Nicholas Ralph

The methodological dynamism of grounded theory

Variations in grounded theory (GT) interpretation are the subject of ongoing debate. Divergences of opinion, genres, approaches, methodologies, and methods exist, resulting in disagreement on what GT methodology is and how it comes to be. From the postpositivism of Glaser and Strauss, to the symbolic interactionist roots of Strauss and Corbin, through to the constructivism of Charmaz, the field of GT methodology is distinctive in the sense that those using it offer new ontological, epistemological, and methodological perspectives at specific moments in time. We explore the unusual dynamism attached to GT’s underpinnings. Our view is that through a process of symbolic interactionism, in which generations of researchers interact with their context, moments are formed and philosophical perspectives are interpreted in a manner congruent with GT’s essential methods. We call this methodological dynamism, a process characterized by contextual awareness and moment formation, contemporaneous translation, generational methodology, and methodological consumerism.

From EN to BN to RN: An exploration and analysis of the literature

Abstract The nursing profession has experienced significant change over the last 100 years. Consequently, the workforce of the 21st century is a diverse entity that is edging toward the specialization of nurses in a specific clinical setting. In such an environment, a common knowledge base is demanded of nurses – a factor that has affected the development of second level, or enrolled nurses (ENs). The forces at play raise questions about nursing roles and scopes of practice. The establishment of education pathways that promote career development has been the stimulus for conversations about the effectiveness of the transition of EN to registered nurse (RN). This paper presents a review of the literature that identifies and explores common emerging themes (making the move from EN; adapting to Bachelor of Nursing; transitioning to RN) associated with this transition through the process of undertaking baccalaureate studies in nursing.

Teaching science content in nursing programs in Australia: a cross-sectional survey of academics.

BackgroundProfessional nursing practice is informed by biological, social and behavioural sciences. In undergraduate pre-registration nursing programs, biological sciences typically include anatomy, physiology, microbiology, chemistry, physics and pharmacology. The current gap in the literature results in a lack of information about the content and depth of biological sciences being taught in nursing curricula. The aim of this study was to establish what priority is given to the teaching of science topics in these programs in order to inform an understanding of the relative importance placed on this subject area in contemporary nursing education.MethodThis study employed a cross-sectional survey method. This paper reports on the first phase of a larger project examining science content in nursing programs. An existing questionnaire was modified and delivered online for completion by academics who teach science to nurses in these programs. This paper reports on the relative priority given by respondents to the teaching of 177 topics contained in the questionnaire.ResultsOf the relatively small population of academics who teach science to nursing students, thirty (n = 30) completed the survey. Findings indicate strong support for the teaching of science in these programs, with particular priority given to the basic concepts of bioscience and gross system anatomy. Of concern, most science subject areas outside of these domains were ranked as being of moderate or low priority.ConclusionWhile the small sample size limited the conclusions able to be drawn from this study, the findings supported previous studies that indicated inadequacies in the teaching of science content in nursing curricula. Nevertheless, these findings have raised questions about the current philosophy that underpins nursing education in Australia and whether existing practices are clearly focused on preparing students for the demands of contemporary nursing practice. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this research.

Contextual Positioning: Using Documents as Extant Data in Grounded Theory Research

The use of documents as a source of extant data is relatively common in grounded theory (GT) research. While GT promotes the dictum “all is data,” finding consistent commentary on how to use documents as data is difficult, especially among seminal works. The need to be aware of the context of extant data is a vital step prior to commencing analysis, especially in view of the lack of physical interaction between the researcher and that data. Contextual positioning is proposed as a tool that can be used to prepare extant data for analysis. Contextual positioning enhances the interactivity of the data collection process and positions the researcher before the document in a more reflexive manner. A model of contextual positioning is presented in this article to assist researchers in positioning extant data (such as documents) more reflexively. A concrete example of the use of this method is outlined to promote understanding of the value of this process.

Future-Proofing Nursing Education: An Australian Perspective

The relevance of pre-registration programs of nursing education to current and emerging trends in healthcare and society could have a significant future impact on the nursing profession. In this article, we use a PESTEL (politics, economics, society, technology, environment, and law) framework to identify significant current and future priorities in Australian healthcare. Following the PESTEL analysis, we conduct a review of the curriculum content of current Australian undergraduate pre-registration nursing curricula. The data were analyzed to determine how nursing curricula were aligned with the priorities identified in the PESTEL analysis. Findings suggest that preparation–practice gaps are evident in nursing curricula as the broad priorities identified were poorly reflected in undergraduate pre-registration programs. The study recommended (a) the establishment of a nationally consistent mechanism to identify current and emerging trends in healthcare and higher education, and (b) an evidence-based framework that enhances forward planning in the design of undergraduate pre-registration nursing curricula.

Editorial: Nursing's mandate to redefine the sentinel event

Historically, the role of a ‘sentinel’ was to stand atop the castle, watching and warning of threats to safety. In modern health care, a ‘sentinel event’ involves watching for, reporting on and learning about incidents such as medication errors or wrong-site surgery to improve patient safety. Sentinel events are defined as ‘an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof’ (Joint Commission on Accreditation of Healthcare Organizations 2012). However, the one-dimensionality of reporting clinical or procedural errors as ‘sentinel events’, while ignoring failures of fundamental care, is akin to guarding only one side of the castle. Clinical errors are increasingly acknowledged in a blame-free environment for good reason (Black et al. 2011). To err is human, however, to be uncaring is unquestionably inhumane. Failing to provide fundamental care such as toileting patients rather than telling them to soil their bed can never be an ‘unavoidable accident’. Whether this results from clinicians’ actions or inactions, executive and managerial culpability, or system-wide failures matters little to the patient on the receiving end. Nurses, as professed patient advocates are optimally positioned to support the dignity of people in their care wherever possible. The indignity of illness, hospitalisation and reliance on health professionals for the most basic of needs is an arduous prospect for even the most resilient among us. Although the indignity of illness can be an unavoidable burden, its being compounded by fundamental failures in the provision of ‘care’ is entirely unacceptable. Until these failures of care are taken seriously enough to be classified as bona fide ‘sentinel’ or ‘never’ events, they will be allowed to continue. Relentless, harrowing reports of gross failures of ‘care’ suggest that some clinicians are merely occupying the position of ‘nurse’, not filling it. Interminable accounts from patients and their families (e.g. The Patients Association 2009, Francis 2013) have led to real concern about a perceived ‘crisis in care’ (Darbyshire & McKenna 2013). While some contend that these incidents are not widespread and factors contributing to their occurrence are complex, nurses cannot become blinkered bystanders, powerless victims or worse, wearily resigned perpetrators.

Interventions for prostate cancer survivorship: A systematic review of reviews

To systematically review the evidence for interventions addressing key domains of the American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO) Prostate Cancer Survivorship Care Guidelines: health promotion, surveillance, physical side effects, psychosocial management, and care coordination.

Does metabolic syndrome predict surgical complications? A protocol for a systematic review and meta-analysis

BackgroundMetabolic syndrome (MetS) is defined by an accumulation of risk factors that include cardiovascular disease, diabetes, chronic high blood pressure, obesity, and hypercholesterolaemia which results in an increased risk of developing serious chronic diseases. MetS is widespread as it is estimated to affect up to 30% of the global population. For people with MetS who undergo surgery, an emerging body of literature points to significantly poorer postoperative outcomes compared with non-affected populations. Surgical patients with MetS are at significantly higher risk of a range of adverse outcomes including death, morbid cardiovascular events, coma, stroke, renal failure, myocardial infarction, and surgical site infections. Increased complication rates result in prolonged hospital stays, a greater need for post-hospitalisation care, and reduced effectiveness of surgical interventions.Methods/designWe will search the following electronic bibliographic databases: MEDLINE, EMBASE, ScienceDirect, and CINAHL, and the reference lists of included articles. We will also search for unpublished literature. Two authors will screen titles and abstract information independently and select studies according to established inclusion and exclusion criteria. Data will be extracted by the study investigators using Review Manager 5 and will include information on demographics, incidence, prevalence, and outcome variables. Subgroup analysis and sensitivity analysis will be performed to assess the heterogeneity of included studies. Meta-analysis will also be carried out if appropriate study groups are identified. A descriptive narrative for statistical data will also be provided to highlight findings of the systematic review and meta-analysis.DiscussionThis study will report and summarise adverse outcomes among adult patients with MetS undergoing surgery across a range of surgical specialties. Developing insights into outcomes of this population of interest is necessary to develop guidelines towards better management of surgical patients with metabolic syndrome.Systematic review registrationPROSPERO CRD42016051071