constructivist grounded theory literature review

Approaches to reviewing the literature in grounded theory: a framework

Affiliation.

• 1 University of West England, Bristol, England.
• PMID: 32643353
• DOI: 10.7748/nr.2020.e1752

Background: There is considerable debate about how to review the literature in grounded theory research. Notably, grounded theory typically discourages reviewing the literature before data are collected and analysed, so that researchers do not form preconceptions about the theory. However, it is likely researchers will need to review the literature to show they intend to address a gap in knowledge with their research. This might confuse novice researchers, especially given that different approaches to grounded theory can have contrasting positions concerning how and when literature should be reviewed.

Aim: To provide an overview of grounded theory and how different approaches might tackle literature reviews.

Discussion: A framework is presented to illustrate some of the commonalities between grounded theory approaches, to guide novice researchers in reviewing the literature. The framework acknowledges some of the tensions concerning researchers' objectivity and sketches three phases for researchers to consider when reviewing the literature.

Conclusion: Reviewing the literature has different meanings and implications when using grounded theory compared with other research methodologies.

Implications for practice: Novice researchers must be attuned to the different ways of reviewing the literature when using grounded theory.

Keywords: grounded theory; literature review; methodology; qualitative research; research; research methods.

© 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

• Cancer Nursing Practice
• Emergency Nurse
• Evidence-Based Nursing
• Learning Disability Practice
• Mental Health Practice
• Nurse Researcher
• Nursing Children and Young People
• Nursing Management
• Nursing Older People
• Nursing Standard
• Primary Health Care
• RCN Nursing Awards
• Nursing Live
• Nursing Careers and Job Fairs
• CPD webinars on-demand
• --> Advanced -->

• Clinical articles
• Expert advice
• Career advice
• Revalidation

Evidence and practice    

Approaches to reviewing the literature in grounded theory: a framework, kris deering senior lecturer in mental health nursing, university of west england, bristol, england, jo williams senior lecturer in mental health nursing, university of west england, bristol, england.

• To build an understanding of research methods associated with grounded theory

• To develop critical awareness of how different approaches in grounded theory might tackle literature reviews

• To learn how to review the literature, depending on the stage of your grounded theory study

Background There is considerable debate about how to review the literature in grounded theory research. Notably, grounded theory typically discourages reviewing the literature before data are collected and analysed, so that researchers do not form preconceptions about the theory. However, it is likely researchers will need to review the literature to show they intend to address a gap in knowledge with their research. This might confuse novice researchers, especially given that different approaches to grounded theory can have contrasting positions concerning how and when literature should be reviewed.

Aim To provide an overview of grounded theory and how different approaches might tackle literature reviews.

Discussion A framework is presented to illustrate some of the commonalities between grounded theory approaches, to guide novice researchers in reviewing the literature. The framework acknowledges some of the tensions concerning researchers’ objectivity and sketches three phases for researchers to consider when reviewing the literature.

Conclusion Reviewing the literature has different meanings and implications when using grounded theory compared with other research methodologies.

Implications for practice Novice researchers must be attuned to the different ways of reviewing the literature when using grounded theory.

Nurse Researcher . doi: 10.7748/nr.2020.e1752

This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

[email protected]

None declared

Deering K, Williams J (2020) Approaches to reviewing the literature in grounded theory: a framework. Nurse Researcher. doi: 10.7748/nr.2020.e1752

Published online: 09 July 2020

grounded theory - literature review - methodology - qualitative research - research - research methods

User not found

Want to read more?

Already have access log in, 3-month trial offer for £5.25/month.

• Unlimited access to all 10 RCNi Journals
• RCNi Learning featuring over 175 modules to easily earn CPD time
• NMC-compliant RCNi Revalidation Portfolio to stay on track with your progress
• Personalised newsletters tailored to your interests
• A customisable dashboard with over 200 topics

Alternatively, you can purchase access to this article for the next seven days. Buy now

Are you a student? Our student subscription has content especially for you. Find out more

13 March 2024 / Vol 32 issue 1

TABLE OF CONTENTS

DIGITAL EDITION

• LATEST ISSUE
• SIGN UP FOR E-ALERT
• WRITE FOR US
• PERMISSIONS

Share article: Approaches to reviewing the literature in grounded theory: a framework

We use cookies on this site to enhance your user experience.

By clicking any link on this page you are giving your consent for us to set cookies.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Wiley-Blackwell Online Open

Discriminating among grounded theory approaches

Kendra l. rieger.

1 Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada

To rationalize the selection of a research methodology, one must understand its philosophical origins and unique characteristics. This process can be challenging in the landscape of evolving qualitative methodologies. Grounded theory is a research methodology with a distinct history that has resulted in numerous approaches. Although the approaches have key similarities, they also have differing philosophical assumptions that influence the ways in which their methods are understood and implemented. The purpose of this discussion paper is to compare and contrast three widely used grounded theory approaches with key distinguishing characteristics, enabling a more thoughtful selection of approach. This work contributes to the existing literature through contrasting classic Glaserian grounded theory, Straussian grounded theory, and constructivist grounded theory in a systematic manner with prominent distinguishing characteristics developed from a review of the literature. These characteristics included historical development, philosophical perspective, role of the researcher, data analysis procedures, perspective of the grounded theory, and strengths/critique. Based on this analysis, three considerations are proposed to direct the methodological choice for a study: purpose, philosophy, and pragmatics. Understanding the similarities and differences in the grounded theory approaches can facilitate methodological transparency and determine the best fit for one's study and worldview as a researcher.

1. INTRODUCTION

When planning a study, the researcher should thoughtfully choose an appropriate methodology based on an awareness of its philosophical underpinnings and its unique characteristics (McEwen & Wills, 2014 ; Morse, Barrett, Mayan, Olson, & Spiers, 2002 ; Ryan, 2018 ). One potential option is grounded theory, a qualitative research methodology that incorporates guidelines for simultaneous data collection and analysis to develop theories about social processes that are grounded in real‐life experiences (Charmaz, 2006 ; Glaser & Strauss, 1967 ; McClement & Harlos, 2008 ; Strauss & Corbin, 1990 ). Methodologies evolve; they are adapted to fit a changing historical or philosophical milieu (Ralph, Birks, & Chapman, 2015 ). Grounded theory has a distinct history that has resulted in the development of numerous approaches. Although these approaches have key similarities, they also are based on differing philosophical assumptions that influence the ways in which grounded theory methods are implemented (Charmaz, 2014 , 2017 ). It can be challenging to navigate the complex array of grounded theory approaches. Researchers need a clear understanding of the critical considerations for selecting an approach that best fits their study.

The purpose of this paper is to compare and contrast three widely used grounded theory approaches: classic Glaserian grounded theory (CGGT) (Glaser & Strauss, 1967 ), Straussian grounded theory (SGT) (Strauss & Corbin, 1990 ), and constructivist grounded theory (CGT) (Charmaz, 2006 ). This analysis will illuminate important considerations for choosing a grounded theory approach and facilitate methodological transparency and consistency (Amsteus, 2014 ; Evans, 2013 ; Morse et al., 2002 ). Although this paper builds upon a substantial body of work, this work contributes to the existing literature by contrasting the three approaches in a systematic manner using prominent distinguishing characteristics developed from a review of the literature. In addition, this analysis incorporates important revisions found in Corbin and Strauss's ( 2015 ) and Charmaz's ( 2014 ) recent editions of their seminal grounded theory texts.

1.1. Background

Grounded theory was initially formulated by Glaser and Strauss ( 1967 ). Strauss and Glaser actively mentored graduate students, and a number of their students have continued to develop and promote grounded theory. Three of the resultant approaches, CGGT, SGT, and CGT, will be analyzed here as they are the most extensively developed and used (Hood, 2007 ; Polit & Beck, 2017 ). Other approaches include situational analysis (Clarke, 2005 , 2009 ), feminist grounded theory (Wuest, 1995 ), and dimensional analysis (Bowers & Schatzman, 2009 ; Schatzman, 1991 ). Situational analysis is often used in combination with CGT, and Clarke ( 2009 ) writes, ‘I would not say that situational analysis is a type of grounded theory but rather that it is an extension of grounded theory’ (p. 234).

Viewpoints about the evolution of grounded theory differ. Some scholars view it as the natural maturing of a methodology (McCann & Clark, 2003a ) and write of how grounded theory developed within a positivist/postpositivist perspective and that a needed move toward a constructivist perspective has been incorporated (Charmaz, 2006 ; Mills, Bonner, & Francis, 2006 ). A positivist paradigm assumes ‘that there is an orderly reality that can be objectively studied’ and that knowledge can be independent of the researcher (Polit & Beck, 2017 , p. 739), whereas a postpositivist paradigm assumes that an objective, observable reality exists but acknowledges that it can never be perfectly apprehended as attempts to understand it are influenced by human understanding (Annells, 1996 ; Ghezeljeh & Emami, 2009 ; Hall, Griffiths, & McKenna, 2013 ). A constructivist paradigm assumes that reality cannot be objectively discovered, but instead ‘people, including researchers, construct the realities in which they participate’ (Bryant & Charmaz, 2007a ; p. 607). In contrast, Wuest ( 2012 ) asserts that grounded theory is firmly rooted in the constructivist paradigm and that researchers bring their own epistemological lens to the study that influences their use of research methods. Others view this evolution as confusing and as an erosion of grounded theory's analytical power (Duchscher & Morgan, 2004 ; Evans, 2013 ; Glaser, 2002 ; Greckhamer & Koro‐Ljungberg, 2005 ).

The various grounded theory approaches have a recognizable set of ‘family resemblances’ (Bryant & Charmaz, 2007b ; p. 11) that are hallmarks of a grounded theory study. Key characteristics (see Table  1 ) include that grounded theory elucidates a process; begins with inductive logic; encompasses simultaneous data collection, analysis, and theory construction; incorporates constant comparison and memo writing; employs theoretical sampling; and focuses on the generation of a grounded theory (Charmaz, 2006 , 2014 , 2017 ; Corbin, 2009 ; Corbin & Strauss, 2015 ; Duchscher & Morgan, 2004 ; Elliot & Lazenbatt, 2005 ; Glaser & Strauss, 1967 ; Hall & Callery, 2001 ; Hood, 2007 ; Hunter, Murphy, Grealish, Casey, & Keady, 2011 ; McCrae & Purssell, 2016 ; Mills et al., 2006 ; Morse, 2001 ; Ralph et al., 2015 ; Walker & Myrick, 2006 ). Although there are identifiable grounded theory characteristics, there are also noteworthy differences between the approaches that need to be examined before embarking on a study (Charmaz, 2014 ; Mills et al., 2006 ).

Similarities between GT approaches informed by the literature

1.2. Data sources

This discussion paper is based on literature ranging from 1965 to 2017. CINAHL, PsycINFO, and MEDLINE were searched from their respective inception dates until 2017 to find relevant literature, using various combinations of the following keywords: ‘grounded theory,’ ‘Charmaz,’ ‘Strauss,’ ‘Corbin,’ and ‘Glaser.’ Additional materials were drawn from library catalogs, reference lists of relevant work, and the gray literature.

2. DISTINGUISHING CHARACTERISTICS FOR CONTRASTING THE APPROACHES

This analysis will examine six distinguishing characteristics that were identified in the literature as constituting the most significant differences between approaches and being the most essential considerations for deciding on a grounded theory approach. First, each approach is rooted in a different historical context (Clarke, 2009 ; Greckhamer & Koro‐Ljungberg, 2005 ; Ralph et al., 2015 ). Second, that historical context was often associated with a particular philosophical tradition that likely influenced the modifications made to CGGT. Although all three approaches have roots in symbolic interactionism (Corbin & Strauss, 2008 ; McCrae & Purssell, 2016 ), they are also imbued with either positivist or constructivist underpinnings that affect research practices (Charmaz, 2000 , 2017 ; Ralph et al., 2015 ). Third, as a result of divergent philosophical assumptions, the role of the researcher differs between the various approaches (Charmaz, 2006 ). The researcher's role involves ideas about the nature of the research–participant relationship (Heath & Cowley, 2004 ), theoretical sensitivity (Mills et al., 2006 ), treatment of the literature (Mills et al., 2006 ), and identification of research questions (Hunter et al., 2011 ). Fourth, differences in the views of data and data analysis procedures are significant, as is the emphasis on inductive, deductive, or abductive logic (Charmaz, 2009 ; Heath & Cowley, 2004 ; Kelle, 2005 ; Reichertz, 2010 ; Walker & Myrick, 2006 ). Fifth, divergent perspectives also exist of the grounded theory that emerges from the analysis (Heath & Cowley, 2004 ; Mills et al., 2006 ). Sixth, these cumulative differences contribute to unique methodological strengths and limitations (Polit & Beck, 2012 ).

3. CONTRASTING DIFFERENCES: DISTINGUISHING CHARACTERISTICS OF THE THREE APPROACHES

3.1. classic glaserian grounded theory, 3.1.1. history and origins.

Glaser and Strauss ( 1967 ) published their revolutionary grounded theory text at the beginning of the qualitative revolution during an era when postpositivism dominated research thinking (Charmaz, 2000 , 2006 ). Their different backgrounds influenced much of their methodological development. Strauss was an expert in symbolic interactionism and Glaser was a quantitative researcher (Stern, 2009b ). Glaser and Strauss’ goal was to establish qualitative research as a rigorous process with reliable data analysis and defend grounded theory from positivist critique (Charmaz, 2006 ). These influencing factors combined to create a rigorous methodological process that had a positivist direction (Bryant & Charmaz, 2007c ). Their differences also ‘planted the seeds of divergent directions’ (Charmaz, 2009 ; p. 129) which eventually led to the demise of their research relationship. Glaser argued that CGGT is the pure form of grounded theory. Although he claims to have stayed true to the original method, Stern ( 2009a ) notes that there has been a subtle evolution of ideas in Glaser's writing. He has continued to develop CGGT in his subsequent publications (Glaser, 1978 , 1992 , 2001 , 2002 , 2003 , 2005 , 2007 , 2009 , 2011 , 2012 , 2014a , b , c , 2015 , 2016a , b ) by, for example, explaining abstract concepts such as theoretical sensitivity (Glaser, 1978 ), developing numerous theoretical coding families (Glaser, 1978 , 2005 ), and describing in detail how to conceptualize data (Artinian, 2009 ; Glaser, 2001 , 2003 , 2005 ). Glaser also launched the Grounded Theory Institute and the associated journal, Grounded Theory Review: An International Journal , to continue promoting, developing, and refining CGGT (Kenny & Fourie, 2014 ).

3.1.2. Philosophical perspective

The seminal CGGT texts have little discussion of underlying philosophical assumptions (Bryant, 2009 ), but these assumptions can be inferred and seem to echo postpositivist presuppositions. Some researchers assert that CGGT is based on a positivist realist ontology that assumes an orderly real world exists which can be objectively observed (Charmaz, 2000 ; Clarke, 2005 ), while others contend that CGGT is actually based on a postpositivist critical realist ontology that assumes a real world exists but acknowledges that it is impossible for people to truly perceive it (Annells, 1996 ; Hall et al., 2013 ; Ralph et al., 2015 ). Further, Charmaz ( 2000 ) argues that CGGT is based on an objectivist epistemology which assumes that the researcher is separate from what is being studied and aims for unbiased discovery of new knowledge. Charmaz ( 2000 ) described a continuum between objectivist and CGT, and Mills et al. ( 2006 ) proposed that a methodological spiral is present between postpositivist and constructivist approaches. Both placed CGGT as the most positivist/postpositivist on these spectrums. The title The Discovery of Grounded Theory (Glaser & Strauss, 1967 ) conveys the assumption that an external reality exists which can be found (Charmaz, 2000 ), and CGGT researchers assert that the data reveal a true theory (Mills et al., 2006 ). Other CGGT characteristics consistent with an objectivist epistemology include valuing a neutral expert observer, separating data and the observer, and developing parsimonious abstractions free of context (Glaser & Strauss, 1967 ; Mills et al., 2006 ).

3.1.3. Role of the researcher

Consistent with the tenets of objectivism, CGGT researchers should have as few predetermined thoughts as possible and maintain their role as detached observers (Glaser & Strauss, 1967 ; Hall & Callery, 2001 ). Glaser ( 2002 ) wrote that through constant comparison, ‘Personal input by a researcher soon drops out as eccentric and the data become objectivist not constructionist’ (p. 6). The focus is on the neutralization of researcher bias through constant comparison, instead of on reflexivity (Charmaz, 2017 ; Mruck & Mey, 2007 ). Further, theoretical sensitivity is ‘the ability to recognize and extract from the data elements that have relevance for the emerging theory’ (Birks & Mills, 2011 , p. 176), and in CGGT, it is achieved through immersion in the data (Glaser, 1978 ). Although Glaser's coding families can enhance theoretical sensitivity (Table  2 ), these codes are applied later in the analysis (Glaser, 1978 ; Walker & Myrick, 2006 ). In CGGT, the literature review is delayed to prevent the researcher from developing preconceived ideas, and the researcher does not need an initial research question or guiding theory because those elements could foster unwanted researcher influence (Glaser & Holton, 2007 ). However, Glaser ( 1978 ) does endorse the use of emergent fit within grounded theory analysis to see whether a pre‐existing category from a previous study fits with the emerging data in the current study (Artinian, 2009 ; Wuest, 2000 ). Emergent fit involves an iterative process of constant comparison with the existing literature and modification of the relevant concepts so that only elements of the pre‐existing theory that fit the data will remain (Glaser, 1978 ; Wuest, 2000 ).

Data analysis procedures

3.1.4. Data and data analysis

Through claims that data are objective and discovered (Glaser, 2002 ), data become a true representation of the research participants’ realities in CGGT. The contexts of the data are not considered unless it emerges as a code (Glaser & Holton, 2007 ). The goal of CGGT analysis is to watch objectively for the emergence of the grounded theory through data analysis procedures (Glaser & Strauss, 1967 ).

Coding involves two phases: substantive coding, which incorporates two subphases of open and selective coding, produces categories and their properties, and identifies a core category; and theoretical coding, which occurs at the conceptual level, involves the use of coding families in some studies, and weaves the categories into a grounded theory (Glaser & Strauss, 1967 ) (Table  2 ). Key differences between grounded theory approaches are apparent in coding—specifically, in the timing and level of researcher intervention (Evans, 2013 ; Walker & Myrick, 2006 ). These differences have fueled a debate about allowing data to emerge versus forcing the data with a preconceived framework, with Glaser claiming that CGGT alone allows theory to emerge because it has no external frame until theoretical coding is conducted (Glaser, 1978 ; Heath & Cowley, 2004 ). Deduction and verification of hypotheses should be left for quantitative researchers, as can be seen when Glaser and Strauss ( 1967 ) wrote, ‘Comparative analysis both subsumes and assumes verification and accurate description, but only to the extent that the latter are in the services of generation’ (p. 28). Although they view constant comparison as incorporating verification, it is only used within the primary processes of induction and generation of theoretical ideas.

3.1.5. The grounded theory

In CGGT, views of the grounded theory have positivist leanings (Charmaz, 2006 ), and Glaser ( 2002 ) stated that CGGT ‘makes the generated theory as objective as humanly possible’ (p. 5). The theory represents a correspondence with reality (Thomas & James, 2006 ), and a certain set of data should produce the same grounded theory if the research was rigorous (Duchscher & Morgan, 2004 ; Heath & Cowley, 2004 ). Glaser ( 1992 ) also asserted that the grounded theory should have explanatory power. In CGGT, the grounded theory surrounds a core category, or major theme, that unites all of the conceptual categories (Glaser, 1978 ). In particular, each grounded theory approach offers distinct evaluation criteria (Table  3 ).

Evaluation criteria for grounded theory studies

3.1.6. Strengths and critique

What Glaser and Strauss ( 1967 ) proposed was revolutionary and a powerful force for the legitimization of qualitative research (Charmaz, 2009 ). CGGT is a flexible approach that is less prescriptive than SGT (Evans, 2013 ), yet it is still rigorous and results in a high level of abstraction. Because CGGT researchers bring few preconceived notions, some assert, the approach results in greater theoretical completeness (Evans, 2013 ; Heath & Cowley, 2004 ). Nevertheless, CGGT has come under significant critique for its lack of explicit discussion of the philosophical assumptions that underlie it (Greckhamer & Koro‐Ljungberg, 2005 ). Numerous scholars have argued that the concept of the uncontaminated researcher is a naïve notion that is not congruent with the tenets of qualitative research (Charmaz, 2008b ; Corbin, 1998 ; Kelle, 2005 ; Mills et al., 2006 ). Other critiques include that CGGT has a limited ability to explicate a meaningful understanding due to a reliance on participants’ overt concerns (Charmaz, 2000 ), an overuse of sociological terms and laissez‐faire guidelines (Charmaz, 2000 ; McCann & Clark, 2003a ), and a tendency to privilege the researcher's knowledge by valuing a distance between the researcher and participants. In the absence of strategies to address this power differential, researchers can elevate their own assumptions and interpretations to an objective status (Bryant & Charmaz, 2007c ; Hall & Callery, 2001 ).

3.2. Straussian grounded theory

3.2.1. history and origins.

The differences between Glaser and Strauss were stressed when the partnership of Strauss and Juliet Corbin emerged (Morse, 2009 ) and they published the Basics of Qualitative Research (Strauss & Corbin, 1990 ). Their goal was to offer an accessible grounded theory text with well‐described techniques (Heath & Cowley, 2004 ). However, this book caused a rift between Glaser and Strauss, and Glaser ( 1992 ) wrote a scathing critique of SGT's prescribed approach. By the 1990s, two divergent grounded theory approaches were evident: CGGT (Glaser & Strauss, 1967 ), and SGT (Strauss & Corbin, 1990 , 1998 ), which seems less positivistic/postpositivistic (Bryant & Charmaz, 2007c ). Strauss died in 1996; however, Corbin continued to develop their approach and believes she has stayed true to the key aspects of their earlier work (Corbin & Strauss, 2008 , 2015 ). Regardless of the significant revisions found in the third and fourth editions (Corbin & Strauss, 2008 , 2015 ), many researchers continue to use earlier versions of the SGT approach (Charmaz, 2014 ).

3.2.2. Philosophical perspective

The philosophical perspective of SGT has pragmatist and symbolic interactionist foundations, but it is also somewhat ambiguous and has evolved over time (Corbin & Strauss, 2008 ; Greckhamer & Koro‐Ljungberg, 2005 ). Symbolic interactionism is an interpretive theoretical perspective ‘derived from pragmatism which assumes that people construct selves, society, and reality through interaction’ (Charmaz, 2014 ; p. 344). Symbolic interactionists do not deny that there is a reality, but assert that it is socially interpreted, and that understanding these constructions is important to comprehend human behavior (Charon, 2010 ). Corbin ( 1998 ) wrote about their first book (Strauss & Corbin, 1990 ): ‘It was meant as a supplemental text, therefore it omits most of the epistemological foundations’ (p. 122). Numerous scholars interpret SGT as moving toward constructivism in the first two texts (Annells, 1997 ; Lomborg & Kirkevold, 2003 ; McCann & Clark, 2003a ; Mills et al., 2006 ). Evidence for constructivist leanings can be found in statements like ‘theorizing is the act of constructing’ (Strauss & Corbin, 1998 , p. 25) and ‘there are many alternative interpretations of data’ (Corbin, 1998 ; p. 122). However, others argued that the original version of SGT is positivist, uses linear approaches, and has a realist ontology, because it assumes an external reality, and objectivist epistemology, because it values unbiased data collection (Charmaz, 2000 ; Evans, 2013 ; Hall & Callery, 2001 ). This vacillation between positivism and constructivism can also be seen as a ‘struggle to move within the changing moments of qualitative research’ (Mills et al., 2006 , p. 4).

An evolution of philosophical perspectives has occurred within SGT (Ralph et al., 2015 ). In 1994 , Strauss and Corbin started positioning themselves as relativist pragmatists, and in the third and fourth texts, Corbin claimed to be a constructivist (Corbin & Strauss, 2008 , 2015 ). Although she admitted their early work was more positivistic, she noted that her new views are reflected in recent work through the acknowledgement of the existence of multiple complex realities that relate to real events, the varied participant responses to events, and the construction of theories by researchers (Corbin & Strauss, 2008 , 2015 ). As well, research techniques and procedures are framed as tools instead of directives. Charmaz ( 2014 ) also viewed SGT as moving toward constructivism in the third edition of Corbin and Strauss's work ( 2008 ).

3.2.3. Role of the researcher

In contrast to CGGT, in SGT the researcher is not viewed as a blank slate and has an interpretive role (Corbin & Strauss, 2015 ), which is more consistent with the stance of constructivism (McCann & Clark, 2003a , b ). The researcher's experience can enhance theoretical sensitivity, facilitate the generation of hypotheses, and create a base for making comparisons (Corbin, 1998 ). In a later edition of their text, Corbin and Strauss ( 2008 ) wrote that ‘objectivity in qualitative research is a myth’ (p. 32). Throughout the evolution of SGT, reflexivity is increasingly acknowledged as vital to ensuring that the researcher's perspectives are helpful, rather than restrictive, during data collection and analysis (Corbin & Strauss, 2008 , 2015 ). Strauss and Corbin ( 1990 ) asserted that theoretical sensitivity is enhanced not just through immersion in the data, as with CGGT, but also through the use of analytic tools such as the flip‐flop technique and waving the red flag (Table  2 ). In contrast to CGGT, in SGT the literature can inform research questions, increase theoretical sensitivity, and stimulate reflections (Strauss & Corbin, 1998 ). Furthermore, a broad research question should be stated before the research begins (Strauss & Corbin, 1990 ). Similar to CGGT, a SGT researcher should not normally begin their research with an extant theory, although later on in the analysis a theoretical framework can be a useful lens through which to view the data (Corbin & Strauss, 2015 ).

3.2.4. Data and data analysis

Given that data are not viewed as being completely separate from the researcher, SGT researchers acknowledge that ‘there is no one “reality” out there waiting to be discovered’ (Corbin & Strauss, 2008 ; p. 10). In contrast to CGGT and CGT, in SGT data analysis the focus is on using analytical tools, which are thinking techniques that promote interaction between the researcher and the data, and this approach is the only one that originally had three distinct phases of coding: open, axial, and selective (Walker & Myrick, 2006 ) (Table  2 ). These phases are more complex and detailed than in CGGT or CGT, and the researcher intervenes more intensively using analytical tools and questions (Strauss & Corbin, 1998 ; Walker & Myrick, 2006 ). Open coding involves coding the text, and discovering a category's properties and dimensionalizing them (Strauss & Corbin, 1998 ). Axial coding involves putting fractured data back together with the use of the coding paradigm, a framework of questions derived from one of Glaser's coding families that facilitates the identification of the relationship between structure and process and the linking of categories and subcategories (Corbin & Strauss, 2015 ). The researcher groups code into three components: conditions, inter/actions and emotions, and consequences (Corbin & Strauss, 2008 ; Thompson, McClement, & Daeninck, 2006 ). At last, a core category is identified during selective coding, and the researcher conceptually relates all categories to the core, or central, category (Strauss & Corbin, 1990 ). In Corbin and Strauss's ( 2008 , 2015 ) latest two texts, open coding and axial coding are presented as iterative and flexible processes, the term selective coding is not used, and this final process is referred to as theoretical integration . The authors have also developed a conditional/consequential matrix to make connections between the macro and micro conditions (Corbin & Strauss, 2008 ).

The SGT researcher intervenes earlier in the analysis process with the use of a preconceived coding paradigm during axial coding and before the development of a core category, differing from CGGT, in which flexible theoretical codes are used after a core category is identified (Walker & Myrick, 2006 ). Another key distinction is the emphasis on deduction and verification of hypotheses, as opposed to induction, as in CGGT (Heath & Cowley, 2004 ; McCann & Clark, 2003a ). Strauss and Corbin ( 1990 , 1998 ) contended that researchers make statements about the relationship between concepts, and these hypotheses are then validated in subsequent data collection. In later texts, there is less emphasis on verification and more on the interplay of induction and deduction (Corbin & Strauss, 2008 ; Walker & Myrick, 2006 ).

3.2.5. The grounded theory

In SGT, the view of the grounded theory has both positivist and interpretivist elements (Charmaz, 2006 ). Consistent with positivist definitions of theory (Charmaz, 2006 ), Corbin and Strauss ( 2008 ) defined theory as ‘a set of well‐developed categories (themes, concepts) that are systemically interrelated through statements of relationship to form a theoretical relationship that can be used to explain some phenomena’ (p. 55). However, the grounded theory is viewed as one possible interpretation that does not exactly represent reality (Corbin & Strauss, 2015 ). Similar to CGGT researchers, SGT researchers aim to identify a core category for the grounded theory (Corbin & Strauss, 2015 ).

3.2.6. Strengths and critique

Strengths of SGT include that the approach offers a clear description of its complex research procedures (Walker & Myrick, 2006 ) and that SGT enables the researcher to focus on both the micro and macro conditions using the conditional/consequential matrix (Mills et al., 2006 ; Walker & Myrick, 2006 ). Some scholars assert that the rigorous analytic tools, such as the coding paradigm, enable the construction of sufficiently analytical theories (McCann & Clark, 2003c ; Mills et al., 2006 ). However, others argue that SGT is rigid and focuses on systematic procedures that interfere with the researchers’ sensitivity to the data and promote a power differential between researcher and participants (Bryant & Charmaz, 2007c ; Evans, 2013 ; Heath & Cowley, 2004 ; Hunter et al., 2011 ). The early timing and intensity of researcher intervention and the emphasis on using analytical tools can force data into preconceived ideas instead of allowing the grounded theory to emerge (Charmaz, 2000 ; Glaser, 1992 ; Walker & Myrick, 2006 ).

3.3. Constructivist grounded theory

3.3.1. history and origins.

Kathy Charmaz, a sociologist, developed CGT based on ideas from two of her mentors: Barney Glaser and Anselm Strauss (Charmaz, 2017 ; Morse, 2009 ). CGT returns to CGGT strategies but has repositioned grounded theory, shifting it from its positivist underpinnings to those of constructivism (Bryant & Charmaz, 2007c ; Charmaz, 2017 ). Charmaz ( 1995 ) began writing about her ideas during the ‘crisis of representation’ (Denzin & Lincoln, 2005 , p. 18), which was a period when qualitative researchers were seeking new models of truth and when objectivity became problematic (Birks & Mills, 2011 ). Charmaz ( 2008a ) claimed that CGT ‘builds on Glaser's useful methodological strategies … but it does not duplicate the logic of inquiry in classic grounded theory statements’ (p. 136).

3.3.2. Philosophical perspective

In contrast to CGGT and SGT theorists, Charmaz explicitly took a constructivist stance with CGT's relativist ontology and subjective epistemology (Charmaz, 2006 , 2014 ; Mills et al., 2006 ). Constructivist grounded theorists acknowledge that reality is a social construction (Ghezeljeh & Emami, 2009 ). CGT researchers do not deny the existence of objectively true worlds, but they are more concerned with the ‘world made real in the minds and through the words and actions of its members’ (Charmaz, 2000 ; p. 523). CGT has a subjective epistemology in that it assumes that researchers are not separate from the research and that knowledge is cocreated (Charmaz, 2000 ). Both Charmaz ( 2000 ) and Mills et al. ( 2006 ) positioned CGT on the far end of the positivist‐constructivist continuum compared with CGGT and SGT.

3.3.3. Role of the researcher

In contrast to CGGT, the CGT researcher is a cocreator of knowledge (Charmaz, 2000 ). As a result, the researcher influences the research through interactions with participants and data (Mulugeta, Williamson, Monks, Hack, & Beaver, 2017 ), and the researcher's experience is valued in this process (Charmaz, 2014 ). Charmaz ( 2014 , 2017 ) also asserted that researchers need to be reflexive to avoid forcing their preconceived ideas on the data, and she viewed memo writing as key to reflexivity. In CGT, theoretical sensitivity or sensitizing concepts can guide the research, but they are only ‘points of departure’ from which to develop ideas (Charmaz, 2014 , p. 30). Also, in contrast to CGGT, the use of extant theories can develop theoretical sensitivity, a literature search orients the researcher, and a research question is developed before the research commences (Charmaz, 2014 ; Harling & Turner, 2012 ).

3.3.4. Data and data analysis

Constructivist grounded theory researchers acknowledge the subjectivity of data and data analysis, a stance that aligns CGT with constructivism. The researcher and participants coconstruct the data, and thus, data are a product of the research instead of an observation or a window on reality (Charmaz, 2006 , 2014 ). Charmaz ( 2014 ) emphasized using intensive interviewing to attend to participants’ stories and to construct theories. In contrast to those who espouse CGGT, CGT researchers use thoughtful probes to understand implicit meanings and are attentive to the participants’ context (Charmaz, 2014 ). In contrast to SGT, CGT analysis focuses on flexible data analysis procedures to elucidate social processes, instead of on the application of external devices (Charmaz, 2006 ).

Constructivist grounded theory data analysis is similar to that of CGGT in that it includes at least two phases, initial and focused coding, and has less researcher intervention than SGT (Charmaz, 2014 ; Mills et al., 2006 ) (Table  2 ). Initial coding involves labeling data with codes. Focused coding uses initial codes that reappear frequently, and are the most relevant, to code and categorize larger portions of data. Focused codes are more conceptual, and certain focused codes are elevated to abstract categories (Charmaz, 2006 ; Ripat & Woodgate, 2012 ). Theoretical integration begins with focused coding and culminates in the final grounded theory (Charmaz, 2014 ). External frameworks such as axial coding (Strauss & Corbin, 1998 ) and theoretical codes (Glaser, 1978 ) can be useful if they ‘earn their way’ into the analysis (Charmaz, 2014 , p. 153).

Constructivist grounded theory is the first grounded theory approach to clearly describe inductive‐abductive logic , which is the iterative process of the researcher moving back and forth between data and conceptualization, as a key part of data analysis (Charmaz, 2009 ). Abductive logic involves contemplating possible theoretical explanations for the researcher's initial observations, and then attempting to confirm or disconfirm these tentative ideas to arrive at the most plausible explanation (Charmaz, 2014 ). Grounded theory researchers make inferences from the data (inductive) and then check them using theoretical sampling and additional data (abductive) (Charmaz, 2014 ). Abductive logic is situated between inductive logic, the focus of CGGT, and deductive logic (Clarke, 2009 ). Some assert that certain SGT texts describe the use of abductive logic without using the term (Bryant, 2009 ; Reichertz, 2010 ).

3.3.5. The grounded theory

Charmaz ( 2014 ) proposes a continuum from positivist theory, which aims to explain and predict through ‘explanatory generalizations that theorize causation,’ to interpretivist theory, which is emphasized in CGT and aims for ‘abstract understandings that theorize relationships between concepts’ (p. 228). An interpretivist theory makes sense of the studied phenomenon by conceptualizing it in abstract terms but does not focus on explaining causality. Further, in CGT, the theoretical understanding emerges from the researchers’ interaction with the data rather than objectively from the data for an unbiased researcher to discover. The grounded theory ‘constructs an image of a reality, not the reality’ (Charmaz, 2000 ; p. 523), and there are likely many possible theoretical interpretations from one set of data (Greckhamer & Koro‐Ljungberg, 2005 ). In addition, the grounded theory may be comprised of theoretical concepts with no core category, given that CGT emphasizes multiple realities that may lack a unitary theme (Charmaz, 2006 ; Heath & Cowley, 2004 ).

3.3.6. Strengths and critique

Constructivist grounded theory offers a reinterpretation of grounded theory, thereby enabling researchers to employ grounded theory without embracing positivist assumptions (Charmaz, 2000 , 2017 ). Constructivist grounded theorists seek to develop mutuality with participants, which uncovers hidden meanings and results in an insightful theoretical interpretation (Charmaz, 2006 ). CGT also addresses the tension between objective emergence from the data, as in CGGT, and the researcher forcing the data with her or his intervention, as in SGT, by focusing on researcher reflexivity and abductive reasoning (Bryant, 2009 ; Charmaz, 2017 ; Duchscher & Morgan, 2004 ; Kelle, 2005 ). CGT offers more clearly described strategies than does CGGT, but it offers fewer prescriptive procedures than SGT (Charmaz, 2000 ). In contrast, Glaser ( 2002 ) argued that CGT erodes the analytical power of grounded theory and claimed that CGT forces the data through interview guides and prolonged interviews, remodels CGGT into a form of qualitative data analysis, and neglects using careful CGGT strategies to render the data objective. Others question whether a methodology can be radically changed and still be the same methodology (Breckenridge, Jones, Elliott, & Nicol, 2012 ; Greckhamer & Koro‐Ljungberg, 2005 ; Morse, 2009 ) and whether Charmaz is trying to legitimize her work by associating it with grounded theory (Thomas & James, 2006 ).

4. IMPLICATIONS FOR NURSING: SELECTING A GROUNDED THEORY APPROACH

With all the available grounded theory approaches, how can a discerning researcher decide on the best approach for their study? I propose three considerations which flow from the distinguishing characteristics analyzed to direct one's methodological choice for a grounded theory study: purpose, philosophy, and pragmatics.

Of utmost importance is that the grounded theory approach must be congruent with the desired knowledge and the study's purpose (Corbin & Strauss, 2008 ; Crotty, 1998 ; Evans, 2013 ; Houghton, Hunter, & Meskell, 2012 ). For example, if the researcher's goal is to discover an explanatory theory and identify variables, then CGGT may be a more appropriate choice. However, if a researcher desires a theoretical understanding of a situated process, then this type of knowledge may be better elicited with CGT (Charmaz, 2014 ; Evans, 2013 ). This deliberation ensures that the type of theory desired from the study is consistent with the methodological approach selected (Mills et al., 2006 ).

It is also crucial to consider one's philosophical beliefs about the form of reality (ontology) and the nature of knowledge development (epistemology). Numerous scholars discuss the importance of choosing a research approach that is congruent with the researcher's personal beliefs (Corbin & Strauss, 2008 ; Crotty, 1998 ; Evans, 2013 ). I argue that CGGT is imbued with positivist/postpositivist assumptions, that SGT has evolved from a postpositivist position toward a constructivist view, and that CGT is clearly based on constructivist ideas about reality and knowledge development. One must determine the best fit with their personal philosophical beliefs and this process necessitates thoughtful reflection (Howard‐Payne, 2016 ).

As can be seen from this analysis, philosophical foundations have significant implications for the methods used in a grounded theory study. For example, the role of the researcher varies between approaches. Researchers need to consider whether they aim to take an objective role to watch for the emergence of concepts that reside in the data (CGGT) or believe that they should acknowledge and reflectively incorporate their previous knowledge and experiences into study procedures (SGT and CGT) (Breckenridge et al., 2012 ; Charmaz, 2014 ; Howard‐Payne, 2016 ). The same holds true for data analysis. SGT's use of axial coding with a coding paradigm is intended to help researchers develop sufficiently theoretical ideas; however, some researchers may value CGGT or CGT for their focus on the emergence of ideas from the data unencumbered by a preconceived framework (Artinian, 2009 ; Charmaz, 2006 ). At last, it is critical to consider how one intends to use extant theories. While CGT encourages the use of theory from the outset of the study, CGGT and SGT recognize the value of extant theory once data analysis begins. Although some researchers use a selected grounded theory approach without fully realizing the implications on study methods, consistency between the methodological approach and its associated methods is essential in rigorous research (Corbin & Strauss, 2015 ; Morse et al., 2002 ). Grounded theory approaches have been rigorously developed over the years, and researchers should use them in a manner consistent with their stated procedures to produce credible findings (Corbin & Strauss, 2015 ).

There are pragmatic considerations that also influence the researcher's selection of a particular grounded theory approach. CGT and SGT procedures are more clearly defined than those of CGGT in the seminal texts and may be more user‐friendly for a novice researcher (Cooney, 2010 ). In addition, SGT offers numerous tools to assist with data analysis, such as the coding paradigm to guide the construction of theory and the conditional/consequential matrix to elucidate broad contextual factors (Cooney, 2010 ; Howard‐Payne, 2016 ). However, the coding paradigm can also become cumbersome if it does not fit the data (Bryant & Charmaz, 2007a ; Cooney, 2010 ; Evans, 2013 ). Some believe that CGGT and CGT methods are more flexible and offer greater creative freedom in theory development (Bryant & Charmaz, 2007c ; Cooney, 2010 ; Evans, 2013 ). Another consideration is the availability of a grounded theory mentor to provide guidance about a particular approach (Artinian, 2009 ), especially if the study is part of graduate work. Through considering the study purpose, the philosophical implications of the different grounded theory approaches, and the specific pragmatic concerns of a situated study, researchers can determine the best fit for their work.

5. CONCLUSION

In the midst of continually evolving methodologies, it is crucial for researchers to be cognizant of the similarities and differences between the grounded theory approaches as they have significant implications for research procedures. This understanding facilitates methodological transparency (Amsteus, 2014 ) and philosophical/methodological congruence (Evans, 2013 ; McEwen & Wills, 2014 ; Ryan, 2018 ). Corbin and Strauss ( 2008 ) fittingly quoted Dewey ( 1934 ) regarding the grounded theory evolution, who observed, ‘If the artist does not perfect a new vision in his process of doing, he acts mechanically and repeats some old model fixed like a blueprint in his mind’ (p. 50). A thoughtful analysis of this evolution helps researchers to discriminate between the approaches to determine the best approach for their study and for who they are as researchers. Most important, this process will result in rigorous research that develops valuable knowledge to inform nursing practice.

ACKNOWLEDGEMENTS

Thank you to Dr. Wanda Chernomas, Dr. Diana McMillan, Dr. Francine Morin, and Ms. Kim Mitchell for reviewing an earlier version of this manuscript.

Rieger KL. Discriminating among grounded theory approaches . Nurs Inq . 2019; 26 :e12261 10.1111/nin.12261 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Kendra Rieger was the recipient of a Manitoba Health Research Council Studentship Award (September 2013–April 2014), a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award (May 2014–April 2017), and a Sir Gordon Wu Graduate Student Scholarship (2014–2017) which provided support for her doctoral work.

• Amsteus, M. (2014). The validity of divergent grounded theory method . International Journal of Qualitative Methods , 13 , 71–87. 10.1177/160940691401300133 [ CrossRef ] [ Google Scholar ]
• Annells, M. (1996). Grounded theory method: Philosophical perspectives, paradigm of inquiry, and postmodernism . Qualitative Health Research , 6 ( 3 ), 379–393. 10.1177/104973239600600306 [ CrossRef ] [ Google Scholar ]
• Annells, M. (1997). Grounded theory method, part I: Within the five moments of qualitative research . Nursing Inquiry , 4 ( 2 ), 120–129. 10.1111/j.1440-1800.1997.tb00085.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Artinian, B. (2009). An overview of Glaserian grounded theory In Artinian B., Giske T., & Cone P. (Eds.), Glaserian grounded theory in nursing research: Trusting emergence (pp. 3–17). New York, NY: Springer. [ Google Scholar ]
• Birks, M. , & Mills, J. (2011). Grounded theory: A practical guide . Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Bowers, B. , & Schatzman, L. (2009). Dimensional analysis In Morse J. M., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. E. (Eds.), Developing grounded theory: The second generation (pp. 86–126). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Breckenridge, J. P. , Jones, D. , Elliott, E. , & Nicol, M. (2012). Choosing a methodological path: Reflections on the constructivist turn . Grounded Theory Review: An International Journal , 11 ( 1 ), 64–71. [ Google Scholar ]
• Bryant, A. (2009). Grounded theory and pragmatism: The curious case of Anselm Strauss . Forum Qualitative Sozialforschung , 10 ( 3 ), 1–37. 10.17169/fqs-10.3.1358 [ CrossRef ] [ Google Scholar ]
• Bryant, A. , & Charmaz, K. (2007a). The SAGE handbook of grounded theory . Thousand Oaks, CA: SAGE Publications; 10.4135/9781848607941 [ CrossRef ] [ Google Scholar ]
• Bryant, A. , & Charmaz, K. (2007b). Introduction In Bryant A., & Charmaz K. (Eds.), The SAGE handbook of grounded theory (pp. 1–28). Thousand Oaks, CA: SAGE Publications; 10.4135/9781848607941 [ CrossRef ] [ Google Scholar ]
• Bryant, A. , & Charmaz, K. (2007c). Grounded theory in historical perspective: An epistemological account In Bryant A., & Charmaz K. (Eds.), The SAGE handbook of grounded theory (pp. 31–57). Thousand Oaks, CA: SAGE Publications; 10.4135/9781848607941 [ CrossRef ] [ Google Scholar ]
• Charmaz, K. (1995). Grounded theory In Smith J., Harre R., & Lagenhove L. (Eds.), Rethinking methods in psychology (pp. 27–65). Thousand Oaks, CA: SAGE Publications; 10.4135/9781446221792 [ CrossRef ] [ Google Scholar ]
• Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods In Denzin N. K., & Lincoln Y. S. (Eds.), Handbook of qualitative research (2nd ed., pp. 509–536). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis . Los Angeles, CA: SAGE Publications. [ PubMed ] [ Google Scholar ]
• Charmaz, K. (2008a). The legacy of Anselm Strauss in constructivist grounded theory In Denzin N. K., Salvo J., & Washington M. (Eds.), Studies in symbolic interaction (Vol. 32 , pp. 127–141). Bingley, UK: Emerald Group. [ Google Scholar ]
• Charmaz, K. (2008b). Views from the margins: Voices, silences, and suffering . Qualitative Research in Psychology , 5 ( 1 ), 7–18. 10.1080/14780880701863518 [ CrossRef ] [ Google Scholar ]
• Charmaz, K. (2009). Shifting grounds: Constructivist grounded theory In Morse J., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 127–193). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Charmaz, K. (2017). Special invited paper: Continuities, contradictions, and critical inquiry in grounded theory . International Journal of Qualitative Methods , 16 , 1–8. 10.1177/1609406917719350 [ CrossRef ] [ Google Scholar ]
• Charon, J. M. (2010). Symbolic interactionism: An introduction, an interpretation, an integration (10th ed.). New York, NY: Prentice Hall. [ Google Scholar ]
• Clarke, A. E. (2005). Situational analysis . Thousand Oaks, CA: SAGE Publications; 10.4135/9781412985833 [ CrossRef ] [ Google Scholar ]
• Clarke, A. E. (2009). From grounded theory to situational analysis: What's new? Why? How? In Morse J., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 194–235). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Cooney, A. (2010). Choosing between Glaser and Strauss: An example . Nurse Researcher , 17 ( 4 ), 18–28. 10.7748/nr2010.07.17.4.18.c7921 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Corbin, J. (1998). Alternative interpretations: Valid or not? Theory and Psychology , 8 ( 1 ), 121–128. 10.1177/0959354398081007 [ CrossRef ] [ Google Scholar ]
• Corbin, J. (2009). Taking an analytic journey In Morse J. M., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 35–54). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Corbin, J. , & Strauss, A. L. (2008). Basics of qualitative research (3rd ed.). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Corbin, J. , & Strauss, A. L. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory , 4th ed. Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Crotty, M. (1998). The foundations of social research: Meaning and perspective in the research process . Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Denzin, N. K. , & Lincoln, Y. S. (2005). Introduction: The discipline and practice of qualitative research In Denzin N. K., & Lincoln Y. S. (Eds.), The SAGE handbook of qualitative research (3rd ed., pp. 1–32). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Dewey, J. (1934). Art as experience . New York, NY: Perigree Books. [ Google Scholar ]
• Duchscher, J. E. B. , & Morgan, D. (2004). Grounded theory: Reflections on the emergence vs. forcing debate . Journal of Advanced Nursing , 48 ( 6 ), 605–612. 10.1111/j.1365-2648.2004.03249.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Elliot, N. , & Lazenbatt, A. (2005). How to recognize a ‘quality’ grounded theory study . Australian Journal of Advanced Nursing , 22 ( 3 ), 48–52. [ PubMed ] [ Google Scholar ]
• Evans, G. L. (2013). A novice researcher's first walk through the maze of grounded theory: Rationalization for classic grounded theory . Grounded Theory Review , 12 ( 1 ), 37–55. [ Google Scholar ]
• Ghezeljeh, T. N. , & Emami, A. (2009). Grounded theory: Methodology and philosophical perspective . Nurse Researcher , 17 ( 1 ), 15–23. [ PubMed ] [ Google Scholar ]
• Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory . Mill Valley, CA: The Sociology Press. [ Google Scholar ]
• Glaser, B. G. (1992). Basics of grounded theory analysis: Emergence versus forcing . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2001). The grounded theory perspective: Conceptualization contrasted with description . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2002). Constructivist grounded theory? Forum Qualitative Sozialforschung , 3 ( 3 ), 1–14. 10.17169/fqs-3.3.825 [ CrossRef ] [ Google Scholar ]
• Glaser, B. G. (2003). The grounded theory perspective II: Description's remodeling of grounded theory . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2005). The grounded theory perspective III: Theoretical coding . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2007). Doing formal theory In Bryant A., & Charmaz K. (Eds.), The SAGE grounded theory handbook (pp. 97–113). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Glaser, B. G. (2009). Jargonizing: Using the grounded theory vocabulary . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2011). Getting out of the data: Grounded theory conceptualization . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2012). STOP, WRITE!: Writing grounded theory . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2014a). Applying grounded theory: A neglected option . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2014b). Memoing: A vital grounded theory procedure . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2014c). No preconceptions: The grounded theory dictum . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2015). Choosing grounded theory: A GT reader of expert advice . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2016a). The grounded theory perspective: Its origin and growth . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. (2016b). The cry for help: Preserving autonomy doing GT research . Mill Valley, CA: Sociology Press. [ Google Scholar ]
• Glaser, B. G. , & Holton, J. (2007). Remodeling grounded theory [Supplemental material] . Historical Social Research , 19 , 47–68. [ Google Scholar ]
• Glaser, B. G. , & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research . New York, NY: Aldine Transaction. [ Google Scholar ]
• Greckhamer, T. , & Koro‐Ljungberg, M. (2005). The erosion of a method: Examples from grounded theory . International Journal of Qualitative Studies in Education , 18 ( 6 ), 729–750. 10.1080/09518390500298204 [ CrossRef ] [ Google Scholar ]
• Hall, W. A. , & Callery, P. (2001). Enhancing the rigor of grounded theory: Incorporating reflexivity and relationality . Qualitative Health Research , 11 ( 2 ), 257–272. 10.1177/104973201129119082 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hall, H. , Griffiths, D. , & McKenna, L. (2013). From Darwin to constructivism: The evolution of grounded theory . Nurse Researcher , 20 ( 3 ), 17–21. 10.7748/nr2013.01.20.3.17.c9492 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Harling, M. R. , & Turner, W. (2012). Student nurses’ attitudes to illicit drugs: A grounded theory study . Nurse Education Today , 32 ( 3 ), 235–240. 10.1016/j.nedt.2011.05.002 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Heath, H. , & Cowley, S. (2004). Developing a grounded theory approach: A comparison of Glaser and Strauss . International Journal of Nursing Studies , 41 ( 2 ), 141–150. 10.1016/S0020-7489(03)00113-5 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hood, J. C. (2007). Orthodoxy vs. power: The defining traits of grounded theory In Bryant A. & Charmaz K. (Eds.), The SAGE handbook of grounded theory (pp. 151–164). Thousand Oaks, CA: SAGE Publications; 10.4135/9781848607941 [ CrossRef ] [ Google Scholar ]
• Houghton, C. , Hunter, A. , & Meskell, P. (2012). Linking aims, paradigm and method in nursing research . Nurse Researcher , 20 ( 2 ), 34–39. 10.7748/nr2012.11.20.2.34.c9439 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Howard‐Payne, L. (2016). Glaser or Strauss? Considerations for selecting a grounded theory study . South African Journal of Psychology , 46 ( 1 ), 50–62. 10.1177/0081246315593071 [ CrossRef ] [ Google Scholar ]
• Hunter, A. , Murphy, K. , Grealish, A. , Casey, D. , & Keady, J. (2011). Navigating the grounded theory terrain. Part 1 . Nurse Researcher , 18 ( 4 ), 6–10. 10.7748/nr2011.07.18.4.6.c8636 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kelle, U. (2005). “Emergence” vs. “forcing” of empirical data? A crucial problem of “grounded theory” reconsidered . Forum Qualitative Sozialforschung , 6 ( 2 ), 1–22. 10.17169/fqs-6.2.467 [ CrossRef ] [ Google Scholar ]
• Kenny, M. , & Fourie, R. (2014). Tracing the history of grounded theory methodology: From formation to fragmentation . The Qualitative Report , 19 ( 52 ), 1–9. [ Google Scholar ]
• Lomborg, K. , & Kirkevold, M. (2003). Truth and validity in grounded theory—A reconsidered realist interpretation of the criteria: Fit, work, relevance and modifiability . Nursing Philosophy , 4 ( 3 ), 189–200. 10.1046/j.1466-769X.2003.00139.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McCann, T. V. , & Clark, E. (2003a). Grounded theory in nursing research: Part 2–Critique . Nurse Researcher , 11 ( 2 ), 19–28. [ PubMed ] [ Google Scholar ]
• McCann, T. V. , & Clark, E. (2003b). Grounded theory in nursing research: Part 1–Methodology . Nurse Researcher , 11 ( 2 ), 7–18. [ PubMed ] [ Google Scholar ]
• McCann, T. V. , & Clark, E. (2003c). Grounded theory in nursing research: Part 3–Application . Nurse Researcher , 11 ( 2 ), 29–39. [ PubMed ] [ Google Scholar ]
• McClement, S. E. , & Harlos, M. (2008). When advanced cancer patients won't eat: Family responses . International Journal of Palliative Nursing , 14 ( 4 ), 182–188. 10.12968/ijpn.2008.14.4.29132 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McCrae, N. , & Purssell, E. (2016). Is it really theoretical? A review of sampling in grounded theory studies in nursing journals . Journal of Advanced Nursing , 72 , 2284–2293. 10.1111/jan.12986 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McEwen, M. , & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer. [ Google Scholar ]
• Mills, J. , Bonner, A. , & Francis, K. (2006). The development of constructivist grounded theory . International Journal of Qualitative Methods , 5 ( 1 ), 25–35. 10.1177/160940690600500103 [ CrossRef ] [ Google Scholar ]
• Morse, J. M. (2001). Situating grounded theory within qualitative inquiry In Schreiber R. S., & Stern P. N. (Eds.), Using grounded theory in nursing (pp. 1–15). New York, NY: Springer. [ Google Scholar ]
• Morse, J. M. (2009). Tussles, tensions, and resolutions In Morse J. M., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 13–22). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Morse, J. , Barrett, M. , Mayan, M. , Olson, K. , & Spiers, J. (2002). Verification strategies for establishing reliability and validity in qualitative research . International Journal of Qualitative Methods , 1 ( 2 ), 13–22. 10.1177/160940690200100202 [ CrossRef ] [ Google Scholar ]
• Mruck, K. , & Mey, G. (2007). Grounded theory and reflexivity In Bryant A., & Charmaz K. (Eds.), The SAGE handbook of grounded theory (pp. 515–538). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Mulugeta, B. , Williamson, S. , Monks, R. , Hack, T. , & Beaver, K. (2017). Cancer through black eyes—The views of UK based black men towards cancer: A constructivist grounded theory study . European Journal of Oncology Nursing , 29 , 8–16. 10.1016/j.ejon.2017.04.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Polit, D. , & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Williams & Wilkins. [ Google Scholar ]
• Polit, D. , & Beck, C. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Williams & Wilkins. [ Google Scholar ]
• Ralph, N. , Birks, M. , & Chapman, Y. (2015). The methodological dynamism of grounded theory . International Journal of Qualitative Methods , 14 ( 4 ), 1–6. 10.1177/1609406915611576 [ CrossRef ] [ Google Scholar ]
• Reichertz, J. (2010). Abduction: The logic of discovery of grounded theory . Forum Qualitative Sozialforschung , 11 ( 1 ), 1–16. 10.17169/fqs-11.1.1412 [ CrossRef ] [ Google Scholar ]
• Ripat, J. D. , & Woodgate, R. L. (2012). Self‐perceived participation among adults with spinal cord injury: A grounded theory study . Spinal Cord , 50 , 908–914. 10.1038/sc.2012.77 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ryan, G. (2018). Introduction to positivism, interpretivism and critical theory . Nurse Researcher , 25 ( 4 ), 14–20. 10.7748/nr.2018.e1466 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schatzman, L. (1991). Dimensional analysis: Notes on an alternative approach to the grounding of theory in qualitative research In Maines D. (Ed.), Social organization and social process: Essays in honor of Anselm Strauss (pp. 303–314). New York, NY: Aldine de Gruyter. [ Google Scholar ]
• Stern, P. N. (2009a). Glaserian grounded theory In Morse J. M., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 55–65). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Stern, P. N. (2009b). In the beginning Glaser and Strauss created grounded theory In Morse J. M., Stern P. N., Corbin J., Bowers B., Charmaz K., & Clarke A. (Eds.), Developing grounded theory: The second generation (pp. 23–34). Walnut Creek, CA: Left Coast Press. [ Google Scholar ]
• Strauss, A. L. , & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques . Newbury Park, CA: SAGE Publications. [ Google Scholar ]
• Strauss, A. L. , & Corbin, J. (1994). Grounded theory methodology In Denzin N. K., & Lincoln Y. S. (Eds.), Handbook of qualitative research (pp. 273–285). Thousand Oaks, CA: SAGE Publications. [ Google Scholar ]
• Strauss, A. L. , & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Newbury Park, CA: SAGE Publications. [ Google Scholar ]
• Streubert, H. J. , & Carpenter, D. R. (2011). Qualitative research in Nursing: Advancing the humanistic imperative . Philadelphia, PA: Wolters Kluwer. [ Google Scholar ]
• Thomas, G. , & James, D. (2006). Reinventing grounded theory: Some questions about theory, ground and discovery . British Educational Research Journal , 32 ( 6 ), 767–795. 10.1080/01411920600989412 [ CrossRef ] [ Google Scholar ]
• Thompson, G. N. , McClement, S. E. , & Daeninck, P. J. (2006). “Changing lanes”: Facilitating the transition from curative to palliative care . Journal of Palliative Care , 22 ( 2 ), 91–98. [ PubMed ] [ Google Scholar ]
• Udod, S. , & Racine, L. (2017). Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses’ practice . Journal of Clinical Nursing , 26 ( 23 ), 5224–5231. 10.1111/jocn.13887 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Walker, D. , & Myrick, F. (2006). Grounded theory: An exploration of process and procedure . Qualitative Health Research , 16 ( 4 ), 547–559. 10.1177/1049732305285972 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wuest, J. (1995). Feminist grounded theory: An exploration of the congruency and tensions between two traditions in knowledge discovery . Qualitative Health Research , 5 ( 1 ), 125–137. 10.1177/104973239500500109 [ CrossRef ] [ Google Scholar ]
• Wuest, J. (2000). Negotiating with helping systems: An example of grounded theory evolving through emergent fit . Qualitative Health Research , 10 ( 1 ), 51–70. 10.1177/104973200129118246 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wuest, J. (2012). Grounded theory: The method In Munhall P. (Ed.), Nursing research: A qualitative perspective (5th ed., pp. 225–256). Sudbury, MA: Jones & Bartlett Learning. [ Google Scholar ]

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Literature Review and Constructivist Grounded Theory Methodology

In grounded theory research it is commonly discouraged to conduct a literature review before data collection and analysis. Engaging with the literature about the researched area in that stage of the research is described as a constraining exercise rather than a guiding one. This can be a puzzling notion for the researcher engaging with grounded theory methodology (GTM), particularly when she/he is expected to produce a literature review in early stages of the research process, e.g., by ethics committees and/or funding bodies. The current article examines this controversial issue by exploring the different stances taken on the subject by the founders of the methodology, as well as the one introduced by constructivist GTM. The different approaches towards the potential impact of a literature review conducted before data collection and analysis are introduced not only as a methodological issue, but also, and more importantly, as an epistemological one. Reflexivity is described as a key...

Related Papers

Andrea Kennedy

The issue of the literature review remains a conundrum and a controversy within the discourse on grounded theory methodology. Grounded theory researchers are expected to minimize preconceptions to ensure the concept of interest is grounded in data, yet at the same time are required to evaluate existing literature to support institutional ethics and scientific review of the research proposal. In addressing this dilemma, we espouse that literature review in grounded theory should comprise a multistage nonlinear approach to the literature and introduce a framework for novice grounded theory researchers. This framework offers a reflexive, dynamic and integrative process for conducting a literature review that allows researchers to minimize preconceptions while maintaining the original intent of grounded theory methodology.

Advances in Nursing Science

Tracey Giles

Forum Qualitative Social Research

Ciarán Dunne

Fur unerfahrene Forscher*innen kann der Versuch, die Ground-Theory-Methodologie (GTM) anzuwenden, entmutigend sein. Um diesem Problem zu begegnen, prasentieren wir in diesem Artikel den Dialog zwischen einer Doktorandin, die die GTM fur ihre Dissertation nutzt und einem Wissenschaftler mit langjahriger GTM-Erfahrung. Wir greifen verschiedene wichtige Fragen auf, fokussieren uns aber auf zwei zentrale Aspekte, die fur Noviz*innen oft besonders herausfordernd sind: Wann und in welcher Weise kann/soll 1. auf bereits verfugbare Literatur zuruckgegriffen werden, und welche Implikationen ergeben sich 2. fur die Verschriftlichung der gesamten Studie, nicht nur der Prasentation der Theorie im engeren Sinne. Durch das Dialogformat, das wir abschliesend reflektieren, erhoffen wir ein besseres Verstandnis der GTM und versuchen, praktische Hilfen zu geben fur "the long, rocky walk through the dark forest of the research process using the GT methods" (WU & BEAUNAE 2014, S.249).

International Journal of Nursing Practice

Nurse researcher

Sheng Villamor

Psychotherapy Research

Heidi M Levitt

International Conference on …

Cathy Urquhart

Daniel A Nagel, RN, BScN, MSN, PhD , Victoria Burns , Diane Aubin

Graduate students who are considering constructivist grounded theory as a qualitative methodological approach would benefit from recognizing the many challenges they will face prior to embarking on this journey. These challenges include a great diversity in approaches to grounded theory, lack of congruity in how the methodology is described and understood within the literature, and a dearth of expertise and/or support within academic committees and institutions. In this article, we describe why we selected constructivist grounded theory for our PhD work and the common challenges we encountered. Drawing on the analogy of preparing for a trip, we proffer strategies for future graduate students including locating one’s ontological and epistemological worldview, finding grounded theory mentors, and facilitating a methodological fit with academic stakeholders. Our recommendations focus on how to navigate the challenging terrain of conducting a qualitative research project within a predominantly post-positivist landscape.

SAGE Open Medicine

Ylona Chun Tie

Background: Grounded theory is a well-known methodology employed in many research studies. Qualitative and quantitative data generation techniques can be used in a grounded theory study. Grounded theory sets out to discover or construct theory from data, systematically obtained and analysed using comparative analysis. While grounded theory is inherently flexible, it is a complex methodology. Thus, novice researchers strive to understand the discourse and the practical application of grounded theory concepts and processes. Objective: The aim of this article is to provide a contemporary research framework suitable to inform a grounded theory study. Result: This article provides an overview of grounded theory illustrated through a graphic representation of the processes and methods employed in conducting research using this methodology. The framework is presented as a diagrammatic representation of a research design and acts as a visual guide for the novice grounded theory researcher. ...

RELATED PAPERS

Virginia Velez Beall

Dileepa Jayakody

Journal of Astrophysics and Astronomy

Shweta Srivastava

Rossitza Konakchieva

Online Journal of Public Health Informatics

Lance Ballester

KP2_09 Sinta Wahyuningsih

The Journal of V. N. Karazin Kharkiv National University, Series "Philosophy. Philosophical Peripeteias"

Karina Krahel

Canadian Journal of Earth Sciences

Allan Ludman

Cornelius Atere

Kachalla Mohammed

Wave Motion

Gaetano Napoli

Frédéric Martinon

DANIEL RODAS ESPINOZA

Advances in Skin & Wound Care

Sevilay Ünver

José Ángel Haut López

Delito y Sociedad. Revista de Ciencias Sociales

Rocío Truchet

European Journal of Cancer

Journal of Medical Cases

Zuhal Sağlam

CLEAN - Soil, Air, Water

Margarita Mironova

راهبردهای توسعه در آموزش پزشکی

omid yousefianzadeh

Atherosclerosis

Encyclopedia of Romantic Nationalism in Europe

Krisztina Lajosi

Anales De La Real Academia Nacional De Farmacia

sandra noemi escobar

IEEE Photonics Journal

Yunchao Zhu

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• No results found

Constructivist grounded theory

Chapter 2 literature review, 3.2 constructivist grounded theory.

Charmaz (2014, p. 342) stated that ‘constructivist grounded theorists aim for

abstract understanding of studied life and view their analyses as located in time, place, and the situation of inquiry’. Unlike objectivist grounded theory, which is

underpinned by positivism, constructivist grounded theory takes interpretivism into account (Charmaz, 2014). Compared to objectivist grounded theorists who view data analysis as an objective process, constructivist grounded theory acknowledges the researchers’ view and the importance of engaging in reflexivity throughout the research process (Charmaz, 2014).

In terms of a constructivist approach, Creswell (2007, p.238) explained that:

‘The constructivism approach incorporates the researcher’s views; uncovers experiences with embedded, hidden networks, situations, and relationships; and makes visible hierarchies of power, communication, and opportunity’.

As Charmaz (2014, p. 240) summarized, ‘a constructivist approach means being

alert to the conditions under which such differences and distinctions arise and are maintained’.

There are two main reasons why constructivist grounded theory (Charmaz, 2006; Charmaz, 2014) was used in this PhD study.

Firstly, Charmaz’s stance on grounded theory is closely related to social constructivism and symbolic interactionism (Charmaz, 2014; Charmaz, 2006; Charmaz, 2005). Charmaz (2014, p. 344) further explained that social constructivism ‘assumes that people create social reality or realities through individual and

collective actions’ and ‘symbolic interactionism is a constructionist perspective because it assumes that meanings and obdurate realities are the product of collective processes’. Therefore, constructivist grounded theory is a useful approach in this

study, as it aims to explore the participants’ meanings and experiences within their social world of being a hearing parent with a deaf child.

Secondly, constructivist grounded theory can integrate subjective experiences with the studied phenomenon (Charmaz, 2005). For example, this study includes the author’s subjective experience as a deaf person growing up in a hearing family. It is further explained that the constructivist approach allows researchers to interpret research work by locating the participants’ meanings and actions in a social process (Charmaz, 2014). Their meanings and actions could reflect the participants’ values and the researchers’ perspective, because ‘the realities are multiple in the

constructivist view’ (Charmaz, 2014, p. 240). As Charmaz (2000, p. 525) suggested,

‘constructing constructivism means seeking meanings – both respondents’ meaning

and researchers’ meaning’.

Thirdly, the main advantage of grounded theory is to allow data collection and data analysis to be intertwined, such as theoretical sampling and memo-writing.

Therefore, the constructivist approach can lead grounded theorists to look at and beyond how the participants view their actions in various situations (Charmaz, 2014; Charmaz, 2006; Charmaz, 2005).

3.3 Autoethnography

‘Autoethnography is an autobiographical genre of writing and research that displays

multiple layers of consciousness, connecting the personal to the culture’ (Ellis and

Bochner, 2000, p. 739). It is further explained that:

‘Back and forth autoethnographers gaze, first through an ethnographic wide-angle lens, focusing outward on social and cultural aspects of their personal experience; then, they look inward, exposing a vulnerable self that is moved by and may move through, refract, and resist cultural interpretations. As they zoom backward and forward, inward and outward, distinctions between the personal and cultural become blurred, sometimes beyond distinct recognition.’ (Ellis and Bochner, 2000, p. 739)

It is argued that autoethnography combines the two approaches of autobiography and ethnography (Ellis, 2004; Ellis et al, 2011).

Generally speaking, scholars have slightly different understandings of the term ‘autoethnography’. According to Reed-Danahay (1997), the word ‘autoethnography’ can be seen as auto (self) - ethno (culture) - graphy (research process). Meanwhile, Chang (2009) argued that the term ‘autoethnography’ consists of three dimensions: autobiography (content), culture (interpretive orientation) and ethnography (methodology). Moreover, Ellis et al (2011) claimed that autoethnography is a method of writing personal experience (auto) with a systematical analysis (graphy) in order to understand the culture (ethno). From this perspective, autoethnography has characteristics combining ethnography and autobiography (Ellis, 2004; Ellis et al, 2011). To summarise, it is best accepted that autoethnography is viewed as ‘part auto

or self and part ethno or culture’ (Ellis, 2004, p. 31, original emphasis).

It can be argued that autoethnography is a family member of ethnography. And ‘autoethnography is an ethnographic inquiry that utilizes the autobiographical

materials of the researcher as the primary data’ from the perspective of methods

(Chang, 2008). When researchers conduct ethnography, they are likely to be a participant observer, collecting data through field notes and/or interviews that are conducted in a field study (Ellis et al, 2011). Ethnography also offers a perspective of cultural practice which helps insiders (cultural members) and outsiders (cultural strangers) to better understand the culture (Maso, 2001).

Similar to ethnography, autoethnography refers to the process of doing a study and the written product produced from the process (Ellis, 2004). In comparison with ethnography, autoethnographers collect data through personal experience and/or interviewing to demonstrate the experience of cultural characteristics that are familiar to both insiders and outsiders (Ellis et al, 2011). As Chang (2007, p. 207) asserted, ‘autoethnography emphasizes cultural analysis and interpretation of the

researcher’s behaviors, thoughts, and experiences in relation to others in society’.

world by learning other people’s stories and understanding their culture. As Wall (2006, p.146) stated, ‘the intent of autoethnography is to acknowledge the

inextricable link between the personal and the cultural and to make room for nontraditional forms of inquiry and expression’. And what is more, autoethnography

acknowledges the researchers’ personal and cultural beliefs and their reflexive mind in response to the collected data. According to Alvesson and Sköldberg (2000, p. 245),

‘Reflection means thinking about the conditions for what one is doing, investigating the way in which the theoretical, cultural and political context of individual and intellectual involvement affects interaction with whatever is being researched, often in ways difficult to become conscious of.’

From this perspective, reflection in autoethnography plays a significant role in thinking of multiple layers of the studied phenomena in personal, social and cultural ways.

3.4 The relationship between constructivist grounded theory and

• Inclusion and Learning in Regular Classrooms (LRC) in the 21 st Century
• Legislative movement for people with disabilities in China
• Chinese perspectives of deafness
• Chinese deaf culture
• Deaf identity
• Education for children with hearing impairments in the early years in China
• Parental involvement in inclusive education in China
• Impact of deafness on parental involvement
• Hearing parents’ perceptions on deaf children
• Constructivist grounded theory (You are here)
• The relationship between constructivist grounded theory and autoethnography
• Ethical considerations
• Data analysis
• The strategies used in the data collection and analysis
• a Parents' response to deafness
• a Parents’ purpose of speech and listening training
• a Parents’ attitudes towards language environments
• b Parents’ choices of mainstream schools
• a The diagnosis of deafness
• b The search for a cure for deafness
• b ‘Software’ strategies: speech and listening training
• a The access to mainstream schools
• b Parents' relationship with teachers
• a Coaching deaf children in moral education
• b Coaching deaf children in academic learning
• c Coaching deaf children in social-emotional skills
• a Deaf children’s academic learning
• c Parenting stress in coaching deaf children

Related documents

• Open access
• Published: 02 April 2024

“To do or not to do”, male nurses’ experiences of providing intimate care to female patients in China, a constructivist grounded theory study

• Xiao-Chen Lyu 1   na1 ,
• Xiang-Yun Sun 2   na1 ,
• Li-Hung Lee 3 &
• Cheng-I Yang 3  

BMC Nursing volume  23 , Article number:  227 ( 2024 ) Cite this article

223 Accesses

Metrics details

Some studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses’ experiences and process of providing intimate clinical care to female patients.

A constructivist grounded theory approach was used to develop a theoretical understanding of male nurses’ experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development.

Chinese male nurses’ experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China.

Conclusions

Chinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

Peer Review reports

Nursing has historically been defined as a caring profession, and caring is viewed as a feminine trait. Despite the historical accounts of men in nursing and the growing importance of male nurses contributing to the diversity of the nursing profession, nursing remains a female-dominated profession in the current era [ 1 ]. In most countries, however, the number of men in nursing has steadily increased over the past decades. In the USA, men represent 13.3% of the nursing workforce [ 2 ]. Men account for 9.5% of nurses in Canada, 10.7% in the UK, and 7% in Australia [ 1 ]. In Asia, the proportions tend to be lower, with 4.9% in Japan and only 2.0% in China [ 3 ]. Like male nurses in most countries around the world, those in China also tend to work in emergency or critical care units. A survey of 30 tertiary general hospitals in Hunan province showed that up to 88.3% of male nurses work in operating rooms or in emergency or critical care units, with only 11.7% working in surgery and internal medicine wards [ 4 ]. Due to the characteristics of these emergency or critical care units, they are highly professional and technical, with higher salaries and more opportunities for promotion. Scholars believe that male nurses actively utilize the choice of work unit as an effective strategy for their adaptation to the nursing profession [ 5 ]. Although nursing is a female-dominated profession, male nurses are part of the nursing profession and should provide quality nursing care to all patients [ 1 ].

Nurses provide basic nursing care that requires physical and psychological closeness to diverse patients. During the execution of some basic nursing care, patients’ body parts that are considered intimate, private and sexual are exposed and touched [ 6 ]. Intimate touch has been defined as involving inspection of, and possible physical contact with [ 7 ], a patient’s private parts. Nurses touch patients in order to perform clinical tasks. The areas of the body that are touched during intimate care provision include the genitalia, buttocks, perineum, inner thigh, lower abdomen and breasts [ 8 ]. Nurses touch areas of the patient’s body such as the breasts for electrocardiograms, the genitalia for catheterization, the buttocks for intramuscular injection, the perineum for washing, etc [ 7 ]. During intimate care, a nurse and a patient need to establish a relationship in a confined space, where a patient has to grant a stranger access his/her body’s most intimate parts and, in turn, the nurse has to see and touch another person’s body [ 6 ]. Although the physical exposure and touching of these patients are necessary steps in the therapeutic and caring process, such “task-oriented touch” can cause stress and may bring about feelings of anxiety, embarrassment and discomfort for both nurses and patients [ 7 ], especially when a nurse is caring for the opposite sex [ 9 ].

There are not many relevant studies in the literature on male nurses providing intimate care to female patients. What is evident from the literature is the challenging and problematic nature of male nurse touch, specifically the perception of sexualized touch in the provision of body care [ 10 ]. During the process of receiving intimate care, female patients might worry about male nurses looking at and touching their bodies [ 10 ]. At the same time, providing intimate care to female patients poses challenges and triggers unpleasant experiences for the male nurses themselves [ 8 ]. Male nurses worry that performing this task-orientated touch on specific areas of the female patient’s body might be misinterpreted by the patients as having a sexual purpose [ 9 ].

Additionally, the attitude of female patients toward receiving intimate care from male nurses may also be influenced by cultural factors. In the West, male nurses are offered more opportunities and autonomy to take care of female patients, whereas the duties of Chinese male nurses are greatly reduced by traditional culture norms [ 3 ]. The traditional Chinese cultural view holds that men and women are different in physiology and psychology, so the etiquette that should be observed should be different, and the communication between men and women should also be cautious [ 11 ]. The Chinese are influenced by Confucianism, and according to the Analects of Confucius, people are advised not to look at what is contrary to propriety, not to listen to what is contrary to propriety, not to speak what is contrary to propriety, and not to do what is contrary to propriety. Previous research has shown that despite society’s progress into modernity, traditional Chinese culture is still deeply rooted in college students’ attitudes toward the exposure of women’s bodies and intimate relationships. To college students educated in the West, the sexual culture in modern Chinese society would seem relatively conservative [ 12 ]. Additionally, it has been argued that male nurses in China may experience the unwillingness of female patients to receive intimate care from male nurses because of the traditional Chinese culture [ 13 ].

According to the information we have, most hospitals across the country, at least in the central provinces, recommend that male nurses be accompanied by female nursing colleagues and communicate appropriately when providing intimate care to female patients, but these are only superficial rules. There is a lack of relevant clear regulations or provision of education and training courses on intimate care to male nurses. Such advice and strategies may protect patients and male nurses from misunderstandings or conflicts during the care process and reduce possible subsequent legal disputes. But this may be of limited help in how male nurses can reduce the embarrassment of providing care to female patients. In view of this, it is necessary for us to deeply understand the experience of male nurses when providing intimate care to female patients, understand their needs, and then try to reduce their distress and improve the quality of care.

Although the literature has highlighted the importance of gender and sexuality issues related to intimate care, male nurses who are particularly disturbed by intimate care should be a focus of future research [ 9 ]. There is very limited literature on the challenges encountered by Chinese male nurses in providing intimate care to female patients. This study intends to use the method of qualitative research (constructive grounded theory) to understand the relevant experiences of Chinese male nurses in providing intimate care to female cases, especially the process of providing intimate care, the influential factors and the relevant context. The purpose of this study was to explore Chinese male nurses’ experiences and interaction processes of providing intimate care to female patients in a clinical setting.

This study was guided by the work of [ 14 ], and a constructivist grounded theory approach was adopted. Constructivist grounded theory takes on a methodology developed by Glaser and Strauss in 1967 and is characterized particularly by its inductive approach to research, with the aim of developing a theory or explanation grounded in the data, rather than pre-existing categories and theoretical frameworks [ 15 ]. Constructivist grounded theory is based on interpretivist, subjectivist assumptions; its methodological underpinnings focus on how participants construct meaning in relation to the area of inquiry, and a constructivist co-constructs experience and meanings with participants [ 16 ]. As a research method, constructivist grounded theory is ideal when little is known about a topic because it offers explanatory power beyond description as to what is happening in practice [ 14 ]. The interpretive nature of the constructivist grounded theory approach allows for the nurse researcher to take her personal and professional experience into account, alongside the existing knowledge informing the field of enquiry [ 17 ].

Sampling and recruitment

It was anticipated that the findings would have wider relevance if data were collected from more than one clinical setting and spanned a variety of nursing specialties [ 17 ]. Therefore, in this study, the male nurse participants were recruited from different wards or units in hospitals in different locations in China. The inclusion criteria for participants were as follows: age of 20 years or more, male nurse license in China, at least 6 months of work experience in nursing and experience in providing intimate care to female patients in the clinic. Participants were invited and clearly informed of their rights and obligations before they decided to participate in this study, and informed consent was obtained from all participating male nurses before the interview.

Purposive sampling was used to locate participants who could share their experiences and perspectives on providing intimate care to female patients because it allowed for intentional locating of participants who could provide rich data on the topic of interest [ 18 ]. Initially, a recruitment poster was sent via email to the research departments and nursing heads of hospitals A and B. Both hospitals were Grade A tertiary hospitals located in Wuhu City, Anhui Province, in eastern China. A list of 25 potential participants who met the inclusion criteria and expressed interest was returned, with the potential participants’ agreement. All were recruited, but four later withdrew due to scheduling conflicts and personal reasons, leaving 21 participants in the initial stage of the study.

Additionally, theoretical sampling, as suggested by [ 14 ], was used as the study progressed in the later stage. Additional data were sought based on concepts developed from the initial data analysis, and the participants were asked to enrich the emerging theory [ 17 ]. For example, from the analysis of the first 21 participants’ experiences, we drew up preliminary theoretical constructs. We wanted to further confirm whether the initial theoretical framework could also be applied to male nurses at hospitals in different provinces. Through introductions, we recruited 4 participants who worked at hospital C, a Grade A tertiary hospital located in Chengdu City, Sichuan Province, in western China. These participants were in the same age group as the previous 21 participants. Through interviews, we learned about their experiences with female patients, who were perceived to be influenced more by traditional Chinese culture. Although they seemed to encounter more female patients who were concerned about receiving intimate care from male nurses, the experiences of these 4 male nurses were in line with the initially developed theory. After 25 interviews, we judged that theoretical saturation had been achieved; i.e., through the data analysis, no new properties of our theoretical categories emerged. Therefore, data collection ceased.

Data collection

Data were collected via semi-structured interviews, which took place in conference rooms in clinical settings. Each participant was interviewed once. All interviews were conducted by the first author, lasted a range of 30 min to one hour, and were audio recorded and transcribed verbatim. The questions asked during the interviews are: (1) What are your experiences and thoughts regarding providing intimate care to female patients in the clinic? (2) What you usually do when you provide nursing care to female patients and you need the patient to expose her private parts or you need to touch her body or private parts? (3) Do you feel comfortable providing intimate care to female patients? (4) Is there anything that you find difficult or disturbing? If so, how do you deal with it? The interview questions were developed based on the research topic, purpose, and personal experiences, as well as modified from a previous study that we believed would contribute to a more complete understanding of the participants’ relevant experiences [ 19 ]. Additionally, during the interview process, the interviewer tried to encourage the participants as much as possible to share their experiences so that we could understand the research phenomenon, and the interviewer did not deliberately interfere or direct the content or ways of sharing of the participants.

Data analysis

In this study, data were analyzed using the method proposed by Charmaz [ 14 ]. This method includes the following elements: initial coding, focused coding, theoretical coding and memo writing. Initial coding is the first level of analysis and is done line by line to find potential categories and processes by opening up the raw data to as many possibilities as present themselves. In this phase, we tried our best to determine the codes for the meaningful experiences, thoughts or opinions on providing intimate care to female patients shared by male nurses. Focused coding is applied when initial codes stand out as significant or appear frequently in the initial coding, and it involves sorting, synthesizing and organizing codes and large amounts of data [ 20 ]. We examined all codes to determine their frequency of occurrence, times, and event contexts, and we aimed to clarify the relationships between them to form categories. For example, during this phase of analysis, we confirmed that three factors— environmental factors, patient factors, and body parts—were related to male nurses’ self-anticipation of acceptance by a patient/family before providing intimate care. The next step is theoretical coding, the purpose of which is to identify potential relationships between categories developed earlier, so as to work out an analytical narrative that could lead towards a theory [ 14 ]. We discussed the codes and categories, drew a figure and visualized their relationships based on the factors of time and context. In this phase, for example, we confirmed that the process of a male nurse providing intimate care to female patients can be divided into three stages, as follows: stage one, anticipation of the level of embarrassment; stage two, deciding on the process/to do it or not to do it; and stage three, protecting both parties and dealing with embarrassment. We also confirmed the categories and codes of the three stages. Additionally, Charmaz suggests including note-taking or memos as part of the cyclical process to help construct the primary categories [ 14 ]. In this study, the early stage of memo taking focused on what we saw happening in the data. Additionally, we focused on what process was at issue and under which conditions this process developed. The later stage of memo taking focused on making comparisons, such as comparing different participants’ accounts or experiences and comparing categories in the data with other categories [ 14 ].

We used the qualitative data analysis software NVivo 14 for Windows to manage and analyze the data. The analytical process was led by the fourth author. Analysis of focused codes and emerging categories were carried out jointly with all authors. The near-final version of the results was presented graphically to 3 study participants at each hospital. They appreciated the presentation of the results, stating that the findings were consistent with their experiences in providing intimate care to female patients.

Rigor and trustworthiness

All authors, having worked as nurses for many years, had worked with male nurses and had expertise in doing qualitative research. Notably, the first and fourth author of this study are both male nurses. In their past clinical experiences, they had provided intimate care to female patients. This was helpful for us to understand the experiences shared by the participants. They also often reflected on their own experiences and the phenomena they had observed and discussed them with the other two researchers to avoid subjectivity when interpreting the experiences of the participants, which would have affected the research results. Additionally, several strategies were employed to establish rigor and ensure the trustworthiness of this research. Member checking, during which the researchers returned to participants and asked them to check and comment on the transcripts with the aim of validating the interviews, strengthened the study’s credibility [ 21 ]. Peer review among the authors was also performed to offer a mechanism for validating the research findings [ 20 ]. Additionally, we used the CASP qualitative checklist; the 10 questions and their suggested belonging considerations in the checklist were used to examine the whole manuscript to enhance its trustworthiness and the quality [ 22 ].

The participants in this study included 25 male nurses from three hospitals located in two different provinces of China. Their age ranged from 22 to 37 years (mean = 28.5). Most were aged less than 30 years (18; 72%) and had bachelor degrees in nursing (21; 84%). The participants came from many different nursing workplaces. Most of them (10; 40%) served in general medical or surgical wards, followed by intensive care units (7; 28%). The others were from the emergency room, operating room, and obstetrics and gynecology wards. Their job experience in nursing ranged from 0.5 to 14 years (mean = 5.4). Table  1 shows the detailed demographic characteristics of the participants. Additionally, besides the basic nursing skills learned at university or college, none of the participants had received relevant education or training on how to provide intimate care to female patients after graduation.

According to the participants’ experiences, we found that these male nurses basically believed that medical care should not be gender-specific. They felt that, as nurses, they should provide any care for female patients, including intimate care. However, considering that patients and family members may be influenced by traditional Chinese culture, they may have concerns and scruples about receiving care from male nurses. Therefore, decisions on implementing intimate care for female patients should take into account not only the standard nursing skills but also the patient’s feelings, and nurses should respect the wishes of patients and family members. The participants made efforts to reduce the patients’ and their own embarrassment while protecting both parties to avoid misunderstandings and disputes during the process of implementing intimate care for female patients.

From the data analysis, three stages, seven themes and associated categories were identified to represent the process of male nurse providing intimate care to female patients in China, as follows: Stage one : anticipation of the level of embarrassment, and its belonging themes of “anticipation of acceptance by patient/family” and “the level of self-confidence”. Stage two : deciding on the process/do it or not do it and the two themes of “getting permission” and “assessing situation and resources”. Stage three : protecting both parties and dealing with embarrassment and its three themes of “protecting both parties”, “dealing with the embarrassing atmosphere” and “turning to female colleagues for help”. Additionally, each of the 7 themes also contained 2–3 categories, for a total of 16 categories. The details of the 3 stages, 7 themes and 16 categories and their relationships are provided in Table  2 ; Fig.  1 . Each theme is illustrated by representative quotes from participants in the following sections.

Framework on the process of male nurse providing intimate care for female patients

Stage one: anticipation of the level of embarrassment

When the male nurses know they have to perform an intervention for a specific female patient that involves the female patient’s private parts, in the first stage, they tend to anticipate the embarrassing situation and degree of embarrassment they may face when conducting the intimate care. The sense of embarrassment is influenced by male nurses’ prediction on the acceptance of the patient or family members toward their care and also their self-confidence in conducting intimate care.

Theme 1: anticipation of acceptance by patient/family

For the male nurses in this study, whether patients and family members could accept them performing this intimate care was the main source of embarrassment. According to their experience, environmental factors (hospital location; the ward or unit), patient factors (age, conscious state, severity of illness, marital status, education level, etc.), and the body parts to be exposed all impact the acceptance of patients and their family.

Environment factors

The province, city or county where the hospital is located may, though not always, affect the education level of female patients and the influence of traditional Chinese culture on patients and their families. In addition, the ward unit where the male nurse serves is also an influencing factor. If it is the emergency room, intensive care unit, or operating room, the patient’s condition is usually more serious. At such times, patients and family members tend to be more accepting of necessary treatment, even if it involves exposure of private parts. In contrast, if the setting is a general medical and surgical ward, patients and family members have more time for consideration, and therefore male nurses may face more challenges.

Our hospital is located in a relatively rural city, and the education level of the patients may be relatively low. Some female patients may have more concerns about accepting care from male nurses. This is also a challenge for us male nurses. (Participant 1)

Basically, the patients in our intensive care unit, they know that they are here, and their condition is relatively serious, so basically, they are more able to accept our treatment and care. (Participant 7)

Patient factor

The female patient’s or family’s acceptance of intimate care performed by a male nurse will vary depending on the condition of the patient. Generally speaking, if the patient is older, critically ill, or comatose or sedated, the acceptance by the patient and family members is usually higher, and the expected embarrassment perceived by male nurses is lower.

If it is a coma patient, the treatment time should be shortened first, and rescue is the first priority…. When the patient is unconscious, the family members generally accept it. The female patient will not feel embarrassed, and neither will I. (Participant 2)

For male nurses, the most challenging cases would be young and conscious female patients. Perhaps influenced by traditional Chinese culture, young female patients tend to feel hesitant, anxious and unwilling to expose their private body parts to a male nurse, who to them is a young male stranger.

That young patient thinks that she is a female patient, and these treatments involving exposed private parts should be done by a female doctor or nurse. (Participant 15)

Additionally, it is not only young female patients who have concerns about receiving intimate care from male nurses. Some male nurses (especially the younger ones) may sometimes have conflicts, psychological barriers and embarrassment when they need to provide intimate care to young female patients, as such behavior violates the traditional Chinese cultural concepts they received.

I think it’s okay for me to care for older women, but if I meet some young women in their 20s and 30s, I think I will mind it a little bit. Because I think there is still a difference between men and women, right? Although as a medical professional, I don’t think there should be any gender distinction, but when facing female patients in their 20s and 30s, I think I still care a little psychologically. (Participant 4)

It is because of the similar age, I am at the same age as her. For example, if a patient is in her 20–30 s, I will feel a little strange… Yes, I will feel awkward when I see her private parts. (Participant 14)

The body parts that need to be exposed for treatment can sometimes affect the acceptance of patients. According to the participants’ experiences, patients and family members have a relatively high acceptance of the ECG with the chest exposed. However, if the patient needs to expose the perineum for catheterization or perineal irrigation, the acceptance of the patient and family members is relatively low.

The ECG monitoring is okay; there is nothing special about the ECG monitoring. Basically, the upper body is okay for the patients, [but] if the lower body needs to be exposed, it will cause more embarrassment than the upper body. (Participant 12)

Theme 2: the level of self-confidence

Male nurses’ perception of embarrassment is also related to their degree of confidence in providing intimate care to female patients. According to their experiences, the self-confidence is affected by their proficiency in the skill, their work experience (novice or senior) and also their previous interactions with female patients and family when conducting intimate care.

Skill proficiency

Some male nurses do not have a good understanding of female anatomy and lack opportunities to practice techniques related to intimate care, which affects their self confidence in performing such tasks. For example, although participant 9 had been working as a nurse for 3 years, the nature of his work unit (trauma and orthopedic ward) meant that he had rarely needed to provide intimate care to female patients in their unit, so he had rarely had opportunities to practice. Therefore, when he occasionally encountered such a situation, he lacked confidence in whether he could perform well.

The difficult part is that I rarely have the opportunity to perform catheterization on female patients; that is, I may have a little lack of proficiency, and I may feel that I am not familiar with the implementation. (Participant 9)

Novice or senior

At the initial stage of nursing work, male nurses have relatively little experience in performing such tasks and have low self-confidence in providing intimate care to female patients. With more and more work experience, they will develop more self-confidence and experience less psychological embarrassment when facing the task of intimate care. Participant 5 (8 years of work experience) and participant 21 (12 years of work experience) compared their confidence levels in providing intimate care to female patients when they first started to engage in nursing work and now.

At that time, I was still inexperienced, that is to say, it was quite embarrassing… maybe, it was because I had no experience in some nursing skills and related communication. (Participant 5)

When I started working, regarding women’s private parts, such as women’s breasts, or private parts of women… I have a little bit of scruples about different genders in my heart, but as I work for a long time, as long as the family members are willing let me to do it [then] I will do it, just treat it as a task. (Participant 21)

Previous positive/negative experiences

For some male nurses, their experience and feelings of providing intimate care to female patients is a continuum. Their past obstetric practice experience at the student stage and the situations they face in clinical work after graduation both affect their confidence in providing intimate care.

At that time, I scrubbed her body, comforted her not to be nervous, and then explained the necessity of such an operation. The female patient was accepting during the process. At that time, I felt that I had learned a new nursing skill, and I was very happy. If I encounter this kind of patient again, I may not worry anymore. (Participant 12)

She said that she didn’t want a boy to do the electrocardiogram for her. In the end, I asked a female nurse to do it. I felt a little bit rejected. This experience probably affected my mood at work for a period of time. I had that thought of never wanting to provide this kind of care to a female patient ever again. (Participant 14)

Stage two: deciding on the process/Do it or not do it

After feeling the anticipated degree of embarrassment, the male nurse will enter the second stage, the process of deciding whether to implement the intimate care himself. At this stage, the male nurse will mainly respect the wishes of the female patient and family members. At the same time, the male nurse will also assess the objective conditions and the possibility of looking for other alternatives.

Theme 3: getting permission

The wishes of patients and family members are the most important basis for male nurses to decide whether to perform a task by themselves. The process includes confirming the wishes of the patient or family members. Sometimes the patient or family members may hesitate, worried about receiving intimate care from a male nurse. They may sometimes ask for the care of female nurses. In such cases, it is necessary for the male nurse to communicate and negotiate with the patient and family members.

Affirm patient and family wishes

When confirming the wishes of the patients or family members, the male nurse participants first explained to the female patients or family members the examination that would be done, as well as the body parts that might involve privacy issues and exposure during the process. Then they tend to observe the facial expressions or reactions of the female patients and family members, or directly ask the patients or family members for their thoughts.

You have to pay attention to her expression, if you feel that her expression is not very happy, we may pay a little attention. Then for this kind of patient, try to let a female nurse do it for her. (Participant 1)

If there is really no female nurse, I will ask her directly, I will ask her, would you like me to do an electrocardiogram for you? And if she agrees, then I’ll do it for her. (Participant 5)

Sometimes, the wishes of female patients present an ambiguous situation, which increases the difficulty of judgment and further work arrangement of male nurses.

I actually like it better. If the patient really wants to refuse me, I hope she can tell me directly from the beginning, because in this way I can quickly find other alternative methods.… If she says she agrees, but in fact she really minds, and then feels very embarrassed and is uncooperative during the treatment, it will cause me some trouble in my work. (Participant 10)

Communicating and negotiating

Sometimes, when a patient or family member hesitates, or asks if there are other female nurses, the male nurse may spend a little more time explaining, communicating, and even coordinating with them.

If the communication is ineffective, I will definitely call a female colleague to help, but if I am the only one on the night shift, and if I encounter a female emergency patient, I will try my best to communicate with her, saying that the treatment is urgent, be patient and explain it to her until she agrees. (Participant 4)

Most of the participants emphasized the importance of communication skills, which not only help to reduce the anxiety of female patients and their families about receiving intimate care from male nurses but also increase the consent of patients and their families.

If you communicate with her well, I think most of the problems can be solved during the communication process. If she minds, she will tell you during the communication. When it comes to intimate care, it will be very smooth. (Participant 9)

Theme 4: assess Situation & resources

The participants may also assess the situations, including whether there are a female nurse who are available and willing to provide assistance and whether the patient is accompanied by family members. This information can be referenced to decide whether to help female patients with intimate care.

Female nursing staff available

Female nurses are the main sources of help when male nurses encounter problems in providing intimate care. If a female nurse is free and willing to help, some of the participants are more inclined to directly seek help from the female nurse in order to avoid embarrassing situations they may face. Male nurses are especially likely to do so when they encounter young female patients and feel a high degree of embarrassment.

For younger female patients who have never been in a relationship or married, for example, before the age of 18, or in their twenties. We usually let a female nurse care for them. We male nurses, basically, there is no need to deal with this type of patients. (Participant 14)

When encountering a patient in her twenties and thirties, such as doing electrocardiograms or perineal scrubbing, we usually let the female nurses do it. If there are no female nurses, only me, or when all the nurses there are male, I then do it for the patient. (Participant 5)

Some male nurses would seek help from their female counterparts when their communication with the patient or family members was ineffective or they were rejected.

For example, for a female patient, her boyfriend did not agree to me providing intimate care to the patient. I had already communicated with him and told him that I was a nurse, but he disagreed and there was nothing I could do, so I had to ask a female colleague to help me. (Participant 19)

Family member accompany

Whether the patient is accompanied by family members is also one of the factors that male nurses consider in decisions on providing intimate care to female patients. Male nurses tend to hope that the presence of family members will be helpful for them to carry out intimate care; otherwise, they would prefer that family members do not appear.

If there are family members at the time, wouldn’t it be better to ask the family members to accompany the patient? Especially for a couple, the husband can accompany the patient during the treatment to eliminate the patient’s doubts. (Participant 2)

After all, we are in the intensive care unit, and patients are usually unconscious. The presence of family members is not helpful for us to perform intimate care. Therefore, I will avoid doing some intimate care for patients when their family members are there. (Participant 7)

Stage three: protecting both parties and dealing with embarrassment

Whether the reason is that the patient or family does not accept the care of a male nurse or no female nurses are available at the time, when male nurses have to perform intimate care of female patients by themselves, they will use some strategies to protect female patients and themselves and to reduce the embarrassment of both parties.

Theme 5: protecting both parties

Protecting patients is the primary task of nursing staff. However, since intimate care involves exposure and touching the private parts of the female patient’s body, the male nurse may worry that the female patient could misunderstand the male nurse’s actions or intentions during the process, causing unnecessary trouble. Therefore, when providing intimate care, the male nurse must not only protect the patient but also do something to protect himself.

Maintaining patient privacy

Regardless of whether the patient is awake or not, male nurses are taught that it is important to protect the privacy of the patient when providing intimate care. Their strategies include asking family members or other people who should not be present to leave, drawing the bed curtains, and trying to minimize the exposure of the patient’s private parts during the process.

I will pull the curtain of the patient’s bed, and then, I don’t let her breasts be fully exposed, and I try to cover some of the patient’s private parts as much as possible without affecting my work. (Participant 18)

Requesting a chaperone

All male nurses in this study are required by their hospitals to find a chaperone to accompany them when they provide intimate care to female patients. This chaperone is usually a female nurse, a female family member or the husband of the female patient. It can reassure patients and protect the male nurses themselves.

I think it is still necessary to have a female colleague with me, so that it feels more secure. For a young girl, if a female nurse is by her side, maybe the female patient’s sense of security will increase a little, and my sense of security will also increase a little. (Participant 5)

Pre-announcing

For the participants, foretelling or explaining the body parts that may be exposed or touched in the next action can prevent the patient or family members from being surprised by the action performed by the male nurse, or even misunderstood as bad-intentioned.

This is actually a way to protect the patient, and also a way to protect myself. For me, I know the procedures needed to perform intimate care, which actions may need me to touch which parts of her body, but the patient, she may not be so clear. So in this case, if I didn’t inform her in advance, it is possible that the patient may have some misunderstandings when I touch her, or even more seriously, cause some legal disputes. (Participant 10)

Theme 6: dealing with the embarrassing atmosphere

For participants, regardless of whether the source of embarrassment comes from the female patient or the male nurse himself, the feeling of embarrassment could affect both parties. Therefore, in the process of providing intimate care, the male nurse may use some methods to reduce the embarrassing atmosphere, such as comforting the patient, talking professionally, remaining silent, or doing it right and fast.

Comforting the patient

Comforting the patient refers to caring for the patient with language, telling the patient not to be too nervous, and relieving the patient’s nervousness. In this study, it usually occurs when the patient or family members have a higher acceptance of male nurses providing intimate care, and when the male nurses feel less stress.

If the patient is awake, she may feel a little awkward. Then we would talk to her and distract her a bit to ease the awkwardness. For example, I will talk to her about her family, work, and some small things in daily life. The patient is usually more relaxed and more cooperative during the process. This is how I have been working for many years. (Participant 15)

Talking professionally

Some participants may also play down the impact of gender factors on intimate care and reduce the degree of embarrassment felt by both parties through the display of professional knowledge. They talk to patients, focusing on professional topics. For example, they try to understand the reasons why patients seek medical help, explain the patient’s health conditions and the reasons for these examinations, and also provide patients with health education and so on.

Generally speaking, I will give her a health education on some relevant knowledge of this treatment or examination, as well as the follow-up matters that patients should pay attention to, so that she can understand that I am on her side, and it is all for her good and health, and let her try to eliminate any concerns about sex. (Participant 7)

Remaining silent and doing it right and fast

When the male nurses feel great stress from conducting intimate care, such as when they encounter a young female patient, it is not easy for them. Many participants tend to choose not to talk with the female patient and try to perform the action “right and fast” to end the moment of embarrassment as soon as possible and also avoid misunderstandings that might occur.

If I know that the care I am going to do is about the private parts of the young female patient, I will be very shy, I will be very embarrassed. When I start, I will only think about how to do it. I will forget to talk to her, to comfort her. (Participant 20)

I feel that if I talk too much, it may cause negative feelings in some female patients. So I usually just get it done quickly and the embarrassment can end. (Participant 16)

Theme 7: turning to female colleagues for help

When the male nurses in this study decided to seek help from female nurses, it was usually in several situations. Sometimes they did so to respect the wishes of the patient or family members, or the male nurses might directly choose not to perform the intimate care by themselves and ask other female colleagues for help so as to avoid embarrassment. They may perform other tasks in exchange for the help from the female nurse. Some male nurses may feel regret about asking female colleagues for help.

For some private bathing or urethral care, we ask the female colleague next door to do it, and we do other things like intravenous infusion and other routine care. (Participant 14)

Sometimes it is unfair to a female colleague, after all, she may be taking a break, so I would feel bad for asking her to help with this. (Participant 16)

Our study explores the male nurses’ experiences and interaction process of providing intimate care to female patients in the clinic within the Chinese context and culture. Using constructive grounded theory, we interviewed 25 male nurses in different hospitals and workplaces, and from their experiences we constructed our understanding of male nurses providing intimate care to female patients. The core finding is that Chinese male nurses’ experiences of providing intimate care to female patients can be constructed as a three-stage process, as follows: (1) anticipation of the level of embarrassment, (2) deciding the process/do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China. Some critical issues around our three stages and seven themes are worthy of further discussion.

Consistent with a previous study [ 23 ], the male nurses in this study generally believe that healthcare should not be gendered and viewed providing intimate care as a fundamental and vital part of their professional responsibility as a nurse. Although it varies from person to person, not only female patients but also some male nurses may also be influenced by traditional Chinese culture. The male nurse may sometime struggle between the duties of nurses, his gender as a man and traditional Chinese culture. Therefore, when the Chinese male nurses are faced with providing intimate care to female patients, they may be hesitant to do so. The reasons they gave were mainly to respect the ideas of female patients and their family members, but there were also subtle indications that they were influenced by traditional Chinese culture. Therefore, in the face of different degrees of embarrassment in different situations, whether to do it and how to do it appropriately are important issues in intimate care.

In the first stage, before providing intimate care, the degree of embarrassment generated by the male nurse is affected by two factors, one of which is the degree of acceptance of intimate care from a male nurse that he expects of female patients and their families. In addition to the patient’s age, the patient’s health status and level of consciousness were mentioned in a previous study [ 24 ]. Among them, the age of the patient is undoubtedly the most interesting. Previous studies in many different countries, including Indonesia and South Africa, have found that male nurses feel particularly challenged and vulnerable to embarrassment when they have to provide care to young female patients [8; 24], suggesting that this is not a unique phenomenon in China but tends to be a cross-cultural phenomenon of male nurses in Asia and even in African countries. For example, in the South African context, care of the body is confined to family based on gender and occurs within the safe environment of the home [ 8 ]. But when facing older female patients, male nurses feel less pressure and less embarrassment, as they more likely to depersonalize or desexualize the situation, ignoring the gender of the patient and providing professional nursing care [ 23 ]. Our findings show that younger male nurses may sometimes have conflicts, psychological barriers and embarrassment, especially when they need to provide intimate care to young female patients. The senior male nurses in this study did not mention relevant experiences in the interviews. We think the reason may have been that the senior male nurses had more relevant experiences and knew how to deal with this type of care.

This study also found that the location of the hospital, as well as the exposed and touched body parts, may also affect the patient’s acceptance and thus indirectly affect male nurses’ embarrassment levels. We suspect that the location of the hospital may affect the education level of female patients and their family members and the degree to which they are influenced by traditional Chinese culture. Compared with their peers in acute and intensive care units, male nurses in the general ward encountered more embarrassing situations and the frequency of providing intimate care was higher. As in a previous study, most participants in this study focused on the body parts and anticipated that female patients and their family might express that such touch was unacceptable, especially on areas considered private and sensitive [ 8 ]. In addition, breast exposure was perceived as less threatening by female patients than was exposure of the perineum [ 25 ]. We suggest that these relationships should be confirmed by further research.

Male nurses’ personal self-confidence in providing intimate care also influences the degree of embarrassment they perceive. Their lack of technical proficiency in intimate care and lack of related experience are the reasons for their low self-confidence. It is not difficult to understand, as they may not be educationally prepared to interact with patients while providing intimate care to female patients [ 10 ]. The lack of implementation experience in clinical work, or negative experiences such as being rejected by patients, aggravated their lack of confidence in providing intimate care to female patients. It is also recommended that all male nurses be provided with adequate simulated pre-clinical training in providing and dealing with the process of providing intimate care [ 23 ].

In stage two, deciding on the process/do it or not do it, it is important to determine whether male nurses will personally provide intimate care to female patients. Although all the male nurses said it depended on the patient’s acceptance and they respected the decisions of the patient or family, in practice, a different attitude was shown. Some male nurses would directly choose to ask female colleagues for help to avoid embarrassment, especially when they can easily find a female colleague to help. They were only charged with providing intimate care to female patients when a chaperone and female nurse was unavailable [ 26 ]. In contrast, some male nurses were still willing to spend a little more time convincing patients and family members when they encountered hesitation from patients or family members. However, all the participants emphasized the importance of communication skills, and respect for patients requires communicating well, soliciting patient input in decisions, and honoring patient values [ 7 ]. Consistent with a previous study conducted in China, the male nurse always made the concerns of female patients their first priority, even though they were excluded from providing some kinds of intimate care to female patients [ 13 ]. In addition, most of the male nurses understood and expressed the view that the unwillingness of female patients to receive care from them could be ascribed to the traditional Chinese culture [ 13 ].

Stage three is protecting both parties and dealing with embarrassment. Consistent with previous findings [ 24 ], male nurses in this study were often apprehensive about using physical touch, and they used coping strategies to protect both parties and deal with the fear of being accused of inappropriate use of touch. When providing intimate care, male nurses were required to follow standard operating procedures, including protecting patient privacy, having a chaperone and pre-announcing, as reported in previous studies [ 23 ]. Their strategies for protecting patient privacy included pulling the bed curtains around and modifying procedural techniques to minimize patient exposure and the need for intimate touching [ 25 ; 27 ]. For the participants, a chaperone could be a female colleague or a member of the family. The presence of a chaperone could also provide protection against unfounded allegations of improper behavior [ 27 ]. Additionally, the need to touch female patients poses a risk for male nurses, as there is a potential for the misinterpretation of male nursing practice as sexually motivated [ 10 ]. The sexualization of male nurses’ touch provides insight into how gender stereotypes create discomfort and suspicion on the part of patients. This in turn impacts male nurses’ perceptions of their own safety while performing intimate and caregiving tasks [ 28 ]. In this study, pre-announcing was used by the male nurses as a strategy to reduce the possibility of being misunderstood by female patients.

Another important finding in the third stage was the strategies used by male nurses to reduce embarrassment in both patients and themselves during intimate nursing care. It has been argued that during the process of intimate care, both female patients and male nurses experience a feeling of discomfort, and that if a patient feels uncomfortable, then the male nurses should feel uncomfortable as well [ 25 ]. In the way of reducing embarrassment, what is more interesting is whether the nurse should talk to the patient. Our research results show that a male nurse should say something to comfort a female patient, whether he is lightly chatting with the patient or talking about health knowledge in a professional manner, to divert the female patient’s attention. Such diversion can make the patient feel less stress and more confident about the situation. Some male nurses are under high pressure. Especially when young male nurses meet young female patients, they may be very nervous, unconfident, or worried that their speech will be misunderstood by the female patients, so they choose not to speak during the process, as they just want to hurry and get things done. This method may help them quickly escape the embarrassing situation, but it may ignore the feelings and needs of female patients [ 29 ].

When the male nurse wanted to avoid embarrassment or was rejected by the female patient, asking a female nurse to help perform intimate care was the main alternative. However, there are still some hidden concerns, such as the general shortage of clinical nursing manpower or the high proportion of men in the workplace, which will inevitably increase the difficulty of finding a female nurse to perform intimate care. Therefore, hospital administrators must understand the challenges and needs of male nurses when providing intimate care to female patients and assist them with necessary education, training, and psychological support [ 24 ]. For example, raising awareness of intimate care conflicts will assist them in developing strategies to deal with uncomfortable intimate care incidents without losing their identity as men. They should be encouraged to reflect on their sociocultural values and be open to listening and learning from their patients [ 8 ].

Nursing implications

In view of the above, the findings of this study shed light on the situations and problems that male nurses may face when caring for female patients and providing intimate care. The experiences shared by senior male nurses and the effective strategies they adopted can also provide a reference for new male nursing staff or male nursing students when they encounter similar situations in clinical practice. In addition, the findings of this study will help nursing managers and nursing educators to guide male nurses and provide necessary psychological counseling and educational training, and they provide a reference for developing relevant policies.

As with all research, the limitations of this study must be acknowledged. First, this study was a constructivist grounded theory study informed by symbolic interactionism; accordingly, it assumes that reality is socially constructed through actions and interactions of individuals and society. Subsequently, the findings reported are only one interpretation of reality and not representative of every reality. In the participant recruitment process, the diversity of the sample in terms of age, nursing experience, workplace, and hospital locations was ensured as much as possible. We also achieved theoretical saturation. However, due to time and financial constraints, this study only conducted in-depth interviews with 25 male nurses, mainly in Anhui Province and a few in Sichuan Province. The absence of data from others may be construed as a limitation. Additionally, the participants might have forgotten details of events that occurred some time ago. Rather, the researchers interviewed the participants with some scripted questions and prompts so as to facilitate the participants to recall their experiences. Furthermore, future researchers should do more than just interview male nurses. It would be better to observe actual instances of intimate care or conduct interviews with other informants, such as female patients, who might provide additional perspectives that would inform the development of theory. In addition, in the future, it may be possible to design a questionnaire on the intimate care provided by male nurses based on the results of this study, and to test its reliability and validity for use as an effective research tool to conduct large-scale research on male nurses so as to detect and efficiently understand the severity of related problems.

This study used constructive grounded theory to show that Chinese male nurses may be influenced by traditional Chinese culture and experience embarrassment when they provide intimate care to female patients. To avoid embarrassment, they go through a do/not-do decision process. In addition, this study also found that at different stages, male nurses have different concerns. For example, in the first stage, it is young female patients with clear consciousness who make them feel the most anxious. They may also lack relevant skills and experience, resulting in a lack of self-confidence. Then, in the second stage, they will evaluate the willingness of the patient and family members, as well as consider whether there are female nurses available to help, and decide whether to perform the intimate care themselves. In addition, communication skills are very important in the process of communicating with patients and family members. The third stage involves strategies to protect both the patient and the nurse and to minimize the embarrassment of both during the intimate care. Furthermore, the relevant hospital nursing administrators should be conscious of the experiences and needs of male nurses in providing intimate care and further provide them with psychological support in a timely manner. In addition, relevant education and training courses should be designed and arranged to provide skills related to intimate care, communication skills, methods to protect patients and themselves, and skills to avoid embarrassment during the provision of intimate care.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Younas A, Ali N, Sundus A, Sommer J. Approaches of male nurses for degendering nursing and becoming visible: a metasynthesis. J Clin Nurs. 2022;31(5–6):467–82. https://doi.org/10.1111/jocn.15958 .

Article   PubMed   Google Scholar  

Egan B. 2022. The male nurse: benefits and percentages of men in nursing. Retrieved from https://www.snhu.edu/about-us/newsroom/Health/Male-Nurse .

Gao Y, Cheng S, Madani C, Zhang G. Educational experience of male students in a baccalaureate nursing program in China. Nurse Educ Pract. 2019;35:124–9. https://doi.org/10.1016/j.nepr.2019.02.006 .

Shen J, Guo Y, Chen X, Tong L, Lei G, Zhang X. Male nurses’ work performance: a cross sectional study. Medicine. 2022;101(31):e29977. https://doi.org/10.1097/MD.0000000000029977 .

Article   PubMed   PubMed Central   Google Scholar  

Zhang H, Tu J. The working experiences of male nurses in China: implications for male nurse recruitment and retention. J Nurs Manage. 2020;28(2):441–9. https://doi.org/10.1111/jonm.12950 .

Article   Google Scholar  

Shakwane S, Mokoboto-Zwane S. Demystifying sexual connotations: a model for facilitating the teaching of intimate care to nursing students in South Africa. Afr J Health Professions Educ. 2020;12(3):103–8. https://doi.org/10.7196/AJHPE.2020.v12i3.1367 .

Lu N, Gao X, Zhang S. Attitudes on intimate touch during nursing care in China. Int J Nurs Pract. 2014;20(2):221–5. https://doi.org/10.1111/ijn.12129 .

Article   CAS   PubMed   Google Scholar  

Shakwane S. Degendering male nursing students’ intimate care provision: a South African perspective. J Mens Health. 2022;18(10):208–15. https://doi.org/10.31083/j.jomh1810208 .

Lehn-Christiansen S, Holen M. Ambiguous socialization into nursing: discourses of intimate care. Nurs Educ Today. 2019;75:1–5. https://doi.org/10.1016/j.nedt.2019.01.002 .

Baker MJ, Fisher MJ, Pryor J. Potential for misinterpretation: an everyday problem male nurses encounter in inpatient rehabilitation. Int J Nurs Pract. 2022;28(1):e12985. https://doi.org/10.1111/ijn.12985 .

Chan ZCY, Chan YT, Yu HZ, Law YF, Woo WM, Lam CT. An ethnographical study on the academic experiences of Chinese male nursing students. Nurse Educ Pract. 2014;14(2):130–6. https://doi.org/10.1016/j.nepr.2013.08.009 .

Sun J, Li F, Wang S, Lu Z, Zhang C. College students still maintain the traditional Chinese concept of love. Heliyon. 2023;9(3):e13786. https://doi.org/10.1016/j.heliyon.2023.e13786 .

Chan ZCY, Lui CW, Cheung KL, Hung KK, Yu KH, Kei SH. Voices from a minority: experiences of Chinese male nursing students in clinical practice. Am J Mens Health. 2013:7(4): 295–305. https://doi.org/10.1177/1557988312473502 .

Charmaz K. Constructing grounded theory. 2 ed. Sage; 2014.

O’Connor A, Carpenter B, Coughlan B. An exploration of key issues in the debate between classic and constructivist grounded theory. Grounded Theory Rev. 2018;17(1):90–103.

Google Scholar  

Tie YC, Birks M, Francis K. Grounded theory research: a design framework for novice researchers. SAGE Open Med. 2019;7:1–8. https://doi.org/10.1177/2050312118822927 .

Andrews H, Tierney S, Seers K. Needing permission: the experience of self-care and self-compassion in nursing: a constructivist grounded theory study. Int J Nurs Stud. 2020;101:103436. https://doi.org/10.1016/j.ijnurstu.2019.103436 .

Metersky K, Orchard C, Adams T, Hurlock-Chorostecki C. Patient roles in primary care interprofessional teams: a constructivist grounded theory of patient and health care provider perspectives. J Interprof Care. 2022;36(2):177–85. https://doi.org/10.1080/13561820.2021.1892616 .

Inoue M, Chapman R, Wynaden D. Male nurses’ experiences of providing intimate care for women clients. J Adv Nurs. 2006;55(5):559–67. https://doi.org/10.1111/j.1365-2648.2006.03948.x .

Wong P, Liamputtong P, Koch S, Rawson H. Searching for meaning: a grounded theory of family resilience in adult ICU. J Clin Nurs. 2019;28(5–6):781–91. https://doi.org/10.1111/jocn.14673 .

Jacques MC, Tribble DSC, Bonin JP. Filters in the coping process of people with schizophrenia: a constructivist grounded theory study. J Psychiatr Ment Hlt. 2019;26(5–6):142–52. https://doi.org/10.1111/jpm.12515 .

Critical Appraisal Skills Programme. 2018. CASP Qualitative Checklists. Retrieved from https://casp-uk.net/casp-tools-checklists/ .

Crossan M, Mathew TK. Exploring sensitive boundaries in nursing education: attitudes of undergraduate student nurses providing intimate care to patients. Nurse Educ Pract. 2013;13(4):317–22. https://doi.org/10.1016/j.nepr.2013.04.007 .

Keogh B, Gleeson M. Caring for female patients: the experiences of male nurses. Br J Nurs. 2006;15(21):1172–5. https://doi.org/10.12968/bjon.2006.15.21.22375 .

Maryunani A, Hariyati RTS, Novieastari E. Phenomenological study on the experience of male nurses in caring for female patients. J Keperawatan Indonesia. 2021;24(1):32–41. https://doi.org/10.7454/jki.v24i1.690 .

Prideaux A. Male nurses and the protection of female patient dignity. Nurs Standard. 2010;25(13):42–9. https://doi.org/10.7748/ns2010.12.25.13.42.c8121 .

Harding T, North N, Perkins R. Sexualizing men’s touch: male nurses and the use of intimate touch in clinical practice. Res Theor Nurs Pract. 2008;22(2):88–102. https://doi.org/10.1891/1541-6577.22.2.88 .

Evans JA. Cautious caregivers: gender stereotypes and the sexualization of men nurses’ touch. J Adv Nurs. 2002;40(4):441–8. https://doi.org/10.1046/j.1365-2648.2002.02392.x .

O’Lynn C, Krautscheid L. How should I touch you?‘: a qualitative study of attitudes on intimate touch in nursing care. Am J Nurs. 2000;111(3):24–31. https://doi.org/10.1097/01.NAJ.0000395237.83851.79 .

Download references

Acknowledgements

We would like to thank the participants for their time, interest, and thoughtful insights in the study. We also thank all the health care providers of the three hospitals for their assistance.

This study was funded by the Scientific Research Project of Higher Education Institutions in Anhui Province (Grant Number: 2022AH040164), and the Special Scientific Research Start-up Funds for the Introduction of Talent in the First Affiliated Hospital of Wannan Medical College (Grant Number: YR20220211).

Author information

The first author XCL and the second author XYS contributed equally to this work.

Authors and Affiliations

The Outpatient Operating Room, First Affiliated Hospital of Wannan Medical College, Anhui, China

Xiao-Chen Lyu

The Department of Geriatric, First Affiliated Hospital of Wannan Medical College, Anhui, China

Xiang-Yun Sun

Department of Nursing, Hungkuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, 433304, Taichung, Taiwan

Li-Hung Lee & Cheng-I Yang

You can also search for this author in PubMed   Google Scholar

Contributions

XCL and CIY designed the study. XCL and XYS collected the data. XCL, XYS, LHL, and CIY analyzed the data. CIY and LHL drafted the manuscript. All authors read and approved the final manuscript. The first author XCL and the second author XYS contributed equally to this work.

Corresponding author

Correspondence to Cheng-I Yang .

Ethics declarations

Ethics approval and consents to participate.

Ethical approval was received from the Ethics Committee of Wannan Medical College Yijishan Hospital (Approval: No. WMCYH015). This study was conducted in accordance with the Declaration of Helsinki. The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participating male nurses before the interview. The quotations used in this study were anonymized to ensure confidentiality.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Lyu, XC., Sun, XY., Lee, LH. et al. “To do or not to do”, male nurses’ experiences of providing intimate care to female patients in China, a constructivist grounded theory study. BMC Nurs 23 , 227 (2024). https://doi.org/10.1186/s12912-024-01896-y

Download citation

Received : 26 May 2023

Accepted : 26 March 2024

Published : 02 April 2024

DOI : https://doi.org/10.1186/s12912-024-01896-y

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Experiences
• Intimate care
• Constructivist grounded theory

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]