Constructivist Grounded Theory Approach Research Articles

Exploring the determinants of disaster and climate resilience building in Zimbabwe’s rural communities

AbstractWith the burgeoning threats from natural hazards and extreme weather events driven by climate change in every section and sector of society, building resilience against disasters and risks posed by climate change has become an unescapable discourse. The study’s main thrust is to establish the determinants of resilience building in Zimbabwe’s rural communities. The study adopted the qualitative constructivist grounded theory approach in conjunction with participatory action research to gain insights from community members and traditional leaders. A total of forty-six participants from Chimanimani District, Zimbabwe participated in the study. The findings revealed that the availability of natural and human resources, collective efficacy, government and development agency support systems, indigenous knowledge systems, and livelihood diversification were crucial determinants of resilience building for rural communities in Zimbabwe. The identified determinants for resilience building signal that these determinants need to be harnessed to inform policy and practice interventions. Furthermore, the availability of the identified determinants implies that rural communities can minimise, and prevent losses, reduce exposure to natural hazards, disasters and climate change risks and manage the impacts of natural hazards whenever they emerge. The study recommends that these determinants be complemented by access to technology, resilient community infrastructures, robust social protection systems, and hazard risk assessment participatory processes by rural communities. In addition, effective emergency and health services, among other contingent measures essential to improve community resilience.

The impact of cohort relationships on BIPOC genetic counseling students: Results from a longitudinal qualitative study.

The transition to graduate school is marked by stress, with academic demands and interpersonal interactions being primary concerns for genetic counseling students. For Black, Indigenous, and People of Color (BIPOC) graduate students, additional stressors caused by the "minority tax" and microaggressions impact their sense of belonging and inclusion. This prospective longitudinal study employed a constructivist grounded theory approach to investigate the experiences of first-year BIPOC genetic counseling students as they transitioned into the first year of their graduate training. We conducted semi-structured interviews with 26 first-year genetic counseling students at three key time points during their first year and analyzed them using reflexive thematic analysis. Here, we report themes related to stressors when transitioning into the genetic counseling training environment, the role of relationships as a source of support in navigating these challenges, and the impact of cohort dynamics on the training experience. Stressors included managing academic rigor and time demands, navigating microaggressions, reactions to discussions about diversity, equity, inclusion, and justice (DEIJ), and managing mental health. Peer relationships emerge as pivotal source of support, but challenging dynamics within the cohort negatively impacted participants, highlighting the importance of fostering an inclusive training environment. Since programs have less control over the composition of each cohort with the advent of the Match system in 2018, we recommend the use of community-building and debriefing activities to strengthen healthy relationships and address problematic dynamics. We recommend that training programs be proactive in creating mentoring relationships between faculty and students rather than waiting until students ask for help. Ultimately, we advocate for a holistic approach to genetic counseling training that maintains academic rigor but also prioritizes the creation of supportive, inclusive, and culturally sensitive learning environments for all students.

“To do or not to do”, male nurses’ experiences of providing intimate care to female patients in China, a constructivist grounded theory study

BackgroundSome studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses’ experiences and process of providing intimate clinical care to female patients.MethodsA constructivist grounded theory approach was used to develop a theoretical understanding of male nurses’ experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development.ResultsChinese male nurses’ experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China.ConclusionsChinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

Vitality of older adults through internal and external connectedness

BackgroundVitality is a relatively unresearched concept and defined in existing literature either on the premise of one's functioning, or in terms of feeling alive. There is, however, little known about the significance of a sense of connectedness to life for vitality, especially from the perspective of older adults. This research aims to explore the association between the concept of connectedness and the perspective of vitality as a sense of aliveness, in order to formulate a theoretical understanding grounded in the subjective perceptions that older adults themselves hold of vitality. MethodsFollowing a constructivist grounded theory approach and theoretical sampling, constant comparative analysis was performed on the transcripts of 15 semi-structured interviews, conducted in the Netherlands with older adults (mean age 73 years, eight females and seven males), regarding their vitality. Concurrently, empirical and theoretical findings were translated into a theoretical conceptualisation. ResultsAccording to the older participants, connecting to life itself enhanced their sense of vitality. This connection was achieved through internal connectedness (connecting to one's own life, intrinsic stimuli and intrinsic goals in an independent manner) and external connectedness (social connectedness, environmental connectedness, engagement with the external world). Furthermore, our findings revealed distinct interactions between internal and external connectedness and facilitating tools, such as freedom from physical constraints, financial freedom and adaptation. ConclusionsOur findings provide a holistic concept of vitality and connectedness and consolidate existing perspectives on vitality into an overarching framework, which can contribute to the development of effective care policy, healthcare interventions and welfare services.

Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study.

Longitudinal qualitative study, based on a constructivist grounded theory and transformative approach. This study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury. An acute inpatient rehabilitation facility in the Midwest United States. In-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization. Participants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once. The experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.

Building an evidence-based multi-level system of quality disability support for adults with acquired neurological disability

Purpose People with acquired neurological disability have the right to quality disability support, yet there is still limited user insights shaping disability services. This research aimed to develop a comprehensive understanding of quality support for adults with acquired neurological disability based on lived experiences. Methods Using a constructivist grounded theory approach, this project engaged 12 adults with acquired neurological disability, 12 support workers, and 10 close others in individual interviews. Each perspective was analysed independently and subsequently merged to construct a holistic model of quality support grounded in lived experience. Results The model of quality support encompasses interconnected themes spanning dyadic relationships, support worker competency, team dynamics, provider practices, and sector-wide considerations. Key elements include recognising the individual’s expertise in their support needs, nurturing effective support relationships, fostering a capable support team, and upholding sector accountability. Authentic choice and personal agency emerged as paramount factors in achieving quality support. Conclusions The findings align with disability rights and individualised funding principles, emphasising the centrality of people with lived experience in shaping support services. The research underscores the need to prioritise authentic choice and individual empowerment, offering valuable insights for both practice and policy development in the disability support sector.

Parental Depression and Self-Stigma Among Chinese Young People Living With Depression: A Qualitative Study.

Self-stigma is detrimental to psychosocial well-being and the recovery journey among people living with depression. However, there has been limited research exploring the experience of stigma internalization when depression runs in families. This study aims to address this gap by (1) characterizing the manifestations of self-stigma among individuals living with depression whose parent(s) also have depression and (2) exploring the potential mechanisms underlying the impact of parental depression on self-stigma. Essential principles of the constructivist grounded theory approach were adopted to collect data through in-depth interviews with 27 participants aged 15-30, living in Mainland China. Many participants perceived depression running in their family as an endless disaster and an incurable illness. These beliefs further led to stigmatizing emotions (such as suppression, anger, and guilt) and behaviors (such as concealment and social withdrawal). Participants also highlighted ambivalent intergenerational relationships, tense family atmospheres, lower parental emotional involvement and support, and a lack of family flexibility due to parental depression. Furthermore, parental depression impacted participants' self-stigma by interfering with family relationships, family functioning, and parenting styles. It also shaped their perceptions of family, illness attribution, and public stigma. Additionally, parental depression had an impact on participants' social functioning, self-esteem, and personality, making them more susceptible to self-stigma. This study emphasizes the crucial role that the family plays in the internalization of stigma among individuals living with depression. It suggests that family dynamics, rather than family structure or economic backgrounds alone, shape this process.

Studying Disability: A Multi-Stakeholder Perspective on Requesting Accommodation in Higher Education

Including students with disabilities in higher education is a global political objective and is considered a human right. However, many students do not feel included and hesitate to ask for the help they need to succeed in their education. This study aims to investigate the processes of requesting accommodation for students with disabilities in higher education from the perspectives of both students and support providers. Six co-creation workshops were held, with a total of 46 participants from various backgrounds relevant to exploring pathways for students with disabilities in higher education and into the workforce. The audio recordings of the workshops were analyzed using a constructivist grounded theory approach to identify and explore processes. Three interconnected processes were identified: determining whether to disclose, asking for accommodations, and studying disability. The analysis showed that these processes could be time-consuming and riddled with barriers, and they did not always result in granted accommodations. Some students ended up using their study time to research their disability and potential accommodations instead of studying their subject matter. To eliminate barriers and promote disclosure, universities should ensure a universally designed education and that staff have the necessary knowledge to assist students in obtaining accommodations.

Developing a model describing voluntary residency attrition: a qualitative study

BackgroundMany factors influencing residency attrition are identified in the literature, but what role these factors play and how they influence each other remains unclear. Understanding more about the interaction between these factors can provide background to put the available evidence into perspective and provide tools to reduce attrition. The aim of this study was therefore to develop a model that describes voluntary residency attrition.MethodsSemi-structured interviews were held with a convenient sample of orthopaedic surgery residents in the Netherlands who dropped out of training between 2000 and 2018. Transcripts were analysed using a constructivist grounded theory approach. Concepts and themes were identified by iterative constant comparison.ResultsSeventeen interviews with former residents were analysed and showed that reasons for voluntary attrition were different for each individual and often a result of a cumulative effect. Individual expectations and needs determine residents’ experiences with the content of the profession, the professional culture and the learning climate. Personal factors like previous clinical experiences, personal circumstances and personal characteristics influence expectations and needs. Specific aspects of the residency programme contributing to attrition were type of patient care, required skills for the profession, work-life balance and interpersonal interaction.ConclusionsThis study provides a model for voluntary resident attrition showing the factors involved and how they interact. This model places previous research into perspective, gives implications for practice on the (im)possibilities of preventing attrition and opens possibilities for further research into resident attrition.

Keeping up with the times in Ireland: Older adults bridging the age-based digital divide together?

In 2021, data on Internet usage for those aged 75 years and older in Ireland indicated that almost half of this cohort (46%) had never accessed the Internet. This study examines the role of informal peer learning in the digital lives of older adults in Ireland. A mixed methods case study methodology was employed. Data were collected from 100 participants by means of an online survey, followed by interviews with 12 participants who opted in from the survey. Interview data were collected and analysed using a constructivist grounded theory approach. My findings indicate that questions surrounding digital technologies were best addressed on an individual level, often from a same generation peer, whether household member, family or other relative, friend or member of one’s social environment. There was evidence of indirect reciprocity from these learning exchanges to a participant’s peers. Research into peer learning in informal social and community environments for older adults has been scarcely addressed heretofore. This research highlights that it is here that much later-life learning relating to digital skills takes place. The principles of intergenerational learning: learning with one another, learning from one another, learning about one another, offer a useful lens for future consideration of informal peer learning related to digital skills development amongst older adults.

‘Are you vaccinated? Yeah, I’m immunized': a risk orders theory analysis of celebrity COVID-19 misinformation

ABSTRACT Background On 11 March 2020, COVID-19 was declared a global health pandemic by the World Health Organization (WHO). Vaccinating populations is paramount in changing the course of a pandemic. The rapid spread of (mis) and disinformation online from celebrities, politicians, and media influencers creates a corrosion of trust in public health interventions. Methods Given the importance of the spread of information during a public health crisis, the current study uses risk orders theory with a constructivist grounded theory approach to analyze an episode of a popular podcast available on YouTube, titled, ‘Aaron Rodgers Tells Pat McAfee His Side of Vaccine Situation.’ Results Findings illuminated three themes concerning COVID-19 medical interventions from celebrity discourse: (1) misinterpreting medical terminology; (2) conflating bodily autonomy and altruism; and (3) political ideology as an impetus for misinformation. Conclusions The discussion offers implications for healthcare practitioners in debunking mis- and disinformation. Foremost, lack of transparency concerning autonomy, liberty, freedom, and choice from public health experts who design messages during a public health crisis creates a space for non-medical influencers to promote pseudoscience, misinformation, and disinformation. This leads to public distrust of medical experts and confuses the public’s understanding of best practices based upon standard of medical evidence and care.

From celebration to utilisation: How linguistic diversity can reduce epistemic inequalities

Working towards reconciliation, the undoing of structural inequalities and segregation often means transforming ‘white spaces’ into less white spaces, including but not restricted to Christian communities. However, it is often overlooked that greater representation of people of colour does not automatically challenge the epistemic authority that tends to rest with white people and/or Eurocentric knowledge systems.This was the backdrop of a study carried out in a multi-‘racial’ South African congregation. The purpose was to understand how white people conceptualised and worked for reconciliation in a context they were culturally dominating. A constructivist grounded theory approach was used to generate and analyse data through ethnographic methods and relationship-based learning of isiXhosa.This article presents the problem identified – the ‘coloniality of knowledge’ in ‘reconciling’ Christian communities. To challenge it and to render theologising more relevant in the intercultural contact zone, several concrete suggestions are subsequently made. They are focussed on creating environments favourable to embracing cultural-linguistic differences and to harnessing them for increased gospel relevance and epistemic equality. The value and the cost of such transformation will be discussed in the end with reference to the South African context.Intradisciplinary and/or interdisciplinary implications: Seeking relationships on the terms of the ‘other’ enables more profound ways of sharing different experiences of the gospel. This approach of decolonising theology can increase cultural and epistemic justice with implications for practical and systematic theology, mission and reconciliation studies, and research in general in cross-cultural settings.

What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine.

The Master Adaptive Learner (MAL) model postulates that learners develop adaptive expertise through cycles of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors of MALs are not well characterized. We sought to define behaviors that characterize MALs within emergency medicine (EM) training. Using a constructivist grounded theory approach, we analyzed semistructured interviews with expert EM educators. These experts reflected on observable behaviors as well as factors in the clinical learning environment that may modulate these behaviors. We recruited using purposive sampling until thematic saturation. We identified four overall themes, of which three described groups of learner behaviors and a fourth described modifiers of these behaviors. Learner behaviors include: (1) critical interrogation of practice, (2) intellectual risk-taking, and (3) intentional curation of a learning network. Critical interrogation of practice encompasses several observable behaviors including learner-driven feedback conversations, independent synthesis of clinical information, appropriate deviation from algorithms based on their conceptual understanding of core principles, intentional use of case variation and hypothetical questioning, and continuous refinement of decisions. MALs also engage in intellectual risk-taking for their development by communicating clinical decision-making processes even at the risk of being wrong, openly addressing errors and gaps, and intentionally seeking out uncomfortable experiences. Intentional curation of a learning network is the deliberate development of a consortium of trusted individuals who serve as mentors and sounding boards. We also identified a fourth theme related to the expression of learner behaviors: learning environment modulates behaviors. Active promotion of psychological safety is necessary for learners to express these behaviors. This safety is mediated through trusting relationships and expert supervisors who serve as colearners and role models. We present several behaviors that allow identification of MALs among EM trainees. These data expand our understanding of MALs and the critical influence of the learning environment. Identification of these behaviors may allow for more precise categorization of targeted curricular interventions and meaningful learning outcomes.

Integrating Social Determinants of Health in Critical Care

BackgroundSocial determinants of health (SDOH) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOH into acute care practice is poorly defined. Research QuestionHow do medical intensive care unit (ICU) clinicians currently operationalize SDOH within patient care, given that SDOH are known to mediate outcomes of critical illness? Study Design and MethodsUsing ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOH during clinical care. Adults admitted to the medical ICU with respiratory failure were prospectively sequentially enrolled. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record (EMR) documentation for up to 90 days following ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control Healthy People SDOH framework. ResultsSixty-six patients were enrolled and over 200 observation hours of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients’ lives into their discussions. Social structures were most frequently invoked when related to: 1) etiologies of acute respiratory failure, 2) decisions on life sustaining therapies, and 3) transitions of care. There was no systematic way in which data about common SDOH were collected (e.g., food and housing insecurity) and some SDOH were rarely or never discussed (e.g., access to education, discrimination, incarceration). InterpretationClinicians do not incorporate many areas of known SDOH into ICU rounds. Improvements in integration of SDOH should leverage the multidisciplinary team, identifying who is best suited to collect information of SDOH during different timepoints in critical illness. Next steps include clinician, patient-, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOH assessment.

Understanding clerkship experiences in emergency medicine and their potential influence on specialty selection: A qualitative study.

The specialty of emergency medicine (EM) is experiencing a significant decrease in student interest. In addition, women are historically underrepresented within the specialty at all levels of training and practice. We sought to understand how clinical experiences and perceptions of EM influence specialty selection by medical students, particularly women. Using a constructivist grounded theory approach, we analyzed semistructured interviews with senior medical students who considered EM as a specialty. We used purposive sampling to recruit from diverse learning environments and represent a variety of experiences. Participants reflected on their specialty selection process and experiences in EM including their perceived acceptance in the work environment. Twenty-five medical students from 11 geographically diverse schools participated. A total of 68% (17/25) identified as women. The majority (21/25, 84%) planned on applying to EM residency. We identified four major themes: (1) distressing interpersonal interactions with patients and the ED care team negatively affect students; (2) EM culture includes behaviors that are perceived as exclusionary; (3) beliefs about the attributes of an ideal EM physician and the specialty itself have a gendered nature; and (4) ease of access to mentors, representation, and early exposure to EM environment increased interest in specialty. Our participants express that EM causes challenges for students to accept the norms of behavior in the field, which is an essential element in joining a group and professional identity formation. In addition, we raise concern that gendered perceptions and language may send exclusionary environmental cues that may negatively impact recruitment of a diverse physician workforce.

Navigating between two figured worlds: A constructivist grounded theory study on residents' workplace experiences with health care management tasks.

Medical residents may be required to handle health care management (HCM) tasks alongside their clinical duties, despite not having received training to perform them. However, little research has been done on how medical residents acquire HCM skills at the workplace and how these experiences impact their learning. We completed a qualitative research study using the Constructivist Grounded Theory approach inform by the Figured World theory. To gather data, we held focus groups and conducted semi-structured interviews with 22 medical residents from various disciplines and learning levels at Pontificia Universidad Javeriana. We utilised iterative data collection and analysis, constant comparison methods and theoretical sampling to construct our findings. We constructed two different worlds to represent how residents acquire HCM skills: the non-managing physician and the physician-as-manager. The former was characterised by a discourse that underplayed the role of the HCM tasks as part of residents' training, was full of negative interactions with the health care team and limited residents' agency. In the latter, residents collaborated and learned from health care team members, had supervisors who modelled how to incorporate HCM tasks into daily activities and expanded residents' agency. Residents developed their professional identity according to the world they were introduced into. Educational leaders must understand that the non-managing physician figured world gives residents a feeling of uprooting and discomfort when carrying out this type of tasks. To transform this world into the physician-as-manager, it is necessary to reconfigure some workplace hierarchies, consolidate interprofessional collaborations and change the discourse perpetuated by influential role models. Supervisors must also strengthen their knowledge of HCM and improve its integration into clinical practice. Any effort to train residents on HCM competencies could be lost if the workplace underscores their value in patient care.

"Putting my life into a story"

This article describes the development, implementation, and evaluation of a digital narrative intervention that combined participatory video (PV) and narrative therapy practices to engage Latinx immigrant young people in processes of personal and societal change. Drawing on ethnographic field notes, process recordings, audio recordings of intervention implementation, and focus group data, this program evaluation offers empirical evidence of the impacts of this innovative, digital narrative intervention on Latinx immigrant young people (ages 18-24) in New Orleans. A constructivist grounded theory approach to data analysis resulted in three main themes: critical reframing, Latinx and immigrant pride, and media literacy. This study unites PV and narrative therapy as complementary approaches to working with marginalized groups to share their stories, suggesting that the combination of these two storytelling practices resulted in several positive outcomes for participants.

What is in a chosen name? An exploratory study on the renaming experiences of transgender people

Background: For transgender people, choosing and using a name congruent with their gender identity has been identified as a factor that improved self-esteem and well-being. This study aims to explore their renaming experiences and to identify the functions of chosen names in affirming gender identity and in expressing the need for continuity or rupture with the past. Method: The study was structured in two phases. The first phase, purely inductive, consisted in nine semi-structured interviews. A short version of the interview guide was used with sixteen other participants during the second phase of the study, which was both inductive and deductive, following a non-systematic literature review. Data was analyzed based on a constructivist grounded theory approach. Results: Two categories of functions of the chosen name were identified. The first category consisted of the functions of chosen names regarding the affirmation of gender identity, which were: the classificatory, the identificatory and the symbolic functions. The second category consisted of the functions of chosen names in expressing participants’ needs for continuity or discontinuity with the past, chosen names being experienced as metaphors of a new beginning, supports for continuity through transformation, compromises between family and cultural identifications and disidentifications. Conclusion: Exploring the renaming process and the functions of the chosen names in the clinical setting with transgender people looking for mental health support may help to identify and enhance gender affirming strategies. This may further assist in reducing aspects of gender incongruence and dysphoria through subjectivation and resilience-developing processes.

Understanding Well-Being in High-Performance Coaches: A Constructivist Grounded Theory Approach

Objectives: The purpose of the study was to explore, in depth, well-being within the unique context of high-performance sports coaching. The aim was to capture the process of well-being while considering the contextual nuances and influences of high-performance coaching environments in a mid-range theory of coaches’ well-being. Design: Constructivist grounded theory served as a guiding approach for data collection and analysis. Method: Individual interviews (n = 20) were conducted with methodological rigour enhanced by originality, usefulness, resonance, and credibility. Aligned with the methodology, we utilised theoretical sampling to aid the development of individual categories. Results: Findings suggest that well-being is an integrating process between coaches’ personal values (identity) and culturally prescribed values (identity), with a degree of harmony as the overall goal. Conclusion: The mid-range theory presents a contextually bound process of coaches’ well-being. It provides a more practical insight into the area and highlights the importance of cultural considerations and competencies.

"What choice do you have knowing your child can't breathe?!": Adaptation to Parenthood for Children Who Have Received a Tracheostomy.

A growing number of parents are navigating parenthood influenced by medical complexity and technological dependency as the group of children with long-term tracheostomy grows. However, little is known regarding the parental experiences of parenthood for this heterogeneous group of children now surviving through infancy and intensive care. This study aimed to analyze how parents of children who have received a tracheostomy adapted to parenthood. Interviews were conducted and analyzed following a constructivist grounded theory approach. Ten parents of seven children living with a tracheostomy in Sweden were recruited via the long-term intensive care unit (ICU). The core variable of parenthood "Stuck in survival" was explained by two categories and six subcategories. The category "Unaddressed previous history" describes the experiences from being in the ICU environment and how the parents are not able, due to insufficient time and resources, to address these stressful experiences. The category "Falling through the cracks of a rigid system" describes how the parents found themselves and their children to be continuously ill-fitted in a medical system impossible to adapt to their needs and situation. Parents placed the starting point of parenthood with the birth of the child, whilst the tracheotomy only constituted a turning point and would lead to the loss of any previously held expectations regarding parenthood. This study identified a previously undescribed period prior to tracheostomy placement, which may have long-lasting effects on these families. The care provided in ICUs following the birth of a child who will require tracheostomy may not be tailored or adapted to accommodate the needs of these families leading to long-lasting effects on parenthood.