Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study

The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians’ experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020–February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment.

Self-Participation Experiences among Well-Adapted Hemodialysis Patients

A successful self-participation experience empowers patients to adapt to living with hemodialysis. However, few studies regarding the subjective experiences of such patient participation have been conducted. This study’s purpose was to describe hemodialysis patients’ perspectives on integrating hemodialysis into a new life regarding self-participation experience. A qualitative study using the grounded theory method was applied. Thirty-two well-adaptive hemodialysis Taiwanese patients attended in-depth interviews. “Integrating hemodialysis into a new life journey” was identified as the core category guiding the entire self-participation experience of hemodialysis patients. The three antecedent themes were “Sense of worthlessness”, “Life is still worth living”, and “Friendly and joyful atmosphere of the hemodialysis room”. Once the patients went through the three antecedent themes, they gradually began making efforts to participate more fully in their hemodialysis. Within this participation experience, the hemodialysis patients exhibited these four interactive themes: “Overcoming one’s predicament”, “Integrating self-care skills into my life”, “Resuming previous roles and tasks”, and “Adapting to independent living”. Finally, most adaptive patients master the hemodialysis life. Encouraging patients to discover that their life is worth living and providing a friendly and joyful atmosphere in hemodialysis units are the keys to facilitating patients’ self-participation more fully.

Social processes in academic-community partnership in health care. A grounded theory study

Background International and national guidelines state that palliative care should be offered to everyone who needs it. To promote the implementation of palliative care in nursing homes, a partnership collaboration was initiated with the goal of implementing high quality palliative care. The partnership consisted of three partner groups: a project group from a non-profit organisation providing health care, managers at the nursing homes and an academic partner. The aim was to explore the social processes within academic-community partnership in a collaboration project. Methods Digital focus group discussions were conducted with 16 participants, representing all three partner groups. One individual digital interview was also carried out. A constructivist perspective of a grounded theory approach was used for data analysis. Results The core category, partnership positioning, covers the social processes of the academic-community partnership in a collaboration project to implement and evaluate health-promoting interventions in clinical health care. The core category was found to have four categories: Pre-positioning, Co-positioning, Re-positioning and GoOn-positioning. The process of partnership positioning is conceptualised in a model. Conclusions Our findings indicate that a new partnership in an implementation project needs holistic, systemic thinking. To enhance implementation in a collaborative project involving different professionals and actors a plan is required to facilitate positioning activities. The process, the roles and the components need to be clearly defined and documented, and the management of a system requires knowledge of the interrelationships between all the components within the system. The development of a conceptual model of Partnership Positioning contributes to knowledge concerning the social dynamic processes which can be applied to support future academic-community collaboration and/or implementation projects. Trial registration Not applicable. The present study has not been considered as a clinical trial.

Sensemaking Processes during the First Months of COVID-19 Pandemic: Using Diaries to Deepen How Italian Youths Experienced Lockdown Measures

The COVID-19 pandemic has brought about disruptive changes in individuals’ lives, breaking the established systems of meaning worldwide. Indeed, in the first months of the pandemic, with individuals being forced to stay at home for a prolonged time to contain the spread of the virus, the need to build new meanings to understand and face this crisis emerged. Building on this, the present study contributes to the understanding of how sensemaking processes were shaped in the face of COVID-19 collective trauma during the very first months of the pandemic. Hence, 36 Italian young adults aged between 21 and 25 submitted daily diary entries for two weeks (T1 was the third week of Italian National lockdown; T2 was the penultimate week before the ease of such stay-at-home orders), resulting in 504 texts. The stimulus was always “Could you describe your daily experience and feelings?”. The Grounded Theory was used. Thus, 15 categories emerged, grouped into three macro-categories. The core category was sensemaking as adaptation. Indeed, the sensemaking process seemed to be a strategy to adapt to the new circumstances related to the lockdown, facing the emotional, cognitive, and activation reactions such conditions by relying on coping strategies and the redefinition of primary as well as broader social relationships.

Meaning and Interpretations of Child Abuse by Abuser Parents: A Qualitative Study

Background: Child abuse has destructive consequences for the abused and the abuser which can launch a cycle of inter-generational violence. Our aim was to understand the constructions of child abuse by adult parents. Methods: The research was carried with generic (basic) qualitative research method. Participants included 12 adults who abused their children during the recent year(2020) at Yazd City. The adult participants were selected by snowball-purposeful sampling. The data were collected through semi-structured interviews and analyzed with grounded theory analysis method. Results: After analyzing transcribes, 6 main categories were constructed: abuse transmission, suffered self, normative violence, relationship problems, institutional inefficiency and pressured family. Life world of harassment emerged as the core category. Conclusion: The findings presented the cycle of abuse created through learning and transmitting.

A model for B2B salesperson performance with service ecosystems perspective: a grounded theory

Purpose The purpose of this study is to develop a model for business to business salesperson performance (SP) with a service ecosystems perspective. Design/methodology/approach To achieve the research aims, classical grounded theory was used. The data was gathered through in-depth interviews with 20 sales managers and main sales actors. Findings After coding and analyzing the data, salesperson institutional performance is introduced as a core category including three main dimensions of regulative, normative and cognitive-cultural performance. Multi-level factors determining SP are identified and performance results are introduced in a multi-level long term way. The sales actors, macro variables, actors’ orientations and sales method are introduced as circumstances, while salesperson stressors are presented as covariants deterring the fulfillment of salesperson’s activities. Originality/value This study focuses on the contributions of the salesperson in the alignment of institutional arrangements or the results of their being institutionalized, as well as determining the factors and variables affecting it.

Spirituality and Spiritual Care among Ethnic Chinese Residing in England: Implications for Nursing

(1) Background: There is a lack of understanding of how spirituality is understood among ethnic Chinese living outside of China. The aim of this investigation was to gain insight into the meaning of spirituality and spiritual care among ethnic Chinese residing in England. (2) Methods: This study employed a grounded theory method. (3) Results: A core category called “seeking a meaningful life” emerged, comprising six categories: “motivation”, “support”, “maintaining standard values”, “achieving a meaningful life”, “relationships” and “perceptions of spirituality”. The core category included a three-stage process influenced by two factors: relationships with others and perceptions of spirituality. In motivated or supported situations of suffering and illness, ethnic Chinese usually follow principles of their Chinese tradition in seeking meaning for a satisfied spiritual life. This process is impacted by their relationships with others and view of spirituality. (4) Conclusions: Participants’ understanding of spirituality and spiritual care was related to seeking meaning and purpose in life. Nurses could incorporate the newly developed life meaning processes into their practice. This could be achieved by culturally explaining suffering and focusing on the significance of physical illness for Chinese people. This would ensure their spiritual care practice delivers culturally competent care for ethnic Chinese. Educators could also incorporate this process within their teaching materials so that this aspect of spiritual care is addressed for this specific group.

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.

Factors Impacting Why Women Stay in Marital Life with Substance dependent Husbands: A Grounded Theory Study

Introduction: Substance abuse is one of the major factors leading to divorce in Iran. Therefore, this study aimed to present a qualitative model of factors affecting women to stay married with substance-dependent husbands. Methods: The grounded theory in the qualitative paradigm was used. Twenty participants (10 women and 10 experts) were interviewed based on theoretical saturation, purposeful, and snowball sampling, and semi-structured in-depth interviews. The interviews were analyzed using the constant comparative method. Results: The participants’ mean age for women was (M=35.2, SD=7.40, n=10) and for experts was (M= 37. 3, SD= 7.42, n=10), half of whom were men and half were women for experts. The results indicated that causal conditions consisted of the child as a barrier to leaving the marital relationship; feeling satisfied with the marital relationship; the attitudes, expectations, and feelings of the spouses; promising behaviors of the husband; financial dependency on the husband, and level of substance-related disorder. The intervening condition was the family of origin’s role. The women's survival strategies in marital life include the use of supportive resources, increasing awareness, and the use of constructive behaviors. The contextual conditions were social and legal factors. Consequences of the core category (A journey with fear and hope), were desirable and undesirable emotions and experiences. Conclusion: The results indicated that spouses of substance-dependent husbands stay in the marriage, not just due to obstacles like familial, social, legal, and financial factors, but also due to resourceful supports, marital satisfaction, and enjoy having a family with husband and children.

Leveraging grounded theory in supply chain research: A researcher and reviewer guide

PurposeThe purpose of this article is to identify and explain most frequently misunderstood steps in the use of grounded theory (GT) as a methodology and provide guidance on proper execution of these elements.Design/methodology/approachThis research provides meaningful guidance to both reviewers and authors interested in applying GT. This research is expected to advance the pursuit of formal theory development.FindingsThere are four most frequently misunderstood steps in the use of GT as a methodology. These are related to the use of literature, theoretical sampling, core category and formal theory development. Proper execution of these elements is important for convincing reviewers and readers that the findings of the research are meaningful and trustworthy.Originality/valueThis paper should be of significant value to researchers who are interested in GT as a methodology. It adds to the few journal articles that address the proper ways to conduct GT.