Grounded theory sampling: 'whole' family research

This paper presents an analysis of the theory and reality of sampling 'whole' families for a grounded theory research project exploring child and family management of acute childhood illness at home. Initial access to families for child health research projects can be difficult given the recent negative image of research involving children portrayed by the media. Once access to families is secured, whole family access may be prevented due to internal family dynamics in a society with rising rates of divorce and remarriage. Ethical issues also arise: individual family members may feel coerced into participating by other family members; if family members are interviewed separately researchers need to be particularly careful to maintain confidentiality; with children extra time is needed to facilitate rapport and an understanding of the researcher role. There is also a tension for children in the early stages of a research relationship between feeling safe and personal privacy. Theoretical sampling may direct data collection with wider members of the family, but it may not be possible to access these people. 'Whole' family research may be the aim, but inevitably each family will decide, collectively and individually, how this is determined

Difficult communication in nursing

PURPOSE: To describe difficult communication in nurse-patient interactions from nurses\u27 perspectives. DESIGN: Grounded theory methodology and follow-up questionnaire. Focus groups of nurses were conducted to explore nurses\u27 perceptions of difficult communication in nurse-patient interactions. METHODS: Using a semistructured interview script, the moderator guided six unit-based focus groups at a 220-bed, Roman Catholic, community hospital, and a recorder took field notes of the interactions. The sessions were audiotaped for transcription and analysis. Level I coding was done by the moderator and recorder after each group. Level II coding was done with the transcripts and conferral of two of the researchers. A follow-up questionnaire with a 5-point Likert scale was used to validate the 13 categories of difficult communication derived from the focus groups. FINDINGS: Five themes were identified: specific diagnoses and clinical situations, patient and family emotions, nurses\u27 emotions, triangle of nurse-physician-patient communication, and nurse coping behaviors with difficult communication. Emotion was the core variable that made communication more difficult. CONCLUSIONS: The groups described five major themes in difficult communication. They also identified the heavy emotional component of nurse-patient communication and the difficulties arising in work relationships that complicated communication