Connectivity: Person-Centred Research Principles to Inform Constructivist Grounded Theory

Abstract

Person-centred approaches to practice recognise the global call to humanise healthcare, where people are valued and their preferences and needs are respected (WHO, 2015). Researchers must also embrace person-centred approaches to further inform person-centredness as the foundation of healthcare policy and practice. Healthcare researchers, policymakers, leaders, educators, and multi-disciplinary practitioners are invited to consider how person-centred methodologies enhance the value and authenticity of research. Person-centred research principles to guide researchers are available (Dewing et al., 2021; McCormack et al., 2017), and one approach proposes an overarching research principle of connectivity; the being, doing, and knowing of the researcher throughout the development, implementation, and dissemination of the research study (Jacobs et al., 2017). An exploration of the principles of attentiveness and dialogue, empowerment and participation, critical reflexivity, and loving kindness that inform connectivity (Jacobs et al., 2017; van Leishout & Peelo-Kilroe, 2021) is presented here. No single methodology is associated with person-centred research, and researchers are encouraged to consider how to incorporate person-centred principles in many different contexts. This paper explores the innovative use of person-centred principles to underpin a constructivist grounded theory (CGT) study illuminating the person-centred nursing process of engaging authentically (McCormack & McCance, 2021). Synergies and connections between the person-centred research principles and Charmaz’s CGT approaches are explored, and further considerations are highlighted. We contend that person-centred research principles support CGT research, explicitly building on Charmaz’s relational approaches and enabling a rigorous foundation for engaging in research, where valuing and respect are central.

Introduction

A rigorous person-centred research and evidence-based foundation is vital to understanding what underpins best practice surrounding person-centred care (Dewing et al., 2021; Jacobs et al., 2017; McCormack et al., 2017; McCormack & McCance, 2021; van Leishout & Peelo-Kilroe, 2021; WHO, 2015). As a well-renowned proponent of person-centred practice and research, McCormack has long contended that applying the principles of person-centredness is essential when conducting research that aims to understand nursing practice (McCormack, 2003; McCormack et al. 2017, 2021). Critical to current healthcare research is ensuring the centrality of the voices of people accessing (and providing) healthcare. These voices inform the “humanising” of healthcare and create a greater understanding of the current experiences of those involved in this complex and challenging arena. While there are no singular person-centred research methodologies, certain principles guide a “value-led and multilayered approach” (van Lieshout & Peelo-Kilroe, 2021, p. 80) to person-centred research.

To add to this discourse, the aim of this paper is to explore how the principles of person-centred research intersect with constructivist grounded theory (CGT) as a contemporary approach to healthcare research, further evolving CGT methodology with the use of person-centredness as an underpinning philosophy. Using person-centred principles as researchers engaging in a constructivist grounded theory study is a novel approach and we consider the synergies and connections, considerations, and possibilities within this paper.

Background

Person-Centred Healthcare Research

Over the past two decades, there has been a steadily increasing body of person-centred healthcare research, using diverse methodologies and methods with a central aim of ensuring new understandings of person-centred practice and care (Dewing & McCormack, 2017; Edvardsson et al., 2017; Manley & Jackson, 2020; McCance et al., 2013; McCormack & McCance, 2006; Wilson et al., 2021). Person-centred research supports the internationally recognised pressing and ongoing concern for the “humanising” of healthcare as the world grapples with increasing health burdens, including the current Covid-19 pandemic (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2018; Global Burden of Disease 2019 Viewpoint Collaborators, 2020; World Health Organisation [WHO], 2015). Complex healthcare needs, ageing populations and constrained healthcare resources impact the ability of healthcare practitioners to provide care. The dominant biomedical model does not always sufficiently recognise the needs of individuals (Buetow, 2016; Fuller, 2017; Santana et al., 2018), and person-centred practice answers the call to ensure safe, respectful care, where “the preferences, needs, and values of patients and consumers” are met (ACSQHC, 2018, p. 11). Healthcare systems must meet these needs in partnership with those accessing the services (WHO, 2015).

One of the difficulties of understanding person-centredness is that there is no consensus on what this term means (Edgar et al., 2020; McCormack, 2020), however a description from well-regarded person-centred academics suggest person-centredness is:

“… an approach to practice established through the formation and fostering of healthful relationships between all care providers, service users and others significant to them in their lives. It is underpinned by values of respect for persons, individual right to self-determination, mutual respect and understanding. It is enabled by cultures of empowerment that foster continuous approaches to practice development” (McCormack & McCance, 2017, p. 20).

Methodologies used in person-centred research must match the person-centred concepts and theories underpinning them, and researchers should consider how their study incorporates core principles in all aspects of the research. Proposed person-centred research principles, considerations, and conditions are presented in the literature (Jacobs et al., 2017; McCormack, 2003; van Lieshout & Peelo-Kilroe, 2021) and have recently been included in texts published to support and guide those interested in nursing and healthcare person-centred research (Dewing et al., 2021; McCormack et al., 2017). Dewing et al. (2021) state that a clear philosophical understanding of the meaning of “person,” “personhood”, and “person-centredness” is fundamental to all person-centred research. The researcher’s values must also be evident and connected to these understandings as a core process throughout the research (Dewing et al., 2021). There is recognition that person-centred researchers may create their research frameworks and guiding principles supported by their understandings of persons and personhood, which will be informed by their ontological and epistemological worldviews (Dewing et al., 2021). Therefore, different approaches may be used to answer specific person-centred research questions, and person-centred principles can be applied broadly to inform research studies (Dewing et al., 2021). Person-centred research considerations when working with healthcare users are essential, ensuring representation, advocating for, giving voice to and valuing those who may be vulnerable (Prior et al., 2020). When using traditional research methods Prior et al., (2020) also note that careful consideration of inclusion and equity is required to ensure adequate representation of healthcare users.

Dewing et al., (2021, p. 10) further propose that person-centred research should lead to outcomes that support the needs of the people being cared for and contribute to “individual flourishing and collective social well-being”. They also believe person-centred research should enhance the understanding of what person-centred research is and how to do it better.

In preparing for a qualitative research study the first author of this article (HP) considered person-centred principles as she was exploring her research axiology and methodological principles and how these would inform the conceptual sense-making (Lincoln & Guba, 2013) required.

The Focus of Our Research Study

The research study we are undertaking aims to improve understanding of the person-centred process of engaging authentically within the nurse-patient relationship from both the nurses and the patient’s perspectives. This study is ongoing and taking place in an Australian regional hospital setting, with nurses from this setting and adults who have recently been inpatients invited to participate. Engaging authentically is one of five key processes in mid-range theories on person-centred nursing and person-centred healthcare practice (McCormack et al., 2021; McCormack & McCance, 2010, 2017, 2019). Person-centred Practice and Nursing frameworks have been developed, refined, and utilised in different care settings and by researchers in various disciplines and contexts (McCormack & McCance, 2021; see also https://www.cpcpr.org/). Within the person-centred nursing framework are nursing processes that focus on the nurses’ actions and interactions, demonstrating person-centred practice (McCance & McCormack, 2017). (See Figure 1: The Person-centred Nursing Framework). Though defined by McCormack and McCance, the person-centred process of engaging authentically has yet to be central in research focussing on the nurse-patient relationship (Pratt et al., 2020). Further understanding and clarification of this person-centred process from the perspectives of both the nurse and the person being cared for are essential to enhance person-centred nursing practice. In exploring methodologies suited to the research question posed, we selected constructivist grounded theory as this supported the explicatory aims of the research (Charmaz, 2014).

Figure 1.

The person-centred nursing framework (McCormack & McCance, 2019).

Constructivist Grounded Theory

Grounded theory is a recognised research methodology spanning over half a century, and multiple variants have been introduced over time as researchers advance their understandings and positions (Apramian et al., 2017; Kelle, 2019; Timonen et al., 2018). Charmaz (2006) reinterpreted grounded theory through a constructivist lens and considered grounded theory to be both a method and a methodology. CGT differs from Glaser and Strauss (1967) approach underpinned by objectivist epistemological foundations. Constructivist grounded theorist’s ontological and epistemological positions recognise the subjectivities that exist in a world of multiple realities, where "generalisations are partial, conditional, and situated in time, space, positions, action, and interactions” (Charmaz, 2014, p. 236). Understanding, therefore, is interpretive and contextual (Charmaz, 2008b).

Furthermore, Charmaz (2014) describes the influences of the pragmatist Chicago School underpinnings in CGT where openness and curiosity of the world are nurtured, and empathy is used to understand participant’s experiences of their worlds. The importance of the relationship between the researcher and the participants during CGT research supports an “aim to enter the studied phenomenon and view it from the inside” (Charmaz, 2008a, p. 133). Enhancing relationships increases the researcher’s understanding of the different perspectives and experiences of the participant’s shared realities (Charmaz, 2004).

Grounded theorists recognise a “constellation of methods” (Charmaz, 2014, p. 14) which are shared principles of theory development, theoretical sampling, progression of abstraction in coding, constant comparison, and memoing (Bowers & Creamer, 2020, p. 4). Though all grounded theory research share methods, Charmaz’s constructivist approaches differ in how the above principles and specific methods are used. To this end the constructivist approach “treats research as a construction but acknowledges that it occurs under specific conditions-of which we may not be aware and which may not be of our choosing” (Charmaz, 2014, p. 13). These specific conditions are contextual, and relate to time, culture, and place, recognising the social construction of reality and that we know the world around us by establishing mutual awareness through interacting with others (Gardner et al., 2012). Participants’ understandings of their worlds and the language they use to describe their experiences become evidence of their realities (Charmaz, 2014). Charmaz, as a social researcher, sees the researchers’ relationship to the research participants, the data, and the data analysis as integral to the approach. This methodology, therefore, relies on the co-construction of experience and meaning in the area of inquiry with the participants, pursuing and presenting the “participant’s views and voices as integral to the analysis” (Charmaz, 2014, p. 236). The creation of shared, constructed reality informs the development of the grounded theory, hence it is “grounded in the data” (Timonen et al., 2018, p. 8).

Charmaz (2008b) encourages CGT researchers to re-examine their epistemic knowledge, research approaches, and methods to ensure they remain open in their perception of what the data is revealing. Charmaz also contends that the researcher is very much part of the CGT research and must be aware of their values and behaviours and evaluate their own underlying beliefs and research methods (Charmaz, 2017). This recognition that researchers come with their values, beliefs, and pre-conceived understandings of the world that inform the interpretation of the data means reflexivity is a fundamental principle embedded throughout research processes (Charmaz, 2014). This strong emphasis on reflexivity indicates that exploration of the impacts of researcher positionality on the relationships, analysis, and conceptualisation is included in the grounded theory and informs research credibility (Charmaz, 2014).

CGT principles highlight the importance of relationships with the research participants and the centrality of their voices to the co-construction of the grounded theory. This importance is also echoed in person-centred research principles, which see values such as “respect, reciprocity, mutuality and self-determination” (Jacobs et al., 2017, p. 52) as central to creating an environment where research enriches lives. Considerable attention is given to how the researcher acts and interacts in person-centred research, embodying person-centred ways of being and supporting the aim of flourishing for all (Dewing et al., 2021). Working in person-centred ways as researchers support Charmaz’s considerations for relational approaches to research participants and the careful and methodical analysis and representation of information which is key to CGT studies. Charmaz mirrors many person-centred values and qualities in her writing and approaches to research. Synergies and connections were noted when investigating person-centred research principles and the CGT approach, as further explored below. We also present considerations in using this approach and the possibilities for others when undertaking research.

Constructivist Grounded Theory and Person-Centred Research Principles: Synergies and Connections, Considerations, and Possibilities

As our research takes place within a healthcare setting, discovering aspects of the nurse-patient relationship and the process of engaging authentically, we will explore the interactions, communications, actions, and behaviours perceived by both cohorts that are significant to them. This research is about a social process, and we contend that the use of CGT fits well. Considering the shared and multiple realities, the social structures and interactions and the care environment will provide context to this exploration.

This research area is multilayered, multifaceted, and complex, where participant experiences and perspectives must be valued, and shared meanings are negotiated and co-constructed with care (Charmaz, 2014). Understanding the socio-political and cultural contexts of care will also play a role (Charmaz, 2014). We recognise the possible impacts of working and being cared for in current healthcare environments. The Covid-19 pandemic placed an extra burden on nurses in an already burgeoning health system and is still contributing to impacts on their health and well-being (Mannix, 2021). A person-centred, compassionate stance when engaging with research participants, including “loving kindness” in approaches (van Lieshout & Peelo-Kilroe, 2021, p. 73), supports the participants as explored further below.

Jacobs et al., (2017) describe the core person-centred research principle as one of connectivity; the being, doing, and knowing of the researcher throughout the research. Connectivity encompasses the “efforts to connect with oneself, other persons and contexts and which is expressed in the way one does the research (doing), talks about it (knowing), and is as a researcher and person (being)” (Jacobs et al., 2017, p. 53). The importance of relationships when working together to enable new knowledge is central to the principle. Included are the related principles of attentiveness and dialogue, empowerment and participation, critical reflexivity (Jacobs et al., 2017), and, more recently, “loving kindness” (van Lieshout & Peelo-Kilroe, 2021, p. 73). These reflect the person-centred approaches used throughout the research, connecting respectfully and empathetically with everyone involved. Enabling dialogue that is open and supportive of others is vital to respected and valued relationships, providing a research environment where ideas are shared, knowledge is created, and human flourishing can occur (Jacobs et al., 2017).

Charmaz has emphasised “flexible guidelines, not methodological rules, recipes, and requirements” in CGT studies (2014, p. 16). Using these flexible guidelines to work in person-centred ways means incorporating the above person-centred principles of attentiveness and dialogue, empowerment and participation, critical reflexivity, and loving kindness (Jacobs et al., 2017; van Lieshout & Peelo-Kilroe, 2021) into our research. Undertaking research that supports the ability to connect with others to learn about their experiences and perspectives meant we wanted to gain an understanding of the healthcare environments (in the context of our research) and to hear from nurses and people who had been cared for in recent times. As an illustration, we included overt observation using a person-centred observational tool, the Workplace Culture Critical Analysis Tool Revised (WCCAT^R) (Wilson et al., 2020), and intensive interviewing in our research design. For us as researchers, a period of observation using the WCCAT^R aims to support a greater understanding of current contexts of care and to note “daily workplace happenings and situations by seeing, hearing and perceiving what is going on” (Wilson et al., 2020, p. 5). For this study, the tool is utilised explicitly relating to the person-centred processes between nurses and the people they are caring for, observed in the context of the care environment. Interacting with the nursing staff during this time of observation also allows them to explore aspects of their work and to share their thoughts with the researcher, inviting reflection and insights into their practice. Being attentive to practice realities during the observational period helps to inform the researcher’s understandings of current practice and provides avenues to explore in subsequent intensive interviews with participants.

Exploring the Person-Centred Principles and Constructivist Grounded Theory

Attentiveness and Dialogue

We have chosen to undertake intensive interviewing in our study, and Charmaz (2014) notes this provides the space and time to support a discourse where research participants can co-construct meaning by reflecting on their experiences. For the person-centred researcher undertaking qualitative interviewing Sandvik and McCormack recommend “a holistic exchange of empathy and understanding” (2018, p. 6) to enhance understandings and insights. Holistic engagement, defined as “awareness and genuine interest in the lifeworld of participants” (Sandvik & McCormack, 2018, p. 4), is an important aspect of the dialogue within the interview process (and extending to the whole of the research). For us, engaging holistically means also intentionally incorporating the McCormack and McCance (2019) person-centred nursing processes into our actions and interactions throughout the research. Though these processes have been developed for practice settings they are equally valued when engaging with research participants (Frost in Anker-Hansen et al., 2021). Being sympathetically present, for example, (McCormack & McCance, 2019) and gaining an understanding of the participants' values and beliefs are important in our conversational interviewing style. This links to the overall person-centred principle of connectivity (Jacobs et al., 2017), where relational aspects of the interactions require close attention, with sensitivity and flexibility framing the thoughtful interviewing style. Charmaz (2014) notes that the quality of the relationships with participants affects the interactions and stresses the importance of establishing rapport and listening intently when gathering information and exploring phenomena with participants. Empowering research participants to share (and perhaps further clarify) their experiences through how interactions are conducted, with attendance to “space, time- and human connection” (Charmaz, 2014, p. 80), will enhance the authenticity of research findings, and support the person-centred aim of human flourishing (Dewing et al., 2021; Titchen et al., 2017). We aim to provide an avenue to carefully attend to the experiences of both the nurses providing the care and those who have been cared for in communicative spaces where, in the words of Bettez (2015, p. 950), “we can represent others…. with the greatest amounts of humanity, dignity, and respect, and attend to issues of equity”. Using reflexivity to ensure our own values of respect and mutuality are informing our actions throughout the research is important to us and will be evident in our co-construction of meaning in this research study. Finlay (2003, p. 225) proposes that reflexivity can be used to consider positionality and “personal responses and interpersonal dynamics” within the research context, strengthening the credibility of qualitative research. As discussed below, person-centred research criterion for rigour may include mutuality and transparency, both attended to when co-constructing meaning by using a reflexive stance.

Interviews are currently underway in our research study, and HP (the primary author), has recognised that though the research is about the process of engaging authentically within the nurse-patient relationship, both nurses and recent inpatients need to tell stories of their experiences that are most important to them. Giving them time and being sympathetically present is important for this to occur. This holistic approach to interviewing has provided rich re-tellings of hospital stays or the current working environments and has led to possibly deeper explorations of “what matters” to the people participating in this research.

Empowerment and Participation

Person-centred researchers note empowerment as a principle involves “facilitating development into self-awareness and self-esteem, capacity building and (individual or collective) action” (Jacobs et al., 2017, p. 53). They define empowerment as “a relational and multi-level (intrapersonal, interpersonal, organisational and societal) construct that refers to human development within relationships and contexts” (Jacobs et al., 2017, p. 53). Empowerment and participation ensure that research participants are given agency within the research processes where they can fully participate with “an overall intent to knowledge co-construction” (Jacobs et al., 2017, p. 54). Constructivist grounded theorists recognise the importance of empowering relationships between the researcher and participants where there is mutuality and “a connection exists between the researcher and the participant in this context and must be respected as such by the researcher” (Gardner, 2012, p. 69). Building mutuality with participants is key to how the researcher attends to the experiences being shared, and the questions being asked to co-construct meaning (Charmaz, 2014). Mutuality is also a key value for person-centred researchers (Dewing et al., 2021), and is defined as "the recognition of the others’ values as being of equal importance in decision-making” (van Dulmen et al., 2017, p. 211). Empowering research participants to share (and perhaps further clarify) their experiences through how interactions are conducted, with attendance to “space, time- and human connection” (Charmaz, 2014, p. 80), will enhance the authenticity of research findings, and support the person-centred aim of human flourishing (Dewing et al., 2021; Titchen et al., 2017).

In exploring empowerment in this CGT study, the focus is on “giving voice” to the research participants. Using a conversational interviewing style Charmaz (2017, p. 91) sees interviews as a “site for exploration, emergent understandings, legitimation of identity, and validation of experience”. Given the co-construction central to this approach, these supportive interactions may give rise to greater self-awareness and self-esteem (Charmaz, 2014).

Interviews with recent inpatients in our research study have been conducted in their own homes at their invitation. This meant the interviews took place in a relaxed environment, at the kitchen table with a shared pot of tea or sitting in comfort before the fire. Participants have all expressed gratitude at being able to share their stories, much of which centred on the good care they received, but also to say what concerned them during their admissions to the hospital.

Loving Kindness

Loving kindness may also support the heightened feeling of connection within person -centred research relationships as it “provides space to create openness, mutual understanding, and respect” (van Lieshout & Peelo-Kilroe, 2021, p. 77). The ability of the researcher and participants to consider loving kindness in terms of “mercy and judgement” is enhanced. These two “compass points” of loving kindness support the researcher to balance any judgements that may be made (as we all do as part of our humanness). Using mercy creates the ability to have understanding and acceptance of differences. van Lieshout and Peelo-Kilroe (2021) applied loving kindness as a person-centred process throughout their collaborative research processes to enhance trust, connection, and a sense of equity when contributing to the research activities. Showing care and compassion to people sharing their thoughts, ideas, and life experiences can enable connection and an experience that supports powerful positive experiences and form “mutually satisfying connections” (Andersen & Ivarsson, 2016, p. 5). Loving kindness as a research principle provides a stance that enables respect and understanding in research relationships and may be integral to providing a sensitive and safe environment for the co-construction of understanding in CGT studies.

We heard nurses in our study expressing differing levels of distress at not being able to provide the care they want due to multiple constraints. This was impacting on the satisfaction they derive from their work, even affecting whether they will stay in their clinical roles into the future. Bringing her own values of person-centredness and the principle of loving kindness enabled the interviewer (HP) to share this distress with participants in a sympathetic, attentive space. This enabled valuable contributions about the context of care relating to the ability to engage authentically in practice, informing the grounded theory study more meaningfully.

Critical Reflexivity

When reflecting on the co-construction of knowledge within the research, the principle of critical reflexivity enables person-centred researchers to be aware of the level of their influence throughout the research. Power structures that influence participation in society can be mirrored in research settings unless critical reflexivity is incorporated into the research processes, and these structures are critiqued, acknowledged, and modified to enhance participant contribution (Jacobs et al., 2017; van Lieshout & Peelo-Kilroe, 2021). Participatory principles are vital to person-centred research and link to reflexivity, ensuring research is undertaken with participants, not on them (Dewing et al., 2021; Jacobs et al., 2017; van Lieshout & Peelo-Kilroe, 2021). Reflexivity is also a critical research process throughout CGT studies, where the researcher considers the influence of their own experiences, worldviews, and assumptions when engaging in all aspects of the research (Charmaz, 2006, 2014, 2020). Researchers acknowledge the “pre-existing structural conditions” and incorporate them into the data collection and analysis procedures (Charmaz, 2006, 2014). Charmaz notes that constructivist grounded theorists develop “methodological self-consciousness” as a means of “detecting and dissecting our worldviews, language, and meanings and revealing how they enter our research in ways we had previously not realised” (Charmaz, 2017, p. 36). This strong reflexivity is embedded in the processes used throughout constructivist grounded theorist’s research studies, with abduction used to reflexively explore unexpected findings, memo-writing to prompt further analysis, and theoretical sampling to develop and refine categories (Charmaz, 2014). Finlay (2002) champions reflexivity as a tool that supports researchers in analysing the impact of personal and interpersonal factors on their research, thus enhancing the integrity and trustworthiness of the research. Critical reflexivity was a starting point for our research study, where underlying assumptions regarding the nurse-patient relationship were explored, and this continues with reflective memo writing and critical discussions. This is important for this study as the researchers are nurses and come with our own values and beliefs, knowledge and experiences from clinical and academic practice. Openness when listening and interpreting other’s stories is vital in person-centred research and CGT, empowering the voice of the participants but also recognising the researcher’s place in the co-creation of new understandings.

Possibilities

We contend that using the person-centred principles discussed above whilst undertaking this research will give voice to both nurses and people who access healthcare to enhance understanding of the care experience at the interface of care. This knowledge about nursing practice and, significantly, what patients experience and expect will, we hope, give rise to some evaluation of current practice by clinicians and others involved in healthcare provision. Allowing nurses and healthcare users to share what is important to them will enable them to feel empowered and heard.

Considerations

Aiming to use person-centred approaches in a CGT study authentically has challenged us. We have wondered whether further explicating the person-centred process of authentic engagement using the constructivist lens and grounded theory methods supports the person-centred research aim of human flourishing for all. Different definitions of human flourishing abound in the literature but perhaps “enabling helpful, supportive relationships based on mutual trust and understanding that empower others to grow and develop, as well as sharing knowledge” (McCormack & Titchen, 2006, in Jackson et al., 2021, p. 237) is a practical way of considering this in person-centred research. Dewing et al., (2021, p. 8), note that person-centred research is not rigid in terms of methodologies but asks for “new weavings of principles for understanding persons, environment, health, and nursing”. We contend that working in person-centred ways in CGT studies is possible for researchers. It is in consideration of the methods used to engage with research participants that challenges may occur, as engagement and learning opportunities need to be present (Dewing et al., 2021). Titchen et al. (2017, p. 33) propose a framework for person-centred research including the prerequisites: “knowing self, clarity of values and beliefs, professionally competent, developed interpersonal, facilitation and research skills, and commitment to the research”. These prerequisites illuminate the essential skills, knowledge, and attitudes of a person-centred researcher. This informs what shape the research will take, and perhaps begins to highlight the difference between person-centred research and other research, where all these essentials are not seen as necessary. The emphasis on a values-driven, person-centred, reflexive approach in person-centred research, means “values are central, are explicit, are considered and are acted upon, and this condition makes explicit the need for considering the values held by all participants in research decision-making” (van Dulmen et al., 2017, p. 211). As researchers, we believe it is possible to strengthen CGT research with these facilitative, values-based approaches, informed by our own explicitly known values and beliefs and supported by a philosophy of person-centredness and recognition of personhood. Underpinning the research with these approaches, alongside the CGT methods for concurrent information gathering and analysis as outlined, will add credibility to our study. Research rigour is discussed further below.

Supporting the researcher’s ability to flourish as well as research participants is undoubtedly an incentive for person-centred researchers. Bringing ourselves into the research in this authentic way shapes the research and supports the flourishing of the research participants and us. However, as Dewing et al., (2021) advise, person-centred research is a challenging option and needs careful consideration.

When considering person-centred philosophy and principles; we have given careful thought to the design and conduct of our CGT research to ensure we are able to maintain a person-centred approach. Our traditional grounded theory research and the observational and interviewing methods of data collection and CGT analysis needed to incorporate the person-centred principles discussed in this article. As person-centred researchers, it is perhaps more in the way the constructivist grounded theory data collection and analysis methods are used, rather than the need for different approaches. We have not discovered any CGT studies using a person-centred approach, but as Charmaz (2014, p. 27) notes “just as the methods we choose influence what we see, what we bring to the study influences what we can see”. Creating safe spaces by incorporating person-centred ways of working, with respect, authentic presence and care, and reflexivity, will support the person-centred research outcomes in all aspects of our CGT research (Jacobs et al., 2017; Titchen et al., 2017). As healthcare continues to be driven by humanist approaches to care, we invite healthcare researchers to look closely at their own lens and ways of being in all aspects of research.

Considering Personhood and Person-Centredness as a Standpoint for Constructivist Grounded Theory

We have presented the overarching person-centred research principle of “connectivity” to inform the being, doing and knowing of the person-centred researcher and the research (Jacobs et al., 2017, p. 52). Importantly, person-centred research is informed by having clarity on person-centredness and understanding “what a person is” (Dewing et al., 2021, p. 2), and this philosophical paradigm could be a standpoint for CGT studies. When underpinning CGT with person-centred philosophy, an epistemological and ontological framework has been presented by Titchen et al., (2017) that includes the research environment and processes, prerequisites for person-centred research, and the outcomes. It is contended that this framework can be used across different worldviews, from the practical to the transformational, always considering the “person-centred values of respect, reciprocity, mutuality and self-determination in every aspect of the research” (Titchen et al., 2017, p. 42).

Charmaz (2014), from her interpretive worldview, sees pragmatism and symbolic interactionism as antecedents of the theoretical perspective of CGT. Charmaz does not see symbolic interactionism as the only theoretical perspective for constructivist grounded theorists however, she also encourages other stances. In her early writings on her work, she acknowledges, “my application of grounded theory derives from a symbolic interactionist perspective tempered by Marxism and phenomenology” (Charmaz, 1990, p. 1161). More recently, she has noted feminist theory and intersectionality (Roschelle & Kaufman, 2004; cited in Charmaz, 2014), and social justice and critical inquiry researchers (Charmaz, 2020) utilising CGT as a methodological approach. Though Charmaz does not appear to have explored personhood in depth in her writings, she does recognise and consider personhood and the valuing of persons in her work. She has, for example, applied Gadow's (1982) conceptual framework for understanding the body-self relationship in her major study on chronic illness and identity (Charmaz, 1995). She agrees with Gadow, who “assumes that the human existence essentially means embodiment and that the self is inseparable from the body” and sees this as important in her conceptualisation and subsequent grounded theory (Charmaz, 1995, p. 659). Carl Rogers and his humanistic approaches are also embraced by Charmaz (2014), ensuring the participant experiences are empathetically recognised and valued during the research processes. Charmaz (2014) sees CGT as a flexible, interpretive approach to qualitative research and encourages innovation in the use of CGT guidelines. Seeking to underpin CGT studies with person-centred philosophy is, we believe, a legitimate and feasible proposition, and will add to the possibilities for person-centred research. In our research, CGT methodology informed by person-centred research principles of connectivity and critical reflexivity provides an opportunity to transform understandings of the nurse-patient relationship and the person-centred process of engaging authentically.

Empowerment and Participation-Creating Spaces and Places for Participants in Constructivist Grounded Theory

As a principle of “connectivity” in person-centred research, considerations of empowerment and participation must be incorporated into research design and methods. Jacobs et al. (2017) describe the need to combine forces and work together to achieve change as ways to be empowered to participate in person-centred research, addressing the possible hierarchical power imbalances between researchers and participants. There are considerations to this person-centred approach in our CGT research, as research design contemplates how participant realities are interpreted and presented by CGT researchers and what part they may play in theory construction. Critical reflexivity supports the systematic approaches required to evidence research quality throughout from both person-centred and constructivist grounded theory perspectives (Charmaz, 2014; Jacobs et al., 2017). Critical reflexivity is also an important principle to ensure actions and interactions are underpinned by the values of person-centredness that safeguard empowerment and participation (Jacobs et al., 2017).

Using the more traditional qualitative research data collection methods such as observation and interviewing (as we are) may pose problems when evidencing this principle in the forms of negotiation and decision-making by research participants. As many research studies use these methods, consideration of the approaches researchers use to invite participants to co-construct information and the kind of dialogue undertaken is essential. As outlined above, Charmaz (2014) stresses the importance of forming effective relationships with participants to ensure an environment where shared meaning is developed. In CGT studies, the methods for data analysis involve the researcher working closely with the information provided by participants with initial word-by-word or line-by-line coding and then seeking further clarification of ideas in subsequent interviews (Charmaz, 2014). Gaining additional input from previous participants can be included in the research design, and conducting follow-up interviews or focus groups adds to participant opportunities to contribute to initial concepts and later theoretical categories, further empowering participants (Charmaz, 2014). Dewing et al. (2021, p. 10), however, challenge traditional member-checking activities, and premise the inclusion of “dynamic peer review” to be a valuable inclusion in person-centred research. Including activities that provide learning opportunities and active engagement for participants are key processes in person-centred research, and these, of course, can be included in CGT research design.

Dewing et al. (2021, p. 9) note that whatever the methods employed, “the experience of being involved in person-centred research must feel different”. The question of how the experience enhances connectivity, and ultimately flourishing, and therefore feels different needs to be central to all decisions made throughout the research, and this may be hard to evaluate. Dewing et al. (2021, p. 162) note that this is “primarily an ontological process”, where personhood is the crucial and over-arching consideration. Researchers are invited to create their own conditions for person-centred research, providing firm foundations to underpin studies and demonstrating new perspectives to frame person-centred research.

Demonstrating Rigour in Constructivist Grounded Theory Research Informed by Person-Centred Research Principles

We aim to provide a quality research study, working with nurses and recent in-patients to explicate further engaging authentically as a process, how it is defined, the enablers and the challenges and barriers to it in this study. Charmaz (2014) has presented criteria for evaluating rigour in CGT studies. These criteria fit the constructivist methodological stance, where the importance of abstract understanding, recognition of subjectivity and contexts is recognised. Charmaz (2006, 2014) suggests that researchers should prioritise credibility, originality, resonance, and usefulness. She has presented a helpful series of questions and guidelines to support constructivist grounded theorists to consider the quality and rigour of their studies (see Charmaz, 2014, pp. 337–338; Charmaz & Thornberg, 2021, pp. 321–322). However, she advises caution in using lists of criteria as a “methodological crutch” that decreases the ability to engage deeply in the research study (Charmaz & Thornberg, 2021, p. 321). Evaluating rigour in person-centred research requires additional differing considerations, underpinned by understandings of personhood and informed by methodological principles. Dewing et al., (2021, pp. 10–11) suggest informed flexibility, sympathetic presence, negotiation, mutuality and transparency as criteria for research rigor in person-centred research, linking this example to conditions for person-centred research established by McCormack in 2003 and included in Dewing et al., (2021, p. 6). These key conditions relate to being person-centred as a researcher and working with the values of person-centred practice. The core value of “respect for the person” (McCormack et al., 2021, p. 15) is, of course, necessary for the ethical conduct of all research, however in person-centred research, this value (and others related to authenticity, shared autonomy and mutuality) must be clearly articulated. Ensuring the values of person-centredness ground all aspects of the research requires relational approaches that support all to feel well-supported and empowered.

Conclusion

Considering the current important worldwide aim of humanising healthcare for all, we have presented an exploration of the relationships and possibilities between person-centred research principles and a CGT approach. Gaining further perspectives around the experience of care using person-centred research principles in CGT studies is very useful and should be embraced by researchers. Applying the philosophy of person-centredness to a CGT research study as a starting point and stance to conduct research would add value to research exploring nursing and healthcare phenomena now and into the future. Using the principles for person-centred research outlined in this article will enable an approach that encourages flourishing for all, the ultimate aim for person-centred research and researchers.

We would like to pay tribute to the late Professor Jan Dewing who was a much respected and important leader of person-centred healthcare research and practice. Her knowledge and wisdom was immense and she was very generous in sharing her understandings with us over the years. Jan has contributed in many ways to the flourishing of healthcare students, academics, researchers, and practitioners and is sadly missed.