Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice.

AIMS AND OBJECTIVE: To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. BACKGROUND: The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. DESIGN: Discursive paper. METHOD: A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. CONCLUSIONS: This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. RELEVANCE TO CLINICAL PRACTICE: Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.

Qualitative Research in Palliative Care: Applications to Clinical Trials Work.

BACKGROUND: While vast opportunities for using qualitative methods exist within palliative care research, few studies provide practical advice for researchers and clinicians as a roadmap to identify and utilize such opportunities. OBJECTIVE: To provide palliative care clinicians and researchers descriptions of qualitative methodology applied to innovative research questions relative to palliative care research and define basic concepts in qualitative research. Body: We describe three qualitative projects as exemplars to describe major concepts in qualitative analysis of early palliative care: (1) a descriptive analysis of clinician documentation in the electronic health record, (2) a thematic content analysis of palliative care clinician focus groups, and (3) a framework analysis of audio-recorded encounters between patients and clinicians as part of a clinical trial. CONCLUSIONS: This study provides a foundation for undertaking qualitative research within palliative care and serves as a framework for use by other palliative care researchers interested in qualitative methodologies.

Supervising for Robust Hermeneutic Phenomenology: Reflexive Engagement Within Horizons of Understanding.

Undertaking philosophically hermeneutic research requires embodying the fundamental hermeneutic notions espoused by Heidegger, Gadamer, and other related philosophers. For both supervisors and students, there is "a way" of working that infuses a hermeneutic project with a particular kind of contemplative openness. In this article, I will draw from my own experience of coming to appreciate the nature of this approach. Reading Gadamer challenged me to see that, before interpreting the meanings inherent in research data, I first needed to grapple with the fact that I brought ready-made prejudices to the interpretation. Further, and perhaps more importantly, was the recognition that while prejudices may have a negative influence, they could also bring a positive view. Just as I needed to understand key Gadamerian notions to shed light on the interpretive nature of philosophical hermeneutics, I will unpack these to underpin the ongoing discussion of hermeneutic research strategies. In articulating "how" to be hermeneutic, I explain how I guide students embarking on hermeneutic research. Discussion centres on surfacing and engaging with preunderstandings through 'presuppositions interviewing', journalling and the careful selection of words that refine and crystallise meanings in ways that reflectively and reflexively engage and expand horizons of understanding. In this article, I use examples from my own experience as a doctoral student and supervisor of doctoral students to assist other supervisors and students understand both the importance of "being hermeneutic" and ways of achieving robust and philosophically congruent hermeneutic research.

Trabajo final de grado y plan de acción tutorial en el curriculum del grado en enfermería. Diseño, desarrollo y evaluación / Final project degree and tutorial action plan in the curriculum of the degree in nursing. Design, development and evaluation

La acción tutorial (PAT), en los estudios universitarios de Enfermería, se halla en el centro de la acción docente del profesorado. El tutor/a orienta en el proceso de aprendizaje y en la preparación del Trabajo Final de Grado (TFG). En este artículo presentamos los resultados de la investigación realizada con tutores y estudiantes, que tiene por objetivo evaluar el diseño y desarrollo del TFG, los resultados académicos y su vivencia y experiencia. Diseño mixto cuantitativo descriptivo y cualitativo de investigación acción participación. Muestra total de 124 estudiantes de 4º curso de Grado Enfermería y 37 tutores del TFG. Técnicas de recogida de datos: resultados académicos y evaluativos; 3 grupos focales con estudiantes y profesores; 3 entrevistas semiestructuradas abiertas a estudiantes. Los resultados constatan que las tipologías más elegidas fueron revisiones bibliográficas (38,75%) y Planes de cuidados (24,2%). El 63,9 % de la temática escogida es Enfermería Maternal, Pediátrica y Clínica. Estudiantes y tutores viven con dificultad la elaboración del TFG y se requiere una mayor cultura tutorial. Es un proceso complejo de organización y coordinación que, sin embargo, permite un trabajo colaborativo de todo el equipo docente (AU)

The Tutorial Action Plan (PAT) in the University School of Nursing, is central to the teaching action of professors. The tutor orients in the learning process and the preparation of the Final Degree Project (TFG). In this paper we present the results of research conducted with tutors and students, which aims to evaluate the design and development of the TGF, academic results and their experience and expertise. A descriptive qualitative and quantitative joint design of research and participation. A total sample of 124 students of 4th year in the nursing degree and 37 TGF tutor. Data collection techniques: Academic and evaluation results; 3 focus groups with students and professors; three semi-structured interviews open to students. Results indicate that the most commonly chosen typologies were literary reviews (38.75%) and care plans (24.2%). 63.9% of the chosen topics include Maternal, Pediatric and Clinical Nursing. Students and tutors struggle to develop the TGF and greater tutorial culture is required. It is a complex process of organization and coordination which, however, allows collaborative work of the entire faculty (AU)

Investigación colombiana en enfermería. Un análisis bibliométrico de su visibilidad en ISI WoS (2001-2013) / Colombian nursing research. A bibliometric analysis of the visibility in ISI WoS (2001-2013)

Objetivo: Evaluar el comportamiento de la actividad científica colombiana en enfermería visible en ISI WoS en el período 2001-2013 para conocer tendencias y regularidades. Métodos: Se emplea el método descriptivo, transversal y retrospectivo de utilidad en los análisis bibliométricos. La búsqueda se realizó utilizando los descriptores Nursing y Colombia con lo cual se obtienen 133 registros. Luego de un proceso de normalización, se examinaron 118 documentos publicados por 526 autores para estudiar la productividad de variables como autores, instituciones, descriptores y revistas, así como la distribución temporal y las redes de colaboración de autores, descriptores y la co-citación de autores y documentos. Resultados: Se visualiza un decrecimiento en la producción anual de documentos, similar a las citas recibidas por año. El español como principal idioma de publicación de las contribuciones, donde el 40% de la producción científica está publicada en la Revista Aquichán y un 62.4% en universidades del país con enfoque a publicar sobre temas de cuidados en enfermería. Por medio del método de análisis de Redes Sociales se obtienen matrices de colaboración y co-citación las cuales permiten concluir la existencia de pocos autores altamente citados, la no presencia de relaciones fuertes de colaboración y diversidad de términos relacionados con áreas clínicas, administrativas y sociales de la enfermería. Conclusiones: La actividad científica presenta un aumento en la cantidad de documentos y citas anuales, aspecto que ha llevado a ganar en visibilidad y reconocimiento en la comunidad científica internacional, aspecto que se percibe en los indicadores obtenidos en la investigación (AU)

Objective: Evaluate the performance of the Colombian scientific activity in nursing, visible at ISI WoS in the period 2001-2013 for know trends and regularities. Methods: A descriptive, cross-sectional and retrospective utility method is used in bibliometric analysis. The search was performed using Nursing and Colombia as descriptors, with which were obtained 133 records. After a normalization process, 118 documents published by 526 authors were reviewed to study the productivity variables as authors, institutions, descriptors and magazines as well as the timing distribución and collaborative networks of authors, descriptors and co-citation of authors and documents. Results: Displays a decrease in the annual production of documents, similar to the citations received per year. Spanish, as their primary language of publication of contributions, where 40% of the scientific production is published in the Journal Aquichán and 62.4% in universities of the country focusing on publishing issues in nursing care. Through the method of analysis of social networks are obtained matrices of collaboration and co-citation which allow us to conclude the existence of few highly cited authors, non-presence of strong collaborative relationships and diversity of terms related to clinical, administrative and social areas of nursing. Conclusions: The scientific activity has increased the amount of documents and annual quotes, aspect that has been gaining visibility and recognition in the international scientific community, aspect perceived at the indicators obtained in the investigation (AU)

A guide to critiquing a research paper. Methodological appraisal of a paper on nurses in abortion care.

In this paper, we have taken a previously published article on nurses' judgements in abortion care performing a systematic critique of the merits of this research using a recognised critiquing framework. OBJECTIVES DESIGN: The qualitative paper chosen for the critique is a grounded theory design and the research terms and terminology associated with this method such as symbolic interactionism are defined. The published paper reported on findings from a study exploring the characteristics of nurses in abortion care. REVIEW METHODS: A published critiquing tool has been applied. It was chosen because it is pragmatic, clearly laid out and accessible as full text to the people likely to need it. It comprises two stages, the first of which centres on the believability of the research. The second stage is more detailed and examines the research process and establishes the credibility of the research in its application to practice. OUTCOME: Develop critical and analytical skills through methodically appraising the merits of published research. CONCLUSION: Nursing as an evidence-based profession requires nurses at both pre- and post-registration levels to be able to understand, synthesise and critique research, this being a fundamental part of many nursing curricula. These have become core skills to acquire since implementing up to date evidence is the cornerstone of contemporary nursing practice.

A Narrative in Search of a Methodology.

PURPOSE: Research papers present us with the summaries of scholars' work; what we readers do not see are the struggles behind the decision to choose one methodology over another. DESIGN AND METHODS: A student's mental health portfolio contained a narrative that led to an exploration of the most appropriate methodology for a projected study of clinical anecdotes told by nurses who work in mental health settings to undergraduates and new recruits about mental health nursing. This paper describes the process of struggle, beginning with the student's account, before posing a number of questions needing answers before the choice of the most appropriate methodology. FINDINGS: We argue, after discussing the case for the use of literary analysis, discourse analysis, symbolic interactionism, hermeneutics, and narrative research, that case study research is the methodology of choice. PRACTICE IMPLICATIONS: Case study is frequently used in educational research and is sufficiently flexible to allow for an exploration of the phenomenon.

Is reflexivity the key to minimising problems of interpretation in phenomenological research?

AIM: To discuss and demonstrate the use of reflexivity in interpretive phenomenological analysis. BACKGROUND: Interpretative phenomenological analysis focuses on understanding individual experiences through interpretation. A double hermeneutic is created as the researcher makes sense of participants' experiences. It is crucial to undergo a process of reflexivity to provide a credible and plausible explanation of participants' accounts and avoid assumptions. DATA SOURCES: Research undertaken with six sub-Saharan African healthcare professionals. REVIEW METHODS: Articles were selected from Cumulative Index to Nursing and Allied Health, Medline and Google Scholar. Searches were based on relevance and with priority to those dated over the past five years. DISCUSSION: This article has reviewed pertinent literature and personal examples of reflexivity in research practice to aid nurse researcher understanding and encourage its use, particularly when employing interpretative methodologies. CONCLUSION: Reflexivity is an active process that may, at times, be difficult and probing, but which is crucial to becoming self-aware and thus able to see any influences that could affect data collection or analysis. This process will increase understanding and allow for a more rigorous approach. IMPLICATIONS FOR PRACTICE: Many practical examples are offered for using reflexivity. Nurse researchers may choose one or a mixture of the options offered, such as use of time and space to distance themselves from their research, aspects of practical self-presentation, or a reflexive diary.

Acknowledging hubris in interpretative data analysis.

UNLABELLED: AIM" To explore the notion of 'hubris' as an important consideration of reflexive thinking in qualitative research and how over-exuberant assumptions when interpreting data can impede conceptual development. BACKGROUND: The author draws on experiences of hubris in his grounded theory PhD study. DATA SOURCES: The study has undergone two phases of data collection and analysis. Phase one involved semi-structured interviews with a purposive sample of 20 registered nurse mentors. Preliminary findings were further developed by theoretical sampling of nurse mentors and practice educators in four major health boards in the UK, including 12 focus groups (n=43) and three further semi-structured interviews. REVIEW METHODS: Recognising hubris as a critical component of reflexive thinking was a feature of a grounded theory study exploring mentors' experiences of assessing students on the borderline of achievement in nursing practice. DISCUSSION: Three examples of hubris contributing to hastily advanced interpretive analysis are discussed in terms of the researcher's personal and professional positioning towards participants, the development of categories and the ethical management of data. The complexity of hubris as an important aspect of . reflexive thinking is highlighted. CONCLUSION: Virtue ethics and the importance of keen interpretative husbandry as part of reflexive mindfulness are proposed, if not as solutions to the dilemmas of hubris, then at least as safeguarding against analytic pitfalls. IMPLICATIONS FOR PRACTICE: The grounded theory study findings will make practice recommendations concerning mentors' support of students on the borderline of achievement of competence. The study will offer a theoretical perspective on mentorship conceptualised as a community of assessors throughout the duration of nursing programmes rather than purely an individual activity between student and mentor.

Understanding the processes of writing papers reflectively.

AIM: This paper explores the writing of research papers using reflective frameworks. BACKGROUND: Reflective practice is integral to professional education and development. However, healthcare students, academics and practitioners have given limited attention to how to write reflectively. In addition, there are limited resources on the practical aspects of writing papers reflectively. DATA SOURCES: The following major databases were searched: PubMed, Medline, King's Library, Excerpta Medica Database, Department of Health database, Cumulative Index to Nursing and Allied Health Literature. The searches were conducted using 'free text' and 'index' terms. Only relevant papers published in English were reviewed and scrutinised. Unpublished reports, internal publications, snowballing from the reference lists and personal contacts were also included in the search. REVIEW METHODS: This is a review paper that critiques the frameworks used for reflective practice. DISCUSSION: Writing papers reflectively is a complex task. Healthcare professionals and researchers need to understand the meaning of reflection and make appropriate use of reflective frameworks. Demystifying the process of reflectively writing papers will help professionals develop skills and competencies. IMPLICATION FOR RESEARCH/PRACTICE: This article provides a practical guide to reflection and how nursing and allied healthcare students, academics and practitioners can practise it. The paper identifies four generic stages in frameworks: description, assessment, evaluation and action, which are illustrated by annotated 'skeletal' examples. It is hoped that this will assist the process of reflective practice, writing and learning.

[How to quantify the qualitative aspects of nursing outcomes classification scales with psychosociocultural indicators]. / Cómo cuantificar los aspectos cualitativos en escalas de clasificación de resultados NOC para etiquetas psico-socioculturales.

Working necessarily with Likert scales to measure Nursing Outcomes Classification (NOC) outcomes has the advantage of unification, but also presents difficulty in reducing the rating from 1 to 5, especially when the research is qualitative and thus includes the use of words and expressions, as well as observations and perceptions. What exactly does a score of 2 or 3 mean with regard to the NOC Health beliefs? In this paper, we make a number of different proposals for operationalizing concepts and transforming them to numbers; however, it should be noted that such proposals always end in a quantitative analysis. Thus, we propose the use of emic/etic qualitative observations for psychosocial and cultural indicators, following ethnographic principles. Basic and applied research on nursing languages must have correct methodological foundations and seek to satisfy the same criteria of methodological suitability as any other research.

[Introduction to qualitative research: the main approaches and designs]. / Introduzione alla ricerca qualitativa: i principali metodi e sistemi di campionamento.

Introduction to qualitative research: the main approaches and designs. The main methods (phenomenology, ethnography, Grounded, narrative enquiry and case studies) and sampling technique of qualitative research are briefly outlined. A practical example is presented for each method.

[Good and bad examples of qualitative research]. / Buoni e cattivi esempi di ricerca qualitativa.

Good and bad examples of qualitative research. Not all the research papers are of good quality and contribute to the development of the knowledge. Good and less good examples of qualitative research are presented and commented on, exploring their contribution to the knowledge of a subject, and motivating why the research can be considered a good or less good example.

Capability beliefs regarding evidence-based practice are associated with application of EBP and research use: validation of a new measure.

BACKGROUND: Beliefs about capabilities, or self-efficacy, is a construct originating in social cognitive psychology. Capability beliefs have been found to be positively associated with intention and healthcare practice behaviour. A measure of an individual's beliefs about his/her capability to apply the components of evidence-based practice (EBP) has potential to be useful in implementation research. AIMS: To evaluate the concurrent validity and internal structure of a new scale measuring nurses' capability beliefs regarding EBP. METHODS: Data were taken from a prospective longitudinal study in Sweden (the Longitudinal Analyses of Nursing Education and Entry in Worklife [LANE]). A cohort of nursing students who graduated in the autumn of 2004 that was followed up 2 years after their graduation was used (n= 1,256). Concurrent validity was tested relating different levels of capability beliefs to extent of research use and application of EBP. An item-response approach was applied in the evaluation of internal structure of the proposed scale (six items). RESULTS: The psychometric analyses indicated that the six items could be summed to reflect a one-dimensional scale. Nurses with the highest level of capability beliefs reported that they used research findings in clinical practice more than twice as often as those with lower levels of capability beliefs. They also participated in the implementation of evidence seven times more often. IMPLICATIONS: There is a need for further studies of the construct and predictive validity of the scale. It should also be validated in other groups of health professionals. Learning including mastery experiences, role modelling, social persuasion, and manageable stress could be used in undergraduate education as well as practice development to increase beliefs about capabilities which might open the way to increased application of EBP in healthcare practice. CONCLUSIONS: This new measure is well grounded in social cognitive theory, functions as a one-dimensional scale and possesses promising properties of concurrent validity.