Symbolic Interactionism is a theoretical perspective that explains human life and human experience (Blumer 1969, Denzin 2004). The beginnings of symbolic interactionism can be attributed to pragmatist philosopher and social psychologist George Herbert Mead when as a faculty member at University of Chicago he formed a core group of faculty called ‘the Chicago school of Pragmatism’ (Baldwin 1986, pg. 10). Mead provided the foundations for Symbolic Interactionism. His teaching spanned a period of 40 years principally at the University of Chicago during the early twentieth century; the writings of Mead were famously summarised in his book Mind, Self and Society (Mead 1934). Meads work was heavily influenced by Charles Darwin and Mead like Darwin believed that our development was part of an evolutionary process. Meads work focussed on behaviour reflecting the pragmatist’s view of John Dewey and William James that knowledge is created through action and interaction of self-reflecting beings (Corbin and Strauss 1998). Consequently, behaviour starts with a reflection on a problem and options to deal with it are tested. The consequences of these actions direct future interactions. Beneficial behaviour is repeated while behaviour that does not achieve the required result is modified. This idea echoes Darwin’s theory of evolution in which traits that benefits individuals are naturally selected and repeated while those that are not useful become less common over time. Meads theory of the development of self has taken a central place in sociological social psychology and encompasses innovative theories of action and temporality which Anselm Strauss (1987) Corbin and Strauss, (1998) and Glaser and Strauss, (1968) helped to preserve.
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Herbert Blumer, one of Meads students, continued the work of Mead at University of Chicago integrating much of Meads work with others whose ideas were foundational in symbolic interactionism like John Dewey, William James, Charles Horton Cooley and Charles S Pierce. The development of the two schools resulted in two varieties of symbolic interactionism, the Chicago School and the Iowa School, both remaining in the pragmatist tradition but each with a different philosophy of science. There is a third approach within symbolic interactionism called the dramaturgical approach made famous by Erving Goffman. Goffman viewed life as a staged drama where interaction was something like a religious ceremony filled with ritual observances. Goffman like many of the symbolic interactionists gave ‘self’ a prominent place in his writings (Charon 2010). Goffman’s focus was not on the self-concept carried by an actor from situation to situation but the socially situated self-developed in and governing specific interactions. According to Goffman (1959) the self is something of collaborative manufacture that must be produced anew on each and every occasion of social interaction.
Symbolic Interactionism assumes that language and symbols play a crucial role in forming and sharing our meanings and actions (Blumer 1969). Symbolic Interactionism views interpretation and action as reciprocal processes each affecting the other. This perspective recognises that we act in response to how we view our situations. In turn our actions and those of other people affect these situations and subsequently we may alter our interpretations of what is, was or will be happening (Blumer 1969). Blumer (1969) believes that Symbolic Interactionism allows the researcher to confront an empirical world that is available for observation and analysis; to raise abstract problems with regards to that worked; to gather data through careful and disciplined examination of that world; to unearth relationships between categories of such data; to formulate propositions with regards to such relations; to weave such propositions into a theoretical scheme; and to test the problem, the data, the relations, the propositions, and the theory by renewed examination of the empirical world. Charmaz (2014) believes that Symbolic
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Interactionism inspires theoretically driven research and leads to fresh theoretical implications. Grounded Theory methods offer the analytical tools and can provide the methodological momentum for realizing the potential of symbolic interactionism in empirical enquiry.
Whilst Blumer’s (1969) symbolic interactionism has acted as the lens or the theoretical perspective underpinning Grounded Theory, there have been critics of Blumer (1969) who believe that the theory only deals with the micro- sociological and not the larger questions which may concern the shape of society, individual’s perceptions, and society as a whole (Lewis 1992, Anells 1996). Criticism has been directed at symbolic interactionism for ignoring influences like class struggle, and moral structures therefore producing a distorted view of social phenomena (Abercrombie, Hill, Turner 1986). More recently Glaser (2005) has refuted the necessity for using symbolic interactionism or any other theoretical framework claiming that a person’s behaviour and concerns should be allowed to emerge without the constraints of a theory. Glaser (2005) believes a solution to this dilemma is to use one of his theoretical coding families provided in his text ‘Theoretical Sensitivity’ (Glaser 1978) which according to Glaser (2005) is compatible with the Glaserian Grounded Theory method. Chamaz (2014) argues that symbolic interactionism can offer grounded theorists an open ended theoretical perspective that can inform grounded theory studies. The researcher is able to draw on symbolic interactionism’s major strength of combining theory and method into a coherent unified whole without forcing the data. Charmaz (2014) considers symbolic interactionism and grounded theory methods to fit and complement each and advance one another with the aim of constructing theory. Evidence suggests that symbolic interactionism has been applied successfully to a wide range of issues in healthcare such as classification systems, clinical trials, exploring social worlds and studying the work setting (Clarke et al 2003). Within nursing recent applications of symbolic interactionism have focussed on a wide range of topics including personal identities in organ
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transplantation (Edgar 2009), and interaction and relationships between nurses/patients and families (Lowenberg 2003).
This study’s aims were to understand the interaction and relationships between the patient, nurse and doctor when it comes to decisions making and end of life care. Using a symbolic interactionist approach I sought to understand from the patient’s perspective what was it like to be diagnosed and live with NYHA stage 3 and NYHA stage 4 heart failure; how did the disease define the patient and how did this affect how they interacted with healthcare professionals with regards to decision making and end of life care. Blumer (1969) believes that human beings interpret or define each other’s actions instead of simply reacting to each other’s actions. Consequently human interaction is mediated by the use of symbols, by interpretation or by ascertaining the meaning of one another’s actions (Blumer 1969). After the action is completed the effects of this action are interpreted or given meaning and then alter the persons perspective and definition of the situation. This changed perspective and definition of the situation can then influence future actions of the individual (Charon 2010). An example of this process can be witnessed on a hospital ward where a patient is admitted for treatment for their heart failure. A nurse will focus on determining the patient’s definition of the situation; conduct an assessment to define the situation for her or himself, as well as ascertaining the physician’s definition of the situation. Health behaviours might be changed through interaction with other healthcare professionals. The person’s self-image (definition of self) might be improved through positive interaction with others. Where interaction and communication may fail is where you have a power struggle in a relationship between the healthcare professional and the patient. Studies undertaken have demonstrated the importance of sharing power in order to allow shared decisions to be made when considering end of life care (Norton et al 2000). The imbalance of power can often result in the patient losing their autonomy to make a decision which may later affect the course of treatment and ultimately end of life care (Martin 1998, Clover et al 2004).
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The theoretical perspectives of symbolic interactionism provided the foundation for this study which was to explore healthcare professional’s decision making when managing the care of those patients diagnosed with end stage heart failure. Symbolic Interactionism therefore provided an important theoretical underpinning to the grounded theory approach used in this research. Like Charmaz (2014) I concur that we are part of the world we study and the data we collect.