Substantive theory of family resilience among couples dealing with prostate cancer: A grounded theory study.

The genetic counseling certification exam, or "oard exam," is a four-hour, 200-question multiple-choice exam. Recently reported first-time pass rates were 80% (August 2024) and 54% (February 2025). The purpose of our study was to explore the experiences of Black, Indigenous, and People of Color (BIPOC) Board exam candidates during these two exam cycles. In 2022, we enrolled 25 BIPOC genetic counseling students in a longitudinal constructivist grounded theory study. Here, we report the results of interviews conducted with this cohort before and after they took the August 2024 (n = 16) and/or the February 2025 (n = 13) Board exam. Interviews were transcribed and analyzed using a constant comparative approach. Among our participants, pass rates were 11/16 (69%) in August 2024, and 5/9 (56%) for first-time and 2/4 (50%) for repeat test-takers in February 2025. We constructed five themes and an overarching theory. Theme 1: The Board exam does not reflect real-world practice, where genetic counselors work with limited time and resources, and emphasizes memorization of information that is readily available online. Theme 2: The likelihood of passing the Board exam is influenced by socioeconomic disparities, particularly in the challenging 2024 job market. Theme 3: Anxiety negatively impacted exam performance. Theme 4: Testing accommodations, such as extended time, were challenging to access. Theme 5: Participants perceived that Board exam outcomes were influenced by luck, because the lack of a detailed content outline forces candidates to self-direct study across hundreds of topics. We theorize that the Board exam is a poor measure of readiness for entry-level genetic counseling as it fails to reflect real-world practice and is influenced by factors unrelated to competence, such as socioeconomic status, mental health, ability to access accommodations, and luck. We recommend changes to the exam format and the provision of official study materials to reduce inequities.

How acute care nurses facilitate advance care planning for older adults with unplanned hospitalizations: A qualitative study.

BackgroundSocio-economic changes and evolving family structures have created unique caregiving challenges in China, highlighting the need for tools to systematically measure child care deficits. This study aims to develop and preliminarily validate the Inadequate Child Care Scale (ICCS), a culturally relevant instrument designed to measure deficits in child care specific to the Chinese context.MethodsThe development and validation of the Inadequate Child Care Scale (ICCS) were conducted through a three-phase process. Phase One involved the generation of an initial item pool informed by a prior grounded theory study. Phase Two included nationwide data collection via a structured survey administered to participants across diverse regions in China. Phase Three focused on evaluating the psychometric properties of the ICCS using Exploratory Factor Analysis (EFA; n = 468) and Confirmatory Factor Analysis (CFA; n = 702), with an emphasis on assessing convergent validity, discriminant validity, and composite reliability.ResultsThe initial item pool comprised 32 items, 30 of which were retained following expert evaluation for content validity. EFA revealed a four-factor structure underlying the scale: Inadequate Daily Life Care, Inadequate Psychological and Emotional Care, Inadequate Safety Care, and Inadequate Educational Care, encompassing 30 items in total. CFA supported the factorial validity of the ICCS, yielding favorable model fit indices (GFI = 0.929, CFI = 0.977, TLI = 0.975, RMSEA = 0.038, χ²/df = 2.025). The scale demonstrated strong internal consistency (Cronbach’s alpha > 0.80) and acceptable test-retest reliability.ConclusionThe ICCS is a psychometrically sound tool for assessing child care deficits in China. Its development fills a critical gap in child care research and provides a foundation for targeted interventions and policy reforms. Future studies should refine the scale further and explore its applications in broader caregiving contexts.

Forms of involving children and young people during nursing procedures: A grounded theory study building on the concept of child centred care.

Over the past decades, an increasing number of adults in the United States have begun identifying as nonreligious, despite many being raised in religious homes. Research has demonstrated that religious disaffiliation and religious differences can create relational distance and challenges in families. However, little research has explored these impacts on intergenerational relationships. With parents' perspectives as a focal point, given their role as gatekeepers between their children and their children's grandparents, we employed a grounded theory approach to the analysis of in-depth interviews with 29 nonreligious different-gender married couples (N = 58 parents), through which we identified four broad themes related to religious differences in intergenerational relationships: (a) engaging in familial religious traditions, (b) religious boundaries with family of origin, (c) children's upbringing as a point of conflict, and (d) children as a relational bridge. Based on connections between these themes, we developed the first (to our knowledge) conceptual model of how nonreligious parents navigate religious differences and intergenerational relationships, titled the Structure of the Influence of Religious Differences on Intergenerational Relationships model. Implications focused on helping families navigate religious differences both through and independent of therapeutic contexts are offered in light of this model. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

ABSTRACT Leisure activities are particularly employed as a significant intervention tool in the rehabilitation of prisoners within correctional institutions. Primary purpose of this study is to provide a theoretical framework that explains the effects of physical – based leisure activities for prisoners and the secondary purpose is to contribute to the understanding of how the effects derived from leisure activities differ according to the type of activity (serious and casual). Research design is based on a qualitative research method: the grounded theory approach. Participants consist of 19 prisoners (mean age = 33.3), selected through criterion sampling, a purposive sampling technique. The effects of leisure activities organised by the prison administration are classified into three main categories: basic, psychological, and growth effects. These effects vary depending on the type of participation. While casual leisure activities provide basic and psychological effects, serious leisure activities are found to offer more comprehensive effects, including growth effects. The findings propose a new effects model that underscores the critical role of physical – based leisure activities in enhancing the prison environment and supporting prisoner rehabilitation, thereby drawing attention to the extensive advantages of leisure involvement.

ABSTRACT Traumatic brain injury (TBI) is associated with an array of physical, psychological and social changes. Adopting positive coping mechanisms following a TBI is important in maximising recovery outcomes including psychological wellbeing and quality of life. Using grounded theory methodology, this study explored the lived experiences of individuals recovering from severe TBI and the development of coping strategies. The research responds to a recognised gap in survivor-centred literature by prioritising the voices of individuals living with the long-term consequences of TBI. Semi-structured interviews were conducted with eight participants who sustained severe TBIs, capturing rich qualitative data on the psychological, social and cognitive challenges encountered during recovery. Five interrelated factors emerged as critical to the development of coping strategies: Purpose, Management and Acceptance which were found to interact dynamically, with Support and Understanding determining to adoption of Effective TBI Coping. The resulting TBI Model of Coping offers a survivor-informed framework that provides new insights into recovery processes following severe TBI. This research highlights the importance of tailored psychological support and the need for interventions that consider the multifaceted nature of coping. The model has practical implications for neurorehabilitation services and contributes to the advancement of personalised care for TBI survivors.

ABSTRACT Recent strides in Artificial Intelligence (AI) have made using AI to automate the process of sermon preparation a possibility. However, AI’s process of preaching is still poorly understood. This paper contributes by evaluating 27 evangelistic sermons generated by ChatGPT using Grounded Theory to study its process of preaching the gospel. The study revealed ChatGPT’s use of sharing personal testimony, delivering the gospel as found in the Bible, and appealing to unbelievers to preach the gospel. The necessity of the transformative power of the gospel was identified as the core category. Theological comprehensiveness and orthodoxy of the sermons were also evaluated.

Compassion, defined as awareness of suffering, empathic attunement, and action to alleviate it, has been widely recognized in health care yet seldom examined systemically within Health Emergency Management (HEM). In Sri Lanka, recurrent crises provide a unique context for understanding how compassion is experienced, enacted, constrained, and sustained across the emergency management system. A constructivist grounded theory study was undertaken through 23 semi-structured interviews with professionals across national, district, and divisional levels, including health staff, administrators, pre-hospital services, security forces, disaster managers, civil society, disability activists, and community representatives. Online interviews were conducted in Sinhala and English, recorded with consent, and analyzed using open, axial, and selective coding with constant comparison and iterative memoing. Findings indicated broad recognition of compassion as essential in health emergencies, yet fragile in the face of stress, rigid rules, poor leadership, and resource shortages. Compassion emerged through interconnected layers: individual roots of upbringing, education, faith, and prior adversity; organizational stems shaped by resources, adaptive policies, and leadership culture; systemic flows of reciprocity between leadership, staff, patients, and communities; and cultural-philosophical traditions such as the Brahma Vihāras and Sangraha Vasthu that infused humanitarian practice with deeper ethical grounding. While some respondents perceived tension between compassion and humanitarian principles, narratives demonstrated that compassion reinforced and animated these principles when supported by organizational flexibility and cultural ethics. Instances of compassionate problem-solving contrasted sharply with harms caused by rigid application of insensitive rules. The Lotus of Compassion in Health Emergencies Model synthesizes these findings, depicting compassion as seeds of innate potential, roots of individual formation, stems of organizational support, leaves of everyday practice, and flowers of visible expression in crises, nourished by leadership as sun and sustained by beneficiary reciprocity as bees and air. Compassion in Sri Lanka’s HEM is thus not an intangible or abstract value but a systemic quality that strengthens resilience and operationalizes humanitarian principles in practice.

This study aimed to immerse itself in the most important cultural aspects that tourists see as the main part of their food experience in Chongqing, a city with an active culinary life. We used semi-structured and in-depth interviews with 50 tourists who had recent culinary travel experience in Chongqing. The interview data were systematized with the grounded theory coding process. It was found that six essential themes characterizing the cultural climate of the culinary experience in Chongqing can be taken as Sensory Immersion, Atmospheric Energy (Yanhuoqi), Communal Dining, Procedural Knowledge, Historical Symbolism, and Authenticity Seeking. The research adds a multi-dimensional and granular paradigm for perceiving cultural aspects of a food destination. Through the deconstruction of the taste of place, it gives detailed, contextual information about the manner in which the tourists both interpret and experience food culture. The results have profound practical implications for both destination marketers in relation to the manner in which they can develop powerful cultural narratives and to policymakers on the role of maintaining intangible culinary heritage.

This grounded theory study examines how socioeconomically disadvantaged and predominantly Black fathers construct fatherhood identity amid systemic adversity. Drawing on 11 focus groups with 40 fathers enrolled in a U.S. Midwestern fatherhood program, the study explores the multidimensional nature of fatherhood and the ways in which structural, interpersonal, and identity-based factors shape paternal engagement. Using iterative coding and comparative analysis, findings reveal three central themes: (a) evolving dimensions of engaged fatherhood that transcend biological ties and traditional patriarchal norms; (b) navigation of intersecting structural challenges, including incarceration, racism, and financial instability, that constrain father involvement; and (c) the role of trauma, social support, and cultural identity in fostering resilient fatherhood. Using a trauma-informed, life-course framework in combination with intersectionality and critical race theory, this study develops a conceptual model illustrating how marginalized fathers balance systemic pressures with sources of strength, such as peer support, co-parenting, and emotional growth. The analysis challenges deficit-based narratives by highlighting fathers' adaptive strategies and internal motivations to remain present in their children's lives. Implications include the need for culturally responsive, trauma-informed programming and policies that affirm marginalized fathers' capacity to nurture, guide, and advocate for their children despite structural inequities.

This constructivist grounded theory study drew out interpretivist understandings of Fijian female Muslims’ perceptions of international Muslim environments, including their counterparts. Underpinned by intersectionality theory, it examined simultaneous influences of gender and religion in impacting tourism of female Muslims, that is, amplifications of both identities on each other. The current study interviewed 27 female Muslims of distinctive backgrounds (e.g. socio-demographic, religiosity). It drew out insights that were not essentialised to female and Muslim perspectives but subjective to female Muslims. In addition, this study highlighted similarities and differences, in terms of cultural familiarity and novelty, within female Muslims internationally, thus the intersectional theoretical underpinning probed into intra-group experiences. Related themes centered on themes were developed: “Cultural Familiarity”, “Cultural Novelty”, “International Female Muslim Interactions” and “Self and Social Transformations”. The current study was situated in the Fijian Muslim community, a Muslim-minority and non-western context in the Oceania-Pacific region.

The transnational family lives of unaccompanied minors (UMs) have gained increasing attention in academic discourse. Transnational family relationships are highly heterogeneous. The aim of this study is to present a typology on the diversity of UMs’ transnational family relationships in order to gain a nuanced view on family relationships. This helps to structure and understand the diversity of experiences relating to transnational family relationships and can serve as a basis for more differentiated research and professional support in practice. This constructivist grounded theory study involved the analysis of 35 semi-structured interviews that were carried out in Germany with (former) UMs (n = 12), social workers/pedagogical staff (n = 20), and experts (n = 3). Five types of UM transnational family relationships were identified. Type 1 describes UMs who do not wish to maintain family contact across borders. Type 2 encompasses UMs who do not have the possibility to maintain transnational family relationships despite wishing to do so. Type 3 involves unstable/ambivalent transnational family relationships, and Type 4 refers to UMs with permanent/regular transnational family contact. Type 5 describes UMs in transition from transnational family contact to face to face contact. Specific characteristics, experiences and stressors, UMs’ aims, perspectives on family reunification, and need for social work support are presented with regard to each type. This study underscores the continued importance of transnational family relationships to displaced UMs and highlights the need to view the diversity of UMs’ transnational family relationships in a nuanced way in research and professional practice.

The paediatric intensive care unit (PICU) is a highly stressful environment affecting children, families and staff. Patient diaries, common in adult intensive care and valued for supporting psychological recovery, are less established in PICUs. Further research is needed to address gaps in understanding diary impact within paediatric settings. The aim of the study was to examine how PICU patient diaries are used by children, families and HCPs. The qualitative approach, Constructivist Grounded Theory, was adopted to ground the meanings and actions constructed by the participants. Eleven families were intensively interviewed initially during their child's PICU admission to a combined general and cardiac unit in the UK. Six families were interviewed post-discharge from the hospital, at follow-up. Ninety-five nurses and health care assistants were interviewed in five focus group interviews. PICU diaries provided a communication tool which strengthened relationships between the parent and their child, nurses and other family members by Creating Connections. The relationships fostered were viewed as Impacting Emotionally on parents and nurses. In an environment with an imbalance of power, the diary supported parental autonomy by Empowering Involvement to make decisions. Providing clear explanations of their child's PICU admission, the patient diary filled any gaps in memory and offered an easily understandable permanent record. Therefore, the diary was a valuable resource supporting Making Sense of the child's complex critical illness journey. The UPDATE study provides an understanding of the role of PICU diaries as a tool for both parents and nurses. These diaries serve as clear and accessible records, bridging gaps in knowledge. By empowering families and healthcare professionals, PICU diaries support the navigation of the complexities inherent in PICU admissions and contribute to Making Sense to enhance clinical practice and compassionate care. The theory generated offers understanding of the impact and use of PICU diaries and the multidimensional use of the diary for the child's parents and nurses to explain and understand the critical illness experience.

Nursing knowledge is neither fixed nor uncomplicated but outcomes driven and competency-based standards underpinning nurse education can result in the dilution of pedagogical principles and a prescriptive and cultural reproduction of knowledge in nursing students. To examine how student nurses navigate the second year of an undergraduate degree programme in the UK and how different learning environments (practice and university) and previous experiences influence their perceptions, meanings and identity. Longitudinal constructivist grounded theory design underpinned by symbolic interactionism and social realism using focus groups and individual interviews. One Higher Education Institution in Northwest England. Year 2 BSc Nursing students (n = 11) FINDINGS: A substantive theory, 'Navigating the second-year landscape: How student nurses construct an identity and engage with knowledge in the second year of an undergraduate degree' was underpinned by six categories: (1) the perceived identity of year two; (2) re-evaluating past, present, future; (3) constructing and balancing identities; (4) engaging with knowledge; (5) reference groups: significant others and the generalized other; and (6) the hidden curriculum: professional socialisation. Students place importance on and seek familiarity in the clinical environment and this can constrain opportunities for deeper critical engagement and hinder the development of autonomous practitioners capable of independent, reflective and critical thinking. Year two marks a pivotal stage in professional identity development and students seek knowledge and guidance from 'significant others' - typically their peers. Informal and hidden elements of the curriculum can influence students' learning and professional identity formation. Findings may have wider implications for opening international discourse on competency-based education including potential transferability to other practice-based professions.

This study examines the decision-making processes of young Iranian adults who intentionally delay marriage. In recent decades, economic shifts, expanded educational opportunities, and evolving cultural values have transformed marriage patterns in Iran, challenging traditional expectations of early marriage. Using a grounded theory approach, qualitative interviews were conducted to explore participants’ lived experiences. Analysis identified key motivations for postponing marriage, including financial independence, educational attainment, emotional maturity, and personal growth. Findings reveal that delaying marriage is a strategic response to modern life complexities rather than merely a reaction to hardship. Two major consequences emerged: empowerment through independence, enhancing life choices and agency; and emotional sacrifice, including loneliness, suppressed emotions, and tension with traditional norms. Overall, marriage delay reflects young adults’ active negotiation of uncertainty and societal expectations. Policies supporting education, employment, housing, and more flexible cultural narratives may assist youth in navigating diverse pathways to adulthood and family formation.

Workplace bullying has become an increasingly salient issue in higher education, particularly within private universities where governance arrangements and employment conditions differ substantially from those of public institutions. Existing research has largely focused on individual risk factors or outcomes, offering limited insight into how workplace bullying is generated and sustained within specific organizational contexts. This study examines the processes through which workplace bullying emerges and persists among teachers in Chinese private universities. Using a constructivist grounded theory approach, this study draws on 6 months of fieldwork, including in-depth interviews with 34 participants (teachers, administrators, and students) and supplementary focus group discussions conducted in two private universities in China. Data were analyzed through iterative open, axial, and selective coding to develop a process-oriented model grounded in participants’ lived experiences and multiple informant perspectives. The findings reveal that workplace bullying is not an isolated interpersonal phenomenon but a structurally embedded organizational process. Power-dominated evaluation and promotion systems, relationship-based governance practices, and gendered forms of control interact to shape teachers’ everyday work experiences. Through mechanisms such as technological monitoring, social exclusion, and moralized performance evaluation, these organizational arrangements erode teachers’ professional identity and emotional resources, producing structural silence and enforced compliance. In addition, strong occupational identity attachment and constrained career mobility limit teachers’ capacity to exit unfavorable work environments, allowing workplace bullying to be reproduced and sustained over time.

To describe and understand relationships between paediatricians and industry in Colombia. Mixed methods study composed of three phases: quantitative (cross-sectional study, e-survey to paediatricians) describing interaction patterns and evaluating the factors that explain the perceived need for industry visits to health services and their influence through multivariate analyses; qualitative (grounded theory study, semistructured interviews) to create an explanatory theory; and an integrative phase (mixed methods explanatory study). We surveyed 218 paediatricians (mean age, 45.2 years), nearly all of whom interacted with industry monthly, mainly with the commercial milk- formula industry (CMFI). Sponsored trips to attend conferences and not having teaching activities were associated with a perception of the potential effects of the trips on prescribing practices. Moreover, being sponsored for an international trip was associated with the perception of indispensability of industry visits for maintaining continuing medical education (CME). In the qualitative phase, four phenomena emerged; two related to the quantitative findings: 'Paediatrician's dependence on industry for CME', and 'Colombian health context facilitates a closer relationship between paediatricians and industry'. Two emerged as explaining factors: 'Normalisation of paediatrician-industry interaction' and 'Paediatrician's prescriptive power: mediator between their conflict of interest with industry and patients'. The integration showed how the qualitative phase explained the quantitative findings. Most paediatricians frequently interact with industry, mainly with the CMFI, and this is perceived as necessary for CME. The normalisation of the paediatrician-industry interaction leads to the underestimation and invisibility of its effects, which fosters the notion of its necessity for the paediatric field.

The Experiences and Needs of Individuals with a Variant of Uncertain Significance on Genetic Tests for Hereditary Cancer Syndromes:A Grounded Theory Study.