Background:Patients with cardiovascular diseases who also suffer from substance use disorders face distinct challenges in nursing care. Similarly, nurses encounter various caregiving challenges. Therefore, this study aims to explore the nursing care process for patients with co-occurring cardiovascular diseases and substance use disorders.Materials and Methods:This grounded theory study, informed by Strauss and Corbin (2015), was conducted at the University of Social Welfare and Rehabilitation Sciences in 2023. The participants consisted of 23 nurses, patients, and other treatment team members, who were purposefully selected from the cardiac and internal cardiac intensive care units of hospitals in Iran. A total of 25 semi-structured interviews were conducted to collect data, with the primary question being: “How is nursing care provided to cardiac patients with substance use disorders?” The primary analysis strategies employed included constant comparison, data questioning, and memo writing.Results:The analysis revealed six main categories: the complexity of care, an inappropriate work environment, and insufficient nurse competency as conditions; discrimination in care and informal care as strategies; and nurse-patient dissatisfaction as consequences. Based on the findings, nurses employ unstructured care to address their most pressing concerns.Conclusions:Nurses encounter various challenges when caring for patients who receive ineffective and unstructured care, which often leads to adverse outcomes. Consequently, developing appropriate care guidelines is essential. Based on the study’s findings, nurses, managers, and researchers can collaborate to enhance care quality and improve nurses’ professional competence.

This study explores the impact of Traditional Chinese Physical Activities (TCPAs), such as Tai Chi and group dancing, on the well-being of non-working full-time mothers. Using a grounded theory approach, semi-structured in-depth interviews were conducted with 40 full-time mothers actively engaged in TCPAs. Data were analyzed through open, axial, and selective coding. Findings revealed that TCPAs function as embodied socio-cultural practices, enhancing emotional regulation, physical vitality, and social belonging. Three key pathways of influence were identified: structural embodiment, communal belonging, and cultural identity reinforcement, forming the core of the "empowerment through embodied tradition" theory. The study highlights the significance of TCPAs in improving full-time mothers' well-being-a demographic often overlooked in public health policies. It recommends that urban planners and health promoters adopt community-based, culturally rooted strategies to enhance accessibility to these activities.

This grounded theory study examined the work-life experiences of LGBTQIA+ managers in Cebu City’s BPO industry to explain how they navigate professional challenges and drive inclusion. Using semi-structured interviews and observations, data were analyzed inductively, revealing three core thematic dimensions: inclusion, authenticity, and balancing personal–professional identities. From these insights, the COREX Theory: Courage, Openness, Resilience, Empowerment through Intersectionality emerged. COREX posits that intersecting identities can function as leadership assets, enabling LGBTQIA+ managers to reshape organizational structures and cultures toward greater equity. The theory reframes intersectionality as an active driver of leadership development, promoting adaptive strategies and collective empowerment across personal and institutional levels. While geographically bounded, COREX offers transferable insights for scholars, policymakers, and organizational leaders committed to fostering inclusive, culturally responsive workplaces that recognize and leverage the unique leadership strengths of LGBTQIA+ professionals.

PurposeCoronary artery bypass grafting (CABG) is an essential intervention for treating coronary artery disease. However, the effectiveness of postoperative rehabilitation often depends on the implementation of early mobilization by patients. In practice, adherence to early mobilization post-CABG is frequently suboptimal. This study focuses on patients who have successfully implemented early activity post-CABG, exploring the situational factors that facilitate early mobilization.Patients and MethodsSemi-structured interviews were conducted with 15 post-CABG patients from three hospitals in Shanghai who had successfully implemented early mobilization. Data collection was conducted from October 1, 2024 to December 31, 2024. Utilizing a constructivist grounded theory approach, the interview guide was modified based on emerging themes throughout the study.ResultsPatients who successfully implement early mobilization typically undergo three main stages: intention, initiation, and maintenance. The study identified three main domains influencing these phases: Core Context (including the perception of the importance of exercise rehabilitation, understanding and beliefs about early mobilization, positive personal experiences with physical activity, and observing positive outcomes from others’ activities); Essential Conditions (including physical condition, psychological preparedness, knowledge literacy, and initial outcomes); External Factors (including the atmosphere and promotion of early mobilization, the development of an exercise rehabilitation system from pre-surgery to ICU to ward, and social support).ConclusionThis study provides a new perspective by examining the situational factors associated with the successful implementation of early mobilization after CABG. By focusing on successful cases, healthcare professionals can better understand the implementation process and experiences, enabling them to develop targeted interventions to improve adherence.

This study aims to explore the needs and expectations of students with physical disabilities and their professional development within the scope of rehabilitation psychological counseling and to develop a model based on the data obtained by taking the opinions of employers who employ individuals with disabilities. For this purpose, grounded theory, which is one of the qualitative research designs, was used. The data were collected through semi structured interviews, and the "Interview Form" developed by the researcher was used during the data collection process. The data were analyzed according to open, axis, and selective coding, and core categories, categories, and sub-categories were created. As a result of the research, the concept of "having a disability" was determined as the core category for individuals with physical disabilities and employers. Depending on this core category, categories and sub-categories were created both in the dimension of individuals with physical disabilities and in the dimension of employers. According to the results of the study, high school students with disabilities between the ages of 14-18 need to discover their strengths, learn effective coping skills, have effective role models and supportive relationships; they have important expectations of being successful in the educational and professional fields and getting a job where they can help other people in line with their abilities, but they do not have expectations in the romantic field. Suggestions for applications and research that can be done in future studies in both groups are presented.

Generative artificial intelligence (GenAI) is advancing rapidly and is increasingly integrated into educational settings. How to effectively leverage GenAI to support instructional design has thus become a critical issue in teacher education. While existing studies have validated the technical potential and functional value of GenAI in instructional design, there remains a notable gap in qualitative investigations into pre-service teachers’ subjective willingness to adopt GenAI and its underlying influencing factors. To address this gap, this present study employed grounded theory to explore the factors that shape pre-service teachers’ intention to use GenAI for instructional design. Semi-structured interviews were conducted with 23 pre-service teachers from Shaanxi Normal University, and the data were analyzed through open coding, axial coding, and selective coding. A theoretical model comprising four major dimensions was developed as follows: (1) technical factors (relative advantage and ease of use), (2) environmental factors (social impact, opinion leader, and facilitating conditions), (3) usage characteristics (purpose of use and method of use), and (4) psychological factors (trust, perceived risk, and a professional self-concept). The findings reveal that pre-service teachers’ intention to use GenAI is not shaped by a single factor but is instead the result of dynamic and interrelated interactions among the four dimensions. This study extends current technology acceptance theories and offers practical insights for the effective integration and promotion of GenAI in instructional design.

Abstract Online interactive learning plays a crucial role in improving online education quality. This grounded theory study examines: (1) what key factors shape EFL learners’ online interactive learning, (2) how these factors form an empirically validated model, and (3) how they interact within this model, through systematic analysis of 9, 207 discussion forum posts from a Chinese University MOOC platform. Results demonstrate that learning drive, course structure, teaching competence, interaction behavior, expected outcomes, and online learning context significantly influence EFL online interactive learning. The analysis reveals two key mechanisms: expected outcomes mediate the effects of learning drive (β = 0.45), course structure, teaching competence, and interaction behavior (β = 0.35) on learning outcomes, while online learning context moderates these relationships (β = 0.25). Specifically, learning drive provides intrinsic/extrinsic motivation, whereas course structure, teaching competence, interaction behavior, and expected outcomes collectively enhance interaction quality and sustainability. These findings, derived through rigorous grounded theory methodology involving open, axial, and selective coding of large-scale interaction data, yield three key contributions: (1) a comprehensive theoretical model of EFL online learning dynamics, (2) empirical validation of mediation/moderation mechanisms, and (3) practical strategies for designing scaffolded interaction protocols and adaptive feedback systems. The study establishes that its theoretically saturated model (achieved after analyzing 7, 366 posts with 1, 841 verification cases) offers educators evidence-based approaches to optimize collaborative interaction in digital EFL environments.

ABSTRACTIntroductionLiving with a suicidal relative impacts multiple life aspects. However, it is not known how religious beliefs and meaning‐making influence relatives' experiences.AimThis study aimed to develop a theoretical framework to understand the role of religion in the experiences of Christian relatives living with a suicidal loved one.MethodsA constructivist grounded theory study was conducted, adhering to the COREQ checklist. Fifteen interviews were conducted with seventeen Christian relatives of suicidal individuals.ResultsFour themes emerged—acceptance of suicidality, seeking and experiencing God's help, surrendering to God, and religion's influence on relationships—forming a framework on how relatives' religious convictions about suicide and the intensity of their personal relationship with God influenced to what extent religion was helpful or harmful.DiscussionChristian faith provided peace of mind and support to relatives who had a personal relationship with God and believed their loved one would go to heaven. Relatives who believed their loved one would go to hell due to suicide and lacked a relationship with God experienced guilt and fear, making them vulnerable to harm from religion.Implications for PracticeEducational institutions and policymakers should specifically empower nurses to discuss spiritual issues when supporting relatives of suicidal individuals.Relevance StatementThis study offers valuable insight into the role of religious beliefs and meaning‐making influencing the experiences of Christian relatives living with a suicidal loved one. It highlights religion‘s role in their coping processes. The findings equip mental health nurses with a deeper understanding of religious coping strategies, enabling them to provide better support to relatives. Integrating spirituality/religion into support allows nurses to respond more holistically to relatives‘ needs, potentially improving their well‐being and resilience. Spiritual care is a part of nursing, but nurses feel unprepared. It is recommended that education and policy focus on nurses to better support relatives.

BackgroundDuring the transition to parenthood, fathers face psychosocial changes that are accompanied by uncertainty and insecurity. Feelings of insecurity may affect fathers’ experiences of pregnancy and childbirth, adjustment to the paternal role, and bonding with their child. There is a need to better understand fathers’ experiences of security and the causal and constitutional factors involved. The aim of this study was to develop a theoretical model of how fathers’ sense of security is constructed during pregnancy and childbirth, with a focus on fathers who are present at birth.MethodsIn line with Corbin and Strauss, a grounded theory methodology was used. The data were analysed using the principles of concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing. A total of 24 interviews were conducted 4 to 14 months after the birth of the participants’ last child during the 2016–2019 period.ResultsGetting one’s bearings during pregnancy and childbirth emerged as the main category for fathers’ sense of security during pregnancy and childbirth. Six categories, ‘preparing for childbirth’, ‘agreeing with her decision’, ‘assessing and weighing risks’, ‘building a trusting relationship with professionals’, ‘taking appropriate supportive role(s)’ and ‘analysing the birth process’, underpin the core category and represent fathers’ strategies for achieving or maintaining orientation in changing situations. Fathers’ orientation strategies are influenced by factors such as personal skills, information, experiences, and the characteristics of professionals in either supportive or inhibiting ways. When fathers succeed in getting their bearings in particular situations, this success opens up possibilities for action and gives them a sense of control. In contrast, a lack of orientation may lead to fathers’ inability to act and may be accompanied by feelings of stress or worry about their female partner and child.ConclusionsMothers’ wishes and needs and the competence of professionals are two essential sources of orientation strategies for fathers. Getting their bearings enables fathers to perceive themselves as competent and to cope with the uncertain and potentially challenging situation of childbirth. A better understanding of the factors that contribute to fathers’ sense of security can help professionals effectively support fathers’ need for security during pregnancy and childbirth.

ABSTRACT Addressing education needs for children whose formal schooling options are limited due to geographical, socioeconomic, racial, or developmental barriers remains an enduring challenge, with global progress flatlining over the last two decades. Although most nation states have adopted right to education mandates, meeting holistic education needs of children requires schooling opportunities to be available, accessible, acceptable, and adaptable. Addressing these collective needs calls for solutions that are rigorous, flexible, and adaptable to diverse context-specific and individually defined learning needs of children worldwide. Although Montessori education methods and philosophical underpinnings hold promising solutions to meet global education needs, its diverse application and use remains underrepresented in the literature. This constructivist grounded theory explored diverse application of Montessori programs worldwide. Analyses were informed by a multi-phase, multi-year investigation from 34 interviews with practitioners (N = 31) in 14 countries to understand where (contexts), why (purposes), and how (processes) the Montessori approach was applied. Resulting theoretical models demonstrate diverse application, adaptation, and implementation processes evident in Montessori settings. Within the context of its vast adaptability, Montessori education may be aptly applied to meet the learning and development needs of children in any setting and under virtually any condition.

The formation of palliative treatment intentions among patients with advanced gynecological cancer in China: A grounded theory study

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical psychologists regarding online psychotherapy for patients with suicidal behavior in the context of the COVID-19 pandemic, to generate a theoretical understanding of this experience. It is a qualitative, exploratory, longitudinal study based on the Constructivist Grounded Theory framework. Ten clinical psychologists who conducted online psychotherapy for patients with suicidal behavior during the pandemic were interviewed at two moments, with an interval of approximately two years: the first round was conducted from December 2020 to March 2021, followed by a second round between November and December 2022. Data analysis led to four categories: (1) Reflecting on suicidal behavior; (2) Addressing specificities of online interventions; (3) Managing suicidal behavior in online psychotherapy; (4) Evaluating online psychotherapy for patients with suicidal behavior. The theoretical model “Pathways of care: main roads and access routes in online psychotherapy for suicidal behavior” was constructed. It was concluded that online psychotherapy for patients with suicidal behavior is complex and requires caution but is feasible and can be important in specific circumstances. This makes it an additional resource for suicide prevention and mental health promotion.

Background and Rationale: Visceral disorders, both functional and organic, significantly impact health-related quality of life and pose a challenge for healthcare systems. Osteopathy offers manual, systemic, and patient-centered approaches for their management, yet these remain controversial due to limited scientific support and methodological inconsistencies. In the evolving landscape of healthcare regulation in Europe, and particularly in Italy, exploring clinical reasoning and operational models in visceral osteopathy is essential. This study aimed to explore the beliefs, clinical reasoning, and management strategies of experienced Italian osteopaths in the treatment of visceral disorders using a Constructivist Grounded Theory approach. Methods: This qualitative study applied a Constructivist Grounded Theory approach to explore the beliefs and clinical practices of 10 experienced Italian osteopaths. Semi-structured interviews were transcribed, coded, and thematically analyzed, integrating literature comparisons to support theory generation. Results: Four core themes emerged: (1) education and professional development, (2) definition and identification of visceral disorders, (3) clinical management strategies, and (4) multidisciplinary collaboration. The findings reveal marked heterogeneity in diagnostic frameworks and treatment rationales, often driven by tradition and subjective interpretation rather than empirical evidence. Palpatory assessments were frequently prioritized over patient-reported outcomes. Conclusion: The study highlights substantial fragmentation in Italian visceral osteopathic practice, echoing challenges across Europe. Promoting a shift towards critical thinking, evidence-based models, shared terminology, and interprofessional integration is essential for contextualising osteopathic contributions to the care of individuals presenting with visceral-related problems. These findings provide insights into the fragmented clinical practices of Italian osteopaths and may contribute to shaping a more critical and evidence-informed approach within Italian osteopathic practice and professional development, which is now more relevant than ever, given the recent integration of osteopathy into the Italian higher education system.

International standards of juvenile justice make clear that the societal response to juvenile delinquency must extend beyond sanctions and behavioral control. A child’s developmental needs and well-being must also be prioritized. However, the needs of children are complex and require the engagement of a variety of professionals and institutions. This paper presents a grounded theory study of the professional response to juvenile delinquency in Lithuania. In-depth expert interviews were conducted with 15 participants representing related professional systems in Lithuania. Responses were analyzed in relation to legal and administrative regulations relevant to juvenile delinquency. Findings indicate that the predominant strategy employed by professionals and institutions is pseudo-recognition. Pseudo-recognition is simulation of assistance but not genuine assistance. The defining feature of pseudo-recognition is inconsistency between public declarations and actual actions. It is oriented toward the interests of professionals and institutions, not the interests of juveniles. Pseudo-recognition is employed when lack of resources, pressure, and false responsibility are present. The study revealed that Lithuania’s current approach to juvenile delinquency bears traces of the Soviet legacy even 30 years since the country’s liberation from Soviet occupation. A hypothesis that pseudo-recognition in Lithuania is linked to totalitarian experience of Sovietism is offered for further research.

In digital societies, social media has emerged as a critical arena for immigrant communities to engage in identity construction, yet there remains limited research on identity negotiation within specific digital platforms in the Chinese context. This study examines how Mainland Chinese immigrants negotiate identity, express emotions, and engage in social interactions on Hong Kong’s LIHKG platform (a locally dominant online forum established in 2016 that serves as Hong Kong’s primary community discussion platform) to adapt to the local socio-cultural environment. The research conceptualizes place as both physical location (Hong Kong as destination) and digital space (LIHKG as virtual locale), exploring how these intersecting spatial dimensions shape identity construction processes. Using grounded theory methodology, we analyzed 800 platform posts and conducted in-depth interviews with 20 Mainland Chinese immigrants. Results reveal a dynamic identity negotiation process characterized by four patterns (integrative, confrontational, collaborative, and avoidance) that immigrants strategically employ across different contexts. Place emerges as a fundamental organizing principle, with immigrants navigating between physical Hong Kong, digital platform spaces, and imagined cultural territories in their identity work. Emotions emerged as critical resources in identity construction, with specific regulation strategies developed to navigate exclusionary experiences. Interactions between immigrants and locals demonstrated significant topic differentiation, with political discussions exhibiting heightened boundaries while professional and everyday topics facilitated collaborative engagement. LIHKG’s platform features—including anonymity mechanisms and voting systems—fundamentally shape these identity expressions and group dynamics. This research contributes to migration studies by incorporating both digital and physical place dimensions into traditional frameworks, integrating emotional sociology, and developing localized theoretical models specific to Hong Kong-Mainland relations. The findings offer implications for digital inclusion policies, platform governance, immigrant support services, and construction of inclusive public discourse across multiple place-based contexts.

ObjectiveThe retention rate of Bariatric Surgery (BS) remains a critical concern, yet the decision-making mechanism among obese individuals considering BS is still unclear. This study aims to identify key stages and core mechanisms in the BS decision-making process.DesignQualitative, one-on-one, and focus group in-depth interviews were conducted.MethodsSemi-structured interviews were conducted in China from September 2022 to February 2023. Using the Straussian Grounded Theory (SGT) approach, an iterative analysis of the BS decision-making process was performed, ultimately constructing a decision-making mechanism for obese patients opting for BS. Reporting followed the SRQR checklist.ResultsInterviews were conducted with 21 obese individuals scheduled for BS one day before surgery. A theoretical model was developed to describe and explain the BS decision-making process. The study identified five key stages in the decision-making process: Initial Attention, Proactive Information-Seeking, Decision-Making Process, Definitive Surgical Decision, Preparation Phase, and Abandonment, with the Decision-Making Process being the most critical. The study examined the influence of External Environment on Cognitive Decision-Making, focusing on social pressure, social support, and peer support. Additionally, the Cognitive Trade-off Theory for Bariatric Surgery (CTT-BS) was established, incorporating five cognitive-level factors.ConclusionThe identified decision-making stages and cognitive theory provide evidence to clarify the facilitators and barriers to BS motivation retention, offering insights for developing strategies to improve BS retention rates.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24035-x.

Strengthening the education of health professionals is imperative to effectively address contemporary public health challenges. Preceptorship, by integrating teaching and care within service settings, stands out as a relevant strategy for developing clinical, ethical, and relational competencies. This study aimed to construct a theoretical model based on the meanings attributed by nurse preceptors to preceptorship in pediatric nursing within the context of hospital-based training at a referral institute specializing in rare and complex diseases in Rio de Janeiro, Brazil. The study used Grounded Theory and Symbolic Interactionism as its methodological and theoretical frameworks, respectively, and involved interviews with 14 preceptors. The resulting model characterizes preceptorship as an interactive process materialized in pedagogical practices that integrate technical skill, empathy, responsibility, and creativity into the daily routine of care. The findings offer valuable insights for strengthening professional training programs in health and contribute to public policies that recognize preceptorship as a component of interprofessional education and of workforce development, with a focus on humanization, safety, and contextualized care.

ABSTRACT This constructivist grounded theory study explored how artmaking influenced the development of professional dispositions among counselors-in-training. The study involved participants who attended CACREP-accredited mental health counseling programs that had a specific emphasis on art therapy. These participants engaged in artmaking activities as a key part of their educational training. Findings demonstrate that artmaking is an effective experiential learning tool that enhances critical counselor qualities such as self-awareness, empathy, problem-solving skills, and interpersonal competencies. Participants described experiencing substantial growth while engaging in creative processes within a supportive and safe learning environment. Emphasizing the importance of a conducive learning environment that fosters experimentation, reflection, and collaboration, findings reveal that integrating art-based experiential learning strategies in counseling programs can enhance students’ ability to relate to clients, improve coping skills, and their professional identity. These results highlight the need for counseling programs to incorporate experiential learning approaches to cultivate comprehensive personal and professional development.

BackgroundMigrant cancer patients face unique challenges in end-of-life decision-making. One key yet underexplored aspect is the decision-making process surrounding the place of dying and death. This study explores the factors influencing these decisions involving migrant cancer patients in Italy.MethodsA constructivist grounded theory approach was employed. Data were collected through semi-structured interviews with 28 participants (patients, family members, cultural mediators, and other key informants, some from a previous grounded theory study). Theoretical sampling guided participant selection for this study, and data analysis followed an iterative coding process, leading to the development of a conceptual model.ResultsThe decision-making process was conceptualized as a gradient field in which three forces interact to shape outcomes: (1) Healthcare as an Attracting/Holding Force—quality medical care in Italy encouraged patients to stay, though its influence diminished as curative treatments ended; (2) Bureaucratic and Financial Barriers as an Obstructing Force—challenges related to residency, access to care, and financial constraints often complicated decision-making, particularly for those considering repatriation; and (3) Social Networks as a Stabilizing Force—the strength of familial and community ties in host country and homeland played a decisive role in shaping preferences. A fundamental opacity about terminality was present, with limited communication and awareness regarding prognosis, further expanding the circle of decision-makers.ConclusionsPalliative care professionals should recognize the importance of transnational networks, consider bureaucratic barriers, and encourage open discussions regarding place of dying and death decision. To navigate these complexities, we propose a question guide for specialists during consultations. This tool aims to enhance culturally sensitive communication, promote shared decision-making, and address the challenges of cross-border end-of-life care. By accommodating transnational ties, palliative care services can better align with the realities of migrant cancer patients, fostering equitable and dignified end-of-life care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12904-025-01821-3.

To apply grounded theory to generate a substantive theory that explains the roles adopted by caregivers or nearest support persons (CoNSP) and their added value when included as patient advocates in long-term outcomes research in rheumatoid arthritis (RA). A cross-national and multi-language qualitative research study, part of an ongoing project by the Outcome Measures in Rheumatology. The data collection was carried out from March 2018 to February 2019. Initially, four participants from the United States were selected. However, after examining the data we realized that adding the CoNSP as patient advocates might be useful to gain a wider understanding. Therefore, participants were contacted again and asked if they could identify a CoNSP to participate in the study. In addition, participants from Spain and Italy with their CoNSP were included. A total of 16 interviews were conducted (eight pairs composed of a person with RA and his/her CoNSP). To generate theory, the Glaser and Straus grounded theory approach was applied. We developed The Advocacy Effect Theory which is formed by the core category Vision which is a three-dimensional category: (i) Sharing the same viewpoint - people with RA and their CoNSP share the same viewpoint on the issues addressed, (ii) Expanding the viewpoint - people with RA and their CoNSP contributed information about the same issues, but the CoNSP provided more detailed insights on some of the topics previously shared by the person with RA, and (iii) A new viewpoint - the CoNSP provide original information about issues or topics that were not previously informed by the person with RA. This theory explains the roles of CoNSP and their added value when included as patient advocates in long-term outcomes research in RA. The Advocacy Effect Theory showed that CoNSP should be included in outcomes research as patient advocates. Their knowledge and contributions are dynamic, adding value by providing access to data that might not otherwise be accessible.