UPDATE ARTICLE

By avenue: dialoging about Grounded Theory

Lorrainy da Cruz Solano^I; Francisco Arnoldo Nunes de Miranda^II; Bertha Cruz Enders^III; Francisca Georgina Macedo de Sousa^IV

^I Nurse. PhD student Federal University of Rio Grande do Norte. Brazil. E-mail: lorrainycsolano@yahoo.com.br
^II Nurse. PhD in Nursing. Professor, Federal University of Rio Grande do Norte. Brazil. E-mail: farnoldo@gmail.com
^III Nurse. PhD in Nursing. Professor, Federal University of Rio Grande do Norte. Brazil. E-mail: berthacruz.enders@gmail.com
^IV Nurse. PhD in Nursing. Professor at the Federal University of Maranhão. Brazil. E-mail: fgeorginasousa@hotmail.com

DOI: https://doi.org/10.12957/reuerj.2018.28047

ABSTRACT

Objective: to think about Grounded Theory as a methodological resource for qualitative research in nursing. Content: the discussion was based on dialogue among authors who converge with the assumptions of Grounded Theory, which run counter to the classic methodological script of qualitative research. Two lines of argument were traced for the thinking to take place: the first based on the Grounded Theory method as such, and the second on knowledge in nursing research. Conclusion: the current situation demands that nursing researchers commit to the population's health needs and the Unified Health System, and requires feasible, effective, efficient problem-solving strategies, of which Grounded Theory is one, instigating knowledge of knowledge in nursing.

Descriptors: Nursing; qualitative research; nursing research; methodological research in nursing.

The Grounded Theory (GT) was developed in the 1960s in the United States by sociologists Barney G. Glaser and Anselm L. Strauss to be an alternative to the hypothetical-deductive tradition of that time ¹.

These authors declared a vanguard statement where they contested notions of methodological consensus and offered systematic strategies for a qualitative research practice. They proposed that systematic qualitative analyses had their own logic and could generate theories².

The GT seeks to understand how social beings live their experiences, capturing meanings, or what they feel, think, and how they interact these beings, considering attention in the human dimension and in related social aspects inserted in the most varied contexts, through a set of collection and analysis procedures and techniques of systematized data³.

It is necessary to emphasize that the purpose of the GT is to look for meanings about these movements and not existential meanings. Therefore, the GT is different from a phenomenological study or a study of social representations, or other studies that also seek to understand the essence of a phenomenon or condition¹.

Regarding the use of the GT as a methodological tool, studies produced in post-graduate programs stricto sensu of Brazilian nursing showed that the last 15 years have been a methodological reference of option for nursing students to develop their academic studies of master and doctorate level. It can be inferred that there was a paradigmatic shift in the valuation of subjectivity, articulating coherently the theoretical references for a better approximation of the reality lived by the individuals⁴.

In this perspective, the present study aims to reflect on the GT as a methodological resource for qualitative research in nursing. For this purpose, the dialogue between convergent authors with the assumptions of the GT was used as a basis for discussion, which go through the upside down classical methodological script of qualitative research.

Two argumentative lines will be drawn to make this reflection happen: firstly, starting with the GT method per se, and secondly, on the knowledge of research in nursing. We hope that this text instigates the compromise of the researchers with the creation of knowledge that surrounds qualitative research in nursing.

The GT as method of discovery

The GT can be defined as a method of discovery in opposition to the methodological idea of ​​a set of ready-made prescriptions. It demystifies the procedure of qualitative investigation by proposing the construction of original analysis of the data demonstrating that research is not so linear ².

Method is understood as a discipline of thought, an exercise to elaborate a cognitive strategy in constant movement of contextualization of information, knowledge and decisions. A path; the thinking activity of living individuals, non-abstract subjects. Individuals capable of learning, inventing and creating while walking. Without effective prescriptions to achieve an expected result⁵.

Based on these premises, it is necessary to single out the objects of study as a result of the constructions and social structures that surround them. Understanding a phenomenon depends on the circumstances surrounding each moment during the research process. The reality cannot be separated from the person who looks at it, and there are therefore several perspectives of the same reality⁶.

It should be noted that there are three main methodological perspectives of the GT: classical (also called glauserian); Straussian (called relativist or subjectivist), and constructivist perspective (Charmaz is a prominent author). Each of these theoretical-epistemological conceptions presents specificities that are materialized in different modi operandi ¹.

The GT is a path that allows the establishment of mutual relations and reciprocal influences between the parts and the whole. It needs a new generation of rational, critical, reflexive, self-critical open theories, capable of self-reform. A theory should not be simply instrumentalized; it must help and guide strategies that are directed by human subjects ⁷. It is a bet on the vanguard of qualitative research by breaking with preconceived ideas that ultimately lead to results of studies imprisoned to the interests of the researcher and/or the academic productive logic.

The components that determine the practice of DBT should include: simultaneous involvement in the collection and analysis of data; production of analytical codes and categories based on the data; constant comparative analysis between each stage of the analysis; development of the theory at each step of the collection and analysis; writing of memoranda to build categories, specifying properties, determining relationships between categories and identifying gaps; theoretical and non-population based sampling; and bibliographic review after the development of an independent analysis⁸.

GT researchers start with the data – separating, classifying, and synthesizing them through qualitative coding². Another relevant difference emerges from the comparative analysis throughout the research process; it is related to the construction of hypotheses that are generated in the course of data collection and analysis of data and not before. Unlike the traditional model, the hypotheses are generated in the course of collecting and analyzing the data, not before. They are provisional and are continually compared with new data from interviews and observations, confirmed, extended, modified or disregarded³. The hypotheses are an important resource for density in the search for new data and for theoretical construction.

The GT aims to build a theory based on data that can come from different sources, from a given social experience. This process is not based on assumptions, nor has the intention to test its findings⁹. To know the unknown.

The possibilities of GT research consist in studying areas with few or no one theory developed; disagreeing with existing theories; mixed studies with quantitative and qualitative data; and seeking to apply a range of data in addition to other methods¹⁰.

It can at the same time favor an open and free way of thinking. Far beyond simply explaining. Explaining is not enough to understand. Explaining is insufficient to understand subjective themes. Social phenomena require knowledge in movement that deals with uncertainty¹¹.

In the GT, the approximation with the literature is limited before and during the analysis to avoid its excessive influence on the researcher's perception, since it can cause an impact on the discoveries of new dimensions of the phenomenon¹².

Constant curiosity about the data is the element that allows the researcher throughout the analytical process to keep on the search for new senses, new looks. A curiosity followed by a creative attitude that collaborates in the approximation with the phenomenon under study¹³.

Thus, the method emerges during the experiment and appears at the end, perhaps to a new path. Theory and method are the two indispensable components of complex knowledge⁵. A theory is not knowledge; it allows knowledge. A theory is not an arrival; is the possibility of departure. A theory is not a solution; is the possibility of dealing with a problem⁷.

Thus, research based on the GT is a qualitative learning method well beyond the operational ability of a set of procedures and techniques. The GT instigates a new way of thinking and doing research in nursing, converging to gather knowledge starting from the data to make a theory. It requires a transformation in the researchers' positions¹³. It is a call to know the knowledge, provoking in the researchers an attitude of permanent vigilance against the temptation of certainty, recognizing that our certainties are not proofs of the truth, as if the world that each one sees was the world and not a world built together with others¹⁴.

Thus, penetrating in the process of qualitative research stimulates new questions and broadens the understanding about the topic under study by deepening the time of research and analysis. There is a constant need to dialogue about theory and method, question/object and method/theory, group and theme/review on the subject¹⁵.

The value of theorization for the production of knowledge in nursing must be considered, placing the professional before the possibilities of creating, innovating, contributing to the knowledge of knowledge. The GT seeks conceptual density through the learning of thinking comparatively in terms of properties and dimensions.

Thus, the theory arises from a logical, systematic and explanatory scheme revealing a deep knowledge of social phenomena. In this way, the preparation of a GT requires theoretical and conceptual knowledge of its main constituent elements, as well as the researcher's ability to become a grounded theorist. A path that takes place while walking where new constructions and contributions emerge¹.

The GT and the knowledge of nursing research

Qualitative research in nursing offers great possibilities for the approximation of the subjective dimensions of human experiences, actions and interactions. The advances made by researches are undeniable in the sense of understanding the processes of living, getting sick, caring for others and being cared for, among other phenomena full of meanings and conceptions¹³.

Thus, researchers of qualitative research must exercise reflective attention and glimpse three fundamental characteristics: qualitative researches relate to human experiences and these experiences have a subjective character, and qualitative knowledge is ideographic and constructed during the research. Thus, in addition to these characteristics, some questions frequently occur in the studies and inadvertently threaten their quality¹⁶.

Minds prepared to respond to the increasing challenges that surround the complexity of the problems imposed on human knowledge are necessary. We cannot forget that the development of science is not achieved by the accumulation of knowledge but by the transformation of the principles that organize knowledge⁷.

Thinking about growth between theory and method consists in generating a broad understanding of health/disease as a social process through a dialogue between areas of knowledge. In the area of ​​health, the theory and method interface makes care with qualitative research be constantly strengthened and expanded. We should not lose sight of the fact that research is far beyond the application of techniques¹⁵.

The GT permeates and sustains the whole process of qualitative research in health and the way it is performed tells a lot about outcomes⁹.

We cannot forget the relationship between researchers and research participants because the way(s) as the researcher pose himself before the object of study, the choices in the process, the way the researcher thinks research delineation have repercussions both on development, insofar as they reflect epistemological and philosophical assumptions, as well as on the results. The GT is a reflexive process that implies the need for permanent self-questioning about the role of the investigators, the methods used and the knowledge produced⁶.

Theoretical individuals are required to have a creative attitude, curiosity and an aesthetic view to transpose the objective relation of the field of research. A critical thinking, flexibility and exchange are required to produce knowledge capable of intervening in the reality in a collaborative way. Theoretical sensitivity and commitment with participants and society are also needed. Finally, determination to face the challenges of going beyond the traditional qualitative research is necessary¹³.

In the other direction, the reductionist thought that calls not the totalities, but the elements as true reality; not the qualities, but the measures; not the human beings but the ceremonial and mathematic statements. So, as Popper said, a good scientific theory is a very audacious theory. Thus, science is not a formula for verifying trivial realities, but is the discovery of something real that is hidden ⁷.

As far as the ethical perspective is concerned, health research requires a commitment from the researchers to go beyond, obtaining results and conclusions of the studies. There must be a desire to change reality, to transform it, to transmute it. This should be the driving force behind human ethics and should be instigated in the production of knowledge and in the training of nursing researchers¹³.

The GT is a method that, when extracting from the experiences lived by significant social subjects, it allows interconnecting theoretical constructs, strengthening the expansion of knowledge in nursing and other areas¹². This is a valuable set of tools for carrying out an analytical research instrument, and for its logical extension, for the elaboration of a theory based on it. Evidence has shown that this method can determine unquestionable descriptions and revealing narratives².

Limitations include the problems to attract funding, a common problem for qualitative research in general. However, some advantages are listed: stimulus to creativity, power to conceptualize, use of a systematic approach to analyze data and to predict the depth and richness in data. In turn, as disadvantages, the following are pointed out: exhaustive process; great potential for bias; literature review without developing assumptions; multiple methodological approaches and limited generalization¹⁰.

Thus, learning the GT as a qualitative method goes beyond the ability to operationalize a set of procedures and techniques. It also involves a new way of thinking and researching about a certain social reality in nursing ¹³.

The contributions of the GT to the expansion of nursing knowledge are significant. The fact that it is an interpretative and systematic approach that draws data from the experience and the reality of involved social subjects produces a way to arrive at reliable results capable of generating actions. It is a fundamental theory to stimulate reflection about the epistemology of nursing knowledge, since nursing is an area based on practice, in such a way that knowledge must reach not just the experience of nurses but also the systematic construction of knowledge¹⁷.

It is understood that nursing is a human science oriented to practice, whose central phenomenon is the provision of care and that knowledge arises from the reciprocal relationship between theory, theoretical work and practice and that this relationship allows professionals to better face their responsibilities towards society. Based on these premises, it can be said that qualitative research produces knowledge capable of effective nursing interventions, based on the needs of the users and contextualized in specific situations¹⁸.

The GT enables explanations of how events occur and enables nurses to explore data with richness and in relatively unknown contexts, allowing an interpretative understanding of what it is doing¹⁷.

It is necessary to be clear about what to research, for which reason, and to whom will the knowledge produced be useful and project what impact will be the impact on society. By visualizing the invisible in the visible, by coming closer to the subjectivity of the other, we can understand the phenomena of interest to nursing that will help in the expansion and production of knowledge. All of this reaffirms the ethical commitment and the social role of qualitative research in nursing^19-20.

CONCLUSION

The GT is a path that is in fact the inside out of traditional qualitative research methodologies, especially in nursing.

The dialogue with the authors about this theme strengthened the importance of qualitative research in nursing, allowing a new perspective of the actions and knowledge that constitute it.

The current situation imposes the commitment of the nursing researcher to the health needs of the population and the Unified Health System - public health policy, requiring strategies to deal with feasible, effective, efficient and resolutive problems. The GT is one of these strategies, instigating the learning of knowledge on nursing.

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