Understanding, choosing and applying grounded theory: part 2

Using a mixed methods grounded theory methodology to explain neonatal nurses' professional quality of life

BACKGROUND

Nurse researchers are constantly seeking novel methods of maintaining philosophical congruence while advancing their knowledge of the human condition using paradigmatically diverse means.

AIM

To provide an overview of the research philosophies underpinning the mixed methods grounded theory (MM-GT) methodology, illustrate its optimal use and introduce a quality-appraisal tool being developed with reference to extant literature.

DISCUSSION

The utility of MM-GT has been effectively demonstrated in the nursing and health literature. Yet, there are examples of how it has been under-used and sub-optimally applied. This article includes a two-phase MM-GT study protocol guided by a pragmatic research philosophy and best practice recommendations that aims to explain neonatal nurses' professional quality of life.

CONCLUSION

Optimal use of MM-GT's five essential components - purposive sampling, constant comparative methods with iterative coding and analysis, theoretical saturation, memoing and theory development - combine to produce high-quality, defensible research outputs and new nursing theory.

IMPLICATIONS FOR PRACTICE

Research outputs, such as publication and presentation, expounding the multifactorial influences affecting neonatal nurses' professional quality of life will not only benefit the neonatal nursing community but also contribute to the corpus of nursing and midwifery research and enhance the health, well-being and retention of nurses and midwives more broadly.

Fostering Hope: Comprehensive Accessible Mother-Infant Dyad Care for Neonatal Abstinence (CAIN)

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Seeking Choice to Fulfill Health Literacy Needs: Health Literacy Opportunities for Consumers in Hospital Waiting Areas

In this research, we explore and theorize on the potential of hospital outpatient rehabilitation waiting areas to respond and contribute to the health literacy needs of consumers. Constructivist grounded theory informed the sampling and analytical procedures. Thirty-three consumers attending outpatient rehabilitation for a range of health conditions were recruited to this multi-site study. Semi-structured interview and participant observation data were collected and analyzed concurrently using the constant comparison method. The substantive theory of "seeking choice to fulfill health literacy needs" and five interdependent categories were developed. Results indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice. Results provide insight into the health literacy needs of consumers in hospital outpatient waiting areas and how health services can appropriately respond to these needs. Future research should investigate the effect of health service environments on health outcomes.

Free Time For Wellness: a co-designed intervention utilizing social networks to encourage physical activity for cancer prevention among low resourced mothers

BACKGROUND

Physical activity is central to chronic disease prevention. Low resource mothers face structural barriers preventing them from increasing their physical activity to reduce their chronic disease risk. We co-designed an intervention, with the ultimate goal of building social cohesion through social media to increase physical activity for low resourced mothers in urban settings.

METHODS

In 2019, we interviewed 10 mothers of children (< 12 years) living in Washington Heights, Manhattan. The interviews were transcribed and coded for themes that guided the creation of a co-design workshop. Washington Heights-based mothers (n = 16) attended a co-design workshop to generate the blueprint for the Free Time for Wellness intervention.

RESULTS

Mothers in our sample had limited time, external support and resources, which hindered them from increasing their physical activity; we learned that in addition to physical health, mental health was a concern for participants. Participants had varying degrees of self-efficacy and trust in social media. Bringing mothers and researchers together in a co-design workshop, we identified types of physical activities they would enjoy participating in, the ideal time to do so, the kind of childcare they needed, and their preferences for communication with the community champion. The interviews and workshop highlighted the need for a community space that mothers and children could co-occupy. The intervention was designed to be 3 months' worth of sample programming with one activity per week, rotating between dance, yoga, food pantry visits and group playdates. Participants were invited to bring their children to a space with one room for the 'participants only' activity and a second room in which professional childcare providers supervised the children.

CONCLUSIONS

Through this two-phased co-design process, we created an intervention with mothers in an urban community with the goal of using social media to bring them together for wellness, primarily through increased physical activity. Despite the co-design of this intervention with a specific community, there are some universal applications of our findings, and of the use of co-design workshops, to other settings.

The experience of becoming a mother following successful in vitro fertilization: A grounded theory

AIM

To develop a theory to explain women's experiences about becoming a mother following successful in vitro fertilization treatment.

DESIGN

This study is a qualitative study based on a constructivist grounded theory approach.

METHODS

Data were collected using a semi-structured interview guide initially that was later to be changed to a flexible interview guide between June 2018 and 2019. Interviews were conducted with 18 women, who became pregnant and mothers following successful in vitro fertilization treatment. Data collection and analysis were performed in a cyclic manner using open, axial and selective coding. This study was reported based on consolidated criteria and was used to report qualitative research data.

FINDINGS

The core category, 'non-spontaneous path to motherhood', involved the following four categories: 'the treatment process is exhausting', 'leaving the infertility world', 'pregnancy under the shadow of fear' and 'getting stuck between fertile and infertile worlds' with 10 sub-categories.

CONCLUSION

This study provides valuable insight into experiences of these women about becoming a mother. Unlike the Becoming a Mother Theory, it can be said that the anticipation stage, the first stage in the Becoming a Mother Theory, begins at the moment of embryo transfer in these women. Furthermore, the personal stage, the final stage in the Becoming a Mother Theory, is not completed within the first year after birth, even women were found to conceal experiences of in vitro fertilization treatment from the social environment even after birth.

IMPACT

This study will provide potential support for obstetric healthcare professionals in better understanding women's experiences about becoming a mother following successful in vitro fertilization treatment.

Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study

BACKGROUND

Wireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have.

AIM

To gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction.

METHODS

A convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding.

FINDINGS

Women using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of 'Being Free, Being in Control', 'Enabling and Facilitating' and 'Maternity Unit Culture'. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups.

CONCLUSIONS

When CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience.

The Perspectives of Australian Naturopaths about Providing Health Services for People with Sleep Disorders

Objective: The purpose of the study was to determine and describe the clinical approach Australian naturopaths take in providing care for people with sleep disorders, as it well known that Australians commonly seek care from naturopathic practitioners and no data on naturopathic practices for people with sleep disorders is currently documented.Participants: Naturopaths registered with the Australian PRACI (Practitioner Research and Collaboration Initiative) involved in the clinical management of people with sleep disorders.Methods: Consenting participants were invited to participate in semi-structured phone interviews conducted with the aid of a project-specific interview guide until data saturation was evident. Interview recordings were transcribed verbatim and analyzed thematically.Results: A total of 20 naturopaths across 5 different Australian states were interviewed, 4 themes were identifiable. Thematic interpretation suggests that (1) sleep health consults were common and involved detailed history taking by providers, (2) herbal remedies supported by lifestyle and sleep hygiene behaviors were the most common treatments recommended, and (3) interprofessional communication to medical doctors was seldom reciprocated. Government-funded research and establishing statutory registration of naturopaths were identified as key steps in profiling the professions role and to develop/evaluate integrated patient-centered sleep health care models.Conclusion: Naturopaths engage in the treatment of sleep disorders yet face barriers in executing an integration of such approaches within the current health care system. Research is required to explore how to overcome these barriers and develop integrated patient-centered models of care within tertiary sleep clinics and/or primary care physicians.