who have adopted
constructivist grounded theory.
Genesis of Constructivist Grounded Theory 1 SS
Constructivist Grounded Theory and Other Versions

of the Method
The Genesis ofConstructivist Grounded Theory

By the early 1990s I had begun to form a critique of earlier versions of grounded
theory and its place in qualitative inquiry. During the 1980s, social construc-
tionist researchers treated their research participants' views and actions as social
constructions but not their own analyses. I thought their stance was contr:1dic-
tory. Hence I brought the researcher's own subjectivity into purview and chose
the term "constructivist" to distinguish my approach from social constructionist
studies of the day. For me, the researcher's own subjectivity is always socially
and temporally located. By now, qualitative researchers widely accept the notion
that the researcher's subjectivity enters the research process, as mixed-methods
researcher Nollaig Frost (2016) proclaims in her subtitle W11y You're Always Part of
tlu: Rtstard, Process Evm Whtn You ·11,ink You're Not.
My perspective is informed by major constructivist researchers such as Yvonna
Lincoln (Lincoln & Gupta, 2013) but also aligns nicely with contemporary social
constructionist views and studies. In the 1990s, however, critics questioned the
place of grounded theory in qualitative inquiry. Both the narrative and posm1od-
ern turns in social science elicited sweeping criticisms of grounded theory as
embedded in an outdated modernist epistemology and research practice (Conrad,
1990; Ellis, 1995; Richardson, 1993). These critics objected to how grounded
theorists fragmented their participants' stories, assumed the researcher's author-
ity, blurred differences among people, and accepted Enlightenment values about
scientific truth, universal generaliZ3tions, human nature, and progress through
scientific knowledge. Unfortunately, these critics assumed that grounded theory
str:1tcgics were inextricably wedded to their originators' early statements and use
of the method. I disagreed. The str:1tcgics could be loosened from their positivist
moorings and be an1bitiously used with a different epistemology.
The budding articulation of my critique followed publication ofStrauss's Qual-
itativt Methods fa, Soda/ Stientists (1987), Strauss and Corbin's (1990) immensely
popular Basics of Qualitativt Reseatth, and Barney Clascr's (1992) acrimonious
response to it. I found Strauss and Corbin's version of grounded theory to be pre-
scriptive and rule-bound in ways that undermined the flexibility of the method
and its potential for making emergent interpretations of data. The strength of
Strauss's pragmatist heritage vis-a-vis grounded theory remained opaque and
undeveloped. Although I concurred with several of Glascr's main criticisms of
the Basics book, I objected to how he couched them. In addition, the positivism
in Glaser's approach had long troubled me.
Essentially, constructivist grounded theory represents my attempt to reposition
the method on new epistemological grounds, an effort Antony Bryant (2002)
soon joined and Adele E. Clarke (2003, 2005) extended in situational analysis.
156 Kathy Channaz
From the beginning I aimed to preserve the flexible strategics that Glaser and
Strauss (1967; Glaser, 1978) originally delineated while also considering earlier
criticisms of the method and recent developments in qualitative inquiry. I wanted
to wrest key gtounded theory strategics from the positivist elements in both Gla-
scr's and Strauss and Corbin's versions of the method, a concern Bryant (2002,
2003, 2009) shared.
Bryant and I each insisted we could use grounded theory strategics without
embracing mid-20th-ccntury assumptions of an objective external reality, a pas-
sive, neutral observer, and a narrow empiricism (Bryant, 2002; Charn,az, 2000).
If, instead, we start with the assumption that social reality is multiple, proccssual,
and constructed, then we must take a broader view and can treat neither data nor
research procedures as unproblematic. We needed to treat research acts per sc not
as given but as constructed. Similarly, our theories about social life arc constructed
rather than discovered. These constructions occur under specific conditions--
of which we may not be entirely aware and may not be of our choosing.
As you will sec, a fundamental part ofconstructivist gtounded theory concerns
increasing our awareness of the conditions of our rcsca.rch, including what we
bring to it and do with it.
Convergence and Divergence Among Versions of

Grounded Theory
In the decades following publication of 11rt Distov,ry of Gro11nd,d ·11r,ory, some
researchers claimed using the method simply to legitimize conducting inductive
qualitative studies. Their unfounded claims muddied what the method was and
how to use it. As different versions developed, however, key components of the
method have become clearer and researchers increasingly state how they relied
on one (or more) of the major versions originated by Glaser (1978), Corbin
and Strauss (2008, 2015; Strauss, 1987; Strauss & Corbin, 1990, 1998), and me
(Charmaz, 2000, 2006, 2014a).
What arc the key components of grounded theory? Where do points of con-
vergence occur between various versions of the method? How do these ver-
sions differ? To what extent?' We can discern numerous points of convergence
between the major versions.
Grounded theorists begin with inductive data, engage in strategics to foster
rigorous analysis, aim to develop theories that account for the data, and value
gtoundcd theory studies for informing policy and practice (e.g., Lavinghouzc,
Snyder, & Ricker, 2014; Richards & Farrokhnia, 2016; Vann-Ward, Morse, &
Charrnaz, 2017). All variants of grounded theory offer helpful strategics for col-
lecting, managing, and analyzing qualitative data. As grounded theory became
a general method, qualitative researchers have made coding data and writ-
ing memos standard practices in their studies. But often, they stretched these
strategics beyond any recognizable version of gtoundcd theory. Subsequently,
Cenesls of Constructivist Grounded Theory 157
qualitative researchers frequently adopt coding 3nd memo-writing for summariz-

ing and synthesizing dati rather than for constructing theories of categories and
processes through using constant comparative analysis.
Thus theory construction-or claims to construct theory--<listinguishes
grounded theory srudies from other rypes of qualit3tivc inquiry. Many grounded
theorists claim to construct theory, but their thin analyses belie their claims. To
3SSCSS whether 3 study used grounded theory methods, I have advocated looking
at the researchers' actions showing points of convergence among the three major
versions. These actions include:
1. Conducting data collection and analysis simultaneously in an iterative process.

2. Analyzing actions and processes rather than themes and strucrures.
3. Using comparative methods.
4. Drawing on data (e.g.• narratives and descriptions) in service of developing
new conceprual categories.
5. Developing inductive categories through systematic data analysis.
6. Defining patterns in the data.
7. Emphasizing theory construction rather than description or application of
current theories.
8. Engaging in theoretical wnpling (seeking more data to ascertiin the proper-
ties and robustness of a theoretical category, not to 3SSUre representation of a
population).
9. Searching for variation in the srudied categories or process.
10. Pursuing developing 3 category (or categories) rather than covering 3 specific
empirical topic.
(Adapttd 011d expandrdjrom Channaz, 2010, p. 11)
Researchers who say they used grounded theory often engage in the first
six actions although may not follow the remainder. Claims of conducting
theorctic31 s3mpling arc increasingly more common, although to wh3t extent
the work is theoretic31 or merely iterative may be deb3table. My position
is and has been flexible: use grounded theory str3tcgies to fit your research
objectives, but just be clear on which srrategies you arc using and to what
extent you use them.
Perhaps the most telling points of convergence and divcrgencc--tum on
whether and to what extent grounded theorists draw on the positivist or pragma-
tist epistemological foundations of the method.• In brief, positivism emphasizes
mid-20th-cenrury conceptions of"tht scientific method." It 3SSUmes an unbiased
observer can discover abstract generalizations about an external world to explain
empirical "facts" separate from this observer. In contrast, pragmatism 3SSUmcs the
observer views a fluid reality through values shaped by language and multiple
perspectives emerging from people's actions to solve problems in their worlds
(Charrnaz, 2006; Mead, 1934). Although both positivists and pragmatists sec
158 Kathy Charmaz
truth as conditional 3nd subject to revision, they h3vc different st:lrting points,
modes of thought, 3nd emphases in research practice (sec Figure 8.1).
When we look 31 the epistemological underpinnings of objcctivist 3Jld
constructivist grounded theory, the fit between pragmatism 3Jld constructivist
grounded theory is striking.
What arc the points of divergence? Juxtaposing Glascr's objcctivist grounded
theory with my constructivist version clarifies the points of divergence (sec
Figure 8.2).
Positivist f>rw11atist
Assumes //i, scientific method T:akcs a problcm..«>lving approach

Prcsuppcms .,, cxtem:al rc::ality Views reality a> fluid, >omewhat
indctcml.inatc
Assumes 2n unbwcd ob>crvcr As,umcs a >ituatcd and embodied
knowledge producer
Assumes discovery of abotnct gencralitic, As>umcs ,ca.rch for multiple pcrspcctiv,.
Aim, 10 explain empirical phenomena Ainu to $tudy people", actions to ~lvc
emergent problems
View, fucts and value, a, ,cparablc Sees facts and values a.s c~constirutivc
Vic~ truth as conditional Views truth » conditional
FIGURE 8.1 Epistemological Underpinnings of Grounded Theory
Clase- Cluim=:
Obj«tivist Crowulcd "/1i,ory (A,,stfll(fivist Cro11ndcd 1n<ory
Sha= key pooitivin a»umption>. Builds on pragmatist assumptions.

AswnlC3 preconceptions arise from Calls for critic:al stance toward earlier
exposure to earlier theories and theories and literatures.
litcl':ilturcs. Aslc.s ~archcn to excavate and
Omits addrc,,ing the =-c:hcr's taken- grapple with their taken-for-granted
for-grantcd preconceptions and pnx:onccptions emanating from their
worldvicw. position:ality and worldvicw.
~ 1nc, a neutral observer who studies Assumes mcarchcr', subjectivity affects the
an external world. rc,carch process.
Add=.. preconceiving r=arch Recognizes the researcher's participation
through narrow topics., interview in co-coruaucting the cha with
guides, and questions; now rejects participants; advocates training in
earlier focus on ~ic processes as interviewing.
preconceiving the research. Aims to study mcaninsz,. actions, and
Aims 10 s111dy how people n:solve a procc$$CS.
problem in their lives.
FIGURE 8.2 Divergences Bctwocn B3mcy Clascr's Objcctivist Groundocl Theory and
K:lthy Channaz's Constructivist Grounded Theory
Genesis of Constructivist Grounded Theory 159
C/as,r Chamuzz
Obj«rivist Crou,ukd 'f1i,ory ConstNttivist Crrmnd,d TIIMry
Treat5 rcRcxivity as optional or a Emplwiz.cs rcftcxivity throughout the
hindrance to emergent analysis. re=rch process.
Sees grounded theory as an inductive Sec, grounded theory as an inductivc-
method. abductivc method.
Oppo,a adding application procedure,; CTcates mcthodologic;al Mr.ttcgies to answer
cmphas:i:zcs emergence. emergent questions.
Punucs 1)21'Simonious theoretical Ainu to offer al»tract undentanding, that
generalizations that are al»tract of arc attuned to difference and variation.
time, place, and individuals. Locates theories (and research process)
Quest for gcncralmtion erases difference. in the historical, social, cultural,
Ainu for sul»tantive and fonnal and situational conditions of their
explanatory middle-range theories. production.
T real> grounded theory as a general Contencb that the method i1SC1f rcftects the
method independent of epi.tcmolol!Y historic.al, social, sitw.tional, cultural, and
and the conditions of its cons.ttuction. ideological conditions of the early 1%0s
in the U.S.
Defends small sample size. Considers rc,can;h objective, and
credibility of the analy;is as affecting
sample type and size.
FIGURE 8.2 (Continued)
This comparison of divergences delineates sharp contrasts. We C3Jl ttcat these

points of divergence as the polar ends of a continuum. Corbin and Strauss (2008,
2015) lie between these two poles but, in my view, the recent editions of their
book come much closer to the constructivist version than to Glascr's objectiv-
ist approach. Other decided proponents of either version may not follow a.II the
originator's pronouncements and preferences. For example, a few grounded
theorists who follow Glaser state that they conduct a literature review before
beginning their research. Some grounded theorists who adhere to constructivist
grounded theory code for topics (sec examples in Bryant, 2017).
Epistemological differences between versions of grounded theory can become
discernible in the kinds ofdata we collect, how we render them and how we posi-
tion ourselves in relation to them, as I outline in the next section.
Methodological Developments in Constructivist

Grounded Theory
Questioning Preconceptions and Developing

Methodological Self-Consciousness
Major differences between grounded theorists and other qualitative researchers
have long revolved around the issue of preconceptions. When Glaser and Sttauss
160 Kathy Charmaz
(1967) nude their original statement, they aimed to wrench sociologists away
from relying on preestablished theories. To develop fresh "nliddle-range"' theo-
ries, they implored researchers to exanline their data without using either extant
theories or research findings, a position Glaser still advocates. Glaser and Strauss's
position assumed that these resources would permeate researchers' thinking and
curtail their possibilities for creating new theories.• Strauss saw such assertions as
rhetorical statements challenging disciplinary practices. Today, nuny grounded
theorists, like Rodrigo Ramalho, Peter Adams, Peter Huggard, and Karen Hoare
(2015), reject Glascr's position. They sec the usefulness of familiarity with the
theories and research beyond completing a requirement for conducting doctoral
research or applying for funding.
Constructivist grounded theorists oppose Glaser's view of preconceptions.
Instead, we endorse Karen Henwood and Nick Pidgeon's (2003) stance of
theoretical agnosticism. Subsequently, we bring doubt and a critical eye to our
appraisals of earlier theories and research literatures. Robert Thornberg (2012)
and Ciar.in Dunne (2011) separately and together (Thornberg & Dunne, 2019)
make strong arguments for reviewing the literature with a critical, analytical cye.7
Glaser's (2013) recent statement reaffim1s his insistence on delaying the literature
review to avoid preconceiving the analysis. Unfortunotely, grounded theorists
who take this tock often publish their papers with scant ottention to the literature
at all, much less using it for comp3l'3tive and onalytic purposes.
Preconceptions ore significant and olfect researchers' analyses. However, Gla-
scr's notion of preconceptions is simultaneously too restrictive and far too limited
(Charrnaz, 2014•, 2014b, 2016). Beyond its impracticality in today's educational
and funding arenas and ossumption of an uncritical, impressionable researcher,
Glaser leaves out two fundamental oreas: (1) subjecting the method itself to rigor-
ous analysis of its mid-century North American assumptions (Charrna:t, 2014b)
ond (2) addressing those preconceptions embedded in the researcher's own posi-
tionality' and in the situation of the research (Clorke, 2005; Clarke et al., 2015,
2018), which I address here. These concerns outweigh a single focus on potential
contamination from prior literatures.
Standpoints shape our worldviews and beliefs Mannheim (1936). Consistent
with Adele E. Clarke et al. (2018) as well as standpoint feminist theorists (Hara-
w.rt, 1991; Harding, 1991), I orguc that addressing positionality is crucial. To do
so, we not only must excavate the preconceptions inherent in our worldvicws but
must exanlinc our taken-for-granted privileges embedded in our various posi-
tions. Wealth, status, race, gender, age, and professional and other affiliations can
shape our views of our research participants, their worlds, and our rcprcscntotions
of them.
If researchers do not d issect the implications of their own positions and privi-
leges, how can they claim to be without preconceptions? Antony Bryant (2017)
raises a dissenting question. He asks, how can researchers explicate their precon-
ceptions when they ore, after all, preconceptions? We do, however, have some
Genesis of ConsllllcUvlst Grounded Theory 16 1
tools. First, I advocate grappling with our preconceptions through engaging in

"strong reflexivity" (Harding, 1991) about our positions and purposes. For Hard-
ing, strong reflexivity requires us to adopt our participants' standpoint and to
look at ourselves, our research projects, and how we conduct them. She also asks
us to stand behind our participants and to look over their shoulders at the social
and cultural content of our rcscarch. Strong reflexivity involves a depth of self-
scrutiny unfumiliar to many researchers.
Second, through engaging in strong reflexivity we can develop "methodologi-
cal self-consciousness" (Charrnaz, 2016), which involves cxantining who we arc
and what we do in our research practice as we proceed with our studies. Meth-
odological self-consciousness also underscores becoming aware of our unearned
and taken-for-granted privileges. Through engaging in such scrutiny, we may sec
intersecting relationships between power, identity, and marginality that otherwise
may remain invisible. This approach helps us to understand the situations of peo-
ple we study, particularly when our research participants arc disadvantaged. Points
of divergence about meanings and actions can become visible and then we can
wrestle with them. Heretofore unrealized points of convergence and connection
may also become tangible. Denise L. Levy (2013) saw herself as an ally but dif-
ferent from the lesbian, f!JJY, bisexual, transgcndcr, trans, queer (LGBTQ) people
she studied. Her definition became more nuanced as she engaged in research. She
writes, "As my knowledge grew, so did my understanding of my own positional-
ity as researcher. I realized that I was not solely an outsider, and had many experi-
ences in common with LGBTQ individuals" (pp. 202-203) .
A deep sense of connection with research participants may remain invisible on
the surface but igrtilc the researcher's passions and pursuits. Sujanc Kandasan1y
and colleagues (2017) aimed to create knowledge for in1proving the health of
Canadian Indigenous people throughout their lives that honored Indigenous ways
of knowing as well as conventional medical infom1ation. The researchers built on
studies that demonstrated receiving good care before and after birth had lifelong
positive effects. They decided to study perinatal health beliefs of cider Indig-
enous women in recognition of their special role in preserving and imparting
cultural traditions. Kandasamy et al. combined constructivist grounded theory
with Indigenous knowledge in a collaborative study with members of Canadian
Indigenous communities. They contend that "adopting a pluralistic Indigenous
worldview" (p. 2) is a decolonizing act because it respects and includes the multi-
ple fom1s of knowledge of Indigenous peoples. In the authors' article explaining
their methodological position, Sujane Kandasamy discloses:
My Position Throughout This Research Journey

(Compiled August 2015)
I am a non-Indigenous minority woman of color who was raised in
Ontario, Canada, in a four- person nuclear family. Although I grew up in
162 Kathy Channaz
the security of a free country, my ancestral roots intertwine in politically

unstable soil where Indigenous peoples faced a string of broken promises.
I am no stranger to understanding what it feels like to have ancestral lands
destroyed by the arrows of a historically patriarchal government. Nor am
I stranger to the feeling of familial loss and grief.
At the age of 21, I lost my younger sister in a tragic accident, leaving my
family tom with emotion. This life-changing hurdle left everything I knew
in a state of anguish and I saw my parents face the unbearable punishment
of having a child taken away from them far too soon. I hope that sharing
this story helps to illustr.1te that this project's roots run deeper than the vein
of its written existence. It also runs through the person who conducted
the heartfelt interviews, 1r.1nscribed each word, and shared the knowledge
through the lens of a unique life perspective-a perspective that empathizes
with the challenges that Indigenous peoples have faced and of course, the
resilience that an individual (and collective) spirit can show.
{Kandasamy tl al., 2017, p. 9)
K.indasamy's reflection reveals her threads of connection to her Indigenous col-

laborators and participants.
Developing methodological self-consciousness also helps researchers who have
been or are members of the studied group. Australian researchers Roxanne Bain-
bridge et al. (2013} integrate the ethics of care and responsibility embedded in
Aboriginal research methodologies with constructivist grounded theory in their
studies of Aboriginal social processes (p. 275). Roxanne Bainbridge writes:
I used auto ethnographic methods to sensitize myself to concepts and further

facilitate my understanding and stimulate reflexivity. This method provided
the option of drawing directly from an inner dialogue-my knowledge as
an Aboriginal woman.
Intuitive understandings of the research phenomenon were brought to
the surface through writing my story. This method illuminated the phe-
nomenon under study as I became a more intimate part of the emerging
research process and more connected to the participants. I was engaged in
varying kinds of relationships with all participants. An autoethnographic
approach helped me both participate more in the lifoworld of the partici-
pants and bring the participants closer to my theorizing (Bainbridge, 2007).
(BainbridJ!t tt al., 2013, p. 281)
Keeping a methodological journal helps researchers to examine their actions and

heightens their awareness of their position in relation to their research.
Richard McGrath (in Charmaz, 2014a, p. 156) kept a methodological jour-
nal to assess how, when, and to what extent his earlier jobs in local Austr.llian
government affected his current research on it. Elaine Keane (2015) developed
Genesis of Constructivist Grounded Theory t 63
mcthodologic:tl self-consciousness through writing reflections about her study of

widening education.al participation among disadvantaged Irish undergraduates.
She said:
It was with genuine surprise that I began to sec the similarity between some
of what I've found in this study and my own personal experiences as an
undergraduate. I have realized the provenance of my interest in social class,
the student experience, peer relationships and social integntion.
(p. 422)
Developing methodological self-consciousness through wntmg reflexive

memos or keeping a reflexive journal is particularly helpful when studying people
whose lives contrast with the researcher's (Hense & Mcferran, 2016). Contin-
ual reflexivity and openness to participants' words and worlds fosters researchers'
growing awareness of which leads lo foUow.
Third, grappling with the implications of participants' worldvicws and experi-
ences can spark excavating our preconceptions and developing methodological
self-consciousness. Reflexive researchers' preconceptions likely surface when they
share multiple, sustained, in-depth relationships with research participants whose
lives clash with their own. Dorothee H<llscher and Vivienne Grace Boz.alek
(2012) studied what happened when a group of privileged white South Afri-
can church members offered shelter and assistance to impoverished foreign black
refugees. The authors observed how quickly the white church members repro-
duced hegemonic dominance in their relationships with the refugees (p. 1106).
Subsequently, the refugees slipped into victim roles and passively hoped, prayed,
and waited for their promised assistance. Despite church members' intentions to
help, their assistance fell short of refugees' needs and thus again reaffirmed the
refugees' low status and dependency.
Both current structural constraints and prcc,cisting hierarchies of race, class,
and citizenship were played out in interactions and shaped relationships between
the two groups. Holschcr's relationship to the refugees not only derived from her
role as a researcher but also from her respective positions as a church niembcr
and as the social worker for the refugees. These multiple positions enhanced
her awareness of the complicity of researchers and professionals in perpetuating
injustice. Thus Holscher and Boz.alck call for continual reflexivity about how our
positionality can be embedded in structures and relationships of which we had
been unaware (p. 1110).
Even if researchers' neglect examining their positionality, irritated and/or
distrustful participants' startling comments and jarring questions can prod the
researcher to sec what he or she takes for granted. Participants may accuse the
researcher of misleading purposes, dishonesty, and inability to understand their
situations. "Why is someone like you talking with people like us?" "Why do you
want to know that?" "What makes you think you can understand what I've been
164 Kathy Channaz
through?" "How do I know that you won't tell my doctor [or other relevant
authority figure such as mother, supervisor, social worker, probation officer] what
I say?" "Arc you going to rnakc a lot of money off of writing a book on us?" Such
questions can be sparked by participants' perceptions of the researcher's age, race,
social class, and embodiment.
Nagging questions may, however, remain unstated yet pcm1catc participants'
responses. Carla Rice (2009) began her study of overweight and disabled women's
body histories when she was overweight. After she lost weight, her relationships
with her overweight and disabled research participants changed. Rice states:
In my conversations with women marginalized by societal misconceptions

about their bodies, some subtly wondered whether I had the insight needed
to revision conventional accounts and enrich understanding about living
with bodily differences.
(p. 254)
Methodological self-consciousness cuts through nai"ve conceptions and self-

serving justifications of research relationships. Robert Carol (2014) points to
research situations in which interviewing has serious disadvantages. He contends
that acting on naive notions of field work relations is counterproductivc when
studying participants whose lives have been shaped by nco-<olonialism. He states,
"The fieldworker, in questioning the nco-colonial subject, cannot help but echo
colonial subjug:ition, if not for him-/herself, at least for the interviewee" (para.
21). Catherine Vanner (2015, p. 1) raises similar concerns about conducting
educational research in postcolonial worlds. She asks: "Am I doing more ham,
than good? The privilege of my social location means that my efforts to support
education in postcolonial contexts risk being patronizing, insulting, threatening,
imperialist, and recolonizing." Nonetheless, Vanner developed ways to reduce
the divide between the Western researcher and nco-<olonial participants. Her
approach encouraged but did not force their participation and respected local
traditions. And she found the flexibility of constructivist grounded theory sup-
ported this approach.
Rethinking Data With Constructivist Grounded Theory
Defining and Collecting Data

Constructivist grounded theory brings scrutinizing data construction, colle<:-
tion, and presentation into the method (Cham1az, 2014a, 2015). Earlier versions
of grounded theory treated the method as a mode of analysis and g:ive scant
attention to data. Grounded theorists rely on dat:1 and rcify data as driving their
analyses. But what stands as data? For whom? For which purposes? How do we
Genesis of ConstructMst Grounded Theory 16S
construct and collect data? How arc our data embedded in larger social structures
than those immediately apparent?
Increasingly, constructivist grounded theorists make links between their data
about individuals, organiz.itions, and social worlds and the social values and stroc-
tures in which these data arc situated. Hence, constructivist grounded theorists
contribute to assessing how data from small qualitative studies reflect larger dis-
courses and trends. For example, ncolibcralism with its assumptions of individual
responsibility, self-sufficiency, competition, efficiency, valuing of profit, and nar-
row accountability pervades public consciousness, political measures, and health,
educational, and social programs in many countries (Charn1az & Belgrave, 2019).
Sinikka Elliott's (2014) observations of high school sex education classes in low-
income schools reveal how middle-class educators imparted ncoliberal values
about personal responsibility to impoverished students who lacked the resources
to act on these values. She writes:
Sex educators' spoken and unspoken lessons in personal responsibil-

ity put forth a limited version of the good sexual citizen, what I call the
responsible sexual agent, which is based on and reproduces social inequali-
ties. The responsible sexual agent is self-sufficient, self-regulating. and
consequence-bearing.
(p. 213)
Constructivist grounded theory has long been known for emphasizing co-
construction ofdata. What docs that mean? Data arc not simply out there in some
external world waiting to be discerned and collected. Constructivist grounded
theorists recognize that we play a part in what stands as data and actively shape
interpretations of them. Co-constroction reflects our relationships with our
research participants.
Robert Ca rot (2009) suggests the kind of respectful involvement with research
participants that co-construction of data ordinarily assumes. In his study of young
men at an alternative school, he learned that they lived by "the code of the
street" (Anderson, 1999). To ensure their safety, this code demanded they respond
aggressively to insults. Yet Carot found that under certain conditions, these young
men abstained from violent retaliation after an adversary had inflicted profound
loss on them. What kind of relationships did Carot forge to learn about situations
he did not witness? He states:
I refer to my interviewees as consultants, as they informed me on matters

I was unable to observe first-hand. For some, the total rime of interviewing
lasted up to 12 hours .. .. Transcripts were provided to consultants when
possible, checked for accuracy, and used as the basis for further questions.
(p. 67)
166 Kathy Charmaz
Talking Back to Critics of Interviewing

Constructivist grounded theorists have also offered new views of dat:1 collection,
with interviewing being the most not:1blc. Most grounded theorists of all sorts, like
other qualit:1tivc researchers, choose intensive interviewing as their m:lin form of
collecting dat:1. Constructivist grounded theorists have answered the sharp criticisms
of intcrvic,ving posed by ethnographers and discourse analysts (Potter & Hepburn,
2012; Silverman, 2007}. For these critics, interviewing is a.n artificial method that
elicits inaccurnre rcttospeetivc oomtives, contrived performances, and justifiC3-
tions of past behavior. Jonathan Potter a.nd Alexa Hepburn (2012, p. 555) conrend
that inrervicwing is "too easy, too obvious, too little srudiod-a.nd leads to poor
research." Does it? n.at's a.n empirical question, not a.n established truth. Curiously.
the critics of inrervicwing overlook two ofits fundamental disadva.nt:1ges: interview-
ing relies on unearned trust a.nd neglects silences {Charmaz, 2016).
Grnnted, interviewers attempt to be open to their participants' words a.nd
worlds and to build trust. When they gain a participant's trust, the benefits of
interviewing arc evident-and largely unrccognized by the critics. These inter-
views offer opportunities for:
• Connection
• Reflection
• Disclosure
• Intimacy
• Emergence
{Charmaz, 2016, p. 46)
Intensive inrervicws give participants a time a.nd place to reflect, reconstruct their
stories, a.nd realize that their lives matter. Inrerviewing can also prompt us to sec
beyond our privileges, a.nd challenge our assumptions (Channaz & Belgrave, 2019).
Arc intensive interviews strntcgic performances as critics contend? Usually
not. Instead, well-conducted interviews arc em~•t i11teractions a.nd thus may pro-
ceed in unanticipated directions--for both the participant a.nd the researcher.
Interviews may spark epiphanies imparting new underst:1ndings of past experi-
ences and relationships (Conlon, Camey, Timoncn, & Scharf, 2015). Interviews
give us a W3Y to !cam about our participants' lives and to hear their stories from
their perspective. Arc these stories inaccurntc? Perhaps oc=ionally. But from a
grounded theory perspective, what matters a11alytiu,J/y is the theoretical plausibil-
ity of a given story.
Reemphaslzlng Process
Although grounded theory has always been a method for the study of processes
or actions, many grounded theory studies have neither emphasized nor meed the
processes underlying a presented theoretical C3tcgory. Constructivist grounded
Genesis of Const,ucUvlst Grounded Theory 167
theory has fostered renewed interest in studying proccsscs (e.g., Byrne, Orange, &
Ward-Griffin, 2011; Vann-Ward et al., 2017). You wiU sec, in the companion
aniclc on preserving self by people with Parkinson disease, that we present a five-
stage theory of their actions as they dealt with their situations. The research par-
ticipants engaged in (a) making sense of symptoms, (b) defining turning points,
(c) experiencing identity dilemmas, (d) roconnccting to the self, and (c) envision-
ing futures (Vann-Ward et al., 2017). Studying their actions generated a substan-
tive theory of preserving self and recommendations for health professionals.
In another roccnt anicle, Jingru Zhang et al. (2017) offer a proccssual analysis
of Chinese backpackers' identity construction. They primarily relied on data from
panicipant observation and 20 in-depth interviews, which they complemented
with 314 additional respon.ses from qualitative surveys. Their analysis reveals that
identity construction among the backpackers is a fluid, continuous process. They
introduce Xiaobcl, a 22-ycar-old woman as an exemplar of the shifts and changes
they discovered in identity construction. Xiaobcl began with a romanticized view
of backpackers:
At that time, I thought they were awesome! They arc free-spirited and
interesting. They enjoy their life and seek what they like. That is a life
I seek too .. . . I guess I didn't really understand what backpacking was at
first, but I bought a backpack and even a tent... . For me, when I took a
backpack and made it pan of my daily life, I became a backpacker.
Over time, however, Xiaobcl became disenchanted:
In the end, I find that most backpackers arc very boring.... They arc not
the backpackers I'd imagined before, and I don't want to be a member of
them . . .. The reason they backpack is not to enjoy beauty, but to show
off how unique they arc.... How can they seek a sense of status in this
way? For me, the definition of a sense of status has been re-shaped now. . ..
Because I know it is easy to do (backpacking] .... The uniqueness of back-
packers has dissolved. I'd like to adopt other forms of travelling. . .. I was
a backpacker during my deferral year (she deferred her studies for a year],
but after that, I am not any more.
(p. 118)
By tracing processes of becoming a backpacker and then rejecting that identity,

Zhang and colleagues not only create an engaging analysis but also contribute to
the literatures on identity reconstruction and ccotourism.
Coding and Memo-Writing

Constructivist grounded theorists strive to use coding and memo-writing as
ima~native strate~cs to learn about their data (Allen & Davey, 2018; Charrnaz,
168 Kathy Channaz
20143; Chiarello, 2015; Elliott, 2014). Wh3t is a code? In keeping with Anselm
Strnuss's (1959) view of n3ming 3S creating containers to define experience,
codes simuluncously label and cont3in dat3 (sec also Mih3S, 2018). Yet codes
do more. As Susan Leigh Star (2007) points out, codes arc "transitional objects"
(p. 84). Codes simultaneously allow us to know more and to conceptualize
our data in a new w.ry. Hence, constructivist grounded theorists often ukc "in
vivo" codes (terms the participants themselves use) apart to analyzc them in
detail.
I view coding 3S a heuristic device to involve us in scrutinizing data, taking
them ap3rt, analyzing and labcling them (Chamuz, 2014a). During their initial
foray into coding, I have urged researchers to conduct line-by-line coding with
gerunds to preserve actions, when possible. But some of my most useful codes arc
not gerunds, such 3S "voice and self merge" (Chamiaz, 2011), and ''suffering 353
moral st3tus" (Charmaz, 1999).
How do constructivist grounded theorists proceed with coding? Kapriskic
Seide (Belgrave & Seide, 2019) studied life in Haiti during the cholera epidemic
after the 2010 eatthquakc. After conducting interviews in Haitian Creole, she
confronted problems in transl3ting the interviews and coding the data in English.
Haiti3n Creole has no direct equivalent to gerunds. Seide determined the infini-
tive came closest to foster studying actions to proceed with coding in English and
soon discovered her participants' contradictory actions about food contamination.
Although seafood was a major source of contamination, some research partici-
pants ate it as its price plummeted. Seide began with concrete descriptive codes
such 3S "avoiding consumption of seafood" and "eating/consuming seafood."
Seide engaged in line-by-line coding, finding it a useful strategy for understand-
ing the data and developing the analysis:
Coding the interviews line by line using the words of the participants was
a tedious tears-inducing labor, yet indispensable for three major reasons: 1)
it prevented me from intellectualizing the lived experienced of the partici-
pants during the epidemic, 2) it helped me construct very detailed con-
cepts, and 3) it facilitated the ftow of the translation process.
By becoming aware of how tcmporality altered her coding, Seide was able to
make analytic sense of discrepant codes within the same interview. Her focused
codes such as "living in foar,""crcating distance from illncss,"and "seeking solace"
portray her particip3nts' experiences and give her directions for studying processes
and nuking connections between them.
For an example ofwhat initial coding looks like, sec Tcxtbox 1. This was taken
from an interview with a nurse for a study ofstaff who work in a custodiaJ institu-
tion for brain-injured people in the United Kingdom.'
BOX8.1 INITIAL CODING: LINE BY LINE

CODING
Acknowledging multipleExcerpt 1. I: (3) The next question

reasons Is thinking about why, um, patients
Repeating all-inclusive
with brain lnJury might exhibit
euphemism-•challengingw challenglng behavlor and you've,
Delineating reasons-stress- you've kind of talked a bit about
ing magnitude of losses: suffer- that, you know, the processes In the
ing rejection; identifying identitybrain. Is there anything else you
loss, family because of personal• want to add to that?
ity changes, children, home, job P-D: There's so many reasons why a
losing one's life, way of patient might display challenging behav-
being in the world ior. loss of identity, you know, loss, they
Suffering massive loss; hav- suffer huge losses, they might lose their
ing alienated others family because of the change in per-
Misbehaving cloaks loss sonality, families just can't cope with,
Misreading behavior (by staff) you know, this changing person. They
Acting up reflects loss might lose their children, they might
Confronting loss constantly; lose their home, you know, they'll lose
surveying probable pasts um, lose their job. I think, I don't think
Explaining all-encompassing enough emphasis is placed on that fact
loss that these people have lost their life. And
Being aware of devastating basically through that they have perhaps
losses; losing one's prior life experienced a huge range, huge range
Having nothing left of losses and because of their behav-
Comparing self with others; ior they may have alienated people so
Explaining emotional that there is just this massive aspect of
response loss that they all have. And again, again
Understanding the magnify- I don't think that there are people that
ing of small slights; appreciate that, that they are doing it
forgetting to place patient's because they are acting up, or they are
behavior in context; staff bifur- doing it because they want something
cating patient's biography when in effect, you know, they might
Acknowledging lack of life just be constantly thinking about how
Pointing out staff's overlook- much they've lost- I mean um, well you
ing loss know. . . patient, well. . _ patient has
Putting self in patient's lost everything she lost her, you know
situation she had a flat with her, well she was
170 Kathy Channaz
Understanding patient's engaged she had a, you know, a really

frustration with varied causes of good job, fantastic social life. And she's
loss got nothing now, and, you know, quite
Connecting patient's losses rightly so that, she's, you know, on
with current mental health days where she's feeling low and sees
Understanding loss of auton- people going off doing things that she
omy, dignity can't do. Her level of arousal is going
Placing patient's anger in to rise, so if you even say wait a minute
context to her, it's importont to her. And I think
Failing to grasp meanings of that's another thing that people forget
loss it that, although it might seem a petty
Lacking empathy-staff small request or something small that.
People forget that to them (patients)
that's, that's important to them and they
haven't got much of a life, um (.) I do
think that once people have been here a
long time, I think some people do forget
that these patients have lost everything.
And quite frankly I think I'd probably
want to be as awkward as I could if it
meant that I would get somebody to talk
to me. Um, if they can't communicote,
you know quite often they'll lose their
ability to speak, you know, they're going
to get frustrated with that If they've lost
their ability to walk, you know it's just
so many, so mony different aspects that
could, you know, it can impact on their
mental health if they had issues before,
or they might, you know, they might
become depressed (2). It's just so, so,
physical issues, things that theycon'I do.
You know, it's somebody who was quite
proud, you know, quite an independ-
ent person who can't wash themselves,
is going to get pissed off with il Some-
thing that people don't, aren't, don't
get a grasp of through just working with
patients every day. I don't think people
really, Idon't think the empathy is always
there.
Genesis of ConstrucUvlst Grounded Theory 171
Observe th3t many of the codes are quite mundane, yet they preserve a sense of
action and indicate the panicipant's meaning in a specific fragment of data. Cod-
ing with gerunds encourages us to explore and compare meanings and actions in
memo writing.
Memo-writing is a form of analysis in which, in narrative form, you explore
your ideas, hunches, and questions about your data, codes, and comparisons.
Memos give you the opponunity to stop and think about your data more deeply
(Charmaz, 2014a; Thornberg & C harmaz, 2014). Codes prompt such thinking
and memo writing preserves it. Which codes appear to best account for the
data? How do they account for the data? Where do they take you? Which com-
parisons can you make? Wh3t's left out? Memo-writing sparks funher questions
and leads to constructing well-developed categories and specifying relationships
between them.
BOX 8 .2 SAMPLE MEMO EXCERPT
Explalnlng All-Enco mpassing Loss

Explaining all-encompassing loss means making explicit unknown or for-
gotten meanings of the magnitude of patients' loss. Explaining here means
pointing out types of loss patients have experienced, delineating their
extent, and making these losses known and understood. Explaining all-
encompassing loss means taking the patient's perspective and looking at
what is lost Loss resides in the chasm between the life once lived and cur-
rent institutional existence. Participant D points out, "I think, I don't think
enough empha.sis is placed on that fact that these people have kut their life.
And basically through that they have perhaps experienced a huge range,
huge range of losses and because of their behavior they may have alienated
people so that there is just this massive aspect of loss that they all have.•
Thus, loss can result in spiraling consequences. Awareness of losing one's
life, one's way of being in the world causes patients enormous suffering
that they may express through frustration, anger, and aggression, which
leads to being rejected and lunher suffering, and subsequently more acting
up. Misbehaving cloaks loss, and then, staff misread the patient's behavior.
Conditions that exacerbate this process include the nature of the patient's
impairment and its relative visibility, the extent to which it complicates daily
life, and the institutional situation itself. To what extent does being sub-
ject to this situation impart messages that lapses in self-control are routine
events and therefore desensitize patients as well as staff to troublesome
behavior?
172 Kathy Channaz
Explaining all~ ncompassing loss not only asks the listener to envision
losses, but also to envision who a patient was before experiencing brain
impairment. Thus, staff would gain a different image of the patient than that
of the person they encounter in their daily work. Explaining links the past
with the present and accounts for the present. (In contrast to Participant D's
accounting for the present by looking at the past, Participant 8 considers
impairment but concentrates on the present, not the magnitude of loss, nor
the suffering it may cause.) Participant D adopts the role of the teacher who
elucidates for the interviewer why patients act as they do. To what extent
can or does she make her views known and heard? How does she deal with
co-workers who fail to grasp these meanings of loss?
By explaining all~ncompassing loss, Participant D presents herself as
empathetic, insightful, and different- separate?- from co-workers. How
does her empathy alter relationships with patients? How and when do her
insights affect her work with patients?
What, if any, are the implications of setting oneself apart from co-workers
in this setting?
From A. Tweed and K. Channaz, Grounded theory methods for mental health prac-
Ulloners. In D. Harperand A. Thompson (Eds.), Qualltal!ve research methods In men·
ta/ health and psychotherapy, pp. 140-141. Chichester, West Sussex, UK. C> 2012
John WIiey « Sons, Ltd.
In this interview excerpt, I treated "explaining all-encompassing loss" 3S what

W3S h2ppening in the data and defined it as Participant D's main 3ction. Note that
in the memo I compared her stmce with that of Participant B. and 3Skcd questions
31 the end of the memo about the impliC3tions of her st:incc. Further comparisons
would 3dvance the analysis. P:uticip:lllt D's statements suggest that it would be useful
to explicate and categorize all the stalf participants' tacit 3SSUmptions about the fol-
lowing; What concept(s) of"the patient'' do they hold? What st:lllds as "3ppropri3tc
="? To whom? Whose responsibility is it? Which values and 3ctions support their
views? Then the scope of the :lllalysis would be extended if other stakeholders such
as patients' rcbtives, mcdic31 experts, and policy-makers were similarly queried.
What Is Theoretical Sampling and Why Does It Matter?

Although it distinguishes the method from other appro3chcs to d3ta analysis,
theoretical san1pling has been the most misunderstood grounded theory strategy.
Most fundamentally, resC3rchers use theoretical sampling to fill out the properties
of 3n emerging theoretical category. But what is a theoretical category? Defini-
tions v3ry widely. In the past, many grounded theorists have taken descriptive
temu from everyday language as theoretical categories but did not develop an
incisive analysis with them. Nonetheless, when the rcscarcher treats such terms
analytically by taking them apart, plumbing their depths for hidden meanings and
taken-for-granted assumptions, and showing how, why, and with what conse-
quences participants use them, such terms can stand as theoretical categories. Few
researchers did that in the past.
ln.ste•d, grounded theorists often cbimed to produce theoretical categories by
creating neologisms and adding "izing" to words. Neither strategy makes compel-
ling theoretical categories, as Sally Thorne and Phillip Darbyshire {2005) affirm.
Categories that not only speak to everyday life but also hold abstract meaning
work well. When grounded theorists treat them 3Il3lytiC311y, these categories bot/r
cover or subsume and conceptualize many descriptive codes. Examples include
"losing a valued self" (Channaz, 2011), "double-victimizing" {Thornberg et al.
2013), and "genetic suffering" {Halpin, 2018, p. 364).
Recent grounded theory works emphasize using theoretical sampling (Bryant.
2017; Channaz, 2014a; Corbin & Strauss, 2015; Morse & Cbrk, 2019; Nelson,
2017). Theoretical sampling enables the researcher to saturate the properties of the
c:itcgory. As James Nelson (2017) points out, theoretical sampling and saturation
foster adding conceptual depth to the c:itegory and, by extension, to the entire
analysis. Although the primary use of theoretical sampling is for developing theo-
retical categories, it is also 3 useful approach (1) to cstlblish variation in the studied
category or process, (2) to reveal differences among people and procc:sscs, (3) to link
concepts in the emerging theory, and (4) to show theoretical patterns {Morse &
Cbrk, 2019). ' 0
Constructivist grounded theorists (Bryant, 2017; Charn,az, 2014a; Kennedy &
T hornberg, 2018) have clarified how rcscarchers use abductivc logic in theoreti-
cal sampling. As Bryant (2017) declares, abduction is no longer an alien concept.
Abduction involves considering all conceivable theoretical ideas broadly, including
those the rcscarcher may create, to account for 3 puzzling or intriguing finding.
Whether rCSC3rchers invoke a preexisting theory or construct a new one, they return
to the field and put their ideas to test. Subsoquendy, they adopt the most plausible
theoretical interpretation to account for the finding (Bryant. 2017; Charmaz, 2006,
2014a; Kennedy & Thornberg, 2018; Peirce, 1958; Reichert, 2007, 2019).
When tackling how to convey theoretical sampling, I asked Jennifer Lois (sec
Channaz, 21043, pp. 193-197) to write an account of how she used theoretical
sampling in her study of how homeschooling mothers managed having little time.
Lois provides a telling account of using abductive logic in theoretical sampling.
When she beg.in her research, she believed she was doing a study of domestic
bbor. But as she g:,thered data, she found a puzzling finding that remained unan-
chored and did not fit her analysis of domestic labor. A homcschooling mother
of 12 children had told her, "what better thing than to give it [her time] to your
children?" {Lois in Charmaz, 2014a, p. 195). Lois realized this mother's statement
was significant but could not understand why she was willing to sacrifice all of her
time to her children. Lois proceeded to conduct follow-up interviews to explore
this time sacrifice. Her first participant told her, "There wiU be time for me later''
(Lois, 2010, p. 434). Previously Lois had viewed such statements as platitudes but
now understood the necessity of analyzing them.
174 Kathy Charmaz
As 3ll exemphr of using theoretical sampling in constructivist grounded theory,

Lois based her approach on four pivotal points. First, she made her preconceptions
about motherhood explicit and grappled with them. Second, she rcalizoo that she
had to push beyond the category of "time sacrifice" to account for these data.
Mmy grounded theorists would have chosen time sacrifice as their core category,
described its properties, showed how it structured these mothers' time, perhaps
spelling out a few consequenccs--and stopped there. Voili! A finished paper. But
Lois did much more. Third, through examining her preconceptions and her data,
she had an epiphmy. The issue was about the mothers' quality of time, not their
quantity of time as she had presupposed. To deepen her analysis, Lois had to exan1-
inc the mothers' subjtttivc sense of time. To do so, she built on earlier ideas: Michael
Fhherty's (1999) on experiencing time and my (Charnuz, 1991) concept of "time-
framcs." Did using these ideas contlminate her malysis? No! Lois maintained a
critical eye and built on these ideas in creative ways. She continued to code around
"time management," and in each round of coding she took her analysis to a more
abstr.lct level. She next conducted a deeper round ofcoding informed by new ideas
about "temporal emotion work" which led to two important codes: "Sequencing:
Eliciting Nostalgia and Anticipating Regret" and "Savoring: Staying Present and
Creating Quality Time." Cassandra, one oflois's participmts, said:
I'm going to be a little old lady someday, all alone with (my) memories. So
I think about that. I don't yearn for that day. I know it's coming. I rry to
appreciate what we have now, because ... it doesn't hst very long at all, in
the great scheme of things.
{Lois, 2010, p. 427)
Lois further developed her codes on sequencing and savoring md created a sophis-
ticated theoretical analysis forming the argument of her article. She posited the exist-
ence of a subchss ofemotions, "temporal emotions," that can only be felt by crossing
the timeframes of the past, present, and fururc. Thus Lois claimed these temporal
emotions carmot be felt without bridging the present to the past or future. Nost:il-
gia, regret, disillusionment, ambition, hope, optimism, and dread all tic the present
to the past or future. She • n raised the level of analysis by concluding that how
we use temporal emotions significantly alfccts our constructing of a continuous self
over time. Through using theoretical sampling, Lois filled out the properties of her
theoretical category, showed how it subsumes md links earlier codes and categories,
and positions it within larger theoretical perspectives." Using abductive rcasoning in
theoretical sampling makes grounded theory more than solely 3ll inductive method.
The Constructivist Tum to Critical Inquiry and

Social Justice Research
Grounded theory, like much of qualitative rcscarch, has been criticized for con-
centrating on immediate assessments of what is happening in the data while
neither critiquing what is happening nor locating the data in its structural concli-
tions. The combination of strong reflexivity and developing methodological self-
consciousness with situating the data in the structural and situational conditions
of its production places constructivist grounded theory, along with situational
analysis, at the forefront of qualitative methods for conducting critical qualitative
inquiry. The constructivist version is useful because it fosters analytic precision,
locates researchers' generalizations, and specifics variation and di1ference in the
studied phenomenon. Critical inquiry can talce the researcher through levels of
analysis from individuals 10 the collective and from the local 10 the global and
subsequently contribute 10 social justice research (e.g., Charn1az, Thornberg, &
Keane, 2018; Levy, 2016).
Social justice stuclies "attend 10 inequities and equality, barriers and access,
poverty and privilege, individual rights and the collective good, and their impli-
cations for suffering" (Charmaz, 2011 , p. 359). Some researchers aim their studies
toward social justice from the beginning. But for others (e.g., Wasserman & Clair,
2010, 2011), social justice implications arise as they become acquainted with their
participants and analyze their data.
What docs critical inquiry involve? Critical inquiry means excavating hidden
mcanin~ and actions, identifying contraclictions, examining purposes, policies,
and pmctices, and evaluating the means and ends flowing from them. It addresses
fundan1ental questions that clitferentiate individuals and collectivities: (1) Who
bm,jits? (2) How? (3) When? (4) Under which conditions? (5) Who suffers? (6)
Why? Grounded theorists have the tools to answer such questions through empir-
ical study. Taking a critical stance leads us to looking at the structures of our par-
ticipants lives, including how hierarchies and rcsourccs--------0r their absenc~hapc
their worlds (Charmaz, 2005, 2017b). Differential control of inforniation, access
10 power along with material resources all influence intemctions and outcomes.
The philosophical roots of constructivist grounded theory in the pragmatist
tt:ldition give the method a strong foundation for conducting dynamic criti-
cal and social justice stuclies. Constructivist grounded theory builds on pragma-
tist emphases on multiple perspectives, problem-solving, language and meaning,
action and process, tempof:llity, and advancing democracy. O ne dictum for
researchers is Pay allentio11 to la1111uaJ1e. Critical researchers can learn much by
tf:lcing how language and action intertwine. Like Adele E. Clarke (2005; Clarke
et al., 2015, 2018), I also advocate identifying and analy:zing silences. The itera-
tive, comparative stf:ltegics of constructivist grounded theory can aid researchers
in analyzing silences as well as deciphering tacit meanin~ and heretofore taken-
for-grantcd actions. Situational analysis provides more tools for mapping those
silences, revealing their alignments with other aspects of the studied situation, and
can make hidden processes and structural arrangements visible. Invisible aspects of
social structure and process provide grist for critical inquiry.
Taking a critical approach means situating the research in its social contexts.
That can necessitate looking beyond the boundaries of current academic knowl-
edge and/or beyond the borders of one's profession or discipline. A critical
176 Kathy Channaz
approach also leads researchers ro explore the structure of participants' (or organi-
2ations') siruations rather than only addressing what is immediately happening
in the data. It can mean placing the data in historical context. Leslie Dubbin,
Monica McLemore, and Janet K. Shim (2017) realized that the research litera-
rure contained few insights about the experiences of African American men's
understandings and experiences of coronary heart disease (CHO), despite the
disproportionate incidence of CHO in this population. The authors proceeded
to explore African American men's experiences of living with CHO through
using critical symbolic interactionism and constructivist g,-ounded theory in an
interview srudy. They began with open-ended questions and followed up with
new questions and probes to learn about the participants' meanings and siruations.
Dubbin et al. asked about how the men's environments influenced living with
CHO and their relative access to resources within these environments as well as
their understandings of CHO and experiences of stress, medical care. and the
effects of CHO on family, work, and social life (p. 500).
Dubbin et al. construct a nuanced analysis by studying their participants'
meanings and viewing them as agcntic actors while continually examining "the
social shaping of local experiences and actions, and the influence of power rela-
tions on everyday life" (p. 501). Thus these researchers view their participants'
interview accounts as socially constructed but also excavate how power relations
have shaped their statements and lives. The participants' stories were embedded
in the racism they experienced in the past. Dubbin et al. call for revealing "the
links between those local experiences, understandings, actions, and behaviors to
the extra-local pressures that heavily influence them" (p. 499).
A researcher's conceptual analysis may show the contradictions and obstacles
that impede social justice. Patrick Lopez-Aguado (2013) studied the work ofgang
interventionists and the daily contradictions they fuced. As former gang members
themselves, police distrusted the interventionists. Yet the police expected these
workers to give them information about the homeboys on the street, while the
interventionists themselves needed community support to maintain funding for
their work. However, should an interventionist be seen giving police informa-
tion, the homeboys would not only distrust him but also might physically attack
him. In short, the interventionists negotiated a precarious position balancing their
relationships with police and the community with those shared with street youth.
To construct his analysis, Lopez-Aguado used constructivist grounded theory and
moved back and forth between data and analysis. He focused his observations to
develop his key categories while still in the field. Lopez-Aguado (2013) writes:
In examining how the interventionists made use of their past in establish-

ing mentoring relationships with criminalized youth, I identified how the
connections generated by this shared background were &.imed and utilized
as an important theme. Focusing on this theme clarified how the interven-
tionists arc positioned between social spheres, enabling them to use their
Genesis of ConsllllcUvlst Grounded Theory 177
connections to estranged populations to appeal to differing priorities: to

civil leaders the interventionists' connection 10 youth represents something
that can be used to reduce gang membership; to youth it is something
that can help them navigate dangerous conmiunities and a punitive jus-
tice system. This led me to develop strut limi11alily 3S a concept that could
describe this positioning between social worlds, as well as articulate how
the interventionists embody this position through their lived experiences,
and utilize its potential to address community needs.
(p. 192, emphasis added)
lopcz-Aguado's concept of street liminaJity captures the gang interventionists'

contradictory position between the police and homeboys. It aJso suggests the dif-
ficult physical spaces that interventionists must negotiate and share while on the
sttect. They traverse other people's turf. Moreover, this concept can enable both
researchers and community leaders to understand the conditions under which
gang intervention can be effective.
Moving back and forth between data and anaJysis with a critical eye can lead to
unanticipated questions and new participants. In their article on using consttuc-
tivist grounded theory in architecture and urban planning, Natalie Allen and Marie
Davey (2018) discuss how constructivist grounded theory assists researchers in
addressing increasingly larger social units. The authors present Davcy's research on
spatial planning during neoliberal governance reform in Auckland, New Zealand.
They found that constructivist grounded theory led Davey to seek new groups of
participants from whom he gained rich insights. Moreover, he then defined piv-
otal emergent themes about the meanings and purposes of spatial planning to key
stakeholders. By following leads in his data, Davey's expanding analysis became
more critical as it successively took larger sociaJ sttuctures into account.
Davey's study revealed that spatial planning in Auckland meant governmental
reterritorialization to alter state-local relations. Using conslTUctivist grounded
theory fostered moving between levels of data and analysis to link participants'
views with larger organizational structures, political ideologies, and economic
strategics. Allen and Davey (2018) state:
Without following consttuctivist grounded theory methods, it is unclear

whether the researcher would have found the mebthcory driving spatiaJ
planning in the forn1 of ncoliberal statc--marlcet resttucturing. The three-part
coding method allowed the researcher to delve further into the dab to under-
stand these broader processes behind the individual participants' perspectives.
The research produced unique insights into spatial planning and the
governance reform that has occurred in the Auckland region. It has enabled
the uncovering of a range of aspects relating to Auckland's development,
governance, and planning that arc broader than solely the study of spatial
planning alone. These aspects provide the basis for a number of questions to
178 Kathy Charmaz
be raised germane to spatial planning in a New Zealand setting and future

areas for investigation.
(p. 229)
Allen and Davey argue that constructivist grounded theory method enables
revealing more useful analyses about the broader causes of plan implementltion
fuilure than other methods. They also contend that the constructivist grounded
theory research approach provided a platfornt to critique the neoliberal project and
its enabling and restricting fuctors as the participants constructed them (p. 229).
Conclusion
In the first edition of this book, I delineated the epistemological foundations of
constructivist grounded theory and described how they diverged from earlier
versions of grounded theory. In this second edition, I briefly out.lined points of
convergence and listed major divergences. This chapter has turned to addressing
how the tenets of constructivist grounded theory shape research practice.
Constructivist grounded theory is a method that continues to move, to
evolve. Over the past decade, constructivist grounded theorists have advanced the
method and, by extension, the conduct of qualititive inquiry. By acting on piv-
otal emphases of the method, researchers show how it takes them to unforeseen
issues, new perspectives, and nuanced analyses.
Developing methodological consciousness can be a humbling experience as
we recognize how our tiken-for-granted perspectives and positions not only
shape our thinking but. moreover, may align us with power interests we disavow.
Ytt by opening ourselves to scrutiny and making constant reflexivity as much
a pan of our method as constant comparison, things can happen. Like Doro-
thee H<llscher (H<llscher & Boz.alek, 2012) and Catherine Vanner (2015), we
can acknowledge the advantages of our positionality and learn new ways of
acting---and researching-that at least reduce hegemonic dominance, if not
establish egalitarian relationships. Like Kaprisk.ie Seide (Belgrave & Seide, 2019),
we can remain open to what our research panicipants experience as we witness
and hear about their situations. Although we cannot replicate their experience,
we can aim to become close to it and try to understand how it looks and feels
from their position. And that can move us to share our analyses with audiences
beyond the academy.
As we engage in research practice, constructivist grounded theory also helps us
to recognize ambiguous data and unanswered questions. This method encourages
us to push our analyses funher as these ambiguities and unanswered questions
arise. As we do, unforeseen theoretical ideas and directions become apparent.
Paying close attention to language helps. Through treating coding as an active,
emergent strategy, constructivist grounded theorists excavate tacit meanings and
actions and make connections between them. Similarly, issues concerning social
Genesis of ConstructMst Grounded Theory 179
justice can become visible such as hidden and taken-for-granted inequalities,

which take us into critical inquiry. The analyses of discrepant professional logics
(Chiarello, 2015), reproduction of inequality (Elliott, 2014), and the imposition
of neoliberal policies (Allen & Davey, 2018) each exemplify how constructivist
grounded theory can help researchers link stories and statements with larger social
practices and policies. Through attentive coding we can move from micro-level
analyses of interviews to collective levels of both theorizing and critique. Thus
we anchor the studied phenomena in its social locations and origins. Theoretical
sampling of our major categories allows us to gain new views and challenge old
assumptions while acknowledging the ambiguities inherent in qualitative inquiry
and the messiness of the research process.
In short, the roots of constructivist grounded theory have grown and its influ-
ence has spread over the past decade.12 Shifting the ontological and epistemologi-
cal grouncls of grounded theory with the constructivist version has produced a
new generation of grounded theorists who advance qualitative inquiry- ,md,
moreover, knowledge.
Acknowledgments
Vann-Ward for contributing our exemplar paper for which she was the lead author
and researcher. I appreciate having had conversations about grounded theory
over the years with Linda Liska Belgrave, Antony Bryant, Cesar Cisneros-Puebla,
Adele E. Clarke, Sharlene Hesse-Biber, Janice M . Morse, Virginia Olesen, David
Silverman, and Terrie Vann-Ward.
Notes
1. The studie> 1 cite here as using consttuctivist 1!JOW1ded theory and methodological
articles discussing the n1cthod arc illwtraOvc. The number of significant publications
f.ir exceeds what [ can cite in this eh.apter.
2. For example, editors Debmont and Atkinson (2010) hold a skcptical view of numer-
OU$ authon' claims to contribute to groW1dcd theory mdluxfs. Their doubt$ iurfacc
when an author "claims to be advancing the discussion ofGrounded Theory, but fails
to add=s the woric of Charmaz (2006) or Clarlce (2005), or any of the papers on the
topics published in Qua/it41;.., Rr~ard, in the recent past" (p. 140).
3. Glaser and his followers proclaim his version is the "cwsic' statement of the method
and declare that Strau,. contributed little to it> original ,tatcment in 1967. They pre-
sent Gb:scr's changes as evolutions of the method and propose pror:agoni3it:S of other
vcnions have rcmodclcd it :according to the canons of conventional qualitative data
analysis (Glaser & Holton, 2004).
4. For more detailed di,cussion of the epistemological contr.ut between po,itivism and
prag,nati,m, sec my chapter in the first edition of thi, book.
5. Middlc.. range theories refer to theories concerning empirical problems. Robert K.
Merton (1957) coined the tcnn to tum sociologiSb away fiom the grand macroscopic
theoric, of the 1950. to dealing with actual problems. From the interprerive pooition,
Herbert Blumer (1969) attacked the unanchorcd grand theorizing ofthe time. Sec, for
example, his 1954 ,,..y "What", Wrong with Social Thcory?"in his 1969 collection.
180 Kathy Channaz
6 . For a detailed history of the method, sec Clarke (2019).

7. Many of the debates about the literature review in grounded theory address it ,s
though it were a single summary occurring at the beginning ofa project. It's not. As l
(Channaz, 2014a) have $1aled, a literature review you begin ,vith should not the one
you end with. At this point. you need to review the relevant literatures that speak to
your finished analysis. With grounded theory and quali12tive =<arch more genttally,
you annot know in advance where your analysis will take you.
8. The pooitionality of the researcher includes all those pooitions that inlluencc his or her
s12ndpoint,, ,uch ,s woddview, ,ocial cw,, privilege, race, age, health, and rclation-
ship 10 the research participants in the rcscarch proccs,. The researcher', po,itionality
may enter the research process without his or her awareness. Con.strucrivist grounded
theorists aim to avoid the unwitting intrusion of their own W\J'CGognizcd positions and
privilege,.
9. Inge S12nge collected these da12 and lcinclly permitted Alison Tweed and me to an.aly:c
them. This coding excerpt is from Tweed & Charmaz. 2012, pp. 138--140.
10. For an illuminating discussion of san,pling~ including theoretical sampling. sec Morse
and Clark (2019).
II. Sec Chamw: (2014a, pp. 194-197).
12. These developments arc al,o discu,scd by many of the connibutors to the two ver>ions
of the Handbook of Croomd,d '/111ory that Antony Bryant and I edited (sec Bryant &
Charmaz. 2007a, 2007b, 2019).
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9
EXEMPLAR
Preserving Self: Theorizing the Socia l
and Psychological Processes of Living
With Parkinson Disease1
Terrie Vann-Ward, Janice M. Morse,

and Kathy Charmaz
Introduction
Parkinson disease res=ch has primarily focused on drugs, gcnomics, or proce-
dures (T. Li, Ho, & C. Li, 2008). Although the cause(s) remain speculative, much
is known about the pathophysiology (Wichmann, Delong, Guridi, & Obeso,
2011). Additionally. various disciplines have examined the psychosocial experi-
ence of people with Parkinson disease using self-repon or standardized measures
(Abudi, Bar-Tai, & Fish, 1997; Schrag, 2006). In comparison, little is known
about the how people face challenges in living with this progressive degenerative
disease (but sec Pinder, I 988; Nijhof. I 995).
People with Parkinson disease experience a wide range of troubling changes
involving neurological, cognitive. and psychiatric difficulties. The disease is
strongly associated with three major public health problems: falls. depression,
and dementia. The disease subtly and deceptively changes how people function,
interact, and subsequently view themselves. Yet they actively strive to maintain
established roles and identity. The public and healthcare providers' limited knowl-
edge of Parlcinson disease and often stigmatizing attitudes (rickle-Dcgnen &
Doyle Lyons, 2004; Pan, Stutzbach, Reichwein, Lee, & Dahodwala, 2014; Pesco-
colido & Manin, 2015) influences both affected individuals' daily lives and profes-
sional trcannent perspectives.
Health professionals know little about how day-to-day management of Par-
kinson disease occurs, how people handle the devastating changes, and how it
affects the self-concept. The experience of living with Parkinson disease cannot
be understood without adequate knowledge. Appreciating how people face life
challenges provides favorable situations for healthcare providers to learn, offer
guidance, and increase their effectiveness in working with them.
Exemplar 189
Thus this chapter focuses on profound changes that occur over time and,
despite these changes, how people with Parkinson disease re!3in their identity.
The research provided debiled insight into their life experiences as parkinson-
ism progressed. Therefore we aim to identify, examine, explore, and theorize
challenging situations and processes people with Parkinson disease experience as
they endeavor to preserve their prediagnostic selves. We address these questions:
What challenges do people with Parkinson disease fuce in daily life? How do they
maintain self-identity? The knowledge generated from these questions enabled
us to develop a substantive theory, Prtserving selffor people wit/1 Parllinso11 disease.
Preserving self is an emerging concept at a descriptive level of development
Qohnson, 1991; Charmaz, 1994; Doka, 1996; Howard, Balne3vcs, Bottorff, &
Rodney, 2011; lrurita & Williams, 2001; King & Jensen, 1994; Logan & Jenny,
1997; Morse, 1997, 2012, p. 127; Ryvickcr, 2009). In this article, we treat Preserv-
ing self theoretically because it is a way of being that susl:lins self-identity through
everyday activities, attitudes, and interactions. Prtstrvi11g self represents the strug-
gles, transitions, and strategics of people who feel they arc losing the normalcy
of familiar roles and interpersonal relationships. 11 is a social process involving
making new meanings (in this case, for people with P3rkinson disease) and taking
action based on these mC3nings to maintain the fonner self. Common attributes
of this concept 3re striving, assening, protecting, and engaging. Failing 10 Preserve
self may lead to diminishing roles, relationships, self-worth, and ultimately, the
loss of one's prior scl(
Strategics to preserve self may be identified through examining people's behav-
iors and emotions during trying times, such as managing chronic illness. Here,
the concept of !'reserving selfserved as an inductive frame for building interpretive
understanding of actions and attitudes reflecting the process of mainbining self-
identity by people with Parkinson disease. Preserving self consists of the follow-
ing five stages that we discuss next: (1) making sense of symptoms, (2) defining
turning points, (3) experiencing identity dilemmas, (4) reconnecting the self, and
(5) envisioning a future.
Literature Review
Description of Parkinson Disease

Idiopathic Parkinson disC3sc (without known cause) is the most common fom1
of neurodcgenerative parkinsonism,1 consisting of approximately 80% of all cases
(Dickson, 2012), yet it remains less understood than other chronic conditions. It
affects all body systems, although each person uniquely experiences symptoms,
severity, and pacing of the disease. A "mask-like" fuce and voice softening dimin-
ish expressiveness. Swallowing difficulties lead to weight loss, malnutrition, and
increased choking. Slowness and stiffness of movement begin as minor problems,
190 Teme Vann-Ward et al.
but gradually reduced muscular function leads to balance impainnenl, gait dis-
turbances, and subsequent falls. Increasing involuntary resting tremors disrupt
deliberate movement and sleep patterns and elicit strong emotions (Chaudhuri,
Odin, Antonini, & Martinez-Martin, 2011}.
Establishing a diagnosis is frequently difficult: people commonly attrib-
ute symptoms to aging, subsequently delaying healthcare for several years until
symptoms can no longer be conrrolled or concealed. Treatments provide limited
symptom alleviation and do nots.low disease progression. Dopamine-replacement
medications (for example, levodopa/carbidopa} improve mobility and function-
ing only for a short time. Disabling side effects appear and medications eventually
become ineffective (Olanow, Stern, & Sethi, 2009). Further, no confirmatory
laboratory tests or procedures exist Qoutsa, Cardberg, Roytta, & Kaasincn, 2014).
Autopsy remains the definitive diagnostic standard (Hughes, Daniel, Kilford, &
Lees, 1992).
Parkinson disease affects 1 of250 people older than age 40, 1 of 100 people
older than age 65, and 1 of 10 people older than age 80 (Eidclberg & Pourfar,
2007). Survival time after diagnosis has been estimated at 8 to 10 years (Elbaz
et al., 2003). Regardless of the lifespan reports, remaining life is spent in varied
and increasing stages of disability.
The Contributions of Quantitative Research

Diagnosis depends largely on quantitative scales for comparing, generalizing, and
(subsequently) identifying the nature of the parkinsonism. T-..o widely adopted
scales arc the Hoehn and Yahr Disease Staging Scale (HY) (Goelz et al., 2004;
Hoehn & Yahr, 1967) and the Schwab and England Activities of Daily Living
Scale {ADL) (Perlmutter, 2009). The HY uses observation to rank the presence of
motor disability, impairments, and balance. The ADL measures functional abili-
ties such as bathing, dressing, and eating.
These scales can assess stages of disability but offer limited insight, for exam-
ple, on depression. Overwhelming sadness, despair, and rrcmcndous loss con-
rribute 10 personal suffering but arc not measurable on such ranking scales. Even
with the availability of multiple depression scales, more than 40% of people with
Parkinson disease have undetected symptoms of depression (Shulman, Taback,
Rabinstcin, & Weiner, 2002). The depth of human feelings cannot be measured
by numbers. Ranking personal situations and emotions docs not measure a per-
son's depth of feelings or offer a glimpse into their understanding of the experi-
ence (Calasiriski, 20011).
The Contributions of Qualitative Research

We built on Charmaz's {19113, 1990, 1991) analyses of the srruggles and losses of
the chronically ill. Multiple and repeated losses of essential physical, valued social,
Exemplar 191
and psychological functioning potentially results in a loss of self. Charmaz pro-

posed that loss of self occurs on a continuum with varying levels of vulnerability,
sensitivity, and diminished function. It is demonstrated through passivity, lowered
self-worth, and social withdrawal. Although Charmaz's model of chronicity may
be applied to Parkinson disease, from a pragmatic clinical perspective, we need to
delve further into day-to-day experiences.
The literature provides insight into general concerns of long-term conditions
but docs not encompass the simultaneous multiple complexities occurring with
Parkinson disease (Schulman-Green et al., 2012). Qualitative studies provide
descriptions of experiences, consistently highlighting symptom difficulties and
occasionally providing realistic applicability. In addition, a few autobiographies
offer a glimpse ofl.iving with the losses of Parkinson disease (Ronstadt, 2013; Ali,
M . & Ali, H., 2004). While qualitative research has begun describing the parkin-
sonian lifestyle, further questions and deeper concerns arise.
Theoretical Concerns: The Concept of Self

We begin with a working definition of the st!f. derived from symbolic interac-
tionism (Mead, 1934; Blumer, 1969). Thus, we assume people actively construct
their own worldviews as they interact with others. Through these interactions,
individuals' experience, sustain, alter, and may transform their sense ofself. Forn1-
ing a self involves a sense of continuity across time that involves intertwining of
the past and an orientation toward a possible future (Giddens, 1991). The self is a
template of action (Mead, 1934; Blumer, 1969; Charmaz, 1983, 1990; Schwalbe,
1983). People use their self-concept notions as a frame of reference for making
decisions and guiding subsequent behaviors.
Methods
Study Design
Constructivist grounded theory shares tile tlleoretical framework of symbolic inter-
actionism, builds on tile pragmatic perspective, and develops tile constructionist point
of view tllrough interpretative understandings of individuals' subjective experience
(Charrnaz, 1990, 2014). Subsequently, this interactive method adopts a problem-
solving approach. By focusing "on process, patterns, and meaning" of experiences
within contexts of daily lives, roles, and relationships (rwcod & Charmaz, 2012,
p. 134), researchers can view problems from participants'pcrspcctive.
The Setting
This community-based study spanned three Midwestern states. The region con-
tains a diverse mix of cultural, racial, and socioeconomic groups ranging from
the wealthiest in the U.S. to the poorest. Environmental hazards resulted from
epic winter snow and cold (Erbentraut, 2014) and spring floods (Rathbun &
Gottfried, 2014). Usual distances and access to food, medication, and healthcare
posed even greater concern for people during these taxing times.
Recruitment Strategies
Recruitment goals focused on involving people over age 40 with self-reported
Parkinson disease, who might typically be hard to find because of age, mobility
problems, or social isolation. Study flyers were distributed to support groups,
libraries, grocery stores, and professional colleagues. Recruitment inform.a tion
was posted on the Fox Foundation's Trial Finder website (2013) and presentations
were conducted at two support groups. Most participants were identified through
snowball and theoretical san1pling,
Data Collection
Data collection took place from September 2013 through December 2014. Mul-
tiple sources of data included interviews, observations, documents, photographs,
and videos. These data opened opportunities for cng,gemcnt and understanding
the meaning of the participant's world (Blaikic, 2000). Interpretive sufficiency
signaled the completion of data collection.
Demographic and Descriptive Data

Demographic data included age. race, marital status, educational level. living
arrangements, and occupation for each participant. Medications, disease staging,
and ADL c,pabilitics were the descriptive data.
A list of all current mcdie>tions was obtained by examining original contain-
ers, whenever possible. Participants more commonly described how and when
medication was actually used. A medication data tool was adapted from the
National Institute of Neurological Disorders and Stroke Common Data Elements
for notating information (Grinnon et al., 2012).
The Hoehn and Yaltr (HY) (1 %7) parlcinsonian staging criteria (Goetz et al.,
2004) is a 5-point categorical scale describing the clinical presence of motor dis-
ability; it docs not measure function. Higher numbers indicate greater degrees
of impaimtcnt. Lay organi:zations, providers, and people with Parkinson disease
commonly designate the terms early, middle, or late to represent disability stages
(National Parkinson Foundation, 2017). The first author completed the HY
while taking into account other conditions influencing motor function and fol-
lowed the scale instructions to "rate what you sec" (Goetz et al .• 2004).
The ADL is a descriptive 10-item sc,le ranking by estimation an individual's
independence in daily self-care. It docs not measure motor dysfunction. A score
Exemplar 193
of 100% represents complete independence, while a 0% score indicates a vegeta-

tive state (Perlmutter, 2009). The ADL scale was completed through observation
and panicipant self-report.
Qualitative Data
The first author, Terrie Vann-Ward. conducted 62 in-depth interviews; all inter-
views ranged in length from one to over four hours and consisted of 25 initial
face-to-face and 34 follow-up interviews (including one dyadic and 22 phone
interviews, as well as 12 home visits).
Interview pacing followed leads given in each in panicipant's verbal and non-
verbal responses (Chamiaz. 2014, 2015). Several guided questions encouraged
reflection and spontaneous sharing. When people tllked about what they had
been through, strong emotion.s were revealed. Most people cried, some softly,
while others sobbed wrenchingly. Being attentive meant acknowledging feelings.
It also meant pausing the conversation, giving people space to regain composure
(Corbin & Morse, 2003).
Observations
Conducting in-home interviews allowed seeing how panicipants moved about,
completed ADLs, and interacted with f.arnily members. Vann-Ward also attended
two support groups and a dance class. Participants' shared personal photos during
the interviews. Other visual data included personal memorabilia, self-portraits,
researcher photographs, and videos ofparticipants and their environments. Docu-
ments included participant emails, notes, celebrity autobiographies, and popular
movies. These data provided essential understanding about living with Parkinson
disease and the course of illness over lime (Dahlke, Hall, & Phinney, 2015).
Ethics
The institutional review board at the University of Utah approved the study and
consenting procedures. Participant consent was obtained prior to interviews and
for release and publication of photos and videos.
The Partidpants
The S:tnlple comprised 25 (15 M/10 F) volunteers with self-reported Parkinson
disease. Their ages ranged from 40 to 95 years, with most people (19) being in
their sixties and seventies. A variety of backgrounds, occupations, and economic
situations was represented. The sample was predominately Caucasian. Three peo-
ple lived alone and one person resided in an assisted living home. The remaining
21 participants lived with spouses and family. Four of the 25 participants lived
with children under age 18. Another four participants shared homes with adult
children over age 18. Each spouse of three married couples participated (n - 6).
Family members wishing to participate completed the consent fomt.
The disease duration ranged from three months to over 30 years. Disease stag-
ing: stage I (n - 0), stage II (n - 0), stage Ill (n - 14), stage IV (n - 8), and stage
V (n - 3). People had a range of sclf-c:,re abilities: participants in stage Ill com-
pleted ADL activities at an independence level of 60% to 80%, while people in
stage V ranged between independence levels of20% to 30%. L-dopa (also known
as levodopa/carbidopa) was used by 22 of the 25 participants.
Analysis
Audiotapes were transcribed verbatim. Transcripts were read with reference
10 corresponding pictures and videos. During the first phase of analysis, the
researcher sorted data into broad categories and then explored them by compar-
ing incidents to incidents. The second phase of analytic abstraction consisted
of focused coding (Cham1az, 2014) with the groups of initial codes compared,
refined, and synthesized with increasingly abstract labels.
The technique of constant comparison infom1ed the entire analysis by
expanding possibilities for seeing the similarities and dilferenccs between various
data. Theoretical questions arose that suggested missing data needed for build-
ing concepts. Thus theoretical sampling directed reexamining data from a new
perspective or finding additional participants for understanding and refining the
emerging concepts (Charmaz, 2014). Theoretical sampling also guided ongoing
data collection to represent maximal variety of experiences, including negative
cases (Charmaz. 2014; Morse & Richards, 2002). The ability to sec participants'
challenges and strategics gained conceptual clarity through theoretical sampling.
Developing the Theory of Preserving Self

Decontcxtualizing narratives and grouping segments into broader categories
(reflecting experiential phenomena) provided an analytical means of organizing
and explaining the relationships between major concepts. This approach pro-
vides a fran1cwork for observing, understanding, and making clinical predictions
(Cham1az. 1990). It enabled Prts,n,ing self to be adopted as a clinically derived
substantive theory, developed abstractly from the experiential proccsscs of people
with Parkinson disease. This theory may be applied to other disabling conditions.
Results
Preserving Self: An Overview of the Theory

Prtstrving self represents the hurdles people encountered and the various means
used to counteract experiential intensity and its impact while trying to remain
Exemplar 19S
Making sense
of symptoms ~ Fnmg
out
Turning points
Unt,:llls1g
,e,11i11de,s
./
Oilenmasof
identity
._________.~
Sifting &
sof1ing
Reoonnecting
Pel 1ci11g risks the self
&rewards
.~
Envisioning a
future
FIGURE 9.1 PrtservillJI Seif for People With Parkinson Disc=
their pre-illness self. The actions and emotional states of the people with Parkin-
son disease can be "seen" through the theory logic, which explicates intensely
personal experiences.
The theory of PrtstrvinJI st!f comprises five interdependent stages: (1) making
sense of symptoms, (2) defining turning points, (3) experiencing identity dilem-
mas, (4) reconnecting the self, and (5) envisioning a future. Between each stage
arc transitions that serve a theoretical role of integrating the stages (311d thcir parts)
into a unified process. Figure 9.1 illusrratcs the stages and transitions; the follow-
ing paragraphs descriptively explain Pmmri1111 self.
Stage 1: Making Sense of Symptoms

Participants struggled to makes sense of tToubling inconsistent physical and emo-
tional symptoms by noticing, confirming, interpreting, and taking action. These
actions occurred before finding out the diagnosis and continuing through early
impairment.
Notitirrg something is diJfe~nt. Symptomatic changes were often subtle and dif-
ficult for people to notice. Other conditions often complicated these difficulties
and confounded the person's ability to decipher new changes. However, a single
symptom with increasing intensity or the presence of multiple symptoms brought
an awareness of declining health. Family members or friends sometimes noticed
developing changes, bringing their concerns to the person's attention.
Co1,jinning that something is dijftrtnL Participants increasingly questioned and
monitored symptoms as they became more serious. A jolting awareness was
described when one or more symptoms signalcd a "wake-up call," indicating a
startling confirmation ofsomething being very different. One man had been feel-
ing increasingly fatigued for "a lime" but paid little attention 10 the symptoms.
He correlated the intrusive fatigue 10 aging and a cross-country driving trip. Pri-
orities changed one morning. "While playing tennis, a friend told me I looked
like I had Parkinson's. He said my face had no expression, my walk was stiff, and
it looked like I might fall over." The increasing fatigue became "a little bit" more
understandable. The disease became a reality. He wanted to find a solution, went
to his internist promptly, who scheduled an urgent neurology appointment.
1"ttrprtting the symptoms. Participants studied the symptomatic nuances and
recognized developing patterns. Their concerns persisted, frequently for several
years, before they considered their situations serious and needing closer attention .
T hese patterns, however, were typically viewed as normal responses to aging or
increasing computer use. Retrospectively, participants recognized symptoms they
believed were probably pre-Parkinson changes. One such symptom was scrawled
handwriting, which was sufficiently concerning for one man that he finally
sought medical advice: "I said to the doctor, 'You know, I'm having a hard time
writing chccks.'That tipped him off that I might have Parkinson's."
TakillJI adio,1. Participants wondered what caused these physical and emotional
symptoms. Tremors and muscular stiffness were blamed on specific activities such as
excessive exertion or carrying heavy items. They kepi trying "this and that" with a
variety of home remedies and treatments, all without lasting benefit. Muscular dis-
comforts and anxiety were temporarily relieved with exercise. Self-medication prac-
tices involved searching home cupboards for pain relievers or muscle relaxants to
treat aches and stiffness. Those who worked blamed a "bad situation" and felt exas-
per.ited while trying to sort through emotional changes and physical discomforts.
I was getting anxious at work; it was ridiculous. My writing was just hor-
rible. My hips started bothering me. I was having issues with sleep. I got
upset about everything. I had all of these medical problems. I didn't know
why these thin~ were happening. Nothing seemed to help.
Sudden acute changes were easily recognized as more serious. Participants

described traumatic injuries {especially old injuries to the head) as having linger-
ing effects throughout their lives and a possible cause for the present neck, arm,
Exemplar 197
or leg spasms, tremors, and/or pain. For example, one nun purchased a walking
cane when his right leg beg.in to tremor. He had not considered seeing the doc-
tor. Instead, he thought a home accident {involving a television falling on his
head) caused his right leg tremors. Because he had emergency treatment at the
time, he believed that he should "learn to adjust."
Of the 25 participants, 10 {40%) had emergency room visits. Experiencing a
health crisis was a13rn1ing. A sudden onset of tremors or chest tightness brought
concerns about the possibility of seizures or a heart attack. Several participants
wondered if they "would malce it'' through. One older man (late stage) was admit-
ted to the intensive care unit and later diagnosed with congestive heart fulure.
The remaining nine individuals were evaluated, given referrals to neurology or
psychiatry, and sent home.
Participants felt frustrated at the length of time spent seeking but not receiv-
ing help. They wondered if their medical doctors could have done something
earlier or better. Some people suggested their doctors were exasperated and were
described as stalling or even avoiding conversations about a definitive diagnosis.
Doctors were recalled as saying, " It could be Parkinson's, but I'm not qualified,"
or "You might want to think about seeing a neurologist."
Transition: Finding Out

Participants were not surprised to find that something was wrong; after all, most
had been living with physical discomforts for several years. Hearing the diagnosis
of Parkinson disease, however, was unexpected. Findirig 0111 brought a range of
emotions: relief, numbness, or shock. Several participants felt relief and thankful
the diagnosis was not something "more serious." They considered various fom1s
of cancer, multiple sclerosis, and Huntington disease far more critical because of
stereotypical images of continual pain, disfigurement, and dementia.
Everyone had unanswerable questions: "What docs this mean?" "What do
I do? Succumbing to the darkest of despair, participants asked questions of Cod
and of themselves. One woman and her husband spent hours driving through
a snowstorm for a long-awaited meeting with the "best" doctor. '"Finally,' the
doctor told me, 'It is for sure you have Parkinson's.' That was a very big surprise,
a very bad surprise. I didn't believe that it was true. There were questions in my
mind. Why me?" Her loud sobbing interrupted her speaking as she talked about
finding out and the intensity of daily reliving.
Several participants did not know what to think. Some recalled driving around
aimlessly, while others remained sitting in their c,r, finally realizing it was time
to go home. The unexpectedness of the diagnosis cast shadows on the future.
Participants younger than age 60 worried about accomplishing hopes and dreams.
"How will I support myself?" "Am I supposed to move to a nursing home?" Sev-
eral participants of childbearing age wondered if having children was "allowed."
These questions were silently asked, but not answered. Participants older than age
198 Tenfe Vann-Ward et al.
60 usually worried about ways to keep working while rctirees looked at continu-
ing an active lifestyle. One man was retired for nearly 15 yean when finding out
the diagnosis. He spoke about his life plans: "We haven't closed up shop. We're
going to keep doing what we've been doing."
Stage 2: Defining Turning Points

A t11ming poi11t is a life-altering event of enormous significance. The emotional
force of the diagnosis vibrated, instantly changing their identity and the funda-
mental aspects of how participants knew themselves. They encountered demand-
ing 13Sks that taxed their abilities and continu311y tested their character. These
challenging times highlighted the disruption of life.
Fearing the wo,st. Living with constant and unpredictable physic:ll, emotional,
and social changes brought fears of the worst possible scenarios: losing body capa-
bilities, memory, and valued roles. The once spontaneous automatic actions ofthe
body now required concentration and determined effort. Holding onto handrails
became a requirement, serving as a signal of personal frailties and leading to wor-
ries of dependency: "I'm afraid about the Parkinson's advancing because I don't
really want to be taken care of."
Losing trusted physic:ll capabilities brought fears of being immobilized in a
wheelchair. One man spoke haltingly about his worst fears: "Not being able to
move, just being kinda like housebound in a wheelchair, and having to be taken
care of. Not being able to talk or swallow. Choking to death . . . not a good way
to go. Yeah" (deep soft laughter and sighing). It was common for participants to
speak of losing body capabilities, dependency, and death within the same breath.
"My biggest fear is keeping the Parkinson's awz.;, keeping the symptoms away.
You don't really die from Parkinson's. You die out of the secondary effects ... if
you choke to death or aspirate or have a bad infection."
All participants, regardless of the staging severity, expressed concern about
dementia, the most worrisome fear. Every potential sign was monitored for indi-
cations of a memory deterioration. Several people read waiting room brochures:
"Has your memory changed?" This question lingered, triggering a new lifestyle:
wailing for dementia.
Several participants looked for rcscarch articles about dementia but had dif-
ficulty understanding the scientific language and subsequently became more
anxious. When browsing the Internet and reading dementia "horror stories," par-
ticipants feared for their own futures: "The scariest thing is that dementia." One
recently diagnosed man spoke with great sadness; tears filled his eyes: "My great-
est fear is that I lose touch with my loved ones and become a burden. My kids,
my wife, I don't want to lose my connection with them. I don't want to miss out
on that lime." Changing memory abilities resulted in embarrassment and shame:
I'm worried. Sometimes I forgot the names of my nieces. We talk often

on Skype. I am so mad because the kids call and I forget their names. I am
Exemplar 199
emb3mssed to ask my sister. I don't know ifit's like some dementi3 or....
I' m really worried.
'Just in case" str3tegics were intentionally developed for remembering aspects

of themselves and signifiC3nt rel3tionships. F3mily photographs lined the walls.
Pocket-sized albums were placed near a fuvorite chair.
Changing communication styles became 3pp3rent early in the illness and con-
tributed to worries about how to sustain relationships. Everyone reported voice
changes beginning even before the diagnosis; symptom intensity was individually
unique. DccrC3Sing voice strength, increasing monotone qualities, with diminish-
ing speech spontaneity compounded already frustr3ting and difficult interactions.
Spouses were sometimes intolerant while children beC3me impatient. Sever:tl p3r-
ticipants mentioned the difficulties of raising teenagers, compliC3ted unimagina-
bly by a soft, non-projecting voice.
Spouses were most affected by their partner's diminishing facial expressiveness
and responsiveness. Stiffened facial movements lose the capacity to smile, laugh,
or even display glimmers of affection. "She doesn't think I'm fun anymore." "He
wonders if I've lost interest." Participants worried about their abilities to function
emotionally and fulfiU responsibilities as a spouse, a parent, and a friend. The pos-
sibility of failure brought worries about disapproval, alienation, or abandonment.
For instance, one man (mid-stage) could no longer speak above a whisper. He felt
his family lost interest in trying to talk with him and were growing distant. They
encouraged him to consider a larynx tr3nsplant. He reluctantly considered it.'
&tkillJI knowftd}lt of a nnv cirtmnsta,1a. Most participants lacked information
about the disease course or impending challenges. Important activities entailed
learning about the disease, the role of mediC3tions, and making decisions about
whom to tell about the diagnosis.
Craspi11J1 tlit situation. To grasp the situation suggests that people have cognitive
and emotional strengths to grapple with issues involving chronic illness living.
Most participants were passively compliant, taking prescribed medications and
recommended therapies. They were not yet ready to consider themselves as per-
manently parkinsonian.
Genef3lly, participants received information when they were diagnosed; how-
ever, it w:is usually "hard to understand." One recently diagnosed man described
the information received from his doctor, "He said he would start me on this
patch. But, he gave no insight. I had no idea whatsoever as to what to expect." Par-
ticipants were not given the information they needed for day-to-day living. "I've
brought up some issues and the doctor has been helpful on some things. He's a nice
guy, but still, he's more clinical." Many chose not to discuss relationships, lifestyle
problerns, or work-related disabilities with the doctor. Instead, they turned to the
Internet for answers, which bcC3me their primary infornution source.
Everyone knew about the presence of support groups from brochures or the
Internet. Participants had vast ranging and emotionally intense opinions; misun-
derstandings were common. Scver:tl participants attended and spoke of feeling
encour:iged by meeting people with the same illness. Others described 311Xicty.
One woman ominously predicted how her mood might be affected by attend-
ing: "I've been avoiding those groups because I'm a&.iid I'm going to hear things
I don't want 10 hear. I feel like I'm going 10 sec people that arc in a worse stale,
and I don't want 10 be depressed."
Co11sidmnx mtdid11,. Participants consistently described surprise at the imme-
diacy of treatment decisions required at the first appoinrment. Mostly, people
accepted the doctor's recommendations, attributing their passivity to feelings of
shock and being overwhelmed. Participants who began taking L-dopa expressed
amazement at how much better they felt.
Participants did not always fill recommended medication prescriptions. Some
people postponed using medication; several hoped 10 participate in clin.ical trials
requiring de novo status. Other participants expressed reluctance to take dopa-
mine replacement medication due 10 evenrualities of the writhing involuntary
movements of dyskinesia (a pem1anent and disabling side effect). Still, other peo-
ple believed that taking L-<lopa would be a sign of personal failure. One middle-
aged woman (mid-stage) waited years before considering L-<lopa, even with her
inability 10 rise from a chair.
DisclosinJl. Participants quickly realized the limited knowledge of other people
regarding Parkinson disease. Sharing personal infomution with work colleagues
posed difficulties, especially for people who planned on continuing employment.
Keeping secrets and keeping private was a tactic used to reduce potentially hurt-
ful siruations. One man told his human resources manager (with the intention of
protecting his "rights") and requested 1r:1nsfcr 10 a "desk job." He believed work-
ing alone would limit staring colleagues and reduce intrusive questions.
Occasionally participants received little support after telling their families.
Some family members avoided hearing about the illness or the person's experi-
ence. Family responses were described: "He (husband) really doesn't want 10 have
much to do with it." uHc has never asked me what it's like." "She said, "I don't
want 10 know and I'll never ask." Several participants were told, "Never mention
that again." Worries over family reactions prompted many people not to speak
about their situation. One woman (mid-stage) described her decision in not tell-
ing her father (both were older adults). "My dad doesn't know that I have Parkin-
son's disease. I just as soon keep it that way. I think that he would get upset. So,
I hope he passes away before I have lo say...."
Transition: Unsettling Reminders

Participants tried to do for themselves, but sometimes, old familiar ways no
longer worked. For example, a person's mouth could not easily form words or
tremors meant holding a martini with two hands. Knowing that other people
saw these changes was embarrassing (Nijhof. 1995). Feelings of interpersonal
inadequacy and increasingly obvious physical limitations jolted awareness that life
Exemplar 201
had changed. Self-defining ch:iracteristics were no longer clear. Participants had

perpetual reminders that they were no longer the same.
Communicating the meaning of unsettling reminders was difficult. Most every
participant, male or female, cried and sobbed heavily. Some people rubbed their
f.ices, others held their heads in their hands, eyes brimmed with wemess, or hands
were grasped and wringing. Emotional expressions were intense, causing each
person to question their sanity.
Stage 3: Experiencing Identity Dilemmas

Living in a blur after the diagnosis, people searched for continuity and predict-
ability in the midst of unanticipated changes. Every participant described return-
ing frequently to idt11tity diltmmas; most considered this stage as a prevailing way
oflifo. Dilemmas often occurred several times daily, sometimes lasting for days or
weeks. Relinquishing comfonable and f.imiliar self-attributes while making room
for a new set of identities was unimaginably difficult. Personalizing new infonna-
tion in useful and understandable ways was perplexing.
Desperately /10/dit1J? onto fonntr stlves. Participants were fiercely determined to
be themselves as before. Behaviors continued, without recognizing or taking ill-
ness changes into account. Sensations of numbness, emotional disconnectedness,
and reliving of diagnostic events frequently occurred. Being unable to respond
or function predictably led to frustration, confusion, and questions about one's
capabilities. Each person described overpowering feelings of doubt and disbelief
surrounding the validity of a Parkinson diagnosis. "The neurologist told me there
is no test, no way to diagnose for sure. If I could have a blood test, then I would
know. I still don't want to believe it. It's hard."
·ri,kinx risks. This was a gray area of personal negotiation in which participants
took risks lay between former and new attributes of self. They took compromis-
ing chances as they fiercely tried to determine their self-boundaries by retaining
old, familiar ways. Participants had tremors while working with sharp power
tools. Some described hiking a usual route, but then found themselves unable to
return home because of "getting stuck." Having a recent fall or constant tremors
did not stop people from climbing ladders or wearing high heels.
Driving a car was important for getting to work, purchasing household neces-
sities, and obtaining medical care. Most participants tried to drive less during
heavy tr:itfic or winter weather; however, they did not consider driving with
tremors or possibilities of freezing episodes as risk-taking. One man routinely
drove hundreds of miles weekly for volunteer work. He described his experience
of tremors while driving:
The shaking is always there. It wants to get out but you hold it in as much
as you can. It starts with the arms, goes into the legs, and then the feet.
I'll be driving along and start shaking and say to myself, "Well, this isn't
202 Terrie Vann-Ward et al.
supposed to bc."This isn't fun when you're driving. You take your mcds,
sit there, and then go.
His confidence w:is boosted by having containers of L-dopa medica-
tion within reach on the passenger scat. For each person, choosing risky
situations supported some aspect of former identities, but also pointed to
wenvhe/minJI new limitations. People tried avoiding risks, but since circum-
stances had changed, determining what defined a risk w:is difficult.
-n.e v,1/nerable self. Emotional pain and continuing physical changes g;,ve con-
cerning reason that future circumstances might worsen, thereby perpetuating a
sense of helplessness. Participants tried, but sometimes the "best strategy" con-
tributes to difficulties. Feelings of disconnection may lead to isolation. As a tem-
porary solution, isolation could be helpful but may lead to paralyzing anxiety and
eroding self-worth.
FtelinJI detatl,ed and diSlonnetkd. Participants described feeling disconnected
from their lives. Facing confrontation with changing circumstances was delayed
by increasing activity involvement. They tried but failed to maintain their fomter
busy activities: babysitting grandchildren, travcling, community activism, cultural
events, movies, and exercise. Feelings like "the same old self" were reported after
successfully completing even one familiar routine.
Erodin11 self-worth. Outlooks on life were described with phrases such as "No
future," "Every day is overwhelming." or "Going through this on my own"
Depression w:is not a commonly used word Only one participant reported
depressive feelings while another person reported feelings of "chronic gloomi-
ness," but not depression.
Para/yzin11 anxiety. Intense fears and constant worrying about unknown
impending doom were common. Anxiety becomes paralyzing when ii domi-
nates feelings, thoughts, and actions. For some participants, incapacitating wor-
ries developed when former skills were challenged or decisions were required.
Instances of anxiety producing decisions include morning clothes sclcaion, din-
ner meal planning, or driving alone through snow for necessities.
Suddenly being unable to move (freezing of gait) caused enormous anxiety.
During one of Terrie Vann-Ward's home visits, a woman stood up to obtain
something. She could not tum after rising, her face becoming a sheet of fear.
Swaying from side to side did not help; her lower body just would not move.
When Vann-Ward extended her arm, the woman held onto it with both hands
and was able to walk into the next room. They talked about what happened to
cause the movement inability:
lntfflliewtt: Do you freeze up very often?

Partinpan I: No, I never freeze.
/nl,n,iewer: Tcll me about what happened.
Partinpant: Oh, that. That's nothing. I get stuck like that all the time.
Exemplar 203
She went on to describe not knowing what to do when being stuck. Feeling
afr:lid prevented her from planning her next actions. "What happens if I fall?
What do I do if I have to go to the bathroom?" The term "freezing of gait" was
not used or understood by most participants. Each individual had personal defini-
tions, explanations, and actions for being "stuck" and becoming unstuck.
Faling hurdles. Fomterly mundane tasks became obstacles complicating the
integration of a past and present self, leaving a person without well-rehearsed
defcnsc strategics. Enomtous energy and effort were required to remain self-
reliant, yet dependencies occurred with frightening frequency.
Plrysic4/ depmdmrits. Parkinson disease gradually diminishes ADL capabilities.
Personal hygiene, feeding one's self, or remaining diaper-free were important,
however, how participants treated these concerns changed with increasing dis-
ability and altered personal views. This middle-aged man (mid-s1agc) described
the efforts of getting dressed: "I do everything myself. It 1akes a lot of time and
I fall all the time when putting on my pants. Why can't I remember that I can't
sland up anymorc and put one leg in at a time?"
Regardless of the disease stage, every participant worked diligently at doing
all they could, risking d iscomfort or injury. Even when they could no longer
feed themselves or walk, participants struggled to continue caring for themselves.
One man (stage V). while relying on daily nursing care, described his determined
attempt to independently shower. "It was tough, but I did it. I didn't finish the
shower because I was afraid of falling. I held onto the walls until someone came
to help. It is an insult to my manhood needing someone to clean me."
The fears and realities of physical dependence compounded with conflict-
ing images of past and present identities brought strong emotional responses.
This man (mid-s1agc) exclaimed, "I don't want to give up. I work, exercise.
I don't want to be taken care oC' Although admitting to using folding canes with
seats, relying on or needing assisrivc devices was denied, even while a cane rested
within reach. One person adamantly refused to consider using a mobility aid:
"I would rather crawl on the ground. That is not me.. . . I don't want anyone to
sec me like that because that is not who I am."
Falls concerned participants, before they routinely occurred. Participants with one
or two past fall incidents (HY stage II to early stage 111) were quick to s:iy, "It was just
a stumble" or "I wasn't watching where I was going." They made promises lo them-
selves and f.unily members to stand up straight, use the handrail, and be more careful.
People who reported fulling "over 100 times" or having had numerous breaks and
fractures (HY stages Ill to V) recognized their susceptibility, but they acknowledged
fulling as to be expected with illness and aging. Naturally, no one wants want to fall
down and get hurt, but attention to safety concerns diminished as fulls increased. This
participant (stage V) spoke about nursing aides interfering with his mobility:
What really bothers me is that damn buzzer on the scat cushion. Every time
I move, they (nursing aides) run here and tell me to stop and sit still. This
204 Tente Vann-Ward et al.
is my 3partment; I should be 3ble to get up when I want to. If I full. then

they C3n help by picking me up.
This nun nude self-detennined independence 3 higher priority th•n preventing

3 potential fall. Another particip3nt (stage IV), every Sunday, carried his wife
(stage V) down the front stairs, placed her into the cir, returned to e3rry a whcel-
ch3ir down the stairs, 3nd went out for dinner. He considered himself C3pablc to
complete this routine. This situation predicts 3 fall.
Rtlalionship depn,dencits. Participants expressed worries of being 3oondoned
by spouses or children when the discasc diminished mental •nd physiC31 •bilitics.
Some people felt marrying a dating partner would ensure permanency. It was
relieving that at least the doctor knew •bout their changing abilities, but "need-
ing'' the doctor became an emotional 3chc. It was difficult to forn1 a relationship
with someone who did not share the same need for connectedness.
Emba.rrassing, humili3ting, or demoralizing situations occurred routinely.
Work-related problems related to misunderstandings of Parkinson disease were
reported by all employed participants. Many were asked to resign because of
the observable symptoms. They said, "Here's the deal. I was asked to not
come back to my job by my boss"; "Well, I just couldn't keep up anymorc";
and "They don't know it has to do with memory- but once they find out,
I'm gone:'
Sometimes well-intentioned family members used hurtful words or actions.
For example, one end- of-life bedridden woman's voice filled with great sadness
when she spoke about her grandchildren (under age 6 years) and their responses
to her physical disabilities. "One of the big kids said to the youngest, "Why don't
you go play with Grandma?" and he said, "No, she's broke." With young children,
it is a little easier to understand why some thin~ arc said. However, adult family
members believed (according to participants) discasc symptoms could be over-
come and frequently made disparaging comments. One spouse said:
I think he fades more than he used to. Sometimes it just pisses you off.
That apathy!
I mean he just puts his little butt down in the chair and watches sports
until the end of the creation. Stop it! I work hard to combat that. We try to
be active. Usually I bully him into going out •nd doing something, which
snaps him out of it. We're signed up for a zillion things.
11,e watchful self. Situations of adversity came to be anticipated. During this

time of viRilanct, p•rticipants were learning skills of sclf-observ3tion, trying to
predict situations in which their symptoms would be manifest. and devclopinR
protective at/ions. They became attentive to subtle nuances of expression, sidelong
glances, and even well-meaning efforts of friends. Participants developed personal
phrasing codebooks to use when facial muscles stiffened. speech became garbled,
Exemplar 205
or with an especially soft voice. For cxantple, "I've had a cold" or "It's loud in
here" helped discretely explain innocent symptoms.
Fi11dinJ1. dim:tio11. Participants developed new understandings of Parkinson dis-
ease by paying attention to symptoms and evaluating their responses to situations,
activities, and medic:itions. One man explained, "Parkinson's is not just in one
place. It's everywhere." Fi11dinJ1. dir,ctio11 relied on observations and actions of the
walthfu/ stlf. Exercise became a daily routine. Dietary intake w.is monitored to
avoid interference with medication absorption. Some participants hired a food
delivery service to avoid driving due to unpredictable muscle freezing episodes.
LeaminJI. prac/i(4./iti,s. Participants realized the import:incc of people in their
lives and the value of trying to maintain prior relationship approaches. This usu-
ally involved degrees of silent compliance in order to achieve personal goals.
Household chores were taken over for which they had little previous experience,
such as cooking, cleaning, or managing the finances. One married couple (both
with Parkinson disease) had recently moved closer to their only child and soon
after became full-time babysitters for their two-year-old grandchild. A cherished
experience became difficult. The wife had mid-stage disabilities while the hus-
band was in the most advanced stages. The toddler and grandfather were outside
while the grandmother was grocery shopping. The child ran into the street, the
grandfather could not speak loud, walk fast, or run. He took action by inten-
tionally faUing on top of the toddler. They were both bruised, but otherwise
unharmed. Leaming practicalities did not always involve planning for untoward
events.
In particular, L-dopa was an important means to hide symptoms, gain a
sense of control, and feel "normal." Participants gained firsthand practical
knowledge of how to use the L-dopa by "experimenting" with self-adjusted
doses to improve functioning before activities or interactions. Dosing infor-
mation did not come from the doctor, nor was self-administration discussed:
instead, participants learned through trial and error. Because L-dopa has a
short half-life, the timing of medication wearing off was not predictable. Peo-
ple dC$cribed being away from home when suddenly (without extra L-dopa)
they were unable to move. This became problematic in situations such as bicy-
cling alone for 50 miles, standing in a busy parking lot, or reaching for money
10 pay the grocery clerk. Embarrassment and humiliation were common. Par-
ticipants addrC$Sed such safety issues by vowing to bring along extra medica-
tion and a cell phone. The very presence of a filled medication bottle seemed
to offer comfort. Medication containers were placed in every household room,
the car, and coat pockets. One middle-aged woman (late stage) spoke of her
reliance on L-dopa:
I carry my pills wherever I go. In case something happens to me, I don't

want to be without them: If I get in a traffic accident or get run over or fall
off my bicycle and end up in the emergency room.
Transition: Sifting and Sorting

Sifti11J1 and sortinJI is a time ofself-evaluation: abilities, successes, hopes, and dreams.
People hold on to the most defining and valued characteristics while letting go of
those that arc no longer purposeful or relevant. Grieving for the past self occurred
during this time. People demonstrated sifti11g a11d sorting by putting away former
interests and considering new activities.
Stage 4: Reconnecting the Self

This stage synthesizes the significant and defining characteristics of former and
current identities. People arc evolvi11g ivith th, i//n,ss and. as a result, new identi-
ties form. With this synthesis comes a sense of continuity, as highlighted by this
mid-stage older adult: "I think that knowing that this is a symptom of things that
change in my brain because of the Parkinson's, makes everything less scary." Val-
ues and convictions arc refined.
Fonni11J1 11tw idtnlitin. Resentful, resolute, and rcforntulatcd described pre-
dominant data patterns. These identities reflect development through Pr,strvi11g
st!f processes, subsequently evolving with a person's experience.
R,smtful. Some participants expressed animosity for their lot in life. State-
ments of anger were directed tow:ud neurological research, doctors, employers,
and family members. Exasperation was described with brain research efforts that
stiU had not identified a cause or cure. Doctors were blamed for medication side
effects. Family members were resented for not providing desired levels of atten-
tiveness. while the capabilities of friends and coUcagues were coveted. "Without
Parkinson',. I would still be young. It's very discouraging." Participants expressed
stigmatizing statements at themselves and others: "I'm such a clod," or "That
person looks too good to have Parkinson's."
R,solute. Participants were relentlessly determined and creative in efforts to
maintain their identities and fulfill responsibilities. For instance, one person (stage
IV) worked full-lime and was the primary care partner for his wife (stage V). He
woke daily at 3 a.m. 10 care for his wife and complete daily tasks before 8 a.m.
work. Because the last dose of L--dopa was the evening before, the effects had
worn off, and he was unable to walk or move his legs. Every night, kncepads were
applied. The following morning, after taking a bedside dose of medication, he
slid to the floor and crawled by pushing and pulling his lower body to the kitchen.
After his knees developed blisters, he began using a boogie board to slide down
the hallway. Other people described walking on their knees after the wearing-
off of L-<iopa. Knee walking became routinized for participants in this study.
Refonnulattd.' Participants redefined themselves as accommodating the parkin-
sonian symptoms. Acknowledging losses of past identities was a means of coming
10 terms with their circumstances. Living with Parkinson disease became a reality.
Participants gained increasing sclf-tolcrancc by recognizing differences between
Exemplar 207
the disease 311d themselves. This nun (mid-stage) spoke of his frustrations of
being a gr:mdparcnt: "When my granddaughter insists on watching cartoons on
television 311d I'm going slowly nud. At least I have a dcfcnsc for that. But that's
not really Parkinson's, that's every grandparent (chuckling)."
Disease symptoms were acknowledged 311d preconceptions gradually set aside.
Several participants explained, "I always thought Parldnson's was just about hav-
ing a shake, but it's not," and "It's not just your body, Parldnson's effects your mind
311d your relationships. It's everywhere." Strategics became refined: "I found solu-
tions for most of the devils that harass me; anxiety and claustrophobia."
People devoted efforts in maximizing their abilities. Some participants "knew"
they should exercise or practice voice techniques more often. One older woman
(advanced stages) developed a ritual of taking lettuce leaves with medication to
aid in preventing vision loss. This man explained his approach to life, "If I do
things I can do, that's all I need to worry about. If I get worse, I get worse; if I get
better, I get better. But 1 will do what I C311 do in the mC311time." They exam-
ined and adjusted former interests while developing new interests. Some people
became avid bicyclists; others developed skills in wood sculpting or painting,
while others became community volunteers.
Priorities became reorganized, "coming down with a disease" placed valued
roles and relationships "where they should be." One late-stage woman, with hand
contracturcs, devoted time daily for exercising her index fingers to ensure capa-
bilities for sending emails to distant fumily members. One woffi311 acknowledged
the diminished dexterity of her hands and put away a lifelong hobby ofcrocheting
without remorse. She felt sitting with her husband every night was more reward-
ing. Some relationships were relinquished, significant ones nurtured, while new
relationships were formed providing companionship, offering accept311ce, result-
ing in feelings of closeness. One man (late stage) spoke about feeling close with
his grandchildren, "I feel happy when 1 sec my grandchildren or their pictures,
I look at them and say, 'Cod! They're so beautiful!' Having fumily, that's what
counts in life." Many people attended Parkinson disease dance groups and consist-
ently described renewed energy and motivation. One participant explained the
importance of the dance group: "The highlight of my life now is this dance for
Parkinson•s."
Becoming reformulated is a process and not a milestone of achievement.
Coming to terms with the disease or the illness docs not imply that people accept
their illness; instead, becoming a rtformular,d sdf represents increasing connected-
ness to newly fom1ing identities 311d relationships.
Transition: Balancing Risks and Rewards

During prior stages, a sense of continuity became disrupted; participants could
not sec themselves as previously envisioned before the diagnosis. Plans and dreams
created for their future were reshaped. While si.fti1111 a11d sortin11 was a method of
208 Teme Vann•Ward et al.
reduction, balandt1J1 risks and rttvards is a strategy of comparison. People looked

at their current abilities and circumstances, imagining what life might be like in
the future, while seeking to establish a base of equilibrium. However, participants
frequently miscalculated the extent of their impaim1ents resulting in an overesti-
mation of abilities.
Stage S: Envisioning a Future

The difficulties of envisioning a future were described by a mid-stage man: "With
Parkinson's, today is the best day you will ever be. Today is tomorrow." Diminish-
ing movement abilities causes people to become firmly anchored to the moment
(litcr:tlly and metaphorically}, subsequently changing sensations of continuity; the
past was compressed, the present became expanded, and the future was shortened.
Becoming a connected self and having a place in the world, relics on experienc-
ing time as a continuous flow. Recognizing the inevitable and moving forward
were difficult.
RttOJ1niz i11J1 tht inttJitahlt. Initially, participants did not realize the major impact
Parkinson disease would have in their lives. This man was diagnosed after age 70.
He described what he was told about the course and prognosis: "I remember the
doctor told me it wasn't a dc:ith certificate, I have 20 more years to live. Then,
when I got more into it, they said there were medicines that would help." Hope
for permanent symptom relief or the possibility of a cure was common. Deep
brain stimulation {DBS} was being considered by several advanced stage partici-
pants. One person wanted a third procedure; another was considering it for the
first time, while a third person wanted DBS, but was told by his doctor that he
would probably "become a vegetable." So, hope was given and hope was taken
away.
None of the participants had an understanding of their disease stage or sever-
ity. Most had hc:ird of the HY from the Internet. Driving difficulties, memory
changes, labile moods, and increasing movement problems were not discussed
with families or physicians. Parkinson disease was recognized as having early, mid-
dle, and late stages, but participants did not know what this meant. For instance,
a man (nearing the end of the middle stage} considered himself as being in the
early stages:
I guess I still think I'm in the early stages. Probably because I sec this as
something that's going to last a long time, 20 to 30 years of this stuff: So,
I better be in the early stages now. I'm trapped enough without getting to
that stage. But, I am hopeful that I'm still in the early stages ofit. It would
be nice ifthis was as bad as it gets. But it probably gets worse (deep sighing).
Peer groups (support or dance} provided opportunities to make friends while

observing people who were at different disease severity stages. Some group
Exemplar 209
members (non-study particip3nts) even 3ttended on 3 "reclining wheelchair"

3ccomp3nied by nursing aides. Scve1"31 people described becoming more under-
sttnding of others less fortunate than themselves and developed gtC3tcr self-
tolerance. This older man (late sttge) described the dance group 3tmosphere,
"There's no judgment, it's all very accepting and e:,sy. You go 3nd do wh3t you
C3n. It's liber:iting."
Social comparisons provided firsthand knowledge of the unique debilittting
decline occurring with Parkinson disease; it became C3Sier for p3rticipants to
recognize future disabilities. However, seeing other people did not provide infor-
mation on how to live with the condition on 3 day-to-day basis: organizing medi-
C3tions, m3n3ging incontinence, or determining home s:ifety haZ3rds.
Pla11ninJ? pravtllltitally rvitJr tu11n,I vision. As 3 result, porticipants felt a duty for
monitoring their he:ilth, evaluating ch3nges, and becoming tre3tment proactive
due to belie& that their efforts would mainttin a sense ofself-responsibility, delay
symptoms, and improve their condition. Twenty-two participants (88%) were
responsible for administering their own medications; one of these people was in
the advanced sttges of disease. Three advanced sttge participants (12%) had medi-
C3tion administered by spouses or by nursing personnel. No one felt assisttnce
was necessary. Medication organiZ3tion and stor:ige varied, from bottles tossed
into larger bins to personalized portable containers. People made independent
decisions regarding how and when to ttke prescribed and non-prescribed medi-
C3tions. Because mediC3tion taking is a private event (unmonitored), it must be
acknowledged that most serious problems were not reported to providers.
Common sense and feedback from family members aided particip3nts as they
strived to make daily life simpler. Scvel"31 people moved within the yC3r before
the diagnosis. Other participants moved within three to five ye3rs after jirrdinJ?
out. Smaller homes and being closer to resources were important. All but one
participant remained in the communities where they spent most of their 3dult
lives. For the people who had not yet moved, they were considering factors on
which to guide the moving decision. These factors included not being able to
climb stairs, difficulties caring for their homes, or being closer to mediC31 cu-e.
However, selecting a new home was based on current situations; the ramifiC3tions
of future disabilities were not usually considered. It was the goal of one family to
walk through their neighborhood for services; they selected a home with a gro-
cery store across the street. Unfortunately, a four-lane highw3y made crossing the
street difficult for a person with a stooped posture, shuffling slow gait, and a cane.
Independence was important. Participants imagined they would ttke public
transportation when no longer able to drive, but did not account for walking
disttnces to the bus stop. Taking the elevated train into the city for specialized
medical C3re meant going to 3 st3tion without an elev3tor 3nd walking up two
steep flights of sttirs. One man (stage IV with dyskinesias) walked sidew3ys. fac-
ing the handrails, and would slowly climb one step at 3 time while le3ning for-
ward 3nd hugging the h3ndrail with his upper body. His wife followed behind to
210 Teme Vann-Ward etal.
prevent him from being bumped by rushed commuters. Community services do

not consistently meet the needs of older adults or people with mobility problems.
Several participants reported having space in their homes for a nursing aide, "if
it should come to that." One middle-aged woman (late mid-stage) lived alone in
her "dream home," but realized she was essentially Jiving in the basement because
stair climbing was difficult. She hadn't thought about future possibilities of home
services, but has considered a rental alT3ngcmcnt. Other participants made deci-
sions to move into nursing homes if assistance was required, such as urinary
incontinence. One man adamantly stated, "I will never have my wife clean me
up. That's when I'm signing myself into a home." People hold strong views of
themselves as always being capable and using care services was considered a "last
resort." lnfom1ation about the variety of home services and resources is not easily
accessible.
Advanced directives were completed by fewer than four participants. Expla-
nations were given: "I still have time"; "I thought was that just for heart attacks
or comas." One woman (mid-stage) considered asking her neurologist to serve
as her power of attorney over healthcare, knowing the doctor would make wise
decisions. The woman had limited alternatives; fumily members were a great
distance and she felt unsure of other relationships. However, she was worried that
her request would not be addressed. Participants, generally, did not know or have
information about advanced planning. The people who had this information felt
they needed to self-advocate for ensuring their advanced directive goals.
Movingfonvard. Every participant knew that Parkinson disease was permanent
and had no cure, and that disabilities would increase. It was difficult for them to
imagine what this might mean. Some people felt overwhelmed by the larger-
than-Jifc qualities of the disease. One middle-aged woman (mid-st:ige) described
her world:
You start out with a little bit of symptoms, then you've got more symp-
toms, then they compound on each other. You feel like you're just going to
keep rolling downhill on a slippery slope; and you can't control it. It's kind
of like that (crying loudly, tears arc falling down checks].
Participants described needing to change their views of the illness before

being able to think of a future. "This is not going to take me over. I'm going to
be the boss of my body. I started getting my frame of mind; you arc what you
think you arc_" One participant "put Parldnson's into the passenger scat. I'm
the only one driving this car." However, occasions arose when aches, pains, and
immobility episodes became consuming, leaving a person to lie in bed until the
next day. Hope and optimism were desired traits but required continual efforts,
as this participant pointed out: "I'm really conscious of and working hard at not
being consumed by the illness. It hasn't miraculously opened up my heart to
Exemplar 211
people who I wouldn't have otherwise liked or wanted to have anything to do

with (chuckling)."
Participants strove to be engaged in citily life. Most people became involved
with volunteer activities; they wanted to "give back" to the Parkinson com-
munity. They sta"ed suppo" groups, actively sought to pa"icipate in research,
and offered guiding friendship to recently diagnosed individuals. The advanced-
stage pa"icipant living in an assisted living home attended community meetings,
voiced his opinions, and read Internet material about current trends in Parkinson
treatment or research. Physically assisted by two nursing aides, using a w31ker,
then being placed onto a bench, he continued his long-time love of music by
playing the piano in the home's foyer. Another participant had continued bicy-
cling, feeling a sense of normalcy with little interference from the movement
disabilities. She sta"ed a cycling group for people with Parkinson disease.
Apathy frequently accompanies Parkinson disease. Family members often
mentioned the participant's lack of interest or enthusiasm; this was dishea"ening
when pointed out because relationships were vital. One ma.n (late stage) clarified
his experience of apathy:
Apathy.... It's something that I don't feel, it's not caring. Apathtia is from
Greek origins. It means without passion, without emotion, without feel-
ing. One of the major results of (the illness) is the inability to get up very
much energy and interest in your work. You kind of dismiss your whole
life before the disease. I have enthusiasm, but most ofit is uken up with . . .
my grandchildren.
Every pa"icipant described having feelings (often intense), but their bodily
expressions were not congruent with their emotions. This was frustrating and
often brought feelings of being trapped within their body, followed by sadness
regarding losses of their relational abilities.
Discussion
How participants responded to daily life challenges was clear; routines and evolving
strategics functioned to preserve fivorcd prcdiagnosis identities, roles, and relation-
ships. People faced their challenges based on past roles and identities while functioning
based in the present moment. This stance affected their relationships, daily activities,
decisions, and ultimately the course of their illness. Over time, strategics emerged
by trial and error (regardless of age or disability), based on the immodiate and ever-
changing nature of problems. Responding successfully meant participants endured
hardships and developed creative methods for sustaining continuity and nomulcy.
This theory of PrmrvinJI selfdescribes how people with Paoonson disease cndcavorod
to maintain their identities through everyday activities, attitudes, and interactions.
Preserving Self Strategies

lnteraaing wit/r ot/rer ptoplt. The data highlighted two Prestrvi11g self str.1tcgies for
maint:iining self-identity: (1) interacting and (2) taking action. These processes
3J"C distinct and identifiable yet blend during d:iily life. Interacting represents the
contexts of a person's rcbtionships and roles. Individuals experience, sustain, and
tr.ln.s fomt their sense of self through relationships with others.
The inner striving for normalcy directed participant's feelings, ways of rcbt-
ing with others, and subsequently their actions. Images of one's self as st.mding
tall, strong, and independent reinforced a person's adamant refusal to consider a
mobility device: "That is not me.... I don't want anyone to sec me like that
because that is not who I am." In the case of falling, the man (stage IV) who
carried his wife (stage V) down the stairs every Sunday saw himself as capable.
His wife, adult children, and his employer all reinforced his self-view. Neither of
these individuals wanted to get hurt, but past self-images warranted their actions.
They set aside their present disabilities (bracketed) as though not applicable to
themselves.
TakillJI action. The second Preserving self strategy was taking action. The self
becomes a frame of reference for making decisions and taking action. Insight
regarding a person's template ofaction (self-identity) must take into consideration
relationships with family, community, and hcalthc3J"e that provide the meaningful
basis for how people feel, think, and act.
Participants were determined to retain their former self. However, by con-
tinually facing ider,tity dilemmas (stage 3), feelings of detachment or disconnected-
ness became states of vulnerability for ongoing isolation, depression, anxiety, and
dependencies (physical and emotional). They searched desperately for comforting
and familiar routines, activities, and ways of rcbting. Subsequently, taking risks
became a method of trying to rcestablish former identities.
TakillJI risks. It became evident that participants had a global knowledge of
Parkinson disease but did not consider the illness as part of a new identity, did not
ascribe it as influencing their lifestyles, and did not always connect their actions
with risk-taking. Their self-perceptions remained as before the illness and thus
affected their decisions and actions. Driving with the possibility of a freezing
episode brings a potential for hazardous situations. Self-adjusting ~opa with-
out knowing side effects or consequences poses potential risk. In both of these
examples, participants become susceptible to vulnerabilities (such as depression or
anxiety) when they cannot perform as previously, incur relationship disappoint-
ments, or fail societal standards and expectations.
Palltmi11J1 ofsu«esif,il strallJli,s. Participants who could reconnect and reformu-
late themselves demonstrated using strategics involving bodily movement, cogni-
tion, and emotions. Engagement with important relationships provided respected
and ongoing feedback. Involvement in activities such as bicycling, music, or play-
ing with children required pbnning, coordination, and activated feelings.
Exemplar 213
Generalizability
This research w:is conducted with a unique participant sample; their illness experi-
ences, and hazardous and diverse settings, required researcher skills. Nevertheless,
the theory is gener:tliz.able to those with Parlcinson disease, may be gcner:tliz.ablc
to those who have with a variety of chronic conditions and who have memory
changes, depression, or live in the community with mobility problems.
Strengths and Umitatlons

SfrtnJl,ths. A variety ofdata collection methods were used which built engagement
and commitment with people. Home observations provided glimpses into previ-
ously private worlds and instances of intimacy. Knowing participants took time
but opened up windows of opportunity for depths of perspective. Addition.Uy.
the unique variety of people during different stages of the disease progression
contributed to understanding the experiential processes of this unique chronic
illness.
Grounded theory provided a means to capture the instability of Parkinson dis-
ease and the chronic deteriorating nature of the condition. The inclusion of var-
ied observational data added invaluable richness which contributed to the clinical
utility of the PresttvinJI. st!ftheory.
Limitations. Recruitment strategics of group presentations, distribution of
flyers, and a website posting were simple yet effective methods of locating par-
ticipants. Yet, over 100 potential participants could not give consent due to the
intensive nature of the study design and time constraints. This limitation points
to how little attention has been given to psychosocial issues. When an empathetic
listener offers time, people with Parkinson disease seek the opportunity to share.
Recommendations for Supporting Processes of

Preserving Self
Leaming the diagnosis was shocking but was time-limited and surpassed by con-
flicting im:iges of past and former selves. Every participant experienced great
difficulty reconciling unsettling reminders of former selves preceding identity
dilemmas. People re-experienced these dilemmas (of varying duration and inten-
sity) throughout the illness. However, people who had strong relationships and
became involved w ith specific activities demonstrated forms of reconnecting and
reformulating. This point docs not mean that people accepted the illness; instead,
they accommodated illness in their lives.
Interventions designed for reducing the impact of unsettling reminders and
identity di/e,n,nas would enhance PrtservinJI. st!f and potentially reduce the loss of
self. These recommendations arc for healthcare professionals, families, and people
with the illness.
Devtlop relatio11ships. People seek familiarity and closeness with family mem-
bers, friends, and their health providers. Nurse practitioners could provide conti-
nuity and linkage between specialty and general medical providers.
Ttadi exptcttd a11d rmexp«ltd fttli11gs and bthnviors. Sustaining trusted relation-
ships become the basis for asking questions, communicating concerns, and pro-
viding "bad news," especially surrounding risk-taking behaviors.
Irrvolvetnent with st11so,y ilrlCJ(rating activities. Loss of self essentially means not
being a whole person. Parkinson disease effects every sensory organ and experi-
ence, alters understanding of a person's position in the world due to mobility
and movement symptoms, and fundamentally reshapes relationships. Integrating
emotions, cognitions, and the body through activities such as dance or bicycling
provided benefit to many participants (Alberts, Linder, Penko, Lowe, & Phillips,
2011; Heiberger et al., 2011; Lewis, Annen, Davenport, Hall, & Lovan, 2014;
Snijders, Toni, Ruzicka, & Bloem, 2011). Even though people in the later stages
participated in dance, this may not always be practical. Integrating activities in the
course of daily activities include preparing vegetables for dinner, folding clothes,
humming, or singing.
Conclusion
The lives of people with Parkinson disease portray their desire to assume respon-
sibilities, satisfy oblig.itions, and share fulfilling relationships as they had done in
the past. Meaningful explanations of their situations were sought, relying on fum-
ily, friends, and healthcare providers as they struggled through day-to-day living,
Substantiating these statements is this fuct: over 95% of people with Parkinson
disease remain living at home. Without thoughtful explanations or guidance,
people arc left on their own to devise ways of making sense of dilemmas while
creating new fomlS of identities, relationships, and futures. The clinically derived
theory of Prrmving se!ftills this g.ip in the literature and clinical practice for sup-
porting and encouraging processes of preserving self.
Experiencing Parkinson disease changes how people experience the past, pre-
sent, and future and how they view thentSclves within these timeframes. The past
provides taken-for-granted markers and measures of the person's present actions.
These serve to preserve the familiar self, as known in this past. Thus those with
advanced disease devote concerted efforts to activities and practices used in the
past that they believe will maximize their health and minimize disabilities. When
this strategy f:iils, people then realize that they are no longer the self they were in
the past. Discontinuities between past and present self lead to reevaluating daily
activities and focusing on what they considered "most essential." Ytt. they based
their imagined selves for the future on the present self and subsequently underes-
timated the effects of progressive impairment.
Last, through analyzing the processes constituting preserving self, we theorize
a descriptive construct and thus show how it offers abstract understandings of
Exemplar 215
experiencing Parkinson disease. These understandings c:in en3ble he:ilth profes-

sionals to assess their patients' situations, make predictions, 3nd refine treannent
plans. In this ~ . constructivist grounded theory analyses make valuable contri-
butions to clinic:il practice.
Acknowledgments
Reprinted from Vann-Wan!. T., Morse, J. M., & Channaz, K. (2017). Preserv-
ing self: Theorizing the social and psychological processes of living with Par-
kinson disease. Qualitative Health Restart/,, 27(7). 964-982. Copyright O 2017
(Sage Public:itions). https://doi.org/ l 0.1177/1049732317707494. Reprinted
with permission.
Notes
1. Parlwuon's disease is an cponymic term. These terms have served as a reward for an
individwl's contribution rcg;irdingacondition (Fargcn &. Hoh, 2014). Style guidelines,
such as those from the Council of Science Edito"' (2014a, 2014b, 2014c) or the Ameri-
can Medical Association (Gws, 2007), recommend eliminating the use of possessive
cponyms. Parkinson disease is the correct form. Even with these guidelines, practices
arc incoru:U-t.cnt. Parkinson"s is often used alone, wually when a pllmll or possessive
form grammatically fits a xntcncc.
2. Parkinson disease is one of 5oevcr.d progressive ncurodcgc.ncntivc parkinsonian disor-
den. Thesc disordcn may be difficult to dutingui:lh from non-progressive forms of
parkinsonism (such as drug-induced). Diagnostic accuracy is low for all forms of par-
kinsonism because people without obvious drug- induced or vascular ea~ may cvcn-
ru.ally be determined to have other atypical forms of neurodegmerative parlw,sonism
as the disease progresses. Examples of more seriow fomu ofatypical neurodegcncrativc
parkinsonism indudc multiple systcn'l atrophy, progrcs.sivc supranudcar palsy. or corti-
cobual dcgcncr2tion. Di:ignoois can only be confim,ed with autopsy (Dickson, 2012;
Wenning, Krismer, &. Pocwe, 2011).
3. At the time of data coUection (2013-2014), larynx tnJUpbntation was a novel and
extraordinarily complex procedure. Tv.o larynx trarup4nts have been documented: the
Clevebnd Clinic in 1998 and UC Davis Medical Center in 2010 (UC Davis Health
System, 2014).
4. Mayan, Mo..c, and Elde,.haw (2006) expanded the concept ofself-reformulation 6-om
interviews with people who had faced death but recovered. They con,idercd self-
reformulation :as 2 desired outcome fiom suffering and 2 goal of rdubilit:ation.
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l1talt/1 and psyc/wtlitrapy: A J1.11id,forstudrnts and prattitiollffl (pp. 131-146). Wc:it Su»ex,
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https://doi.org/10.1002/mds.23695
SECTION VI
Situational Analysis
10
FROM GROUNDED THEORY TO
SITUATIONAL ANALYSIS
What 's New? Why? How?
Adele E. Clarke
We arc today in the midst of an exciting renaissance in qualit:itive inquiry not

only in the social sciences but also in the humanities, professions, and beyond.
Within this renaissance, established research methods such as grounded theory,
created by Barney Glaser and Anselm Strauss (1967), arc being rcintcrrogated and
revised.' In fuct, Antony Bryant (2002) used the phrase "regrounding grounded
theory" to describe the array of new approaches in the grounded theory tradition.
Situational analysis (SA} is both an extension and rcgrounding of grounded
theory. In developing situational analysis (Clarke, 2003, 2005), I sought to push
grounded theory fully around what is now called "the interpretive turn." That is,
profound changes took place acr= academia and beyond after 1970, varyingly
labcled as postmodern, poststructural, linguistic, and other "turns." These were
provoked by the theoretical interventions of Michel Foucault, Jacques Dcrrida,
Donna Haraway, Gilles Delcuzc, Felix Cuattari, Susan Leigh Star, Brian Mas-
sumi, and others. As these new theoretical perspectives and understandings of
social life saturated qualitative inquiry in the new millennium, they largely coa-
lesced methodologically under the umbrella concept of "the interpretive turn"
and have reshaped qualitative inquiry. 2
To clarify further, Clifford Ceertz (1973, p. 5) asserted that the fundamental
contrast in approaches to research was between positivism as an "experimental
science in SC:3l'ch of laws" and an '•interpretive science in search of mC3Jling."
Thomas Wilson (1970, p. 701; emphasis added) captured the key distinction
within s«ia/ srien« researth when he wrote, "In the interpretive view of social
interaction, in contrast with the normative paradigm... the mtar,in,Rs efsituations
and (l(tions arr i11terprtlatio,is formulated on particular occasions and ... subject to
reformulation."Thus in the new millennium, the key distinction 111ithin research
per sc began to be grasped more widely acr= the social sciences and humanities
224 Adele E. Clarice
as bthvu,1 nonnativt a11d i11terprttive approa,hes. The initially distinctively Amcri-

c.m tradition of symbolic inter:ictionism had long rested on interpretation as the
fundamcn131 means of human meaning-making (e.g., Blumer, (1969) 1993), thus
always already groundinggrou11ded theory as part of the interpretive tum.
Moreover, and at the core ofsituational analysis, Wilson (1970, p. 706, empha-
sis added) had also argued that "much more careful attention needs to be given to
the way in which a particular i11t,ractio,1 is embedded in larger soda/ co11texts:• Rabinow
and Sullivan (1987, pp. 20-21; emphasis added) further asserted that the inter-
pretive tum was based on "the realization that :ill human inquiry is necessarily
eng:igcd in understanding the human world from withi11 a spttifa situatio11. 71,is situ-
ation is always and at 011cc historical, moral, a11d political" Thus the situatim1-<ontcxt
writ largo-has long held great import in the interpretive tum.
Based upon these theoretical and methodological developments that under-
gird the interpretive turn, I fumed situational analysis as a new approach to
qualitative analysis deriving from both the Straussia11 grou11ded thtory (Strauss,
1987; Strauss & Corbin, 1990, 1998) and constructivistgroundtd theory (Charrnaz,
2000, 2006, 2007, 2008, 2014) approaches, and sharing their roots in prag-
matist philosophy and intcractionist social theory.> But situational analysis also
braids in new theoretical and methodological foundations. First is the work of
Foucault on going beyond the knowing subject in qualitative research (clas-
sically the interviewee) and focusing in addition on discourses as central to
contemporary social life. Second is taking nonhuman entities in the situation
explicitly into account empirically. This move also positions situational analysis
as posthumanist--going beyond the assumption that only humans "really" mat-
ter or 0 mnttcr most0 in a given situation . Dclcuzc and Guattni's concepts of
the rhizome and assemblage arc the third new facets of theoretical grounding,
deepening analysis of relationalities in the situation. I discuss each of these in
greater detail later.
To accomplish its new goals methodologically, situational analysis has a dif-
ferent conceptual infrastructure or guiding metaphor from the action-centcred
"basic social process" focus that undergirds grounded theory. In situational analy-
sis, the basic soda/ processes of Oltio11 arc replaced by focusing instead on tire situatio,1
under study as the key unit of analysis. Situational analysis then uses the relatio11al
atialyses revealed through tht rtstanher maki,ig several ki111Js of analytic maps to under-
sta11d tire dense complexities of a particular situation broadly co11ceivtd.
Specifically, in doing situational analysis, the researcher makes four kinds of
maps to frame and analyze the situation of inquiry:
I. Situational maps specify all the elnnents found in the sit11atio11, human and
non human.
2. Relatio11al maps then analyze relations among all the tlen1mts specified in the situ-
ational map.
Grounded Theory to Situational Analysts 225
3. Soda/ ~rldslarmas maps diagram all the colltctivt actors (social worlds, organi-
zations, instirutions) and their arenas of commitment and action in the
situ3.tion.
4. Positio11al ,naps detail positions taktt1 a11d 1,ot takm in all t/1t major dtbatts in the
discourses found in the situation.
All four maps offer fresh and distinctive analytic pathways into empirical social
science data that attend to its complexities. Like many other recent innovations
in qualitative inquiry, siruational analysis is a hybrid approach. Together, its old
and new theoretical and methodological groundings generate siruational analysis
as a disti11Ctively relational and ecological approach to tmpirically 1111dmta1ulinK social life.•
The data for a siruational analysis research project can be produced through in-
depth interviews and/or ethnographic observations, as is usual in grounded the-
ory. However, siruational analysis also strongly urges focusing on or also including
txt,mt distount materials found in the situation under srudy as data-narrative,
visual, and/or historical materials. These may include all kinds of documents,
websites, imagery, material cultural objects, technological apparatuses, scientific
or other specialized literarurcs, social media, and so forth. In SA, 1vhatev,r disami11t
mattrials txist in the sit11ation of it"111iry art vinvtd as totistituti11t of that situation--int,gral
parts ofit-and therefore worthy of analysis.
Like constructivist grounded theory,' siruational analysis also brings critical
social justice approaches to qualitative inquiry and has deep feminist, antiracist,
decolonizing, and democratizing roots and commitments. In particular, sirua-
tional analysis offers distinctive concepts and maps to help analytically grapple
with power in both its more solid and fluid forms. These critical tools include the
concepts of implicated actors and actants, relational power analytics, and bound-
ary objects. Siruational analysis also encourages collaborative research strategics
that can support more inclusive participatory, decolonizing, and (post)colonial
projects. The final section ofthis chapter details thcsesiruational analysis concepts.
Like social theory, research methods travel, and even as a relatively new method,
siruational analysis has been quite widely taken up internationally and transdis-
ciplinarily. There is a second edition of the primary text, Situational Analysis:
Grounded Theory Afttr tht ltit,rpretivt 'fi1111 (Clarke et al., 2018), with a companion
website rich in resources about the method.• There is also a reader of published
siruational analysis research, Situational Analysis in Practiu: MappinK Rtsearch With
Crotmded '11ieory (Clarke et al., 2015) with a second edition due out in 2021, and
a German translation (Clarke, 2012a), along with German, French, Portuguese
and English language siruational analysis publications. 7 We have also given work-
shops on siruational analysis in many venues. All have broadened the uptake of
siruational analysis.
Significantly, siruational analysis has now been used in a very wide array of
disciplines and spccialtics. These include aging srudics, communications, design,
226 Adele e. Clarke
disaster studies, drug and addiction studies, education, ethnic studies, family ther-
apy, food studies, health and medicine studies, Indigenous and postcolonial stud-
ies, library and information sciences, nursing, occupational science, organi2.1tions
and management, psychology, public health, qualitative methodology and critical
inquiry, science and technology studies, sexuality studies, social work. sociology,
trauma studies, and women's and gender studies. Lists of published situational
analysis research exemplars can be found both on line on the companion website
and in the second edition of Situational Analysis.•
One of the best articles about "how to do" situational analysis research is
included in this volumc-oociologist Jennifer Foskct's {2015) "Situating Knowl-
edge" (see also Foskct, 2004, 2010; Fosket, Kawan, & Lafia, 2000). In fact, read-
ers unfamiliar with situational analysis may well grasp it more fully by reading
Foskct's chapter first as it opens situational analysis up beautifully. Reading an
exemplar from your own discipline or spccialty is also an excellent way to under-
stand situational analysis as an approach and the kinds of analytic work it can help
you do.
Overview of the Chapter

In this chapter, I answer the following questions: In the move from grounded
theory to situational analysis, what is new in situatio11al a11alysis? Why did I think
those things were important? And what kind of a method is situational analysis
anyway? W11at d!ffermt kinds of rvork dots it do from grounded theory? Jennifer Fos-
ket's paper, "Situating Knowledge,'' follows right aficr this chapter. Using her
dissertation research as the exemplar, she walks the reader through doing a situ-
ational analysis project, presenting several maps. In short, this chapter introduces
and explains situational analysis method, and Foskct's chapter demonstrates doing
situational analysis research.
Grounded theory and situational analysis arc both what Susan Leigh Star
(1989) called "theory/methods packages"-thcir methodological and theoretical
premises arc mutually imbricatcd, both of fundamental importance.• That is, for
pragmatists, theories imply methods. They come "prcpackaged" with assumptions
about "how we can know" (epistemology) and "what can be known" (ontology),
and vice versa.•• Epistemology and ontology arc joined at the hip. The very idea
ofa theory/methods packages assumes that "method, then, is not the servant of
theory: method actually grounds theory" Qcnks, 1995, p. 12).
As a "theory-methods package," situational analysis is based on both old and
new methodological considerations as a mode of qualitative inquiry, and I begin by
discussing them. My critique of Strauss and Corbin's {1990, 1998) conditional
matrices ofgrounded theory led me to develop the situational matrix and ultimately
situational analysis maps and method. Thus the shift to focusing on the situation
as the core unit of analysis is new in situational analysis, and I disc= why the
situation is so important.
Grounded Theory to Sltuattonal Analysis 227
I next rum to how I conceived situational analysis thtorttitally. Like Str:1ussian

and constructivist gro11ndtd theory which it extends, siruational analysis's primary
taproots arc in pragmatist philosophy and Chicago intcractionist sociology with
its strong ecological emphases (Star, 1995b). Situational analysis also deeply inte-
grates intcractionist Anselm Str:luss's social worlds/arenas theory. But situational
analysis also braids in newer theoretical foundations noted earlier from Foucault,
Dclcuzc, and Cuanari, and the fundamental import:ince of taking nonhunun
entities in the situation explicitly into account.
Next I describe the four main kinds of nups (noted earlier) that, along with
analytic and other mcmoing, constitute doing the situational analysis method.
Situational analysis also offers import:int new critical tools for analysis. Last,
I discuss them, including analyzing collective actors' power relations, boundary
objects, implicated actors and actants, and strategics for democratizing representa-
tion from the margins. I also describe how situational analysis maps incite broader
research collaboration and panicipation, particularly useful in democratizing,
decolonizing, and (post)colonial research. In conclusion, I return to valuable les-
sons learned from Str:luss and Dewey.
This chapter can only offer an overview of these issues. It is not intended as a
"how-to" chapter on doing situational analysis (sec Cl3rkc et al., 2018), but as an
introduction to what situational analysis has to offer as a new approach within the
grounded theory tradition and how its affordanccs arc accomplished.
What's New in Situational Analysis?
Drawing deeply but not only on Anselm Strauss, situational analysis both extends
and goes beyond Str:1wsian grounded theory. What is situational analysis about?
Why create a new approach? How arc Strauss's contributions both preserved and
reconfigured for the new millennium? What new possibilities docs situational
analysis bring to the grounded theory "auction housc"--on offer to all?"
What's New Methodologically in Situational Analysis?

Methodologically, situational analysis emerged from my deep engagement with
qualitative inquiry, especially Strawsian grounded theory, my critique of Strauss
and Corbin's (1990, 1998) important innovation of the "conditional matrices,"
my critique of the concept of"contcxt," and my conceptualization of"the situ-
ation" as an a11alyti,: .framnvotkfar qualitalivt inq11iry. I next discuss each in rum.
From the Conditional Matrix to the Situational Matrix

Action is at the hc•rt of Straussian grounded theory. Anselm Strauss's prag-
matist intcractionism led him to think about action temporally, proccssually,
interactionally, and structurally (Hildenbrand, 2004, p. 17). In 77,e Discovery of

Croundtd 1n,ory, Cbser and Strauss (1967, pp. 239--242, emphasis added) used
the tcmt 0 structural proces.s0 :
One of the central issues in sociological theory is the rebtionship of(social)

structure to (social] process.... Sociological theory ordinarily does not join
structure and process so tightly as our notion of"structural proa:ss" does ....
A major implication of our book is that stmcture a11d proa:ss are r,/attd mort
compltxly (a11d more inltrtslingly) than is commo11/y conceived.
Thus from the outset, grounded theory was aimed at what today might be called
"dcconstructing" and complicaring the age-old stmcture vmus process binary in
social theory, presciently seeing them instead as i11txtricably interwoven in ways
that today would be viewed as poststructural (e.g., Hildenbrand, 2007; Striibing,
2017, 2019).
In his later work, done while I was his student, Strauss sought to incorporate
and integrate analyses of stnutural process in new ways, pushing grounded theory
in directions that were more structurally and contextually sensitive. He worked
assiduously on fr:iming and articulating ways to do grounded theory research that
included specifying the structural condition-eeking to literally make them vis-
ible in doing grounded theory analysis. Strauss's provisional solution, brgely pur-
sued with Juliet Corbin, was the conditio11a/ matrix, a strategy for supplementing
grounded theory's usual prowsua/ emphasis with serious attention to more struc-
tural contextual "ronditio,is." 12 Strauss's pragmatist interactionist sociology was
based most of all in understanding action as a situattd activity. Thus, for Strauss, the
conditional matrix was a situating dtvicc-a heuristic means ofmablinggroundtd theory
rtstarthm to t11visio11 the ronttxts and conditions u11dtr which tht adion is o«urritlJI.
The several versions of the conditional matrices Strauss and Corbin produced
provide systematic paths for grounded theorists to follow to facilitate specifying
the salient structural conditions that obtain for the phenomenon under studyu
(see Figure 10.t (Strauss & Corbin, 1990, p. 163)). Here the concentric circles
represent the more structural conditions wit/ri11 which the focus of analysis dwells.
Structural conditions are portrayed as co11ttxt, arrayed around the central action
focus from local to global (from near the center/ core to faraway places on the
periphery). Action is in the center of the diagra~he grounded theory social
process.
Specifically, the conditional matrix frames a number of concerns that are to be
considered by the analyst, generally organized into "levels": international (eco-
nomic, cultural, religious, scientific, and environmental issues); national (political,
governmental, cultural, economic, gender, age, ethnicity, race, particular national
issues, etc.); and, depending on where the research is undertaken, community,
organizational, institutional, or local group and individuaV(inter)actional setting.
At t/u, corefar Strauss is action (sec also Clarke, 2008a, 2010a; Strauss, 1993). In bter
versions of the conditional matrix (e.g., Strauss & Corbin, 1998, p. 184), these
Grounded Theory to Situational Analysis 229
FIGURE 10.1 Str.tuss and Corbin's 1990 Conditional Matrix

S.utct: From S<nuss and Corbin (1990) 1/dsia cf Qu•Htdl/t,t Ra,m/t. <:opyrigl>t 1990 by S.g, Pul>lla-
dons Jn<;. Rtprintcd wilh pennis:s!on of the publisher.
conditions spiral around the central focus of analysis, implying that such condi-
tions may be closer in or more peripheral, adding a sense of fluidity and improv-
ing the diagram." But both the micro/macro range of conceptualiZ3tion and the
assumption of the matrix as a separate "context" arc preserved. 15
Giving considerable credit where it is clearly due, the conditional matrices
certainly opened Straussian grounded theory up to analyzing social structuring
in ways that arc highly important, and to this day they remain rare and important
in qualitative inquiry. As Carey (2002, p. 202) noted, Str.tuss's was "a sociology
of structuration before Anthony Giddens invented the wor:d." All in all, however,
especially given the primacy of the nation st:1te, the conditional matrix remains a
very modernist vision.
Peter Hall's (1997, p. 401, emphasis added) critique on this point, which I share,
is that "the imagery of the conditional matrix as a set of concentric circles, while
perhaps simply a heuristic device, conveys an erroneous vision of social topogra-

phy, one that I tvould rather leave to empirical exa111inotion!' There arc two problems
here. First, the concentric circles seem to predetem1ine relations between par-
ticul3r concerns and the phenomenon under study. Second, the matrix gestures
too abstractly toward the possibk salien<e of strudural tltmnits of situations rather
than insisting on concrete and detailed empirical spe<ification of structural e/emmts
and their clear explication as requisite for thorough analysis. 16 That is, tlte re/a/ions
among tlte important elements need to be etnpirically spttifad, studied, and interpreted.
In sum, to me, the conditional matrices ultimately did not do the conceptual
analytic work Strauss and Corbin w:inted to do in groundod theory method.
My critiques ultimately provokod me to develop new strategics to better focus
empirically a11d analytilally on the broader situation. Figure I 0.2 is my altemativ~hc
.. ------- .......
, -- '
, , ''
, ,,
,,
..
., ''
''
, ,, ..,j ..# ''

'
,, ,
'\ 0
%;o ~ I;)'°~ '\
!'!
, ~~,;; C "9~
,,
<>4.
CG--11,
%"'
~~
8~
~~
,i
~e~
..~,:, '
\
Oj,~ %~ ::i:-2- '
o.,-1c0 o-?,, ~ '
'
"<;
V
'¾~c~>?_. ef,~~
$<:f,~
Political Economic Elements THE S11\JATION Symbolic Elements

OF ACTION
e~>5,
#~ell' ~
'l'P~
'r-~~ t#
I~
$& ,,
f 'ii;.,,
,
!~
~~
~ ,,
~ ,,
..... - - - - ....
FIGURE 10.2 Clarke's Situational Matrix
S.-:From Cbrkcet al. [2018, p. 45) Sil,,.,i<nr4/ AMlysis: Croundtd TlltotyAjln lht lnltrpfttivt 11ml.
Copyrig)u 2018 by Sag• Publlcadons, Inc. R•printcd with pormlsslon of lh• publisher.
Crounded Theory to Situational Analysis 231
silllational matrix. In gcncrnting the situational analysis method, I essentially pushed

Smuss and Corbin's (1990, 1998) grounded tlieory conditional matrices around the
interpretive rum to instead focus empirically on and analyzc tl,e broader sit11ation
as the phmomtnon u11dtr sllldy.
Here the conditions of the situation are in tht situation. Thtrt is no s,~I, 1hi11g as
"context, 0 and no concentric or spiraling circles. The conditional elements of the
situation need to be specified in the analysis of the situ3tion itself as tliey are ,011-
stitutivt of it, not merely surrounding it or framing it or contributing to it. 11,ey
art ii. Reg,mllcss of whether some actors might construe them as local or global,
internal or external, close-in or far away, or whatever, the fundamental question
is: "How do these conditions appear-make themselves felt as conscquenti~
integral parts ofthe empirical situation under examination?" At least some answers
to that question can be found through doing situational mapping and analyses.
Many of the elements Strnuss and Corbin included arc also present in the
Situational Matrix. Here we can sec that the elements forntcrly 3rr3ycd around
the action are now imaged as in the action-they are i11t,gral pmts of the sit11ation
of «tio11. This matrix, like those of Sll':luss and Corbin, is an absll':lct version.
The diagrnm as a whole is the situation of inquiry. People and thin~. humans
and nonhumans, fields of prncticc, discourses, disciplinary and other regimes/
forniations, symbols, technologies, controversies, organizations and institutions--
each and all can be present, mutually constitutive, and consequential. Many kinds
or genres of people and thin~ can be in that situation, and the labels here arc
generic. They become specific through doi11g empiriCill situatio11a/ analysis research.
Ultimately, in situational analysis what s11Ultures and <»nditio11s 011y situation is
an tmpiriC41 question-or set of qutstior,s. In sum, Sll':luss and Corbin's conditional
matrices pointed in very important directions analytically in terms of attending
to structural conditions. But w ithout serious engagement with poststrucruralisms
and actually specifying empirical sll':ltegies for their specification, they simply did
not go far enough.
But, you may well be asking, why "situation" and not "context"?
From Action and Context to the Situation as

the Unit ofAnalysis
By the early 1990s, I was strongly objecting to the conc<:pt of "context" (Clarke,
1991) because it is predicated on the assumption that a subject and its contexts arc
separable. In science and technology studies where I have dwelled, and elsewhere
in social theory, a different poststructurnl assumption is made-that thin~ arc so
"context-dependent" that they arc ,o-constilutivc---hclp make each other up (e.g.,
Jasanoff, 2004). For example, Haraway (1991b) famously argued that knowledges
arc "situated"- historically, geopolitically and otherwise sitc-,;pccific. They a,uld
not exist as "tht same thi11g" al anotlin pl«e or timt. They must be adopted and
adapted and arc in prncticc altered through their (rc)S)"ounding."
2 3 2 Adele E. Clarice
I therefore began to think more seriously and conceptually about "the situa-
tion," as the Situ31ional Matrix revw. The fundamental assumption ofsitu31ional
analysis is that everything in the situation bot/, co-cotutit14/es and tiff,cts most every-
thing else in the situation in some way{s}. Everything actually in the situation or
understood 10 be part of it "conditions the possibilities" {yes, FouC3ult} of inter-
preting that situation and taking action b3sed on those interpretations (Blumer,
1969}.
I gradually can1e to rely deeply here on pragmatist philosophers' discussions of
situatcdncss and situations. 11 for example, John Dewey (1938, pp. 66-68; empha-
ses in original and added} brilliantly framed the concept of the situation and its
ultim3tc import:
What is designated by the word "situation" is not a single object or event

or set of objects and events. For we never experience nor form judgments
about objects and events in isol3tion, but only in co,111taio11 with a contextual
who/,. The latter is what is C3lled "situation" [p. 66).... In actual experi-
ence, there is never any such isolated singular object or event; an object or
event is always a special part, phase, or aspect, ofan environing experienced
world-a situatwn . ... There is always a field in which observation of this
or that object or event occurs [p. 67).. . . l¾e /iw and act i11 co,m,clion rvirlr
tht txisti11g ,nviro11mtt1I, not i11 co11ntdion rvitl, isolated objtdS, even though a
singular thing may be crucially significant in deciding how to respond to
the total environment [p. 68).
Dewey is arguing th3t in practice, in life, things havt, meani11g only in relationship to
the siluation(s) i11 which they are found or O<:lUr. We make sense of the world through
understandi11g situations. Understanding situations is therefore the project of situ-
ational analysis as a method.
But Dewey (1938, p. 68; emphases added) also framed the situation as itself hav-
ing a gestalt that makes the whole greater than the sum of its parts--"something
that was not there before": "It is to be remarked that a situatio11 is a ruholt in virtue
of its immediat,ly pervasiw quality. . .. that which binds all constituents into a whole
but ii is also unique; it constitutes in e3ch situation an individual situation, indivis-
ible and ,mduplicable." The situation becomes an entity sui generis--a distinctive
phenomenon unique unto itself-including tht relationality of th, tlem,nts in their
particular kmporal and spatial ,co/OK'f which transfomu them. No wonder we return
10 Dewey today.
In contemporary social theory, Deleuzian scholar Brian Massumi (2002,
p. 211) builds further on this important "gestalt" of situ3tions, naming that which
makes a situation greater than the sum of its parts its "exccss"-which then
"btlo11gs to their joint situation. More precisely, it enters their situation." The agency
of tlte situation its,lf 1/11,s btco111,s palpabl, if not visibl,. Massumi (2002, pp. 209-210;
emphasis in origin3l} further theorizes, "There are other ways of approaching
the situation than bare-braining it. ... (W)hat is at stake is no longer factuality
and ilS profitability but rather relation and iis gtnitivity. The question is: what new
thoughis docs (the situation) ... make it possible to think?" Situational analysis
itself builds on this "genitivity of the situation" through analysis (sec also Clarke &
Friese, in prep.).
This ccntering on the situation and ilS overall gestalt in situational analysis is
precisely why situational analysis is so strong at handling emergent phenomena
and new facclS of older phenomena. In making the situational map, the researcher
empirically builds up a portr.lit of the situation in all ilS uniqueness. Then the
complexities of relations withi11 it arc analyzed with relational maps, and ilS col-
lective actors and their commimtcnts through social worlds/arenas maps. Last,
positions taken and not taken in major debates arc detailed. A "thick analysis"
(Foskct, 2015, p. 196) of the unique situation is thereby built up, allowing emerg-
ing phenomena to come to the analytic forefront.
My methodological attention to the situation was also channclcd through
several other inspirational texts. For cxantple, in his classic methods text The
Rmarth Act, Nonnan Denzin ((1970], 1989, 2009) deemed "situating interpret:1-
tion" requisite for qualititivc inquiry. I taught his short section for years, craving
more. Haraway's (1991 b) classic feminist theory paper on "Situated Knowledges"
was another key theoretical inspiration." There were others too, but in key ways,
Dewey said it all.
In sum, the methodological heart ofsituational analysis lies in empirically expli-
cating the situation of interest. 77,r silllation as a whole is to be described and ana-
lyzcd through mapping. Morrionc (1985, pp. 161- 162; emphasis added) noted,
"Situations have a career-like quality and arc linked in various ways ... to other
situations." Hall (1997, p. 400; emphasis added) wrote, "Anselm Strauss (1993) has
contributed more than any other interactionist to the conceptualization of social
organization and our understanding of rtlatioris amo11g situations." While situational
analysis opens up and extends this aspect of Strauss's methodological cng:igcmcnt,
without the Straussian conditional matrices, situational analysis would not exist.
What's New Theoretically In Situational Analysis?

Now that you have a grasp of the situation as the new unit of analysis in situ-
ational analysis, I want to briefly discuss the older and newer theoretical foun-
dations on which this method rests to deepen understanding of ilS innovations.
As noted earlier, situational analysis extends both Straussian grounded theory
(SIT3uss, 1987; Strauss & Corbin, 1990, 1998) and constructivist grounded theory
(Channa.z, 2000, 2006, 2014). SIT3ussian grounded theory was "packaged" by
him with both pragmatist philosophy and Chicago school symbolic intcractionist
theory. 20 Rooted in SIT3ussian grounded theory, constructivist grounded theory
as elaborated by Channaz shares its pragmatist interactionist roots, but deepens
its constructivism through enhanced reflexivity about the researcher and research
234 Adele e. Clarice
processes (sec Charmaz, this volume). Siruational analysis funhcr innovated by
incorporating and building upon Anselm Str:1uss's social worlds/arenas theory,
discussed next.
From Chicago Ecologies to Social Worlds/Arenas

Pragmatist philosophy and Chicago sociology, both of which undergird grounded
theory and SA, were deeply ecological in orientation (e.g., Ccfl'i, 2016). Chi-
cago School sociology focused on "people in placcs"-<:ommunities of different
types (e.g., ethnic neighborhoods, elite arC:IS, impoverished slums), distinctive
J0e3Jes (e.g .• taxi dancehalls, the stockyards), and signal events of varying tem-
pornl durations (e.g., a strike). The sociological task was "to make tht troup the
focal center and to build up from its discoveries in conue/t situations, a knowledge
of the whole" (Eubank in Meltzer, Petras, & Reynolds, 1975, p. 42, emphases
added). As Baszanger and Dodier (2004, p. 16) assen, "The main point here was
to make an i,wentory efa spQ.(t by studying the different communities and activities
ofwhich it is composed, that is, which encounter and confront each other in that
space." These "inventories of space" often took the fonn of areal maps, usually
done from u3bovc such as 3 city map.21
0
Most important, the communities, organizations, kinds of sites, and collectivi-

ties represented on such maps were viewed it1 r,/a//011 to one a,wthn-, and within their
laf}leT situations. Thus rtlatio11a/ity was a fearured concern of interactionism from
early on. "The power of the ecological model underlying the trnditional Chicago
approach lies in the ability to focus now on the niche and now on the ecosystem
which defined it" (Dingwall, 1999, p. 217). Susan Leigh Star (1995b) called this
analytic affordancc "the figure/ground gestalt switch," and it is fundamentally
important in actually doing siruational analysis."
Researchers in the Chicago tradition later called themselves symbolic inter-
actionists, the name coined in 1937 by Herbert Blumer (1969, p. 1), and con-
tinued to study "social wholes" in new ways. Their foci shifted from urban areas
to srudies of work, occupations, and professions, moving from local to national
and international groups. Significantly, JleOJlraphic bou11daries were often dropped
as necessarily salient. They were replaced by the concept of "shared u11ivmes <if
discourse" as boundary-making and marking. Moreover, attention was increasingly
placed on the relationships of groups to other "social wholes," the inln-aaions ef
collet:tive QC/ors and their distint:tive universes ef discourse ..,
lnteractionists Anselm Strnuss (Strnuss, Schatzman, Bucher, Ehrlich, & Sab-
shin, 1964; Strnuss, 1978a) and Howard Becker (1982) further defined social
worlds as groups with shared commitments to certain activities. Over time,
such groups develop a "life of their own," for example, a recreation group, an
occupation, a theoretical trndition, or even an academic discipline. Social worlds
generate shared perspectives that form the basis for both individual and collective
identities and for developing commitment to collective action." People typically
participate in a number of social worlds simult:tneously, and such participation

usually remains highly fluid.
Social worlds are themselves univents of discourse and often have their own dis-
tinctive vocabufaries (Mead, 1938/1972, p. 518; Str.1uss, 1978a). For Mead, uni-
verses of discourse cannot meaningfully be lifted out of their experiential habitat
or situation; they are situatiot1-dtpt11drnt (CefaY, 2016, pp. 165-167). Clearly draw-
ing upon Mead, Strauss's social worlds/arenas theory makes similar assumptions--
that so<ial worlds are m11/tiplt colltCtivt attors participating in all kinds of negotiations
(Clarke, 2020a) embedded in broader and often contentious substantive arenas.
To understand social worlds, you need to understand their broader situations-
the arenas of action in which they are embedded.
Art11as are silts where soti,,/ 1vorlds mett and focus on matters about which all the
involved social worlds care enough (1) to be committed to act and (2) to produce
discourses about their own world, other involved worlds, and issues of arena
concern. Thus, arenas are sites of action and discourse production in often com-
plicated w:iys. Further, because social worlds' perspectives, commitments, and
goals often differ, perhaps dramatically, arenas are usually sites of contention and
controversy. As such, their discourses art tspttially good for analyzing ht1erogtt1tous
persptctiv,s or positions and for analyzi11g pow,r it1 «lion (a lesson from technoscicnce
studies, e.g., Nelkin, 1995).
Arenas arc also especially good conceptual frames through which to analyzc
colltctivt actors. Peter Hall (1997, p. 397) noted: "A view of social organization is
offered that emphasizes rtlatio11s among situatio1rs, linkages between consequences
and conditions, and networks of collective activity across space and rime." Susan
Leigh Star's (1995a) "ecologies ofknowlcdgc approach" further emphasized rela-
tions among social worlds, especially through her concept of"boundary objects"
(Star, 2010; Star & Griescmcr, 1989). Star asserted that particufar objects that arc
taken up by multiple worlds arc "interpreted" differently by those worlds to bet-
ter meet their own needs and goals. And of course, such boundary objects can
be sites of contest.ltion par excellence, making them superb sites of ethnographic
cntrcc. The social worlds/arenas conceptual toolbox is indeed impressive...
Through social worlds and arenas fr:imes, interactionist research can address
more global elements, increasingly important today. But like the basic social pro-
cess/action fr:imcwork ofgrounded theory, social worlds/arenas analyses also can-
not do everything we want to do analytically. Foucault helps next.
Foucault: Discourse Studies and Moving Beyond

the "Knowing Subject"
The first new theoretical root of situational analysis method is Foucault's work on
discourse and the importance of moving beyond "the knowing subject." Foucault
challenged the social sciences by decentering the "knowing subject" (the individ-
ual human as the ideal agentic social actor, usually studied through interviewing)
to focus instc.ad on "the social" as constituted through discursive practices 3nd on

discourses tl,nns,/ves as c,mstitutivt of subjectivities.
Foucault (1972) bcgan with the concept of "discursive fonnatio1is"-<mays
of do,ninalll discourses that bind toget/rer social irifurlllions abol4t partirular pra,tices
(Dreyfus & Rabinow, 1983, p. 59). Dornina11t discourses arc reinforced through
extant institutional systems ofbw, media, medicine, cduC3tion, and so on-often
operating in conjunction. A discourse is effectcd---3ctcd out or 3Ctcd through--
in disciplining practices which produce subjects 3nd subjectivities through sur-
veillance, CX3mination, and v3rious technologies of the self-ways of producing
ourselves as properly disciplined subjects (e.g., FouC3ult. 1973, 1975, 1978, 1988).
For CX3mplc, the various institutions of medicine (from hospitals to pharmaceuti-
cal companies) and the media (from newspapers to TV and the Internet) together
produce "hcalthscapes"~tcnsivc narrative and visual discourses on health and
the responsibilities of citizens to pursue it. We constitute ourselves and arc con-
stituted by and through them (e.g., Clarke, 2010b).
Drawing on FouC3ult, situational analysis goes beyond "the knowing sub-
ject" to also 3ddrcss and analy:i:c salient discourses dwelling within the situ3tion
of inquiry. We arc, like it or not, constantly aw3Sh in seas of discourses that
are constitutive of life itself. Situational analysis cnrolls Foucault's poststructural
3pprooches to take these into account, following "FouC3ult's footsteps" (Prior,
1997) into sites ofhis serious thcori:z.ing ofhistorical, narrative/textual, and visual
discourscs.26
Deleuze and Guattari: Rhizomes and Assemblages

Despite having taught their work for two dec3des, I did not realize until 2013
how deeply indebted the situational analysis situational and relational m3ps arc
to Delcu:zc 3nd Guattari's (1987) concepts of rhizome and asscmblagc. They
offer new ways of thinking about fomu and temporalitics--linkages, relations,
unexpected nodes, temporary 311ianccs, 3nd emergencc--and of IT3nsitory rcla-
tionalitics, all of which are very important in situational analysis and are wholly
epistemologically compatible.
The concept of rhizome, poached from botany, refers to a largely subterranean
network of roots that grows horizonta//~crpendicular to the force of gt3vity-
3nd can send out new shoots from any nod.-uch as irises, couch grass, and
bamboo. Jn their famous essay, Delcuze and Guattari (1987, p. 21; emphasis
3dded) state:
It has neither beginning nor end, but always 3 middle (milieu) from which
it grows and which it overspills.... ·11,e rlrizome pertains to a map that must
bt prod,u,d, constnuted, a rnap t/rat is always deta,/,al,I,, amnectablt, rtvmiblt,
rnodijiablt, and has rnultiplt nitry,vays and txits and its <>Wn lints offlig/rt. It is
tracin11s that must be put or, t/re map, not t/re opposite.
Crounded Theory to Situational Analysis 237
Rcvisioning is requisite. Key here arc spatiality, rclationality, and alliances in rela-
tions. Rhizomatics arc generative, fluid, tcntativc--widc open, emergent and
responsive rclationalities. So too arc situational maps, as we shall sec.
Delcuzc and Guattari's (1987) concept of assemblage brings together hetero-
geneous entities in dynamic, fluid relations. An assemblage can expand, contract,
and so forth, and is an inherently unstable phenomenon. It is precisely the /oose-
ntss of the connections among heterogeneous entities, and the in.stahilily of those
connections, that make the concept of assemblage an inspirational metaphor for
theorizing the situation in SA. Dclcuzc and Guattari (1987, p. 23) themselves
recognized the challenges that grasping assemblages poses: "It's not easy to sec
th.ings in the middle, rather than looking down on them from above or up at
them from below, or from left to right or right to left: try it, you'll sec that eve-
rything changes." Ytt doing research requires us to do just that-to attempt to
"sec th.ings in the middle" at one historical moment, while acknowledging that
things arc always changing, that our analyses arc--m,d ca11 only ln----partial and
temporally bounded.
Dclcuzc and Guattari :lid and abet the shift from foregrounding process and
tcmporality so central to grounded theory to instead emphasizing the more
structural relationalities revealed by the analytic mapping strategics of situational
analysis.
Taking the Nonhuman Explicitly Into Account

I created situational analysis at the turn of the 21st century (Clarke, 2003, 2005),
and my theoretical grounds for including the nonhuman were pragmatism, intcr-
actionism, and science and technology studies, especially Donna Haraway's {1985,
1991b) work and the use of the term nonhuma11 in actor-network theory (ANT).
Specifically, since the interpretive and posthumanist turns, studying action-the
analytic ccnter of grounded theory-can no longer be considered sufficient.
Humans a.re not enough.
In addition, fresh methodological attention needs to be paid to no11l111111a11
objects i11 situatiom--tlrin11s of all kinds. These may include cultural objects, tech-
nologies, animals, media, nonhuman animate and inanimate pieces of material
culture such as furniture, architecture, and the lively discourses that also constitute
the situations we study- from cups and saucers to lab animals to TV progran,s.
Some arc products of human action (and we can study their production pro-
cesses); others arc construed as "natural" (and we can study how they have been
constructed as such). 77
"Things" have long held an important place in pragmatism and intcraction-
ism.20 For example, Blumer (1969, pp. 10-11, emphasis added) noted: "objtcts
are the product of symbolic interadion. An object is anything that can be indicated,
anything that is pointed to or referred t<>--a cloud, a book, a legislature, a
banker, a religious doctrine, a ghost, and so forth." This explicit constructionist
a11d materialist view of the nonhuman tacitly informed some of our research
(Cl:irke & Star, 2003, 2008).
Let me further clarify and situate the term "nonhuman." Over the past sev-
eral decades, the importance of thing$-materialitics-has been retheorized in
a number of ways through poststrucrural lenses. Foucault's (1973) ·11,e Order
of rhi1111s raised fresh ways of conceptualizing how "things" and their clas-
sifications organize our grasp of the world. Actor-network theory (ANT),
developed especially by Bruno Latour, Michel Callon, John Law, and Made-
leine Akrich in science and technology studies, furthered this move, initiating
explicit and theoretical and methodological starus for the non human and using
that term.29
In ANT, "nonhuman actants" :ire not only present in siruations but also have
agency in those situations. Woolg:ir (1991) caprured this vividly in research on
"how computers configure their users," foaruring the agency of nonhuman pro-
grams in making us do things differently. Moreover, with laptops or cell phones
in place, we :ire continuous with our technologics--we :ire "cyborgs" (cybernetic
org,misms) (H:iraway, (1985), 1991a).
This reconceptualization of the nonhuman as not only important but also
agentic is deeply provocative and productive. Adequate a,1alysts of sihlalions bei11J1
researched ,nust i11dude the nonhuman expliatly and in C1»1siderable detail. Significantly,
this takes up the challenge of posthumanism-the idea that only humans "really"
maner or "maner most," and asserts that the social includes agentic nonhuman
actants. "By acknowledging nonhumans as components and determinants of the
arrangements that encompass people, this line of research probll!ltUltizts the social and
d1allen11es traditional rendtri1111s of it as relatio11s betwttn people" (Schatzki, Cetina, &
von Savigny, 2001, p. 11, emphasis added). A key argument in science and tech-
nology srudies has been that the nonhunun and the human :ire co-constirutivc---
lOJlelher co,1stituti1111 t/1e rvorld and e01h other.
Significant here, suth protesses of aH01istnu:tion and co-co1istitutio11 can be studied
thro1111h usi1111 the sit11ation as the locus of analysis, and txpliatly i111:/udin11 all a,uilytically
perti,w11 11onhuma,1 (inc"1dinJI ltthnical) elements alon11 with the human 011 silltalional
maps. Siruational analysis thus offers a distinctively materialist constructionism.
Nonhunun actants structurally condition the interactions within the situation
through their specific material properties and requirements.'° Their agency is
everywhere.
In sum, the theoretical tap roots of siruational analysis lie in pragmatist phi-
losophy, Chicago School ecologies and interactionism. Its newer theoretical
roots include Foucauldian discourse srudies going beyond "the knowing sub-
ject," Dcleuzc and Cuanari's rhizomes and assemblages, and taking the nonhu-
man explicitly into account. These come together in the methodological shift to
focusing on the siruation as the unit of analysis in siruational analysis nupping, to
which I now tum.
Mapping Situations In Situational Analysis
In doing a situational analysis, the situation of inquiry is tmpirit,al/y constructed

through nuking four very different kinds of maps and following through
with analytic work and memos of various kinds to document and detail the
analysis-in-progress.
1. Situational maps lay out the major tltmt11ls human, nonhuman, discursive, and
other, empirically found in the research situation ofinquiry.
2. Rtlationa/ maps, made using situational maps, map and analyzc relations
among the different elements in the situation.
3. S«ial UN>rldslam1as maps lay out the colltaivt aao,s and tht artna{s) of commit-
ment and discourse within which they arc cng;,ged in ongoing ncgotiations-
meso-lcvcl interpretations of the situation.
4. Positional maps lay out the major positions taktn, and not taktt~ in the data vis-
a-vis particular axes of difference, concern, and coniroversy around issues in
the situation ofinquiry
All four kinds of nups provoke analytic work, offering fresh ways into social sci-
ence data especially well suited to contemporary studies from solely interview-
based to multi-sited research projects. (For guidance in doing situational analysis
research, see Clarke et al., 2018, esp. chapters 4-9. For templates for nuking each
of the four kinds of maps, sec the SAGE companion website at https:/ /study.
sagcpub.com/clarkc2c/student-rcsources/tcmplates.)
Situational Maps
The initial maps done in SA--situational maps--lay out the major human, non-
human, discursive, historical, symbolic, cultural, political, and other elements in
the research situation of concern and provoke analysis of relations among them.
These maps capture the messy complexities of the situation in their dense rela-
tions and permutations. They intentionally work a~ainst the usual simplifications
so characteristic of scientific work (Star, 1983) in particularly poststructural and
interpretive ways. Sec Figure I 0.3.
The messy situational map also works as an excellent "holding device," a place
to "put"-ca.sily write down-all the possible elements (deleting any that do
not empirically pan out), and to add new elements as they emerge through fresh
data gathering. Once an clement is empirically confirmed through data, if it is
seemingly important analytically, the researcher can follow through with further
theoretical sampling (sec Charmaz, 2014, chapter 8).
Situational maps arc also excellent rtstard1 dts~n tools. Even a very prtlin,inary
situational map helps in planning a situational analysis research project. especially
Nonhurnan
AclantA
Oisoourse on
'tJ"
ldea,Concept
1
lnfras1ructural
Elementt1
FIGURE 10.3 Abstr.lct Situational Map: Messy Version

Sou,a: from Clarke <t al. (2018, p66) Situ,ti_, Analy,is: Ctound<d 'T1it«y Ajltt tht lnlnprr1M 1lml.
Copyrig)n 2018 by Sage Publications, Inc. Reprinted with permission of the publisher.)
because researchers typically have to discuss many facets of the design in disserta-
tion proposals and research gnnts l011g btfort any research has been done! Having
some idea of the important elements to be researched in the situation under study
enables writing stronger and clearer proposals.
In Figure 10.4, you can sec the basic categories more clearly. These catego-
ries derive in part from my own work and from Str:mss's (1993, p. 252) "general
orders" within his negotiated or proccssual ordering framework: spatial, temporal,
technological, work, sentimental, moral, aesthetic, and so on, In terms of laying
out the n13jor elements in situations, these categories arc fairly generic-common
across research situations.
It is important to note that there is no absolult nttd lo include all of thrst a,t,gorits
in any givm analysis. What appears in yoursitu3tional map is based on yo11rsituation
lndirid,ud HJ.man Elonnu,IActors NonJiw,,..,,. EkmmtslAd,mts

e.g., key individuals and significant e.g., technologies; m>tcrial inli»trucrure.;
(unorganizcd) people in the situation, specialized information and/or
including the rcscarc:hcr knowledges; material ..things"
Colkcd"" H""""' ElnnmtslAct,,n lmplicotol/Silmt Actors/Aa.,,,ts
e.g., panicular group,; specific as foWld in the situation
organizations
Di,a,,,;,. Co,sstn,ctions oflndwid,ud Diso,ni,c Co,sstn,ctum of Nonliwm11n
and/or Colkctin Hwman Actors Actanls
as found in the situation as found in the situation
Politicol/Economic Ekmmts Sod«,Jn,rol/Symbolk Ekmmts
e.g., the state; particular indwtry/ics; e.g., religion; race; sexuality; ~ndcr;
local/rq;ional/global orders; political ethnicity; nationality; lOl:,,os; icons; other
partie,; NGO.; politicized i,.ue• vuual and/or auru symbols
Tmrpon,J Ekmmu Spa1i4l Ekmmu
e.g., hi.storical, seasonal, crisis. and/or c.g,. spaces in the situation, goographic2.I
a.jcctory a.peas :upccts, local, rq;ional, national, globol
,patialwucs
Major 1.ssrus/D<IH,t,s {USNal/y &'4uJ Di:saJ11rus (Hi:stotical, Nomititt,
Conwud) andlorV"uxo1)
as found in the siruationj and 3ec e.g.. normative expectations of acton,
positional map actant::s, and/or other specified elements;
moral/ethical elements; nws media
and othCT popular cultunl discounc>;
siruation-$pccific discourses
Other Kinds of Elements
as found in the situation
FIGURE 10.4 Abstract Situational Map: Ordered Version

So1nu:From Clark«t al. [2018, p. 131J Sit•oJiana/A1141yro: C""""1td ·n.-y Aj/n th< 1111,rp,rtivt 7lon.
Copyris)lt 2018 by Sage Publlcadons, Inc. Reprin1ed wilh pennlsslon of lhe publisher.
of inquiry-yo11r projfd. Both messy and ordered situational maps arc done and
redone across the career of the research project along with analytic memos.
Mapping Relationality With Situational Maps

Once you have an empirically based messy situational map, you can begin doing
the second kind of map, relational maps. These constitute the next phase of
analytic work in situational analysis. Here rtlalio,is amonJ! tlrt various elttnents in the
situation arc the analytic focus.
Taking each clement in tum, the researcher thinks about it in relation to all the
other elements on the map. In Figure 10.5, as an example, the clement focused
on is Organization #1. The memo on this map would specify the ,iaturr: of the
key rc/ations/Jips of Organization #1 by desaibirlJI tire nature of tatli /ine--,:ath relatior,
Non-Human
ActantA
o~n\Zalion
t3
Key Event
112
Discourse on
•N·
Location
Infrastructural
Element t1
ln<llvidua1
R
FIGURE 10.S Abslr.lct Rclatiorul Map: Focus on Organization #!

Swr«: From Cbrke et al. (2018. p. 139) SilW41i<>M/ AM/y,;S: Croimd,4 '/1,«<y Ajl,rllr< /nltrpmivt 1lml.
Copyright 2018 by Sag< Publications, Inc. R<printed with p,nnission ofth< publisher.
btt1v,m two (or more) d,mn,ts. This m3pping is done systematically, one clement at a
time. Such rel3tion31 an:tlyses arc the major work done with the situation3J map.
It par:tllels the word by word, line by line coding procedures in grounded theory,
similarly relying on being highly systematic in carefully an:tlyzing the empirical
data to generate a rich 3nalysis.
Relational maps portray the major and minor relationships or "rcl3tion31ities"
in the situ3tion. In memoing the maps, you focus on the most interesting rela-
tions and then theoretically sample them-gathering more dat.1 about them. Ulti-
mately this helps the an:tlyst decide which storics--which rclation~o pursue as
the heart of the project. We cannot tell every story.
Both the situational and relational maps arc usu:tlly working maps for the
rescarchcr(s). Thus, neither usually appears as the focus of a chapter or publica-
tion. Exceptions to this arc often presented to demonstrate an unusually wide
range of elements found in a particular situation-its inherent complexities-or

why a particular clement was worthy of extended focus. For published exam-
ples, sec Foskct (2015, this volume), Martin, Pauly, and MacDonald (2016), and
Aldrich and Rudman (2015).
Social Worlds/Arenas Maps

Soda/ rvorlds arc groupings of varying sizes that arc distinctively collective (e.g.,
a recreation group, an occupation, a theoretical tradition, or even a discipline
or an organization), each of which has "a life of its own." They can be quite
small or even vast. Participants in social worlds generate shared perspectives that
form the basis for both individual and collective identities. These perspectives
undcrgird the commitments of that social world to colledivt action in the arenas
in which it is involved. A social world has shared commitments to certain activi-
ties, and participants share resources of many kinds toward actions to achieve
their goals.
Art11as of concern are constituted of multiple social worlds all committed to
particular issues and prepared to act in some way(s) in that arena. They may also
have other commitments in other arenas. In arenas, "various issues arc debated,
negotiated, fought out, forced and manipulated by representatives" of the par-
ticipating worlds and subworlds (Strauss, 1978a. p. 124)." Social worlds actively
participate in arenas in which their agendas arc pursued. For example, a scientific
discipline would be active in arenas where funding for their research is allocated,
where knowledge relevant to their discipline is generated and published, where
policy based on their research is decided, and so forth. The empirical questions here
are: Which worlds care about what issues, and what do they want to do about
them?
Usually social worlds/arenas maps arc initially done once you have gathered
some data about your project, once you arc beginning to get a handle on what
might be going on more broadly. In doing a social worlds/arenas map, one tries
to make colltdivt sense out of the situation. Sec Figure 10.6.
The main goal ofsocial worlds/arenas analysis is to delineate the colledivt OIJ!Oll•
izationa/ and institutional IJ{tors adivt in that situation. The overall goals arc to make
the broader situation of your project clear and legible to others and to provoke
your own analysis. A clear understanding of what worlds arc involved, why, and
how so, can be important in terms of analysis of power relations and possibilities
for change. Such issues arc too often ignored in qualitative inquiry.
In Figure 10.6, the dotted lines indicate the usually quite porous boundaries
of both social worlds and arenas. The porous nature of these boundaries and their
plasticity arc vital to situational analysis, as it is through them that changes of
many kinds enter-and leavo-thc situation of inquiry. This porousness gives
social worlds/arenas analysis its flexibility, its plastic capacities to take change and
different perspectives into account, its fluid postsrructural analytic edge.
244 Adele E. Clarke
..
'
' ,
:..::_
''
',,
, ....... _
' '•
'
/
FIGURE 10.6 Abstmct Social Worlds/Arenas Map

Sou«,: From Clarke etal. (2018, p. 152) Si1Udlion41 AM/y,is: Crownd,d '£1,,o,y Afl,rlltt lnlnpmitlr '/Im!.
Copyright 2018 by S2g• Publications, Inc. R•printed with pennission ofth• publisher.
In terms of exemplars, Foskct's chapter (this volume) offers an excellent sim-

plified social worlds/arenas map, and a specialized project map of the clinical trial
she studied including all the worlds involved, the stakes they had in that trial, and
what they contributed to it. Many articles and dissertation and book chapters arc
based on social worlds/arenas nups (e.g., Alonso Yanez, Thumlert, & de Castell,
2016; Strong, Vegter, Chondros, & McIntosh, 2017).
Positional Maps
Situational analysis pioneered in integrating discourse analysis with grounded
theory, thereby extending grounded theory (Clarke, 2003, 2005) . .,. Positional
maps arc integral t ~ t the very core of-making situational analysis a fully post-
structural approach to qualitative inquiry. In a situational analysis project, posi-
tional maps arc the analytic tools applied distinctively to the discursive materials in
the situation, g.ithcred through fieldwork, participant observation, interviewing,
and the collection of documents, websites, and any and all other such discourse data
fo,md in the situatio11 ofinq11iry.
Positional maps analyzc the discourses in the situation of inquiry broadly con-
ceived They do very different kinds of analytic work than the situational and
social worlds/arenas maps. 77., tore goal of positio11a/ maps is to lay 0111 the major
positions takm on ismes in distoursrs fou11d in the sit11ation--topics of focus, concern,
and often but not always contcstation and controversy. Positional maps focus on
issues, positions on issues, absences of positions where they might be expected
(sites of discursive silence), and differences in discourses central to the situation
under study.
Perhaps the most important and radical aspect of positional maps in situational
analysis is that positions are 1101 to"tlattd or associated with pmo11s orgroups or i,utitu-
tio,u. Instead , we seek to move with Foucault (1973, p. xiv) beyond "the knowing
subject" here. Positio,u on positional maps art positio,u 14km in discourses. Individuals
and groups of all sorts may and commonly do hold multiple and oftm to11tradit1ory
positions on the same issue. Positional maps seek to represent this heterogeneity
of positions in aU its richness, not to link the positio,u to particular aaors and thereby
simplify them. This is a distinctively poststructural move, intentionally designed
to reveal complexities.
Figure 10.7 offers an abstract positional map that portrays positions on a par-
ticular issue in the larger situation of concern. There arc two main axes, 1 and 2,
and an infinite number of positions along them is possible. Six different positions
arc shown on this map: A, B, C, D, E, and F. Positional maps also reveal possible
positions for which you have not found any data. If, after searching further data,
this remains true, you have identified a site of silence. One of the powerful things
positional maps do is to "help silences speak"--to allow you to name them and
explore reasons for the silence. Typically, a number of different positional maps
will be done for a situational analysis project, each focusing on the positions
found in relation to different axes of inquiry.
Positional maps center on complexities, differences, and controversies which
arc themselves heterogeneous. Thus positional maps offer improved means of
representing debates and positionality interpretively (sec Clarke et al., 2018:
chapter 7). Because of this, many situational analysis publications ccntcr on posi-
tional maps (e.g., Fisher, 2014; Friese, 2010, 2013; Cagnon, Jacob, & Holmes,
2015; Sala2ar-Torres & Ohman, 2015; Washburn, 2015).
In sum, each kind of map in situational analysis docs distinctive kinds of work
in delineating and analyzing the situation under study and its different forms of
complexity and relationality (Clarke & Keller, 2014). Situational and relational
maps detail the elemmts and their dttue relations in the situation. Social worlds/are-
nas maps ccntcr on the re/afio1,a/ flologirs of colltllive, organizational, and institutional
246 Adele E. Clari<e
+++
Position
A Position
I'
A Position
X C
I
s
I Position
B
Position
D Position
C
AXIS2 +++
++ = more so
- - lessso
FIGURE 10.7 Absttact PO&itioll31 Map

Swt«: From Cbrke et al. (2018, p. 167) Si/tt4/icn,,/ Anal),ds: Crovnd,4 '11,,ory AjUTlh< lnlnprrtivt 1Jan.
Copyright 2018 by Sag< Publications, Inc. R<printed with p,nnission ofth< publisher.
tnlilies, rarely pursued. Positional maps offer in-depth analystS ofdebates and co11t,sttd
issues in 1l1t situation--including positions 1101 taken or silenced.
Together, the four situational analysis maps centcr on elucidating the key ele-
ments, relations, discourses, structures, and conditions of possibility that char-
acterize the situation of inquiry. Thus situational an.alysis can deeply situate
research projects individually, collectively, organizationally, institutionally, tem-
porally, geographically, materially, discursively, culturally, symbolically, visually,
and historically.
Together, the maps and memos about them constitute tht overall situational
a11alysis research analysis---a rtlational tcolOfly of the situatio11. They provide what
Park (1952) called "the big picture" or "the big news," or what Star (1995b)
called an "ecology of knowledge" of the situation under study." The maps
portray the assemblage of elements and the ecology of relations among them,
major collective actors 3Ild fundamental issues 3Ild debates in the broad situa-
tion studied.
TogC!hcr these maps answer the questions: Where 3Ild when in the world is this
project going on? What and who arc involved in this situation? What is going on
in this situation? What is at stake in the situation for the <lilfcrent entities involved?
What "con<litions of possibility" for change arc offered in this situation? What
con<litions render which ch311ges essentially impossible? What and who are ren-
dered invisible or marginalized {implicated actors)? By whom {who has what kinds
of power in the situation)? Why and how do these con<litions matttrr To whom?
Situational analysis studies can st3Ild on their own, independently, as the
method is fully grounded and empirically 3Iltbitious. Alternatively, in a larger
study such as a dissert:1tion or book project, the rcscarcher(s) might want to com-
bine situational 3Ilalysis with constructivist grounded theory (Chmnaz, 2014)
with which it is wholly compatible (sec e.g., Friese [2013) foran example). Com-
bining the study of action, situations, and discourses is very analytically potent.
In addition, researchers may use the maps to design situattd int,rvtntio,is based on
their research--policy-rclatcd actions to implement changes in education, clini-
cal nursing or medicine, and so on. While not discussed here, situational analysis
is also used in the analysis of narrative, visual and historical materials {sec Clarke
et al., 2018, chapters 10-13).
New Critical Tools of Situational Analysis
As a long-term feminist and social justice advocate, a major goal I had in creating
situational analysis was to "build in" innovative tritilal tools useful for the explicit
analysis of power relations."' The focus of this section, these tools include analyz..
ing collective actors' pqwer rtfatio,is, bo1mda,y obj«ts, impliC4ted adors and ackmts, and
dttnocratizi11~ rtprtstnlation by attending to the margins. Mapping :also enhances
possibilities for a,l/aboratio11, potentially making research more participatory and
democratic (Clarke, 20193).
Analyzing Collective Power Relations

In situational analysis, social worlds/arenas maps arc its distinctive Strnussian
interactionist approach to analyzing colltttivt structuring and action in the situa-
tion. This kind of "big picture" analysis of social structuring and action is rarely
pursued in qualitative inquiry. In social worlds/arenas maps, the focus is on soda/
action-1101 by aggregates of individuals but by self-aware ,ollettivities of people
committed to acting together about something. All of the social worlds involved
in a particular arena of committed action will have differing identities, discourses,
and agendas for action in that arena. Examining these with care reveals the politics
and power relations of the arena vividly.
Ultimately, social worlds/arenas maps also situate the research more broadly.
As Colapietro (2011, p. 32) asserts,
Situations must themselves be situated in a field, or more accurately a mul-

tiplicity of fields, so that a critical understanding of the power, limics, and
mutability of these situations becomes (at least) an imminent possibility and
(at best) a tr:msfonnativc fictor.
At best, social worlds/arenas maps can point to feasible "conditions of possibility''-

diroctions and strategics for social change.
Analyzing Boundary Objects

Strauss student Susan Leigh Star developed the concept of boundary objects for
entities (elemencs in situational analysis lingo) that exist at junctures where varied
social worlds meet in an arena of mutual concern." Boundary objects can be
treaties among countries, software programs for users in different settings, even
conccplS themselves. Here the grounded theory basic social process is "tra,islati11g
the objoct" so that it can address the multiple specific needs or demands placed
upon it by each of the different social worlds using it.
A boundary objoct is often a key clement for many if not most of the worlds
involved in an arena. Hence it can be a site of intense controversy and competi-
tion for the power to define and use it according the specific needs and goals
of a particular world. This enmeshment of boundary objects in power relations
makes them excellent sites for critical analysis. Moreover, focusing on a boundary
object can be an important analytic pathway into an often complicated situation,
allowing the analyst to better understand the different participancs through their
distinctirx: relatiotis with and discourses abol4t the specific boundary object in question.
This kind of analysis can also provide a critically useful "big picture" of relations
in the arena.
Boundary objects can be human or nonhuman. For example, in Star and
Criesemcr's (1989) historical study of a regional zoology museum, the muse-
um's animal, bird, and fish specimens were the boundary objects among the
social worlds involved including zoologists, collectors, administrators, donors,
curators, research scientists, and taxidermists. All had distinctive concerns
about the specimens that needed to be mutually addressed for it to become a
fu11ctio11a/ zoology museum. In Clarke and Montini's (1993) study of the abor-
tion pill RU486, the pill was the boundary object, very differently constructed
by the different social worlds involved with it, from women's health groups to
the FDA to medical associations to right-to-life organizations and so forth.,.
In some situations, boundary objects arc also implicated actors or actants, dis-
cussed next.
Grounded Theory to Slluatlonal Analysis 249
Analyzing Implicated Actors and Actants

In addition to individuals and collectivities as agcntic actors in a situation, there can
also be implicated actors and/or 11011/,uman a,:tants." These concepts provide means of
analyzing the situatcdncss of less powerful actors and the consequences of others'
actions for them. They also raise issues about the discursive "'nstruaions of actors and
nonhuman actants and the work such constructions nuy do in a situation.
There arc at least two kinds of implicated actors. First arc those who arc
physically present but generally silenced, ignored, or rendered invisible in the
situation by those having greater power. Second arc implicated actors not physi-
cally present but so~/y disamiv,ly <onstnllttd by other actors in that situation. They
arc conceptualized, represented, and perhaps even targeted by the work of those
other actors, hence they arc di$cursively present. Ntith,r is actively involved in
self-representation in the situation. Nor arc their thoughts, opinions, or identities
sought out by other actors through any empirical mode of inquiry, such as asking
them questions. Implicated actors arc neither invited by those in greater power to
participate nor to represent themselves on their own terms.
EX.lmples of actors present but silenced or rendered invisible in the situation
of inquiry arc women scholars and scholars of color in traditional histories of
academic disciplines and professions. They were there in those worlds, but their
presence and contributions were often ignored and/or erased, requiring usually
fcmirust and antiracist archaeologies to excavate, resurrect, and resituatc them
(e.g., Deegan, 1990; DuBois, 1993; Morris, 2017). An cX.1mple of actors solely
discursively constructed is women users of most contraceptives by the reproduc-
tive scientists who designed them who were quite shocked at women's objections
and rejections of their technologies (e.g., Clarke, 1998, 2000). They had never
asked, "What do Ul()mtn want?"
There can, of course, also be impli<at,d alla11ts--implicatcd 11onhuman actors-
in situations of inquiry." Like humans, implicated actants can be physically and/
or discursively present in the situation. Here human actors (individually and/or
collectively as social worlds) discursively construct nonhuman actants from those
human actors' own perspectives. The analytic questions here include: Who is
discursively constructing what? How and why arc they doing so? For CX.1mple, a
heterogeneously constructed implicated actant is the nulc birth control pill. Most
people, if they have heard of it, will have done so in the question, "Whatever
happened 10 the male pill?" Although technically feasible sine, the 1970s, the
intensely negative of discursive constructions of the male pill as emasculating and
of men as irresponsible sexual partners asserted by contraceptive scientists and
policy nukcrs have delayed rclC3Sc for decades (Oudshoom, 2003; Piotrowska,
Wang. Swerdloff, & Liu, 2016).
The concepts of implicated actors and actants arc particularly useful in the
explicit analysis of power in social worlds in arenas, and in situations more gener-
ally. Such analyses arc both complicated and enhanced by the fuct that there arc
often multiple discursive constructions circulating of both the impliC3ted human

and nonhuman actors in any given situation. Analyzing power involves analyz.-
ing whose constructions of whom/what exist. Which arc taken as "the real"
construction~• the ones that "nuttcr most" in the situation by various par-
ticipants? Which arc contested? Whose arc ignored? By whom? What happens
when heretofore silent/silenced impliC3ted actors suddenly open their mouths
and speak out? Through analyzing the discursive constructions of impliC3tcd
actors and actants, researchers can grasp a lot about the social worlds and arenas
in which they exist and consequences for the less powerful.
Democratizing Representation From the Margins

In developing situational analysis, I relied on Star's (1995b) pragmatist and femi-
nist ccologic:31 mode of analysis, which urges attention to what is at the mar-
gins in a situation, and Deleuz.c and Guattari's (1983) injunction to attend to
"minor literatures." Emerging through the interpretive tum, situational analysis
is committed to epistemic diversity and inclusivity in research. Thus rather than
focusing our analytic gaz.c solely on major or dominant discourses produced by
the powers that be, provoked by feminism, critical intcractionism, other identity
politics, Star's ccologic:31 view, and Dclcuz.c and Guattari, I emphasize the impor-
tance of also e3rcfully seeking out minor and marginalized actors, social worlds,
and discourses and analyzing them."
Specifically in tcnns of representational politics, situational analysis discourse
analysis insistently sttks to rq,rtsent most of the pntinmt discourses in the situation--
not just the major or master discourse that usually trumps others. This radically
pluralist and democratizing representational strategy has roots in Dcwcyan prag-
matism and intcractionism.
By 1101 a,uilyti<ally rtprodutin11 tht poHltr relations of domination a11d i,uttad o.fferin11
a,UJlysts that rtprrstnt tlu:full a"ay of dis<ourses, situatio11"1 a111Jlysis t,mu up tlu: volume
011 lesstr but still prestnt dis<.ourses, ltsstr but still prtstnt partidpa11ts, the ma'llinalized,
the quiet, the silmt, a11d t/,e silt1utd. Such analyses amplify not only differences
but also resistances, recalcitrancies, and sites of rejection of major discourses per
sc. Moreover, some minor voices/discourses may be empowered through such
democratizing representational practices that recognize and acknowledge their
discursive and other contributions. This can be critical indeed.
Enhancing Collaboration Through Mapping

In myriad ways, situational analysis maps and mapmaking operate as what Fou-
cault (1978) called "incitements to discourse," liftoff devices raising the level and
intensity of exchanges and engagements between researchers and participants.
They operate as "pushy invitations"-urging people to question, argue, (re)
think, clarify, and most of all keep on with analysis fur beyond the usual scholarly
exchange.
Grounded Theory to Situational Analysis 25 1
Several colbbor.itivc manifcst:ttions arc afforded by map-making processes per

se. First, the long-established grounded theory pedagogical tr.idition of"working
group" coding and analysis sessions begun by Anselm Str.tuss at the University of
California, San Francisco (UCSF) in the late 1960s has extended easily to situa-
tional analysis. Here people learning or doing grounded theory and/or situational
analysis research gather regularly, taking turns presenting their work in progress
for discussion and critique. Preliminary maps, interviews, field notes, later maps,
memos, write-ups, chapters, whatever, arc distributed in advance for comment
(Lessor, 2000; Wiener, 2007). Maps work wonderfully in focusing such working
sessions. Key questions include: What is missing from the map? Is there anything
there that docs not seem to belong on this particular kind of map? Where docs it
belong? How might a map be reworked to clarify something?
Second, grounded theory and situational analysis have both been used in
Indigenous/decolonizing research where their capacities for collaborative coding
and mapping by diverse researchers as well as by participants arc highly valued,
along with their rigorously empirical approaches (e.g., Bainbridge, Whiteside, &
McCalman, 2013; Cenat, 2009, 2015; McCalman, Bainbridge, Brown, Tsey, &
Clarke, 2018). Third, students report having much more ebbor.iteand productive
discussions with advisors and others using draft maps as foci. As visual represen-
tations of the analysis to date, maps allow quick access, document progress, and
help assess where to go next in terms of both data colleaion and analysis. Fur-
ther, researchers from and/or researching in other cultures, (post)colonial and/or
Indigenous sites report that being asked to carefully specify the elements in the
maps often helps to clarify significant cultural differences with advisors and others
and in various writc-ups.40
Last, in reflecting on their colbborativc efforts, research groups of colleagues
and student/faculty teams have explicitly noted the usefulness ofthe maps in both
organizing work sessions and deepening the analyses. There were also lamenta-
tions that such sessions had not been fully memocd as that would have r.iised the
level of later analytic work."
In sum, all these critical analytic capacities of situational analysis enhance
the possibilities of research for deepening political understanding and grasping
potential sites and feasible directions for change. As Rancicrc (2009, p. 49) notes,
"every situation can be cr.icked open from the inside, reconfigured in a different
regime of perception and signification." The inhtrtnt potential for social change
in situations under study awaits our analysis.
Reflections
To mia~ in tritital posttrwdtm rr~ard, is lo tak~ part in a proms oftritital U)(J,fd

makin11,x,1idtd by th, sl111d<>Wt:d owt/in, of a dr,am of a world /,ss cu,iditiu,r,d by n1is-
ay, su.ffcrirlJl, a11d JI~ po/ilia of dmit. It is, in short, a pra.x,n4(ics of l,o~ in an a~
cfcynital ,,..,.,,.
(Ki,,dr,/o, and McLzrrn, 1994, p. 154)
252 Adele e. Clarke
Developed to further the shared project of critical world making, situational
analysis offers new kinds of map making as fresh analytic devices for grounded
theorists. Deeply important to situational analysis arc Strauss's social worlds and
arenas theory, Foucault's emphasis on discourse and going beyond the know-
ing subject, the analytic centrality of the nonhunun, Stlr's ecological analytics,
Deleuzc and Guatt:ui's rhizomes and assemblages, and the pragmatist concept of
"the situation" per sc. Through mapping, these tools together enhance capaci-
ties to grasp ecologies and their rclationalitics. For both grounded theory and
situational analysis, a strong analysis should generate theorizing that comfortably
"handles" the data at a conceptual level, offers integration of the concepts gener-
ated, seriously addresses complexities and variation in the data, and provides a
fresh theoretical grasp of the phenomenon. Ideally, the analysis also opens up sites
for practical applications and social change.
In closing, I want to return to my mentor, Anselm Strauss, a brilliant teacher
in terms of making you as the student do the work of design, data gathering, and
analysis yourself. He was extremely supportive and asked wonderful questions,
but would ntverdo the analysis for you. As a student, this can be very hard. But the
great gift given is that you rc31ly learn how to do your own research and analysis.
That was what he wanted most from and for his students.
Over the years of creating and elaborating situational analysis, I have thought
much about how to honor, extend and even go beyond Anselm as a revered
teacher. Like most of us, I have had too much academic experience of those
who need to put others down in order to push themselves up. As Anselm's
student and later colleague, I learned that doing one's own work well was the
best path "up." I also learned from him (Strauss, 1996) that trying to improve
research tools is a most worthy endeavor. I was in so very many ways deeply
fortunate in "finding a creative present in the context of a revered past" (Dun-
ning, 2003, p. 10).
In my efforts to create and sustain SA, I have thus felt very reassured by the
epigraph from John Dewey on the dedication page of Strauss and Corbin's (1990,
1998) &sits books. Here Dewey offers a commentary on the importance of
change in keeping ide:as vital: "If the artist docs not perfect new vision in his pro-
cess of doing, he acts mechanically and repeats some old model fixed like a blue-
print in his mind" (Dewey, (1934) 2005, p. 50). Strauss and Corbin (1994, p. 283)
further noted that "no inventor h:as pemiancnt possession of the invention-
certainly not even of its namc- ,ind furthermore we would not wish to do ,x,."
I am still working on being that comfortable about SA.
Yct. again, it ,vas a great grounded theory bash. Special thanks to Jan Morse
for her good energies in bringing us all together-not just once but twice.
I sincerely hope situational analysis continues to make useful contributions to
the grounded theory auction. Please feel free to try on-and best wishes for
happy mapping!
Grounded Theory to Sltuattonal Analysis 253
Acknowledgments
Figures 10.1 and 10.4 to 10. 7 originally appeared in the following publiC1tions:
Figure 10.1: Strauss and Corbin's 1990 Conditional Matrix. From Strauss, A.
L., & Corbin, J. (I 990). The BasifS of Qualitative Analysis: Crout1ded Theory
Proctdurts and ·rt,hniquts. Thousand Oaks, CA: Sage.
Figures 10.4 to 10.7: Claske, From Adele E. Claske, Carrie Friese & Rachel
S. Washburn. Situatiot1al A,,alysis: Grounded Theory After tilt Inttrpretive 1i1m,
second edition. Copyright 2018 by Sage Publications, Inc. Reprinted with
permission of the publisher.
Notes
I. On the renawancc in qualitative inqui,y, sec, e.g., Atkinson, Coffey, and Delamont
(2003), Bryant & Channaz (2007b, 2019), Bryant (2009, 2017), Channaz (2000,
2006, 2014), ctul<c (2019b), Cbrl<e, Frie<c & Washburn (2015, pp. 22-50), Den-
zin & Lincoln (1994, 2000, 2005, 2011, 2018), and Lather (1991, 2007). On Anselm
Stnw.s, sec B-=ngcr (1998b), Clarlcc and Star (1998), and Lessor (2000), all avaibblc
at http://dnc2.uaf.edu/public/ansclmstnwwcssay,.hcrnl (acce<scd February 1, 2018);
sec also Bryant (2009), Chamiaz (2008), Chamiaz and Clarke (2020), Corbin (1991,
1997), Hildenbrand (2004), ~e< (1991), Striibing (2007, 2017, 2019), and Wiener
(2007). On Glaser, sec Martin and Gynnild (2011).
2. On "the interpretive tum" ,cc Rabinow and Sulliwn (1987), Clarlce, Frie<c, and
Washburn (2018, pp. 8-12, 62~3), and Clarlcc (2019b). Sec also Clarlce (2009).
3. When lint developing her methodoloi,,y in the 1990s, Channaz (2000, 2014,
pp. 13-14) dutinguished between c01istnutivut and c01istnutionist approodl<S, asserting
that those calling thcrmclvcs colUttUctioni.sts did not necessarily or thoughtfully and
rcAcxivcly view their own work as corutructcd interpretations.. while constructiv-
ists did so. Today she sccs many social consttuctionuts taking a considerably more
rcftcxivc stance toward their worlc. Thw the in-practice differences have narrowed.
With Channaz, I view most everything as construc:tcd and interpreted. an assumption
integral to my version of intcractionum (sec also Blumer 1969). On comtruction-
i=, Hobtcin and Gubrium (2007) offer chapters on constructioni,m across the di,ci-
plines. Channaz (1995, 2000, 2006, 2007,2008, 2009, 2014) focuses on constructivist
grounded theory. Sec aJ.o Velody and Williams (1998) and Weinberg (2015).
4. While I ,ketch these new theoretical and methodological foundatioru in ,hi, chapter,
we develop them much more fully in Cbrkc et al. (2018: chapters 1-3).
5. The critical capacities and analytic, ofconstructivut grounded theory have been ambi-
tiowly elaborated by Chamw: (2011, 2012, 2016, 2017a, 2017b; Channaz Thorn-
berg & Keane 2018). On situational analy,i, as a critical approach, sec also Cbrl<c
(2019a) and Clarke et al. (2015, pp. 77--81, 180-184). Sec :ilio Cbrkc & Chamuz
(2020).
6. The Situalianal Analysis companion web,itc is at https://midy.sag,:pub.com/clarkc2c
(acccs:scd January 29, 2018). Resources avaibblc ontine include FAQ, about SA,
templates for doing all four kinds of situational analy,is nups, exemplars from many
fields, tips for teaching and learning situational analy,is method, video and multimedia
resource,, and the downloadable bibliography from the text.
7. Situational analy,i, work. in German include Clarlcc (2011, 2012a; Clarke & Keller
2011). In French and Portugue<e, sec Henckcs (2007), and Clarke (2010. (2008b)).
Cbrkc's situational analy,i, publications arc listed at the end of this volume.
8 . For c.xcmpla.r, from thc>e fields, sec Appendices B and C of Clarke et :,J. (2018,
pp. 374-383) Sit11•tio111JI An.Jy,is: Croundtd 'n1tory Afi,r th, /111npmivt Tum. They arc
also aV2ibblc at https://study.:1o2gcpub.com/clan:c2c/studcnt-rcsowccs/cxemplars-of-
,iruatiorul-an:,Jy,is-projccis (accessed January 29, 2018); for links to select articles, sec
hnps://study.,agcpub.com/clarke2c/student-rcoourccs/,ogc-jown:,J-articles (accessed
January 29, 2018).
9. Both Dewey (1939) and Blumer (1969) vividly asserted the non-fungibility of theory
and method. Feminist interactionist Leigh Stir (1989) further developed the concept
of"theory/methods pack2gc" as co-constitutive (sec Clarke et :,J. [2018, pp. 23-2SD.
Using a 0 p:ackagc., well involvCJ the r<:$CU'Chcr in learning the theory and the practices
.nd how to articulate them with your own substantive won< (sec Clarke, 1991, 2005,
pp. 2-5;Star, 1989, 1991a, 1991b, 1999,2007;Star&Strams, 1998;Strams&Corbin,
I 997). Such a pacJc.gc may eventually become what Star (2007) ailed the grounded
theory way of "knowing and doing IOJl<llttr." On Star, sec also Clarke (2020b).
10. On the importance ofundcntanding cpi.tcmology and onto~'Y,SCC Carter and Litdc
(2007).
11. Fi.her and Strauss (1978, pp 458-459) ailed intenctioni.m an "auction house," not.
ing that people came and went. buying particular items at will. The grounded theory
tradition operates similarly-for better and wonc. The questions addn:sscd in this
chaptcr:arc answered more elaborately in Clarke et :,J. (2018: chaptcn 1-3) and Clarke
(2019a); sec also Clarke (2005, pp. xvii-81).
12. On the conditiorul matrices, sec Strauss (1987, 1991, 1993, 1995; Straws & Corbin,
1990, 1998; Corbin & Strauss, 1990). Straws would likely have been f.uniliar with
Ocwcy's (1938, p. 60) concept of"the matrix of inquiry," and I suspect it was a key
J'C$0W'C<:' in his development ofthe conditional matticcs.
13. SmuM and Corbin pursued wrious versions of the conditional matrices across a dec-
ade, attempting to refine this tool of grounded theory. Sec Straws and Corbin (1990,
p. 163, 1998, p. 184), Corbin (1991, p. 37), Straws and Corbin (1991, p. 457). In
NtRO(iali""', Strauss (1978b, pp. 98-99) had earlier distingui.hed between a broader
stmdural context and a narrower. more immediate tl(JlOlialio,J context. Later. So-aus.s
and Corbin (1990, p . 100) di.tinguished among caus:,I, int<:rvening. and contextu:,J
conditions.
14. In Corbin's (Straws & Corbin, 1998, p. 184) lint revised edition of "/7r, Basia, pub-
lished soon alter Strauss died in 1996. the individu:,J repbced action as the central
analytic in the matrix, but this was changed back to action in subsequent cditioN
(Corbin & Strauss, 2008, 2015). Strauss (1991, pp. 455-464) also published a paper
he and Corbin had presented at meetings of the American Sociologic:,J Association
in 1990, including a research-based project matrix that showed important further
empiric:,) development of the matrix concept (Strauss, 1991, p. 457).
I 5. Hi.torically in the socw sciences, research was conceptualized as ccntcrcd on the
micro (interpcnonal), mcso (social/organization:,J/institutiorul), and/or maao (broad
historical patterns such as the development of :agriculrurc. transportation, industriali-
zation, globalization) levels. Qualitative =eh was thought to hold sw-zy largely, if
not only, over the micro level (though abo punucd at the mc:so lcvcf), while quantita-
tive iurvcy research targeted both micro and mcso levels. Some quantitative research
addressed macro levels, as did armchair theorizing, only margirully based in empiric:,)
research. By and large, poslStructur:,I theorico reject thi. tripartite fiamcwork. seeing
thi. construct not only as outdat<:d but :,lso as f.iiling to grasp a fundamental assump-
tion ofpoststructur.al thinking--that phenomena arc coco1ufitulivt--prod11ctd tlmn~I• tl~
r,/olio,u of tnlilia al •II ltvtls of O'Jl.aniz•tio,ral <0mplt:xity (e.g., Jasanoff, 2004). That is,
social relations till""°" .U levels. miling social phenomena non- fungibly ":,)) of the
abovc."Thercforc, an:,Jytic focus (both quantitative and qualitative) should be on com-
plexities, relationalities, and ecologies. Thi. strat<:gy iisclf situates the study ofrelations
as explicitly located in space and time-as explicitly silu•kd. Sec Clarke et :,J. (2018,
pp. 62-63).
16. Nor doc. Charmu (2014) di>cw:s them. Corbin and Smu,s (2014) di,cu,s the condi-
tional matrices in ch2p1<r 8 on contexL M ost w<>undcd theory rc=rch papers I have
read r.irdy utiw::.c conditional matrices in the 2nalysi.s, nor arc diagrams commonly
0
wed to integrate a conccptu21 framework. In.stead, generating simple 0 thcmcs is typi-
cally deemed an:alytically ,ufficicnt, though it rarely is and :an:al)'SC$ remain thin and
,h;allow.
17. This wuc is :also at the hC211: of Leigh S12r', (S12r & Cric.cmcr 1989; S12r 1991a, 2010)
2lgWYICnts 2gain>< Bruno utour's (1986) concept of"immut2blc mobiles," which ,he
countered with her own concept of "boundary objccu." She too a,gues for knowledge
as :alway, deeply situated, finnly :and «oloti,olly ,mb<dd,d. While mobile, travel. they arc
adopted and adapted for use in new situations 211d arc thereby transformed. Sec :also
Bowker, T immcm,ans, Clarke, and Balka (2015, pp. 171-259) and Clarke (2020b).
18. Sec Clarke et 31. (2018, pp. 15-18, 47-49, and 68-71).
19. The earliest >Ociological framing wa, William I. Thoma, and Dorothy Swayne Thom-
as', ((1923] 1978, (1928) 1970) funous theorem of"thc definition of the situation."
It wa, foundational for both symbolic interactionism (c.i;,, lllumcr, 1969), and for
corutructionism more bro:adly (Wcinb<rg, 2015). The theorem echoed prag,n:,mt
philosopher George Herbert Mead', (1927/1964, p. 315) :uscnion that situations arr
OTJIOtuZOliMIS of pmp,ttill(S that stratify noturr. Sec :also Cc&:i (2016).
20. In both his rcscarch 211d theoretical writings, Strau,s (c.i;,, 1987, 1991, 1993) 2"Crted
the "goodn= offit" bccwccn pragmatism (e.g., Mead and Dewey), ,ymbolic intcr.ic-
tionism (c.i;,, lllumcr, [1969] 1993), and later ,oci;al con,tructionism (c.i;,, Ilc"l,,cr &
Luckmann, 1966). Toward the end of his career, Straw, publi>hcd extensively on
intcractionist theory and theorists. Sec http://dnc2.ucsf.edu/public/211selmstrau,s/
cv.html (accc,scdJanuasy 23, 2018). On intcractionism, sec c.i;,, Reynolds and Her-
man (2003).
21. On areal nups,scc e.g., Fine (1995) and Kurtz (1984). For Chicago School examples,
sec e.g., Parle (1952), Blumer (1958), and Hughe, (1971 , c,p. pp. 267, 270).
22. The rcscarchcr's capacity to use soci:al worlds/areno.s an:aly,is to open up a situation
c,scntially depends upon doing such b""talt...witchini;, Here a (wually quite complex)
,oci;al world can itself be an:alyzcd as an arena. Alternatively, ascno.s themselves can be
conceived as more like world> and analyzcd .., arenas in a larger complex domain of
multiple and oficn competing arenas. Sec :also S12r (1995a).
23. For cxamplc, sec Bucher (1988) on reform-oriented segments .., ,oci;al movements
inside the medical profcs.sion. The concept of a ..univcnc of discourse.. comes origi ...
nally from Mead ((1938) 1972; sec also Ccfa,2016).
24. Sec Shibur:ani (1955, 1986), Straw, (1959/1997), and Becker (1960, (1967)/1970).
25. On key concepts in social worlds/arcno.s theory, sec Clarke et 31. (2018a, pp. 71- 77).
Straus, and collcaguc, (1964) developed the basic ideas of soci:al worlds/asenas the-
ory and negotiated onlCT theory in an early collaborative research project. Straw,
later developed thcsc ideas more theoretically (Smuss, 1978a, 1978b, 1982a, 1982b,
1991, 1993). For wori<s discussing or using the social worlds/arenas 6-:uncwork, sec
Da=ngcr (1998a, 1998b), Buchcr (191!8), C...per (1998a, 1998b), Clarke (1991,
1998, 2020., 2020b; Clarke & Montini, 1993), Carroty (1997), Star (1989), Wiencr
(1981, 1991, 2000), and reviews in Clarke and S12r (2003, 2008). llcckcr (1982) and
Shibut2ni (1955, 1986, pp. 109-116) also wrote on social world>, though not linked
to grounded theory.
26. Recent worlc on Foucault and pragnutism clarifies why Foucault and interactionism
C2l1 be so comfortably braided together in SA. Several addition:al concepts ofFouc:ault's
arc central to siru•tional an31y,is anolyticoJly: the~. disciplining. fields of practice(,),
conditions ofpossibility, and the dispo,itif. Sec Clarke et al. (2018, pp. 77-85).
27. Many of us using g1oundcd theory took the nonhuman into account in our substan-
tive rcscarch fordccadc. (Clarke, 199S; Star, 1989; Clarke & Star, 2003, 2008). But we
did so willJOfll the methodological reflexivity rcquUltc to nuke this innovation explicit
and clearly pomaucrural, accomplished by ANT (sec note 29). Recent developments
256 Adele E. Clari<e
such as the .. new•• materialism. 0 thc ontological rum.•• and variow cbborations of
ponhumanilm postdate my development ofsitu2tion.al an21~ and its indwion ofthe
nonhuman (Clarke., 2003, 2005).
28. Onpng,nati,m, intcnctionmn, and "thini;s."scc e.g .• Mead ((1927] 1964); McCarthy
(1984, pp. 108---109). Parle and Burgc,s ((1921) 1970). and Cef:u (2016).
29. On actor-network theory (AN1), sec e.g.. Latour (1987, 2005) and Law and H:mard
(1999). For intcnctioni>t critique, of actor-nctworlt theory, scc Clarke et al. (2018,
pp. 363-364, 371n21). Especwly on nonhunun "l,'Cncy, sec Casper (1994), Latour
(2005), and uw and H:ward (1999).
30. Caspcr's (1998b, sec abo 1994) concept of"worlt objects" was generated through her
research on feta! surgery. Sec e.g.. Clarke (1995) on the salience of nonhumans in
scientific ==eh in n:productivc physiology, and Hanway ((1985) 1991a, 2007), on
the vexed boundary between human and nonhuman.
3 1. On social worlds/arenas theory in SA. sec Clarke et al. (2018: chaptcr 3). For initial
worlt sec Clarke (1991). For Stnw.'s final statcmcnt on his theory, sec Stnuss (1993,
pp. 209--260). More gcncr.illy, sec notco 23--26.
32. A. a doctoral >tudent. 1 a,ked Stnu.s whether one could usc grounded theory to analyzc
historical documents (one gcnrc of discourse material). He wd yes, and I then uscd it in
several discourse analysis proj«ts (e.g.. Clarke, 1995; Clarke & Montini, 1993), includ-
ing my disscrt2tion (Clarke. 1998), which intcgratcd analyses ofscientific litcraturco and
primary azcluval materials as disco= with intcrvicw and obscrn.tional data.
33. Both Star (1995b) and 1 (Clarke, 1998) were deeply inftucnccd by Rosenberg's (1979)
C2llic:rat1,,umcnts in an article on «ologiesofknowlcdgc.
34. The fturry ofnew work on critical qualitative inquiry includes e.g., Dcmin, Lincoln,
and Tuhiw.u Smith (2008), Cannella, Pc!Tcz, and Pasquc (2015), Denzin and Cuaroino
(2016), and a Special Issue on Critical Qualitative Inquiry, guc,t edited by Mirka
Koro-.Ljungbcrg & C:ailc Cannella of the /,,t,nu,/io,u,/ R.tvinv of Qu,,/i/4/ivt Inquiry
10(4):327-498. On critical grounded theory, sec note 6 . On critical SA, sec Clarke
(2019a) and Clarke et al. (2015, pp. 77~1. 180-184).
35. On bou,idory ohj,as, sec Star (1988, 2010; Star & Cricocmer 1989; Bowker & Star
1999), Bowker et al. (2015, pp. 171- 259), and Clarke and Star (2003, 2008).
36. For further cxemplan of boundary objects, sec e.g.• Fricoc's (2009, 2010, 2013) work
on cloning of cndangcn:d specico, Washburn's (2015; Clarke et al .• 2018: ch2ptcr 12)
worlt on biomonitoring outcomes, and Fwicr's (2014) = h on PTSD.
37. I developed the concept of impli<4l(d Odon earlier in my career as part of my own
development of social world,/an:nas theory (Clarke 1991; Clarke & Montini, 1993),
and latcr cbbontcd it as part ofsituational analysis (Clarke, 2005, pp. 46-48; Clarke
et al., 2015, pp. 93-95, 2018, pp. 76-77).
38. Special thanks to Laura Mamo for important early discussions on this point.
39. Sipcandy, punuing minor discourses involves extending critical Foucauldian di.-
course analysis, and following in Foucault', /41,r footsteps when he began to punuc
analysco ofrc>istancc as well as of power (Clarke et al., 2018, pp. 225-227).
40. For a Mexican environn,cntal exemplar, sec Clarke et al. (2018: chaptcr 8), focused on
Alonso Yanez' project, and Alonso Yanez et al. (2016).
41. For other ~hen• rcAcct:ions on using situational ana1)'3,U collaboratively. 5CC
Clarke et al. (2015, pp. 234-240, 285-291, 314-321).
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Roudodgc.
11
EXEMPLAR
Situating Knowledge
Jennifer Ruth Fosket
In her now classic piece, "Situated KnowlodgC$: The Science QuC$tion in Femi-
nism and the Privilege of Panial Perspective," Donna Haraway (1991) reclaims the
metaphor of vision to aniculate a kind of objectivity which accounts for the his-
torical contingency of all knowlodge claims yet simultaneously maintains a com-
mirmcnt to some degree of "truth" to those claims. For Har.tway. the seeming
conrradiction in simultaneously occupying both of these positions can be usefully
navigated through this metaphor. Vision, she arguC$, while often rcprC$cntod oth-
erwise, is nccC$S3rily partial as it is embodied within a specifically situatod subject.
Haraway (1991, 1999) insists on recognizing the materiality, the cmbodicd-
nC$S of all pcrspcctiVC$. There is no longer a view from nowhere but always a
view from somewhere specific, marked, intcrC$tod, and inherently partial. This
partial, situated objectivity-vision is politically advantageous because it insists that
all positions arc located within realms of political mancuvcring and social change
and reveals how they arc so. It also allows particular embodied actors to be held
accountable for what it is that they sec and do with their vision.
Following on thC$C and other aniculations of "situatod knowlodgc," schol-
ars, C$pccially feminist scholars, have conducted "situatod" analyses of social
phenomena. ThC$C have been pursued through foregrounding the pcrspectivC$,
expcricnCC$, and voiCC$ of people located at the margins, as well as through de-
stabilizations of the assumod "objectivity" of dominant knowlodge producers via
foregrounding their knowlodgc as equally cultured, markod, and situattd as any
other. The theoretical implications of situated knowlcdgC$ and postmodcmism
more broadly become more problematic, however, in trying to understand the
multiplicity of positions, the cultural, economic, historical, and social elements
that each and all situate a particular knowledge or set of knowledges. This is
methodologically problematic simply due to the sheer number of possibilities, the
268 Jennifer Ruth Fosket
messiness of data collected at multiple and not necessarily congruent sites, and the
deanh of traditional methodologies that can help malce sense ofit.
Recently, Adele E. Clarke (2003, 2005) theorized an "updated" grounded
theory that attends to the problematics and projects of posnnodemity thus pro-
viding methodological means to make sense of just these kinds of complexities
and differences. Clarke aniculates new approaches to analysis within a grounded
theory framework that she calls situational analyses. Situational analyses utilize
various types of maps to provide access points into one's data, to act as tools
for drawing linkages between variously conceptualized sites and to propel the
researcher into w hat I have called "thick analysis" (Fosket, 2002). In this paper,
I discuss the usefulness of Clarke's methodological innovation for empirically
studying situated knowledges gleaned through my own experiences of using it to
study a large-scale, multi-sited clinical trial.
Framing My Problem: Clinical Trials as Situated

Knowledge
I conducted a multi-sited ethnography of a clinical trial in order to explore the
emergence of new knowledge and practices aimed at treating risk for breast cancer
(Foskct, 2002, 2004, 2010). Intrigued by the recent emergence of pharmaceuti-
cals aimed at intervening into bodies that were classified as "high risk" for breast
cancer in order to reduce that risk, I sought to understand who and what were
imponant to the construction of this new knowledge. To me, this new knowl-
edge seemed to mark a radical shift in how pharmaceuticals arc being thought
about and used, how high risk for breast cancer is being conceptualized, and how
prevention is being understood and enacted. I wanted to explore these shifts in
knowledge as they were emerging, to track and make sense of the competing
discourses budding around this new phenomenon called chtmoprevmtio11.
To tackle these questions, I chose to focus on one large-scale chcmopreven-
tion clinical trial. Often depicted as the gold standard for biomedical knowledge
production, a clinical trial seemed to be an ideal location to explore the construc-
tion of knowledge in aaio11. I collected data from multiple sites and positions in
order to grasp how the trial looked from each. Instead of a few devoted people
working full-time to conduct the research, the clinical trial I actually studied con-
sisted of numerous people working with varying levels of comminncnt and time
and included as imponant players those located in key organizations as weU as in
other often surprising and sometimes marginal sites and sources. As 1 began to
uncover the layers of experience, action, and meaning that constituted the trial,
it became increasingly evident that, while ultimately producing what appeared
to be a coherent set of knowledges defined as objective, the knowledges being
produced were fragmented, partial, and very much situated.
However, in order to get to a place where I could begin to make sense of what
aU of this meant. I had to find my methods. I began with a desire to conduct a
Exemplar 269
social worlds analysis that evolved into situated analyses as I delved further into
the process. I next describe these methods.
Situated Analyses
A centr.11 focus of grounded theory has long been on uncovering the basic social
process-the kinds of action-at the heart of the phenomena being studied. In
contrast, Clarke (2003, 2005) argues that we need to move beyond a sole focus
on action to a more broad and full focus on the entire situation in all of its many
complex parts. The theoretical roots of this lie in social worlds/arenas theories
first aniculated by Anselm Strauss (1978a, 1978b, 1991) and Howard Becker
(1982) and elaborated by Adele E. Clarke (1991, 1998; Clarke & Montini, 1993).
In his theoretical work that formed the basis for his methodological innovation
of grounded theory, Anselm Strauss (1978b) understood social order as negoti-
ated and thus fluctuating, unpredictable, emergent, and always contingent. From
this emphasis on group action and organizational dynamics, Strauss (1978a) and
Becker (1982) proposed social worlds/arenas theory where social worlds consti-
tute the shared realities within which people act, interact, and make meanings
of their situations in w:i.ys that give rise to shared realities. Within social worlds
and the substantive arenas of shared concerns and commitments in which those
worlds intersect, knowledge is constructed in an ongoing fashion vis-a-vis the
everyday practices of whatever the world is focused around.
Adele E. Clarke (1991, 1993) asserts that social worlds/arenas theory offers a
useful w:i.y to understand the historical construction of particular phenomena by
examining the social worlds that participated in creating it. Within this frame,
distinctive constructions of knowledge can be viewed as emerging within par-
ticular social worlds which share specific goals and have stakes in constructing
knowledge in particular ways. In social worlds/arenas theory, theoretical possibili-
ties open up to view knowledge as collectively constructed in everyday practices.
Here, social worlds (rather than individual positions) arc understood as resources
for knowledge production. As articulated by Clarke, social worlds/arenas theory
understands the negotiated nature of knowledge construction as conflictual and
shaped by power. This theory provides a dynamic and interactive len.s through
which to view multiple constructions of knowledge because it acknowledges the
constant contentions going on among •nd within social worlds over how a par-
ticular phenomenon will be constructed and the w:i.ys in which these interactions
are, ultimately, mutually constitutive.
With her conceptualization of situational analyses, Clarke moved these the-
ories further (2003, 2005). Here social worlds/arenas theory expands to include
as consequential elements everything within a given situation. That is, it is not
just the social worlds and their human and nonhuman elements that situate
and shape knowledge and practices, but histories, discourses, symbols, institu-
tions, material things, and anything else conceived of as present in the situation.
270 fennlfer Ruth Fosket
Thus in theorizing the processual and interactional character of knowledge

construction, it is important to grasp the interactions and practices engaged in
not just by humans but also by all of the other consequential elements in the
situation. What Clarke's theorizing offers is a concrete analysis of knowledge
that not only notes how it is situated but vividly dcconstructs what constitutes
that situation.
Within this framework, an understanding of the work of scientific knowl-
edge production requires an understanding of everything in the situation: the
workplaces and their organizations, scientists and other workers, theories, mod-
els, research materials, instruments, technologies, skills and techniques, sponsor-
ship and its organization, regulatory groups, audiences, consumers, and so on.
Each of the relevant elements is not merely contextual (i.e., background) but
conditional. Each element is an integral aspect of the situation itself, constitutive
of the practices and contingencies of the research work that constitutes the very
construction of knowledge. Even those elements that arc not pi,ysically present in
the situation arc part of the situation in a very real sense.
In order to analyze these complex and multi-sited situational elements, Clarke
(2003, 2005) articulates various types of maps that can be used as methodological
srratcgies in doing situational analyses. Specifically, she describes situational maps,
which plot all of the relevant elements in the situation and enable analyses of their
relationships; social worlds/arenas maps, which illuminate the social worlds, col-
lectivities, and arenas of commitment which engage with the situation; and posi-
tional maps, which lay out the interests, commitments, and positions explicitly
taken (or absent) in various discourses found within the situation.
Clarke describes situational analyses as approaches which, among other things,
can help free a researcher from "analytic paralysis." One source of analytic paraly-
sis that emerged for me resulted from questioning how to make sense of the
multiple elements emerging as I interrogated various sites of the clinical trial.
Following grounded theory, I had been continuously coding and writing memos
throughout my data collection process. Indeed, these analytic processes led me
to the various sites at which I collected data, helped form the questions I asked
interviewees, and helped me probe deeper into my data. However, at some point,
I felt lost amidst mountains of data which I intuitively knew were interrelated, but
which I could not initially figure out how to wrap my brain around. In attempt-
ing such a potentially disparate and non- unified or universal analysis, I needed
tools that could tic elements together, conceptually linking the various situated
positions, identifying their interrelationships, and seeing as complexly woven
together what might otherwise appear isolated. Situational analyses provided such
tools for me. By sitting down in the middle of my living room floor with a huge
piece of paper, paralysis broke as I began drawing circles and lines, mapping the
various positions and elements that I was grnppling with. As I sketched this and
subsequent maps, I was clarifying relationships between elements, understanding
who and what was important to the situation, and I was, for the first time, able
Exemplar 271
to conceptualize the wholeness of what I w:is studying- rather than fragmented

bits of interesting ideas and data.
At the same time as my needs prompted the use of tools, so too did the tools
themselves shape my analysis. As I began mapping I clarified and extended my
research agenda--realizing how very situated the situation truly was. For me,
mapping the various social worlds and other elements in STAR provided great
insights into my data. The maps themselves turned out to be v.Juable anifacts,
visually representing the complex array of factors that nuke up the STAR trial.
To illustrate my use of situational analysis, I present and briefly describe here
my own use of the first two types of maps Clarke, situational and social worlds/
arenas, for my research on a clinical trial. (For a greater elaboration of the clinical
trial and my conceptualizations and uses of these maps, please sec Foskct (2002) .)
These maps reflect my own partial and situated knowledge and do not exhaust
every possibility, but rather represent those elements and actors that emerged as
most salient in the fieldwork that I conducted.
Locating the STAR Trial

The clinical trial I studied is called the Study of Tamoxifcn and Raloxifcnc--or
the STAR trial. Its purpose was to compare tamoxifcn, 3 breast cancer treatment
drug that had recently been FDA-approved for use in healthy women to reduce
their risk of breast cancer, with raloxifcne, 3 drug thought to similarly reduce
breast cancer risk without as many side effects. The STAR trial is located within
the newly emerging chemoprcvention arena. Chcmoprcvention, the practice of
ingesting pharmaceuticals or nutraccuticals to reduce the incidence of disease, is a
relatively new phenomenon within the arena of breast cancer and I used the social
worlds/arenas map to conceptually locate its emergence at the intersections of
groups, organizations, and interests that had, until the trial was begun, maintained
separate spheres. Figure I I.I locates the chcmoprcvcntion and STAR trial arenas
within larger intersecting arenas.
The chcmoprevention arena is located at the centcr of this =P· This arena
includes the STAR trial and also includes other clinical research and practices cur-
rently ongoing around chemoprevention that I do not l:lkc up in my research. The
chemoprevention arena is itself situated at the intersections of the treatment and
prevention spheres of the breast cancer arena. Because chcmoprcvcntion involves
administering drugs previously used as treatments to prevent breast cancer, it rep-
resents an innovative prt11et1liot1 cndeavor l:lkcn up primarily by lrtal1t1t111-oricntcd
oncologists. Thus it begins to blur the lines between treatment and prevention in
unprecedented ways. I have also included breast cancer genetics as an arena that
intersects with treatment, prevention, and chemoprcvcntion aren35 as well. Also a
newly emerging arena, breast cancer genetics currently represents another exam-
ple ofa site where treatment and prevention lines arc becoming increasingly fuzzy,
as genetic 355cssments may trigger more active prevention strategics.
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FIGURE 11.1 Locating the srAR Tri:il
Both the treatment and prevention spheres arc part of the larger breast cancer
arena which includes myriad other elements, worlds, and arenas that I do not
depict here. The breast cancer arena itself is located at the intersections of the
women's health and cancer arenas. These two arenas each represent much larger
arenas in and of themselves, and here they overlap around the breast cancer arena.
(They also overlap around arenas that have emerged for other types of cancer
impacting women, not represented here.) The women's health and cancer arenas
arc themselves located in the much larger domain of U.S. healthcare.
Mapping the Situation: Who/What Matters to STAR

Upon entering the field of STAR, one of the first things I realized was that this
"site" itself consisted of multiple sites. It comprised many different elements com-
plexly organized and webbed together to form what I ultimately conceived of as
the "srAR trial arena." Nonhuman actants (things of various kinds fiom furniture
to technologies to discourses), social actors, body parts, research protocols, organi-
:z:,tions, and paperwork represent key elements in the constitution of the trial,
Exemplar 273
3lld critical activists and p3SSionate advOC3tes :1re central. Addition31ly, the deeper
I delved into the rese:1rch, the more obvious 3lld import3llt the historical and
political situatedness of STAR became. By requiring the rCSC:1rcher to map out all
of the "analytically pertinent human and nonhum3ll, material and symbolic/dis-
cursive elements of a particular situation as framed by t.hose in it and by the analyst"
(Clarke, 2005, p. 87), situational maps draw out complexities and reveal which
anticipated 3lld unanticipated elements of the situation matter.
Figure 11 .2 represents my situational map, highlighting the most salient ele-
__
ments. The categories used here :1re not absolute but reflect what ended up being
most meaningful to me and central to my analysis as I made sense of my data.' An
,_,
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s.cw Men-atata/A.cttn:lml
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FIGURE 11.2 STAR Trial Situational Map

274 JennKer Ruth f<>sket
important ospcct of siruational maps as analytic tools is their use in uncovering

relations between clemcnts. 2 In the remainder of this section, I narrate this siru-
ational map, highlighting certain of the key elements and relationships in depth.
Multiple culrural discourses, ideologies, and/or rhctorics prevalent in U.S.
society and/or in U.S. biomedicine arc key elements to the siruation of~TAR
because they arc consequential in shaping the ways in which brcost cancer is
thought about, treated, and its "risks" attended to. The STAR trial is nude pos-
sible not just through securing the necessary tools, bodies, resources, research-
ers, and other material needs, but also through the management of credibility
and legitimacy derived through ideological, culrural, and discursive elements
(Epstein, 1996). Certain culrural idcos about women's bodies, about the origins
of disease and the most appropriate sites for prevention, about the dangers of risk
and the importance of classifying the normal and pathological distinctly, about
what counts 3S good research and scientific knowledge, and what the causes,
consequences, and appropriate responses to cancer arc, all crc:itc a situation in
which STAR appears as a credible solution to a particularly constructed problem
of "brC:tSt cancer risk." For instance, I argue that the prominence of a "down-
stream approach" to healthcare, an approach that focuses not on prevention of
discosc but on its treatment, already well accepted in the U.S., itself contributes
to chcmoprcvcntion's credibility 3S a reasonable prevention option. In a frame-
work already accustomed to treating symptoms of individuals, the idea of trc:iting
risk is a logical extension of nomutivc biomedical ideology and practice. Thus
"downstream medicine" becomes an important discourse in my map. As another
cxan1plc, "clinical trials" appear 3S a discour,c in my map. By this I refer to the
dominance of clinical trials 3S the most credible form of biomedical knowledge
construction (Marks, 2000), and this history and current stronghold powerfully
shape the situation of STAR.
In addition to rhetorics/discourses/idcologies, key social processes arc also
important elements in my situational map. Biomedicalization and its attendant
processes of standardization and risk osscssmcnts arc social processes very much
at work in the shaping of the STAR trial. Biomedicalization is a social pro-
cess through which incrcosing aspects of the life world become identified by
and imbued with medical and technoscicntific meaning and subject to inter-
ventions via the V3St armamcntarium of tcchnoscicntific tools, knowledges, and
organizations at the disposal of biomedicine (Clarke, Fishman, Fosket, Mamo, &
Shim, 2003, 2010; Foskct, 2010). In our elaboration of this concept, however,
we emphosizc that biomedicalization is not just imposed from above but is part
of a culrural system with which individuals also pragmatically and often inescap-
ably engage. In this way, biomedicalization is also an ideology-a way of thinking
about and acting toward health and wellness-that is prevalent and consequential
in shaping the subsequent knowledges and practices related to health.
The STAR trial is also very much a product of the growing emphasis on risk
assessment which is part of biomedicalization. Populations of women previously
Exemplar 275
considered "nonnal" arc tr.msfonned into "potentially ill" populations as a result

of their classification into "high-risk" categories. With biomcdicalization comes
an increased attention to risk and the transformation of bodies designated at risk
through pharmaceutical interventions. T hese risk assessments are fundamental to
the crcclibility of a trial like STAR in that they create a group of women who arc
considered at high enough risk to be legitimate users of chemoprcvcntion drugs
(Foskct, 2004, 201 O).
In constructing a situation:il map, non human elements arc important features
consisting of matcri:ils, tools, and other "things" in the situation. Highly signifi-
cant nonhuman actants in the STAR arena arc the pharmaceuticals themselves,
tamoxifcn and raloxifcnc. Computers, computer networks, special software, and
the Internet arc also all critical nonhuman actants in the situation of STAR.
Without computer networks and standardizing specialized software progranlS,
STAR could not function as the multi-sited research project it is.
Blood, tissue, tumors, DNA, and other body parts arc taken from women's
bodies and stored, analyzed, transported, isolated, and used in multiple ways as
data for STAR. As these elements become preserved, packaged, sent from place
to place, banked, and so forth, they become nonhuman actants in the production
of knowledge about chemoprcvcntion and breast cancer risk. However, I also
tcnn these "(dis)embodicd elements" and highlight them here so as not to efface
their human origins. These once embodied elements of research participants'
bodies arc deeply consequential for STAR as they represent the raw data which
shape actions on a daily basis (i.e., if a segment of breast tissue is found to contain
cancerous cells, interactions with and participation by the woman to whom that
breast tissue belongs will change profoundly). These elements and the knowledge
regarding the dangers and/or efficacy of tamoxifcn and raloxifcnc that they rcvc:il,
will ultimately guide the representation of the findings of STAR and subsequent
actions taken as a result of it.
Many, many different individu:ils arc key players in STAR and appear in the
situational map. Each researcher, each wonun engaging in the enrollmcnt process,
whether or not she ultimately chooses to join, each doctor referring women into
the trial, or making the choice not to do so, and every other individu:il making
choices and taking actions that arc related to STAR arc consequential because it
is ultimately the collaborative, intcractional, and collective actions of each of these
individu:ils that propel and shape the clinical trial. There arc direct relationships
between many of these individuals and other elements in the situation-they arc
linked to organizations listed; they procure and engage with the nonhuman act-
ants and (dis)embodied elements; they arc shaped by and act within marketplaces
and social processes described; and many of these individuals arc also situated
within particular collcctiviti~cial worlds whose interests, contributions, and
stakes in the trial arc elaborated later in my social worlds map (sec Figure 1t .3).
In addition to those who ma.kc a difference in STAR through their everyday
actions and interactions around the trial, other individuals represent key players
276 Jenn~er Ruth Fosket
NCI (Divuion oC C..00,
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bted o9i6 ■-.~w.wr',STAK
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Aw:bibfCf'. K&mi(-, ud pl.a,c,clt,o..
...........,_,_,_
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b r i : l k ~ (IDOM)', ~ .
ripl lo IDldtct nloa.if'- - prOYCIIICaOD
or ,iat ~ power u . .p
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FIGURE 11.3 STAR Trial Social Worlds Mlp
in the situation due to their role in the emergence of chemoprevention, risk

assessment, breast C3Jlcer, or other arenas that shape the situation ofSTAR. These
include those individuals who posed the theories and instigated, popularized, or
(JCIVed the way for key rCSC3rch and conceptual shifts that led to chemoprevention
and eventually, to STAR.
As consequential actors within the organizations, institutions, and social worlds
that conduct, monitor, oppose, support, and represent STAR, innumerable indi-
viduals could be cited as important to the situation, including the person who
monitors the books and signs the paychccks, the person who sustains the lives of
those who spend long hours working in the labs that process potential participants'
Exemplar 277
blood =-iplcs, and endless others. What is interesting and important about high-
lighting this is that it demonstrates the sheer numbers of people involved, to vary-
ing extents, in the coUaborativc interactions required to conduct such scientific
research. The work of so many visible and invisible individuals plays its part in
shaping just how and why STAR emerges in the ways it docs. While some indi-
viduals arc important elements in and of themselves, they arc also important in
terms of the collective organizations in which they arc situated. There arc myriad
collectivities and institutions that represent key elements in STAR including the
professional organizations to which researchers belong which publish journals and
hold conferences where knowledge about STAR is traded; those innumerable col-
lectivities to which individuals important in STAR belong and which shape their
ways of being in STAR; and the various institutions and organizations that play
key roles in STAR. In addition, other healthcare organizations and institutions also
play key roles in the situation of STAR. They arc important to STAR as sources
of potential participants, and STAR recruitment efforts target healthcare provid-
ers located in a variety of organizations and institutions. They arc also important
as groups with whom local sites and the National Surgical Adjuvant Breast and
Bowel Project (NSABP) need to cooperate for data coUcction purposes: pathology
reports, mammograms, physical results, and so forth.
Fin2lly, various media constitute an additional important clement in the situ-
ation of the STAR trial. Media fundamentally problcmatizc the ways in which
knowledge is accessed, disseminated, and constructed. Popular media have been
important players in STAR from the outset when national media began to run
"news stories" of STAR that double as recruitment opportunities for the NSABP,
complete with a 1-800 number to caU "for more information" at the end of the
news rtory. In these moves, news items arc transformed into marketing strategics,
"infomcrcials" for biomedicine and for the pharmaceutical companies whose
drugs arc on trial. Since then, coverage has continued and media outlets arc
considered and used as crucial sites for STAR recruitment. They arc also used
as tools for activirts' critiques. Media arc also important as sites of direct to con-
sumer advertising of tamoxifcn, which shapes the trial in important ways already
discussed.
Scientific literature media have also been important sites wherein claims and
countcrclaims about STAR and chcmoprcvcntion take place. During the early
1990s, the scientific literature was a source of not insignificant critique of tamox-
ifcn as chcmoprcvcntion. The controversies over the early design and conduct of
the Breast Cancer Prevention Trial were discussed in letters to the editor of the
L.a,utt (e.g., Cosl3, 1993), news articles in Sdi:rue (e.g., Marshall, 1993, 1995), and
other media sources. There was much concern expressed in these articles regard-
ing giving toxic drugs to healthy women to prevent a disease that strikes with
relative infrequency, and whether the evaluation of the "risk" of drugs should be
different for prevention than for actual c:mccr therapy (e.g., Love, 1995; Pitot,
I 995; Bush & Hclzlsoucr, 1993).
Another important way to think about collectivities is in terms ofsocial move-

ments. The collective organizing of social movements in health and illness must
be considered key elements within 3IIY biomedical situation 3S these movements
have brought about profound changes in the ways that biomedicine, including
biomedical r=rch, is thought about and practiced. Several social movements
arc pivotal to the situation of STAR, most importantly breast cancer movements,
women's health movements, and AIDS activism. These movements arc important
for the changes they have provoked in policy, institutions, treatments, and in dis-
cursive constructions of health, wellness, disC3Sc, research, and the meanings and
rights of patients. STAR h3S most certainly been shaped by the historical gains of
these movements 3S well 3S by current activism.
Discourses, social proccsscs, markets, nonhuman actants, individuals, collec-
tivities, and social movements all represent central elements constituting the situ-
ation of STAR. While m3Ily of these elements also and simultaneously come
together around various other issues, this particular conglomeration of actors,
actants, social forces, and processes arc those which I conceive as mattering to
STAR. As this analysis highlights, clinical trials like STAR do not take place in
a vacuum 3S biomedicine and biomedical research arc not separate from, but arc
intimately part of, larger cultural and social contexts. Next, I focus in even more
closely to elaborate the key social worlds that constitute STAR.
Mapping the STAR Trial Arena

While the situational elements described in the previous section arc constitu-
tive of the situation of STAR, this is only true in so far as there arc committed
groups, individuals, and organizations that engage in the work of making STAR
an actual arena of action. Social worlds arc the sites of action around STAR
within which the elements already described come to matter. Social worlds map-
ping involves identifying the collective commim1cnts and actions organized into
social worlds that come together to constitute the social arena of interest (Clarke,
2005}. Within social worlds analyses (e.g., Clarke & Montini, 1993}, one begins
by empirically specifying the key players (individuals and groups} who arc active
around the phenomena of interest and those important in the historical construc-
tion of the phenomenon.
STAR is 3II arena consisting of intersecting social worlds concerned about the
issue of brc3St cancer chcmoprcvcntion. Figure 11.3 represents a simplified ver-
sion of my social worlds map of STAR, including who they arc, their stakes, and
their contributions. There arc a couple of important things to notice in viewing
this map. First, the filled-in oblong running down the middle of the map repre-
sents the STAR trial. The circles that overlap with this oblong represent social
worlds "officially" linked to STAR-that is, those who have an organizational
role in STAR. arc considered a part of the trial by those who designed it and/
or have a legal and/or fiscal role in the trial. Those social worlds not overlapping
Exemplar 279
the oblong represent social worlds that I conceptualize as crucial to the STAR
arena, but that arc not "official" participants. Additionally, some of the circles
overlap with each other and others do not. The overlapping circles represent
social worlds that arc interconnected in some official capacity-fiscally, organiza-
tionally, and/or in terms of personnel.
Discussion
The elements, social worlds, and arenas represented by these maps and described
in the previous sections illuminate my efforts at situating the knowledge con-
structed in clinic:al trial research rcg:,rding women's bodies, risks, and the appro-
priateness of biomedical intervention. The maps enabled me to organize and
make sense of the data I had collected and the preliminary thoughts I was having
about a vast number of things that, unrelated in many ways, all shared common
linkages to the production of knowledge at the site of the STAR trial. Once
visually available to me in the fom1 of a map, I could begin to systematic:ally flesh
out each clement, understand its relationship to STAR and to other elements,
know what needed to be elucidated about them, and decide on next steps in my
research process. In these very concrete ways, the methodological maps aided my
process of undertaking a situational analysis of a clinical trial. In this discussion
section, I further explore ways in which situational maps can help materialize
some of the sometimes elusive goals of feminist and postmodcm theory in the
concrete practices of empirical research.
Difference and Complexity

One of the striking benefits of situational mapping is the ability to make sense of
and an:alytically compare and contrast non-congruent data sources. Conducting a
multi-sited ethnography that was revealed to be increasingly complex as I under-
took its mapping meant that my data derived from heterogeneous sources through
heterogeneous methods. I conducted archival research in medical journals on
the emergence of chcmoprcvcntion drugs; textual analyses of FDA proceedings
as well as popular media articles; in-depth qualitative interviews with various
types of participants; participant observation at meetings; and analyses of images.
Whereas another project might home in on one of those data sources as primary
and use the others for framing or contextual background infomtation, for me,
each source was considered of comparable importance to my understanding of
the situation of STAR. The maps allowed for this heterogeneity as each clement
can be added in the map and considered as part of the analysis.
This is increasingly valuable to sociology and social studies ofscience in particu-
lar as more and more cross-disciplinary coll:iborating and intellectual borrowing
means that research studies arc often composed of a hybrid of mcthods-<ociologists
including serious historical analyses, utilizing anthropological ethnographic
280 fennlfer Ruth fosket
methods, and/or analyzing texts or cultural representations. Situational analyses

provide an important tool for engaging with such transdisciplinarity in ways that
at the same time produce richly sociological analyses.
Simultaneously to providing tools for analyzing such postmodcm projects,
situational analyses arc also valuable in helping to initiate such projects and create
useful complexity and depth in what might otherwise be thin. In my mapping
of the srAR trial, multiple elements arose that I had not previously considered
important and propelled me in new directions, helping me delve deeper into the
complexity of the situation ofsrAR.
Relationships and Blurring the Macro/Meso/Micro

One of the central uses of situational analyses is to discover the relationships
between elements through mapping. Clarke (2005, p. 142) writes of situational
mapping:
All mapping strategics are at base relational. This is a radical aspect of the
approaches offered here compared 10 "normal" social science and positivist
approaches that arc at base atomistic, based on supposedly isolable "vari-
ables" and intentionally dccontcxtualizing (for lack of a better term).
Additionally, because these elements can be heterogeneous, these relationships arc

often relationships amongst elements located at distinct conceptual levels. In this
way, situational maps help to blur distinctions between micro/macro/mcso levels.
They help to understand dynamic interrelationships between elements at all of
these levels and how many may exist at multiple levels simultaneously.
For instance, through doing relational analyses using my situational map I was
able 10 sec linkages between discourses and social processes of consumerism,
practicalities of clinical trial research practice, and the nonhuman elements of
the study pills. Women participants in srAR arc required to take two pills a
day, one each of the drug they have been randomized 10 and a placebo made 10
look like the drug they were not randomized to. This is an interesting necessity
brought on by the marketing of pharmaceuticals, such that tamoxifcn, sold under
the brand name Nolvadcx by AstraZeneca and raloxifcnc, sold under the brand
name Evista by Eli Lilly, arc each purposefully created to look distinctive and
thus inspire brand recognition. Yet such distinction works at cross-purposes 10
a double-blind randomized controlled clinical trial, where 1101 recognizing what
brand is being taken is paramount. Instead of providing anonyrnizcd drugs, the
pharmaceutical companies provide their own drug and a placebo that looks just
like it. This "solution" exemplifies the dominance of consumerism, where logos
proliferate, and the right to market one's brand is not to be hindered even during
clinical trials.
Exemplar 281
Relativism and Positlonality and Reflexivity

While situational analyses maintain a commimient to researching a particular
phenomenon of interest from multiple perspectives, one of the benefits of situ-
ational analyses is that such projects do not assume or imply a theory of relativ-
ism. Haraway argues, "Relativism is a way of being nowhere while claiming to
be everywhere equally. The 'equality' of positioning is a denial of responsibility
and critical enquiry" (Haraway, 1991). Within Clarlcc's articulation of situational
analyses, positional maps in particular provide this kind of attendance to the dif-
ferences in power and responsibilities that shape the various positions investigated.
Within positional maps, the analyst explicitly marks the actants and knowl-
edges in the situation as intnestcd. It is not possible within this type of analysis
to claim a "view from nowhere" because the researcher is literally specifying the
positions taken by those that constitute the situation. Through each of the types
of maps, the research is constantly situating the people and thin~ of import to
the situation within real worlds of interests, politics, passions, histories, and more.
In this way, it is not just otl,n positions that become glaringly obvious, but one's
own as well.
Inevitably, in conducting this kind of situational analysis, the researcher must
consider themselves as elements in the situation. In this way, reflexivity becomes
an intimate part of the research agenda. Clarke (2003, 2005) asserts in her
description of situational mapping that researchers' own experiences of research-
ing should be considered data in mapping. In uncovering the siruatcdncss of the
STAR trial, I needed to sec the ways in which I am part of that situation. This
was evident in thinking through how my presence and particular situatedncss in
the world of breast cancer shaped the research in fundamental ways-it shaped
who I had access to and what kinds of thin~ those who I interviewed were ready
to share. My entrance into the world of breast cancer politics began in 1993 when
I attended my first Breast Cancer Action (BCA) meeting with my teacher and
friend, Christine Lafia, who had recently been diagnosed with breast cancer. We
soon became active participants in the organization, drawn to its radical and femi-
nist politics and unflinching telling of difficult truths about breast cancer. In 1996
Christine died of breast cancer, and my experiences with her illness, dying, and
death drew me even more passionately into the world of breast cancer scholarship
and activism. In the almost 10 years since, I have continued to be a part of Breast
Cancer Action, always as a member and sometimes as an activist volunteering at
various venues. Indeed, some of my fieldwork experiences at national conferences
were paid for by BCA where I was both a fieldworker and an activist, collecting
data for my research and writing excerpts for BCA's website. I have made many
friends through my work with BCA and received invaluable support and exper-
tise for this research. Mostly I have found this connection and my clearly messy
involvement with my object of study of benefit to my research. I am constantly
learning from the 3ctivists I engage with and know much more 3bout the arena of
breast cancer than I could ever possibly know if I were not so involved.
However, I am also aware that my positioning poses some dilemmas. I am
clearly not a neutral observer. My very first foray into the world of chemopre-
vention was 10 write a letter to the editor criticizing the emergence of chemo-
prevention for breast cancer as 3n extreme eX3mple of individualizing prevention
3nd shifting prevention policy away from locating fundamental causes of breast
cancer. I have not strayed too far from this position since. Although my mind has
been changed and certainly cxp3nded in numerous areas, I began this research an
interested participant in the field 3nd these interests arc surely evident throughout
my research.
In addition 10 this larger dilemma, my positioning within my field of study
also posed practical dilemmas. Many people who I interviewed formally or infor-
mally at conferences and meetings knew of my connection with Breast Cancer
Action. While this connection opened many doors (indeed, a couple of people
explicitly stated they were only 3grccing 10 be interviewed by me bttause of my
connection to BCA), it also closed others or made for suspicion and skcpticism.
I had people refuse to participate in my research because my connection with
breast cancer activism was seen to situate me as irremediably biased on the issues
I was studying.
Howard Becker (1967} describes circumstances in which as social scientists
we find ourselves critiqued for aligning with the interests of some of those who
we study 3.nd thus producing biased knowledge cl3ims 3boul particular social
phenomena. I find this analysis most useful for understanding my own position
within my field of inquiry. He argues that the circumstances in which such accu-
sations of partiality emerge, and those situations in which they do not emerge,
arc revealing for what they tell us about credibility. The social scientist is apt to
find her or his knowledge claims delcgirimatcd when the knowledge produced
represents, or appears to represent, the perspectives of marginalized gi-oups or
individuals, the less powerful elements in the situation. In contrast, representing
the perspective of dominant groups rarely incites such critique of partiality or
intcrestcdncss.
We can use the notion of a hierarchy of credibility to understand this phe-

nomenon. In any system of ranked groups, participants take it as a given
that members of the highest group have the right to define the way things
really arc.
(&cker, 1967, p. 241)
There is an assumption that those at the top have privileged access to infomu-
rion and thus any knowledge derived from such superordinates will automatically
be more credible than those produced by subordinates. Moreover, Becker argues
that these assumptions arc imbued with morality such that we foci beholden to
Exemplar 283
respectfully accept the definitions of reality imposed by th= in dominant posi-

tions. Thus within this framework, by refusing to reproduce this hierarchy of cred-
ibility and by asserting heterogeneous definitions of reality including some from
the perspectives of non-dominant groups and individuals, my own productions of
knowledge arc vulnerable to dismiSS:11 on the grounds that they arc "biased."
In addition to my experience in the field detailed earlier, situational analyses
provoke me to explore how the preconceptions, ideas, passions, and interests
shape the very conceptualizations of the problem to begin with. In mapping the
trial, I have most definitely emphasized not just those elements that seemed most
important to me but also those that are most interesting to me. What is interesting
about a situational map is that you can include even elements that you did not end
up researching. In this way, the maps can make more evident one's own biases as
a researcher. Seeing an clement there that I know I chose not to pursue forces me
to ask myself why not. In this w.rt, constant reflexivity is integral to situational
analyses and any notion ofrelativism is replaced by bold awareness of positionality.
Conclusion
Utilizing situational analysis, my research highlights concrete ways in which the
situation shapes the production of knowledge-or, in other words, illuminates
situated knowledge in action. The knowledge that can be, and is being, produced
by STAR is contingent upon the everyday work practices of those producing
that knowledge. And those everyday practices arc constrained and enabled by the
various situational elements shaping the work--5haping various interpretations of
what is politically and ethically feasible, what is economically practical, scientifi-
cally doable (Fujimura, 1987) and so on. Utilizing situated analyses, my project
makes vivid the "situated" part of situated knowledge, highlighting various ways
in which situatedncss shapes knowledge production in the everyday practices of
conducting STAR.
Notes
1. Also. this situational map d0<'5 not exhaustively list :all of the elements in the sitw.tion.
but rather lists thoec di:at ended up mc»t central to my analysis--previous vcnions of
the map contained clcmcn~ that ultimatdy did not remain pertinent.
2. Part of the work involved in thil technique is to dnw lines between each clement and
the other elements and identify what the rcl.atioruhips =-<he nature of the line.
I undertook this procc>s to fruitful ends, but the result2nt m= of lines 2nd words defic.
vuual reproduction here. It abo provoked memos about the rcl.atiomhips.
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lion. New Brunswick, NJ: Transaction Publisher>.
SECTION VII
What's Next?
12
THE CHALLENGES TO AND
FUTURE(S) OF GROUNDED
THEORY
Janice M. Morse, Barbara J. Bowers, Adele E. darke,
Kathy Charmaz, Juliet Corbin, and Caroline Jane Porr
The groundswell of grounded theory research-both the major refinements of

grounded theory approaches and their applications to research projects in the
U.S., Britain, and beyond-is leading to changes and compromises in grounded
theory methods. They arc positive and negative, intentional and unintentional.
These changes extend from the nature of the phenomena studied, 10 the study
context, 10 the interpret3tions and misinterpret3tions of strategics and methods.
They may also extend from cultural and linguistic adapt3tions 10 the use of vari-
ous and varied theoretical underpinnings and even from personal references. All
ofthese changes have had impacts on grounded theory research products, altering
the research processes as well as the final articles or other outcomes, for better or
for worse. In this chapter, we ask: Is grounded theory emerging and evolving? Or
disseminating, diluting, and disappearing? Or both?
As with all qualitative inquiry, grounded theory methods arc changing. Since
the publication of the Discovery book in 1967, many changes have been techno-
logical: computers now manage data and expedite analyses; recorders and cameras
have increased the accuracy of collected dat3; and both have contributed lo the
increased volume of data collected.
Huge changes have also occurred in the broader acceptance of qualitative
inquiry. It has earned its place in academia, and now vast numbers of research-
ers arc using these methods. Concomitantly, the publication of many texts and
a huge number of articles, both methodological and substantive, have dissemi-
nated and normalized grounded theory methods. And of course, the develop-
ment of different grounded theory strands or approaches has changed the &cc of
grounded theory. Five of these have been formalized, adopted, and arc discussed
in this text. Together these changes have resulted in the emergence and evolution
of grounded theory.
But at the same time, less desirable changes have also come about, perhaps
from misunderstandings of grounded theory per se. It is concerning to us that
these products have found their way to conferences, publication on the Internet,
and even into refereed journals. Rather like the party game played with everyone
sitting in a circle, a message is whispered from one person to another, and has
become unrccogniZ3ble upon reaching the end of the chain. Publication on the
Internet, in predatory journals, the lack of knowledgeable mentors and research-
ers simply not taking time to conceptualize in their rush to get "it" out, have
all resulted in research touted as grounded theory (or worse, as "approaching"
grounded theory), that is diluting the reputation of "good" grounded theory.
In this chapter we consider these problems as "thrcats"to grounded theory and
attempt to delineate the most unacceptable trends that arc now producing inad-
equate grounded theory research in each tradition. Some of these threats arc due
to what we sec as myths about grounded theory :ind we delineate those myths.
We then discuss the char:icteristics of "good" grounded theory in each of the five
traditions and ways to strengthen :ind ensure rigorous grounded theory research.
In closing, we envision what we sec as the futur<>-<>r more aptly futurcs-<>f the
evolution of grounded theory methods.
Present Threats to Grounded Theory

In Chapter 1 we addressed the types of grounded theory literature and develop-
ments since its inception in t 967. Here we address factors that arc diminish-
ing the quality of grounded theory for researchers considering doing grounded
theory research.
M:iny of the research products we sec simply do not meet minimum standards
for a "contribution to the litcr:iturc"that demonstrates a clear understanding and
explication of the grounded theory method used, why it was selected, how and
why it was adapted if done, and so forth. Sadly, this criticism holds for examples
of all five approaches within the grounded theory tr:idition we have been dis-
cussing. But it also holds true for other research methods as well. For example,
Michael Lynch (2012, p. 452), former editor of Soda/ St11dies of Science, noted:
"(O)vcr the past decade, I have been led to the sad conclusion that the volume
ofBADANT (Banal and Derivative Actor Network Theory) greatly exceeds the
well-researched and broadly infonnativc written work that rides under the ANT
banner." T hat is, a well-founded, innovative sociological approach to analyzing
knowledge creation gained popularity among diverse disciplines and over time
has become both commonplace and almost unrccognizably bad. We grounded
theorists arc not alone!
You may have heard of the ideas/notions/myths about grounded theory that
we discuss next. They arc fa~ beliefs about grounded theory that have developed
into false expectations which, in tum, have led to fuulty and disastrous pr:ictices.
Challenges and Future(s) 291
While such issues may be influencing all traditions of grounded theory, some
3ffect certain strands of grounded theory more than others, and we discuss spe-
cific myths next.
The important first thing is that you understand why these arc all actually
myths. We therefore start with a discussion of the following eight (sometimes
overlapping) myths about grounded theory research:
Myth 1: Crou11ded theory restart/, is easy to team and to do.

Myth 2: Crou11ded theory is a reript ofstq,-by-slep ltdmica/ /asks.
Myth J: Crou11ded theory dots 1101 use lht extant subs/a11livt a11d lheore/ical literatures.
Myth 4: lnq11iry ceases as soo11 as data b,gu, to replicate.
Myth 5: Crou11ded theory is biased.
Myth 6: The ourco,ne does 1101 IUJve to bt a theory or theorizing.
Myth 7: Crou11ded theory is of lillle value.
Myth 8: Tables a11d/or tharts of 1/1tmatil palltms art suffirimt r,su/ts of analysts.
The overall concerning question is: why docs so much research go so "wrong"
in the process of doing grounded theory?
Myths That Misconstrue Grounded Theory Research
Myth 1: Grounded Theory Research Is Easy to

Leam and to Do
The belief that grounded theory research is easy to learn and to do, and that anyone
can do it without any training or, minimally, after a single worlcshop, or by adhering
to instructions in a book or article, has led to the oversimplification of grounded
theory research. Initially, as grounded theory w.is increasingly used in research and
as the numbers of strands of gi-ounded theory elaborated, grounded theory created
an enormous amount ofintcrcst across the social sciences and beyond. Overall, the
research produced w.is strong and fuscinating, and gi-ounded theory methods, as
wrinen, appeared doable to students both new to research and without adequate
guidance or instruction or even without mentors or access to workshops or courses.
As a result, some research projects labcled as "grounded theory" but missing
crucial elements appeared at conferences and have even been published. But they
arc actually "weak" or poor examples of gi-oundcd theory. Such research often
lacks essential components of grounded theory:
• It may have inadequate samples.

• Theoretical sampling may be inadequate or wholly absent.
• Coding schemas may be simplistic and based on a priori theories or
assumptions.
• The research product may lack adequate conceptualization and theorizing,

and may not be grounded theory at all!
Unforrunatcly, such truncated and simplified research may then appear as

grounded theory articlcs--and subsequently be used by other researchers as a
substitute for the original methods texts.
But what do students without mentors do? Leaming from a book may "teach"
a student how to manipulate and process data but not "how 10 think like a
grounded theorist" about the data. Methodological texts cannot teach how to
identify inferences or how to perform processes of abstraction and conceptualiza-
tion. Nor should the student have a brilliant idea about his or her data can this
give the student the confidence to present it or to argue for innovative ideas and
positions. C-Ood ,nentorship is essential for ro11d11cting good grounded theory mearth.
Otherwise, beginners' research often remains thin, descriptive, and atheorctical
and docs not report anything new. It is not robust and decreases the legitimacy of
grounded theory. It is not grounded theory!
Significantly, in many such articles researchers claim to be employing the
grounded theory method but arc using it only superficially--0r actually not at all.
Their approach may have violated several of Corbin and Strauss's (1990) canons
of grounded theory:
• Data collection and analysis have not been iterative processes.

• There is no evidence of theoretical sampling.
• Use of the semi-structured interview (as compared to an open-ended inter-
view with accompanying field research) has not permitted the capturing of
potentially relevant aspects of the topic.
• Concepts have been often been imported and imposed from prior research
and understandings.
• Concepts have not been given the opportunity to "cam their way into the
data" as the researcher's own understanding evolved, demonstrating their rel-
evance to this evolving theory.
• There is no evidence of the use of constant comparative analysis.
• There is no evidence of theoretical development beyond description or, at
best, a thematic structure is identified.
• Of greatest concern, interpretations of data may occur in leaps that arc not
justified from these data but may be something the researcher cxpcaod to sec
because it appeared in the literature.
Sadly, the n:l1vc researcher may not even be aware of these limitations. Addi-
tionally, the problem of inexperience is being compounded, as the first group
of mentor-free students graduate, accept teaching positions, and then teach new
cohorts of students to do grounded theory "as they did."
Do you have a solution?
Challenges and Future(s) :Z93
Myth 2: Grounded Theory Is a Recipe of Stepwise

Technical Tasks
Some authors mimic qualitative research methods including grounded theory
methods, reducing the doing of grounded theory research to a series of tech-
niques and steps. Such toolbox approaches to method arc "seductively simple,
requiring as they do only a detailed understanding of what is already known and
experienced;;,. tlrt simplific4tion firs its sed11dion" (Kuntz, 2015, p. 125, emphasis
added). If performed merely as a "toolbox" of techniques, grounded theory is
reduced to a technical/mechanical exercise and "forgoes the possibility of cri-
tique in favor of the certainty of method" (Kuntz, 2015, p. 125), which prior-
itizes procedures. Somehow the manipulation of data miraculously produces a
grounded theory!
As a set, these ''steps" arc often clearly described so as to be conducted sequen-
tially, which in itself essentially violates the essence of conducting grounded the-
ory research as an openly interactive or even simultaneous process. Thinking
about grounded theory research 3S a series of methodological tasks is inadequate
and particularly antagonistic to the original intent. Rather, grounded theory
should be understood as a mode of conceptualizing, abstracting and theorizing
of substantive content and what is known in the literature to formulate a new
substantive theory To offer a metaphor, the procedural operations in grounded
theory then become as useless as writing a recipe that describes processes of meas-
uring, mixing, stirring, boiling, or baking without providing information about
ingredients, purpose, or the delicious emerging product.
The original descriptions of grounded theory presented the analytic processes
and procedures as principles, a "canon and procedures" that "guide the researcher
towards understanding" (Corbin & Strauss, 1990, p. 420). In an effort to commu-
nicate this research process, subsequent articles described the process in steps that
became increasingly rigid in the litcr:iturc. Eventually, taking these steps overrode
the more important processes of conceptualization and the needs to understand
various phenomena theoretically. (Sec for example Pandit (1996], who describes
the process in four phases and six steps. simplifying the entire analytic enterprise.)
Ytt as early as 1973, Schatzman and Strauss made a pica against "mechanistic"
and "linear thinking" (p. 141). They wrote:
casual observations (may prove) more critical or fruitful than the planned,
systematic ones, of carefully prepared "designs" and expectations mutilated
by unforeseeable events; and of initial hypotheses that subsequently proved
too foolish for later disclosure. Surely, even the most skilled an experienced
researcher would tell how "disorderly" some research opcr:itions can be,
indeed, how often certain operations arc little more than r:indom motions
in search of meaning.
(pp. 144-145)
294 Janice M. Mone et al.
More recently, John Llw (2004) has similarly written about the messiness inherent
in social science research and argues against "hygienically" clC311ing up the messes
of actual social life. Social inquiry produces social realities and social worlds-as
wcll as describing and also enacting them. We must be aware of the relationship
between methods and the knowledge we produce and not cr:isc the tr3ces of our
efforts by "tidying up."
The Dilution of Grounded Theory Resources

Soon after the Discov,ry book was published in 1967, articles began appearing that
"summarized" or "explicated" grounded theory methods from the original book-
length text to short articles or methods sections (often in one or two paragraphs).
These were then used and cited as the sole source for their conduct of grounded
theory research by other authors.
One of the first of such articles was a book review (Strutzcl, 1968) published
in N11rsing Rcrearth a year after Glaser and Strauss's Discovery book was published.
Clearly the purpose of the book review was to bring an assessment of grounded
theory to the attention of nurse researchers and not to produce a source for
doing research. But this review, summarizing the conduct of grounded theory,
was apparently deemed complete enough to be used and cited (or miscited) as the
way to do grounded theory. It has received 1859 citations in Google Scholar, and
somehow Glaser and Str3uss arc even added as first authors!
Even journal-length articles describing the method continue to be published
and still remain inadequate when used as a guide by new researchers. Other
sources for abbreviated guides to grounded theory arc the methods sections of
research articles that have used grounded theory. These have then been copied by
subsequent researchers. One example is a single chapter of a grounded theory text
that provides no more than limited understanding of the method. Finally, some
researchers claim that their project was "informed"by grounded theory methods,
failing to note how this occurred. The overall problem is that other researchers
subsequently use them as major resourCC$-'and cite them as such-for conduct-
ing their own rcscarch. Such approaches incvit:1bly have very poor outcomes for
researchers who choose to use these resources instead of the original texts.
The important spirit of genuine inquiry and the pursuit of conceptual devel-
opment arc both forever loot if research is conducted as a series of technical tasks
or is inadequately communicated as a short summary of tasks undertaken. On
the other hand, by not advocating adherence to rigid procedures, we do not
mean that "anything goes" in constructing a grounded theory! But the evalua-
tion of a grounded theory study cannot and must not be based on using the rigid
chccklists that have been appearing in the liter:iturc (sec, e.g., Tong. Sainsbury, &
Cr:iig, 2007). Such checklists commonly include techniques that appear in var-
ious qualitative methods texts, gleaned from many d!Jfttetil kinds of qualitative
methods. Emerging researchers, anxious to produce a rigorous product, arc too
=ily misguided into checking all of the items, whether they arc appropriate or
not, even those contrary to the interpretive aims of grounded theory.
Grounded theorists do not seek consistency in or rcplie:ttion of their data.
They work interpretively; even participants themselves may not be aware of (or
recognize) the implie:ttions of their shared work or recognize themselves in the
completed abstracted theory. The researcher may have uncovered meanings or
a rationale for behaviors of which participants themselves were not previously
aware, although in retrospect, they may recognize. Hence it is problematic to use
a second researcher to "confimt" a coding system or to implement strategics of
"inter- rater reliability." This keeps the research descriptively shallow and obvi-
ous, even invalidating the inquiry as legitimate grounded theory research (Morse,
I 997}. It works against generating the interpretive abstractions at the core of
grounded thoory. Despite the authors' intent, such checklists arc not guides that
ensure solid inquiry; nor arc they rigorous indicators of quality. ·n,,y should not
be used.
Remember, grounded theory, like most other qualitative research methods,
is a co,uq,tual approDll, to inttrprtti11g human bel,avior that entails a theoretical way of
t/1i11ki11j/ about a problem or an i>sut.
Myth 3: Grounded Theory Research Does Not Use the Extant

Substantive and Theoretical literatures
A mega-myth (frequently attributed to Barney Glaser) is the assertion that
grounded theorists do not "use" the existing related substantive and theoretical
literatures. Yct ignoring the literature would fail to provide the researcher with
the opportunity to situate his or her project in the extant research or to become
familiar with the concepts and theories that have been associated with their par-
ticular topic and that may expedite fresh abstractions and theorizing. In addition
to exploring the literature at the proposal stage, the researcher must continue to
examine any relevant literature as the analysis proceeds, whenever possible com-
paring the emerging concepts with what is already published. This process docs
not invalidate induction, for the researcher is developing new concepts from his or
her own data. It is crucial to understand that rather than allowing the literature to
lead the inquiry, the researcher is looking for new substance, and linking findings
and analyses with what is already known, including possibly challenging some of
what is known.
Another related problem, but in contrast to the "fear of violating induction," is
the blind ad/1ert1ue to extant substa11tivt a11d tl,,oreticJJI literatures. For instance, if and
when researchers arc designing their projects using semi-structured interviews
developed from personal experience or expectations and/or selective literature.
This means that their interviews prcframc, prcstructurc, or mold their data and
subsequently their findings. They cannot reveal anything new but can only sim-
ply reiterate descriptively that which is already known. Such narrowing of data
collection procedures do violate induction. Moreover, such problems arc com-

pounded when combined with inadequate data and a failure 10 conduct genu-
inely interpretive inquiry. To prevent such failures, researchers should be using
unstructured narrative interviews, or at most guided interviews, and ideally also
collect, analyzc, and memo field-related materials. Field notes about the research
settings and exchanges should be carefully taken and included in the analyses.
Myth 4: Inquiry Ceases as Soon as Data Replicates

Another problem is the criterion of "saturation." The meanings of saturation
arc diverse as the chccklist used to ensure it is attained. But one thing is clear:
saturation is not the simple replication of information in two sequential inter-
views. Rather, it is a rich understanding of the phenomenon that enables the
researcher to anticipate the behaviors, beliefs, attitudes, and actions of the partici-
pants according to the research questions. And yes, at the point that saturation is
reached, the analysis, which is being conducted concurrently with the interviews,
is reasonably well developed.
What arc the ramifications of using an inadequate sample? First, consider the
ways in which the sample may be inadequate. The sample may be too small (often
fewer than 15 participants) and each individual's experience may be entirely dif-
ferent fi-om others in the group, so that patterns will be difficult to identify. Or
the sample may be extremely homogenous, so that there is limited variation in
the data obtained. If a semi-structured interview is used, interviews may be overly
controlled by the interviewer and the questions work to limit the approach, the
topics, and the responses of the participants. This also further restricts variation in
details of the participants' experiences.
Y« with such limited data, researchers may report that "saturation was
reached"! These researchers may consider "saturation" to be any replication of
experiences reported by one or two participants and believe that terminating data
collection is then appropriate. Jn a sense, saturation probably has been reached,
for their sample and data collection methods have not allowed for the collection
of variation. Furthermore, if the topic was a routinizcd cxpcricnco--onc that the
context was highly organized or habitual and allowed for little ambiguity or par-
ticipant variation-then study outcomes will be predicable, be of little interest,
and contain no new findings.
The question researchers must consider is "saturation of what?" No one ever
saturates on all dimensions of the research matrix or all components of the study.
And "conceptual saturation" is not the same as "information saturation" often
resulting fi-om a plethora of descriptions and not fi-om actual conceptualization
of the data. This is not the type of saturation that Schatzman and Strauss (1973)
describe.
One serious result of misunderstanding the nature of saturation and truncating
analysis prematurely is that the researcher has i1111dequate data to identify and vtrify
the categories, concepts and theory. There is a continuing debate in the literature
about "how many subjects" arc sufficient (e.g., Guest, Bunce, & Johnson, 2006).
Ye,. not surprisingly, qualitative researchers have not been able to rationalize a
particubr number.
The type of sampling used varies widely. It depends upon the pacing of the
project, including moving from convenience to theoretical sampling (Morse &
Cbrk, 2019), the quality of the interviews and the participants' eloquence, the
type of interview (unstructured, guided interview, or semi-structured interview
and/or documentation), the nature of the phenomenon studied (tightly bounded
or complex), and of course, the skill and theoretical knowledge of the researcher.
All these elements contribute to determining "how many participants" arc suf-
ficient. As these factors arc individualized for each researcher and research ques-
tion, any standardization of the "proper" number of participants would be rather
a silly exercise. Even the recommendation of data "saturation" cannot be antici-
pated at the proposal planning phase of research.
However, the costs of an inadequate sample arc extreme. With an inadequate
sample, the abductivc identification of the major concepts and developing the
theory is protracted. Without confinning/vcrifying data and the incorporation
ofncgativc cases into the theoretical scheme, the theory may be obtuse and inad-
equate. Consequently, the researcher lacks certtinty. The research lacks the theo-
retical density, scope, and richness essential for translation and application.
Importantly, some principles regarding sample size arc evident: a larger sam-
ple is required if the researcher is using semi-structured interviews rather than
unstructured, narrative interviews. With semi-structured interviews, a smaller
amount of data is being collected from each participant (and these data arc limited
by the parameters of the questions). Probing in semi-structured interviews docs
not compensate for the freedom and potential breadth that an unstructured inter-
view offers when seeking participants' perspectives, descriptions, and experiences.
In the published literature, we have noted a pattern: small samples arc often
characteristic of research presenting analytic themes, rather than the recom-
mended construction of concepts, categories, and integrated theorizing of those
concepts and categories. For example, Charmaz (2014, p. 107) writes: '"Twelve
interviews may generate themes but may not command respect." Without the
development of theory, this research is docs not provide new insights, docs not
provide results that arc transferable to other settings, nor infonnation that may be
clinically applied. In other words, such research is neither significant nor useful
and should not be published. It clearly is not grounded theory research.
Myth S: Grounded Theory Is Biased

Often an individual researcher may conduct a grounded theory project and other
researchers may raise concerns about issues of reliability and validity, or biased
results. At one level, the serendipitous nature of qualitative inquiry means that a
298 Janice M . Morse et al.
second researcher examining the same data or findings may not reach the same
analytic conclusions. But a lack of replication should not cause apparent con-
cern. The interpretive nature of grounded theory and researchers' varied agendas
mold the nature of the theory produced. Is this considered "bias"? Not if the
research question is logically argued, linked 10 the extant literature, and the find-
ings and interpretive results of the study arc robust, theoretically strong, and well
articulated.
To clarify, in grounded theory research, the traditional quantitative require-
ments of rigor simply do not hold. Qualitative researchers may not have empirical
referents for the subjective phenomena they arc studying. The narurc of evidence
required by phenomena or required for the abstract concepts and phenomena
may not align with preconceived plans. Quantitative methods for ascertaining
reliability and validity not only do not hold, but risk invalidating the interpretive
nature of qualitative inquiry per sc (Morse, 1999).
In grounded theory research, data may or may not be used in an organized
manner; referents may be used concurrently, or insights may be recogniuxl after
the fact (sec Schatzman & Strauss, 1973, p. 144). Such inquiry is not linear, to
be completed in planned steps as expediently as possible. Rather the researcher
pursues only those operations "that facilitate (his) inquiry" (p. 144). Grounded
theory resC:lrCh is primarily a cognitive activity and a way of thinking about and
interpreting data conceprually.
But some grounded theorists, especially those steeped in more interpretive
traditions, also recognize that the researcher is present emotionally and reflexively
as well (e.g., Star, 2007; Charmaz, 2014). Both constructivist grounded theory
(e.g., Charmaz, 2014) and situational analysis (e.g., Clarke, Friese & Washburn,
2018) assert that researcher reflexivity is integral to grounded research processes.
Myth 6: The Outcome Does Not Have to Be a Theory

or Theorizing
The last and greatest threat to grounded theory research is researchers who write
that their research "approaches" grounded theory methods. They do not get very
close.
First, these researchers, who commonly just develop themes (usually attrib-
uted to Braun & Clarice, 2006), often explore the patterns of their themes and
subthemes but stop their analysis 31 this stage. Rather than developing grounded
concepts and categories, the use of themes limits the development of concepts
and docs not adequately reveal the relationships between the concepts or delve
into the transitions so crucial for understanding processes in a grounded theory
research project. Such researchers commonly truncate their inquiry. For instance,
they may end their analysis before reaching the level of developing concepts and
a theory of their phenomenon of interest which integrates those concepts. While
they may have used thematic analysis and presented their results as a thematic
structure, they make no attempt to develop this rudimentary structure. Funhcr,

there arc no concepts, no attention to change and transitions, no basic social
process or core focus on bchaviors enacted in response to the phenomenon-in
shott, there is no theory. & such, the research is incomplete as a grounded theory
project and should not be labeled as such. Rcscarcher(s) have ended their analysis
before reaching the level of developing concepts and elaborating on the process
of behaviors surtounding their phenomenon of interest that arc necessary for
building a grounded theory.
Second, other researchers may label their work as "grounded theory" because
they used selected strategies gleaned from grounded theory methods, such as "the-
oretical sampling" or exploration of "negative cases" during data collection or
"constant comparison" in the analysis. But they have not actually developed their
concepts and their analysis to the level of a grounded theory. This separation
or selective "cherty-picking" of strategics inherent in the process of conducting
grounded theory and applying them to other methods of descriptive research
docs not necessarily invalidate those other methods. However, claiming to have
conducted a pattial grounded theory as a type of grounded theory is inadequate
and inappropriate. Such research should not be published. Researchers claiming
to offer grounded theory research should complete their projects with concepts
and theorizing, and reviewers should insist on this for publication.
Myth 7: Grounded Theory Is of Uttle Value

Some researchers claim that grounded theory is actually useless. But to us the
problem is that "grounded theory" projects with the flaws depicted earlier should
simply not even be called grounded theory, much less published. They arc with-
out value or wonh as research. That is, such research, despite the label, is not truly
grounded theory; assumptions may have been violated, data arc not theoretically
developed-the topic is obvious.
On the other hand, well-conducted grounded theory research is science at its
best. Read the supplemental chapters in this text for stellar examples.
Myth 8: Tables and/or Charts of Thematic Patterns

Are Sufficient Outcomes ofAnalyses
& you read work claiming to be grounded theory projects, a relatively recent
problem in its development is emerging. This is the use of tables to present and
illustrate codes and coding decisions, often substituting such tables for the bulk of
the narrative analysis. Tables arc being used to illustrate text from the interviews,
and the codes arc used to illustrate "coding patterns." The authors neither synthe-
size nor provide deep description of the emerging concepts.
Significantly, these tables may properly be used to illustrate an intermediate
stage of the analysis (for instance, sec Corbin, 1986, pp. 104-107). However,
such t.tblcs do not substitute for the synthesis and description of categories in the
completed project. There the rcsc:irchcr assumes responsibility for explicating
the categories and synthesizing these data, using panicipant quotations to fully
illustrate description.
While the threats discussed c:irlicr arc primarily pcnincnt to Glascrian, Straus-
sian, and Channazian/constructivist grounded theory, other problems may also
directly affect the other approaches to doing grounded theory.
In addition to our "myths" about grounded theory rcsc:irch projects discussed
earlier, constructivist grounded theorist Antony Bryant (2017, 2019) recently
published a parallel set of problcmatics. He calls them the GTM (grounded the-
ory method) Mantra: "a collection of phrases and fomis of words used ... or
perhaps we can say intoned, by many GTM researchers" (Bryant, 2020).
The GTM Mantra consists of a series of potentially misleading and conten-
tious statements that offer easy targets for criticism. As we did earlier, Bryant
elaborates on each of these in his aniclc. However, instead of reiterating his com-
ments here, we insert our own in brackets (in italics).
• All is data. [ Yes, do pmrne data beyond intnviews, and bring a aitital eye to bear 011
all potential data as to '1tdibility and rt leva,l(t.)
• GTM is an inductive method. [ Yes, BIJI" even more so ii is abdudivt in develop·
i,,g conceptual grou11ded tl,eorttit:4l analyses.]
• The theory will emerge from the data. (Aaually, the researcher needs to develop
co11(tp/S a,1d jig1<re out liow they relate to 011e another in order to malt a grounded
tl,eory of X.)
• Start research with no preconceptions. (No scholar ,an be i11telltdually or theo-
retically 11an,, by the time you i11itiate a serious reseauh project.]
• Don't read the literature. (Initial reading ofliterature relevant to your overall project
allows you to frame a Ji!OOd r,search question; pursui,,g 11ervly relevant literatures later
i11 /Jre research trajectory allows you to disti11guish and refine your findings. )
• Use GTM where there is no existing research. (Yes, a11d CTM ,an also oper1
important new doon in research areas already explored.)
Thus we arc very much in accord with Bryant's critical assessment of what he calls
the GTM Mantra.
Bryant (2020) also sees commonalities shared across the variants in the "fam-
ily" of grounded theories. Here he emphasizes the importance of "open cod-
ing" (wherein previously prepared codes arc eschewed) and men1oi11g, theoretical
sampli1ig (to gather more data precisely pertinent to the developing theory) (sec
also Morse & Clark, 2019), and the value of theorttical sat11ratio11 as legitimating a
stopping point for exploring that category. He finds the opmness to sermdipity of
grounded theory research as among its most radical and unique properties, poten-
tially leading to unforeseen insights.
Next we tum to the particular problems confronting each of the five approaches
to grounded theory research and possible "solutions."
Problems and Criteria for Strong Glaserian Grounded

Theory Research
According to Phyllis Noeragcr Stem (student and protcgce of Barney Glaser and
Anselm Strauss), Glaser coined the tcnn "grounded theory" as the systematic
approach that he and Strauss used to generate their Awareness of Dyin11 (Glaser &
Strauss, 1965) theory explaining how hcalthcarc providers, patients, and family
members deal with death and dying in hospitals. The methods from that project
became the basis for the Discovtry text later published in 1967. Although the
two sociologists shared the same research goals during the dying project, each
contributed different background training in sociology. Strauss, steeped in inter-
pretive Chicago School sociology, understood that sociological theory can derive
from everyday behavior of people. In contrast, Glaser was taught sociology at
Columbia University and trained to rely on abstract, hypothetical statistical mod-
els from survey research to formulate sociological theory (Glaser, 1991). Yet both
rejected the testing ofspeculative theories to understand the phenomena ofdeath
and dying and together set out to develop theory grounded in everyday real-life
bchaviors a.nd activities in hospital settings.
Many of the problems confronting Claserian grounded theory can be miti-
g:,ted if researchers, in addition to reading the seminal DiJ<()vtry text written by
the co-originators, also carefully sift through Cbscr's texts, especially 11rtoreti<al
Sensitivity: Adva11c,s in the Metl,odolOf(y of Crou11d,d Theory (1978). The particular
problems confronting Glaserian grounded theory research pertain to insufficient
training, the recipe approach, limited data collection, and preoccupation with
description, as outlined here:
Embarlzi1111 on • 1/'o,mdtd th,ory rtstard, projttt wit/1 i11suffident lrainin11:
As mentioned earlier, it is a myth that grounded theory is easy to learn

and do. Reading seminal texts should complement attendance at work-
shops, taking courses, and obtaining guidance from a mentor. If a graduate
student, there should be a committee member, if not the supervisor, with
grounded theory methodological expertise, capable of providing ongoing
mcntorship.
App/yin// a rtdpe approQl/,:
To think like a grounded theorist is to recognize that grounded theory

research is, yes, a systematic approach, but one guided by basic princi-
ples and opcration.s. Fundamentally, the researcher is trying to figure out
how people respond, cope, adapt, or manage the phenomenon of interest.
Research operations arc designed to enable discovery of a pattern ofbehav-
iors in reaction to a common concern (the core variable) which emerges
as the basic social process. During the dying project, the two social science
researchers systematically applied techniques to invcstig:,te participants'
302 Janice M. Mor>e et al.
viewpoints and interpretations as to what problems confront medical and

nursing personnel when caring for polliativc patients and what arc the
actions pcrfom1cd by personnel in response. These became intcgr:il to for-
mulating a substantive theory of dying and death.
UtnitillJI data tolftttion to i11ttnlitwS:
In seeking to understand, infer, and explain how hospital personnel respond

to the phenomena of death and dying, interviews were important, but
equally essential were observations and more. In fact, "all" is data (Glaser,
1992). That is, interviews, observations in the research setting, and docu-
ments, websites, films, and Twitter and other social media platforms, arc
each and oll viable sources. Data may and should "include everything from
what the researcher sees, hears, smells and feels about the research topic, to
everything the researcher knows based on academic, research and pcnonal
experiences"
{Sttm & Porr, 2011, p. 39).
Preoaupatio11 with dtstriptio,1 offindinJIS and 1101 ahstrattion Olld tOlllq,tualization:

Glaser {1991) learned from Strauss that "data come first, then theory" (p. 12).
But what has become problematic is the notion of"worrisome accuracy" (Glaser,
2001) wherein researchers arc anxiously wanting to ensure every single partici-
pant detail is described exactly. When not abstracting up from the specific details
and into the generation of concepts, researchers arc not focused on theorttitally
interpreting what is going on in the data. Stem {2007) advised:
I have found that, in the years since Glaser and Strauss' 1967 publication,
·11re Discovery of Grounded ·11,eory, researchers have placed more and more
emphasis on the accuracy of collected data rather than concentrating on the
developing theory. These researchers arc in grave danger of developing a
rich description of the social scene rather than a theorctie:tl one.
a,. 90)
Criteria and Strategies for Strong Glaserian Grounded

Theory Research
The following arc criteria and strategics to equip researchers to produce strong
Glascrian grounded theory research.
• Consistently foc11s on takinJI data analysis to an abstratt explanatory level. Strauss

{1995) was surprised at the lack of theory construction in qualitative research
handbooks written for social science researchers. A strategy to avoid getting
caught up in destribi11J1 data is to aim for explanation. View data through an
interpretive lcns------0bscrving social interactions and listening to pc~cctives

and experiences, for example-in searching for clues as to the what :1J1d why
ofhunun bchaviors.
• Ust a111sla11t comP"ratiw, n1tthod of a11a/ysis. To refine the method of constant
comparative analysis, Glaser drew from his studies ofliterature at the Univer-
sity of Paris, qualitative nuthcm.atics with Paul l..azarsfcld :1J1d the sociology
of science with Robert K. Merton at Columbia University. Glaser found
that comparinJ( texts (e.g., documents or interview transcripts) line by line
could promote abstraction and advance conceptualization. As the researcher
begins analysis, labcled codes •nd emerging conccptu•l categories should be
compared with new incoming data until a substantive theory develops. Seri-
ous problems arise when researchers wait to initiate analysis until all the data
have been collected. It is the back-and-forth reiterations of data collection
and the generation and comparison of conceptualized analytic findings that
is "grounded theory's modus operandi" {Stem & Porr, 2011) that promotes
and invigorates "conceptual sense-making'' (Glaser, 1998).
• Always i,ulude rhtortlical samplinJ(, Theoretical s•mpling is an important pro-
cedure during theoretical coding which focuses the researcher's attention on
expanding the properties and dimensions of concepts once the core variable,
emerging basic social process, 3Jld relevant conceptual categories have been
determined. Delve into the literature, consult with scholars and experts. Gla-
scr's (2005) theoretical codes or "coding families" can also foster elaborating
concepts by stimulating thoughts about causes, context, contingencies, and
conditions, for example, that also assist inferring where, when, and how con-
cepts are relevant in the basic social process and evolving theoretical structure.
• Measure riJ(Qr appropriately. Is the substantive theory grounded in the data?
This is the main question for researchers to consider to ensure their research
is of value and worth. As Suddaby (2006) informs us, Glaser and Strauss
rejected positivist notions of fulsification and hypothesis testing •nd, instead,
described an organic process of theory emergence based on how well data fit
conceptual categories identified by an observer, by how well the categories
explain or predict ongoing interpretations, and by how relevant the catego-
ries arc to the core issues being observed.
(p. 6J4)
Researchers should watch that ongoing conceptualization fits all incoming data,
being careful to never force a fit with preconceived ideas but always allowing
the data to dictate (Glaser & Strauss, 1967).
• Rrlevana is another criterion of rigor during Glascrian grounded theory
research. Do participants verify that the core variable and process exist and
arc relevant to their everyday reality? And docs the substantive theory worl,?
Docs the new theory adequately offer interpretation or explanation? Fill3lly,
researchers should demonstrate that along the way, they were open and
304 Janice M. Mo~ et al.
flexible to mod!fiabi/ity--modifying theoretical claims through continuollS

verification, confirmation with other data sources, and by comparing with
deviant cases {Glaser, 1978).
Problems and Criteria for Strong Straussian Grounded

Theory Research'
Quality is tlusi"", h,,,d lo spmfr, but"" oftnif«I'"' l,1<>1v ii whm "" s« ii./,, this
n:spttt, trs,t4tth is like 12.rt rtJJ/in tha,r sdma.
(S,ak, 2002, p. 102)
In Smussian grounded theory as a qualitative method, the terms "quality" and

"credibility" arc vastly preferred over "validity" and "reliability," which arc crite-
ria seen as appropriate to quantitative but not qualitative research. High-quality
qualitative research is interesting, clear, logical, and makes the reader want to read
more. It grasps the lived experiences of those studied and frames them conceptu-
ally while providing sufficient descriptive detail to allow the reader to reach their
own conclusions :ibout "fit."
Certain specific conditions tend to foster high quality in the construction of a
Str.1ussian grounded theory. In brief, these include:
• Metl,odolOJliral amsismu:y. The researcher carefully and completely uses 311 the
strategics and procedures specified as part of that method and explains any
deviations clearly. The credibility of any method is reflected in its proper IISC.
• Clarity of purpose: The researcher should be clear from the outset that if they
arc doing Straussian grounded theory, their goal is development of a substan-
tive theory. While good descriptive research docs have a place in nursing and
elsewhere, it should not be called grounded theory research unless it offers
conceptual development and theorizing of a phenomenon.
• Stlfawmmess: Because the researcher is an interpreter in qu3li13tive inquiry,
it is very important to be aware of one's biases and assumptions. Keeping a
journal or memoing about reflexive process issues is crucial in noting, nam-
ing, and clarifying such influences.
• Training in qua/itativt inquiry: What the researcher brings to the research in
terms of qualifications, experience, and perspectives is central in qualitative
inquiry. Training in qualitative research is requisite; it is simply not true that
"anybody can do it" Educational foundations in methods, data-gathering,
and analysis can be transformative.
• A 'Jteli11g far tl,e topic": In some ways or other, the focus of study should
"matter" to the researcher. They should have a developed sensitivity about
the area of focus, be willing to "step into the shoes" of participants, and be
excited about doing rich descriptions and analyses.
• A willing11ess to work IUJrd: Doing strong qualitative research involves a lot
of hard work, often challenging recruitment of participants, long hours of
Challengesand Future(s) 305
lr.lnscribing or checking tnnscriptions, reading and rereading interviews and

fieldnotcs. Doing grounded theory analyses is also often difficult, challenging
work.
• A willing11ess to relax a11d g,t i11 to11l/1 with the mativt s,lf Brainstorming, throw-
ing out analytic codes and categories and starting over, trusting one's sense
that you've "got it" or not, and keeping going. Being open to new ideas is
crucial.
• A "mtthodol<>J!iuil a1vam1tss": The researcher should be aware of and sensitive
about slr3tegics used, decisions taken, methodological consequences, and so
forth. Anticipation of potential criticisms is part of this and very helpful and
useful.
• A dtsire to do r,s,ar,I, 'Jor its 01vt1 sake": To pursue a research-focused circcr,
one should have a deep comminncnt to doing research, not merely go
through the steps for career reasons.
All the foregoing constitute conditions that foster higher quality in the research
and construction of a Stnus:sian grounded theory.
What questions should be asked to assess Slr3ussian grounded theory research?
The following arc suggested:
1. How was the original sample selected? How did later sampling proceed?
2. What major categories emerged?
3. What were some of the events, activities, or actions indicating those
categories?
4. On the basis of what categories did theoretical sampling proceed?
5. What were some of the statements of relationship made during the analysis
and on what grounds were they validated?
6. Wtte negative cases (that did not "fit" the analysis) presented? How were
these accounted for?
7. How and why was the core category selected? On what grounds?
8. Are the concepts systematically related? The key word is that theory
t'explains," it docs not just "describe."
9. Is variation built into the theory?
10. Arc the conditions and consequences ofthe key processes noted and clarified?
11. Has process been taken into adequate account?
12. Do the theoretical findings seem significant? To what extent?
13. Do the findings become part of the "conversation" about that phenomenon?
Are they widely taken up?
What criteria should then be used to assess Straussian grounded theory
research? The following criteria obtain:
I. "Goodness of fit": Do the findings resonate/"fit" with the experiences of

those in the field and professionals who attend to those areas? Docs the
analysis "ring true" to participants emotionally as well as professionally?
2. Applicability of findings: Docs the analysis offer new insights and alternative
paths? Can it be used to develop policy, change practices, and/or add to the
knowledge base?
3. Concepts: Docs the analysis offer original concepts that generate fresh
understandings of a phenomenon? Arc the concepts developed in tcm,s of
specifying properties and dimensions showing density and variation?
4. Contcxruali.zation of concepts: Arc sufficient background and description
offered within which the concepts and theorizing nuke deep sense?
5. Logic: Is there a logic.11 flow of ideas in the write-up? Docs it make sense?
Arc mcthodologic.11 decisions described and justified?
6. Depth: Is there sufficient depth ofconceptual development with richness and
variation?
7. Variation: Is sufficient variation demonstrated? Arc there examples of things
that do not fit the analysis? Anselm Strauss emphasized that life is very com-
plicated and research should seek to capture as much complexity as possible
by building in variation
8. Creativity: Arc the findin~ presented in creative and innovative ways? Docs
the research add something new to the knowledge base or at least update it
vis-:i-vis different conditions?
9. Sensitivity: Docs the researcher demonstrate sensitivity to the participants
and to the data? Did the data drive the analysis or vice versa?
10. Evidence ofmcmoing: One of the key principles ofStraussian grounded the-
ory is mcmoing often, deeply, and with care. Memos should allow tracking
of the developing analysis as well as of methodological decisions made along
the trajectory of the research. Memos should grow in depth and abstraction
as the project progresses. There should be evidence of this in final report.
Doing good Straussian grounded theory is clearly not "an easy way out," nor
should it be. Attending to these criteria will enable researchers to accomplish
their goals.
Problems and Criteria for Strong Dimensional Grounded

Theory Research
Dimensional analysis shares much with the other grounded theory methods
described in this book. It is fimtly grounded in Chicago School sociology, sym-
bolic intcractionism, like some but not all other versions of grounded theory.
It shares many of the coding and memoing procedures used by constructivist
grounded theory. It also shares the importance of both theoretical sampling and
conceptual mapping throughout the analysis process. Studies purporting to use
dimensional analysis, like the other grounded theory methods, often succumb to
premature closure.
The distinctions between dimensional analysis and the other grounded theory
methods arc more related to emphasis rather than to subsl:lllce. For example,
dimensional analysis is more explicitly insistent than the other grounded theory
methods that all analysis, research and natural (everyday understanding and prob-
lem solving), is grounded in a perspective. Dimensional analysis, as a process, also
emphasizes the dangers of what Schatzman labeled "rccognition/rccall," the com-
mon but unfortunate habit of imposing preconceived {although often implicit
and unspecified) labels and structures on emerging data thereby misinterpreting
their "findings" as grounded in the data or "discovered" when in fuct they were
(unwittingly) imposed.
It is a focus on the integration of perspective and the generation of dimen-
sions and dimensional matrices that distinguish dimensional analysis from the
other grounded theory approaches. While not often pursued in studies using
dimensional analysis, and not a focus of concern for Schatzman, the centrality
of perspective suggests an important opportunity to explore the consequences
of differing perspectives in terms of power imbalances and their consequences.
Criteria for Strong Dimensional Analysis Research

The following criteria arc particularly important in assessing dimensional analysis
research:
• Clarity regarding the perspectives of (multiple) data sources.

• Inclusion of relevant perspectives in comparative analysis.
• Explication of consequences of power differences of varying perspectives.
• Explication of how perspectives inherent in available literature align with or
differ from perspectives found in data sources consulted during study.
• Informed by symbolic interaction with focus on process.
• Ongoing generation of conceptual matrices throughout analysis.
• Explication of dimensions called out in the different data sources and rela-
tionship to perspective.
• Identification of theorizing possibilities that were not pursued or saturated.
• Interview questions that encourage informant freedom to identify relevant
dimensions of a phenomenon and their relationships to each other.
• Avoidance of"recognition/recall" or categories brought by the researcher to
the analysis.
• Identification of conditions related to variation in dimensions and dimen-
sional configurations.
• Interview questions or research questions that assume the salience of a par-
ticular perspective or categories.
Each and all of these contribute to building a strong dimensional analysis.

308 Janice M. Molle et al.
Problems and Criteria for Strong Constructivist

Grounded T heory Research
Constructivist grounded theory has now been innovated and pursued for over
20 years (e.g., Charrnaz, 1995, 2000, 2006, 2014; Bryant, 2002, 2017, 2019},
including its strong emphasis on social justice research (e.g., Charrnaz, 2011,
2016; Charniaz, Thornberg, & Keane, 2018}. The major area of wealmcss in con-
structivist grounded theory research is lack of development of a grounded theory
ortheorizing ofthe substantive area under study (Charrnaz, 2015). Another com-
mon wc:ikncss is failure to begin analysis of data when data arc initially gathered
and produced, which commonly leads to under-analysis of the data overall as
it becomes too daunting. Many researchers fail to pursue theoretical sampling,
allowing their emergent areas of analytic interest to direct data gathering and
analysis. Fear of theorizing is a common underlying problem here. Also, many
newcomers to grounded theory arc not yet comfortable with the ways in which a
constructivist grounded theory research design is itself emergent based on pursu-
ing areas of theoretical payotf.
Lack of adequate memoing can easily lead to thin stories with thin presen-
tations of data that support what theorizing there is. Strong memos allow the
researcher to digest the data and reflect upon them, learning to move around in
the materials in ways that should and c.1n lead to richly theoretical and substan-
tively dense articles and chapters. Premature tern1ination of analysis is another
classic practico--thinking that as soon as you have come up with "something,"
the analysis is "over," rather than just getting started.
Criteria for Strong Constructivist Grounded Theory Research

Criteria for a strong constructivist CT research project include making a number
of assumptions during the conceptualization and execution of the research that
also undergird the write-ups. These include:
• Assuming multiple realities among participants and researcher(s).

• Assuming mutual construction of data through interaction between
researcher(s) and participants.
• Assuming that the researcher(s) themselves construct the categories of
analysis.
• Viewing the representation of data not as a "mirror of nature" (Rotty, 1979)
but as inherently problematic: relativistic, situational, and partial.
• Assuming that the observer(s)'s values, priorities, positions, and actions affect
their (our) views.
That the researcher makes these assumptions should be evident in the style of
writing and how thin~ are written up. There should be an inherent analytic
openness to alternative interpretations and possibilities rather than a simplistic and

simplifying "This is what I found."
A constructivist grounded theory project also has distinctive objectives:
• Views generalizations as partial, conditional and situated in time, space, posi-

tions, actions and interaction, hence docs not ovcrgcncralizc.
• Aims for interpretive understanding of historically situated data rather than a
tacitly ruiivc realism.
• Specifics the range of variation within the data and in the possible interpreta-
tions of that data.
• Aims to create theory that has credibility originality, resonance, and
usefulness.
Like the assumptions noted earlier, these objectives should be clear in the ways
in which the constructivist project is written up, evidence presented, theorizing
offered, and so forth.
Last, there arc some distinctive implications for data analysis in doing con-
structivist grounded theory research. These include:
• Acknowledging subjectivities, distinctive experiential materials, throughout

the data analysis.
• Viewing co-constructed data as beginning the analytic direction of the
research rather than as ending the analytic process.
• Engaging in reflexivity throughout the research process, including in
writing up, reflecting upon how one's own positionality may affect one's
interpretation.
• Seeking out and carefully re-representing participants' views and voices as
integral to the analysis.
Thus constructivist grounded theory is distinctive from initial strategics of project

conceptualization to and including the development of final project products
(reports, articles, etc.). The spirit of constructivism is pervasive, and such work is
clearly different from Glaserian objectivist grounded theory (sec also Charmaz,
2014, esp. 236).
Problems and Criteria for Strong Situational Analysis

Research
Situational analysis research has roots in and shares in most of the assumptions
and data analysis practices of constructivist grounded theory as outlined earlier
(sec Clarke, Friese, & Washburn, 2018, Chapters 1-3), hence they will not be
repeated here. Instead we offer questions for researchers to ask themselves toward
writing a strong situational analysis research report or article. As the time comes
310 fanlce M. Morse et al.
to write up a project, you may or may not feel ready to do so, even if you arc
analytically ready. And the flow of events may not be yours to designate! That is,
deadlines arc a fact oflifo---for students, faculty, and most others doing research.
Questions to ask oneself to assess whether a situational analysis research project
is basically complete and fully analy:red include the following:
• Have I pursued each of the four kinds of maps thoroughly (situational, rela-
tional, social worlds/arenas, and positional maps)?
• Have I revised them all based on new data gathered?
• Have I really wrinen adequate memos on each of the maps? Memos can and
should include both analytic insights and reflections on the research process,
including what else may need to be done.
• As I have more or less finalized each of the four types of maps, have very few
if any new ideas emerged? Have I followed through on those that needed it?
• Have I really gathered adequate data to support making and interpreting
each nup?
• Can I easily write a three- to five-paragraph summary of each of my maps?
(Or, do I fully grasp my data, maps and analysis?); and
• Is there anything that I still feel I should really do that I haven't done?
More specific questions about the scope of the four major situational analysis
maps and memos include these:
1. Is the project explicitly situate~located in space, time, and history in my

memos (ready to be cut and pasted into various write-ups)?
2. Arc all the key elements involved in the situation analyzcd fully, specified
and delineated (in situational maps and memos), and the key relations among
them fully analy:red (in relational maps and memos)?
3. Arc the specifics of the broader situation carefully laid out (in social worlds/
arenas maps and memos), including how the worlds and arenas arc both
mutually influential and consequential in that specific situation?
4. Have all the key collective (organizational/institutional} entities-social
worlds-important in the situation and their commitments been analyzed
and memoed?
5. Have all the major debates in the discourse materials found in the situa-
tion been analyzed (in positional maps and memos}, including checking that
missing positions in the data arc really missing by theoretically sampling for
further relevant data?
6. Have the nonhuman elements in the situation been taken seriously and their
consequences for other actors in the situation analy:red and mcmocd?
7. Has the analysis pursued whether there arc implicated actors and/or actants
in the situation and mcmocd this? [Implicated actors arc solely discursively
constructed by other actors with greater power in that situation for their (the
other actors') own purposes. Implicated actors may be human or nonhu-
man, physically present but silenced, or solely discursively present. Regard-
less, they arc not allowed self-representation. This concept provides SA with
a critical tool for grasping subtle and blatant uses of power and their conse-
quences (Clarke et al., 2018, pp. 76-77)
8. Have all the seemingly most important aspects of the overall SA project been
articulated in the memos?
Before writing your project up, it is also important to reflect again o n the
research process itself. Good questions to ponder here include these:
• How has my understanding of the situation of inquiry changed over time? Is

there anything I want to flag and memo?
• What omissions or elements were present in early maps that arc not in later
maps? Do they seem to matter now?
• What lines ofinquiry did I pursue based on early maps, and where did that
take me?
• Is there any line of inquiry I should still pursue before writing it up?
• What lines of inquiry could be taken up in future projects (by me or some-
one else)? Where else might this research lead?
Reflecting on your research process in this way can help demonstrate just
how much you have learned and accomplished to date. Remember that no
one project can accomplish everything. A wonderfully thoughtful and reflexive
article by Jenny Fosket (2021, this volume), an early user of situational analysis,
focuses on wrapping things up to be ready to write it up. She walks the reader
through both the analytic and emotional processes she went through as she tried
to pull it all together into her excellent dissertation research (sec also Foskct,
2004, 201 0).
Happily, the very act of making the four kinds of maps and memos usually
enables researchers to sec the tremendous utility of keeping on with the analy-
sis, keeping it open, and keeping going on the project. Anxiety creates a great
temptation to cut analysis short and tidy things up into project maps. Don't be
seduced into premature analytic closure. And if you have been seduced and have
done project or other "final" maps prematurely, do not hesitate to go back and
do more versions of any of the situational analysis maps. Then revise or redo your
"final" project map(s) accordingly. Because the tacking back and forth between
data collection, data mapping and analysis, and writing is a central feature of both
grounded theory and situational analysis, revision is normal-part and parcel of
the method. Careful revisions make for stronger publications and better grounded
theory research overall.
Excellent Grounded Theory
How, Then, Do We Overcome These Problems?

Moot articles discussing "how to identify excellent grounded theory" arc written
for eval,,atu111 tht quality of a compltJtd 11roundtd thtory research proja.t-a disserta-
tion committee, editors and reviewers, readers of the published articles, and those
wishing to implement your findings. These articles evaluating grounded theory
research largely focus on the technical aspects of grounded theory but not on the
topic you arc developing. However, all this talk about method and evaluating
at the end of the project is really like shutting the barn door after the horse has
bolted. Receiving a poor evaluation at the end of a study is too late to mal<c the
necessary corrections. This is why we emphasize reading and rereading the major
"how to" texts for the approach to grounded theory research you arc using and
accessing workshops, mcntorship, and preliminary audiences for your "work in
progress."
But what about the most important aspect (and the reason we arc doing
grounded theory research): examining the topic of importance? Remember, we
arc using a grounded theory approach to answer a question trot is significant: the
issue may not rove been adequately addressed in the literature; we suspect that the
knowledge surrounding the issue use is poor or inadequate; or we need to address
an issue pertaining to our practice-one that will make a profound difference to
the way we arc presently approaching certain problems, whatever they may be
(teaching, healthcare, child-rearing, or even selling a car).
Next we discuss how to self-evaluate your grounded theory while it is being
constructed-for the researcher who seeks to develop a wonderful grounded the-
ory. How, during the process of doing grounded theory research, do you know if
it will be any good? How can you try and mal<e sure it is good?
Doing Excellent Grounded Theory Research

In the five decades since grounded theory was first described, various criteria
for its "worth" have been developed-mostly for evaluation AFTER the study
has been completed. Much more useful arc some "criteria" or landmarks for the
researcher to use and implement while the study is underway. Trot is, our unique
discussion here is intended for researchers in the process of developing a project,
not an external, post hoe evaluation of the end product. We hope that by present-
ing these internal landmarks, the end results of grounded theory research will be
much improved.
Criteria for the development of excellent grounded theory research while it is
being developed center on three major phases of the research:
1. Starting: The self-assessment of your preparation to do a grounded theory

research project.
2. Data coUcction, analysis, and mcmoing: The self-monitoring of the ongoing

process of doing grounded theory research, analysis, and memoing-the self-
monitoring of the ongoing processes of doing grounded theory work and
researcher' reflexivity about those processes.
3. Finishing and polishing: Your self-evaluation of the almost completed pro-
ject, prior to submission for publication.
The criteria we offer next were first developed by Gl3Scr and Strauss (1967)
and then expanded through Glaserian (e.g., Glaser, 1978, 1992, 1998) and then
Straussian (e.g., Strauss, 1987; Strauss & Corbin, 1990, 1994, 1998) grounded
theory since that time. We incorporate criteria for evaluating the completed
projects whenever possible. (Specific criteria for the evaluation of Schatzman's
dimensional analysis and Clarke's situational analysis arc noted earlier.)
Starting: Are You Ready to Do a Grounded Theory

Research Project?
Sclf-aw:ircness and reflexivity arc the first skills to be acquired for the grounded
theory researcher. Grounded theory questions come from the researcher's inter-
ests and sensitivities and from the literature reviews and assessments. Importantly,
a grounded theory research question is not the type of targeted question that is
typically used in quantitative research. A good grounded theory research question
must be broad enough to encompass the phenomenon of interest in its entirety
(evaluate its full scope) and not be restrictive and narrow, because you do not
actually know what you will find. Remember, diKovery is why you arc doing a
qualitative project.
The most critical aspect of your research question is that it must reflect the
researcher's grounded theory perspective. How docs one develop this perspective?
First, remember that grounded theory is an interactive process, focusing on action
and temporal change. Traditionally grounded theorists used symbolic intcrac-
tionism 3S a theoretical underpinning to their inquiry. But there is some opinion
that this is no longer essential. However, some serious theoretical grounding is
requisite to be certain that the research grasps the underlying epistemological and
ontological issues in the research.
Importantly, this grounded theory perspective on the research question-how
to focus on action and changc-<arries the researcher right through the entire
research project. This includes the selection of participants, data collection, data
analysis, memo writing, and a grounded theory mode of conceptualizing the data
analytically in an integrated fashion-in a word, theorizing.
Your proposal literature review is developed to support your initial question. It
provides the broader "landscape" that surrounds your topic. It provides you with
information about the research that has been done, the theories used to support
this research, and the types of data and results offered. It identifies the theories
that have emanated from this reseatch, provides an overview of what is known,
which concepts arc used, and helps you locate the knowledge gaps. The review
includes all previous grounded theory research, and both qualitative and quantita-
tive reseatch on the topic.
Significantly, your review extends beyond the previous 10 years; it should
cover the entire course of knowledge developed in this area. Your aim in doing
this review is to help you feel confident about what was known about the topic
(in its broadest sense) and the population and community that you will involve
when conducting the study and begin data collection. You may use this knowl-
edge not only as a guide but also as a reflective lens while you maintain your
inductive stance. You goal is to feel competent, feel expert about your topic, and
have an in-depth knowledge of relevant concepts and theories.
One aspect of research that makes many new researchers very nervous is the
process of interviewing. Make certain that you arc competent in using your
recorders and cameras. Develop a coding system for labeling data and partici-
pants. Develop a secure system for the organization and stor:ige of data and
consent documents. Some recommend preparing a kit to take with you into
the "field" containing all the things you will need. Pr:ictice doing interviews
with your friends and relatives from start to finish, including explaining what
the study is about and what will happen in the interview, obtaining consent,
and responding to their mock questions. And of course, pr:ictice closing the
interview, thanking your participants, and exiting. Decide in advance whether
or not you will share research results with your participants if they so desire
and let them know if so. Only when you feel ready arc you really ready to
start.
Data Collection, Analysis, and Memoing: Self-Monitoring/

Assessments of the Ongoing Processes of Doing Grounded
Theory Research
From the r=chcr's perspective, as the r=ch becomes increasingly focused,
the r=ch question is malleable and modifiable as the project progresses. Often
when you begin observing or interviewing, you find that your initial hunches
were incorrect or off base and may actually need to be refined or refocused in the
actual reseatch setting. Therefore, once data collection and analysis have com-
menced, if you need to refine your question, expand, or redirect your literature
review, do so immediately.
Most new (and established) researchers do multiple revisions of their research
question(s) and interview guide. This is normal-part of the way that qualitative
inquiry unfolds as you work on it. Be sure to write memos about why and how
you change your qucstion(s) or guide so that you can retr:ice your own research
processes. You think you will remember but you won't. If necessary, even submit
a modification to your institutional review board.
Challenges and Future(s) 31S
No matter which type of grounded theory approach you :trc using, there is
agreement that the results must not be superficial. They must provide a deep under-
standing of the topic, and the grounded theory perspective must be maintained
throughout. The data collected (usually via a guided or unstructured interview, and
ideally ob6crvations and/or collection of related documents) :trc analyzcd inuncdi-
atcly. Analysis and memoingand pursued concurrently. Multiple data sources may be
used: interviews of various types (stories, conversations, semi~cturcd or guided
interviews (individual, dy:idic, or group]); observations (structured or unstructured),
video recordings; and documents such as letters, reports, and records. Today obser-
vational methods arc less common in grounded theory research than they used to
be. This is an unfortunate trend, and we hope that observational strategics cam their
way back into grounded theory rcsc:trch. Ethnographic grounded theory is well
established if not frequently pursued (e.g., Charmaz & Mitchell, 2001).
Such diversity of research data and materials, often called "triangulation"
(Denzin, 2017), provides different perspectives and different "slices of data." This
enables the researcher to reflexively confirm hunches, build concepts, and inves-
tigate conceptual linkages as they :tre identified more easily and richly. Thus later
interviews :tre often quite different from the first interviews, and later observa-
tions :tre more focused and theoretically sensitive.
The researcher's conceptual abilities must be astutely interpretivo-that is,
imagination, insight, and creativity based on the empirical grounding, the "theo-
retical sensitivity and sensitivity to the subtleties of the action/interaction" (Cor-
bin & Strauss, 1990, p. 426). The analysis is facilitated by coding and the use of
memos (Belgrave & Seide, 2019). The use ofa computer program for qualitative
research is the researcher's choice, as long as you realize that the computer docs
not do the analysis for you; it merely puts these data in a fom1at that facilitates
your thinking and analyzing about these data and memoing your analysis.
How many "subjects" :tre necessary or sufficient is the tricky question. You
must interview panicipants and begin analyzing those interviews as soon as pos-
sible. Concurrent data collection, analysis, and analytic mcmoing enable you to
both modify the direction of inquiry and to confirm/verify your analysis as you
proceed. Selecting participants from a variety of backgrounds provides a variety
of perspectives and integrating analysis of negative cases that don't fit the major
patterns enriches the findings. Categories and concepts must be dense, well-
devcloped, and linked logically 10 one another. An "unimaginative analysis" or
superficial understanding may result when the researcher either docs not "draw
on the fuller resources of data or fails 10 push data collection far enough" (Cor-
bin & Strauss, 1990, p. 426).
In grounded theory research, sampling ceases when the researcher reaches
saturation. As previously mentioned, this is one of the most misunderstood con-
cepts in qualitative inquiry. Saturation is NOT the simple replication of interview
material; saturation is reached when the researcher has in-depth understanding of
the research topic, is very familiar with the context, and can predict responses or
316 Janke M. Morse et al.
how participants will respond. Once the rcscarchcr can speak in generalities about
the interviews, ("These people usually do this or that') and can anticipate their
response or reactions in certain siruations, saturation has probably been reached,
and the theory may be constructed.
At this time, the researcher must become rcimmcrscd in the literature. But
the type of literature now sought has changed from that cx;imincd at the begin-
ning of the project. At this time the researcher is looking for other concepts or
theories, and the results of others' projects, to compare with the findings from the
present project. These findings from the library are used comparatively ("Arc
these concepts the same or dilfcrcnt from the ones in my project?"). In this way,
the literature assists the researcher in support of the emerging findings by show-
ing what is new and innovative, and what is already known and supported by the
prior work of others. If concepts have been previously identified, this must be
noted, and those concept labels at least noted if not used, and any dilfcrcnces
clarified. Once the new analysis is developed to the level of theory development,
the theory is solid, confirn1cd, logical, and makes sense when presented to those
in the setting. The researcher has investigated negative cases and integrated them
into the theory. It meets Glaser and Sttauss's (1967) criteria of"fit."
Finishing and Polishing-Your Self-Evaluation of the

Completed Project, Prior to Submission for Publication
How do you know when you arc finished? Aim for an outcome that is theoretical
and provides innovative and insightful explanations yet fits with what is known; if
there arc discrepancies, explore and explain them. Your theory must make sense,
be logical, and be comprehensive. The findings should be useful and recognizable
to those in the setting who should readily accept them, report that the findini,
help them sec and understand what was previously "under the surface." The
results should also provide directions for further inquiry.
At this point, write your article according to the requirements of the journals
you select. There arc lots of criteria for the completed project that you may use
at this time. But our advice to you is it to get the article "pre-reviewed" prior to
submission. Ask several of your colleagues to review to ensure that it is clear and
concise and that it meets the publication criteria for grounded theory research
and those of the selected journal. If you arc concerned about your writing, have
it professionally edited, and have any figures professionally drawn. Good luck!
The Futures of Grounded Theory

Why arc we "pushing" for you to become an excellent grounded theorist? And
why do we care about researchers adhering seriously and scrupulously to the
ambitious sttatcgics and ways of doing grounded theory research? Why doesn't a
researcher have the freedom to apply various strategics to the phenomena they arc
studying, as the project develops, or even as they so choose?
Challenges and Future{s) 317
Actually, in grounded theory a researcher docs have the freedom to apply vari-
ous strategics to the phenomena they arc studying, as long as tire rtstartkr attai,is
agrou11dtd theory pmpeaive. And of course, new variants ofgrounded theory wiU
continue to arise under the broad rubric of grounded theories. But these variants
should be and must be developed with a full and rich understanding of how and
why the "new" perspcaivc or strategics vary from the original, and how they
differ. Such innovations must be the purview of experts. Research is not a free
for all. Just doing anything qualitative or grounded theory-ish docs not suffice!
We also lament the present use of qualitative inquiry as a supplement to the
quantitative component in mixed-method design, deemed the "little qu.al." This
belittles qualitative contributions. Limitations on the acceptability of grounded
theory methods, for instance excluding them from consideration in the Journal of
Mixed Methods, is also intellectually inappropriate. We hope this is only a passing
rad and that editorial criteria will be revised to include QUAL-qual and QUAN-
quan as legitimate mixed-methods designs. For instance, a qualitative core pro-
ject, such as a grounded theory research project combined with a qualitative or
a quantitative supplementary project in a mixed-methods design, would make a
fine contribution to mixed-methods research.
Reading Excellent Grounded Theory

Reading grounded theory is the best way to become expert yourself. Such read-
ing must be done analytically: inspect the text to sec how data were gathered and
verified and how the analysis convinces the reader of its validity. Examine how
the codes, categories, and concepts were developed, identified, presented, and
defined, and how they act. What work docs coding do with the phenomena to
develop categories and concepts? How do the concepts hold the theory together?
Were figures or diagrams used to clarify relationships among the concepts? How
was the theory generated and abstracted? What is its scope?
Over time, knowledge develops, expands, is modified, and is changed. Quali-
tative methods play a critical role in the development of what we know. Grounded
theory research contributes to a specific and specialized segment of this knowl-
edge: that concerned with phenomena with negotiated changes and perspectives,
with interactions, and with our understanding of behavior.
Responsibility for knowledge development lies within us, within each of our
disciplines.
Last Words
I¼ all hav, a stak-, in thtj,llun: ofl(Tound,d 11~,y.
Ust iro1mdtd ll~ory in II~ tmys t/,aJ ivorkfar Y"" bul mokt wl,aJ you do and hoiv
yt111 do it ,xp/itit.
·1;.,,, your worl: at1d t/1< m,1l,odfan,,.,d and ,n:at, many 11roundtd tl1<oria.
(/,rfnvin• .,,;tl, Katlay C/u,mw:, 2019)
3 18 Janice M. Morse et al.
Note
1 This >Cction is b:iscd on Corbin and Straws (2008, Chapter 14).
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INDEX
Pag,, numbers in itali< indiate a figure and page nwnbcn in bold indiate a table on the
corToponding pag,,. Pa1,,c numbers followed by "n" indicate a note.
abduction 173 Adarm, P. 160

abductive identification 297; s« also adequate data 82, 310
identify/identification advoc:;acy: action 47, 49-53, 59-60, 74;
abductivc logic 173 concept 50; core phenomenon of 45,
abductivc reasoning 4-6, 174 47, 59, 74; defined 50; proccu 47, 49,
abstnct concept 29,102,298; s«also 59, 61; skills 73; succc:ss 53, 61; sc, also
conccp~ nul'$C advocate
abstnction 8~5; analytic 194; Afiican American 176
conceptualization 302-303; data 3-4; Akrich, M. 238
grounded theory rocarch 4; interpretive Allen, N. 177-178
295; memoing 306; proccs= 292; "all is data"Bl-412, 300,302
theoretical codc:s 85-86; theoretical Amazon.com40
development and 3; theorizing295; American Medical Association 215n1
theory 35 American Nurses' Association 70
abwcd women 90--105; comtant American Sociological Association 254n14
comparuon 95-96; emergent fit analy,is: bcginning32; categories 35;
95- 96; overview 90--91; principle:, coding 28; comparative 42, 47, 91, 93,
ofpncticc 97-104; procc,ocs and 98, 100, 104, 115-118, 120, 123, 126,
challenges in intervention 94-95; 157,303; data 28, 31, 33-34, 37, 41,
putting intervention into practice 57; diagrams 30--31; discourse 244,250,
104; Strengthening Capacity to Limit 256n32, 256n39;excellentgrow,ded
lntrwion (SCLI) 91-94; theoretical theory 314-316; grow,ded theory
:scn>itivity 95-96 32, 36; interviews 39; lay capacity for
actioru/interactions 29-30, 35; arena 247; 125; learning and 111, 114, 123--126,
routine 29; situational analy,is 231-233; 251; line-by-line 32-33; logic 34,
stntcgic 29; taking 212 119, 124-125, 280,306; memoirs 40;
actor-network theory (AN1) mcmo,30-31; natw'al 111, 117, 123,
237-238, 290 124-126; Parkinson disca,c 194; procc,s
322 Index
35, JOO, 113, 118,306; ,ituational 126; compa.rcd with ,ocia) world,!
analy,i> 231-233; Strau»ian grounded arena> analy>C$ 235; core category
theory 31-35; teaching 35, 116-117, 91; core variable 301, 303; grounded
125, 253n6; theory of 114--116; theory methods 126; heterogeneity 91;
wiimaginative 315; wi,11Ucturcd32 identification 5, 118-119; infonnants
analytic abduction 6 119; re,11Ucturing life 84; ,hilt from
2nalytic ab5traction 194; su ,Jlso :ab1ttaction focus 113; ,ituatfonal analy,i> 224, 269;
analytic example, Stra=i2n grounded tnn.sbting the object 248; victim, of
theory 35--42 home fires 84
analytic needs 6 Basia of Qualilaliw Ra,anh (Straws and
analytic paraly,i, VO Corbin} 3-10, 27,155,252, 254nl4
analyzing the ,ysicn, 60 BCA su Brea.t Cancer Action (BCA)
anger 39; patient 170; positive 41; re,idual Becker, H. 234, 269, 282
37; >totements 206 bchavion: ba.ic ,ocial procc» (BSP) 299;
ANT s« actor-network theory (AN1) emotiomand 189; employee 81; human
anxiety 196,200,207,212,311 303; leadership 69; ob>crvations of86;
appliability offindinS,' 306 personal and ,ocial 94; phenomenon
arena: action 247; boundary object 299; r.itionale 295; real-life 301;
248; brca>t cancer 271-272, 272; rak-toking 214; ri,ky 96
chcmoprcvcntion 271, 272; collective Bcnolicl,J. Q. 15
:actors 239; community 61, 65; concern Bcrgman-Evans,B. 132
235; !i,'Ovcmmcnt 65; maps, situational bwcd grounded theory 297-298
analy,i> 234--235, 243-244, 244; bwcs: assumption, and 304; personal 28;
mutual concern 248; social 278; profc»ional 28; r=her 283
STAR trial 272, V5, 278-279; biomedicalization 274--275
sy,tcm 62; X 244 Bittner, E. 7
as>cmbbgc,: elements and the ecology of Blumer, H. 26-27, 179n5, 234, 237,
rcbtioru 246; in,pir.itional metophor 254n9
237; rhizome and 224, 236-238, 252; boundary objects: concept 235, 255n 17;
,ituational analy,i> 236-237 contcstuion pu excellence 235; critical
a1.SCS:Smcnts: components S7-S9; excellent tools 225; situational analy,i> 248
grounded theory 314--316; genetic 271; Bowen, D.J. 13, 18
health 93; immediate 174; liter.iturc Breast Cancer Action (BCA) 281-282
review, and 313; mk 274--275; ,tarting Breast Cancer Prevention Trial m
>clf-a,$d$tllent 312 Bryant, A. 16, 155, 160, 173, 223, 300
Atkiruon, P. 179n2 BSP s,, b>sic ,ocial procc» (BSP)
atrociti.,. 40 Bucher, R. 113
auction howc 227, 254n 11
audience: analyru 126, 178; bewildered Callon, M . 238
87; knowlcd1,oe 54; logic 125; Cambodia40
preliminary 312; primary I 20; Canada 83, 84
research en and I 26; ,trategizc 56 categorical rcbtionships 74
awareness contexts 4 category(ic,): analy,i> 35; codes 54-55,
Awam= ofDyinx (Cb>cr and Straws} 8, 57-58; conditional context 50; core
8, 80,301 S, 29-31, 35, 91, 174; dimeruions 29;
linking31; propcnic, 29
Bainbridge, R. 162 Cauca,ian 193
Banal and Derivative Actor Network Certified Nurnng A..i>tont (CNA)
Theory (BADANl) 290 130-131, 141
barriers 52, 54, 58, 72, 175 challenge> 289-317; exceUent grounded
ba.ic ,ocia] proceu (BSP} 5, 118-119, 248, theory 312-316; myths 291~300;
269,299,301,303; actio~entcred prc>cnt threats 290-291; wong
224; bchaviors 299; compantive analy,i> coru11Ucti vi,1 grounded theory
Index 323
308--309; strong dimensional analy>is concept, 27, 306; abstnct 29, 102, 298;
r=rch 307; strong dimensional advocacy 50; aiteb'Ories 82-83, 85, 92,
grounded theory 306-307; strong 118, 157, 303; changing self36; coding
Cwerian grounded theory 301-304; 27; importance 34; initialanaly>is 31;
strong siruational analy>is 309-311; level 29; locating 29; lower-level 34;
strong Stnussian g:ounded theory potential 32; prcwarself36; saturation
304-306 30; SBAT 47; ofsclf191; sensitizing
changing self 36, 38 162; surviving: reconciling muhip)c
Chamuz, K. 16-18, 18n1, 43, 159, realities 41; themes 34; in vivo Zl
179n2, 190-191,253n3,297 conccpnnlization: al»tnction 302-303;
chemoprcvention 268,271, 274-279, 282 advance 303; assumptions 308; contnry
Chcnitz, W C. 13 100; grounded theory 92; micro/nucro
Chicago ecologjcs, situational analy>is range of229; nonhuman 238; original
234-235 102; philosophical assumptions 96;
Chicago interactionist sociol<>i,,y 227 processes 292-293; r = h aims 83;
Chicago School Socioloi.,y 112-113, 115, situation 227; situational analy>cs 269;
233-234,238,301,306 social organization 233; lhcorctical
cbrity of purpo.sc 304 undcrst:1nding of stntcgjcs 82;
Cbrl<e, A. E. 12-13, 17, 18n2, 155, theorizing and 292; theory generation
160,175, 179n2, 225, 248,268--270, and 88
280-281 conditional context 47, 49-50, 52, 59
clinical supportteam 134 conditional matrix/matrices 56-58,
CNA ,,, Certified Nuning Assist:1nt 56-59, 228, 254nl3; advocacy SS;
(CNA) Qualitotiv< A,14iysis far S«ial Samtists
coding27-28: constructivist grounded 115; siruational analy>i,227-231, 229
theory 167-172; dab S; system 56 conditions 29, 58
coding practices: a.xial coding 54, 114; confinning lhat something is different 196
focused coding I 94; initial coding conjuring 118
169-170; line-by-line coding 12, consequences 30; abusive male parmcr 94;
32-33, 137, 168-170;theoretical blat:1nt uses of power 311; classifications
coding 303; in vivo codes 168; of dab 53; comprehcn.uve description
word-by-word coding 5, 242 139; conditions and 56, 235; of
cognitive cfron 5 differing imp)cmcntation $tratcgics
Cohen, L W 134 137; participant, 173; pcnpcctivc for
Colapietro, V. 248 selection 120; potential risk 212
Coleman, M . T. 132 constant compan,tivc nlcthod Me grounded
collaboration through mappiJ1g, situational theory
analy>is 250-251 const:lnt comparison 6, 95-96
collective actors 225, 235, 247-248 consaucrionism: nutcrialist 238: social
combat:1nt:137-39, 41 255n20; symbolic interactionism
communication skills 53, 64-65; s« olso 255n19
skills constructionist approaches 253n3
compar.itive analysis 47; beginning too constructivism 13, 18,233,309
early 123; centnlity 126; const:lnt 47, constructivist approaches 253n3
91,93, 98,104, 117-118, 157,303; constructivist grounded lhcory 153-179,
dimen.uons 117; direction 120; doing 224, 233, 298; coding 167-172;
42; nuning pooitions 117; operations convergence I 56-159; criteria
116; power of 115, 118; processes 100, 308-309; critical inquiry 174-178;
118; timing of 126; s,, oiso analy>is critics ofintC1Vicwing 166; data
componcn~ 16, 45; UWSl-mcnt 57-59; 164-174; divergence 156-159;
goal 49, 59; intervention 99- 100; explaining all<ncompassing loss
nonhumans 238; practice 100-104; 171-172; memo-writing 167-172;
process 49 method 155-156; methodological
324 Index
sctf~onsciownC-$$ 159-164: overview dccolonizingrc,carch 161,225,227,251;

153-154; queotioning preconception, stt also rcscarch
159-164; n:cmplusizing proce» deep brain ,cimulation (DBS) 208
166-167; $0CWjU$bce r=ch Delamont, S. 179n2
174--178; ,trong =rc:h 30S-309; DeleU%C, G. 223, 227, 236--238, 250, 252
theoretical sampling 172-174 de-medicalizacion 131
context 29; conditional 49; situational democratizing rcpracntation~ situational
analysis 231-233; undent2nding 62-63 analysis 250
contextualization of concepts 306 demographic data, Parkinson di:scasc
contcxftW questions 40 192-193
Omii,uu,/ P,m,u1atimis ofAction (Str2ws) 27 Denzin, N. 16, 87, 233
convergence 115-119, 156-159 depth 306
Corbin,J. 13, 114, 154, 159,226, 228, Derrida,J. 223
231, 254n13, 292; &sia of Q,,olitativ, d=ripcive data, Parlciruon di,case
~otd, 8-10, 27, 155,252, 254n14; 192-193
conditional matrix 56; conditional design 293; buildin11 I 34; dissemtion
matrix model 74; context 49; pregnancy propo,al, 240; environmental 131;
study 30 Green Howe nuning home model
core category 5, 29-31, 35, 91, 174 130; iHEAL 93; intervention, 213;
core variable: basic soci.al procos (BSP) methods and 130; mixed-method
301, 303; Glascrian grounded theory 317; r=arch 6, 239, 308; ,ltuated
82-86 intervention, 247; >tudy 191, 213
coronary heart cfucasc (CHD) 176 development: of code, 6; prot«ave
creative self 305 actioru 204; rclacion,hips 214
creativity 306, 315 Dcwcy,J.25-26,232,254n9
credibility, hierarchy of282 diagranuning 56-57
criteria: consauctivist grounded theory di~u30-31, 34
30S-309; dimcn,ional grounded grounded theory, dilution of294--295
theory 307; Gwcrian grounded theory dimeruional analysis (DA) 111-126, 307,
301-304; ,ituational analysis 3()()..311; 313; convergences with grounded
Straw,ian grounded theory 304--306 theory 115- 119; learning to do analysis
critical inquiry/research 174--178, 226 123-124; natural analysis 124--126;
critical tools, situational analy,is 247- 250 new path 119-126; rccOl!Jlition/rccall
culture change, Crecn Howe nur.sing 122-123; Schattrn:an's re>poruc to
home model 131 grounded theory I 15-119;
cyborg, (cybernetic organism,) 238 Str2u»-Schatunan coU.boration
112-1 IS; ,crong rc,casch 307
DA s« din,eruional analysis (DA) dinteruional grounded theory 306-307
Darbyshire, P. 173 dimeruionality I 24
dat:1 27; :abetnccion 3-4; acqui.sicion di,coursc(s) 27J; analyst, 166; analyzing
40; adequate 82,310; analyw 28, 31, hctcrogcncom pcnpcctivcs 235;
33-34,37,41,57, 136-137,311,313, chemoprcvcncion 268; data 245;
315; collection 30-31, 81, 135--137, dominant 236, 250; extant materials
164--165, 192-194,215n3,302,311, 225; Foucauldian 238; hi5torical,
313, 314--3 I 5; con,tructivi,t grounded narrative, and/or visual 241; lively 237;
theory 164--174; Gwcrian grounded master 250; minor 256n39; mulciple
theory 81-82; inductive 4, 156; cultural 274; narrative and visual 236;
mappin11 311; meanin11 28; memoing po,itional maps 245; production 235;
313, 315; memoirs 40; replication shared univcrs.,. of234; situational
296-297; ,crutinizing 36; typeo 31 analy,i, 250; social life 224; $OCW
Davey, M. 177-178 proc= 280; specific boundary object
Davis, F. 7 248; studies 235- 236; trends 165;
DBS su deep brain stimulacion (DBS) universe of255n23; universes of235
Index 325
discounc analysis 244, 250, 256n32, emergent intcraccioiu 166

256n39; sc, also analy,is empower 56--57, 67-70
discourse material,: extant 225; found in engaging in u,uc, 70
situation 31 O; g,:nrc 256n32; historical environmental (external) characteristics 58
18, 236; nuntive 18, 236; textual 236; Esm11ials of A«<SSibl, Cro11nikd Tho,y
visual 18, 236 (Stem and Porr) 10, 88
discourse irudics.. situational analysis ethics: ofcare and =ponsibility 162;
235-236 Parkiruon di,ca,c 193
Dis<oi,ery of Crormikd Tho,y: Strakfliesfor excellent grounded theory: analy,is
Qi,alitatiw R.t1'arrli, '/1,, (Glaser 2nd 314-316; ==ments 314-316;
Strauss) 7-12, 17, 114-115, 156,228, challenge. 312-316; data collection
289, 294, 301 314-316; doing =carch 312-316;
discursive comtruction(s.) 241; actors finishing 316; mcmoing 314-316;
249- 250; chang,:s 278; multiple 250; overcoming 312; polishing 316;
negative of249; nonhuman actants 249; proccs,e, 314-316; rcoding317;
situational matrix 230 ,elf-evaluation 316; ,elf-monitoring
discursive fonnation(s) 236 314-316; ,tarting 313-314; stt also
disease, coming down with 207 grounded theory
di.s.scmirutc information 71 explaining all-<ncomp..sing loss
divergence, constructivist grounded theory 171- 172
151>-159 extant discounc material, 225
Doctoral Nursing Program 79~0 extant ,ubotantive, grounded theory
Doctoral Program in Sociology 7 29S-296
double-victimizing 173 external charactcri.5tics 56
Dubbin, L. 176
Dunne, T. 160 &cilitation 56--57, 63-67
fear: living in 168;ofthe wor>t 198;of
ecoloi,,y: Chicago 234-235; inten.ctionism violating induction 295
238; ofknowlcdg,: 235,246; relational feeling detached and discoMectcd 202
245-246, 252, 254n15; of relations 246; feeling for the topic 304
,parial 232; temporal 232 feeling, and bchavion, expected and
economic conditions 29 unexpected 214
Eden Alternative 132 feminist grounded theory 92; .,, also
education 54; doctoral program 113; excellent grounded theory; grounded
extcmive nurse program 140; high theory
,chool ,ex 165; of nursing students fi,Id Res,ard,: StraJ,xiafor a Natwal
6s-69; r=arch 164; umupporrive Sociology (Strau,, and Schatzman) 11
educational program 73 finding direction 205
educational prog,am. unsupporrive 73 finding out 197-198
effect change 72 finding,. Green Hou,c nursing home
Eldershaw, L. P. 215n4 model 13S-139
Elliott, S. 165 finishing, excellent grounded theory 316
emergence: chcmoprcvcntion 276, finishingand polishing313
279, 282; of concepts 12; conceptual Fuhcr, n. 254n11
categoric, 83; form, and temporalitic. Flaherty, M. 174
236; Gla,crian grounded theory 86-87; Fo,ke~J. 226,244,311
grounded theory t'>-18; knowledg,: and Foucault, M. 223, 227, 23S-236, 238,
practices 268; myth 8<>-87; OJ1!;>nic 250, 255n26
proccs, of theory 303; phamuceutical, Fox Foundation, Trial Finder website 192
268; phenomenon 45; in qualitative frcczingofgait202, 203
re,can;h 121; theoretical catcgorie,59; Fricoc, C. 13
rrust in 87 Frost, N. 155
emergent fit 95-96 future, envisioning 208-211
326 Index
C2mt, R. 164-165 excellent 313-314; stepwise technical

Ceenz, C. 223 wks 293-295; saatcgics 4--o; Sa:um's
gcncnlizability, Parkinson disease 213 literature 13-15, 14; texts8-t1, 8-13,
..generic social processes" 4 14-15; theoretical literature$ 29S--296
geographic boundaries 234 Crowulcd '/11<ory Ha,ulbooks (Bryant and
Cwcr, ll. 6-13, 17, 18nl, 43, 114-115, Charmaz) 16
159-160, 179n3, 223, 228,289,294, Grounded Theory Institute 12, 87
301,303,313,316 CTM Mantra 300
Cb.scri2n grounded theory 12-15, 14, Cuattari, F. 223, 227, 236-238, 250, 252
79-88; "all is da12"81-82; core variable
82- 86; criteria 301- 304; da12 81-82; Haitian Creole 168
emergence 86-87; honoring originators Hall, P. 229, 233, U.7
of grounded theory 87~; strategics Handbook of Q,1alitati"" Racard1 (Denzin
302- 304 and Lincoln) 16, 87
global pcr,pcctivc 17-18, 52, 59, 175, H=way, D. 223,231,267
212,228,231,235 Henwood, K. 160
goal> 49, 57, 59, 63 Hepburn, A. 166
"goodnc» of lit'' 25Sn20, 305 heterogeneity, basic social process (BSP) 91
g,a,ping the situation 199 high-ri>k carq,>0ries 275
Great Britain 13, 168 H=, K. 160
Green Hou,c nul3CS 134-135 Hoehn and Y:ahr Disease Staging Scale
Green Hou,c nur,ing home model (HY) 190, 192, 203, 208
130-148; backl!'ound 131; culture Holscher, D. 163, 178
change 131; da12 analysis 136-137; da12 Holton,J. 87
collection 13S--137; design 130; Eden homecoming 38
Alternative 132; finding, 138--139; Hui,:gard, P. 160
Green Hou,c nu= 134-135; Hughes, E. 26
implication> 130-131; integrated huzdles, facing 203
nur,ing model 144-147; methodology
135; method> 130; parallel nursing idcali,m 38
model 143- 144; purpo>e ofsrudy 130; identify/identification 57, 57, ~ I ;
n:auiting 135; rc,carch 132-134; re,ults abductivc 297; defined 60; interactions
130; rigor 137; ,an1ple 138; saturation SO; interactions/actions SO; stratcgizc
137; ,citing 137; Shahbazim 134-135; and SO, 60, 74; saarq,,y and 59
>taf!" cmpowenncnt 131-132; aaditional identity: dilemmas 201-205, 212-213;
nur,ing model 140--141; typology 139; fomUng new 206
visitor model 142- 143 illnc$.S: creating diKancc from 168;
grounded theorists 295 evolving with 206
grounded theory (Cl) 3-18; analysis 32, immu!llblc mobiles 255n17
36; arriclcs and book chapters 16-17; in,plicated actors/act:mts 225, 227,
bia.cd 297-298; charactcri>tio 3; 247-250,256n37, 310-311
convergences llS--119; da12 replication implication,: da12 analysis 309; C=n
296-297; dilution of294-295; House nuning home model 130-131;
ca,y to learn and to do 291 - 292; participants 29; SCLI theory 96; shared
emergence 6- 18; extant subs.tantivc worl<: 295; social jwticc 175; theory for
295-296; futures of316-317; Cb.scr's practice 93-94
literature 13- 15, 14; international incitements to disc:ourlC 250
di»cmination 17-18; is oflittle value Indigenous research 153, 251
299; bndscapc 7, 7-17; maturation induction 29S--296
S, 14; methodology 45; monol!'"ph.s inductive da12 4, I 56
8-11; origins 6-7; outcome 298-300; inferring 118,303
rcgrounding 223; rc,carch 291 - 292, infomcrcials 277
295-296; saturation 296-297; s!llrting information dissemination 71
Index 327
initially arnilyzing the sy,tem 60 Latour, B. 238, 255n17

Institute of Medicine 131 Law,J. 238, 294
institutional actors 243 leadership value, 54
integrated mining model, Green House learning: analysis and 111, 114,
144-147 123-126, 251; to do analy,i, 123-124;
integration 13, 30, 82, 113, 163, 203, pr.actic.iiti,. 205
252,307 lcsbi2.n, gay, biscxml, tr.msi:,iendcr, tnnS,
inter.acting with other people 212 queer (LCBTQ) 161
inter.actionum 27, 176, 191, 234, Levy, D. L. 161
237-238,250,254n11,255n19--20, LCBTQ s« lc,bian, g;,y, bucxual,
255n26,306,313 transKCndcr, trans, queer (LCBTQ)
inter.actions/actions SO liauon, being 65
internal char.acterutics 5~57 limitations, Parkinson dUC>SC 213
international duscmination. grounded Lincoln, Y. 16, 87, 155
theory 17-18 linear thinking 293
interpretive a!nttaction 295 line-by-line analysi, 32-33
interpretive tum 223- 224, 231, 250 linking. catq,-ory 31
intervening condition., 52, 58, 72-73 litenrurc reviews 159- 160, 180n7,
intervention: components 99-100; putting 189-191, 313-314
into practice 104 locating concept> 29
Intervention for Health Enhancement logic 173, 306
After Leaving (,HEAL) 91, 93- 99, 102, Loi,.J. 173-174
104-105, 105n2 Lopcz.-Aguado, P. 17~1n
interview guide 1S8, 314 lower-level concept> 34
interviewing 16, 164, 166,245,314 Lynch, M. 290
interviews, unffl'\Jcrurcd .31
inventory of a ll)2CC 234 macro/n,c,o/micro 254n 15, 280
in vivo codes 168 making compari,on, 28
in vivo concepts 27 mapping: data 311; ,iruational analysis
issues, S)'$tCnu, community 61 175, 231, 233, 237- 247; siru,tion, 18,
239- 247; social world, 271; SfAR
J011mal ofMixnl M<1/1ods 317 trial 272-279, 273,276; theoretical
'Ju$t in case., scnrcgics 199 ,ampling and conceptual 306
map,: pooitional map, 244-247, 246;
Kanda,amy, S. 161 project map, 244, 311; rebtional maps
Keane, E. 162-163 224, 233,236,239,241-242,245;
Kcrry,J. 81, 85 situational map,, m...y 239,240,241,
knowing,ubjcct 224, 235-236, 238, 245, 281; ,iruational map,, ordered 241,241
252 market value 85
knowledKC 54; biased 282; biomedical Marvasti, A. 83
274; building rebtion.,hips 52; cre2tion M:wumi, B. 223, 232
290; dominant 267; ecology of 235, materialist constructionism 238
246; expertise and 65; i;aps 314; material po,,c,,ion, 85
in-depth 83; of new circunuc:a.ncc, marur.ation of grounded theory
seeking 199; nurse 51; prof=ional 33; 5, 14
rcspon,ibility 317; .cientific 155,270, May, K. 15
274; ,iruated 267-268, 283; ,kills 94; Mayan, M.J. 215n4
$0Ciologic;al 86; trasulation 90i srt also McCr.ath, R. 162
,iruating knowledge Mclemore, M. 176
Me2d, C. H. 26
LaFia, c. 281 m=urc rigor appropriately 303
land.cape, !!"Ounded theory 7, 7-17 mcchanutic thinking 293
Lao, 40 medicine. considering 200
328 Index
memoing 6, 16, 313; abotraction 306; Nehon,J. 173

analytic 31 S; con$tant comparison and ncurodcgcncrativc parlcinsonWll 189
85; evidence 306; excellent grounded new theoretical foundations, situational
theory 314-316; grounded theory 5, analysis 233-238
87; lack ofadequate 308; maps 227, noncombatant 37. 39; s« also combatants
242; open coding 300; procedu= 306; nonhuman actonhctantslclcmcnt:s 224,
rdlcxive process 304; strategics 6 230,238-239,240-241,249-250,
mcmoin40 269, 2n,215-278,280,310-311
memos: analysis 30-31; page 34; writing Northeast 45
34, 36, 42, 167-172 North Victnamcsc 39
mentor/mentcc relationships 65--67 Northwest 45
mento,-protc1,,ce relationship 79 noticing something is different 196
Merton, R . K. 179n5 NSABP s,, National Surgic.al Adjuvant
methodological awarcnc,s 305 Brca>t and Bowd Project (NSABP)
methodological consistency 304 nune adv0<2tc 45-76; categorical
methodological sdf-consciousnco, I 54, rclationsh.ips 74; conditional matrix
159-164 56-58, 56-59; paradigm model
methodology: constructivist grounded 53- 55, 54-55; story line 47- 53; study
theory I 55-156; Orcen House nursing participants 45-47, 46; subotantive
home model 130, 135; Parl<lnson theory 74-75; theoretical categories
disca,c 191-192; situational analysis 59-73
227-233; Straussian grounded theory Nursing Home Reform Act of1987 131
27-31 Nur,i,,g ~s,atd, 17
middle-range theorie, 179n5 nursing sti.ff replacements 140-142,
Midwcat45 144-145
minor litcraturc(s) 250; s« •lso literature
review objectivism/objectivist 158-1 59, 309
mixed-method design 317; s,, •lso design obocrvatiom, Paskimon disca,c 193
modifiability 304 Olcscn, V. 7, 11
monographs ofgrounded theory 8- 11 open coding 300; s« also coding
Montini, T. 248 open-ended interviews 31
Morsc,J.M.88n1, 215n4,252 Onlerof11,inJ(S, 71r,(Foucault) 238
moving forward 210 organization31 culture 61
multi-sited clinical trial 268 outoomcs 54, 57; grounded theory
multi-sited ethnography 268, 279 29S-300; ,ucccs, 73
multi-sited rc,carch projcct:1 239, 275 overcoming. excellent grounded
multi-sited situational elements 270 theory 312
myths 291-300
paradigm 29, 53-55, 54-55
Nahm, H. 7, 113 parallel nuning model, Green House
National Green House Organization 134 143-144
National Sull!ical Adjuvant Brca>t and pasalynng anxiety 202; ,,, also anxiety
Bowel Project (NSABP) 2n Parle. R. 26, 246
natural analysis 111, 117, 123, 124-126; Paskinson disease 188-215, 215n1-2;
s,, also analysis analysis 194; conccptofsclf191; data
needs: analytic 6; basic 92, 99; community collection 192-194; demographic
1n; cider 134; goal, and 235; nutcri31 data 192-193; de.scription 189-190;
274; nurse 51-52, 60; older adults 210; dcscriptive data 192-193; ethics 193;
people with mobility problems 21 O; generalizability 213; limitations 213;
personal 92; reader 49; recognition literature review 189-191 ; methods
60; refugees 163; resident clinical 146; 191-192; obocrvations 193; overview
victims 85-86 188-189; participants 193-194;
n~tivc cases~. 6, 194, 297,299,305, preserving self 194-214; qualitative data
315-316 193; quantitative rescasch 190-191;
Index 3:Z9
rccruiancnt stt2tegies 192: results identity dilemmas 201 - 205; making

194-211; S<tting 191-192; strengths ><nsc ofsymptoms 195-197; Parlcinson
213; study design 191; thcoretial disease 194-214, 19S; preserving self
concerns 191 scntegics 212; reconnecting the self
particiPfflts 84; demographics 45, 46; 206-208; sifting and sorting 206;
giving voice to 68; Parkinson ducasc ,cntegies 189, 212; supporting proc=c,
193- 194 213-214; turning point l9S-200;
partnering 62 unsettling reminders 200-201
potriotum 38 prewar sclf36
potteming of succcs.ful scntcgics 212 principle, of practice 97-104
poy- for-performancc 148 p r = 57; advocacy 47, 49, 59,
Pein:c. C. S. 25 61; analysis 35, 100, I 13, 118,306;
perception: paniciponts 164; risk 34; challen1,,c, in intervention 94-95;
sclf-perceptions 212; signifiation 251 defined 29, 60; excellent gwunded
personal biases 28; Set also bwcs theory 314-316; generic social 4 ; to
personal chanctemtia 55 goals SO; rcscorc:h 4, 17, 39, 41-42, 74,
personal conditions 29 153-155, 162,179, 180n8,289,293,
personal information, disclosing 200 298,311 , 314; story line 47; surviving
personal intcractiom 81 40
perspectives: centrality 307; embodicdncs. professional biases 28
267; gwunded theory 12-13, 313, professional i,,uc, SS
315, 317; integration 113,307; project maps 244,311; ,,, also maps
interventionist I 04; multiple 40, 122, professional nursing organization(s), being
175, 281; non-dominant groups 283; active member in 69- 70
participonts tn, 191, 297; potients promote 5~57, 70-72
171; personal 120; profcssio1121 I 16, protective b"OVcming 29
120-121, 188; rc><archcrand informant
119-121, 126; shared 95,234, 243; qualitative analysis 126
social worlds 235; sociologial 113; Q,,olil4Jivt A11alysisfor S«ia/ S<imtists
scntegies 13; tactics 39; taken-for- (Scnws) 11, 114-115
granted 178; theoretial 18, 122, 174 qualitative data, Parkil1$0n disease 193
physial dependencies 203 Q,,oli141ivt H,a/1/, R..:s<ard, 15
Pidgeon, N . 160 Q,,olil4livt M,tl,ods for S«ia/ S<imtists
planningpragmatically with tunnel (Scnws) 155
vuion 209 qualitative re><arch 40, 42-43, 254n IS
polishing, excellent grounded theory 316 quantitative research 190-191
Porr, C. J. 18, 88 questioning preconceptions 159-164
positionality 160-161, 163, 178, 180n8, questions, asJcjng 28
245, 281- 283 Quint,). 8
positio1121 maps 239, 244-247, 246; sc,
also maps Robinow, P. 224
positivism 11, 155, 157, 223 R:unalho, R . 160
pos><>Sions of worth 85 Rancierc,J. 251
po,thumanism 238, 256n27 reading. excellent grounded theory 317
Potter,). 166 reasoning Kt abductivc reasoning
pr:icticc component 100-104 received interpretations 122
pragmatism 13, 27, 157- 158, 237, 250, reclining wheelchair 209
25Sn20, 25Sn26 rccognition/rccall 122-123
preconceptions 154, 1S8, 159-164, 174, recognizing need 60
207,283,300 recognizing the inevitable 208
prcgJ>ancy study 30, 34-35 reconnecting the sclf206-208
prc><rvingself: balancing risks and rewards recruitment Green House nur:sing
207- 208; defined 189; envisioning• home model 135; scntegics, Parkinson
future 20S-21 I; finding out 197- 198; disease 192
330 Index
rccmph.asizing process, con.sauct:iVUt Sande.low>ki, M. 47

grounded theory 166-167 sarur11ion 6,315; concept 30, 43;
reAcctions, situational analysis 251-252 conceptual 296; Crccn House nursing
reAcxivity 313; corutant 178, 283; home model 137; gJ"Owidcd theory
continual 163; enhanced 233; grounded 296-297; infom,ation 296-297;
theory 1.59; methodological 255n27; replication of infomution 296; rcocarch
po,itionality and 281 - 283; = h e r 42; researchers 296,315; strategie,6;
298; research procC$S 309; theoretical 300; theoretical ,.,,,pling 6,
sclf-awarcnc,.s and 313; stimulate 162; 43, 59,173
"1'0ng reflexivity 154, 161, 175 SllAM ,,, SC$Sler Branden Advocacy
reformulated sclf206-207 Matrix (SBAM)
relational ecology 245--246 SBAT,,, SC$Sler Branden Advocacy
relationality 234, 241-243, 242 Theory (SBA1)
relational maps 224, 233, 236, 239, Schatzman, L. 7, 11, 13, 111, 114, 120,
241-242, 245; s,,o/so maps 293, 296; natural analysis 123, 125;
relations among situations 233, 235 rccognition/rccall 124; rcocarch analysis
relationship/coalition builder 63 123, 125; rc,ponsc to gJ"OUnded theory
relationship dependencies 204 115-119
relative value, assigning 118 Schwab and England Activities of Daily
relax. willingness to 305 LivingSC2le (ADL) 190, 192-193, 203
rclevmee 303 Schwalbe, M. 4
Reprcscnt2tional practice 250 SCLI ,,, Strengthening Capacity to Linut
rcscwch 7:1; analysis 126; decolonizing Intrusion (SCLI)
161,225,227,251; design 6,239,308; scafood, e2ring/consuming 168
desire to do 305; excellent grounded second-generation grounded theory
theory 312-316; Orccn House nuning 130, 135
home model 132-134; Indigenous Seide, K. 178
153,251; procc,.s4, 17, 39, 41-42, 74, self-assessment, starting 312
153- 155, 162, 179, 180n8, 289,293, sclf-aw.u-cncss 304,313
298,311,314 self-consciousness, methodological 154,
Ratorcl, Aa, Th, (Denzin) 233 159--164
rcscntfuln.,., 206 sclf-cvaluacion,c.xccllcntgroundcd
rcoidcnt c:uc proc= 141, 143-144 theory 316
rcoo1utcnC$S 206 5e:Jf-monitoring~ excellent grounded
rcoporuibility, taldng/transfcrring 67-68 theory 314-316
restructuring life 84--85 self: holding onto fom,er 201; losing a
R,stmduritlJ{ LJft Aji,r Hom, Lo,s by Firr valued 173; s«also preserving self
(Stem and Kerry) 81 self-rcfom,ulation 21 Sn4
rhizomes: asscmblaJ!"S and 224, 236-238, self-wonh, eroding 202
252; situational analysis 236-237 sewitivity 30, 306
Rice,C. 164 sensitizing concepts 162
rigor 137,303 sensory integrating activities 214
risk 34: =ents 274-275; bchaviors SC$Sler Branden Advocacy Matrix (SBAM)
96; and rewards, balancing 207-208; 45,47, 48, 49--50,52-53,56-57, 74
taking 201,212 SC$Sler Branden Advocacy Theory (SBA1)
ritual-suppon connection 85--$6 47,49,52,58, 74-75
roles SS setting: Green House nursing home model
routine action.s/intcr2ctions 29 137; P:ultinson disease 191-192
rules of cnga1,..,ment 3S--40 ,hared perspectives 234
shared wiiverscs of discourse 234
3.alllplc. Green House nun:ing home model Shim, J. K. 176
138 ,imng and sorting 206
sampling: selective 299; snowball 192; Silverman, D. 83
theoretical 30 ~ituatcd interventions 247
Index 331
Situated Knowlodi,•:o: The Science individual 232; of inquiry 224-225,

Question in Feminwn and the Privilege 236, 239, 243, 24S--246; irutitutional
of Panial Perspective (Hanwoy) 267 171; methodological attention 233;
situating knowledge 267- 283; clinical methodological shift 238; pertinent
tri>h 268-269; complc.>city 279-280; discouncs 250; problematic 122;
difference 279-280; rnacro/mcso/micro rca.s.1cssing and rccV2.luating 73;
280; po,itionality 281-283; reAexivity reLttionalitics 224; rcscan:h 4, 160, 239;
281-283; relationships 280; relativi,,n turning 33; understand the context 62
281-283; situated analy>cs 269-271; ski&: advoacy 73; communication 53.
Study ofTamoxifcn and Raloxifene 64--65; knowledge 94
(STAR) trial 271-279, 272 snowball wnpling 192
situational analysis (SA) 223-252; action social conditions 29
231-233; analysis 231- 233; arenas maps social constructionhm 255n20
234-235, 243-244, 244; assemblage> social interaction 82
236-237; basic social process (BSP) 224, socialjwtice: rcscasch 174-178, 308; work
269; boundary objects 248; Chicago for 71
ec-0logjcs 234-235; collaboration social ritual 85-86
througlt mapping 250-25I; coDcctive social science theory 4
acton' power relations 247-248; S«i41 S,udits of Sam« 290
conditional matrix 227-231, 229; social worlds/arenas analysis 234-235,
context 231-233; criteria 309-31 I; 243-244,244, 255n22
critical tools 247-250; democratizing social worlds/arenas theory 227, 234-235,
representation 250; discounc studies 255n25,256n37,269
235- 236; implicated acton 249-250; sociological eye 113
knowing subject 23S--236; mapping sociological theory 301
situations 239-247; methodology sociologist I 13
227-233; new theoretical foundations sorting 4, 54, 19S, 206-207
23.>--238; nonhuman 237-238, Southwcst45
249- 250; positional maps 244-247, spatial ecology 232
246; reAections 251-252; rclationality staff" empowerment, Crccn House nursing
241-243, 242; rhizomcs236-237; home model 131-132
situational maps 239-243, 240-241; staff responsibilities 133
situational matrix 227-231, 230; social standpoint theory 160-161, 180n8
worlds 234-235, 243-244, 244; writing Stange, I. 180n9
"1'0ng 309-31 I Star, S. L. 168,223, 234,246,248, 250,
Siruational AMlysis: C,o.,nd,d 1"1icory Aft« 254n9,255n17
rh, fotnprrtiv, Tum (Clarke) 225 stepwise technical task>, grounded theory
Situational Analysis in Procti«: Mapping 293- 295
R.rs,ard, With Cromu!,d 11~ory Stem, P. N. 10, 12-13, 35, 8.>--84, 88,
(Clarke) 225 88nl, 301-302; collection--coding-
situational mapping 280 analytic 85; discovery ofgrounded
situational nups 245, 283nI; messy 239, theory 80; RrnrM<turinx U.fe Afl,r Home
240,241,281; situational analysis Lou by Fii, 81; views on Glaser and
239- 243,240- 241 Stnu,.. 79-80
situational matrix. 5itu.atiorul analysis story line 47-S3
227-231, 230 strategic actions/intcnctions 29
situation/situatedne,.. 4-5, 232, 249, str.1tcgics 4-6, 302-304
255nl9, 273,281, 283; analytic 33; Str.ltcgizc S0, 56-57, 60, 61-63, 74
assessment 65; bad 196; biomedical Stnws, A. L. 6, 8-1 I, 13, 17, 86-87,
278; collective organizational and 112- 115, 154-156, 159-160,223,
institutional acton 243; conditions 231; 226,228,231,234,240,251, 254nl I,
contextualizing 32; dimcnsiomlizing 254nl3, 269,289,292-294,296,
125; elements 241,270,281; gcnitivity 301,313,316; 2pproach to qualitative
233; grasping 199; human world 224; research 42; Basics ofQualitativ,
332 Index
Rcs<arm 8-10, 27, 155,252, 254n14; reasoning 174; an:alytic need, 6; cbinu
conditional matrix 56; conditional of conducting 157; comp2I'UOn groups
nutrix model 74; context 49; cduc,tion 85; conceptu:al clarity 194; constant
25-26; leadership oftC2m rc,carch 7, comparison 95; comtructivist grounded
12; worldview 25 theory 172-174; convenience 297;
Stnussi.m grounded theory 12-15, 14, defined 28, 30; major cate1,,orie, 179;
18,25--43,224,227,229,233; analy,u primary use 173; rccxamining data 194;
31-35; analytic example 35-42; rcscorchcr31, 35, 173; saturation 6,
backi;round 25--27; criteria 304--306; 43, 59; secondary data 93; ,cn,itivity
methodolo1,,y 27-31; problems and 75; theon,tical coding 303; theoretical
criteria 304--306; saong 304--306 interpretation 85; su also .sampling
Stnus,-&hatzman colW>oration 112-1 15 thcorctial saturation 300
Strengthening Capacity to Limit lncrwion theorciical ,cmitivity 30, 74, 95--96, 315
(SCLI) 91-94, 99--100, 101 11i,orrtical Sensitivity: Advon<.s i11 Iii,
,trcngt),$, Parkinwn di= 213 MttluxlolOKY of C rou,ul,d '/1u:ory (Cla,cr)
saong rcffexivity 154, 161, 175 11,301
structural process 228 theon,tical sorting 4, 54, 195, 206-207
Strutzcl, E. 17 theory comtruetion 3-4, 86, 95, 157,302
study dcsign, Parlcinson disease 191 theory/method, package, 226, 254n9
study puticipants 45-47, 46 theory of analy,u 114--116
substantive theory 74-75 thick an:aly,u 233, 268; stt oho analy,u
Suclcbby, R. 303 thin~ done while in role, SS
suffering as moral ,tarus 168 Thoma,, W. I. 26
Sullivan, W. M. 224 Thornberg. R. 160
,upporting proccssco 213--214 Thome, S. 173
surviving:: reconciling multiple rcalitiC5 41 thtt2ts s« challenges
Swanson,). M. 13 time-&.mes 174
,ymbolic interactionum 11, 176, 191, time management 174
224, 255n19-20, 306,313; s«also time sacrifice 174
intcractionism tnditional nursing model, Green House
,ymptom,, interpn,ting 196 140-141
training in qualiti:tivc inquiry 304
teaching: analy,u 35, 116-117, 125, tnJUition 200-201
253n6; expected and unexpected tnJUlating the object. BSP 248
feelin~ and bchaviors 214 triangulation 31 S
temporal ccoloi,,y 232 trust in cmc1l:,.rcncc 86; s« also emergence
temporal emotion work 174
texts: comparing 303; of i;roundcd theory United States 39-40, 73, 83--84, 192, 274
8- 11, 8- 13, 14-15 universes of discour3C 235
thcon,tic:al catci,,orics 59-73; empower University of C:alifomia, San Franruco
67-70; 6cilitatc6'.Hl7; identify ~ 1 ; (UCSF) 7, 11-12
intervening condition:,. 72-73; promote
70-72; ,tntegjz<: 61--63 validation 31
theoretical concerns. Parkinson Vanner, C. 164, 178
di>c=l91 Vann-W:ud, T. 193,202
thcon,tic:al hmcworlcs 27, 113, 191 variation 30<,
thcon,tic:al g;,.rncs 32 Venn diagram SO
thcon:tic:al literatures, grounded theory victims of home fires, BSP 84
295- 296 VietCong(armedconununutpolitical
thcon,tic:al process 100-104; Stt oho n,volutionary organization) 39-41
proccs.scs Viernam 36- 39
thcon:tic:al sampling 6, 28, 30, 41, Vietnam War 37- 38, 73
172- 174; abductive logic 173; abductive vigilance 204
Index 333
vuitor model, Green Ho= 142- 143 Wilson, T. 223

vulneroble sclf202; ,,. also pmerving self women s« abused women
Woofii,r, S. 238
wall ofsilence 37 work hard, willingr,css to 304-30S
"wandering aimlessly" stage 84, SS working group 2S I
war experience 36--37, 39 work life quality 141 - 142, 144-14S
W""1bum, R . 13 ..worrisome accuracy"' 84, 302
Washington, DC 73 writing memos 34, 36, 42
watchful sclf204-20S
W1,y y..,,,.. Ahwys Pott oftli, R,s,mrh YouTubc 17
Pro«ss &m W1tm y.., 'l1,i11k y..,,,. Nol
{Frost) !SS Zhani;.J. 167
Wicker, A. 28 Zimmcmun,S. 134
ABOUT THE AUTHORS
Barbara). Bowers is the Associate Dean for Research, the Helen Denne Schulte
Professor, the Charlotte Jane and Ralph A. Rodefer Chair, and the Director,
Center for Excellence in Long-Tem1 Care at the School of Nursing and directs
the qualititive and mixed methods research core at the Institute for Clinical and
Transbtional Research at the University of Wisconsin-Madison. She obtlincd a
BS in nursing from the University of Michigan, Ann Arbor, a MS from Wayne
Stite University, Detroit, and a PhD in sociology from the University of Califor-
nia, San Francisco (UCSF), where she studied with Leonard Schatzman, Anselm
Strauss, and Barney Glaser.
Her association with Lenny Schatzman began during her tenure as a predoc-
toral student at UCSF. She was the first of Schatznun's students to use dimen-
sional analysis as the research method for her dissertation. Spending many hours
in Schatzman's officc----as his thoughts about dimensional analysis evolved, stiy-
ing in clooc contact with Schatzman over the subsequent years-has given her a
close-up view of the methodology, its application, and how it differs from other
grounded theory approaches. Dimensional analysis has been used by many of
Schatzman's students, their students, and increasingly by others, familiar with
studies using the methodology, who sec dimensional analysis as a useful approach.
Wide dissemination and robust debates have yet to eventuate as the methodology
is still largely passed on orally. Lenny Schatzman died in 2008, before he was able
to complete his book on dimensional analysis.
Resources
Bowers, B. J. (I 91!7). lntcri;cncr2tiorul nregiving: Adult cucgivcrs and their aging par-
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Bowen, B.J. (1988). Family perceptions ofcare in nuning homes. Th, C<ronJol,wst, 28(3),
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Bowers, B.J. (1989). Grounded theory: From concepruali.zation to research process. In B.
Saru,r (Ed.), Paths to lmmvkd11<: lnnltllOtM =arc/, nw:tlu>ds in 11uninK (pp. 3'.>-58). New
York: National Lc:igucofNuning.
Bowers, B. J. (1996). ·n,,,rtlatio,uhip btt,wm s14ffinK and quality i11 IOJIK•kml cart Jaaliti,s.
Report to the 105th U.S. Congress, Subcommittee on Health: Appropmtcncss of
Minimum Nur,c Staffing Ratios.
Bowers, B. J. (2009). Hearing the consumer voice in manab'Cd long-tcnn care pro-
gnms in Wisconsin. Disability and Hralth, 2(1), c12. http,://doi.o,wl0.1016/j.dhjo.
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Bowers, B. J., & Becker, M. (1992). Nur>e aides in nuning homes: The relationship
between organization and quality. n,, Cnontol,wst, 32(3}, 360--366.
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supcrvuion. Admi11istration in S«wl Wod,. 23(1), 29-49.
Bower>, B.J., Esmond, S. L., &Jacobson, N. (2000). The rdation>hip between staffing and
quality in long-term care facilities: Exploring the views ofnur>e aidcs.)01,ma/ ofNursinK
Cart Quality, 14(4), 5>-64.
Bowers, B.J., Esmond, S. L, &Jacobson, N. (2003). Turnover reinterpreted: CNAs talk
about why they lcave.Jo,mu,/ of Crronto/Oj/ica/ Nursi11J1, 29(3), 36-43.
Bowen, B.J., Esmond, S. L, Norton, S., & Holloway, E. (2006). The consumer/provider
relationship as care quality mediator. In S. Kunkel & V. Wcllin (Eds.) , Consu111<r voiot
and moi<t in /01,K•tmn cart (Chapter 10). New York: Springer.
Bowen, B. J., Fibich, B., &Jacobson, N . (2001}. Care as service, care as relating. care as
comfort: Undentanding nuning hon1e residents' perceptions of quality. 71,, Cnontolo-
}/ist, 41(4), 539-545.
Bowers, B.J., Lauring, C., &Jacobson, N. (2001). How nur,c, manage time and worlc in
long-term care facilities.Jo,,rru,/ ofAdwmtrd NursinK, 33(4}, 484-491.
Bowen, B.J., & Nolet, K. (201 l}. Empowering direct care workcn: Lessons learned from
the GREEN HOUSE® model. &,iior Ho11si11K and Cartjounu,/, 10'.>-I 14.
Bowcn, B.J., Nolet, K., &Jacobson, N. (2016}. Sustaining culrurc change: Experiences in
the Green House model. Hra/1/1 Strvi«s Resurrh, S1(1, Part II), 398-417. http,://doi.
o,wl0.111 l/1475-6773.12428
Bowen, B.J., Roberts, T. Nolet, K., & Ryther, B. (2016). Inside the Green House 'black
box': Opportunities for hi!lh-quality clinical decision making. Hraltl1 Strvi«s Resrarc/1,
S1(1, Part II), 378-397. https;//doi.o,wl0.1111/1475-6773.12427
Caron, C . D., & Bower,, B. J. (2000}. Method, 2nd application of dimensional analysis:
A contribution to concept 2nd knowledge development in nuning. In B. L Rodg-
cn & K. A. K.nafl (Eds.), Gm«pl dwtlopmrnt ;,, nursi,w,fo,mdafiMas, 1ulmiq11cs mu/ appli.
t4tions (pp. 285--319). Philadclphi:a: W.B. Saunden.
Caron, C . D., & Bowen, B. J. (2003}. Deciding whether 10 continue, shore or relinquish
carcgiving: Caregiver views. Q,,alitatiw Hra/1/1 R<S<arc/1, 13(9), 1252- 1271.
DcVorc, D. J., & Bowers, B. J. (2006). Childorc for children with disabilities: F.milics
SC21'Ch for specwiz.cd care 2nd cooperative childcare partnenhips. /,fonts & Yocu11r 01i/.
dm,, 19(3}, 20'.>-212.
Cilmorc-Bykovskyi, A. L, & Bowen, B.J. (2013}. Undcntanding nuncs' decisions to treat
pain in nuning home residents with dementi2. ~arch in Oro,~olo}/ical NursinK, 6(2},
127- 138. https://doi.o,wl0..3928/19404921 -20130110-02
Hamilton, R ., & Bowen, B. J. (2005). Disclosing genetic tc.t results to family members.
)01mu,/ of Nursi111r Schofannip, 37(1}, 18-24.
336 About the Authors
Hamilton, R., & Bowen, B. J. (In press). Conveti,-cnce of :ag,,, g,,netic risk, and trcalment
decisions in young women (18-39y/o) at risk for hereditary breast and ovarian cancer.
Cmttks in M~dici,K.
J{jng. B., & Bowers, B. J. (2011 ). How nurses decide to ambuhtc hospi121i2ed oldcradults:
Development of• conceprual model. '/7i, C,ro,,tol~t, 51(6), 78&-797. hnpo://doi.
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J{jng. B., & Bowers, B. J. (2013). Attributing the responsibility for ambulating patients.
/11/cn14/io114/j,11m14/ of N,,ninJI Studits, 50(9), 1240--1246. hnps://doi.org/10.1016/j.
ijnuntu.2013.02.007
J{jng. B., Gilmorc-Bykovslcyi, A. L., Roi.bnd, R., Poln=k, B., Bowers, B.J., & J{jnd, A.
(2013). The con,cquencc, of poor communication during hospital- to-okilled nuning
facility lranSitions: A qualitative ,tudy. )011n14/ of th, Amnican C,riarrics Soci,ry, 61(!),
1095-1102. httpS://doi.org/10.1111/ji;s.12328
Lutz, B., & Bowers, B. J. (2000). Patient-<entcred care: Understanding its interpretation
and implementation in health c:uc.Joumal ofSd,ofurly Inquiry for N11ninJ1 />n,ni«, 14(2),
183-187.
Lutz, B., & Bowers, B. J. (2005). The inRucnce of disability on evctyday life. Qualira1iw
Hralth Rrsrarch, 15(8), 1037-1054.
Lutz, B., Bowers, B.).. Esmond, S. L., & Jacob.on, N . (2003). Improving primary care
for persons with disabilities: The nature of expertise. Disohi/ity & Sarirty, 18{4),
443--455.
Norton, S., & Bowers, 8. J. (2001). Worlcing toward consensus: Providers' strategics to
shift patients from cU12tive to palliative treatment choices. Rr~ard, in Nursit1Jl & H~alll,.
24(4), 258-269.
Oycsanya. T., & Bowers, B.J. (2017a). 'Tm trying to be the safety net": Family protection
of patients with modcrate-to-ocverc TBI during the hospital 312y. Q,,alitativ, Hralt/1
Resram,, 27(12), 180+-1815. hnpo://doi.org/10.1 ln/1049732317697098
Oycsanya. T., & Bowers, B. J. (2017b). Managing visitors during the hospital >tay: The
experience offamily caregivers of patients with traumatic brain injury.joumal ofFamily
N,,ninJI, 23(2), 273-298.http>://doi.org/10.11n/1074840717697673
Pandhi, N ., Bowers,B.J., & Chen, F. (2007). A comfortable relationship: A patient derived
dimension of ongoing care. Family M,ditin,, 39(4), 266--273.
Roberts, T., & Bowers, B. J. (2015). How nursing home re>idents develop relation.hips
with peers & staff: A 1,..-ounded theory ,tudy. 1nlml41io11al Jouma/ of NwsinJI Studirs,
52(1), 57~7. hnp,://doi.org/10. 1016/j.ijnuntu.2014.07.008
Tiucz.ck, A., Mischler, E., Bowers, B.).. Petenon, N., Morris, M., Farrell, P., ... Carey, P.
(1991). P1ychological impact of&lsc-positive results when screening for cystic fibl'OOS.
Prdialri< H,/mono/OJIY, 7, 29-37.
Wobbcr, R., Bowen, B. J., & McKenzie-Green, B. (2010). Staff response> to age related
health changes in people with intellccrwl disability in gi-oup home>. Dis,,bility &
S«uty, 25.
Pennie Sessler Branden, PhD, CNM, CNE, RN, received a d iploma from
Albany Medical Center, School of Nursing, a BSN from George Mason Univer-
sity, an MSN and Midwifery certificate from Columbia University, and a PhD
from Villanova University. She has taught in nursing programs for more than
15 years and is currently engaged in research, writing, consulting, and advising

doctoral students on their dissertation work.
As a certified nurse-midwife and educator, Pennie Sessler Branden has alw:,ys
had an interest in women's health, patient advocacy, and empowerment. This pas-
sion led to her dissertation work and the discovery of the Sessler Branden Advo-
cacy Theory. She believes that advocacy is an ongoing, active, and participatory
undertaking not only at the one-on-one, nurse-to-patient level but also in many
venues and with various people and groups. Through her grounded theory work
she has worked closely with Juliet Corbin and has learned its importance and
applicability 10 all healthcare issues. Pennie Sessler Branden continues her work
in advocacy and grounded theory.
Resources
Brmdcn, P. S. (1998). Contraceptive choice and patient compliance: The health care pro-
vider's clullcnb-c.Jouma/ of N111s,-Midwiftry, 43(6), 471--482.
Branden, P. S. (2012). 77ic 11urs, as adeo<at,: A pound,d t/1<ory pmp,di.,,. ProQucst
LLC.
Brmdcn, P. S., & Shans-Hopko, N . C . (2017). Crowing clinical and academic nursing
leaders: Building the pipeline. NursinR Administration Q,u,ttmy, 41(3), 258-265.
Kathy Charmaz was Professor Emerita of Sociology and served as Director of

the Faculty Writing Program at Sonoma Stlte University for 20 years before
her retirement in 2016. This program assisted faculty in writing their research
for scholarly publication. Professor Charmaz completed a 5-ycar undergraduate
program in occupational therapy and worked in physical rehabilit1tion for several
years before pursuing a master's degree in sociology at San Francisco State Col-
lege. Subsequently, she became a member of the first cohort of doctoral students
at the University of California, San Francisco in 1968 where she studied with
Anselm Strauss and Barney Glaser. She was the second student to receive a doc-
toral degree from the UCSF Graduate Program in Sociology and the first to write
a grounded theory dissertation.
Kathy Charrnaz wrote, co-authored, or co-edited 15 books including two
aw:,rd-winning books, Good Days, &d Days: ·n,, &!fin Cl,ronic Jl/11ess and Tim,
and Consln1ding Crou11ded 11reory; the latter has been translated in Chinese, Japa-
nese, Korean, Persian, Polish, and Portuguese. She co-authored a text with Scott
R. Harris and Leslie Irvine, ·n,e Soria/ &!f and Everyday uft: Undmta11di11g the
World //,rough Symbolic lntnadio11ism and co-edited a handbook with Antony Bry-
ant,·11,, Sagt Ha11dbook of Cu"e,11 Dtvtlopm,11ts in Grounded Thtory. She wrote or
co-authored many articles and chapters about conducting and writing qualitative
research.
Professor Channaz received the 2006 George Herbert Mead Award for life-
time achievement from the Society for the Study of Symbolic Interaction, the
2017 Leo G. Reeder award for a distinguished career from the Medical Sociol-
O'Cf Section of the American Sociological Association, and the 2018 Lifetime
Achievement Award from the International Congress of Qualitative Inquiry.
Throughout her career, she traversed the globe to give professional development
workshops and classes on grounded theory methods, intensive interviewing, sym-
bolic interactionism, and writing for publication.
Professor Kathy Charmaz passed away in July 2020.
Resources
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tion>I researchers. Q),alitotiw lnq11i,y, 20(9), 1074-1084. httpl://doi.org/10.1177/
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studies. In N . Dcnnn & M. Giardina (Ech.), Quolitotiw i11q11i,y throu11h a aiticol lms.
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12(3), 299-300.
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theory. /r,t,motio1,a/ }<>11mol of Qr,olitari.,. M,tlrods, 16{1), 1-l!. httpl://doi.org/10.
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Q),alitatiV< l,,quiry, 23(1), 34-45.
Clwnw:, K., & Bclgr2ve, L L (2012). Qualitative interviewing and grounded theory
analysis. In]. F. Gubrium,J. A. Hobtcin, A. Marva>ti, & K. M. Marvasti (Ech.), /·/atld-
book of inkrvkw m,arrh (2nd ed., pp. 347- 365). Thou,and Ow, CA: S.ge.
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Cham12Z, K., & Clarl<e, A. (In prc,s). Pioneer article: Anselm Strauss. In P. Atkinson, S.
Delamont, M. Hanly. M . Williams (Ech.). 'fJ,, SAGE m,ydop,dia of ru,arrl, 11i,t/,ods.
London: Sab"'·
Cham12Z, K., & Henwood, K. (2008). Grounded theory in psychology. In C. Willig &
W. Stainton-Rogcrs (Ech.), Hatulbook of qualitativ, ru<art/1 i,r psychalaf(Y (pp. 240-259).
London: Sag,:.
Clwnw:, K., & Henwood, K. (2017). Grounded theory in psychology. In C. Willig& W.
Stainton-Rogers (Ech.), Handbook ofq,tolitatiw t<S<arrl, in psycl,o/Of(Y (2nd ed., pp. 238-
255). London: Sag,:. (Revised and upd,tcd version of the 2008 chapter.)
Cham12Z, K., & Iu12, S. (2017). Subjective stories and social issues: StntciPes for making
connections. Q),alitativ, M<1hods in Psydro/OJ{)' B111/,1in, 23 (Spring), 11-14.
Ch2m=, K., & Mitchell, R. G. (2001). Grounded theory in cthn0gr2phy. In P. Atkinson,
A. Colfc:y, S. Delamont, J. Lofland, & L. H. Lofland (Eds.), Ha,ulboak of <1/rt"'fl"'phy
(pp. 160-174). London: Sag,:.
Clw11122, K., Thornberg, R ., & Keane, E. (2018). Evolving grounded theory and social
justice inquiry. Jn N. K. Denzin & Y. E. Lincoln (Eds.), Ho,ulb,,ok ofqualitotiv, r,s,ard,
(5th ed., pp. 411-443). Thowand Oalu, CA: Sage.
Cbrl<e, A. E., & Charmn, K. (Ed,.). (2014). SAGE btndunorl:s in s«iol r,s,:arrh m,t/,ods
4-w,/umt s,t: Crou,ultd t/1<ory and situational analysis. London: Sage.
Volume I: Tht history ar,d tSsttttials ofgrou11dtd theory

Volume JI: Grounded thtory in disdp/in,s attd rrstarch
Volume Ill: Croundd theory txtmplars atross disdp/ir,,s
Volume IV: Situatio11al a11alysis: Essmtials and ,x,mp'4rs
Cbrl<e, A. E.• & Chumaz, K. (Fonhconung). Fhg,hip article: Grounded theory and ,iru-
ational analy,u. In P. Atkinson, S. Ddamont. M. Hardy, & M. Williams (Ed,.). Th,
SACE n,,ytlop,di4 of,-arch n,,t/1ods. London: Sage.
Mor,c,J.• Stem, P. Corbin,J., Bower,, B.• Chamuz, K., & Clarice, A. E. (2009). D<vtlop-
inJl J!Mlnd,d ln,ory: 1k s«otul JlNl<TOli<m Walnut Creek, CA: Left Coa,c Pr.ss.
Thornberg, R ., & Channaz, K. (2012). Grounded theory. In S. Lapan, M. Quan:aroli, &
F. Riemer (Eds.), Q,ia/iwi., r,s,:arr/,: An inJroduaion f4 nu:tlwds atul d,sifl',s (pp. 41-<>7).
San Francisco: Jos,cy-Bas:s.
Thornberg, R ., & Channaz, K. (2013). Grounded theory. Jn U. Flick (Ed.). Handb,,ok of
qualitati., a,,a/ysis (pp. 153-169). London: Sab"'·
Thornberg, R .• Pertwnw, L., & Cham,az, K. (2014). Consaucting grounded theoty. In
0. N. Saracho (Ed.). 1-landb<>ok of res,arch m,tl,ods in tarly du/dl,ood td11lotion (pp. 405--
439). Charlotte, NC: Information Age Publishing Inc.
Twood, A., & Charmn, K. (2012). Grounded theory for mental health practitioners. In
D. Harper & A. Thompson (Ed,.). Q,ialiwtiw rrstarrh mtthods in mmtal l1<alt/1 and pry-
,/.,th,rapy: A Jlllidtfor studmu a,ul prottiliot,m (pp. 131-146). Chichc,tcr, Ww. Su""x,
UK: John Wiley & Som.
Vann-Waid. T. Morse, j.. & Charmaz, K. (2017). P=crving self: Theorizing the social
and psychological proccs,c, of living with Parlcimon <liscasc. Q,ialitaJiw H,alt/1 R.,s,arrl,,
27(7). 964-982.
Wcrcr., F.J., Ch•rmaz. K., McMullcn, LJ.,Jo,sclson, R., Anderson, R., & McSpaddcn, E.
(2011). Fiv< '"'>" ofdoi11Jl q11ali1a1iv, a,ialysis: P11tt1ot1u:t10l0J1Ual p,ydwlOJlY, J1t0U11dtd /kc,y,
di.stoune mwlysis, na"ali~ reset1rd1, and fon,;i;vt ;nquiry. New York: Guilford.
Adele E. Clarke'ssociological tr:1ining included working with Renee Fox 3t B3r-

nard College. a Jll3Ster' s at New York Unive~ity with Eliot Freidson, a PhD at
Unive~ity of California, S:m Francisco (UCSF) with Anselm Str:luss and Virginia
Olesen, and a postdoc in organizations at Sunford Unive~ity with Richard Scott.
Upon Str:luss's retirement, she W3S hired i nto the Doctoral Prog,:im in Sociology.
School of Nu~ing. UCSF, where she now is Professor Emerit3 of sociology and
history of health sciences. For over 20 yea~. she t3ught the UCSF qu3lit3tive
research methods sequence of courses in sociology and nu~ing and has published
on qualitative inquiry in German. French, ltali3n, and English. Her book Situ-
ational Analysis: Crou11dtd 111tory A.ftn t/1t Postmodtm 'limi (S•ge, 2005) won the
2006 Ch3J'lcs Horton Cooley Award of the Society for the Study of Symbolic
Interaction (Gemun translation 2012). The second edition (Sage. 2018) adds
two new co-authors, Carrie Friese (London School of Economics) and Rachel
Washburn (Loyola Marymount U niversity, Los Angeles).
Professor Clarke's research centers on studies ofscience, technology, and medi-
cine, especially medical technologies for women such as the pap smC3J', contra-
ceptive development, and RU486. Her major work on the reproductive sciences
in biology, medicine, and agriculture, Discipli11in11 Rtproductio11: American LJft Sd-
tntists and th, "Problem of &x" (University of California Press, 1998), won the
Eileen Baskcr Memorial Prize of the Society for Medical Anthropology. and
the Ludwig Fleck Award of the Society for Social Studies of Science. Her latest
book is a feminist environmentalist intervention for reproductive and eco-justicc,
Makin// Ki11 Not Pop111"tion (Prickly P3J'adigm Press, 2018), co-edited with Donna
Haraway.
Adele E. Clarke won the 2012 J. D. Bernal Prize for Out:st:mding Conrribu-
tions from the Society for Social Studies of Science and the 2015 Leo G. Reeder
Award for Distinguished Service to the Field by the Medical Sociology Section
of the American Sociological Association.
Resources
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plexitat dcr entschcidcnde Punk<: Zur Bcgrundung dcr Siruatioruanalyse. In Ciintcr
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E.J. Hackett, 0. Amsterdamska, M. Lynch, &J. Wajernan (Eds.), n,, J,a,,dbook ofsam«
and tcdtno/OJ!Y st11dies (3rd ed., pp. 113--137). Cambridge, MA: MIT Pn=
Keller, R., & Cbrlce, A. E. (2019). Siruaring the >OCiology of knowledge approach to
discounc (SKAD) in intc,prctivc inquiry. In A.-K. Homidge, R . Keller, & W. J.
Schunemann (Eds.). Auw/1 in seas ofdisun,nc: A prani,;,lJ111ide to the sotiolOJ!Y ofl,u,-1,dR<
oppro«li lo distourse. London: Routlcxlgc.
Juliet Corbin collaborated with Anselm Strauss for 16 years. She received a BSN
from Arizona State University, Tempe, a MSN from San Jose State University,
and a DNSc from University of California, San Francisco (UCSF) and she served
as a postdoctor:tl research fellow in the Department of Social and Behavioral Sci-
ences, UCSF. She holds a position as Senior Scientist at the International Institute
ofQualitative Methodology, University of Alberta, Canada. She retired from for-
mal teaching in 1999 but continues to work with students on an individual basis,
offering workshops and selected presentations on grounded theory methods.
Juliet Corbin was also a family nurse practitioner and held a position as lec-
turer at San Jose University. She has presented keynote addresses and workshops
on grounded theory methods internationally. She has received numerous awards
for her research, including the Nurse Scholar of the Year Award from Thomas
Jefferson University and from Sigma Theta Tau, and the Book of the Year Award
from the Amtrica11 Journal ofNursi11g.
Resources
Corbin, J. (1982). J>rottdiw R"""'""R' Stra1,w,s for nw1w}li11x a prr,.,Ullll)' <0tnbi11td wit/1 a
cl1ro1Jic itltias. Doctonl dissertation, uc.5F, San Francisco.
Corbin, J. (1986). Coding, writing memos, and diag,:imming. In C . Chenitz &
J. Swanson (Eds.), Quali1a1iv, ,rs,ar,h ;,, 11ur,inx (pp. 102- 120). Menlo Park, CA:
Addison-Wc.lcy.
Corbin,). (1986). Qualitative analy,is for grounded theory. In C. Chcnitz &). Swanson
(Eds.), Qualitatiw r,s,arrh i11 nuni,,t (pp. 91-101). Menlo Park, CA: Addison-We.Icy.
Corbin, J. (1987). Women's perceptions :u,d management of a pregnancy complicated by
chronic illness. Hta/1/1 Carr for Wo,n,n J,,i,,,.,,1ional, 8, 317- 337.
Corbin, J. (I 990). Balancing resource dcm:u,d against supply: Maintaining qualiry of
life in the elderly chronically ill. In C. Chcnitz,J. Takano-Stone, & S. A. Salisbury
(Eds.), 171t clini,al pradiu ofx,ronJolO;llk•I 11unir1x (pp. 547- 555). Philadelphia: J.B.
Saunders.
Corbin, J. (1991). Anscbn StTaus,: An intellectual bi~hy. In D. Maines (Ed.), S«ia/
OT]lOnizations and soda/ pro«ss (pp. 17-42). Hawthorn, NY: Aldinc de Gnryter.
Corbin, J. (1992). The carcgjving tTajectory: An interactive proccssual &.mcwodc. R,v,,,
J,,,~n,atio,ra/r D'adiqn Om,munautairt (International Review of CommW1ity Develop-
ment), 28168, 39-49.
Corbin, J. (1994). Rcspon.sc to the article operationalizing the Corbin and StTauss tTajcc-
tory model. Scholarly lnqHiry far Nurnr1x Pradict, 7(4), 265-268.
Corbin,). (1996). Rehabilitation: A biog,:iphical medical process. In T. Schott, B. Badura,
H.-J. Schwogcr, P. Woll; & P. Wolter> (Eds.), Ntue W<;E< in dtr R,lwbilitatio,1 (pp. 174-
181). Wcinheim, Germany:Juvcnta V ~
Corbin, J. (1998). The Corbin and StTauss chronic illness tTajectory model: An update.
Sdu,larly Inquiry far N11rn11x Pradi«: An lntmuitio,wljounwl, 12(1), 3>-41.
Corbin, J. (1999a). Kritistl1t Analyst von &Jl<bnisstn dtr P/9/eforsdmnx. Wtrl.wrrr0;11far Sl11di-
n1britf (Modul). Jena, Germany: FH Jena Fachbcrcich Sozialwcscn.
Corbin,J. (1999b). Rcspon.sc to ":u,aly,is and evaluation of the tTajectory theory of chronic
illness management." Sdrclarly /1,quiryfor Nur,i11x Pradi«, 13(2), 105-109.
Corbin, J.. & Hildenbrand, B. (2000). Qualitative Forschung. In B. Rennen-Allhoff &
D. Schaeffer (Eds.), Handb11th ~ , s d u , f t (pp. 159-186). Wcinhein,, Germany:
Juventa.
Corbin, J.. & Morse, J. M . (2003). The unsaucturcd intc.ractive interview: lssucs of reci-
procity and ri,k.s. Qualitativ, J,,quiry, 9(3), 335-354.
Corbin,J., & StTaw,, A. L. (1984). Collaboration: Couple, worlting together to manage
chronic illness. lnoax,, 6(4), 109-115.
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wodc. Qualitati,,,: SociolO;IIY, 8(3), 224-247.
Corbin,)., & StTauss, A. L. (1985b). Issue, concerning regimen management in the home.
Ax,inx a11d S«i,ty, 5, 249-265.
Corbin,)., & Strauss, A. L. (1987). Accompanin,ents ofchronic illness changes in body, self,
biog,:iphy and biog,:iphical time. Rcs,ard, ;,, tl1t SociolO;IIY of Htaltl, Carr, 6, 249-281.
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al /u,n1t. San Fr.incisco, CA: Jo""Y Bass. Germ:u, translation, R. Piper GmbH & Co.
1993.
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e..Juative criteri>. Qualitatiw So<iology, 13(1), 3-21. Reprinted in Z,,itsdirift filr Sozi.
ologi, ?JS, 19(.6), 418-427.
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Newbury Park, CA:~"'-
Corbin, J., & Stnws, A. L. (19912). A nuning model for chronic illnc,s m:anab'C-
ment b.ucd upon the tnjcctory fnmc work. Scholarly lnljuiry for NursinJl Pra,tkt, 4(3),
155-174.
Corbin,J., & Srnws, A. L. (1991b). Comcbock: Overcoming clis2bility. In G. Albn:tch &
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-n,, Corvin and S/,ouss m,r,inJl mod,/ (pp. 9-28). New Yo,1c Springer.
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71-83.
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the tnjcctory fnmeworlc. In Jap:ancsc tnnsbtion of P. Woog (Ed.), 77,, d,toni, illnas
trajmoryfrom,worl:: '/11< Corbin and St,ou,s nuninJl mod,/. Tokyo: lgal<u-Shoin.
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Sage.
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CA: Sogc.
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C. (1984). Cluoni< illness and th<qu4lity of life (2nd ed.). St. Loui>: C.V. Mooby. Jap:ancsc
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1984.
Jennifer Ruth Fosket is a freelance writer living in Berkeley. In addition to her

extensive work on brC3St cancer, which is the focus here, she co-authored Uving
Grun: Commu11iti,s th1Jt S1utain (New Society Publishers, 2009) and co-edited
BionitdiLalization: Teth110SlitnCt a11d Transformations of Htalth and II/nm i,1 tht U.S.
(Duke University Press, 2010).
Marilyn Ford-Gilboe is a Professor and Echo C hair in Rural Women's Health

Research in the Arthur ubatt Family School of Nursing at The University of
Western Ontario. Her research and scholarship focus on reducing health inequities
and promoting the health of marginalized women and fan1ilies, particularly those
affected by violence, using diverse methodological and analytic approaches. She is
currently studying violence an1ong women living in rural communities, and testing
novel nursing and health care interventions designed to improve the health, safety
and quality of life of women who have experienced intimate partner violence.
Marilyn Merritt-Gray is a well-published retired Professor at the Faculty of Nurs-

ing, University of New Brunswick, Canada. Her practice and research interests
arc health program design and women's physical and mental health, particularly
for women with trauma histories who arc rurally located. She has extensive expe-
rience working at a governance level within the not-for-profit service sector.
Janke M. Morse is a Distinguished Professor and the Ida May "Dotty" Barnes, RN,
and D. Keith Barnes, MD, Presidential Endowed Chair in the College of Nursing,
University of Utah. She was fom1erly a professor, founding director, and scientific
director of the International Institute forQualitltive Methodology (IIQM), University
of Alberta, and professor of nursing and bchavioral science at the Pennsylvania Stltc
University. She holds PhDs in both nursing and anthropology and uses andu-opologi-
cal research methods to explore the illness experience. suffering, and comforting.
Janice M. Morse is an authority in qualitative research methods. In 1991,
Morse and Joy Johnson published ·nit I/111,ss Exp,rimce: Dim,nsions of Sufftri11g,
a collection of six grounded theories, and the last chapter in that book ("The
Illness Constellation Model") became one of the first meta-analyses in qualita-
tive inquiry. Since then, Morse has used grounded theory with a number of
topics, including breastfeeding, and various studies exploring the illness experi-
ence. She has served as founding editor of the Qualitativt Htalth Research journal,
the International Joun1al of Qualitativt Mtthods, and the Global Qualitativt Nursing
Research journal. She has published more than 420 articles and 23 books and
is a follow of the American Academy for Nursing, American Anthropological
Association, the Society for Applied Anthropology, and the Canadian Academy
for Health Sciences. Her contributions to nursing and health research have been
acknowledged: she is the 5th Episteme Laureate (the biannual research award,
Sigma Theta Tau International); she received Lifetime Achievement Awards in
Qualitative Inquiry from the International Congress of Qualitative Inquiry and
the IIQM; and she has been awarded honorary doctorates from the University
of Newcastle, Australia, and Athabasca University and the University of Laval,
Canada.
Resources
Corbin, J., & Morse, J. M. (2003). The unmuctured intcroctive interview: Iuucs of reci-
procity and risb. Q,ialita1i"" Inquiry, 9(3), 335-354.
Martz, C ., & Morse, J. M . (2016). The changing mture of KUilt in &mily can:givinl!'
Through care tnnsition.s or parents at the end of life. Qu,,litotiw H,.!1/1 Rtstom,.
http,://doi.org/10.11n /104932316649352
Morsc.J. M . (1991). Ncb,otiating com.mittncnt and involvcn\Cnt in the patient-nurse rcla-
tioruhip.Jo1m14/ of Advan«d Nunint, 16, 455-468.
Morse, J. M. (2000). Raponding to the cue> of suffering. Htalth Out far Won,m /ntmu,.
tionol, 21, 1-9.
Morse,). M. (2001a). Situating grounded theory. In R. S. Schreiber & P. Nocroger Stem
(Eds.), Usintpou11d,d t/r,o,y i,inuni11x (pp. 1-15). New Yoric: Springer.
Morse, J. M . (2001b) Tow.ud a praxis theory of suffering. Ad_,, in Nuni,ljl Scitti«,
24(1), 47-59. ~talian: Veno una teoria della pr:wi della >0ffercnz.a (rnduzione di Luca
Mori). Salut« S«i,til, 1, a cw-a di Enzo Ciorgo e Willem Tou,ijn, FrancoAngeli, 2003,
ps.169-185; Commentary: Mori, l. l'OS$Crfvzione della >0fferenza nel bvoro di Janice
Morse, pp. 186-189).
Morse,). M . (2002). Interviewing the ill. In J. Cubrium &J. Hobtcin (Ed>.), Handbook of
i,11,rvinv m,orc/1 (pp. 317- 330). Thou>and Oab, CA: Sage.
Morse, J. M. (2007). Sampling in grounded theory re,carch. In T. Bryant & K. Charmaz
(Eds.), Ham/book of!l""•ndtd t/r,o,y (pp. 229-244). London: Sage.
Morse,). M. (2009). T..,.Jcs, tcn.sion.s and resolutions. In). M. Morse, P. N. Stem,). Cor-
bin, B. Bowers, K. Charmaz, & A. Clarke, A. {Ed>.), Dn,,/opinx J11011ndtd tli,o,y: Tiu:
s«ondJ1;n1<roJion (pp. 13- 21). Walnut Creek, CA: Left Coast Pr....
Morse,). M. (2012). The implications of interview type and strucrure in mixed method
designs. In J. Cubrium, J. Holstein, & K. Marvasti (Eds.), S.JJ:t handbook of intmAnv
r,s,om, (2nd ed.). Thousand Cab, CA: Sage.
Morse,). M. (2018). Theoretical Coalc,ccnce: A method to develop qualitative concepts
and theory. The example of enduring. Numnt R,s,orrh, 67(2), 1n-187. https://doi.
org/ I 0.1097/NNR.0000000000000263. goo.gl/ed12rnF.
Morse,). M., & Carter, 8.J. (1995). Stntcgje, of enduring and the ,ufferingofl=: Mode.
ofcomfort used by a resilient survivor. Holisti, Nursint Pratti«, 9(3), 33-58. Reprinted
in Danish: Ed by Nete Crcu Klinisk SY19Pleje, bd 1,11, og 111, 2000.
Morse,). M., & Carter, B. J. (1996). The essence of enduring and the expression of suf-
fering: The rcfom,ubtion of self. Stholarly Inquiryfar N,,nint Pratti,,, 10(1), 4~0.
Morse, J. M ., & Cbrk, L. (2019). The nuanc.,. of theoretical sampling for grounded
theory. In T. Bryant & K. Charmaz (Eds.), SACE /,ant/book of ,11rrrr11 dtvt/opmttllS iu
Jl10llndtd t/r,ory (Chapter 7, 2nd ed., pp. 145-166). London: Sage.
Morse, J. M., & Johruon, J. L (1991). Understanding the illn= experience. In J. M.

Mol>C & ). L Johnson (Eds.), U1ulmtam!i"!I t/i, i//n,ss ,xp,ooi«: DinlfflSi/JIIS ofsufferi11J1
(pp. 1- 12). Newbury Park, CA: Sab"'· RelJievcd fiom http://content.lib.ul2h.cdu/
cdm/singlcitcm/collcction/wpace/id/10102/rcc/149
Mol>C, ). M., & O'Brien, 8. (1995). Preserving self: From victim. to patient,
to disabled person. Journal of Adv.Jn«d Nuni1111, 21, 886--896. https://doi.
org/l0.1046/j.1365.2648.1995.21050886.x
Morse.). M., & Proctor, A. (1998). Maint>ining patient enduru,ce: The comfort work of
trauma nurses. Clini,al Nur,in11 lw,ar</1, 7(3), 250-274.
Morse.). M .• Stem, P. N .• Corbin, )., Bowers, 8., Clurrnaz, K.• & Clarke, A. (2009).
Cro1111dtd th,o,y: "/1i, s«otulJlfflmilion. Walnut Creek, CA: Left Coa.t Press.
Ouwson, J. M., Clark, L.• Morse,). M., Hammer, N., Allen, N., & Grant, M. (2107).
Psychosocial response to new-onset diabetes as a long-term effect ofallogcncic hcmat-
opoietic stem cell tnnsplantation. QualitaJiv, H,alt/1 R-arr/1, 27(12), 1816--1827.
https://doi.org/10.1177/1049732317719434
Penrod,)., & Morse,). M. (1997). Strategics for ass=ingand fostering hope: The Hope
Assessment Guide. 0,,,./"KY M1n,s Forum, 24(6), 1055--1063.
Vann-Ward, T, Morse,)., & Clurrnaz, K. (2017). Preserving self: Theorizing the social
and psychological processes ofliving with Parkinson disease. Q114lil4tivt H,alt/1 R,:s,atd,
27(7). 964-982.
Kimberly Nolet is a research program manager with the Center for Aging
Research and Education at the University of Wisconsin-Madison School of
Nursing. She has a master's degree in education with an emphasis on adult edu-
cation. Her work focuses on research and interventions aimed at improving care
for older adults across long-term care settings and improving work life quality for
the nursing workforce. Of particular interest is understanding how interventions
arc implemented by healthcare organizations to improve both care and staff satis-
faction with work life. Recently developed interventions include an onlinc nurse
residency program for long-tern, c.irc nurses, an onlinc nurse leadership course, a
geriatric simulation toolkit for nurse educators, a decision support tool for family
caregivers, and a guide to implementing organizational change in long-tern, care.
Resources
Bowers, B.J., & Nolet, K. (201 I). Empoweringdin,,:t arc workers: Lessons learned fiom
THE GREEN HOUSE® model. &nior Housin11 & Carrjoun14/, 19(1), 109--120.
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ations on development and implementation. ·17,, Cmmtolop,ist, 54(Suppl. I), S53-S64.
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Robcn,, T., Nolet, K. , & Bowers, B. (2019). Exploring variation in Certified Nursing
Assistant assignments &om the perspective of nursing home residents: A comparison
of adopters and non-adopters of consistent assignment. Jour,14/ of Applitd Cm11wlOJ[)',
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Bowers, B.J., Nolet, K., &J2eoh<on, N. (2016). Swt>ining culture change: Experiences in
the Green House Model. H,alt/1 Sm,i«s R,s,atd,, 51(Suppl. 1), 398-417.
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Box": Opportunitio for high-quality clinical decision making. Hra/11, S,rvi«s Resram,,
51(S1), 378-397.
Caroline Jane Porr is an associate professor al Memorial University of New-

foundland Faculty of Nursing. Caroline Jane Porr co-authored • book with
Phyllis Noer.iger Stem titled Essei1tials of Acwsible Cro1mded 'Theory, shortly after
completing her grounded theory doctoral research 31 the University of Alberta
to cam• PhD in public health nursing. She has• master's degree in public health
nursing from the University of Calgary and a BScN degree from McMaster Uni-
versity. While completing her doctoral program, Caroline Jane Porr was also a
Canadian Institutes of Health Research two-year training follow under the sci-
entific directorship ofJanice M . Morse at the IIQM, University of Alberta. As a
nurse educator, Caroline Jane Porr shares her grounded theory therapeutic rela-
tionship model with baccalaureate nursing students and teaches grounded theory
methods to graduate students in the MScN program. Caroline Jane Porr also
mentors doctoral students and has conducted several graduate-level courses and
workshops internationally (in Vietnam and China) as a visiting scholar. She was
recently presented with the Memorial University President's Award for Outstand-
ing Teaching (Faculty).
Resources
Porr, C. (2012, October). Crou11drd t/i,o,y, ,thnOJ(Taphy a,ul pl,mcmmolOI('( or, res,a,d, tools
for social worl: prodi«. Proceeding, of Scientific Conference Cclcbr2ti11g International
Social Wale Day: 'Social Wale For People's Happiness,' Hanoi, Vietnam.
Porr, C., Drummond,]., & Olson, K. (2012). E,tal,lishing therapeutic rcbtionships with
vulnerable and potentially stigmatized clients. Qr,alitatiw: Hra/th Rma,d,, 22(3), 384-
396. hnps://doi.org/10.1177/1049732311421182
Porr, C., Caudinc, A., Woo, K., Smith-Young.)., & Crccn, C. (2019). How community
nu=, manage ethical conflicts: A grounded theory >tUdy. C/o/Jol Qualitati11< NumnJI
R.esrarrh, 6, 1- 9. hnps://doi.org/10. 1ITT/2333393619894958
Porr, C., Craffigna, C .• Mayan. M., Wall, S .• & Vieira, E. (2011). The evocative power of
projective techniques for the elicitation of meaning. lnkmational Joumal of Quatitaliw
Methods, 10(1), 30--41.
Porr, C., Olson, K., & Hcg;,dorcn, K. (2010). Tiredncos, fotiguc and exhaustion in the
context ofa majordcpn::s,ivc disorder. Qualitativr Health RLsea,d,, 20(10), 1315-1326.
https://doi.org/10.1 lTT/104973231037084 I
Stem, P, & Porr, C. (201 la). Essnuials <(-,,jhkflTOUtukd t/.,cry. Thousand Oaks. CA: Sage.
Stem, P., & Porr, C. (201 lb). Stem and Porr (2011) response to rcviewcn. -n., CftnJnd,d
"/1.,o,y R,.,inv, 10(3), 87- 91.
Strickbnd, J. T., Wells, C. F., & Porr, C . (201 S). Safcguasding the children: The can-
cer journey of young mothers. OntolOI('( N11rsi"I( Forum, 42(5), S34-S41 . hnps://doi.
org/10.1 188/1 S.ONF.S3'h541.
Leonard Schatzman p:isscd away in 2008 in S3n Francisco after a distinguished

career as a sociologist. Schatzman w:is best known as a master teacher and story-
teller and for his articubtion of dimensional analysis. He graduated from Indiana
University with a degree in history after serving in the army during World W-:,c II.
He received a PhD in sociology fron1 the University ofChicago in 1945, under the
supervision of Ernest Burgess, where he first met Strauss. Strauss w:is a significant
mentor and the most prominent source of Schatzman's early exposure to sociology.
Schatmlan worked with Strauss and a small rcscarch team in Chicago for three year,,
producing their well- known work on psychiatric ideologies. In 1961 Schatzman
joined Strauss as f.iculty in the School of Nursing at the University of California, S3n
Francisco to initiate a rcscarch training program. Schatzman and Strauss remained
close colleagues and fiiends until Strauss' death in 1996.
Resources
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9(4), 337- 349.
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Stotc5, ,ocial problem>. S«ia/ Problmu, 16(1), 60-72. hnp,://doi.org/10.2307n99526
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Englewood Cliffi, NJ: Prentice-Hall-Prentice-Hall Methods ofSocial Science Serie,.
Strauss, A. L., & Schatzman, L. (19S5). Cross-cw. interviewing an analysis of interac-
tion and communicative ><yb. /-lunurr, OrJia,rizolion, 14(2), 2S-31. http5://doi.
org/10.17730/humo.14.2.j4S342222Slx41g7.
Strauss, A. L , Schatzman, L., Bucker, R ., Ehrlich, D., & Sabshin, M. (1981). Psytl,ialric
id,o/oflics ond inslilulio,u. New Yodt: Rou~cdgc, Taylor & Francis Croup.
Phyllis Noerager Stem, of Indianapolis, p3SScd away May 4, 2014. She w:is born
in San Carlos, California, to Phillip and Crace (Zocllin) Nocragcr on September 2,
1925. After high school she earned hernursing diploma from Mount Zion Hospitll
as part of the federally funded Cadet Nurse Corps, to alleviate the severe short1ge
of nurses after WWII. Upon graduation she worked in several health fucilitics in
California and Arizoru. She continued her education, c:iming an and from the
College of San Mateo, a BSN degree from San Francisco State University, and, then
MN and DSN dcgrccs from the University of California, San Francisco (UCSF).
Phyllis Nocrager Stem held fuculty positions at California State University at
Hayward. UCSF and Northwestern State University and was a professor and director
ofDalhousie University School of Nursing in Halifix. Canada. She joined the fac-
ulty of the Indiana University School of Nursing as a professor and department chair
offumily health nursing and was named a professor emerita upon her retirement.
Phyllis Noerager Stem is best known for her resc:irch and campaigning on
behalf of women's hc:ilth, interrutionally. With colleagues in Canada, in 1984
she founded the International Council on Women's Health Issues and served as
Council General until 2002. She served as editor-in-chief of the refereed journal
Health Cattf,,r Womni /ntm,ational from 1983 to 2001 and as such was able to assist
the publishing careers of several first-time authors. Phyllis Nocrager Stem is con-
sidered an expert in classical (Glaserian) grounded theory and has generated several
theories on fumily crisis situations and the impact of culture on healthcare. She was
member of an expert panel on cultural competence, served on the editorial boards
of Q11a/itative Health Research and bmts in Mmtal Health, and was a reviewer for a
number of nursing journals. She continued to mentor a number ofinternational
students who chose grounded theory as their doctoral rcsc:irch method.
Phyllis Noerager Stem received a Lifetime Achievement Award for Contribu-
tions to Women's Health lnterrutionally, an Honorary Doctorate of Laws from
Dalhousie University, and Distinguished Alumna and a Living Legend of the UCSF.
Terrie Vann-Ward, PhD, APN, FNP-BC, GNP-BC, is an independent prac-

titioner, tc:icher, and rcsc:ircher. She focuses on issues of chronic illness facing
older adults.
Colleen Varcoe is a professor in the School of Nursing at the University of

British Columbia, Canada. Building on her hospital-based diploma in nursing,
she has a baccalaureate in nursing, master's degrees in both nursing and edu-
cation, and a PhD in nursing. Her research focuses on violence and inequity,
emphasizing both interpersonal and structural forms of violence such as rac-
ism and poverty. Her completed resc:irch includes studies of risks and health
effects of violence and how to promote health for women who experience
violence, including a specific focus on Indigenous women. She has studied
how to promote equity-oriented hc:ilthcare (cultural safety, harm reduction,
and trauma- and violence-informed care) at the organizational level. She
has worked with various Indigenous communities, organizations, and issues,
including in healthcare and the criminal justice contexts. She has published
over 150 articles and book chapters and several books, including a widely used
text on relational nursing practice.
Judith Wuest is Professor Emerita at the University of New Brunswick, Fac-

ulty of Nursing in Fredericton, Canada. She received a BScN degree from
University of Toronto, followed by an MN degree at Dalhousie University in
Halifax where she was mentored in Glaserian grounded theory methods by
Phyllis Noerager Stem. Subsequently she completed a PhD at Wayne State
University in Detroit, Michigan, where she integrated feminist and critical per-
spectives with grounded theory methods. Her research interests include wom-
en's health, particularly intimate partner violence and women's carcgiving, and
men's health in the context of cumulative lifetime violence. She is internation-
ally known as a grounded theorist; however, research questions emerging from
her grounded theory analysis led to quantitative theory testing, survey design,
and intervention development. From 2010 to 2014, she led a feasibility study
implementing the nurse-led, grounded theory-based "Intervention for Health
Enhancement After Leaving" as part of domestic violence outreach services in
New Brunswick.
Resources
Ford-Cilboc, M., Mcnitt-Cray, M ., V=oc, C., & Wue>t, J. (2011). A theory-based pri-
mary health care intervention for women who have left abusive partners. Ad11anas ;,,
N"nin., &im<,, 34, 198-214. hnp,://doi.org/l0.1097/ANS.0b013c3182228cdc
Ford-Gilboc. M., Wu.,.._ J., & Mcnitt-Gray, M. (2005). Sacn1,>thcning capacity to limit
intrwion: Theorizing funily health promotion in the aftcnnath of woman abuse. Q,141-
itatiw H,alth Ra,arm, 1.5(4), 4TT-501.
Macintosh, J., Cronkhite, M., Wueu.J., & Merritt Gray, M. (2010). Worlcpbce bullying
in health arc affects meaning of work. Qualitatiw H,alth Rcs,atd,, 20, 1128-1141.
Mcrritt-Gr.y, M., & Wuest,]. (1995). Counter>ctingabwc and brcakingfu:c: The proccs, of
leaving revealed througl, women's voices. Hrolth Carefor Wor11n1 ltlkmllt.,,.,/, 16, 399-412.
O'Donnell. S., Maclntosh,J., & Wuot,J. (2010). A theoretical undcntmding ofsicknos
absence among women who have experienced workplace bullying. Q,14/j14/jv, H,altl,
Ra,a,r/,, 20, 439-452.
Wuot, J. (1995). J;cminist g,oundcd theory: An cxplontion of congiuency and tensions
between two traditions in knowledge discovery. Qualita6w H,altl,Rocanh, .5(1), 125-137.
Wuest, J. (1997a). Fraying connections of caring women: An exemplar of including dif-
ference in the development of explanatory fr.uncworks. Ca,14dim, Joumal of Nunin11
Ra,o,r/1, 29, 99-116.
Wuest,]. (1997b). Illwninating environmental inftucnccs on women's caring.Jouma/ ef
Advan«d Nursir111, 26, 4~58.
Wuest,J. (1998). Scttinii boundaries: A >lralCl,'Y for precarious ordering ofwomen's carinii
demands. Rr:s,arm in Nur,i1111 and J-1,allh, 21, 39--49.
Wuest, J. (2000a). Ncgotiatinii with hdpinii systems: An example of g,oundcd theory
evolving througl, cmcf1!cnt fit. Q,14/itativc H,alth Ra.arm, 10, 51 - 70.
About the Authors 3.S.S
Wuc,t,J. (2000b). Repatteming care: Wornc,n's proactive management off.unily caregiv-

ing demands. H,alth C,,.for Womm ln1<matio1ral, 21, 39~12.
Wuc,t,J. (2001). Precarious ordering: Toward a fom,al theory ofwon,cn'• caring. 1-1,alth
C,,.for Wonim l1Umt41i«l41, 22, 167- 193.
Wuc,t,J. (2011). Arc we there yet? Positioning qu2litative r=arch differently. Quali1a1i,,,
H,alth Rn,arm, 21(7), 87S-883. https:/ /doi.org/10.1177/1049732311401424
Wuc,t, J. (2012). Grounded theory: The method. In P. Munhall (Ed.), Nuni1111 m,a,,/,:
A q,,alitativ, pmp«tiv, (pp. 225-256). Sudbu,y, MA: Jonco & Bartlett.
Wuc,t,J., Berman, H ., Ford-Cilboc, M., & Merritt--Cray, M. (2002). IUumiruting social
determinants ofwomen's health wing grounded theory. Htalth OJt<for Wonom lntmra-
lional, 23(8), 794-808.
Wuc,t, J., Ericson, P, & Stem, P. (2001). Connected and disconnected support: The
impact on the coregiving process in Alzhcimcr'• disc3SC. Htalth O,r,for Wonom lnlmra-
lional, 22, 115-130.
Wuc,t, J., Ford-Cilboc, M .• Merritt-Cray, M., & Berman, H. (2003). Intrusion: The
central problem for funily health promotion among children and single mothers alter
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CONTENTS

1 The Maturation of Grounded Theory 3

2 Strauss's Grounded Theory 25

3 Exemplar: The Nurse as Advoa1te: The Sessler Branden

4 Glaserian Grounded Theory 79

5 Exemplar: Building on "Grab," Attending to "Fit," and

6 Dimensional Analysis 111

7 Exemplar: Developing the Green House Nursing Care

8 The Genesis, Grounds, and Growth of Constructivist

9 Exemplar: Preserving Self: Theorizing the Social and

10 From Grounded Theory to Situational Analysis: What's

11 Exemplar: Siruating Knowledge 267

12 The Challenges to and Furure(s) of Grounded Theory 289

Ch2pccr 5 is reprinted from Wuc,t,j.. Ford-Cilboc, M ., Mcrrict-Cr2y, M., & V=:cc, C.

The Back Story to this Volume

The Second Edition

Develop1ntnt and lmplnntntatio11, coauthorcd by Barbar., J. Bowers and Kimberly

Grounded theory consists of a systematic approach to inquiry for the purpose of

• Description, understanding, and analysis of both action and change

These three characteristics make grounded theory distinctly powerful.

The documentation and understanding of patterns of action and change lift

The Strategies of Grounded Theory

Abductivc reasoning involves (I) analyzing :m interesting or puzzling finding;

The Emergence of Grounded Theory Methods

The Origins of Grounded Theory

The Landscape of Grounded Theory Methods

1. AulhONld by Ulo origlnato~ of grounded

FIGURE 1.1 The Landscipe ofCroundod Thoory Methods

Texts Authored by the Originators of Grounded Theory

A. Origi,10/ M<1Ws "lixrs B. R,s,,mh MonOJ('aphs

Do~ Author(s) 1i1k o.,, Aul/10,(s) 1i1t,

1967 Gbscr& TI1t Dis<OfltT)' of 1964 Strauss, Psyd,i,,1ri,

A. OriJ1i,,a/ M<11"'4s Texts B. Ra,arm Morwf(faplrs

TABLE 1.1 (Conrinucd)

A. Origj,,.J Mtdwds Tetts B. R,s,,um MonOJlT•phs

2007 Bryant & Hondbookof 1993 Gwer(Ed.) Exo1t1p/,s of

/)at, A utlw,(s) Oat, 1itl,

2016 Closer Cround,d n~ry

Later Uterature ContribuUng to Glaser's and/or Strauss's

I Schatzman (1991) Strause

FIGURE 1.2 The Maturation of Grounded Theory Methods

Cmnal C,ound,d 11u:ory Tcxts DisapN,u:-Sp,afr Cround,d 11,,ory T cxts

1999 Dey Crou,u/inJI Cround,d 2001 Locke Crourukd

CmnoJ Cround,d Tirco,y 1cas DiJ<ipNt1t-Sprofa C=n<kd 1'ko,y 1C<t<

2013 Urquhart Crou,ultd Tirco,yfor 2009 An::inia.n. Cl=rian

With these elabor:11ions of grounded theory, changes inevitably occurred.

Short Articles and Handbook Chapters Addressing Specific

Articles and Book Chapters That Summarize, Clarify,

The Global Dissemination of Grounded Theory Methods

Bryant, A. (2019). Vari,ti,s of X'"'"ul,d th<o,y. London: Sage. hnp,://doi.org/10.4135/

features of Dcwcy's philosophy that stand out as having a significant impact on

1. The individual is a thoughtful being who responds to events and problems

After graduating from the University of Virginia in 1939, Strauss attended

A Synopsis of Strauss's Method

interaction. For example if a woman who continues to work during her

development in terms of their properties and dimensions. Memos should

"very maturing" experience. His description of the experience was interesting to

The responder, a Vietnam veteran, stated that he would be happy to answer my

Mcod, C. H. (1959). In A. E. Murphy (Ed.), Plulosopl,y of tk ,,,..m1. i...s.J.lc, IL: Open