Introduction
This chapter provides a critical overview of the approach employed by this research in terms of the underpinning conceptual framework. The importance of developing a conceptual framework for a research study is discussed first. The theoretical perspective of symbolic interactionism is then outlined in terms of key tenets, principles and relevance to the focus of this study. This is followed by a discussion of the use of grounded theory as an approach within this research. Since grounded theory methodology has, over the four decades since its original inception, come to embody several variants in application, this discussion will make explicit the ways in which grounded theory methodology is interpreted and applied within this study, specifically outlining the more recent variant of situational analysis. Discussion will focus upon the assertion that grounded theory as an approach, in the form developed by Anselm Strauss, has its roots in the perspective of symbolic interactionism. The way in which situational analysis extends and augments a grounded theory approach will then be outlined. These elements will then be drawn together with key relevant theoretical perspectives from reviewed literature, within a summary of the conceptual framework for this study as it has evolved and emerged during the process of conducting the research.
The Importance of a Conceptual Framework for
Research
Ravitch and Riggan (2012) outlined several key reasons why a research study should be guided by an explicit conceptual framework as ‘guide and ballast’ to the research process. They suggest that conceptual frameworks identify presumed relationships among key factors and constructs to be studied and that these factors may emerge from a variety of sources, including the researcher’s own previous experience or tentative theories, as well as established theories/empirical work. They also see a conceptual framework as a tool for, but also reflexively informed by, the researcher’s learning and suggest that it can constitute an argument for the importance of a study, justifying research both substantively and methodologically. Taking these factors together, Ravitch and Riggan (2012) assert that a conceptual framework:
“Is a guide for research; it serves to situate the research questions and the methods for exploring them within the broader context of existing knowledge about a topic, even as the researcher seeks to generate new knowledge about that topic” (P. 136).
Leshem and Trafford (2007) examine the utility of conceptual frameworks as a useful underpinning for academic research, and draw similar conclusions. They see a twofold role for a conceptual framework in guiding research. Firstly, an explicit conceptual framework can bring theoretical
clarification in terms of what is being investigated. Secondly, it can help researchers to clearly articulate the aims and focus of research, and how research aims will be achieved. In addressing these two aspects, Leshem and Trafford (2007) argued that that a conceptual framework can act as a catalyst which raises the level of the researcher’s thinking from being descriptive, in terms of analysing and presenting data, to conceptualising the research process itself. Ravitch and Riggan (2012) further indicated that conceptual frameworks evolve alongside research studies as they unfold, that they are constructed rather than found. In this sense, they argue, conceptual frameworks originate from three primary elements. First are the personal interests of the researcher: these encompass curiosity, biases, ideological commitments, theories of action, epistemological assumptions, institutional position, social location and position within the research itself. Secondly comes topical research, previous research which has focused upon or is relevant to the area of interest, including an appreciation of research approaches which have been used previously. Thirdly is a theoretical framework, which constitutes theoretical stances which inform or ‘frame’ the focus of the research in terms of explaining inter-relationships between elements present within the research focus.
These positive aspects of utilising a conceptual framework should be balanced against potential pitfalls. The principle potential drawback relates to the danger of entering the research situation with pre-conceived ideas, rather than truly allowing what exists in the situation to emerge during the study, or be 'discovered'. This also relates to the wider engagement with literature relating to the research situation. Lempert (2007) identifies this tension, and outlines the need for a pragmatic approach whereby some understanding is needed in order to recognise gaps in theorising and potentially new phenomena of interest emerging from the research analysis. My own approach to the use of literature and the conceptual framework outlined here relates to this pragmatism, tempered by an awareness of the need to be reflexive. My own reflexivity as a researcher is discussed in chapter seven of this thesis.
It is useful to re-state the research questions of this study at this point:
1) How do student mental health nurses develop role congruity within their pre-registration preparation for practice?
2) How do mental health nurses maintain role congruity within their ongoing professional practice?
• It is concerned with a specific professional group, that of mental health nurses.
• It is concerned with the professional practice of this group within the context of mental health.
• It is concerned with the personal and professional development of mental health nurses. • It is thus concerned with professional role development at the individual level in terms of
learning and development.
• It is also concerned at the level of the profession of mental health nursing in terms of the evolution of practice within the broader context of mental health services.
• It is thus concerned with capturing dynamic processes in a complex, interacting and changing environment.
It follows that the conceptual framework must effectively and coherently address all of these factors in clearly articulating the nature of the focus of study, and the research design in addressing the stated aims.
Symbolic Interactionism as a Theoretical Perspective
Symbolic interactionism has its roots within ‘pragmatism’ in the early and mid-decades of the last century. Blumer (1969) draws and builds upon Mead (1934) in outlining three key tenets of a symbolic interactionist approach.
Firstly, human beings act towards things on the basis of meanings they have for those things. ‘Things’ can be physical objects, social (other human beings) or abstract (ideas), which individuals encounter in daily life. Secondly, the meanings held for these things arise out of and are derived from social interaction with others. Thirdly, as individuals, human beings deal with and modify these meanings as necessary through an ongoing process of interpretation. Considering these principles with regard to this study focus, mental health nursing roles and their associated meanings are at the very centre of interest. Participants within the study were encouraged to relate the ways in which they approach their roles in practice. The ‘things’ which mental health nurses deal with include the physical environment within which their roles are enacted, service users presenting with mental health problems, other mental health nurses and other professional groups working within mental health settings. The ongoing processes of interpretation and negotiation around existing and potential roles is also very evidently in focus, including the ways in which student mental health nurses come to internalise these factors.
Blumer (1969) distinguishes the symbolic interactionist position with respect to ‘meaning’ from a realist position, where meaning is seen as intrinsic to the object viewed (i.e. it 'exists' independently of interpretation), and also from a position where meaning for an object is constructed by the individual. Blumer emphasizes that symbolic interactionism sees meaning relating to an object
arising from interaction between people. Meanings are social products defined by people who engage in defining activities during their interactions. This research is fundamentally concerned with the ways in which mental health nurses and other ‘social actors’ interpret and define situations during their interactions, and learn to do so in the first instance. Chapter two has set out the ways in which nursing roles have been influenced by developments in knowledge and technology with regard to how mental health problems are understood and responded to. These changes in mental health nursing roles and practices have involved interactively re-negotiating roles at the level of both individual and profession.
Blumer goes on to identify several ‘root images’ with which symbolic interactionist study is concerned. Firstly, in terms of the nature of human society, a fundamental tenet is that what we perceive as social structure and culture arise from individual and collective human action. This is the converse to a functional view, whereby societal structure is seen as the pre-requisite for interaction. It then follows that the nature of social interaction is viewed as an interaction between social actors and not between factors attributed to them. Social interaction is seen as forming human conduct, not simply acting as a setting where it is expressed. A distinction is made between non-symbolic interactions which are responses without interpretation involved (routine, reflexive, automatic responses), and symbolic interactions where interpretation is involved. Blumer uses the analogue of a boxer responding instinctively (non-symbolic) to an opponent’s blow, or perceiving it as a ‘feint’ and responding differently (symbolic, involving interpretation). With regard to this research study, a key focus is the way in which mental health nurses approach their roles in helping relationships with service users. This involves responding intentionally and strategically, having interpreted the presenting situation symbolically, and learning to do so in the first instance.
In examining an interaction, Blumer highlighted three elements as evident in terms of gestures. Firstly, a gesture instigated by one individual towards another signifies what that individual expects in response from the other. Secondly, the gesture also indicates what the gesturer plans to do in terms of action. Thirdly, the gesture also signifies the joint action that arises via both (initial gesture and response). Again, in relation to this research, mental health nurses execute their roles (or learn to do so) in various defined contexts or situations with specific interactional intentions. This is arguably particularly the case when a defined therapeutic strategy such as CBT is being employed. For Blumer the significance of considering an interaction thus indicates the requirement that each involved party necessarily must be able to take the perspective of each other’s roles in order to understand intentions. In considering the human being as an acting organism, the central issue here for Blumer is the notion of the self as an object, with human beings having the ability to see the self from an external perspective and engage in self-talk. This links to the nature of human action in that, from a symbolic interactionist perspective, human beings are constantly constructing and
guiding action based upon interpretation and not just simply responding. This applies to both individual and collective action. These last two aspects highlight very specific issues with regard to the practice of mental health nursing. These are the ability to empathise with service users, as part of the development of a therapeutic relationship, and the need for self-awareness within the therapeutic use of self. These aspects are foundational to the development and maintenance of a therapeutic relationship, and at the heart of theories and frameworks for mental health nursing practice such as those espoused by Peplau (1991), discussed earlier in chapter two.
This brings discussion to the last of Blumer’s root images, that of the inter-linkage of action. Since meaning is created via social interaction, group membership and action constitute a particularly important focus of analysis for symbolic interactionism. Fundamentally, human group life is seen as comprising ‘lines of action’ between group members, with joint action comprising the social organization of actions and behaviour by and among group participants. Though joint action of a group is an inter-linkage of separate acts of the participants, joint action, importantly, is seen as more than the aggregation of individual actions, having a character in its own right in terms of the collectivity of group action. Blumer points out that collective group action must still undergo a process of formation, within which participants still guide their acts via the formation and interpretation of meanings. Blumer makes three key points regarding joint action.
Firstly, in instances of joint action that are repetitive and stable existing in the form of recurrent patterns of collaborative joint action, there is a tendency to see regularity in the form of ‘norms’ and ‘social order’. He points out that even within such regularized patterns, new situations and problems inevitably arise, are not catered for by existing rules and need to be dealt with. It is also the case that, even with established patterns of joint action, each instance still needs to be formed via designation and interpretation. In this sense norms, values and social roles are still subject to processes of social interaction. From the perspective of symbolic interactionism, social processes within group life create and uphold rules, rather than rules creating and upholding group social processes. Also, group life is characterized by extended connections of actions within complex networks involving division of labour/functions. A symbolic interactionist perspective retains a focus upon the participants within networks rather than seeing the systems and networks themselves as primary and self-operating entities. Networks and systems are seen as functioning because of the interaction of individuals in terms of how they define and interpret situations and act. The focus is upon the sets of meanings that lead participants to act as they do within their positions within organisations/networks in terms of how meanings are formed, sustained or may change via social interaction. The final point Blumer makes regarding joint action is that, whether long established or new patterns of joint action are considered, all arise against the background of previous actions. Participants bring their existing world view (objects, meanings and interpretations) to the formation of joint actions. This gives a linkage to previous joint action for
the respective participants. This latter aspect of symbolic interactionism relates to this research in widening consideration to the collective profession of mental health nursing, including debates around what future roles should or might entail within the changing context of mental health service delivery.
This overview of symbolic interactionism as a perspective serves to illustrate the relevance of this theoretical perspective to the substantive area of focus for this research study. The ways in which mental health nurses initially engage with their role(s) and subsequently manage their role(s) within the context of their practice can be seen to be fundamentally captured within the tenets of symbolic interactionism.
The relevance of symbolic interaction to the research approach itself will now be shown in discussion of the application of grounded theory/situational analysis approaches to research, and in particular to the study informing this thesis.
Grounded Theory as an Approach to Research
Since the original conceptualisation of the grounded theory as an approach to research in 1967 by Glaser and Strauss, there has been much debate regarding the interpretation and application of the key elements of the approach. Charmaz (2006) summarises grounded theory method as a systematic, inductive and comparative approach to qualitative research which has the aim of constructing theory, involving data collection and analysis proceeding simultaneously and iteratively.
Following their original collaboration (Glaser & Strauss, 1967), Barney Glaser and Anselm Strauss, the two originators of the grounded theory approach, subsequently disagreed over some fundamental applications and interpretations of the approach. Glaser (1992) suggested that Strauss, in his later outline of a grounded theory approach (Strauss & Corbin, 1990), had taken an increasingly divergent approach from the original tenets and had arrived at an approach which was ‘forcing’ emergent analysis from data rather than allowing a theory to ‘emerge’. Glaser would advocate approaching a research context without pre-conceptions informed by reviewing literature, whereas Strauss saw literature as informing ‘theoretical sensitivity’. Glaser (2007) further distinguished between ‘formal grounded theory’ and ‘substantive grounded theory’. For Glaser, substantive theories relate very specifically to the substantive area which they have emerged from in a descriptive way, whereas formal theories are truer to his original view of grounded theory and can have conceptual application beyond the substantive area studied.
Charmaz (2000) suggested that grounded theory, in the years since its original conception by Glaser and Strauss, had become increasingly deployed in a way which aligned with a
‘constructivist’ perspective, whereby the nature of a phenomenon under study is accepted to be a ‘construction’ of the participants of research rather than an explicit claim to represent the objective ‘reality’ under study. Bryant and Charmaz (2007) usefully distinguish between the use of the term grounded theory as; a) a research approach/method and b) the product of a research study. In this sense, they suggest that there are studies which claim to employ a grounded theory approach which do not follow the process through to the development of theory. Interestingly, they also suggest that studies can be identified which, whilst not purporting to use a grounded theory approach, nevertheless result in a theory which is ‘grounded’ in the study data.
Bryant and Charmaz (2007) present an overview of the ways in which grounded theory as an approach has been adapted, developed and enhanced by researchers in many differing contexts and applications over some forty years since its original inception, suggesting that many of the early tenets of the grounded theory approach were in need of extrication from what had become an outdated epistemological stance, perceived as leaning towards positivism and empiricism. In this respect, they suggest that grounded theory methodology has become a ‘contested concept’. A key question here is whether different approaches to the use of a grounded theory approach are simply variations on a theme, or have come to constitute distinct approaches. They propose three broad interpretations or versions of a grounded theory approach which can be distinguished as follows:
1) A ‘Glaserian’ position/version: observing the tenets and underpinnings of Barney Glaser’s interpretation, as outlined above.
2) A position/version aligned with the iteration of a grounded theory approach as espoused by Strauss and Corbin (1990).
3) A ‘constructivist’ position/version.
For Bryant and Charmaz, a ‘constructivist’ version of grounded theory emphasizes how data, analysis and methodological strategies, together with research contexts and researcher position, perspectives, priorities and interactions, all become ‘constructed’ within the research context.
It is useful to make an important clarification at this point. Andrews (2012) points out that the terms ‘constructivist’ and ‘constructionist’ are often used inter-changeably, and that the term