Rationale

Grounded theory (GT) was initially developed by Glaser and Strauss1 as a research methodology to generate theory from data. Used extensively in the discipline of nursing since 1970,2 GT systematically gathers and analyses data in the generation of theory.3 Theories generated via GT methods are said to be grounded in data, meaning data drives the generation of theory instead of applying a theoretical framework to the research design, data collection and analysis.4 GT is a universal research method that can be undertaken using three different approaches: Classic (or Glasserian), Straussian or Constructivist.5

The aim of classic grounded theory (CGT) is to generate, develop or discover a theory,1 and theories generated from CGT research can act as drivers of change.4 Data collection and analysis occur simultaneously in CGT, with codes and categories developed from data through a constant comparative method that facilitates the emergence of a theory.3 The GT method advocates line-by-line coding as a first step because it forces the researcher to take a fresh look at the data, compare data fragments and ask analytic questions about them. This method of analysis facilitates data synthesis but, more importantly, allows CGT researchers to move beyond description through forming new concepts that explicate what is happening.

The CGT approach offers valuable strategies to develop researchers’ theoretical analyses6 and presents important opportunities to develop, enhance and improve nurse behaviours. For example, Flenady et al7 undertook a CGT study to explain the behaviours of emergency department registered nurses (RNs) when they perform respiratory rate observations. Analysis of data collected from 79 RNs revealed that health sectors forced compliance in recording observations meant that this group of RNs are more than likely to record a respiratory rate without actually counting respirations.7 The emergent theory called ‘Rationalising Transgression’ identified two significant factors that impact current practice.7 First, RNs in emergency departments report suboptimal practice occurring regarding respiratory rate collection methods and second, this poor practice occurs in part because nurses believe that respiratory rate observations are not required for every patient. Second, organisational requirements mandate that a value for this vital sign be given at each observation round are superfluous and redundant. From this CGT study, valuable insight into the behaviours of this cohort of nurses was identified and and important understanding of how these observations were collected was ascertained—both important factors that impact patient safety and quality nursing practice.7

Despite the important contribution of GT to nursing practice and knowledge, elements related to rigour are not always well understood and challenges continue to arise concerning authentication and trustworthiness when applying GT as a research methodology.8–10 Moher11 recommends reporting criteria as essential for researchers so that the disclosure of research methods and findings is transparent and explicit. Significant work has been undertaken in creating quality criteria and recommendations when executing qualitative research.12 Yet, it has been suggested the domain of qualitative research is unnecessarily brimming with templates and standard protocols, and the use of such templates is considered to enhance the rigour of qualitative research.13 It is assumed that only practices that increase methodological transparency, and thereby increase the replicability of one’s research, are essential for trustworthiness.14 However, there is a growing school of thought that rather than using rigid templates and protocols, the use of guiding principles and researchers’ own reasoning through the application of the methodology is in itself a trustworthy template for rigour.13

The use of GT in nursing-related studies has grown significantly over the last 20 years, and with this increasing popularity, recurrent calls for enhancing rigour and quality have been made.12 Ambiguity regarding rigour when dealing with narratives and people rather than numbers and statistics continues,15 therefore it is beneficial that qualitative researchers have the ability to establish that their research is credible.8 Tobin and Begley (p. 369)10 state ‘without rigour, there is the potential of fictional journalism masquerading as research!’

CGT was the sole focus of this systematic review because the authors’ particular interest was to appraise the methodological accuracy of CGT studies to determine if the tenets were followed when discovering a substantive theory.

Few publications exist that appraise the accurate application of GT methodology within health research. In 2009, Ali et al undertook a systematic review which appraised the methodological rigour of GT research published in the field of physiotherapy.16 They found one of the main problems that undermined the rigour of GT studies was the multiple versions of GT methods used. This problem manifested itself in a state of methodological incoherence whereby methods seemed mixed and matched. The authors concluded, such methodological incoherence might have prevented the analysis from progressing beyond the concrete level of describing information because the abstract level of exploring, explaining and theorising variations within data was not present.16 Similarly, Valvi et al undertook a critical evaluation of GT studies that focused on online and mobile customer behaviours.17 Their study identified weaknesses regarding the methodological conduct of the GT which impacted the resulting generation of theory.17 Valvi et al found that it was apparent from their critical evaluation that researchers’ had pre-conceptions and inadequate knowledge of GT methodology and concluded firm knowledge of the different versions of GT ought to precede GT application.17

Likewise, Hutchison et al critically reviewed GT research within exercise physiology.18 They reviewed 21 articles that report on GT studies conducted between 1999 and 2008 and concluded it was crucial that both authors and reviewers of future studies understand the key tenets of GT methodology and the limitations associated.18 Research rigour in GT can only be judged if authors present a clear and detailed account of their research process and researchers must recognise that GT represents a complete research process where appropriate actions need to be considered at every stage.18

The earliest process of undertaking CGT as specified by Glaser and Strauss in 1967 included constant comparison, systematic coding, theoretical sampling and writing of memos. While this iterative process was evident, there was a lack of clear guidelines for researchers to follow. In response to these identified methodological deficits, a Guideline for Reporting and Evaluating Grounded Theory (GUREGT) research studies was developed by Berthelsen et al.19 The GUREGT is a validated, 25-item checklist that, that CGT researchers can employ when they aim to produce a study, addresses the main tenants of the GT approach.19 Berthelsen et al concluded that when the GUREGT is used for reporting or evaluating GT studies, researchers’ ability to identify information missing in manuscripts, as well as preserve the theoretical sensitivity of GT studies is enhanced (p. 75).19

With the increasing use and misuse of GT in nursing research, it is essential that researchers understand and identify the differences when applying the three main types of GT methodology20 and the intention of this systematic review was to focus on one iteration of GT, CGT. The GUREGT provides a benchmark for rigour in regard to the components required to produce a high-quality theory. The GUREGT also provided us with a well-defined list of divergence between the three main iterations of GT.

CGT is a valuable methodology for informing nursing-related studies.21 However, there is a paucity of literature evaluating the application quality of GT studies in nursing, particularly CGT. This systematic review will apply the constructs of GUREGT to appraise how consistently researchers adhere to the principles of CGT methodology. The results of this review will provide a framework to inform the precise application of CGT in future research. This in turn will enhance the rigour of subsequent CGT studies, which will better inform nursing practice and education going forward.

Review aim and objectives

This systematic review aims to develop an understanding of the application of CGT methodology in the field of nursing research. Specifically, this review will appraise the quality of its application against the validated framework, the GUREGT, explicitly the CGT guiding principles.