Constructivist Grounded Theory Design Research Articles

Adaptive adjustment to the needs of families caring for children and adolescents with physical disabilities in north-eastern Tanzania: a grounded-theory study

ABSTRACT Background Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context. Objective The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania. Methods This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow’s hierarchy of needs, informed the analysis. Results Challenging needs were grouped into five categories, which were linked to Maslow’s hierarchy of needs and related to the central concept of ‘adaptive adjustment’: (1) ‘barely surviving’; (2) ‘safety needs in jeopardy’; (3) ‘sociocultural protection’; (4) ‘self-esteem far beyond reach’, and (5) ‘dreaming of self-actualisation’. Conclusion Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.

Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting

IntroductionThe phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems. MethodsA qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity. ResultsA working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning. ConclusionThe working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.

An Exploration of Support for Clinical Education Partners.

Effective academic-clinical partnerships require a greater understanding of how academic programs can best support clinical education (CE) faculty. This study aimed to determine resources and support that clinical partners need. As the number of physical therapist (PT) programs, cohort sizes, and CE weeks have risen, so has demand for CE sites. Conversely, staffing reductions, increased administrative duties, and rising productivity expectations have decreased the time available for clinical instruction. To promote a successful CE experience, there must be a renewed understanding of CE faculty needs. Clinical education faculty affiliated with any of the 8 contributing programs from the Ohio-Kentucky Consortium participated in survey research (n = 24) and subsequent interview (n = 4) and focus group (n = 6) research. Constructivist grounded theory design was used to explore the needs of CE faculty. Academic and clinical partners developed the initial survey and used survey results to establish interview questions. The investigators iteratively assessed data saturation and clarity of results of coded survey, interview, and focus group data to determine whether the study's aims of identifying CE faculty needs had been met. The aggregated results yielded 5 main themes of Director of Clinical Education support for CE faculty needs: student readiness for CE experience; effective academic-clinical partner communication; collaborative management of exceptional students; judicious standardization of CE processes; and provision of CE faculty development resources. Clinical education faculty have noted challenges that affect their ability to mentor students. They want academic programs to be more collaborative and proactive with communication, resources, and support. Future research should address aids and barriers to proactive communication, resource provision, and academic-clinical partner collaboration.

Recovering from physical trauma in late life, a struggle to recapture autonomy: A grounded theory study.

The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. A qualitative study with a constructivist grounded theory design. Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. No patient or public involvement.

Personal benefits of older adults engaging in a participatory action research (PAR) project

Participatory action research (PAR) is the process of conducting research with people rather than for them and is perceived as an empowering activity for older adults who participate in it. However, there is little evidence that outlines and explains the reasons why older adults engage in PAR. Thus, the aim of this study was to better understand the personal benefits for older adults participating in PAR. We based our study on the experiences of four older adults who volunteered for CareComLabs, a Swiss-based PAR project, for more than two years. A constructivist grounded theory design was used to explore the benefits of participating in CareComLabs by conducting in-depth, semi-structured interviews. The analysis yielded four categories of personal benefits of participating in CareComLabs: (a) enriching relationships; (b) broadening horizons for older age; (c) keeping in touch with one's profession; and (d) interacting in a nurturing community. Our findings may have implications for policies and frameworks focused on the identification of the potential of participatory action research as a community resource.

Financial medicine as a source of moral distress: An unrecognised pathway to moral injury in the South African EMS systems

IntroductionThe phenomenon of Financial Medicine is a wide spread practice within the South African prehospital domain, which remains poorly researched. Similarly the impact of this phenomenon is not well understood, with many healthcare providers grappling with the moral dilemmas introduced into the work systems through the effects of the practice of Financial Medicine. Persisting, repetitive moral dilemmas can lead to instances of Moral Distress and Moral Injury. The practice of Financial Medicine in the South African prehospital domain proves to introduce many moral dilemmas and subsequently can serve as a source of Moral Distress and Moral Injury. MethodsThis study used a qualitative research methodology in the form of a constructivist grounded theory design. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity. ResultsThe sub-category presented in this study stems from the development of 6 final analytical labels that were abstracted in the process of a theory construction, not presented in this article. This sub-category is nested under 1 of the final analytical labels, and comprised of 3 preliminary analytical labels and an associated code and proposition list. ConclusionUnderstanding the sources of Moral Distress and Moral Injury within the South African prehospital domain are key steps in promoting and supporting the adoption and sustainability of ethical practices. This article presents a key finding that demonstrates a link between the experience of the phenomenon of Financial Medicine and the suffering of a Moral Injury by South African prehospital personnel.

Voices of those living with type 2 diabetes in Belize: barriers to care before and during the COVID-19 pandemic

Belize has the highest national prevalence of type 2 diabetes (T2D) of Central and South America, and fifth direst in the world. T2D is the leading cause of death in Belize, a country facing burdens of increasing prevalence with few resources. Since March of 2020, the COVID-19 pandemic has exacerbated the difficulties of those living with T2D in Belize. To address T2D issues in Belize, our interdisciplinary research team explored the barriers to care and self-management for adult patients with T2D in Belize prior to and during the COVID-19 pandemic.Research relationships between Canadian (ARH) and Belizean (LE) authors have been ongoing since 2016. Together we used a qualitative Constructivist Grounded Theory design generating knowledge through 35 semi-structured patient interviews, 25 key informant discussions, and participant observation with field notes between February 2020 to September 2021. We used Dedoose analysis software for a systematized thematic coding process, as well as iterative verification activities. Findings revealed several barriers to care and self-management, including: 1) the tiered health and social care system with major gaps in coverage; 2) the unfulfilled demand for accurate health information and innovative dissemination methods; and 3) the compounding of loss of community supports, physical exercise, and health services due to COVID-19 restrictions. In the post-pandemic period, it is necessary to invest in physical, nutritional, economic, and psychosocial health through organized activities adaptable to changeable public health restrictions. Recommendations for activities include sending patients informational and motivational text messages, providing recipes with accessibly sourced T2D foods, televising educational workshops, making online tools more accessible, and mobilising community and peer support networks.

Public health nurses experience of mental health encounters in the context of primary health care: a constructivist grounded theory study

BackgroundIn primary health care people with mental health needs are often overlooked or masked with physical complaints. It has been suggested that public health nurses lack sufficient knowledge when encountering people with mental health problems. Low levels of mental health literacy among professionals are associated with negative patient outcome. There is a need to understand public health nurses process and strategies used when encountering a person with mental health problems in order to promote mental health. This study aimed to construct a theory that explains the process of public health nurses experience when encountering people with mental health problems based on their knowledge, attitudes, and beliefs about mental health.MethodsA constructivist grounded theory design was used to meet the aim of the study. Interviews were conducted with 13 public health nurses working in primary health care between October 2019 and June 2021, and the data analysis was performed according to the principles of Charmaz.ResultsThe core category, “Public health nurses as a relationship builder – to initiate the dialogue” reflected the process while the main categories “Being on your own”, “Being on top of things- knowing your limits”, and “Professional comfort zone” reflected conditions that were decisive for initiating a dialogue.ConclusionManaging mental health encounters in primary health care was a personal and complex decision-making process that depends on the public health nurses’ professional comfort zone and acquired mental health literacy. Narratives of the public health nurses helped to construct a theory and understand the conditions for recognizing, managing and promoting mental health in primary health care.

“Seeing the day-to-day situation”: A grounded theory of how persons living with dementia and their family caregivers experience the hospital to home transition and beyond

Most older adults with dementia live at home, they primarily receive care provided by family members and friends. Given the decline in memory and other cognitive functions, there to be higher rates of touch points with the health system for those living with dementia. Evidence has shown that these care transitions mark critical changes in the lives of older people, including significant and far-reaching changes to family caregivers. Therefore, it is imperative that complex social processes enacted by persons with dementia and their family caregivers in response to care transitions be more thoroughly explained. This study took place in Canada between 2019 and 2021 and adopted a constructivist grounded theory design. Twenty-five people participated in 20 interviews: 4 people living with dementia and 21 caregivers. We report on six concepts grounded in the data that are linked to a core process engaged in by the participants throughout the care transition journey and beyond: Seeing the day-to-day situation. This study contributes theoretically to the care transition literature by making explicit not only the visible work done by patient-caregiver days during the care transition journey, but it has also illuminated the ongoing processes engaged in by caregivers who are navigating the health and social care systems with their family member living with dementia. During the care transition, and beyond, the caregiver is forced to take over and connect the dots. Even though the caring experience is fraught with traumatic and very challenging situations, for many caregivers, they rise above and can reconcile their suffering with a desire to help their family member and others who may be going through similar experiences. This theory provides a foundation on which to develop theory-driven interventions that focus on support the patient-caregiver dyad during care transitions.

A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study.

This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic. A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data. A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior. The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.

Menstruation behaviour influencer model: a grounded theory of menstrual experiences of shame, embarrassment, stigma and absenteeism among pubescent girls in semi-urban and rural secondary schools in Enugu State, Nigeria.

severally, studies had identified menstrual-associated shame, embarrassment, stigma, and absenteeism among pubescents in school with resultant challenges on their bio psycho-social functioning. However, what is not clear is the contribution of the home and school to the experiences. The objectives of the study were to explore the experiences with menstruation and menstrual hygiene management; explore the experiences with menstrual-associated shame, embarrassment, stigma, and absenteeism among participants; explore the bio-psycho-social issues associated with the experiences; understand the meaning of the experiences and propose a mid-range theory that explains the influences on pubescents´ menstrual behaviours. constructivist grounded theory design was used to explore the experiences of 20 purposively recruited pubescents from rural and semi-urban secondary schools. In-depth Interviews, focused group discussions, key informant interviews, and observations were employed to collect data until data saturation. Open and focused coding was conducted to identify emerging themes and sub-themes. These themes were returned to participants and literature for verification. four (4) categories and eleven (11) sub-categories emerged from the data and formed four (4) themes that influence pubescents´ menstrual behaviour. They include: 1) individuals´ bio-physiological status, knowledge of menstrual health and menstrual characteristics; 2) regimenting school through strict rule enforcement, punishment/motivation, forced participation, and compliance; 3) scheduling academic activities/examination, sporting and other extra curricula activities; and 4) providing menstrual support by individual and institutional efforts to pubescents. Based on the relationship with other themes, the menstrual behaviour influencer model was proposed. menstrual influencers require the interaction between menstrual support and menstrual enablers by institutions for positive menstrual behavior. Failure to achieve this balance will lead to menstrual-associated shame, embarrassment, stigma, absenteeism, and school drop-out.

Barriers to the use of clinical practice guidelines: a qualitative study of Danish physiotherapists and chiropractors

Purpose Low back pain (LBP) is the leading cause of disability worldwide. Providing evidence-based practice (EBP) for patients with LBP is more cost-effective compared with non-EBP. To help health care professionals provide EBP, several clinical practice guidelines have been published. However, a relatively poor uptake of the guidelines has been identified across various countries. To enhance future implementation of EBP, the aim of this study was to explore barriers to using LBP guidelines in clinical practice. Materials and methods A qualitative constructivist grounded theory design was employed in order to gain an in-depth understanding of the barriers. Semi-structured interviews (+/− observations) of nine physiotherapists and nine chiropractors from primary care in the Central Denmark Region were conducted. Results Two key barriers were found to using guidelines in practice: (1) a scepticism due to doubts about validity and applicability of the guidelines, which emerged particularly among physiotherapists; and (2) a deep biomechanical professional identity, due to perceived role, interest, lack of skills, and patient preferences, which emerged particularly among chiropractors. Conclusions For guidelines to be better implemented in practice, these key barriers must be addressed in a tailored strategy. Furthermore, this study showed a difference in barriers between the two professions.

Adopting a ‘System of Caring' as a leadership strategy toward professionalisation within South African emergency medical services: A grounded theory

Professionalization is a key agenda within South African prehospital care. Emergency Medical Services (EMS) agencies continue to grapple with operationalising the process of professionalising, with a number approaches described in literature. This research presents a System of Caring developed within the context of EMS as an approach to achieving professionalization. Methods: A qualitative research design in the form of constructivist grounded theory design was used. Participants were enrolled using purposive and theoretical sampling. Data were analysed using coding procedures in a constant comparative analysis approach supported by theoretical sensitivity. Analytical diagrams consistent with grounded theory methodology were also employed, primarily in the form of inter-relational diagraphs. Results: Six main categories were established with associated coding lists. Coding lists were used to develop groups of propositions that were then abstracted to construct final analytical labels that captured the elements of the System of Caring. These elements include caring for the leaders, caring for the team, caring for the patient, caring for each other (collegial) and caring for self. The components of each element were also abstracted, and the System of Caring developed. Conclusion: While there are various well-established definitions for the term care, within the context of the perceptions of the participants of this study, care (and caring) means a combination of constructed environmental conditions and people-process practices that recognises the well-being of the people within the processes. This 'System of Caring' offers a practicable way to operationalise caring into the workforce and move toward exploring how to promote professionalism within the workforce, through a 'System of Caring'. While this may have been reasonably extrapolated before, this research allows for a poignant insight into how EMS agencies can promote professionalization within EMS systems within South Africa, through the 'System of Caring'.

Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory

BackgroundIntensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses’ burnout during the pandemic can help to develop appropriate mitigation measures. ObjectiveThe objective of this study was to examine intensive care nurses’ experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout. MethodsThe study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months’ experience in intensive care and experienced caring for COVID-19 patients. FindingsThis paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category ‘pandemic pervasiveness’ was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout. ConclusionMany issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses’ burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.

“We Have to Keep Advocating and Helping and Doing What We Can”: Examining Perinatal Substance Use Services in the Absence of Integrated Treatment Programs

Effective treatment of substance-exposed pregnancies requires gender-responsive care coordinated across agencies and systems. A deeper understanding of the perspectives, experience, and practices of professionals providing these services is needed to improve care. This study examines service provision for perinatal substance use through the perspectives and experiences of healthcare and social service professionals. Using a constructivist grounded theory design, data were collected over a 7-year period. Data collection consisted of interviews and focus groups with professionals as well as observations of professional meetings and workshops where practices and procedures were discussed. A multi-level model of service delivery is described. The role of affect, particularly around issues of custody, is discussed along with structural level actions that develop in the absence of integrated treatment. Structural support both within and across systems of care is crucial to developing coordinated and compassionate care and to increasing engagement in care services.

\u201cThe medications are the decision-makers\u2026\u201d Making reproductive and medication use decisions among female patients with rheumatoid arthritis: a constructivist grounded theory

ObjectiveTo examine how female patients with RA form decisions about having children, pregnancy, and medication use.MethodsWe employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model.ResultsWe recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system.ConclusionOur framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.

Higher education internationalisation at the crossroads: effects of the coronavirus pandemic

The COVID-19 pandemic has influenced nearly every aspect of people’s lives, and has set new conditions for universities to operate their internationalisation practices. Together with the rapidly changing global environment, higher education internationalisation has reached a crossroads. Through a constructivist grounded theory design, this study explores experts’ thoughts about the coronavirus crisis’s influences on the internationalisation of higher education and its future direction, taking different national and regional contexts into account. Interviews with 20 world-leading scholars in the field suggested that COVID-19 has had complex effects on university internationalisation and it is necessary to consider such effects beyond the simple distinction between challenges and opportunities. New approaches to conceptualise and implement internationalisation are essential, while the logic of capitalism remains powerful. When looking at the future, many factors other than the coronavirus will exert their force. New conditions have raised new requirements for internationalisation, and therefore, new knowledge is needed to maintain its relevance and sustainability.

Construction of a conceptual model of comprehensive care for Indonesian children with human immunodeficiency virus

PurposeTo construct a conceptual model of comprehensive care for Indonesian children with Human Immunodeficiency Virus. Design and MethodsA qualitative constructivist grounded theory design. Purposive sampling was used to interview 12 children with Human Immunodeficiency Virus and 8 family members with the age of the children ranged from 9 to 18 years, and 23 health professionals, including general practitioners, paediatric specialists, nurses, midwife, and nutritionist from public health centres and provincial hospitals in East Java, Indonesia. Data was analysed using constant comparative coding methods, theoretical sensitivity, memo writing, and diagramming to facilitate the development of the substantive theory. ResultsExploring the perspectives of the participants has revealed the need to enhance the delivery of comprehensive care across the continuum, because HIV care and services for children was sub-optimal. Understanding children's needs and preferences forms the foundation of the development of a framework for the comprehensive care of children with HIV consisting of child-centred care and social support, delivered by integration and coordination of care through a healthcare service. ConclusionsThe conceptual model provides new knowledge and has the capacity to bring together optimal care across the continuum addressing the challenges of fragmentation of care for children and their families. Practice implicationsThe model informs that children with HIV not only need pharmacotherapy, but also other care interventions depending on their individual needs, preferences, and age. Implementing the model may help to resolve such problems, to improve collaborative practice and enhance children's participation, thereby promoting children's health outcomes.

Exploring factors which contribute to the resilience of nurses working in the neonatal care unit: A grounded theory study

ObjectivesThis study aimed to produce a theoretical model to understand factors which affect the resilience of neonatal nurses.Nurses experience high levels of burnout due to the occupational stress they are exposed to. Burnout negatively affects both staff and patient outcomes, and in this population would likely affect the establishment of crucial early caregiver-infant relationships in the neonatal unit. Research suggests that increasing nurses’ resilience can protect them against burnout, thus understanding factors that affect resilience in this population is critical. Research methodologyThe study adopted a constructivist grounded theory design. Setting and participantsAll participants were qualified registered nurses employed on a permanent basis in a Level 3 neonatal unit.Thirteen registered nurses attended one individual semi-structured interview. A constructivist grounded theory approach was used to analyse the subsequent verbatim transcripts. FindingsThe resulting model identified that individuals working as nurses in the neonatal unit function within different systemic contexts: the nursing team; the family unit; the broader neonatal team; the National Health Service and their world outside the unit. Each context presents different practical, emotional and ethical challenges. These challenges are navigated through a combination of contextual, interpersonal and intrapersonal strategies. ConclusionsThe model is contextually embedded and extends existing literature pertaining to resilience of healthcare staff in other contexts. Suggestions are made in terms of adaptations to the organisational, social and individual contexts to benefit nursing resilience. Implications of the findings are also considered within the context of the ongoing Covid-19 pandemic.

‘Staying alive’ with antiretroviral therapy: a grounded theory study of people living with HIV in Peru

BackgroundTo achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004...