Substantive Theory Research Articles

School Social Workers' Responses to Racial Injustice During COVID-19: A Need for Anti-Racist Practice in K-12 Schools

ABSTRACT This qualitative study examines how school social workers (SSWers) responded to the U.S. racial injustices highlighted by the media during the first year of the COVID-19 pandemic. SSWers were interviewed during what some scholars dubbed a “moment of reckoning and crisis” following the murder of George Floyd and the subsequent nationwide demonstrations for justice that aimed to challenge racialized police violence (Villarreal Sosa 2022, p. 67). Seventeen SSWers in K–12 public schools from various school districts across three states (Minnesota, Colorado, and Nevada) completed two key informant interviews related to their experiences during the spring and fall semesters of 2020. A constructivist grounded theory approach, including three coding cycles, was used to analyze participant narratives. A substantive theory for understanding SSWers’ responses (or lack of responses) to racial injustices during this period emerged. The findings provide an initial understanding of how SSWers’ responded to racial injustice during this moment of crisis and some of the factors that impacted their responses. The most common responses to racial injustice during this moment of crisis included: 1) engaging in conversations about race and racism and 2) participating in learning opportunities about race, racism, and racial justice. Our theory highlights how (lack of) structural support influenced SSWers’ responses. Implications for school social work (SSW) practice, curriculum, and research are discussed.

Role adaptation of nurses caring for older adults with terminal diseases in geriatric hospitals.

To understand the role adaptation process of nurses caring for older adult patients with terminal diseases in Chinese geriatric hospitals. The Chinese government has been encouraging the conversion of secondary general hospitals and some tertiary hospitals into specialized geriatric hospitals; however, research on nurses' adaptation to caring for older adult patients with terminal diseases in these hospitals is lacking. Individual in-depth interviews were conducted with 13 registered nurses with a minimum of two years of experience caring for older adults with terminal diseases. Following Glaserian grounded theory, open, selective, and theoretical coding were conducted for data analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research checklist. "Guards of the shining sunset" emerged as the core category. Participants experienced three stages: "chaotic me," "rational me," and "inclusive me." They highlighted two causes, three contexts, two intervention conditions, three strategies, and two consequences. The study shows that nurses play a key role in "guarding the shining sunset" of older adult patients with terminal diseases. The observed role adaptation process provides theoretical support for interventions to assist nurses in becoming inclusive "guards of the shining sunset." Nurses play a unique role as guardians protecting the end-of-life quality of elderly patients. Their role needs to be expanded and strengthened via effective coping strategies and comprehensive legal, education, welfare, and professional promotion support policies. The substantive theory offered by this study may be applied by nurses, department leaders, geriatric hospital managers, and national-level institutions to underpin future interventions and improve role adaptation.

Approaching a substantive theory of moral reckoning in special education leadership: Innovative grounded theory methods using extant data on principals

This original grounded theory research addresses leading for inclusion within the context of special education services and the educative outcome of equity as a moral aim of schooling in the United States. We pinpoint the critical positionality of the principalship in realizing both the letter and spirit of special education law in the US and its consequent practice. Through a secondary analysis of extant qualitative data, we examine dis/ability in schooling and administrative decision making in the day-to-day reality of implementation and present a working substantive theory of moral reckoning for special education leadership. Principals’ thinking and professional praxis revealed the existence of varying layers of ethical deliberation, ranging from surface appraisals, partial judgments, and conflicting calculations to deep, soul-searching deliberation. We conclude with recommendations for future research and practice.

Transforming personally and professionally through global cultural experience: A grounded theory study

Participation in international educational programs during nurses' and midwives' preregistration education provides an opportunity to experience healthcare in different cultures. Short-term outcomes of participation have been reported; however, little has been published regarding long-term outcomes and theoretical processes for nurses and midwives who participate in such programs. To provide in-depth understandings through a theoretical model of long-term outcomes and impacts for nurses and midwives who participate in international educational programs during their preregistration education. Constructivist grounded theory methodology was employed in this study. Thirteen general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives from eight different countries were interviewed. The substantive theory, "Transforming personally and professionally through global cultural experience," presents an explanation of processes and long-term impacts for those who participated in international programs during their preregistration education.

A Multilevel, Emergent Journey to Unpack Team Process Dynamics

In this essay, I reflect on my journey as a scientist endeavoring to unpack team processes and effectiveness, offering observations, learning points, and insights I gained along the way. I have organized my journey into three phases; (1) developing multilevel theory as a set of meta-theoretical principles that provide a foundation for theory and research on team processes and effectiveness, (2) substantive theory and research focused on learning, regulation processes, development, adaptation and team leadership, and (3) process theorizing, team dynamics, and computational theorizing and modeling. I close with some recommendations for advancing the science of team process dynamics and effectiveness.

The impact of cultural practices on the outcome of IT risk management implementation

PurposeThe objectives of this research are two-fold. The first is to explore, describe and explain the relevance of the concept of Information Technology risk management (ITRM) implementation processes. In this regard, we were required to understand the interaction between contextual issues, the ITRM framework itself, IT individual interpretations toward them and their effect on implementation. The second objective is to develop a theoretical model for use in guiding the design and analysis of the proposed empirical work. The study introduces a fresh perspective to an established research area. It is argued that without more emphasis on the dynamic nature of the implementation process, an incomplete understanding of the problem will result.Design/methodology/approachThe study adopts an interpretive methodology to a multiple case study design gathering and analysing qualitative evidence. A series of three case studies was designed around 22 semi-structured in-depth interviews conducted to investigate IT individuals’ role in facilitating a successful ITRM implementation.FindingsThe findings provide new insights in relation to ITRM implementation by considering IT individual culture. The research develops a substantive theory involving a schematic model involving a set of theoretical propositions. These findings suggest a dynamic approach to implementing IT risk management framework — one that considers the interaction over time of intentions, context, process and action around risk management frameworks.Research limitations/implicationsThis study makes important theoretical contributions to the understanding of organizational implementations by taking a dynamic view of implementation, identifying different individual IT culture archetypes, emphasizing the role of social aspects and developing a set of key factors and contextual conditions.Practical implicationsThis model offers managers an understanding of how IT individual culture and the factors and contextual conditional work together over time to ensure a successful ITRM implementation. Meanwhile, it sheds some light on how managers treat IT individuals with different levels of experience differently.Originality/valueWe theorize IT individual culture and the factors and contextual conditional and show their effects on ITRM implementation success, thus making an essential contribution to the information systems and implementation research and practice. Moreover, we provide a novel methodology to conceptualize ITRM implementation as a cultural process through which IT people socially construct the meanings and purposes of their work activities. This research answers scholars’ call to construct more accurate explanations of innovation outcomes in an increasingly IS implementation world.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study.

This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations. Strauss and Corbin's Grounded Theory. Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached. A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment. Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process. Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment. This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations. The COREQ guidelines were utilised. No patient or public contribution.

애착외상경험을 가진 내담자의 상담과정에 대한 근거이론 연구

The purpose of this study is to understand what clients with attachment trauma experience experienced in short-term counseling with an integrated approach, explore the process of change, and build a substantive theory based on this. I'm doing it. For the purpose of the study, among adult clients aged 18 or older who had past attachment trauma experiences and who visited a local counseling center for various superficial complaints and received counseling, 13 people who voluntarily expressed their willingness to participate in the study were selected as final participants. The data collected through in-depth interviews using a semi-structured questionnaire were analyzed according to the grounded theory method suggested by Strauss and Corbin, and as a result of the analysis, 114 concepts, 40 subcategories, and 18 categories were ultimately derived. The research results based on data analysis are summarized as follows. First, the central phenomenon experienced by participants who experienced attachment trauma during short-term counseling in an integrated approach was ‘struggling to face a torn heart.’ Second, the core category of the counseling process of participants who experienced attachment trauma was ‘reconstructing attachment trauma into a story of acceptance and change.’ This study provides clues to a more in-depth understanding of people who have experienced attachment trauma and appropriate and effective treatment intervention, and provides a paradigm to approach attachment trauma research at an ontological level. It is significant in that it can provide basic data and practical knowledge to centers or public institutions that provide consultation.

A Grounded Theory Approach to Understanding Men Confronting Infertility.

Purpose: This study aims to delve into the process of men confronting infertility. Design: This research employed the Straussian grounded theory approach. Methods: The study encompassed interviews with 16 participants from a private fertility center in Isfahan, Iran, between March 2023 and March 2024. The interviews were semistructured. Data analysis was carried out concurrently using constant comparative methods and standard grounded theory techniques. the participants' main concerns were identified, culminating in developing a substantive theory centered around a core category. Findings: The primary category for men struggling with infertility was "forced concealment." This was exhibited through the suppression of emotions, maintaining secrecy about infertility, hiding treatment, and attributing infertility to their wives to counteract threats to their masculinity. Factors such as partners, family, societal surroundings, care providers, and beliefs influenced the adopting of the "forced concealment" strategy. Conclusions: The "forced concealment" theory offers insights into the experiences of men struggling with infertility. The study highlights the necessity of formulating culturally sensitive strategies that enable healthcare providers, nurses, and health system managers to effectively fulfill their roles and address the challenges and needs of couples confronting male infertility. This can be realized through a comprehensive approach that integrates nursing skills and competencies.

People First, Mission Always: A Tension‐Centered Approach to Conducting Safe, Effective Logistics

ABSTRACTLogistics organizations' cultures inherently produce tension between safety and operational requirements. Perhaps counterintuitively, such tension is important for organizations to achieve safe practice and effective operational outcomes. In this study, we evaluate how logistics managers and workers create, identify, and manage various tensions between operational requirements and personnel health and safety during an extended period of uncertainty. Using a grounded theory (GT) approach, this research draws on multiple data sources from six global U.S. Air Force logistics organizations during the first year of the COVID‐19 pandemic. A six‐stage GT empirical analysis process revealed a tension‐centered approach to safe, effective logistics, presented as a substantive (middle‐range) theory with an accompanying process model. Data demonstrate operations‐ and people‐focused cultural elements are activated based on respective requirements, thus inducing tension between potentially competing, yet interrelated, areas. In high‐performing organizations, logistics managers and workers address tensions via a balanced focus to alleviate conflicts and conduct safe, effective logistics. This research responds to calls for organizational culture research using qualitative methods while offering implications for theory and practice. Specifically, logistics leaders can use the process model to prepare personnel to safely and effectively handle dynamic operational logistics in the face of unforeseen crises or changes.

The social processes that emergency nurses use to achieve sustainability: A constructivist grounded theory.

To examine the experiences of emergency nurses and develop a substantive theory that describes the processes they use to support or prevent sustainability in their nursing practice. Constructivist grounded theory. Between February 2018 and January 2019, observations and semi-structured interviews were conducted with 29 emergency nurses. Data underwent constant comparison, and coding was performed in three phases: open, focused, and theoretical, employing constructivist grounded theory. Additionally, some situational analysis mapping was undertaken and integrated as a method to explore the broader context affecting nursing practice. The study achieved theoretical saturation and rigour was ensured through evaluations of credibility, transferability, and confirmability. A substantive grounded theory was constructed to describe the basic social process of 'Achieving Personal and Professional Sustainability' with subprocesses that included 'Driving forces', 'Developing and using armouries', 'Balancing work-life', and 'Making emergency work effective'. This theory delineates two phases, 'exploration and establishment' and 'maintenance', and two key properties: 'Constructing and evolving professional identity' and 'Perceiving and reshaping the meaning of effective work and care'. The theory also highlights the dynamic interplay of individual, social, and institutional elements. 'Achieving Personal and Professional Sustainability' is important for emergency nurses to sustain themselves personally and professionally in their work. This research has substantial and global impacts. Emergency nursing can use this information as a guide to better understand strategies for both personal and professional sustainability. Policymakers may use the findings to foster a supportive work environment and enhance nurse well-being. Implementation of recommendations can lead to improved patient care outcomes. The methodological approach offers potential for future research, positively impacting emergency nursing practice and workforce sustainability worldwide. Reporting adheres to EQUATOR's COREQ guidelines for qualitative studies. No patient or public contribution.

Gaining by losing: The daily living experience of international female doctoral students in Aotearoa New Zealand

ABSTRACT This Straussian grounded theory study explored how female doctoral students from South East Asia managed their daily occupations while studying in Aotearoa New Zealand. Twenty-three participants who were living or had lived in Auckland, one of Aotearoa New Zealand’s metropolitan cities, completed semi-structured, in-depth interviews on their experiences of occupation in that context. Data were also collected via participant observations. The analysis of data through open, axial, and selective coding yielded a substantive theory: Gaining by Losing , which entailed a three-stage process of Choosing to be International Students, Meeting Challenges, and Returning Transformed. Each stage was characterised as being in dynamic tension of initially exploring opportunities/making sacrifices, then encountering difficulties/making adjustments to daily occupations while studying, and ultimately living with their choice/experiencing changes. The findings revealed that temporarily moving to a city with a high cost of living elicited changes in the way they performed daily occupations, such as studying, cooking, shopping, caring for children, and so forth.

The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study.

Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Clinical practice enhanced by interdisciplinary theoretical perspectives

Background Experience-based knowing in general practice includes advanced interpretation of subjective, complex and particular phenomena in a social context. Enabling different metapositions for reflexivity may provide the accountability needed for such knowing to be recognized as evidence-based practice. Objective To demonstrate and discuss the potential of substantive theories to enhance interpretation of complex challenges in clinical knowing in general practice. Methods We present a fictional case to demonstrate how interdisciplinary substantive theories, with a relevant and specific match to concrete questions, can situate the clinical interaction at an accountable platform. A female patient with Parkinson’s disease consults her GP complaining that the disease is restraining her life and threatening her future. The GP has some new ideas from Bandura’s theory of self-efficacy and introduces the patient to strategies for further action. Findings The case presents an example of how a relevant substantive theory may offer the GP: 1) a sharper focus for achievement: recognising the issues of fear and identity in chronic, progressive illness, 2) a subsequent position for individualized understanding of adequate strategies: encouraging physical and social activity in a well-known context, and 3) an invitation to consider further possibilities: finding ways to alleviate the burden of fear and progressive decline; engaging in joyful living. Implications General practice knowledge embraces a diversity of sources with different evidence power. The transparency mediated to clinical practice when supported by relevant substantive theories may contribute to recognition of experience-based knowing as evidence-based practice.

Proactive health behavior in middle-aged and older adult females with urinary incontinence: A grounded theory study.

To develop a conceptual framework for proactive health behavior among middle-aged and older adult females with urinary incontinence. Qualitative grounded theory study. There is a growing body of research emphasizing the pivotal significance of proactive health behavior. Proactive health behavior can empower patients to actively manage their illnesses and facilitate disease recovery. Clearly defining patients' relevant beliefs and assumptions regarding proactive health behavior can effectively promote their adoption. However, there is currently a lack of relevant research in this area. We conducted in-depth interviews with middle-aged and older adult females with urinary incontinence (n = 17) and nursing caregivers (n = 9). We used theoretical sampling, whlie conducting continuous comparative analysisi and data collection. The study has yielded a substantive theory to facilitate healthcare professionals' comprehension of proactive health behavior in middle-aged and older adult females with urinary incontinence. The foundation for middle-aged and older adult females to adopt proactive health behavior is having a certain level of health literacy regarding their conditions. Patients' internal motivation to engage in proactive health behavior includes a sense of health responsibility and health demands. Additionally, external support received by patients can also facilitate their adoption of proactive health behavior. The proactive health behavior practices of middle-aged and older adult females mainly include proactive medical care behavior and establishing a healthy lifestyle. The conceptual framework established in this study offers theoretical support for middle-aged and older adult females with urinary incontinence to adopt proactive health behavior. It provides a basis for future exploration of proactive health behavior among this demographic and informs the development of more effective health interventions and support measures tailored to their needs. The study specifically elucidates the mechanisms and manifestations of proactive health behavior adopted by middle-aged and older adult females with urinary incontinence, laying the foundation for clarifying the level of proactive health among patients and implementing corresponding intervention measures. Additionally, it can also serve as a reference for related research on other diseases.

Using Grounded Theory to Develop a Substantive Theory for Grandparent-Caregiving in Uganda: The GRACE Model.

Few studies have focused on developing theories to explain caregiving as performed by grandparents who provide care for their grandchildren in any setting. Theory development that is grounded in the experiences and cultural context of those being studied is needed to inform research, subsequent care, and overall well-being, especially of populations that are understudied. This manuscript was informed by Constructivist Grounded Theory, semi-structured in-depth and individual interviews. Also, three methodological phases were followed: (a) concurrent data collection and analysis procedures, (b) developing categories and relationships among them, and (c) defining the core category and building the substantive theory. The methodological steps involved in generating a substantive theory, the GRAndparent-CarEgiving (GRACE) model, are reported. Research, and subsequently the well-being and health care of grandparent-caregivers, needs to be informed by culturally congruent theories that are founded in the experiences and cultural context of the individuals being investigated.

Christian Contemplative Prayer: An Embodied Spirituality of Healing and Well-Being Through the Ministry of the Holy Spirit

Within Christian spirituality, contemplative prayer practice is rooted in scriptural teachings, ancient practices, and intentional silent awareness of the Holy Spirit’s presence. Despite the growing popularity of this embodied spiritual practice, limited empirical evidence exists investigating its effects on Christian contemplative prayer practitioners. This grounded theory study explored the long-term (2 to 40+ years) lived experience of thirty-six practitioners. Findings conceptualized the property of the Ministry of the Holy Spirit as it analytically emerged from its four dimensions including: Holistic Healing, Spiritual Formation, Soul Care, and Faith. These findings help to further develop Holley’s substantive theory integrating Christian contemplative prayer, Well-being, and Embodiment, bringing greater understanding to practitioners, minsters, and scholars alike. The findings were also part of the Holy Spirit Symposium (Biola University’s 2023), which presented an integration of various aspects of the Holy Spirit’s ministry of healing within the body.

IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study)

BackgroundIn the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity.MethodsInitial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to ‘test’ the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved.ResultsThree explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women.ConclusionsThe IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status.Trial registrationISRCTN57127874.

A balance of unsafe care incidents and interactive cooperative care: A constructivist grounded theory study of safe care ecosystem for older inpatients.

To explore older inpatients and their caregivers' care experience and how this relates to the gerontology care practice. Research interest in the conceptualization of safe care for older inpatients was growing, and these studies were predominantly reported from a single or healthcare perspective. There is a shortage of literature on how patients and their caregivers conceptualise safe care. Constructivist grounded theory. Stage 1 included semi-structured interviews with inpatients. Stage 2 included semi-structured interviews with caregivers and six field notes. Purposive and theoretical sampling were used to recruit 61 participants across six healthcare institutions. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, field notes and memo writing. The substantive theory to emerge from the data was A balance of unsafe care incidents and interactive cooperative care. This core concept was informed by four categories: unsafe care incidents, interactive cooperative care, person-centred care, contextual conditions, and one care outcome. The relationships between these categories constituted a balance in which patient-centred care was the core, unsafe care incidents were the barriers, interactive cooperative care was the facilitator, and the result of the balance was the care outcome. The balance constituted a safe care ecosystem under the interaction of contextual conditions. Interactive cooperative care is vital in enabling care stakeholders to reduce unsafe care incidents, which facilitates them in achieving safe care and further constructing a healthy care ecosystem. This theory identifies barriers and facilitators encountered by care stakeholders to cope with everyday problems and guides them in developing personalised care plans to ensure patient safety.

Excuse, justification and collapse

ABSTRACT For any putative excuse, why not recast it as a justification rendering one’s wrongful conduct ultimately permissible? This paper confronts the worry that many, perhaps all, excuses might collapse into justifications – either in morality or criminal law. It is an especially pressing problem for normative expectations views, on which excuses speak to a lower standard than justifications. I argue that the prospects for decisively blocking collapse within morality look bleak – at least if we adhere to an important constraint of the present project. I want to see if we can block collapse without appealing to a substantive theory of moral wrongness or taking on robust theoretical commitments about interpersonal morality. This is especially important for criminal law purposes, though I concede that blocking collapse in morality likely requires substantive commitments. Accordingly, I develop a more ecumenical way to block collapse within the criminal law, although not morality. The key is to attend to differences in how the legislature can legitimately assign weight to reasons in determining which actions it deems to be wrong vs. how individuals can fairly be expected to assign weight to reasons, which is key to assessing culpability. Institutional considerations impact the former but not the latter.