Evolution of a grounded theory: Conflict resolution through culture brokering ‘This amicle describes the evolution ofthe middle-range substantive theory of culture brokering, The theory was generated by frst conducting a concept analysis that yielded 12 attributes of the concept of culture brokering. ‘The concept analysis was accomplished using the antropology, health-related, and business literature, In ad tion, data from an interpretive ethnographic study were used to further develop the concept of culture brokering. ‘The theory was then generated from four grounded theory studies. Each study was used to frame the grounded. ‘theory model and to strengthen and refine the categories and links between categories within the basic socal process of culture brokering. The culture brokering theory can guide the practice of nurses in situations where conflict is present in the health care interaction. The theory is grounded inthe experiences of nurses attempting conflict resolution in the context of health care interactions. Key words: culture brokering, grounded theory, ‘ursing theory, theory construction Mary Ann Jezewski, RN, PhD 1HE IMPORTANCE OF building a Assistant Professor knowledgebase, generating and test- School of Nursing ing theory, and developing a grand theory University at Buffalo, State University of for nursing has been discussed in the nursing New York literature since the 1960s, Wald and Buffalo, New York Leonard! advised the empirical approach (explanation, description, and hypothesis generation) to build theory. They also en- couraged the use of concepts and hypotheses from actual nursing experiences to build nursing practice theory. Wald and Leonard emphasized the importance of the bond be- tween the development of nursing practice and theory development. Recent discussions of the history of theory in nursing have also emphasized the importance of this scholar- ship for nursing as a practice profession. Meleis* proposed that the experiences of nurses and clients be considered and ac- counted for in nursing theories to enhance the descriptive and explanatory power and the scope and utility of the theories. ‘The types of theory best suited for nursing practice are the middle-range theories, that ‘Ady Nurs Sel 1995317(3):14-30 ‘© 1995 Aspen Publishers, Inc. 4is, theories that are more focused in applica- tion and more readily testable. For the pur- poses of this discussion, theory is defined as a creative and rigorous structuring of ideas that project a tentative, purposeful, and sys- tematic view of phenomena. One method of developing theory with an important his- tory in nursing is the grounded theory method of Glaser and Strauss.‘ This qualita~ tive method of inquiry has been refined and clarified by the originators of the method and by others." Grounded theory is a con- stant comparative method of data collection and analysis generating middle-range, sub- stantive, and formal theories that are grounded in the everyday experiences of people in the study situation. As the title of this article implies, evolu- tion is an important aspect in the generation of theory. The dictionary defines evolution as a gradual process in which something changes into a different and usually more complex or better form." Theory develop- ment is a gradual process that takes time and cannot be forced for expediency. In this ar- ticle, the author presents the development of a grounded theory of culture brokering and explains the basic assumptions that guide this research. Next, I discuss the evolution of the culture brokering theory, from the first intuitive glimmer that this concept might in some way explain what goes on when there is conflict in health care interactions. In ad- dition, I describe the generation and refine- ment of culture brokering as a middle-range substantive theory. The generation and re- finement process includes the development of the concept of culture brokering from lit- erature sources and the empirical generation of the culture brokering theory based on four grounded theory studies. Both process and product are described. Culture Brokering 15 PERSONAL AND PROFESSIONAL ASSUMPTIONS Certain assumptions influence my re- search and theory generation. They evolve from my background in anthropology and nursing. First, I view culture in its broadest form, as a system of learned and shared standards for perceiving, interpreting, and behaving in interactions with others and with the environment. A second assumption is my view of the health care system as a cultural and social system. This view is in- fluenced by Kleinman’s"? discussion of the health care system as a system of meanings and behavioral norms attached to particular social relationships and institutional set- tings. Kleinman’s concept of a health care system consists of relating external factors (Gocial, political, economic, historical, epi- demiologic, and technological) to internal processes (psychophysiologic, behavioral, and communicative). This model grounds health care in sociopolitical structures, a symbolic system built out of meanings, val- ues, and behaviors. ‘As I began to study the grounded theory method, I was influenced by symbolic interactionism and the writings of George Herbert Mead and Herbert Blumer, as well as those who were influenced by them.'*5 Symbolic interactionism influences the way I view interactions between health care pro- viders and clients in the context of expect- ing, giving, receiving, and evaluating health care, Other closely aligned assump- tions that influence my thinking evolve from my practice experience, which has demonstrated that professional nurses are a valued component in clients’ interactions within the health care system. The nurse and client interact on an ongoing basis, and16 AbvANces IN Nursina SciENcE/MaRcH 1995 the interaction provides a basis for shared meaning. During an interaction, individuals bring a set of values and beliefs to the interaction that influences the degree of shared mean- ing possessed by the participants. The nurse comes to know the client, and a trusting re- lationship is built over time. In turn, nurses are able to interpret the client's needs to oth- ers. Nurses are the bearers of information, support, guidance, and caring who interact, with the client to effect appropriate health care. My use of the term “client” applies to the person who is seeking care as well as all those people who are “connected” to that client by kinship or friendship. Another assumption is that people have a right to health care that, ideally, they are able to manage in cooperation with the health care provider. When this ideal is not possible, when people are politically, eco- nomically, or personally powerless to use care autonomously, someone needs to inter- vene. This intermediary must provide a bridge between the clients and the providers in the health care system. CONCEPT DEVELOPMENT Concept analysis is recommended as a way to begin to examine information in preparation for theory construction? Con- cept development (creating conceptual meaning) allows one to examine attributes or characteristics of a concept. Concept, analysis is described by Walker and Avant? as a formal linguistic expertise used to de- termine the defining attributes of a concept. It is a rigorous and precise procedure that yields tentative meaning to a concept. The eight steps of concept analysis as described by Walker and Avant include 1, selecting a concept; 2. determining the aims or purposes of analysis; 3. identifying all the uses of the concept that can be discovered; 4, determining the defining attributes; 5. constructing model cases that reflect the critical attributes; 6. constructing borderline, related, con- trary, invented, and illegitimate cases; 7. identifying antecedents and conse- quences; and 8. defining empirical referents (occur- ences of the concept). The theoretical definition that emerges from concept analysis summarizes insights that form while creating conceptual mean- ing and describes the essential meaning of the concept. The method of concept analy- sis used for culture brokering was guided by Wilson'6 and Chinn and Jacobs," and it is similar to the approach Walker and Avant? described in their writings. Development of the concept of culture brokering eventually led to the generation of the culture broker- ing theory using the grounded theory method of inquiry. PROCESS OF CONCEPT DEVELOPMENT Early in my doctoral studies in anthropol- ogy (1983-1986), I was a research assistant on a project that focused on describing in- tercultural communication patterns in a pe- diatric clinic serving a multiethnic, inner- city community." The method of inquiry was interpretive ethnography. Data collec- tion included 8 months of participant obser- vation in the clinic and informal and formal interviews with staff and families of clients who used the clinic. During analysis of data,