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Journal of Advanced Nursing, 2000, 31(6), 1476±1484                                    Methodological issues in nursing research



 Methodological issues in grounded theory
 John R. Cutcliffe RMN RGN BSc(Hons)
 Doctoral Student, Lecturer in Mental Health Nursing
 and Practice Development Co-ordinator, Shef®eld University,
 Shef®eld, and RCN Institute, Oxford, England




 Accepted for publication 9 December 1999



                                       CUTCLIFFE J.R. (2000) Journal of Advanced Nursing 31(6), 1476±1484
                                       Methodological issues in grounded theory
                                       Examination of the qualitative methodological literature shows that there
                                       appear to be con¯icting opinions and unresolved issues regarding the nature
                                       and process of grounded theory. Researchers proposing to utilize this method
                                       would therefore be wise to consider these con¯icting opinions. This paper
                                       therefore identi®es and attempts to address four key issues, namely, sampling,
                                       creativity and re¯exivity, the use of literature, and precision within grounded
                                       theory. The following recommendations are made. When utilizing a grounded
                                       method researchers need to consider their research question, clarify what level
                                       of theory is likely to be induced from their study, and then decide when they
                                       intend to access and introduce the second body of literature. They should
                                       acknowledge that in the early stages of data collection, some purposeful
                                       sampling appears to occur. In their search for conceptually dense theory,
                                       grounded theory researchers may wish to free themselves from the constraints
                                       that limit their use of creativity and tacit knowledge. Furthermore, the interests
                                       of researchers might be served by attention to issues of precision including,
                                       avoiding method slurring, ensuring theoretical coding occurs, and using
                                       predominantly one method of grounded theory while explaining and describing
                                       any deviation away from this chosen method. Such mindfulness and the
                                       resulting methodological rigour is likely to increase the overall quality of the
                                       inquiry and enhance the credibility of the ®ndings.

                                       Keywords: grounded theory, methodology, rigour, nursing, sampling, creativity,
                                       re¯exivity, precision


                                                                        therefore be wise to consider these con¯icting opinions.
 INTRODUCTION
                                                                        This paper begins with a brief overview of grounded
 Since Glaser and Strauss' discovery in 1967, and its                   theory in order to identify the rudiments of the method.
 application within sociological study, grounded theory                 Then it identi®es and addresses four key issues, namely,
 has been used in many other ®elds including anthropol-                 sampling, creativity and re¯exivity, the use of literature,
 ogy and nursing. Many authors have written about the                   and precision within grounded theory.
 method, and scrutiny of this literature shows that there
 appear to be con¯icting opinions and unresolved issues                 Brief overview of grounded theory
 regarding the nature and process of grounded theory.
 Researchers proposing to utilize this method would                     A grounded theory is a theory that is induced from the
                                                                        data rather than preceding them (Lincoln & Guba 1985).
 Correspondence: John R. Cutcliffe, 11 Blackthorne Close, Kilburn,      Glaser & Strauss (1967 p. 3) provide an initial de®nition of
1 Derbyshire DE56 0LF, England. E-mail: john.cutcliffe@shef®eld.ac.uk   grounded theory. They state that it is a theory that will:

 1476                                                                                                   Ó 2000 Blackwell Science Ltd
Methodological issues in nursing research                                            Methodological issues in grounded theory

¼ ®t the situation being researched and work when put into use.    changeable. Patton (1990) argues that all types of sampling
By ®t we mean that the categories must be readily (not forcibly)   in qualitative research can be termed purposeful
applicable to and indicated by the data under study; by work we    sampling. Interestingly, in his list of 15 different sampling
mean that they must be meaningfully relevant and be able to        strategies Patton does not list or de®ne theoretical
explain the behaviour under study.                                 sampling. This apparent confusion only serves to confuse
                                                                   neophyte qualitative researchers (Coyne 1997). However,
   It is rooted in symbolic interactionism, wherein the
                                                                   if the researcher can describe his/her sampling strategy in
researcher attempts to determine what symbolic mean-
                                                                   suf®cient detail, this should minimize any confusion
ings, artifacts, clothing, gestures and words have for
                                                                   regarding sampling (Morse 1991b), improve the quality of
groups of people as they interact with one another.
                                                                   the research (Coyne 1997), avoid method slurring (Baker
Symbolic interactionists stress that people construct their
                                                                   et al. 1992) and provide some clari®cation of the use of
realities from the symbols around them through interac-
                                                                   theoretical sampling in nursing research.
tion, therefore individuals are active participants in
                                                                      Glaser (1978), Sandelowski et al. (1992), Becker (1993)
creating meaning in a situation (Morse & Field 1995).
                                                                   and Coyne (1997) each delineated theoretical sampling
Grounded theory both describes and explains the system
                                                                   from purposeful/selective sampling, in as much that,
or behaviour under study and consequently is a method-
                                                                   purposeful sampling involves the calculated decision to
ology for developing theory that is grounded in data
                                                                   sample a speci®c locale according to a preconceived but
systematically gathered and analysed (Strauss & Corbin
                                                                   reasonable initial set of dimensions. In contrast, theoret-
1994). Consequently, grounded theorists search for social
                                                                   ical sampling has no such initial calculated decisions. The
processes present in human interaction (Hutchinson
                                                                   grounded theory researcher seeks further interviewees/
1993). They aim to discover patterns and processes and
                                                                   sources of data in order to add to the fullness of the
understand how a group of people de®ne, via their social
                                                                   understanding of the concept. Hence, theoretical sampling
interactions, their reality (Stern et al. 1982).
                                                                   is an integral part of the process of grounded theory.
   A central feature of grounded theory is its method of
                                                                   However, it should be noted that before the researcher has
constant comparative analysis (Glaser & Strauss 1967), in
                                                                   begun to collect and analyse data, the researcher has no
that data collection and analysis occur simultaneously
                                                                   evolving theory which can act as a guide for further
and each item of data is compared with every other item of
                                                                   theoretical sampling.
data. The theory induced is conceptually dense (Strauss &
                                                                      Baker et al. (1992) maintained that the researcher using
Corbin 1994), that is theory with many conceptual rela-
                                                                   grounded theory initiates the sampling process by inter-
tionships, and these relationships are embedded in a
                                                                   viewing signi®cant individuals. Perhaps it is these signi-
context of descriptive and conceptual writing.
                                                                   ®cant individuals that Morse (1991b) is referring to when
                                                                   she describes a good informant as one who has the
SOME RESEARCH DESIGNS                                              knowledge and the experience the researcher requires, has
                                                                   the ability to re¯ect, is articulate, has the time to be
Sampling in grounded theory                                        interviewed and is willing to participate in the study.
                                                                   Glaser (1978) asserted that in the initial stages of theoret-
Grounded theory uses non-probability sampling. In order
                                                                   ical sampling, decisions for collection of data are based
for concepts and categories to emerge during the data
                                                                   only on a general sociological perspective and on a general
analysis, the need for sampling of speci®c data sources
                                                                   subject or problem area. Morse (1991b) submitted that the
continues until each category is saturated. Therefore, at
                                                                   researcher initially chooses interviewees with a broad
the beginning of the study, there are no limits set on the
                                                                   general knowledge of the topic.
number of the participants, interviewees or data sources.
                                                                      These positions and arguments thus appear to indicate
The researcher continues selecting interviewees until they
                                                                   that individuals are chosen initially who can provide a
are saying nothing new about the concepts being explored.
                                                                   relevant source of data, and this relevance is determined by
Thus the selection of participants (and other sources of
                                                                   the requirements for generating and delimiting the theoret-
data) is a function of the emerging hypothesis/hypotheses
                                                                   ical codes (Hutchinson 1993). Therefore, when a grounded
and the sample size a function of the theoretical complete-
                                                                   theorist is commencing his/her data collection, it appears
ness (Baker et al. 1992).
                                                                   that they do enter into a process of purposeful sampling,
  Sampling within grounded theory is therefore described
                                                                   which is then superseded by theoretical sampling as the
as `theoretical' rather than purposeful (Glaser & Strauss
                                                                   data/theory highlight the direction which further sampling
1967, Glaser 1978, Becker 1993) in that it is driven by the
                                                                   needs to follow. This argument is supported by Sande-
emerging theory. However, other authors of qualitative
                                                                   lowski et al. (1992) and Coyne (1997 p. 625) who states:
research methods do not make such a distinction (Lincoln
& Guba 1985, Morse 1991b). Indeed, they suggest that the           ¼ theoretical sampling does involve the purposeful selection of a
terms theoretical and purposeful sampling are inter-               sample in the initial stages of the study.


Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484                                                   1477
J.R. Cutcliffe

   A second issue in sampling that warrants attention is that   subsequent theoretical sampling would also re¯ect the
of the choice between a wide and diverse sample or a more       limited experience. The data obtained from such an
`focused', narrow, concentrated sample. It is reasonable to     individual, when analysed and coded, is unlikely to
say that the literature on this issue is confusing and          indicate the lines of inquiry, the necessary sources of data,
con¯icting. Hutchinson (1993) argues in favour of a wide,       which would then lead ultimately to the `fullest' or most
diverse sample in that this ensures extensive data that cover   complete understanding of the social process. It should be
the wide ranges of behaviour in varied situations. Lincoln &    noted that it is possible that the fullness of the phenom-
Guba (1985) make similar arguments. They advocate, since        enon may be uncovered during subsequent interviews
the purpose of sampling will most often be to include as        (Hutchinson 1993). However, this argument does appear
much information as possible, maximum variation                 to highlight the importance of selecting an appropriate
sampling to be the usual sampling mode of choice.               gatekeeper, and therefore also indicates a degree of
   Another argument may be constructed that reasons in          a-priori sample selection.
favour of a more narrow or focused sample, rather than            Yet Lincoln & Guba (1985) deliberate that there can be
maximum variation. Since the researcher in grounded             no a-priori speci®cation of the sample and that initially
theory is concerned with uncovering the situated, contex-       any sample unit will do as well as any other. Nevertheless,
tual, core and subsidiary social processes, the social          Morse (1991b p. 129) highlighted that selection of an
processes need to be shared and experienced by the              adequate and appropriate sample is critical in qualitative
individuals who make up the researched group. Other-            research and that the eventual quality of the research is
wise, if an individual has no experience of the social or       contingent upon the appropriateness and adequacy of the
psychosocial process, how can they comment on it?               sample. Furthermore she states:
Consequently, grounded theorists using a more narrow
                                                                ¼ it is essential for the researcher to discover who will be the
or focused sample seek out participants who have experi-
                                                                most appropriate informant before beginning interviews and that
ence, the most experience, in the topic of interest (Morse
                                                                informants must be carefully selected or carefully chosen
1998). Indeed, Lincoln & Guba (1985) point out that
                                                                according to speci®c qualities.
grounded theory has been termed `local theory' as it brings
together and systematizes isolated, individual theory. It is      She sums up her arguments regarding sample selection
an aggregate of local understandings. Selection of a sample     by stating:
of participants who have only a limited experience of the
                                                                ¼ informants must be knowledgeable about the topic and experts
social process, or put another way, a sample that isn't
                                                                by their virtue of their involvement in speci®c life events and/or
local, is thus likely to provide data and a subsequent
                                                                associations.
theory that has a partial or limited understanding of the
process being studied. Glaser & Strauss (1967) highlight          The author of this current paper is not advocating strict
how the choice between sampling narrow or wider                 adherence to sample criteria set prior to commencing data
substantive groups is directed by the conceptual level of       collection. Such rigidity is only likely to limit theoretical
the theory that the researcher intends to induce. They          sampling (Morse 1991b). Yet, it appears to be logical for
indicated that if the researcher intends to induce a            the researcher to consider criteria for sample selection
substantive theory that is applicable to one substantive        prior to starting to collect data. Therefore the author
group, then the researcher needs to sample groups of the        argues that this purposeful sampling should be considered
same substantive type (e.g. a narrow sample). A more            for the ®rst interview (especially as this individual occu-
general, or wider substantive theory would thus be              pies the role of `gatekeeper') and possibly the second
induced by sampling wider substantive groups, and if            interview. Following this theoretical sampling to guide
the researcher is concerned with inducing a formal theory,      sample selection would be more appropriate.
he/she will select dissimilar substantive groups from the
larger class, and thus increase the theory's scope.
                                                                Creativity and re¯exivity in grounded theory
   Lincoln & Guba (1985) argue that the purpose of
maximum variation within theoretical sampling is best           A further issue that warrants consideration is that of
achieved by selecting each unit of the sample only after        creativity and re¯exivity. Few would dispute that qualit-
the previous unit has been taped and analysed. Conse-           ative methods invariably involve interaction between the
quently the ®rst unit of the sample (®rst interviewee) often    researcher and the data. Turner (1981) reasoned that in
acts as a `gatekeeper'. This ®rst set of data and subsequent    social inquiry there is an interaction between the
analysis can set the `tone' or highlight the direction for      researcher and the world that they are studying. Indeed,
further theoretical sampling. The notion of a `gatekeeper'      Lipson (1991) expounded that re¯exivity refers to
again raises the sampling issues identi®ed in this paper. If    researchers being part of, rather than separate from, the
the ®rst unit of a sample only has a limited experience of      data. Altheide & Johnson (1994) argue that theories
the social process being studied, one could argue that the      induced from qualitative methods always include some-

1478                                              Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
Methodological issues in nursing research                                                      Methodological issues in grounded theory

thing of the researcher. Hutchinson (1993 p. 187) made                     be seen in attempts to establish the credibility of qualit-
speci®c remarks concerning re¯exivity and grounded                         ative ®ndings by using criteria developed for establishing
theory:                                                                    the credibility of quantitative ®ndings (Hammersley 1992).
                                                                           Also, it can be seen in attempts to translate these quan-
¼ because grounded theory research requires interpersonal
                                                                           titative criteria into terms more in keeping with the
interaction, the researcher is inevitably part of his or her daily
                                                                           qualitative paradigm (Cutcliffe & McKenna 1999).
observations.
                                                                              Attempts to discount the researcher's values, know-
  However, while there appears to be little argument that                  ledge, beliefs and experiences could also be regarded as an
grounded theory inevitably involves interaction between                    attempt to gain credibility with scientists who use quan-
the researcher and the world they are studying, how this                   titative or positivistic methods by decreasing any chance
interaction affects the emerging theory remains a matter                   of personal bias. Such endeavours appear to be upholding
for debate. Morse (1994) contends that qualitative                         the philosophical position that there is one true reality,
methods (including grounded theory) have been plagued                      and that personal values, knowledge and experience
with con¯icting advice concerning the application of prior                 would only serve to contaminate the researcher's repre-
knowledge (including the researcher's previous experi-                     sentation of this reality.
ence and knowledge which they bring to the study).                            However, the philosophical position of qualitative
Berger & Kellner (1981) and Hutchinson (1993) advocate                     methods is dissimilar to that of quantitative methods.
that the qualitative researcher needs to become aware of                   Qualitative researchers believe that reality is constructed
their own personal preconceptions, values and beliefs and                  from human perspectives, shared (social) and individual
then hold them in abeyance. These authors add that if                      interactions and meanings of given situations and
these processes are not carried out, the scienti®c enter-                  phenomena. To strive to attain more credibility according
prise collapses and the researcher will perceive a mirror                  to an alternative philosophical standpoint appears to be at
image of hopes/fears and not the social reality.                           best inappropriate and at worst, a distraction from the
  A vigorous counter-argument exists that posits it is the                 potential that creativity can bring.
re¯exivity and the researcher's creativity within this                        That is not to say that the grounded theorist has license
re¯exivity that makes grounded theory valuable. Turner                     to invent concepts, categories and posit these as a theory
(1981 p. 227) stated:                                                      that represents the meanings that a group of individuals
                                                                           ascribe to their shared interactions and social world.
¼ an advantage of grounded theory is that it directs the researcher
                                                                           However, what it does is legitimize the researcher's
immediately to the creative core of the research process, and
                                                                           creativity as an integral part of the grounded theory
facilitates the direct application of both the intellect and the
                                                                           inductive process; liberating the restrictions on the
imagination to the demanding process of interpreting research
                                                                           researcher's tacit knowledge that discounting such know-
data.
                                                                           ledge creates. Turner (1981 p. 228) stated:
  Stern (1994 p. 217) supports this viewpoint:
                                                                           ¼ competent development of grounded theory rests in part upon
¼ it is the creativity in the act that brings the real truth of a social   a sensitivity to these often tacit processes of perceiving and
situation into being, and following grounded theory techniques is          understanding, and upon a willingness and an ability to bring
one way to approach this creative process.                                 them into the open for discussion.

   Morse (1994) encourages qualitative researchers to take                   Lincoln & Guba (1985 p. 208) constructed similar
more risks in their theory development. It is worth                        arguments when they stated:
considering whether or not such a movement could
                                                                           ¼ admitting tacit knowledge not only widens the investigator's
involve transition from a position where concerns for
                                                                           ability to apprehend and adjust to phenomenon in context, it also
holding prior knowledge and beliefs in abeyance predom-
                                                                           enables the emergence of theory that could not otherwise have
inate, to an alternative position more concerned with
                                                                           been articulated.
creativity. Perhaps consideration of why some researchers
advocate the need to acknowledge and discount any prior                      Hence there is a need for the grounded theory researcher
knowledge and beliefs may shed some light on this issue.                   to acknowledge his/her prior knowledge and tacit know-
It is reasonable to say that for many years qualitative                    ledge, to bring such knowledge into the open, to discuss
research methods have been regarded by many scientists                     how it has affected the theory development (Turner 1981)
who use quantitative or positivistic methods as a `poor                    and allow the interplay between the researcher's know-
relation' of quantitative methods. Consequently, some                      ledge, values and beliefs and the data to occur; to allow
qualitative researchers have been anxious to be seen as                    the researcher's creativity to explore and articulate
credible in the eyes of their such scientists. Evidence of                 theoretical links.
this can be seen in some of the language used to describe                    The choices of which facts and lines of inquiry to
and explain early qualitative methods (Morse 1994). It can                 follow and which not to follow are guided, to some

Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484                                                           1479
J.R. Cutcliffe

extent, by the subconscious perceptual and intellectual        enon, and therefore have already decided that a grounded
processes of the researcher's mind (Turner 1981). Conse-       theory method would be suitable'. Consequently Lincoln
quently, to deny a researcher who is using grounded            & Guba's (1985) and Stern's (1994) arguments appear to
theory access to this knowledge and to restrict the            occupy a position further along the continuum of know-
creativity necessary to utilize it, is likely to limit the     ledge generation. Given these considerations both argu-
depth of understanding of the phenomenon and impose            ments appear to be cogent and not necessarily
unnecessary, rigid structures. As a consequence, the           contradictory of one another.
researcher would be left questioning themselves each              Many proposed research questions require conceptual
time they draw upon their tacit knowledge, or when they        clarity. For example, within the author's doctoral study,
experience a moment of insight into the world they are         having identi®ed that there is an absence of literature that
investigating. The researcher would be left asking them-       explains if or how hope is inspired in bereavement
selves:                                                        counselling and thus a grounded theory method would
                                                               be indicated, it may still be appropriate and indeed
Does that thought originate from my knowledge, experience or
                                                               prudent, to review the available literature that focuses on
beliefs or does it belong to the interviewees?
                                                               hope and the literature that focuses on bereavement
  Yet, importantly, the mechanism for checking the             counselling. Such a review may help provide a sense of
authenticity or representativeness of such knowledge           the key elements of hope that are implicit in the literature,
and insight exists within the grounded theory method,          it may help provide some conceptual clarity of the nature
whereby such trustworthiness is achieved by exploring          of hope and the nature and practice of bereavement
the possible or emerging concepts/categories in further        counselling and this examination of the relevant literature
interviews. If the hunch belongs solely to the researcher,     would help the researcher to differentiate hope from
and is not a part of the world being investigated, this will   similar and related concepts.
have no meaning for the interviewees and can be                   If there is a need for a review of the literature in order to
discarded in due course.                                       clarify concepts and de®ne terms, the key questions that
                                                               need to be asked appear to be, how rigorous and thorough
                                                               should this literature review be and at what point in the
Literature reviews in grounded theory
                                                               theory induction should this literature review occur?
It is well documented that when utilizing a grounded           Smith & Biley (1997 p. 20) acknowledged that a detailed
theory method the researcher should avoid conducting a         and comprehensive literature review is not the ®rst stage
literature review prior to commencing data collection and      in grounded theory. However, they go on to point out that
analysis (Stern 1980, Stern et al. 1982, Stern & Allen 1984,   some reading may occur prior to data collection. They
Lincoln & Guba 1985, Stern 1994, Strauss & Corbin 1994,        state:
Hickey 1997). By avoiding a literature review at the
                                                               General reading of the literature maybe carried out to obtain a feel
beginning of the study it is more likely that the emergent
                                                               for the issues at work in the subject area, and identify any gaps to
theory will be grounded in the data.
                                                               be ®lled in using grounded theory¼ but it is important that the
   Another view is proffered by Hutchinson (1993), who
                                                               reading is not too extensive.
suggests that a literature review should proceed data
collection and analysis in grounded theory. In that, it is       Their justi®cation for this technique is that the
the review of the literature that can identify the current     researcher then approaches the subject area with some
gaps in knowledge, or help provide a rationale for the         background knowledge. It is the opinion of the author of
proposed research. Perhaps the apparent disagreement           the current paper that such statements may confuse
between these two positions can be explained if one            potential researchers who are contemplating using
considers the longitudinal nature of the generation of         grounded theory. Just how much reading is `extensive'
knowledge, and the different positions that these argu-        and similarly `too extensive'? To advocate that the
ments appear to occupy on this longitudinal continuum.         researcher approaches the ®eld of study with this back-
   Hutchinson's (1993) arguments can be located in a           ground knowledge may produce the situation where the
position that has a starting point: `What do we know about     researcher has already begun to form tentative conceptual
this phenomenon?' Therefore, at this point, she has not        and theoretical links. This, as discussed earlier, is inap-
begun to consider what is the most appropriate method-         propriate for grounded theory.
ology. That will be indicated by the current extent and          However, no potential researcher is an empty vessel, a
depth of knowledge available regarding the phenomenon,         person with no history or background. Further, as it is
whereas, Lincoln & Guba's (1985) and Stern's (1994)            common for many researchers to pursue a particular
argument can be located in a position that has the starting    theme throughout their research activity, they may already
point, `We already recognize that there is a distinct dearth   possess some background knowledge of the substantive
or even absence of knowledge concerning the phenom-            area they intend to study. Indeed, the researcher and all

1480                                             Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
Methodological issues in nursing research                                         Methodological issues in grounded theory

  his/her knowledge and prior experience is bound up with          clarify the concepts, before going on to induce a theory that
  the interactive processes of data collection and analysis.       explicates and explains how they relate to one another.
  As Strauss & Corbin (1994 p. 278) indicated, the analyst is         The other issue regarding literature reviewing in
  also a crucially signi®cant interactant and Glaser (1978)        grounded theory is: When should the second review of
  offered similar remarks when he argued that everything is        the literature occur? Hutchinson (1993) argued that
  data. Thus, the researcher would perhaps be unwise to            because the preliminary literature review can sensitize
  carry out reading that provides him/her with anything            concepts (i.e. add to the conceptual clarity) and increase
  more than, as Glaser & Strauss (1967) term, a partial            an awareness of the gaps in the knowledge, this second
  framework of local concepts, which designate a few               review turns to an entirely new body of literature. Stern
  principal or gross features of the situations that he/she        (1980), Stern & Allen (1984) and Strauss & Corbin (1994)
  will study. As such knowledge becomes part of the                argue that selective sampling of the second body of
  researcher and consequently becomes part of the inter-           literature should be woven into the emerging theory
  active process. Instead of allowing the theory to emerge         during their third stage on grounded theory induction,
  from the data, the researcher albeit implicitly, is likely to    the stage they term concept development.
  enter into a deductive process. Comparing the data                  However, in contrast to these arguments, Glaser (1978)
  provided by the interviewees with the knowledge (and             asserts that the researcher should refrain from accessing
  pre-formed conceptual frameworks) already present in             this second body of literature until the theory has emerged
  his/her mind. Therefore, as indicated earlier, there may be      from the data. Therefore it occurs at a later stage. What this
  value in reading literature that assists in concept clari®-      difference of opinion indicates is that there are funda-
  cation. To draw upon Glaser & Strauss (1967) explanation         mental differences between Glaser's and Strauss' version
  of these principal or gross features of the area of study,       of grounded theory (and these are explored in the next
  they suggest that if a researcher intends studying hospi-        section of this paper). Consequently, the stage at which
  tals, he knows there will be doctors, nurses, and admis-         the researcher begins to weave in the second body of
  sion/discharge procedures. Indeed, having this initial           literature appears to depend upon which version of
  conceptual clarity prior to entering the study, perhaps          grounded theory is being used.
  helps the researcher to reach conceptual density, enhance
  the richness of concept development (Strauss & Corbin
                                                                   Precision in grounded theory
  1994) and subsequently the process of theory development.
     To return to the example of hope inspiration in bereave-      There appear to be several issues regarding precision and
  ment counselling. If the researcher wishes to investigate if     clarity in grounded theory and each of these warrants
  the concepts are linked, and if so, how? it might be             consideration. These issues can be described as method
  worthwhile to begin by highlighting the current concep-          slurring with other similar yet different qualitative meth-
  tualization of both hope and bereavement counselling             odologies, e.g. phenomenology (Baker et al. 1992). The
  within the relevant empirical literature. As there is an         absence of theoretical coding in some studies which
  absence of substantive or formal theory that indicates how       propound to be grounded theory (Strauss & Corbin 1994,
  such concepts may be related, neither of the reviews of          Melia 1996). Additionally, does the term grounded theory
  literature provide the researcher with an implicit theory        represent but one single method or, alternatively encom-
  which could be tested during the data collection.                pass several methods (May 1996, Melia 1996).
  However, what it can do is provide an understanding of              Stern (1994) af®rmed that although there may be simi-
  the concepts and thus provide ®rm conceptual clarity and         larities in all interpretative methods, the frameworks
  an understanding upon which the rest of the emergent             underlying the methodologies differ. Baker et al. (1992)
  theory can be built.                                             constructed similar arguments and further reasoned that
     This process may not be appropriate for certain types of      failure to explicate qualitative methodologies is resulting
  research question. For example, factor isolating questions       in a body of nursing research that is mislabelled. Morse
  such as `What is caring?'. What appears to become evident        (1991a p. 15) warned of this mixing of methodologies and
  is that the decision whether or not to conduct a review of       stressed that:
  literature to help conceptual clarity may depend upon
                                                                   ¼ the product is not good science; the product is a sloppy
  what the research question is, but more importantly the
                                                                   mishmash.
2 level of theory (Dickoff & James 1968) to be induced.
     Thus, if the researcher is concerned with inducing factor       Thus by paying attention to the resolution or precision
  isolating theory, it may be disadvantageous to carry out         of qualitative research methodology the researcher is
  such a review of the literature. In contrast if the researcher   endeavouring to ensure rigour (Baker et al. 1992, Cutcliffe
  is concerned with factor relating theory, it could be            1997). Such rigorous studies should `stand up' better to
  advantageous to carry out the literature review in order to      critique by enabling the reader to examine whether or not


 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484                                               1481
J.R. Cutcliffe

the chosen methodology was appropriate to the nature of            most demand upon the grounded theorist's creativity.
the research study.                                                Further, it is perhaps theoretical coding and the postu-
  However, Stern (1994) acknowledged that she is                   lating of previously undiscovered or unarticulated links
comfortable with the evolution of a methodology, and               that enables the development of the theory.
that she does not regard researchers `tinkering with' a               If the grounded theorist concentrates on substantive
given method as problematic. Further, she highlights the           coding as the chief and almost exclusive feature (Strauss &
advantages of combining different qualitative methodolo-           Corbin 1994) then it is possible that this limits the
gies. Therefore the dif®culty does not lie with blending           researcher to inducing factor isolating theory, in as much
one qualitative methodology with another, indeed the               as substantive coding facilitates the researcher in asking
resulting methodology may produce a more thorough,                 the questions, `What is this?', `What are the components of
multidimensional understanding of the phenomenon. In               this social process?'. Introducing theoretical coding
support of this position, Wilson & Hutchinson (1991)               enables the researcher to induce factor relating theory.
propose the triangulation of Heideggarian hermeneutics             Theoretical coding facilitates the researcher in asking the
and grounded theory. For example, these methods could              questions, `What is happening here?', `How do the
be combined in order to examine the nature of hope                 substantive codes relate to each other as hypotheses?'.
inspiration in bereavement counselling. The grounded               To ignore the central feature of the methodology (Strauss &
theory would enable the researcher to ask, `How does this          Corbin 1994) and then subsequently call the methodology
inspiration occur?', `What if ``X'' were to happen here?',         grounded theory is a clear indication of imprecision.
`What symbolic meanings, gestures, words or behaviours                Another issue of precision is whether or not the term
explain the social reality of the process of hope inspiration      grounded theory encompasses more than one methodo-
in bereavement counseling?'. The Heideggarian phenom-              logy. If so, is it appropriate to call a methodology
enology would enable the researcher to ask the questions,          grounded theory or would another term have to be used?
`What is the lived experience of receiving such hope in a          As indicated in the introduction grounded theory was
bereavement counselling setting?', `What meanings do both          discovered by Glaser & Strauss (1967), both of whom had
the counsellors and the client ascribe to this experience?'.       distinctly different academic backgrounds. It maybe no
  The crucial issue then, even when using combined                 surprise then that the subsequent development of the
methodologies, is that there is still precision. The method-       methodology since then has taken a different path for each
ologies are combined purposefully and with intention, and          author.
the researcher subsequently makes explicit what she/he                According to Stern (1994), Glaser, who has a back-
has done and why. The mixing of methodologies does not             ground in statistical analysis, insists on allowing the
occur by accident. Similarly, the researcher does not call         theory to emerge, whereas Strauss, whose sociology was
the product of this mixing grounded theory or phenome-             ®rmly rooted in the Chicago school (i.e. a school of
nology, but tells the researcher the methodology is some-          sociology which has its roots in the symbolic interac-
thing different, e.g. a combination of two methodologies.          tionist tradition, Robrecht 1995), prefers a method that is
  The second issue regarding precision in grounded                 tightly prescriptive. Stern (1994) and Melia (1996) also
theory is that of substantive coding and theoretical coding.       suggest that Glaserian grounded theory would be expected
Strauss & Corbin (1994 p. 277) were adamant that some              to be immediately applicable to individuals and groups
researchers who:                                                   who shared the problem under study and would be
                                                                   expected to be testable. However, theory produced using
¼ think they are doing grounded theory studies often seem to
                                                                   Strauss' version of grounded theory has its applicability
concentrate on substantive coding as the methodology's chief and
                                                                   downplayed (Stern 1994). The crux of the dichotomy is,
almost exclusive feature, but do not do theoretical coding.
                                                                   according to Glaser (1992) the fundamental difference
   Few would dispute that substantive coding is an integ-          between emerging and forcing. Stern (1994) argued a key
ral part of data analysis within grounded theory, but if the       difference is the questions each author asks of the data. As
intellectual rigour halts at substantive coding, then it is        Strauss examines the data, he stops at each word and asks,
debatable that the researcher used a grounded theory               `What if ?', whereas Glaser keeps his attention on the data
methodology. The author of the current paper would argue           and asks, `What do we have here?'.
not. Glaser (1978) argues that it is the theoretical coding,          According to Stern (1994 p. 20):
the conceptualization of how the substantive codes may
                                                                   Strauss brings to bear every possible contingency that could relate
relate to each other as hypotheses, which enables the
                                                                   to the data, whether it appears in the data or not. Glaser focuses
substantive codes to be integrated into a theory. It is this
                                                                   his attention on the data to allow the data to tell their own story.
theoretical coding that can provide the full and rich
understanding of the social processes and human interac-             Glaser (1978) went as far as to claim that Strauss'
tions which are being studied. The author of this current          evolution is a departure from the original methodology
paper suggests that theoretical coding perhaps places the          and represents an erosion of grounded theory (Melia

1482                                                  Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
Methodological issues in nursing research                                           Methodological issues in grounded theory

1996). Indeed he asserts that the two methodologies                 sion. The author concludes by making the following
should have different names, with Strauss' version being            recommendations.
termed, full conceptual description.                                   When utilizing a grounded method researchers should
  If the crux is in the different questions asked of the data,      consider their research question and clarify what level of
what happens if the researcher asks both questions?                 theory is likely to be induced and then decide when they
Further, if the researcher asks another question, is he/            intend to access and introduce the second body of litera-
she using another different version of grounded theory?             ture. They should acknowledge that in the early stages of
For example Turner (1981 p. 232) asked:                             data collection, some purposeful sampling appears to
                                                                    occur. They may wish to free themselves from the restraints
¼ what categories, concepts or labels do we need in order to
                                                                    that limit their use of creativity and tacit knowledge. The
describe or account for the phenomena discussed in this para-
                                                                    researchers might be served by attention to issues of
graph?
                                                                    precision, including avoiding method slurring, ensuring
  Stern (1980 p. 281) proposed that the researcher exam-            theoretical coding occurs, and predominantly using one
ines the data, line by line, and produce substantive codes:         method of grounded theory while explaining and
                                                                    describing any deviation away from this chosen method.
These codes are called substantive codes, because they codify the
                                                                       Such mindfulness and the resulting methodological
substance of the data, and often use the very words used by the
                                                                    rigour is likely to increase the overall quality of the
actors themselves.
                                                                    inquiry and enhance the credibility of the ®ndings.
   If the nature of the grounded theory is determined in
part by the questions asked of the data, then does the
                                                               References
researcher have to predetermine the questions she/he will
ask and then ensure that this is the only question they ask Altheide D.L. & Johnson J.M. (1994) Criteria for assessing inter-
of the data? The author of this current paper suggests that      pretative validity in qualitative research. In Handbook of
this might be somewhat restrictive and disabling. If the         Qualitative Research (Denzin N. & Lincoln Y.S. eds), Sage
researcher has to pause and ask himself, `What questions         London, pp. 485±499.
                                                               Baker C., Wuest J. & Stern P.N. (1992) Method slurring: the
am I asking of the data and consequently does this differ
                                                                 grounded theory/phenomenology example. Journal of
from the methodology I chose originally?', then the
                                                                 Advanced Nursing 17, 1355±1360.
researcher may be becoming more concerned with process Becker P.H. (1993) Common pitfalls in published grounded
questions rather than creative, interpretative questions.        theory research. Qualitative Health Research 3, 254±260.
Consequently, substantive coding and theoretical coding Berger P. & Kellner H. (1981) Sociology Reinterpreted. Anchor
could be impeded.                                                Books, New York.
   Perhaps a combination of questions of the data, a Coyne I.T. (1997) Sampling in qualitative research: purposeful
combination of `What if?, `What do we have here?' and            and theoretical sampling; merging or clear boundaries? Journal
`What categories, concepts or labels do we need to account       of Advanced Nursing 26, 623±630.
for the phenomena?', would provide a richer and more Cutcliffe J.R. (1997) Qualitative nursing research: a quest for
complete understanding. Providing the researcher makes           quality. British Journal of Nursing 6, 969.
                                                               Cutcliffe J.R. & McKenna H.P. (1999) Establishing the credibility
explicit what questions they have asked, then some issues
                                                                 of qualitative research ®ndings: the plot thickens. Journal of
of precision have been addressed. Consequently, the
                                                              3 Advanced Nursing 31, 374±380.
researcher can predominantly use either Glaser's or Dickoff J. & James P. (1968) A theory of theories: a position paper.
Strauss' version of grounded theory and then augment             Nursing Research 17, 3.
their method by including additional questions. The Glaser B. & Strauss A.L. (1967) The Discovery of Grounded
author of the current paper posits that providing the            Theory: Strategies for Qualitative Research. Aldine, Chicago.
researcher explains what she/he has done and how she/he Glaser B.G. (1978) Theoretical Sensitivity. Advances in the
did it, straying outside of the boundaries of one particular     Methodology of Grounded Theory. The Sociology Press, Mill
version is less of an issue than limiting the potential depth    Valley, California.
of understanding that strict adherence to one version Glaser B.G. (1992) Basics of Grounded Theory Analysis: Emer-
would produce.                                                   gence vs. Forcing. Sociology Press, Mill Valley, California.
                                                                    Hammersley M. (1992) What's Wrong with Ethnography? Routl-
                                                                      edge, London.
CONCLUSION                                                          Hickey G. (1997) The use of literature in grounded theory.
                                                                      Nursing Times Research 2, 371±378.
Researchers intent on utilizing a     grounded theory meth-         Hutchinson S.A. (1993) Grounded theory: the method. In Nursing
odology should pay attention to       methodological issues,          Research: A Qualitative Perspective 2nd edn (Munhall P.L. &
including those addressed in          this paper; sampling,           Boyd C.A. eds), National League for Nursing Press, New York,
creativity and re¯exivity, the use    of literature, and preci-       pp. 180±212.



Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484                                                 1483
J.R. Cutcliffe

Lincoln Y.S. & Guba E.G. (1985) Naturalistic Enquiry. Sage,           Sandelowski M., Holditch-Davis D. & Harris B.G. (1992) Using
  London.                                                               qualitative and quantitative methods: the transition to parent-
Lipson J. (1991) The use of self in ethnographic research. In           hood of infertile couples. In Qualitative Methods in Family
  Qualitative Nursing Research: A Contemporary Dialogue                 Research (Gilgum J.F., Daly K., Handel G. eds), Sage, London,
  (Morse J.M. ed.), Sage, London, pp. 73±89.                            pp. 301±323.
May K.A. (1996) Diffusion, diffusion or distillation? The case of     Smith K. & Biley F. (1997) Understanding grounded theory:
  grounded theory method. Qualitative Health Research 6,                principles and evaluation. Nurse Researcher 4, 17±30.
  309±311.                                                            Stern P. (1980) Grounded theory methodology its uses and
Melia K.M. (1996) Rediscovering Glaser. Qualitative Health              applications. Image 12, 20±23.
  Research 6, 368±378.                                                Stern P.N. (1994) Eroding grounded theory. In Critical Issues in
Morse J.M. (1991a) Qualitative nursing research: a free for all. In     Qualitative Research Methods (Morse J.M. ed.), Sage, London,
  Qualitative Nursing Research: A Contemporary Dialogue                 pp. 210±223.
  (Morse J.M. ed.), Sage, London, pp. 14±22.                          Stern P. & Allen L. (1984) Qualitative research Ð the nurse as a
Morse J.M. (1991b) Strategies for Sampling. In Qualitative              grounded theorist. Health Care for Women International 5,
  Nursing Research: A Contemporary Dialogue (Morse J.M. ed.),           371±385.
  Sage, London, pp. 126±145.                                          Stern P.N., Allen L. & Moxley P. (1982) The nurse as a grounded
Morse J.M. (1994) Emerging from the data: the cognitive processes       theorist: history, process and uses. Review Journal of Philos-
  of analysis in qualitative enquiry. In Critical Issues in Quali-      ophy and Social Science 7, 200±215.
  tative Research Methods (Morse J.M. ed.), Sage, London,             Strauss A. & Corbin J. (1994) Grounded theory methodology: an
  pp. 23±43.                                                            overview. In Handbook of Qualitative Research (Denzin N.K. &
Morse J.M. (1998) What's wrong with random selection? Quali-            Lincoln Y.S. eds), Sage, London, pp. 273±285.
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  2nd edn. Sage, London.                                              Wilson H.K. & Hutchinson S.A. (1991) Triangulation of qualita-
Robrecht L.C. (1995) Grounded theory: evolving methods. Qual-           tive methods: Heideggerian hermeneutics and grounded theory
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1484                                                   Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484

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Methodological issues in grounded theory

  • 1. Journal of Advanced Nursing, 2000, 31(6), 1476±1484 Methodological issues in nursing research Methodological issues in grounded theory John R. Cutcliffe RMN RGN BSc(Hons) Doctoral Student, Lecturer in Mental Health Nursing and Practice Development Co-ordinator, Shef®eld University, Shef®eld, and RCN Institute, Oxford, England Accepted for publication 9 December 1999 CUTCLIFFE J.R. (2000) Journal of Advanced Nursing 31(6), 1476±1484 Methodological issues in grounded theory Examination of the qualitative methodological literature shows that there appear to be con¯icting opinions and unresolved issues regarding the nature and process of grounded theory. Researchers proposing to utilize this method would therefore be wise to consider these con¯icting opinions. This paper therefore identi®es and attempts to address four key issues, namely, sampling, creativity and re¯exivity, the use of literature, and precision within grounded theory. The following recommendations are made. When utilizing a grounded method researchers need to consider their research question, clarify what level of theory is likely to be induced from their study, and then decide when they intend to access and introduce the second body of literature. They should acknowledge that in the early stages of data collection, some purposeful sampling appears to occur. In their search for conceptually dense theory, grounded theory researchers may wish to free themselves from the constraints that limit their use of creativity and tacit knowledge. Furthermore, the interests of researchers might be served by attention to issues of precision including, avoiding method slurring, ensuring theoretical coding occurs, and using predominantly one method of grounded theory while explaining and describing any deviation away from this chosen method. Such mindfulness and the resulting methodological rigour is likely to increase the overall quality of the inquiry and enhance the credibility of the ®ndings. Keywords: grounded theory, methodology, rigour, nursing, sampling, creativity, re¯exivity, precision therefore be wise to consider these con¯icting opinions. INTRODUCTION This paper begins with a brief overview of grounded Since Glaser and Strauss' discovery in 1967, and its theory in order to identify the rudiments of the method. application within sociological study, grounded theory Then it identi®es and addresses four key issues, namely, has been used in many other ®elds including anthropol- sampling, creativity and re¯exivity, the use of literature, ogy and nursing. Many authors have written about the and precision within grounded theory. method, and scrutiny of this literature shows that there appear to be con¯icting opinions and unresolved issues Brief overview of grounded theory regarding the nature and process of grounded theory. Researchers proposing to utilize this method would A grounded theory is a theory that is induced from the data rather than preceding them (Lincoln & Guba 1985). Correspondence: John R. Cutcliffe, 11 Blackthorne Close, Kilburn, Glaser & Strauss (1967 p. 3) provide an initial de®nition of 1 Derbyshire DE56 0LF, England. E-mail: john.cutcliffe@shef®eld.ac.uk grounded theory. They state that it is a theory that will: 1476 Ó 2000 Blackwell Science Ltd
  • 2. Methodological issues in nursing research Methodological issues in grounded theory ¼ ®t the situation being researched and work when put into use. changeable. Patton (1990) argues that all types of sampling By ®t we mean that the categories must be readily (not forcibly) in qualitative research can be termed purposeful applicable to and indicated by the data under study; by work we sampling. Interestingly, in his list of 15 different sampling mean that they must be meaningfully relevant and be able to strategies Patton does not list or de®ne theoretical explain the behaviour under study. sampling. This apparent confusion only serves to confuse neophyte qualitative researchers (Coyne 1997). However, It is rooted in symbolic interactionism, wherein the if the researcher can describe his/her sampling strategy in researcher attempts to determine what symbolic mean- suf®cient detail, this should minimize any confusion ings, artifacts, clothing, gestures and words have for regarding sampling (Morse 1991b), improve the quality of groups of people as they interact with one another. the research (Coyne 1997), avoid method slurring (Baker Symbolic interactionists stress that people construct their et al. 1992) and provide some clari®cation of the use of realities from the symbols around them through interac- theoretical sampling in nursing research. tion, therefore individuals are active participants in Glaser (1978), Sandelowski et al. (1992), Becker (1993) creating meaning in a situation (Morse & Field 1995). and Coyne (1997) each delineated theoretical sampling Grounded theory both describes and explains the system from purposeful/selective sampling, in as much that, or behaviour under study and consequently is a method- purposeful sampling involves the calculated decision to ology for developing theory that is grounded in data sample a speci®c locale according to a preconceived but systematically gathered and analysed (Strauss & Corbin reasonable initial set of dimensions. In contrast, theoret- 1994). Consequently, grounded theorists search for social ical sampling has no such initial calculated decisions. The processes present in human interaction (Hutchinson grounded theory researcher seeks further interviewees/ 1993). They aim to discover patterns and processes and sources of data in order to add to the fullness of the understand how a group of people de®ne, via their social understanding of the concept. Hence, theoretical sampling interactions, their reality (Stern et al. 1982). is an integral part of the process of grounded theory. A central feature of grounded theory is its method of However, it should be noted that before the researcher has constant comparative analysis (Glaser & Strauss 1967), in begun to collect and analyse data, the researcher has no that data collection and analysis occur simultaneously evolving theory which can act as a guide for further and each item of data is compared with every other item of theoretical sampling. data. The theory induced is conceptually dense (Strauss & Baker et al. (1992) maintained that the researcher using Corbin 1994), that is theory with many conceptual rela- grounded theory initiates the sampling process by inter- tionships, and these relationships are embedded in a viewing signi®cant individuals. Perhaps it is these signi- context of descriptive and conceptual writing. ®cant individuals that Morse (1991b) is referring to when she describes a good informant as one who has the SOME RESEARCH DESIGNS knowledge and the experience the researcher requires, has the ability to re¯ect, is articulate, has the time to be Sampling in grounded theory interviewed and is willing to participate in the study. Glaser (1978) asserted that in the initial stages of theoret- Grounded theory uses non-probability sampling. In order ical sampling, decisions for collection of data are based for concepts and categories to emerge during the data only on a general sociological perspective and on a general analysis, the need for sampling of speci®c data sources subject or problem area. Morse (1991b) submitted that the continues until each category is saturated. Therefore, at researcher initially chooses interviewees with a broad the beginning of the study, there are no limits set on the general knowledge of the topic. number of the participants, interviewees or data sources. These positions and arguments thus appear to indicate The researcher continues selecting interviewees until they that individuals are chosen initially who can provide a are saying nothing new about the concepts being explored. relevant source of data, and this relevance is determined by Thus the selection of participants (and other sources of the requirements for generating and delimiting the theoret- data) is a function of the emerging hypothesis/hypotheses ical codes (Hutchinson 1993). Therefore, when a grounded and the sample size a function of the theoretical complete- theorist is commencing his/her data collection, it appears ness (Baker et al. 1992). that they do enter into a process of purposeful sampling, Sampling within grounded theory is therefore described which is then superseded by theoretical sampling as the as `theoretical' rather than purposeful (Glaser & Strauss data/theory highlight the direction which further sampling 1967, Glaser 1978, Becker 1993) in that it is driven by the needs to follow. This argument is supported by Sande- emerging theory. However, other authors of qualitative lowski et al. (1992) and Coyne (1997 p. 625) who states: research methods do not make such a distinction (Lincoln & Guba 1985, Morse 1991b). Indeed, they suggest that the ¼ theoretical sampling does involve the purposeful selection of a terms theoretical and purposeful sampling are inter- sample in the initial stages of the study. Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484 1477
  • 3. J.R. Cutcliffe A second issue in sampling that warrants attention is that subsequent theoretical sampling would also re¯ect the of the choice between a wide and diverse sample or a more limited experience. The data obtained from such an `focused', narrow, concentrated sample. It is reasonable to individual, when analysed and coded, is unlikely to say that the literature on this issue is confusing and indicate the lines of inquiry, the necessary sources of data, con¯icting. Hutchinson (1993) argues in favour of a wide, which would then lead ultimately to the `fullest' or most diverse sample in that this ensures extensive data that cover complete understanding of the social process. It should be the wide ranges of behaviour in varied situations. Lincoln & noted that it is possible that the fullness of the phenom- Guba (1985) make similar arguments. They advocate, since enon may be uncovered during subsequent interviews the purpose of sampling will most often be to include as (Hutchinson 1993). However, this argument does appear much information as possible, maximum variation to highlight the importance of selecting an appropriate sampling to be the usual sampling mode of choice. gatekeeper, and therefore also indicates a degree of Another argument may be constructed that reasons in a-priori sample selection. favour of a more narrow or focused sample, rather than Yet Lincoln & Guba (1985) deliberate that there can be maximum variation. Since the researcher in grounded no a-priori speci®cation of the sample and that initially theory is concerned with uncovering the situated, contex- any sample unit will do as well as any other. Nevertheless, tual, core and subsidiary social processes, the social Morse (1991b p. 129) highlighted that selection of an processes need to be shared and experienced by the adequate and appropriate sample is critical in qualitative individuals who make up the researched group. Other- research and that the eventual quality of the research is wise, if an individual has no experience of the social or contingent upon the appropriateness and adequacy of the psychosocial process, how can they comment on it? sample. Furthermore she states: Consequently, grounded theorists using a more narrow ¼ it is essential for the researcher to discover who will be the or focused sample seek out participants who have experi- most appropriate informant before beginning interviews and that ence, the most experience, in the topic of interest (Morse informants must be carefully selected or carefully chosen 1998). Indeed, Lincoln & Guba (1985) point out that according to speci®c qualities. grounded theory has been termed `local theory' as it brings together and systematizes isolated, individual theory. It is She sums up her arguments regarding sample selection an aggregate of local understandings. Selection of a sample by stating: of participants who have only a limited experience of the ¼ informants must be knowledgeable about the topic and experts social process, or put another way, a sample that isn't by their virtue of their involvement in speci®c life events and/or local, is thus likely to provide data and a subsequent associations. theory that has a partial or limited understanding of the process being studied. Glaser & Strauss (1967) highlight The author of this current paper is not advocating strict how the choice between sampling narrow or wider adherence to sample criteria set prior to commencing data substantive groups is directed by the conceptual level of collection. Such rigidity is only likely to limit theoretical the theory that the researcher intends to induce. They sampling (Morse 1991b). Yet, it appears to be logical for indicated that if the researcher intends to induce a the researcher to consider criteria for sample selection substantive theory that is applicable to one substantive prior to starting to collect data. Therefore the author group, then the researcher needs to sample groups of the argues that this purposeful sampling should be considered same substantive type (e.g. a narrow sample). A more for the ®rst interview (especially as this individual occu- general, or wider substantive theory would thus be pies the role of `gatekeeper') and possibly the second induced by sampling wider substantive groups, and if interview. Following this theoretical sampling to guide the researcher is concerned with inducing a formal theory, sample selection would be more appropriate. he/she will select dissimilar substantive groups from the larger class, and thus increase the theory's scope. Creativity and re¯exivity in grounded theory Lincoln & Guba (1985) argue that the purpose of maximum variation within theoretical sampling is best A further issue that warrants consideration is that of achieved by selecting each unit of the sample only after creativity and re¯exivity. Few would dispute that qualit- the previous unit has been taped and analysed. Conse- ative methods invariably involve interaction between the quently the ®rst unit of the sample (®rst interviewee) often researcher and the data. Turner (1981) reasoned that in acts as a `gatekeeper'. This ®rst set of data and subsequent social inquiry there is an interaction between the analysis can set the `tone' or highlight the direction for researcher and the world that they are studying. Indeed, further theoretical sampling. The notion of a `gatekeeper' Lipson (1991) expounded that re¯exivity refers to again raises the sampling issues identi®ed in this paper. If researchers being part of, rather than separate from, the the ®rst unit of a sample only has a limited experience of data. Altheide & Johnson (1994) argue that theories the social process being studied, one could argue that the induced from qualitative methods always include some- 1478 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
  • 4. Methodological issues in nursing research Methodological issues in grounded theory thing of the researcher. Hutchinson (1993 p. 187) made be seen in attempts to establish the credibility of qualit- speci®c remarks concerning re¯exivity and grounded ative ®ndings by using criteria developed for establishing theory: the credibility of quantitative ®ndings (Hammersley 1992). Also, it can be seen in attempts to translate these quan- ¼ because grounded theory research requires interpersonal titative criteria into terms more in keeping with the interaction, the researcher is inevitably part of his or her daily qualitative paradigm (Cutcliffe & McKenna 1999). observations. Attempts to discount the researcher's values, know- However, while there appears to be little argument that ledge, beliefs and experiences could also be regarded as an grounded theory inevitably involves interaction between attempt to gain credibility with scientists who use quan- the researcher and the world they are studying, how this titative or positivistic methods by decreasing any chance interaction affects the emerging theory remains a matter of personal bias. Such endeavours appear to be upholding for debate. Morse (1994) contends that qualitative the philosophical position that there is one true reality, methods (including grounded theory) have been plagued and that personal values, knowledge and experience with con¯icting advice concerning the application of prior would only serve to contaminate the researcher's repre- knowledge (including the researcher's previous experi- sentation of this reality. ence and knowledge which they bring to the study). However, the philosophical position of qualitative Berger & Kellner (1981) and Hutchinson (1993) advocate methods is dissimilar to that of quantitative methods. that the qualitative researcher needs to become aware of Qualitative researchers believe that reality is constructed their own personal preconceptions, values and beliefs and from human perspectives, shared (social) and individual then hold them in abeyance. These authors add that if interactions and meanings of given situations and these processes are not carried out, the scienti®c enter- phenomena. To strive to attain more credibility according prise collapses and the researcher will perceive a mirror to an alternative philosophical standpoint appears to be at image of hopes/fears and not the social reality. best inappropriate and at worst, a distraction from the A vigorous counter-argument exists that posits it is the potential that creativity can bring. re¯exivity and the researcher's creativity within this That is not to say that the grounded theorist has license re¯exivity that makes grounded theory valuable. Turner to invent concepts, categories and posit these as a theory (1981 p. 227) stated: that represents the meanings that a group of individuals ascribe to their shared interactions and social world. ¼ an advantage of grounded theory is that it directs the researcher However, what it does is legitimize the researcher's immediately to the creative core of the research process, and creativity as an integral part of the grounded theory facilitates the direct application of both the intellect and the inductive process; liberating the restrictions on the imagination to the demanding process of interpreting research researcher's tacit knowledge that discounting such know- data. ledge creates. Turner (1981 p. 228) stated: Stern (1994 p. 217) supports this viewpoint: ¼ competent development of grounded theory rests in part upon ¼ it is the creativity in the act that brings the real truth of a social a sensitivity to these often tacit processes of perceiving and situation into being, and following grounded theory techniques is understanding, and upon a willingness and an ability to bring one way to approach this creative process. them into the open for discussion. Morse (1994) encourages qualitative researchers to take Lincoln & Guba (1985 p. 208) constructed similar more risks in their theory development. It is worth arguments when they stated: considering whether or not such a movement could ¼ admitting tacit knowledge not only widens the investigator's involve transition from a position where concerns for ability to apprehend and adjust to phenomenon in context, it also holding prior knowledge and beliefs in abeyance predom- enables the emergence of theory that could not otherwise have inate, to an alternative position more concerned with been articulated. creativity. Perhaps consideration of why some researchers advocate the need to acknowledge and discount any prior Hence there is a need for the grounded theory researcher knowledge and beliefs may shed some light on this issue. to acknowledge his/her prior knowledge and tacit know- It is reasonable to say that for many years qualitative ledge, to bring such knowledge into the open, to discuss research methods have been regarded by many scientists how it has affected the theory development (Turner 1981) who use quantitative or positivistic methods as a `poor and allow the interplay between the researcher's know- relation' of quantitative methods. Consequently, some ledge, values and beliefs and the data to occur; to allow qualitative researchers have been anxious to be seen as the researcher's creativity to explore and articulate credible in the eyes of their such scientists. Evidence of theoretical links. this can be seen in some of the language used to describe The choices of which facts and lines of inquiry to and explain early qualitative methods (Morse 1994). It can follow and which not to follow are guided, to some Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484 1479
  • 5. J.R. Cutcliffe extent, by the subconscious perceptual and intellectual enon, and therefore have already decided that a grounded processes of the researcher's mind (Turner 1981). Conse- theory method would be suitable'. Consequently Lincoln quently, to deny a researcher who is using grounded & Guba's (1985) and Stern's (1994) arguments appear to theory access to this knowledge and to restrict the occupy a position further along the continuum of know- creativity necessary to utilize it, is likely to limit the ledge generation. Given these considerations both argu- depth of understanding of the phenomenon and impose ments appear to be cogent and not necessarily unnecessary, rigid structures. As a consequence, the contradictory of one another. researcher would be left questioning themselves each Many proposed research questions require conceptual time they draw upon their tacit knowledge, or when they clarity. For example, within the author's doctoral study, experience a moment of insight into the world they are having identi®ed that there is an absence of literature that investigating. The researcher would be left asking them- explains if or how hope is inspired in bereavement selves: counselling and thus a grounded theory method would be indicated, it may still be appropriate and indeed Does that thought originate from my knowledge, experience or prudent, to review the available literature that focuses on beliefs or does it belong to the interviewees? hope and the literature that focuses on bereavement Yet, importantly, the mechanism for checking the counselling. Such a review may help provide a sense of authenticity or representativeness of such knowledge the key elements of hope that are implicit in the literature, and insight exists within the grounded theory method, it may help provide some conceptual clarity of the nature whereby such trustworthiness is achieved by exploring of hope and the nature and practice of bereavement the possible or emerging concepts/categories in further counselling and this examination of the relevant literature interviews. If the hunch belongs solely to the researcher, would help the researcher to differentiate hope from and is not a part of the world being investigated, this will similar and related concepts. have no meaning for the interviewees and can be If there is a need for a review of the literature in order to discarded in due course. clarify concepts and de®ne terms, the key questions that need to be asked appear to be, how rigorous and thorough should this literature review be and at what point in the Literature reviews in grounded theory theory induction should this literature review occur? It is well documented that when utilizing a grounded Smith & Biley (1997 p. 20) acknowledged that a detailed theory method the researcher should avoid conducting a and comprehensive literature review is not the ®rst stage literature review prior to commencing data collection and in grounded theory. However, they go on to point out that analysis (Stern 1980, Stern et al. 1982, Stern & Allen 1984, some reading may occur prior to data collection. They Lincoln & Guba 1985, Stern 1994, Strauss & Corbin 1994, state: Hickey 1997). By avoiding a literature review at the General reading of the literature maybe carried out to obtain a feel beginning of the study it is more likely that the emergent for the issues at work in the subject area, and identify any gaps to theory will be grounded in the data. be ®lled in using grounded theory¼ but it is important that the Another view is proffered by Hutchinson (1993), who reading is not too extensive. suggests that a literature review should proceed data collection and analysis in grounded theory. In that, it is Their justi®cation for this technique is that the the review of the literature that can identify the current researcher then approaches the subject area with some gaps in knowledge, or help provide a rationale for the background knowledge. It is the opinion of the author of proposed research. Perhaps the apparent disagreement the current paper that such statements may confuse between these two positions can be explained if one potential researchers who are contemplating using considers the longitudinal nature of the generation of grounded theory. Just how much reading is `extensive' knowledge, and the different positions that these argu- and similarly `too extensive'? To advocate that the ments appear to occupy on this longitudinal continuum. researcher approaches the ®eld of study with this back- Hutchinson's (1993) arguments can be located in a ground knowledge may produce the situation where the position that has a starting point: `What do we know about researcher has already begun to form tentative conceptual this phenomenon?' Therefore, at this point, she has not and theoretical links. This, as discussed earlier, is inap- begun to consider what is the most appropriate method- propriate for grounded theory. ology. That will be indicated by the current extent and However, no potential researcher is an empty vessel, a depth of knowledge available regarding the phenomenon, person with no history or background. Further, as it is whereas, Lincoln & Guba's (1985) and Stern's (1994) common for many researchers to pursue a particular argument can be located in a position that has the starting theme throughout their research activity, they may already point, `We already recognize that there is a distinct dearth possess some background knowledge of the substantive or even absence of knowledge concerning the phenom- area they intend to study. Indeed, the researcher and all 1480 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
  • 6. Methodological issues in nursing research Methodological issues in grounded theory his/her knowledge and prior experience is bound up with clarify the concepts, before going on to induce a theory that the interactive processes of data collection and analysis. explicates and explains how they relate to one another. As Strauss & Corbin (1994 p. 278) indicated, the analyst is The other issue regarding literature reviewing in also a crucially signi®cant interactant and Glaser (1978) grounded theory is: When should the second review of offered similar remarks when he argued that everything is the literature occur? Hutchinson (1993) argued that data. Thus, the researcher would perhaps be unwise to because the preliminary literature review can sensitize carry out reading that provides him/her with anything concepts (i.e. add to the conceptual clarity) and increase more than, as Glaser & Strauss (1967) term, a partial an awareness of the gaps in the knowledge, this second framework of local concepts, which designate a few review turns to an entirely new body of literature. Stern principal or gross features of the situations that he/she (1980), Stern & Allen (1984) and Strauss & Corbin (1994) will study. As such knowledge becomes part of the argue that selective sampling of the second body of researcher and consequently becomes part of the inter- literature should be woven into the emerging theory active process. Instead of allowing the theory to emerge during their third stage on grounded theory induction, from the data, the researcher albeit implicitly, is likely to the stage they term concept development. enter into a deductive process. Comparing the data However, in contrast to these arguments, Glaser (1978) provided by the interviewees with the knowledge (and asserts that the researcher should refrain from accessing pre-formed conceptual frameworks) already present in this second body of literature until the theory has emerged his/her mind. Therefore, as indicated earlier, there may be from the data. Therefore it occurs at a later stage. What this value in reading literature that assists in concept clari®- difference of opinion indicates is that there are funda- cation. To draw upon Glaser & Strauss (1967) explanation mental differences between Glaser's and Strauss' version of these principal or gross features of the area of study, of grounded theory (and these are explored in the next they suggest that if a researcher intends studying hospi- section of this paper). Consequently, the stage at which tals, he knows there will be doctors, nurses, and admis- the researcher begins to weave in the second body of sion/discharge procedures. Indeed, having this initial literature appears to depend upon which version of conceptual clarity prior to entering the study, perhaps grounded theory is being used. helps the researcher to reach conceptual density, enhance the richness of concept development (Strauss & Corbin Precision in grounded theory 1994) and subsequently the process of theory development. To return to the example of hope inspiration in bereave- There appear to be several issues regarding precision and ment counselling. If the researcher wishes to investigate if clarity in grounded theory and each of these warrants the concepts are linked, and if so, how? it might be consideration. These issues can be described as method worthwhile to begin by highlighting the current concep- slurring with other similar yet different qualitative meth- tualization of both hope and bereavement counselling odologies, e.g. phenomenology (Baker et al. 1992). The within the relevant empirical literature. As there is an absence of theoretical coding in some studies which absence of substantive or formal theory that indicates how propound to be grounded theory (Strauss & Corbin 1994, such concepts may be related, neither of the reviews of Melia 1996). Additionally, does the term grounded theory literature provide the researcher with an implicit theory represent but one single method or, alternatively encom- which could be tested during the data collection. pass several methods (May 1996, Melia 1996). However, what it can do is provide an understanding of Stern (1994) af®rmed that although there may be simi- the concepts and thus provide ®rm conceptual clarity and larities in all interpretative methods, the frameworks an understanding upon which the rest of the emergent underlying the methodologies differ. Baker et al. (1992) theory can be built. constructed similar arguments and further reasoned that This process may not be appropriate for certain types of failure to explicate qualitative methodologies is resulting research question. For example, factor isolating questions in a body of nursing research that is mislabelled. Morse such as `What is caring?'. What appears to become evident (1991a p. 15) warned of this mixing of methodologies and is that the decision whether or not to conduct a review of stressed that: literature to help conceptual clarity may depend upon ¼ the product is not good science; the product is a sloppy what the research question is, but more importantly the mishmash. 2 level of theory (Dickoff & James 1968) to be induced. Thus, if the researcher is concerned with inducing factor Thus by paying attention to the resolution or precision isolating theory, it may be disadvantageous to carry out of qualitative research methodology the researcher is such a review of the literature. In contrast if the researcher endeavouring to ensure rigour (Baker et al. 1992, Cutcliffe is concerned with factor relating theory, it could be 1997). Such rigorous studies should `stand up' better to advantageous to carry out the literature review in order to critique by enabling the reader to examine whether or not Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484 1481
  • 7. J.R. Cutcliffe the chosen methodology was appropriate to the nature of most demand upon the grounded theorist's creativity. the research study. Further, it is perhaps theoretical coding and the postu- However, Stern (1994) acknowledged that she is lating of previously undiscovered or unarticulated links comfortable with the evolution of a methodology, and that enables the development of the theory. that she does not regard researchers `tinkering with' a If the grounded theorist concentrates on substantive given method as problematic. Further, she highlights the coding as the chief and almost exclusive feature (Strauss & advantages of combining different qualitative methodolo- Corbin 1994) then it is possible that this limits the gies. Therefore the dif®culty does not lie with blending researcher to inducing factor isolating theory, in as much one qualitative methodology with another, indeed the as substantive coding facilitates the researcher in asking resulting methodology may produce a more thorough, the questions, `What is this?', `What are the components of multidimensional understanding of the phenomenon. In this social process?'. Introducing theoretical coding support of this position, Wilson & Hutchinson (1991) enables the researcher to induce factor relating theory. propose the triangulation of Heideggarian hermeneutics Theoretical coding facilitates the researcher in asking the and grounded theory. For example, these methods could questions, `What is happening here?', `How do the be combined in order to examine the nature of hope substantive codes relate to each other as hypotheses?'. inspiration in bereavement counselling. The grounded To ignore the central feature of the methodology (Strauss & theory would enable the researcher to ask, `How does this Corbin 1994) and then subsequently call the methodology inspiration occur?', `What if ``X'' were to happen here?', grounded theory is a clear indication of imprecision. `What symbolic meanings, gestures, words or behaviours Another issue of precision is whether or not the term explain the social reality of the process of hope inspiration grounded theory encompasses more than one methodo- in bereavement counseling?'. The Heideggarian phenom- logy. If so, is it appropriate to call a methodology enology would enable the researcher to ask the questions, grounded theory or would another term have to be used? `What is the lived experience of receiving such hope in a As indicated in the introduction grounded theory was bereavement counselling setting?', `What meanings do both discovered by Glaser & Strauss (1967), both of whom had the counsellors and the client ascribe to this experience?'. distinctly different academic backgrounds. It maybe no The crucial issue then, even when using combined surprise then that the subsequent development of the methodologies, is that there is still precision. The method- methodology since then has taken a different path for each ologies are combined purposefully and with intention, and author. the researcher subsequently makes explicit what she/he According to Stern (1994), Glaser, who has a back- has done and why. The mixing of methodologies does not ground in statistical analysis, insists on allowing the occur by accident. Similarly, the researcher does not call theory to emerge, whereas Strauss, whose sociology was the product of this mixing grounded theory or phenome- ®rmly rooted in the Chicago school (i.e. a school of nology, but tells the researcher the methodology is some- sociology which has its roots in the symbolic interac- thing different, e.g. a combination of two methodologies. tionist tradition, Robrecht 1995), prefers a method that is The second issue regarding precision in grounded tightly prescriptive. Stern (1994) and Melia (1996) also theory is that of substantive coding and theoretical coding. suggest that Glaserian grounded theory would be expected Strauss & Corbin (1994 p. 277) were adamant that some to be immediately applicable to individuals and groups researchers who: who shared the problem under study and would be expected to be testable. However, theory produced using ¼ think they are doing grounded theory studies often seem to Strauss' version of grounded theory has its applicability concentrate on substantive coding as the methodology's chief and downplayed (Stern 1994). The crux of the dichotomy is, almost exclusive feature, but do not do theoretical coding. according to Glaser (1992) the fundamental difference Few would dispute that substantive coding is an integ- between emerging and forcing. Stern (1994) argued a key ral part of data analysis within grounded theory, but if the difference is the questions each author asks of the data. As intellectual rigour halts at substantive coding, then it is Strauss examines the data, he stops at each word and asks, debatable that the researcher used a grounded theory `What if ?', whereas Glaser keeps his attention on the data methodology. The author of the current paper would argue and asks, `What do we have here?'. not. Glaser (1978) argues that it is the theoretical coding, According to Stern (1994 p. 20): the conceptualization of how the substantive codes may Strauss brings to bear every possible contingency that could relate relate to each other as hypotheses, which enables the to the data, whether it appears in the data or not. Glaser focuses substantive codes to be integrated into a theory. It is this his attention on the data to allow the data to tell their own story. theoretical coding that can provide the full and rich understanding of the social processes and human interac- Glaser (1978) went as far as to claim that Strauss' tions which are being studied. The author of this current evolution is a departure from the original methodology paper suggests that theoretical coding perhaps places the and represents an erosion of grounded theory (Melia 1482 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
  • 8. Methodological issues in nursing research Methodological issues in grounded theory 1996). Indeed he asserts that the two methodologies sion. The author concludes by making the following should have different names, with Strauss' version being recommendations. termed, full conceptual description. When utilizing a grounded method researchers should If the crux is in the different questions asked of the data, consider their research question and clarify what level of what happens if the researcher asks both questions? theory is likely to be induced and then decide when they Further, if the researcher asks another question, is he/ intend to access and introduce the second body of litera- she using another different version of grounded theory? ture. They should acknowledge that in the early stages of For example Turner (1981 p. 232) asked: data collection, some purposeful sampling appears to occur. They may wish to free themselves from the restraints ¼ what categories, concepts or labels do we need in order to that limit their use of creativity and tacit knowledge. The describe or account for the phenomena discussed in this para- researchers might be served by attention to issues of graph? precision, including avoiding method slurring, ensuring Stern (1980 p. 281) proposed that the researcher exam- theoretical coding occurs, and predominantly using one ines the data, line by line, and produce substantive codes: method of grounded theory while explaining and describing any deviation away from this chosen method. These codes are called substantive codes, because they codify the Such mindfulness and the resulting methodological substance of the data, and often use the very words used by the rigour is likely to increase the overall quality of the actors themselves. inquiry and enhance the credibility of the ®ndings. If the nature of the grounded theory is determined in part by the questions asked of the data, then does the References researcher have to predetermine the questions she/he will ask and then ensure that this is the only question they ask Altheide D.L. & Johnson J.M. (1994) Criteria for assessing inter- of the data? The author of this current paper suggests that pretative validity in qualitative research. In Handbook of this might be somewhat restrictive and disabling. If the Qualitative Research (Denzin N. & Lincoln Y.S. eds), Sage researcher has to pause and ask himself, `What questions London, pp. 485±499. Baker C., Wuest J. & Stern P.N. (1992) Method slurring: the am I asking of the data and consequently does this differ grounded theory/phenomenology example. Journal of from the methodology I chose originally?', then the Advanced Nursing 17, 1355±1360. researcher may be becoming more concerned with process Becker P.H. (1993) Common pitfalls in published grounded questions rather than creative, interpretative questions. theory research. Qualitative Health Research 3, 254±260. Consequently, substantive coding and theoretical coding Berger P. & Kellner H. (1981) Sociology Reinterpreted. Anchor could be impeded. Books, New York. Perhaps a combination of questions of the data, a Coyne I.T. (1997) Sampling in qualitative research: purposeful combination of `What if?, `What do we have here?' and and theoretical sampling; merging or clear boundaries? Journal `What categories, concepts or labels do we need to account of Advanced Nursing 26, 623±630. for the phenomena?', would provide a richer and more Cutcliffe J.R. (1997) Qualitative nursing research: a quest for complete understanding. Providing the researcher makes quality. British Journal of Nursing 6, 969. Cutcliffe J.R. & McKenna H.P. (1999) Establishing the credibility explicit what questions they have asked, then some issues of qualitative research ®ndings: the plot thickens. Journal of of precision have been addressed. Consequently, the 3 Advanced Nursing 31, 374±380. researcher can predominantly use either Glaser's or Dickoff J. & James P. (1968) A theory of theories: a position paper. Strauss' version of grounded theory and then augment Nursing Research 17, 3. their method by including additional questions. The Glaser B. & Strauss A.L. (1967) The Discovery of Grounded author of the current paper posits that providing the Theory: Strategies for Qualitative Research. Aldine, Chicago. researcher explains what she/he has done and how she/he Glaser B.G. (1978) Theoretical Sensitivity. Advances in the did it, straying outside of the boundaries of one particular Methodology of Grounded Theory. 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