Turning a Curve: How People Use Everyday Resources to Negotiate Recovery From Cancer Treatment With Curative Intent.

Many more cancers are treated with intent to cure now than in previous decades, but for most, this involves significant effects from which people need to recover psychologically and socially, as well as physically. This longitudinal photo-elicitation interview study uses grounded theory to explain how people discharged from specialist care made use of everyday social and material resources to manage this process at home. Recovery is presented as a curve in life's pathway requiring gradual reorientation, drawing on social worlds and domestic resources to calibrate this process. Findings are described in three stages: (1) responding to diagnosis and treatment, (2) using social resources for meaning-making, and (3) developing assets for recovery. During treatment, participants drew on past identities to reinforce their sense of self, and personalized health care communication supported this process. In the weeks after treatment, new frameworks of understanding were constructed from perspectives on cancer encountered in the family, workplace, and outpatient clinics. Recovery processes included the negotiation of personal change, the renegotiation of close relationships, and the use of everyday resources to regain three sensations: control, comfort, and continuity. Supportive care would benefit from an individualized exploration of the assets that can help people to negotiate this challenging phase as treatment comes to a close. Possibilities for self-care (the maintenance of health and well-being in the context of everyday life) can be explored and assessed through personalized discussion around the identities, social worlds, and everyday resources available to each individual.

Development, evaluation and adaptation of a critical realism informed theory of procedural pain management in preterm infants: The PAIN-Neo theory.

AIM: To present the development, evaluation and adaptation of the PAIN-Neo theory. DESIGN: Theory development. DATA SOURCES: A review of literature was conduct from 1980 to 2021. RESULTS: Using a critical realism paradigm, this paper presents the PAIN-Neo theory, which was developed from an analysis of existing theoretical perspectives on paediatric procedural pain, empirical studies conducted with preterm infants, and the research team's pain management expertise. The theory was then empirically tested and fine-tuned. IMPLICATIONS FOR NURSING: The PAIN-Neo theory highlights that the neonatal nurse is part of a larger picture as she is influenced by factors related to her unit, hospital and country of practice. This theory emphasizes the importance of parental involvement in pain management, which is consistent with family-centred nursing practices. CONCLUSION: The PAIN-Neo theory reflects the complexity of pain management nursing. This theory is innovative and specific enough to guide practice, structure research projects and contribute to the body of knowledge in the discipline of nursing.

Protecting Personhood: A Classic Grounded Theory.

The importance of perceiving and considering patients as healthcare partners has been increasingly promoted. Healthcare systems around the world are now highly interested in patient engagement, participation, collaboration, and partnership. Healthcare professionals are advised that patients, as autonomous beings, should be active in and responsible for a portion of their own care. The study presented here focused on patients' perceptions of interprofessional collaboration. It was conducted using the classic grounded theory methodology. The theory of protecting personhood emerged as the core concept of hospitalized patients, cared for by interprofessional healthcare teams. This theory encapsulates the process hospitalized patients go through to find balance in their sense of self, oscillating between personhood and patienthood in the unfamiliar hospital environment. The process consists of four stages: the stage of introspection, during which hospitalized patients become aware of their self as a person and as a patient; the stage of preservation, when patients find a balance between the sense of personhood and patienthood; the stage of rupture, wherein patients experience an imbalance between their sense of personhood and patienthood; and the stage of reconciliation, in which personhood is restored. The theory of protecting personhood offers insights into a better understanding of hospitalized patients' experiences and strategies, revealing the importance of relationships, and the driving force of empowerment. This study is about patients' perspectives of interprofessional healthcare teams. A grounded theory process allowed the emergence of patients' concerns and expectations, leading to a substantive theory grounded in the patients' data.

Being fast or cautious? Sociocultural conditions influencing the sexual pathways of Black females in the United States.

BACKGROUND: Black females in the United States face unique sociocultural conditions that impact their sexual development and increase their risk for sexually transmitted infections (STI), including but not limited to chlamydia, gonorrhea, and HIV. Research has not adequately explained how sociocultural conditions contribute to this increased risk. The purpose of our investigation was to explore the sociocultural conditions that influence Black cisgender females risk for STI. METHODS: This grounded theory study involved in-depth audio-recorded interviews with 20, primarily heterosexual, Black females ages 19-62. RESULTS: Findings informed a conceptual model that builds on previous theory about the sexual development of Black females and explains how sociocultural conditions impact two, participant identified, sexual pathways: Fast and Cautious. Movement on these sexual pathways was not always a linear trajectory; some participants shifted between pathways as their sociocultural contexts changed (i.e., sexual assault, STI, and level of protection). The Fast sexual pathway often led to greater STI risk. CONCLUSIONS: This model may inform future research designed to prevent STI/HIV and promote the sexual health of Black females across the life course.

Toward a moral commitment: Exposing the covert mechanisms of racism in the nursing discipline.

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

The Hierarchy-of-Hypotheses Approach: A Synthesis Method for Enhancing Theory Development in Ecology and Evolution.

In the current era of Big Data, existing synthesis tools such as formal meta-analyses are critical means to handle the deluge of information. However, there is a need for complementary tools that help to (a) organize evidence, (b) organize theory, and (c) closely connect evidence to theory. We present the hierarchy-of-hypotheses (HoH) approach to address these issues. In an HoH, hypotheses are conceptually and visually structured in a hierarchically nested way where the lower branches can be directly connected to empirical results. Used for organizing evidence, this tool allows researchers to conceptually connect empirical results derived through diverse approaches and to reveal under which circumstances hypotheses are applicable. Used for organizing theory, it allows researchers to uncover mechanistic components of hypotheses and previously neglected conceptual connections. In the present article, we offer guidance on how to build an HoH, provide examples from population and evolutionary biology and propose terminological clarifications.

Toward Convergence Disaster Research: Building Integrative Theories Using Simulation.

Scholars across disciplines use simulation methods as tools to build theories; however, the full potential of simulation methods has not been fully used for building theories in convergence disaster research. Simulation methods could provide four unique opportunities for building theories for convergence disaster research. First, simulation methods could help researchers model the underlying mechanisms of disaster phenomena by enabling integration of qualitative and quantitative data. Second, they could help researchers specify and characterize the mechanisms affecting specific disaster phenomena by facilitating integration of empirical information with existing theoretical elements from different disciplines. Third, simulation methods could enable multilevel understanding of relationships between factors influencing disaster phenomena and emergent behaviors across different levels of analysis (e.g., individual, household, neighborhood, and community levels). Fourth, simulation methods could help researchers integrate theoretical elements on disasters across different disciplines (e.g., engineering, social science, sociology, and epidemiology) for a more convergent understanding of complex relationships affecting resilience at different levels.

Measuring nurses' health policy participation: WSPPIR instrument development and psychometric evaluation.

AIM: To measure nurses' health policy participation by developing and psychometrically testing the Waddell Spectrum for Policy Participation Influence and Research (WSPPIR) Instrument. DESIGN: Instrument development; based on a nursing conceptual framework. METHODS: This four-phase study was conducted in 2018 to estimate content validity, construct validity, and internal consistency reliability of the WSPPIR instrument. Phase 1- item generation for the multi-dimensional concept of health policy participation as described in WSPPIR theory. Phase 2- a content validity index was calculated based on ratings by seven experts. Phase 3- cognitive interviews of five nurses. Phase 4- 306 Registered Nurses completed the WSPPIR instrument. Exploratory factor analysis was used to identify and to estimate construct validity, Cronbach's alpha was calculated to estimate internal consistency reliability. RESULTS: The 38-item WSPPIR Instrument consists of five subscales (Professional Nursing Organizations; Health Care Delivery Systems: Organizations that Deliver Health Care Services; Governance Levels: City/Town, State, National, Global; Valuing Health and Policy; Influence Skills) and exhibits adequate estimates of reliability and content and construct validity, as a measure nurses' health policy participation. CONCLUSION: As efforts to enhance nurses' health policy participation continue globally, the WSPPIR instrument should be useful in measuring individual nurses' health policy participation and benchmarking health policy participation for the nursing profession at large. IMPACT: The WSPPIR instrument will be useful to individual nurses, educators, and the profession as we work to systematically and strategically increase nurses' participation in and influence on health policy.

Conceptualizing Qualitative Data.

Qualitative research is practiced across diverse disciplines and contexts, and this produces a wide range of perspectives on the role of conceptualization and theory development. It also results in a hugely varied mix of submissions to qualitative research journals in terms of their level of conceptual elevation. This editorial explores why we conceptualize qualitative data, and some common challenges evident in current qualitative practice.

Multidimensional Property Supplementation: A Method for Discovering and Describing Emergent Qualities of Concepts in Grounded Theory Research.

Multidimensional property supplementation is a grounded theory method for analysis that conceives of concepts as multidimensional spaces of possibilities. It is applied in an iterative process comprising four steps: expansion, whereby vague codes are split and contraries postulated; abstraction of practically significant differences in terms of properties and dimensions; geometrization of properties to create conceptual subspaces that supplant subcategories and have additional, emergent qualities; and unification of the concept by validating it against data and relieving it of properties that do not tie in sufficiently with other concepts. Multidimensional conceptual models encourage the researcher to elaborate properties that explain, predict, or guide action. Fully developed, they can be easily connected to others in a process and function, by virtue of their emergent qualities, as falsifiable hypotheses in their own right. For these reasons, multidimensional property supplementation is open to epistemological justification without presuming acceptance of techniques specific to grounded theory.

The core of Katie Eriksson's caritative caring theory - a qualitative study from a postdoctoral perspective.

BACKGROUND: For about 40 years, Katie Eriksson developed the caritative caring theory at Åbo Akademi University in Finland. However, a description regarding the most substantial concepts and the relationships between these is lacking and thus needs to be explored. AIMS: The aim of the study was twofold: to explore and describe central concepts in the development of caritative caring theory from a postdoctoral perspective and to uncover and explore the relationships between the concepts. METHODOLOGY: The design of the study was qualitative with a mixed method approach. The material was collected from a postdoctoral group (n = 38) mainly through electronic questionnaires. The texts were interpreted through manifest and latent content analysis. FINDINGS: The analyses generated five main categories including subcategories. The main categories were 'Caring' 'Ethos', 'Suffering' 'Health' and 'The human being'. The relation between the main concepts compiled as 'A tentative synthesis of the main concepts and the relationships between them'. CONCLUSION: This study contributes to an understanding of the most fundamental and valuable concepts in the development of caritative theory during its first 40 years according to postdoctoral researchers' perspectives. This study also displays that the concepts ethos and caring have the strongest relationship followed by that between caring and health, indicating the inner core of ethos and love within caring which bears the potential of enhancing the patient's well-being and health.

No-go theorems: What are they good for?

No-go theorems have played an important role in the development and assessment of scientific theories. They have stopped whole research programmes and have given rise to strong ontological commitments. Given the importance they obviously have had in physics and philosophy of physics and the huge amount of literature on the consequences of specific no-go theorems, there has been relatively little attention to the more abstract assessment of no-go theorems as a tool in theory development. We will here provide this abstract assessment of no-go theorems and conclude that the methodological implications one may draw from no-go theorems are in disagreement with the implications that have often been drawn from them in the history of science.

Trans-Planckian philosophy of cosmology.

I provide some philosophical groundwork for the recently proposed 'trans-Planckian censorship' conjecture in theoretical physics. In particular, I argue that structure formation in early universe cosmology is, at least as we typically understand it, autonomous with regards to quantum gravity, the high energy physics that governs the Planck regime in our universe. Trans-Planckian censorship is then seen as a means of rendering this autonomy an empirical constraint within ongoing quantum gravity research.

Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis.

BACKGROUND: The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. METHODS: We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. RESULTS: The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system. CONCLUSIONS: Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks.

Theoretical Perspectives of the Baltimore Ecosystem Study: Conceptual Evolution in a Social-Ecological Research Project.

The Earth's population will become more than 80% urban during this century. This threshold is often regarded as sufficient justification for pursuing urban ecology. However, pursuit has primarily focused on building empirical richness, and urban ecology theory is rarely discussed. The Baltimore Ecosystem Study (BES) has been grounded in theory since its inception and its two decades of data collection have stimulated progress toward comprehensive urban theory. Emerging urban ecology theory integrates biology, physical sciences, social sciences, and urban design, probes interdisciplinary frontiers while being founded on textbook disciplinary theories, and accommodates surprising empirical results. Theoretical growth in urban ecology has relied on refined frameworks, increased disciplinary scope, and longevity of interdisciplinary interactions. We describe the theories used by BES initially, and trace ongoing theoretical development that increasingly reflects the hybrid biological-physical-social nature of the Baltimore ecosystem. The specific mix of theories used in Baltimore likely will require modification when applied to other urban areas, but the developmental process, and the key results, will continue to benefit other urban social-ecological research projects.

Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development.

BACKGROUND: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD: The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges. RESULTS: Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION: Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.

Parent's perspectives of the pathway to diagnosis of childhood cancer: a matter of diagnostic triage.

BACKGROUND: Early diagnosis is crucial for the treatment of childhood cancer as it in some cases can prevent progression of disease and improve prognoses. However, childhood cancer can be difficult to diagnose and barriers to early diagnosis are multifactorial. New knowledge about factors influencing the pathway to diagnosis contribute to a deeper understanding of the mechanisms that influence this time span. Qualitative research in the field is sparse but can be expected to lead to additional useful insights that could contribute to efforts shorten time to diagnosis. The purpose of this study was to explore parents' experiences of the pathway to diagnosis in the time between their noticing bodily or behavioural changes and their child's diagnosis. METHODS: The study is a qualitative interview study carried out in large Danish hospital. Thirty-two interviews with a total of 46 parents of children with cancer were included for analysis. The children were diagnosed with haematological cancers (n = 17), solid tumours (n = 9) or brain tumours (n = 6). Data were analysed applying the theoretical model of pathways to treatment and an inductive-deductive approach. A revised 'diagnostic triage' model was developed and validated by member checking. RESULTS: The pathway to diagnosis was influenced by various factors which we present as consistent parts of a new diagnostic triage model. Each factor impacts the level of urgency assigned to bodily and behavioural changes by parents, general practitioners and specialists. The model of diagnostic triage was developed and validated to understand mechanisms influencing time from the point parents notice changes in their child to diagnosis. The model identifies dynamic movement between parental triage in everyday life and professional triage in a healthcare system, both affecting appraisal and case escalation according to: 1) the nature of bodily and behavioural changes, 2) parental intuition, 3) social relations, 4) professional-child-parent interaction, and 5) specialist-child-parent interaction. CONCLUSIONS: Diagnostic triage is a model which explains mechanisms that shape the pathway to diagnosis. It is a contribution aimed at supporting the clinical diagnostic process, that ultimately could ensure more timely testing, referral and diagnosis, and also a novel theoretical framework for future research on diagnostic pathways.

Rethinking emotion science: new theory section for Cognition & Emotion.

A cumulative emotion science requires sustained investments in theory development. To encourage such investments, a new section will be added to Cognition & Emotion that is specifically devoted to theory. In this Editorial, we first lay out the rationale for the new Theory section. Next, we consider the added value of theory for research on cognition and emotion. Building on these notions, we outline the kinds of articles that are to be published in the new Theory section, with Klaus Scherer being the inaugural Editor of the Theory section.

Health Care Professionals' Awareness of a Child's Impending Death.

Health care professionals' (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs' initial awareness of a child's impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a "delicate dance of figuring out" key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

Asian Immigrant Parents' Role Enactment While Accessing and Using Services for Their Child With Developmental Disabilities in the United States: A Meta-Synthesis Study.

We conducted a meta-synthesis to explore how Asian immigrant parents in the United States enact their perceived parental role while using health and educational services for their child with developmental disabilities. We identified 11 qualitative studies for analysis, and examined these studies using a constant comparative approach and thematic analysis informed by role theory and acculturation theory. Based on our analysis, five themes related to parents' role enactment emerged: (a) parents perceive a multifaceted parental role; (b) parents' individual factors influence their role enactment; (c) system factors influence parents' role enactment; (d) parents use coping strategies to address role dissatisfaction; and (e) parental role enactment is a continuously evolving process influenced by acculturation, which spirals them toward their ultimate goal of helping their child thrive. Findings can inform practitioners' and researchers' understanding of how to create a culturally safe environment to support Asian immigrant parents in realizing their parental role.