Journal of Advanced Nursing, 2000, 31(6), 1476±1484                                    Methodological issues in nursing re...
Methodological issues in nursing research                                            Methodological issues in grounded the...
J.R. Cutcliffe   A second issue in sampling that warrants attention is that   subsequent theoretical sampling would also r...
Methodological issues in nursing research                                                      Methodological issues in gr...
J.R. Cutcliffeextent, by the subconscious perceptual and intellectual        enon, and therefore have already decided that...
Methodological issues in nursing research                                         Methodological issues in grounded theory...
J.R. Cutcliffethe chosen methodology was appropriate to the nature of            most demand upon the grounded theorists c...
Methodological issues in nursing research                                           Methodological issues in grounded theo...
J.R. CutcliffeLincoln Y.S. & Guba E.G. (1985) Naturalistic Enquiry. Sage,           Sandelowski M., Holditch-Davis D. & Ha...
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Methodological issues in grounded theory

  1. 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 of1 Derbyshire DE56 0LF, England. E-mail: john.cutcliffe@shef® grounded theory. They state that it is a theory that will: 1476 Ó 2000 Blackwell Science Ltd
  2. 2. Methodological issues in nursing research Methodological issues in grounded theory¼ ®t the situation being researched and work when put into use. changeable. Patton (1990) argues that all types of samplingBy ®t we mean that the categories must be readily (not forcibly) in qualitative research can be termed purposefulapplicable to and indicated by the data under study; by work we sampling. Interestingly, in his list of 15 different samplingmean that they must be meaningfully relevant and be able to strategies Patton does not list or de®ne theoreticalexplain 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 inresearcher attempts to determine what symbolic mean- suf®cient detail, this should minimize any confusionings, artifacts, clothing, gestures and words have for regarding sampling (Morse 1991b), improve the quality ofgroups of people as they interact with one another. the research (Coyne 1997), avoid method slurring (BakerSymbolic interactionists stress that people construct their et al. 1992) and provide some clari®cation of the use ofrealities 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 samplingGrounded 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 toology for developing theory that is grounded in data sample a speci®c locale according to a preconceived butsystematically 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. Theprocesses 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 theunderstand how a group of people de®ne, via their social understanding of the concept. Hence, theoretical samplinginteractions, 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 hasconstant comparative analysis (Glaser & Strauss 1967), in begun to collect and analyse data, the researcher has nothat data collection and analysis occur simultaneously evolving theory which can act as a guide for furtherand each item of data is compared with every other item of theoretical The theory induced is conceptually dense (Strauss & Baker et al. (1992) maintained that the researcher usingCorbin 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 theSOME RESEARCH DESIGNS knowledge and the experience the researcher requires, has the ability to re¯ect, is articulate, has the time to beSampling 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 basedfor concepts and categories to emerge during the data only on a general sociological perspective and on a generalanalysis, the need for sampling of speci®c data sources subject or problem area. Morse (1991b) submitted that thecontinues until each category is saturated. Therefore, at researcher initially chooses interviewees with a broadthe 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 indicateThe researcher continues selecting interviewees until they that individuals are chosen initially who can provide aare saying nothing new about the concepts being explored. relevant source of data, and this relevance is determined byThus 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 groundedand the sample size a function of the theoretical complete- theorist is commencing his/her data collection, it appearsness (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 theas `theoretical rather than purposeful (Glaser & Strauss data/theory highlight the direction which further sampling1967, 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 aterms 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. 3. J.R. Cutcliffe A second issue in sampling that warrants attention is that subsequent theoretical sampling would also re¯ect theof 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 tosay 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 mostdiverse sample in that this ensures extensive data that cover complete understanding of the social process. It should bethe 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 interviewsthe purpose of sampling will most often be to include as (Hutchinson 1993). However, this argument does appearmuch information as possible, maximum variation to highlight the importance of selecting an appropriatesampling 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 bemaximum variation. Since the researcher in grounded no a-priori speci®cation of the sample and that initiallytheory 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 anprocesses need to be shared and experienced by the adequate and appropriate sample is critical in qualitativeindividuals who make up the researched group. Other- research and that the eventual quality of the research iswise, if an individual has no experience of the social or contingent upon the appropriateness and adequacy of thepsychosocial 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 theor focused sample seek out participants who have experi- most appropriate informant before beginning interviews and thatence, the most experience, in the topic of interest (Morse informants must be carefully selected or carefully chosen1998). Indeed, Lincoln & Guba (1985) point out that according to speci®c qualities.grounded theory has been termed `local theory as it bringstogether and systematizes isolated, individual theory. It is She sums up her arguments regarding sample selectionan 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 expertssocial process, or put another way, a sample that isnt by their virtue of their involvement in speci®c life events and/orlocal, is thus likely to provide data and a subsequent associations.theory that has a partial or limited understanding of theprocess being studied. Glaser & Strauss (1967) highlight The author of this current paper is not advocating stricthow the choice between sampling narrow or wider adherence to sample criteria set prior to commencing datasubstantive groups is directed by the conceptual level of collection. Such rigidity is only likely to limit theoreticalthe theory that the researcher intends to induce. They sampling (Morse 1991b). Yet, it appears to be logical forindicated that if the researcher intends to induce a the researcher to consider criteria for sample selectionsubstantive theory that is applicable to one substantive prior to starting to collect data. Therefore the authorgroup, then the researcher needs to sample groups of the argues that this purposeful sampling should be consideredsame 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 secondinduced by sampling wider substantive groups, and if interview. Following this theoretical sampling to guidethe researcher is concerned with inducing a formal theory, sample selection would be more appropriate.he/she will select dissimilar substantive groups from thelarger class, and thus increase the theorys scope. Creativity and re¯exivity in grounded theory Lincoln & Guba (1985) argue that the purpose ofmaximum variation within theoretical sampling is best A further issue that warrants consideration is that ofachieved 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 thequently the ®rst unit of the sample (®rst interviewee) often researcher and the data. Turner (1981) reasoned that inacts as a `gatekeeper. This ®rst set of data and subsequent social inquiry there is an interaction between theanalysis 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 toagain raises the sampling issues identi®ed in this paper. If researchers being part of, rather than separate from, thethe ®rst unit of a sample only has a limited experience of data. Altheide & Johnson (1994) argue that theoriesthe 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. 4. Methodological issues in nursing research Methodological issues in grounded theorything 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 establishingtheory: 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 theinteraction, the researcher is inevitably part of his or her daily qualitative paradigm (Cutcliffe & McKenna 1999).observations. Attempts to discount the researchers values, know- However, while there appears to be little argument that ledge, beliefs and experiences could also be regarded as angrounded 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 chanceinteraction affects the emerging theory remains a matter of personal bias. Such endeavours appear to be upholdingfor 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 experiencewith con¯icting advice concerning the application of prior would only serve to contaminate the researchers repre-knowledge (including the researchers previous experi- sentation of this reality.ence and knowledge which they bring to the study). However, the philosophical position of qualitativeBerger & 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 constructedtheir own personal preconceptions, values and beliefs and from human perspectives, shared (social) and individualthen hold them in abeyance. These authors add that if interactions and meanings of given situations andthese processes are not carried out, the scienti®c enter- phenomena. To strive to attain more credibility accordingprise collapses and the researcher will perceive a mirror to an alternative philosophical standpoint appears to be atimage 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¯exivity and the researchers creativity within this That is not to say that the grounded theorist has licensere¯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 researchersimmediately to the creative core of the research process, and creativity as an integral part of the grounded theoryfacilitates the direct application of both the intellect and the inductive process; liberating the restrictions on theimagination to the demanding process of interpreting research researchers 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 upon¼ it is the creativity in the act that brings the real truth of a social a sensitivity to these often tacit processes of perceiving andsituation into being, and following grounded theory techniques is understanding, and upon a willingness and an ability to bringone 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 similarmore 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 investigatorsinvolve transition from a position where concerns for ability to apprehend and adjust to phenomenon in context, it alsoholding prior knowledge and beliefs in abeyance predom- enables the emergence of theory that could not otherwise haveinate, to an alternative position more concerned with been articulated.creativity. Perhaps consideration of why some researchersadvocate the need to acknowledge and discount any prior Hence there is a need for the grounded theory researcherknowledge 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 discussresearch 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 researchers know-relation of quantitative methods. Consequently, some ledge, values and beliefs and the data to occur; to allowqualitative researchers have been anxious to be seen as the researchers creativity to explore and articulatecredible 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 toand explain early qualitative methods (Morse 1994). It can follow and which not to follow are guided, to someÓ 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484 1479
  5. 5. J.R. Cutcliffeextent, by the subconscious perceptual and intellectual enon, and therefore have already decided that a groundedprocesses of the researchers mind (Turner 1981). Conse- theory method would be suitable. Consequently Lincolnquently, to deny a researcher who is using grounded & Gubas (1985) and Sterns (1994) arguments appear totheory 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 necessarilyunnecessary, rigid structures. As a consequence, the contradictory of one another.researcher would be left questioning themselves each Many proposed research questions require conceptualtime they draw upon their tacit knowledge, or when they clarity. For example, within the authors doctoral study,experience a moment of insight into the world they are having identi®ed that there is an absence of literature thatinvestigating. The researcher would be left asking them- explains if or how hope is inspired in bereavementselves: counselling and thus a grounded theory method would be indicated, it may still be appropriate and indeedDoes that thought originate from my knowledge, experience or prudent, to review the available literature that focuses onbeliefs 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 ofauthenticity 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 naturewhereby such trustworthiness is achieved by exploring of hope and the nature and practice of bereavementthe possible or emerging concepts/categories in further counselling and this examination of the relevant literatureinterviews. If the hunch belongs solely to the researcher, would help the researcher to differentiate hope fromand 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 todiscarded 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 theLiterature 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 detailedtheory method the researcher should avoid conducting a and comprehensive literature review is not the ®rst stageliterature review prior to commencing data collection and in grounded theory. However, they go on to point out thatanalysis (Stern 1980, Stern et al. 1982, Stern & Allen 1984, some reading may occur prior to data collection. TheyLincoln & 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 feelbeginning of the study it is more likely that the emergent for the issues at work in the subject area, and identify any gaps totheory 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 datacollection and analysis in grounded theory. In that, it is Their justi®cation for this technique is that thethe review of the literature that can identify the current researcher then approaches the subject area with somegaps in knowledge, or help provide a rationale for the background knowledge. It is the opinion of the author ofproposed research. Perhaps the apparent disagreement the current paper that such statements may confusebetween these two positions can be explained if one potential researchers who are contemplating usingconsiders the longitudinal nature of the generation of grounded theory. Just how much reading is `extensiveknowledge, and the different positions that these argu- and similarly `too extensive? To advocate that thements appear to occupy on this longitudinal continuum. researcher approaches the ®eld of study with this back- Hutchinsons (1993) arguments can be located in a ground knowledge may produce the situation where theposition that has a starting point: `What do we know about researcher has already begun to form tentative conceptualthis 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, adepth of knowledge available regarding the phenomenon, person with no history or background. Further, as it iswhereas, Lincoln & Gubas (1985) and Sterns (1994) common for many researchers to pursue a particularargument can be located in a position that has the starting theme throughout their research activity, they may alreadypoint, `We already recognize that there is a distinct dearth possess some background knowledge of the substantiveor even absence of knowledge concerning the phenom- area they intend to study. Indeed, the researcher and all1480 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
  6. 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 Glasers 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. 7. J.R. Cutcliffethe chosen methodology was appropriate to the nature of most demand upon the grounded theorists 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 linkscomfortable 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 substantivegiven 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 thegies. Therefore the dif®culty does not lie with blending researcher to inducing factor isolating theory, in as muchone qualitative methodology with another, indeed the as substantive coding facilitates the researcher in askingresulting methodology may produce a more thorough, the questions, `What is this?, `What are the components ofmultidimensional understanding of the phenomenon. In this social process?. Introducing theoretical codingsupport 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 theand grounded theory. For example, these methods could questions, `What is happening here?, `How do thebe 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 methodologyinspiration 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 termexplain 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 methodologyenology 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 wasbereavement counselling setting?, `What meanings do both discovered by Glaser & Strauss (1967), both of whom hadthe 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 themethodologies, is that there is still precision. The method- methodology since then has taken a different path for eachologies 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 theoccur by accident. Similarly, the researcher does not call theory to emerge, whereas Strauss, whose sociology wasthe product of this mixing grounded theory or phenome- ®rmly rooted in the Chicago school (i.e. a school ofnology, 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) alsotheory is that of substantive coding and theoretical coding. suggest that Glaserian grounded theory would be expectedStrauss & Corbin (1994 p. 277) were adamant that some to be immediately applicable to individuals and groupsresearchers who: who shared the problem under study and would be expected to be testable. However, theory produced using¼ think they are doing grounded theory studies often seem to Strauss version of grounded theory has its applicabilityconcentrate on substantive coding as the methodologys 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 keyral part of data analysis within grounded theory, but if the difference is the questions each author asks of the data. Asintellectual 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 datamethodology. 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 relaterelate to each other as hypotheses, which enables the to the data, whether it appears in the data or not. Glaser focusessubstantive 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 richunderstanding of the social processes and human interac- Glaser (1978) went as far as to claim that Strausstions which are being studied. The author of this current evolution is a departure from the original methodologypaper suggests that theoretical coding perhaps places the and represents an erosion of grounded theory (Melia1482 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(6), 1476±1484
  8. 8. Methodological issues in nursing research Methodological issues in grounded theory1996). Indeed he asserts that the two methodologies sion. The author concludes by making the followingshould 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 ofwhat happens if the researcher asks both questions? theory is likely to be induced and then decide when theyFurther, 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 ofFor example Turner (1981 p. 232) asked: data collection, some purposeful sampling appears to occur. They may wish to free themselves from the restraints¼ what categories, concepts or labels do we need in order to that limit their use of creativity and tacit knowledge. Thedescribe or account for the phenomena discussed in this para- researchers might be served by attention to issues ofgraph? precision, including avoiding method slurring, ensuring Stern (1980 p. 281) proposed that the researcher exam- theoretical coding occurs, and predominantly using oneines 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 methodologicalsubstance of the data, and often use the very words used by the rigour is likely to increase the overall quality of theactors themselves. inquiry and enhance the credibility of the ®ndings. If the nature of the grounded theory is determined inpart by the questions asked of the data, then does the Referencesresearcher have to predetermine the questions she/he willask 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 ofthis might be somewhat restrictive and disabling. If the Qualitative Research (Denzin N. & Lincoln Y.S. eds), Sageresearcher has to pause and ask himself, `What questions London, pp. 485±499. Baker C., Wuest J. & Stern P.N. (1992) Method slurring: theam I asking of the data and consequently does this differ grounded theory/phenomenology example. Journal offrom 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 groundedquestions 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. Anchorcould be impeded. Books, New York. Perhaps a combination of questions of the data, a Coyne I.T. (1997) Sampling in qualitative research: purposefulcombination 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 forcomplete understanding. Providing the researcher makes quality. British Journal of Nursing 6, 969. Cutcliffe J.R. & McKenna H.P. 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