Using Grounded Theory to Develop a Substantive Theory for Grandparent-Caregiving in Uganda: The GRACE Model.

INTRODUCTION: Few studies have focused on developing theories to explain caregiving as performed by grandparents who provide care for their grandchildren in any setting. Theory development that is grounded in the experiences and cultural context of those being studied is needed to inform research, subsequent care, and overall well-being, especially of populations that are understudied. METHODS: This manuscript was informed by Constructivist Grounded Theory, semi-structured in-depth and individual interviews. Also, three methodological phases were followed: (a) concurrent data collection and analysis procedures, (b) developing categories and relationships among them, and (c) defining the core category and building the substantive theory. RESULTS: The methodological steps involved in generating a substantive theory, the GRAndparent-CarEgiving (GRACE) model, are reported. DISCUSSION: Research, and subsequently the well-being and health care of grandparent-caregivers, needs to be informed by culturally congruent theories that are founded in the experiences and cultural context of the individuals being investigated.

Advancing Nursing Science: Deriving a Middle-Range Theory for System-Level Communication Research in Complex Hospital Environments.

Background: Millions of injuries and deaths occur yearly from preventable errors, despite interventions applied at the point of care. Although evidence suggests that system-level factors are responsible for hospital system health and patient safety, research has largely not accounted for hospital complexity. Prior to the authors' research regarding the communication of system-level events that influence hospital system health and patient safety, no nursing-specific communication theories that accounted for hospital complexity were identified. However, theory-guided research holds the potential to boost scientific knowledge through the provision of a robust foundational understanding of phenomena. Purpose: The purpose of this article is to discuss the concept derivation used to create a middle-range theory for the guidance of research involving system-level communication in complex healthcare environments as it relates to hospital system health and patient safety. Methods: Concept derivation as described by Walker and Avant (2018) was conducted using parent concepts from the Effective Nurse-to-Nurse Communication Framework, Symbolic Interactionism, Information Theory, Gerbner's Communication Model, and Complexity Theory. Results: Authentication of the derived Effective System-to-System Communication Theory (ESSCT) was confirmed through identification of coherent relationships between the concepts and conceptual statements, alignment with the nursing metaparadigm, and peer review by a subject matter expert from the nursing discipline. Additionally, research revealed an overall congruency between the research findings and the ESSCT's theoretical statements. Implications: The current healthcare climate necessitates that research involving communication be optimized by a germane theoretical underpinning that accounts for hospital complexity. The authors contend that the use of the derived theory may assist such endeavors.

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.

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.

Mapping visual working memory models to a theoretical framework.

The body of research on visual working memory (VWM)-the system often described as a limited memory store of visual information in service of ongoing tasks-is growing rapidly. The discovery of numerous related phenomena, and the many subtly different definitions of working memory, signify a challenge to maintain a coherent theoretical framework to discuss concepts, compare models and design studies. A lack of robust theory development has been a noteworthy concern in the psychological sciences, thought to be a precursor to the reproducibility crisis (Oberauer & Lewandowsky, Psychonomic Bulletin & Review, 26, 1596-1618, 2019). I review the theoretical landscape of the VWM field by examining two prominent debates-whether VWM is object-based or feature-based, and whether discrete-slots or variable-precision best describe VWM limits. I share my concerns about the dualistic nature of these debates and the lack of clear model specification that prevents fully determined empirical tests. In hopes of promoting theory development, I provide a working theory map by using the broadly encompassing memory for latent representations model (Hedayati et al., Nature Human Behaviour, 6, 5, 2022) as a scaffold for relevant phenomena and current theories. I illustrate how opposing viewpoints can be brought into accordance, situating leading models of VWM to better identify their differences and improve their comparison. The hope is that the theory map will help VWM researchers get on the same page-clarifying hidden intuitions and aligning varying definitions-and become a useful device for meaningful discussions, development of models, and definitive empirical tests of theories.

Middle-Range Theory of the Adapting Foster Family: Mathematical Modeling in Nursing Science.

Nursing science has the epistemic advantage of using nursing practice for developing middle-range theories to bridge abstract ideas with clinical research. The theory of the adapting foster family draws upon extant theories of both family systems theory and transition theory while integrating experiences from nursing practice. The new theory provides a framework for improving outcomes for children in foster care through greater placement stability. Theory development incorporated a literature review, concept exploration, statement synthesis, and mathematical theory modeling to elucidate the interaction between concepts and provide insight to the unique fostering experience.

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.

Toward an attentional turn in research on risky choice.

For a long time, the dominant approach to studying decision making under risk has been to use psychoeconomic functions to account for how behavior deviates from the normative prescriptions of expected value maximization. While this neo-Bernoullian tradition has advanced the field in various ways-such as identifying seminal phenomena of risky choice (e.g., Allais paradox, fourfold pattern)-it contains a major shortcoming: Psychoeconomic curves are mute with regard to the cognitive mechanisms underlying risky choice. This neglect of the mechanisms both limits the explanatory value of neo-Bernoullian models and fails to provide guidance for designing effective interventions to improve decision making. Here we showcase a recent "attentional turn" in research on risk choice that elaborates how deviations from normative prescriptions can result from imbalances in attention allocation (rather than distortions in the representation or processing of probability and outcome information) and that thus promises to overcome the challenges of the neo-Bernoullian tradition. We argue that a comprehensive understanding of preference formation in risky choice must provide an account on a mechanistic level, and we delineate directions in which existing theories that rely on attentional processes may be extended to achieve this objective.

The Post-Traumatic Growth Journey of Women Who Have Survived Intimate Partner Violence: A Synthesized Theory Emphasizing Obstacles and Facilitating Factors.

Suffering intimate partner violence (IPV) is a devastating personal experience and post-traumatic growth (PTG) is a positive, psychological change in a person, following trauma such as IPV. There is a gap in the literature when it comes to theories on PTG after surviving IPV. The aim of this theory development was to synthesize an approach to understanding the PTG journey of female IPV survivors. According to our theory, their PTG journey includes eight main components: 1. The women's early experience of trauma, 2. The consequences of that trauma, 3. Their experiences of IPV, 4. The consequences of IPV, 5. The facilitating factors to PTG, 6. The hindering factors to PTG, 7. Their experience of PTG, and 8. The lingering effects of IPV. According to our findings, PTG is a real possibility for female IPV survivors, and it is likely to improve their mental health, well-being, and quality of life, as well as that of their children, loved ones, and communities, thereby decreasing the damaging effects of IPV. The theory can be useful for professionals when guiding female survivors of IPV to promote their recovery and healing. Due to the lack of research in this field, additional research is needed to further develop this theory.

Socialism Order of Worth and Analytical Adequacy Axiom.

Boltanski and Thévenot (On justification. Economies of worth, Princeton University Press, Princeton, 2006) constructed in their seminal work On Justification the Orders of Worth (OW) framework as a research program for further empirical and theoretical development. This article suggests two methodological additions to extend the analytical capacities of the OW framework: The Socialism OW and the analytical adequacy axiom. The polito-philosophical Socialism OW, which acknowledges '(collective) welfare' as its mode of evaluation (worth) and the higher principle of 'solidarity' as its test, is rooted in the political philosophy of Rosanvallon (The society of equals, Harvard University Press, Cambridge, 2013). In addition to the systematic justification of the canonical text, this article also offers a tabular presentation for the construction of a new OW in relation to the axioms. In the article, first, the existing OW are put under scrutiny discussing the test category of solidarity, which was added and creates an analytic overload for the Civic OW. Second, analyzing the case of the German binary statutory health system, comprising of a private (first-class) and a public (second-class) healthcare, the capacities of the existing OW are discussed to identify a blank spot in the OW framework for empirical analysis. Accordingly, the descriptive analysis of the German binary health system is less about how the system is justified, and much more about understanding how given OW operate within it as coordinative devices. This systematic analysis of a situation of (temporary) agreements, especially of investments in forms, amends the OW use for empirical analysis of critique and justification in a situation.

Body image in women diagnosed with breast cancer: A grounded theory study.

Using a Straussian grounded theory methodology, we explored the meaning women attribute to body image and how they understand their breast cancer experience as influencing their body image to develop a grounded theory of body image for women diagnosed with breast cancer. Interviews were conducted with 27 women who had completed treatment for breast cancer in Canada. Data were analyzed through a process of open, axial, and selective coding using constant comparison techniques and memo-writing. A grounded theory of body image for women diagnosed with breast cancer was developed around the core category of body image: what it means to women, which was underpinned by six themes and 17 subthemes. This theory explains how women diagnosed with breast cancer define body image and illustrates intrapersonal and interpersonal factors that can undermine or support their body image, along with strategies they used to manage their body image. This theory can guide research and practice aimed at enhancing body image and minimizing its consequences for women diagnosed with breast cancer.

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.

Bridging gaps by including culture: Development and empirical test of the culturally informed theory for disordered eating among Black women.

BACKGROUND: Leading eating disorder (ED) theories were informed primarily by samples of White females. Therefore, ED theories lack consideration of sociocultural factors that may impact ED symptom development among Black women. The current study proposed the first culturally informed theory for disordered eating among Black women, positing that ethnic discrimination, strong black woman (SBW) ideology (cultural and societal expectations of strength), and culturally informed appearance satisfaction may significantly impact stress. Stress may be associated with coping-motivated eating behaviors, which may lead to maladaptive weight control behaviors. METHODS: Black women (N = 208) completed surveys assessing socio-cultural factors, stress, commensal and binge eating, and maladaptive weight control behaviors. Path analysis was used to test the proposed theory. RESULTS: The final model had a good fit for the data. Findings overall supported the hypothesized model. Specifically, higher ethnic discrimination (ß = 0.044, p = .003), greater endorsement of SBW ideology (ß = 0.074, p =< .001), and lower culturally informed appearance satisfaction (ß = -0.032, p = .025) were associated with greater stress. Stress was positively associated with binge eating (ß = 0.457, p = .046), and binge eating was significantly associated with excessive exercise (=0.152, p = .008) and purging (ß = 0.273, p = <.001). In contrast, commensal eating was not associated with stress or weight control behaviors (p values = .697 to .749). CONCLUSIONS: The current study found that stress, as influenced by sociocultural factors, may play a role in binge eating, and subsequently, weight control behaviors among Black women. This theory is a starting point for future research on the specialized conceptualization of eating and maladaptive weight control behaviors among Black women.

Triangulation approach to developing, evaluating, and applying the evolving theory of adolescent acceptance of asthma.

Acceptance is a term used by healthcare professionals regarding patients' psychosocial adjustment to chronic conditions. This paper describes a triangulation approach, applied over 25 years, to develop and evaluate a theory of adolescent acceptance of asthma. The theory was used to guide the development and evaluation of an education and counseling program focused on fostering acceptance. The approach was effective in (a) defining acceptance and isolating its attributes; (b) identifying its antecedents and consequences, and specifying relationships among them; (c) revealing overlooked variables and augmenting theory; and (d) using theory to guide development and evaluation of the self-management program.

Supporting care home residents in the last year of life through 'Needs Rounds': Development of a pre-implementation programme theory through a rapid collaborative online approach.

Background: Realist evaluation aims to address the knowledge to practice gap by explaining how an intervention is expected to work, as well as what is likely to impact upon the success of its implementation, by developing programme theories that link contexts, mechanisms and outcomes. Co-production approaches to the development of programme theories offer substantial benefits in addressing power relations, including and valuing different types of knowledge, and promoting buy-in from stakeholders while navigating the complex social systems in which innovations are embedded. This paper describes the co-production of an initial programme theory of how an evidence based intervention developed in Australia - called 'Palliative Care Needs Rounds' - might work in England and Scotland to support care home residents approaching their end of life. Methods: Using realist evaluation and iPARIHS (integrated Promoting Action on Research Implementation in Health Services) we sought to determine how contexts and mechanisms of change might shape implementation outcomes. Pre-intervention online interviews (n = 28) were conducted (February-April 2021), followed by four co-design online workshops with 43 participants (April-June 2021). The online interviews and workshops included a range of stakeholders, including care home staff, specialist palliative care staff, paramedics, general practitioners, and relatives of people living in care homes. Results: This methodology paper reports developments in realist evaluation and co-production methodologies, and how they were used to develop context, mechanisms, outcomes (CMOs) configurations, and chains of inference. The initial (pre-intervention) programme theory is used to illustrate this process. Two developments to iPARIHS are described. First, involving stakeholders in the collaborative co-design workshops created opportunities to commence facilitation. Second, we describe developing iPARIHS' innovation component, to include novel stakeholder interpretations, perceptions and anticipated use of the intervention as they participated in workshop discussions. Conclusions: This rapid and robust co-production methodology draws on interactive collaborative research practices (interviews, workshop discussions of data, illustrative vignettes and visual methods). These innovative and engaging methods can be packaged for online processes to develop, describe and interrogate the CMOs in order to co-produce a programme theory. These approaches also commence facilitation and innovation, and can be adopted in other implementation science and realist studies.

Integrating Self-Management Education and Support in Routine Care of People With Type 2 Diabetes Mellitus: A Conceptional Model Based on Critical Interpretive Synthesis and A Consensus-Building Participatory Consultation.

The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management. Methods: Seven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop. Results: A conceptual framework is proposed in which integration is influenced by five interacting components: the programme ethos of the diabetes self-management education and support intervention (content and delivery), care system organisation (the framework in which such interventions are delivered), adapting to context (the aspects of the people receiving and delivering the interventions), interpersonal relationship (the interactions between the deliverer and receiver of the intervention), and shared learning (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support. Discussion: Integration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training. Conclusion: This synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.

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.

An evolutionary concept analysis of learner-centered teaching.

BACKGROUND: An increasing emphasis on a paradigm shift from the traditional teacher-centered approach has led to the adoption of learner-centered teaching in many nursing education programs. However, the lack of consensus regarding the meaning warranted an analysis of learner-centered teaching. OBJECTIVE: The objective of this analysis was to clarify the concept of learner-centered teaching for nursing education and research. DESIGN: An evolutionary framework was used to perform a comprehensive review of both theoretical and empirical literature relevant to learner-centered teaching. An evolutionary concept analysis is a method of inquiry used to analyze the literature, with the purpose of identifying the attributes, antecedents, and consequences of a concept. SAMPLE AND SETTING: Empirical and theoretical literature selected from the fields of education, nursing, and medicine. METHODS: A comprehensive review and analysis of theoretical and empirical publications from nursing, medicine and education disciplines provided a rich data source for this concept analysis. RESULTS: Four defining attributes of learner-centered teaching were identified: autonomy, empowerment, collaboration, and engagement. Four antecedents, three surrogate terms, eight related concepts, and nine primary consequences of learner-centered teaching were also identified. Exemplar cases of learner-centered teaching emerged from personal teaching practice experience and the empirical literature. CONCLUSIONS: Learner-centered teaching is a complex concept with many aspects conceptualized or operationalized which make it difficult to authoritatively define the concept. However, the features of learner-centered teaching identified in this analysis offered a good basis for the evaluation, application, and further development of the concept in nursing.

[Analysis on developmental characteristics of acupoint theory].

The theory of acupoints has gone through a long process from its embryonic form to its maturity, including its gradual improvement in later generations. Starting from the acupuncture literature in different historical periods, we, in the present paper, gave some examples and analyzed the connotation of important concepts in the development of acupoint theory. It is believed that the signs of the establishment of acupoint theory mainly include the standardization of acupoints' names, the specific description of acupoint positioning, the enrichment and explicitation of the content of acupoints' indications, the highlights of the meridian theory via classification of acupoints, and the interpretation of connotations of acupoints from a clinical perspective.