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Abstract

Background: Work-family interaction is defined as a process in which the functioning behavior) of a worker in one domain (e.g., home) is influenced by strain reactions (negative or positive) accumulated in the other domain (e.g., work). Previous studies have reported work-family interaction as challenging and considered one of the most prevalent psychosocial risks in Chile. Among occupational groups, nursing has been highlighted as one of the most affected due to the high representation of women in the profession and demanding working conditions. However, limited research has explored work-family interaction as a social process, particularly within the context of critical care units which are characterized by high levels of stress.

Aim: To theorize the work-family interaction process among nurses in intensive care units.

Design: A qualitative study will be conducted using constructivist grounded theory, underpinned by symbolic interactionism as the theoretical-methodological framework.

Methods: The sampling strategy will be intentional and theoretical. Data collection will involve in-depth interviews, non-participant observations, and document analysis. The study will take place in two inpatient healthcare centers in Chile—one public and one private—one of which is the largest in the country. Data analysis will use constant comparison methods and multilevel coding. To ensure rigor, the project is structured according to the 13 criteria proposed by Charmaz and Thornberg for constructivist grounded theory studies. The project has been approved by the Scientific Ethics Committee.

Conclusion: The resulting theory will offer valuable insights into the work-family interaction process among nurses in intensive care units, providing a solid theoretical foundation for its understanding and subsequent management. It is anticipated to be useful for education in the field, institutional decision-makers, and the development of public policies.

Keywords

work-family interaction nursing critical care units intensive care units constructivist grounded theory grounded theory occupational health occupational health nursing

Introduction

Background

Workers are exposed daily to a variety of health and safety risks, including psychosocial risks. These risks are defined by the Joint Committee of the World Health Organization (WHO) and the International Labour Organization (ILO) as “interactions between and among work environment, job content, organizational conditions and workers’ capacities, needs, culture, personal extra-job considerations that may, through perceptions and experience, influence health, work performance and job satisfaction” (Joint ILO-WHO Committee, 1984, p. 3).

The nature of psychosocial risks has been categorized into 10 groups (Instituto Nacional de Seguridad y Salud en el Trabajo, 2018): a) Job content; b) Workload and work pace; c) Work schedule; d) Control; e) Work environment and equipment; f) Organizational structure and culture; g) Interpersonal relationships at work; h) Role within the organization; i) Professional development; and j) Work-life balance. Work-life balance is the only psychosocial risk category that considers the worker’s personal and family dimensions and has been one of the least explored areas (Pujol-Cols & Lazzaro-Salazar, 2021). Three primary perspectives dominate its study (Vesga Rodríguez, 2019): 1) Conflict, where work and family are seen as incompatible and antagonistic domains; 2) Balance, which involves strategies or practices aimed at harmonizing or balancing the demands of each domain; and 3) Interaction, the most recent perspective, where family and work spheres bidirectionally influence each other, with both positive and negative effects possible.

The work-family interaction is defined as “a process in which the functioning (behavior) of a worker in one domain (e.g., home) is influenced by strain reactions (negative or positive) accumulated in the other domain (e.g., work)” (Geurts et al., 2005, p. 322). The relevance of studying work-family interaction lies in its implications for both workers’ personal outcomes and organizational consequences. When such interaction is in conflict, it could serve as a source of anxiety for workers (Shanafelt et al., 2020), an indicator of job turnover (Yildiz et al., 2021), and a negative influence on psychological well-being, job satisfaction, and life satisfaction (Houlfort et al., 2022). For workers with children, it can also have direct and indirect adverse effects on child mental health (Bilodeau et al., 2023).

In this context, the ILO recognized the importance of work-family interaction by publishing Convention No. 156 in 1981, concerning workers with family responsibilities. This convention aims to support workers across all economic sectors (ILO, 1981). Chile acknowledged its significance by ratifying the convention on October 14, 1994, which remains in effect (ILO, 1983). However, despite this ratification, work-family interaction among Chilean workers has persisted in a state of conflict. This is corroborated by the results of national assessments, which, by law in Chile, must be conducted using the Copenhagen Psychosocial Questionnaire (COPSOQ), the agency responsible for publishing these results is the Superintendence of Social Security (SUSESO) (SUSESO, 2016, 2017, 2018, 2019, 2020). In 2015 (SUSESO, 2016), work-family conflict was identified as the psychosocial risk with the highest prevalence in the “high risk” category, a pattern that persisted from 2016 to 2019 (SUSESO, 2017, 2018, 2019, 2020).

The significance of these findings is underscored by the results of the National Time Use Survey, which in its latest iteration revealed that, on average, worker women in Chile dedicate three more hours per day than men to all unpaid work activities (INE, 2016), highlighting gender as a critical factor in work-family interaction inequalities. Before the COVID-19 pandemic, the ILO predicted a potential increase in work-life imbalance among workers (ILO, 2019). This was confirmed and exacerbated by the pandemic, as supported by a literature review published in 2021, which concluded that COVID-19 led to significant psychosocial burdens at work, particularly among women (Franklin & Gkiouleka, 2021).

In the healthcare context, nursing professionals have been disproportionately affected, experiencing higher levels of work-family conflict compared to other occupational groups (Ekici et al., 2020). Nursing, a profession with approximately 90% female representation globally (WHO, 2020), faces unique challenges. Ortega (2019) attributes nurses’ heightened exposure to psychosocial risks to this gender imbalance and to hostile working conditions that undermine their ability to provide family care (Rendón-Díaz & Vergas-Bertancourt, 2019). Nurses working in Intensive Care Units (ICUs) are more affected than those in general wards (Rony et al., 2023; Zhang et al., 2013). This disparity is linked to the demanding nature of critical care work, characterized by high physical demands, constant stress, and emotional exhaustion, which may hinder their ability to disconnect from work and fully engage in family life.

Moreover, some nurses’ experiences have revealed their inability to fulfill caregiving roles for their children or sick relatives, leaving them feeling hopeless and overwhelmed (Crowe et al., 2022). While some nurses reported having no alternative career options, others expressed a desire to leave the profession but were unable to do so.

Knowledge Gap

Despite the significant relevance of work-family interaction, there are elements that could be improved and should be addressed in future studies. These knowledge gaps have been categorized into two main areas:

a) Focus and Scope in Studying the Phenomenon: The research network on psychosocial risks and evaluation methodologies, including the Copenhagen Psychosocial Questionnaire (COPSOQ) and one of the most widely used tools for assessing psychosocial risks (Vazquez et al., 2018), emphasizes the need to further explore and deepen its dimensions, including work-family interaction (Burr et al., 2019). Quantitative methodologies for studying this phenomenon have been associated with biases, such as social desirability and the omission of specific problems (Pujol-Cols et al., 2019). As a result, authors have highlighted the necessity of employing more advanced methods for qualitative analysis of this phenomenon (Mumu et al., 2021).

b) Unaddressed Elements in the Work-Family Interaction Process: Studies have identified the need for future research to incorporate factors such as organizational elements, which are currently understudied (Yildiz et al., 2021). Similarly, more focused research on healthcare workers (Lukasczik et al., 2018), understanding worker family-level vulnerabilities, particularly those of children (Van den Eynde et al., 2020), and exploring under what conditions and for whom sacrifices lead to more negative outcomes (Houlfort et al., 2022) are needed.

Based on the foregoing, there is a clear need to study work-family interaction, particularly among nursing professionals working in ICUs, who represent a particularly vulnerable group. If the outlined issues persist over time, the negative consequences described by the scientific community could likely intensify. Addressing these problems will provide a deeper understanding of the phenomenon, serving as a foundation for its management. Furthermore, understanding and theorizing this phenomenon will contribute to the development of responsible and necessary reconciliation policies aimed at improving workers’ quality of life from an occupational health perspective.

Therefore, this paper describes the research protocol to theorize the work-family interaction process among nurses working in ICUs in Santiago, Chile, using a constructivist grounded theory approach. The developed grounded theory will support the development of practice and research in the field, contributing to the disciplinary, professional, and scientific advancement of nursing.

Method

The study was designed to investigate and conceptualize the work-family interaction process among nurses in ICUs through a constructivist grounded theory, addressing a crucial theoretical-conceptual need to establish the foundations for an adequate approach to this phenomenon.

Paradigm, Ontological, and Epistemological Stance of the Study

The paradigm, ontological, and epistemological stance of this project has cross-cutting implications for its development, as it serves not only as a guide for its design but also as a framework that will underpin the entire research process (Guba & Lincoln, 2002). Defining paradigmatic stances has become an increasingly complex task, particularly in the current era, where various approaches present blurred boundaries, challenging the positions of earlier qualitative researchers regarding certain hegemonic paradigms (Denzin & Lincoln, 2011).

According to Guba and Lincoln (2002), a paradigm represents the basic beliefs that define a worldview, which, in other words, refers to an individual’s position within that world and the scope of possible relationships with it. In the context of a study, the paradigm determines what is being undertaken and what lies within or beyond the boundaries of the investigation. This project is grounded in the paradigm and epistemological stance known as constructivism, in which meaning is not discovered but rather constructed; therefore, different individuals may construct meaning in different ways (Crotty, 1998). As a result, the ontological stance adopted is relativism (Guba & Lincoln, 2002), where realities are understood as multiple and intangible mental constructions. These constructions are shaped by the individuals or groups involved, and it is important to note that they are not absolute truths but rather more or less informed and/or sophisticated interpretations.

Positionality

As previously discussed; by adopting a constructivist stance, the theoretical development will result from the co-construction between the researcher and the participants. For this reason, it is essential to address the researcher’s positionality. The lead researcher is a Chilean man. He studied nursing, a profession with significant female representation, which fostered greater gender sensitivity—not only through interactions with women from diverse backgrounds but also through his professional training. During his education, he had his first exposure to occupational health research, which he further developed during his postgraduate studies, initially focusing on psychosocial risks and later specializing in work-family interaction. Regarding his clinical experience as a nurse, he primarily worked in ICUs, including during the COVID-19 pandemic, where he directly experienced the phenomenon under study. He is currently a full-time professor at a university in Chile.

Design

Considering the nature of the phenomenon under study and philosophical underpinnings to explore, the work-family interaction process among nurses, the investigation uses a qualitative research approach to conceptualize this social process (Strauss & Corbin, 2002). The study of social processes originates from sociology (Mihanovich, 1945), based on the assertion that all complex social events are composed of social processes. In this context, methodological proposals aim to understand these processes, capturing not only their depth but also their theoretical potential (Palacios Rodríguez, 2021).

This study protocol uses Constructivist Grounded Theory (CGT) developed by Kathy Charmaz (2000) as an epistemological variation of GT (Glaser & Strauss, 1967). CGT is inductive and is distinctly characterized by two elements (Charmaz, 2017a, 2017b): first, CGT systematically introduces doubt into the analytical process, and second, utilizing CGT involves designing and adapting methodological strategies to explore what the researcher discovers along the way.

According to Charmaz (2017b), CGT adopts strategies from the original Grounded Theory with distinctive elements: 1. Adopting a relativist epistemology; 2. Recognizing that both the researcher and participants hold multiple perspectives, roles, and realities; 3. Embracing a reflexive stance toward the researcher’s background, values, actions, situations, relationships with research participants, and representations of them; 4. Situating the research within the historical, social, and situational conditions of its production. Constructivist Grounded Theory attends to the language, meanings, and actions of both the researchers and the research participants.

Setting and Participants

The study will be conducted in the Metropolitan Region of Chile. Chile, located on the southwestern margin of South America, has an approximate population of 19 million inhabitants distributed across 16 regions (Pan American Health Organization, 2024). The largest region is the Metropolitan Region, home to approximately 40.0% of the national population. This region is characterized by adverse working conditions including 50.2% of the country’s occupational diseases, 60.7% of workplace and commuting accidents, and 24.6% of all fatalities resulting from workplace and commuting accidents (SUSESO, 2022).

In Chile, individuals have access to a mixed healthcare system, which includes both public and private healthcare networks (Mella & Narváez, 2022). Within the Metropolitan Region, two hospital care centers have been selected to reflect both systems: a high-complexity public healthcare facility and a private healthcare facility.

The total number of ICU nurses across both institutions is approximately 256 (the source of this calculation has not been referenced to protect the anonymity of the participants), working in clinical and managerial positions. Nurses working in ICUs will be included in this study due to their high exposure to the phenomenon of interest (Rony et al., 2023; Zhang et al., 2013). As a result, the study will include nurse administrators and the adult family members of nurses to provide an in-depth exploration of the work-family interaction process.

Sampling

At the beginning of the study, initial sampling will be employed, using a convenience sample to capture the phenomenon and obtain a broad understanding of it. Subsequently, during the development and conclusion of the study, a purely theoretical sampling approach will be adopted, deliberately selecting participants who have had a particular or different type of experience. Theoretical sampling involves starting with data, constructing provisional ideas, and subsequently examining those ideas through additional empirical research (Charmaz, 2014). Theoretical sampling serves as the basis for modifying interview questions or determining what questions should be asked, how they should be framed, and for what purpose (Foley et al., 2021).

The emerging theory will be constructed by linking concepts. Finally, the theory will be recontextualized, with theoretical transferability serving as the final criterion for its completion (Charmaz, 2006, 2014; Morse & Clark, 2019).

Recruitment

After obtaining approval from the ethics committee (more details see below), the principal investigator will contact the management of Institution 1 and Institution 2, as well as the coordinating nurses of the ICUs. During these interactions, the purpose and details of the study will be explained.

Subsequently, physical and digital copies of an informational flyer about the study will be distributed through the official communication channels with the nursing staff in the respective units. An informational meeting will then be held with the target population to present the study and address any questions. During this session, participants will be asked whether they wish to participate. Those interested will receive a copy of the informed consent form, and their contact information (phone number or email) will be recorded to coordinate subsequent meetings based on their availability. Through this process, nurses and nurse administrators from the institutions will be contacted.

Additionally, upon completing the participation of the nurses, they will be asked whether they agree to include adult members of their nuclear family in the study. In cases where the response is affirmative, participants will be asked to contact their family members to obtain their permission and share their contact information with the principal investigator, who will then inquire about their interest in participating in the study.

Initially, data collection will be conducted using purposive sampling. Based on the findings from this initial sampling phase, theoretical sampling will be employed to collect and analyze additional data necessary to achieve saturation of the properties within each category.

Data Collection

Based on symbolic interactionism as the theoretical-methodological framework, it is assumed that society, reality, and the self are constructed through interaction, which, in turn, depends on language and communication (Charmaz, 2006). Considering the premises of symbolic interactionism, it is assumed that the use of meaning by human beings in their actions is the emergence and application of already established meanings. It is important to note that the fundamental principle of symbolic interactionism is that every social framework is composed of individuals engaged in action (Blumer, 1982).

Three data collection methods will be used: non-participant observation, in-depth interviews, and document analysis to develop grounded theory (Polit & Beck, 2018; Sadín Esteban, 2003). Methodological precedents in the field will be considered, which recommend observation as the initial and essential method for immersing in the data, guiding the subsequent information-gathering techniques (Charmaz, 2014).

Non-Participant Observation

This study will employ non-participant observation, defined as observation by external agents who do not intervene in events and have no relationship with the subjects, acting solely as spectators (Campos Covarrubias & Lule Martínez, 2012). This method has proven invaluable for understanding phenomena as it allows for the characterization of the physical and social environment; the description of interactions among actors; the identification of strategies and tactics of social interaction; and, finally, the identification of the consequences of various observed social behaviors (Sandoval, 2002).

In the present study, observation will guide the other data collection methods. These observations will encompass the beginning, development, and end of work shifts. For instance, observing how a nurse says goodnight to their children from their workplace may reveal behaviors, attitudes, emotions, or questions that could be further explored through interviews. These interviews, in turn, could enhance the observational process by identifying which events or situations should be considered, thereby enriching the understanding of the phenomenon.

Lefrançois and Probst (2020) highlighted that observational data allows interview questions to be grounded in observed practices. Similarly, work-family interaction elements, such as shift handovers, will be observed to capture dynamics that might not surface through other methods.

Field notes will record Individual and collective actions (Charmaz, 2006), detailing anecdotes and observations; significant processes occurring in the environment; topics participants find interesting or problematic; participants’ use of language; contexts and actions within scenes; analytical ideas progressively developed. Field notes will be recorded on paper and subsequently digitized for analysis.

In-Depth Interviews

In-depth interviews thoroughly explore meaning from the participant’s perspective (Rutledge & Hogg, 2020) as an expert. These experts are individuals who have either experienced the phenomenon firsthand or have observed others experiencing it (Morse & Clark, 2019). In this context, nurses, their family members (adults only), and nurse administrators will be interviewed.

Based on the types of questions suggested by Strauss and Corbin (2002) for initiating a grounded theory study, guiding questions were designed, as presented in Table 1. These questions are broad and open-ended, allowing subsequent detailed inquiries based on participants’ responses (Charmaz, 2006).

Table 1.

Interviews guide

Participants	Guiding questions
Nurses	- How is your routine on a day when you have to go to work?
	- What are your thoughts on the relationship between work and family life?
	- Tell me about a situation where you believe your work has influenced your family life
	- Tell me about a situation where you believe your family life has influenced your work
Family members of nurses	- How is the routine on a day when your relative has to go to work?
	- What are your thoughts on the relationship between work and family life?
	- Tell me about a situation where you believe your relative’s work has influenced family life
	- Tell me about a situation where you believe family life has influenced your relative’s work
Nurse administrators	- What are your thoughts on the relationship between work and family life of nursing staff?
	- Tell me about a situation where you believe the work of nurses has influenced their family life
	- Tell me about a situation where you believe the family life of nurses has influenced their work

The interview duration will depend on the interviewer’s skills and the cooperation and richness of information provided by the interviewee. For this study, a minimum of 30 min and a maximum of 90 min per interview is planned (Izcara Palacios & Andrade Rubio, 2003). The schedule will be coordinated in advance with participants.

The interview location will be agreed upon in advance with the participants, prioritizing their preferences, e.g., for family members, it could be in cafés or their homes; for nurses or management staff, it could be in hospital offices, meeting rooms, etc. The selected locations must meet the following criteria: absence of elements that may hinder the conversation, such as phone ringing, street noise, environmental pollutants, interruptions by third parties, among others (Hernández Sampieri et al., 2014). Additionally, the space should be comfortable for the participant, quiet, well-lit to allow observation of the interviewee, and promote privacy, especially when discussing complex topics, ensuring there are no interruptions or witnesses (and if witnesses are present, their role as silent participants should be negotiated) (Amezcua, 2015). These conditions aim to help the interviewee feel at ease and not judged (Qu & Dumay, 2011).

In addition, measures will be taken to minimize participant discomfort. For example, the researcher’s attire will be tailored to match the participant’s profile (Hernández Sampieri et al., 2014), fostering a more symmetrical relationship. The recommended distance between the interviewer and interviewee of approximately 1 m will also be maintained. These measures aim to create an atmosphere of trust and empathy.

Techniques recommended by Izcara-Palacios and Andrade-Rubio (2003) will be employed, including. Managing Silences: Silences will be used when discussing sensitive topics to encourage dialogue. Neutral Tactics: Expressions such as “ah,” “yes,” “of course,” or non-verbal cues like nodding or an expectant expression will show interest in the participant’s discourse. Recapitulating and Repeating Ideas: This technique will help gather additional information on specific topics and convey interest in the subject matter. Reinvigorating Interaction: Used to extend the interview by clarifying aspects or introducing new topics.

Documents

Existing texts in the field will be considered data, even if created for other purposes. According to Charmaz (2006), these texts are valuable for identifying the social, economic, historical, cultural, and situational contexts. Documents will be used to analyze the institutional and legal framework of the phenomenon, capturing macro- and meso-level insights into the work-family interaction of nurses.

Below, Table 2 presents the documents that will be considered in this study. However, as previously mentioned, throughout the research process and through the different data collection techniques, ideas, elements, or phenomena may emerge that will require a macro and/or meso-level analysis, supplemented by additional documents.

Table 2.

Documents considered for the analysis of the legal and institutional framework of the work-family interaction process

Level	Documents considered	Foundation
Legal framework (macro level)	Decree 100. Establishing the revised, coordinated, and systematized text of the political constitution of the republic of Chile	A text that establishes the fundamental norms defining the structure of the state, the rights and duties of citizens, and the manner in which political power is exercised in Chile
	- Chapter I: Foundations of the institutionality
	Article 1°: The family is the fundamental nucleus of society. It is the duty of the state to safeguard national security, provide protection to the population and the family, strive to strengthen it, promote the harmonious integration of all sectors of the nation, and ensure the right of individuals to participate in national life with equal opportunities
	- Chapter III: Constitutional rights and duties
	Article 19: The constitution guarantees all individuals: 4°. Respect and protection of private life and the honor of individuals and their families, as well as the protection of personal data
	Supreme decree no. 594: Basic sanitary and environmental conditions in workplaces	Regulation establishing the basic sanitary and environmental conditions in workplaces
	- Article 3°: Companies are required to maintain necessary sanitary and environmental conditions in workplaces to protect the lives and health of workers, whether they are direct employees or contractors performing activities on behalf of the company
	2024 labor code	Includes practical skills and responsibilities of adults to care for, protect, educate, and ensure the healthy development of their families
	- Book I: Individual employment contract and labor training. Title I: Individual employment contract. Chapter IV: Working hours
	- Book II: Worker protection. Title I: General rules. Article 306: Topics for collective bargaining, including agreements for reconciling work with family responsibilities. Title II: Protection of maternity, paternity, and the reconciliation of personal, family, and work life
	- Book IV: Collective bargaining. Title VI: Agreements on special working conditions. Article 376: Agreements for workers with family responsibilities
	Exempt resolution no. 1448 of 2022. Updates the protocol for monitoring psychosocial risks in the workplace and repeals exempt resolution no. 1433 of 2017, issued by the ministry of health	Provides guidelines for addressing psychosocial risks, including work-family interaction. Includes orientations on temporality, monitoring, prescribed measures, and the formation of application committees
Institutional framework (meso level)	Strategic planning of the participating institutions	Will identify institutional objectives, necessary actions to achieve them, and human resource management strategies
Institutional framework (meso level)	Organizational charts of the participating institutions	Will provide insights into the hierarchical and functional structures of the participating institutions, as well as the relationships between units, departments, areas, and/or positions

Data Analysis

The analysis of data involves the process of transforming raw data into conceptualizations and subsequently generating a theory to understand such data. This process primarily relies on constant comparison and multi-level coding. It is essential to note that analysis in CGT is not a linear process, as comprehension and the generation of analytical connections may occur at any stage of the research process (Charmaz, 2014).

Constant Comparison

Constant comparison refers to the comparison of concepts based on their properties and dimensions (Corbin, 2016). It serves as an essential tool that accelerates and facilitates analysis, stimulates consideration of properties and dimensions, and guides theoretical sampling. This method assists the researcher when there is ambiguity or lack of understanding regarding the meaning of an incident or event in the data or when a shift in perspective is required. It encourages the researcher to think and generate questions more rapidly, fosters abstract descriptions regarding the similarities and divergences of a particular phenomenon, challenges assumptions, and broadens analytical horizons (Charmaz, 2014; Strauss & Corbin, 2002). For this study, data-to-data comparison, data-to-category comparison, and category-to-category comparison will be used.

Initial Coding

Charmaz (2014) identifies two stages of coding: initial coding and focused coding. During the initial coding phase, the researcher adheres closely to the data, coding actions while remaining open to theoretical possibilities. This process involves addressing the following questions: What is the nature of work-family interaction? What do the data from observations/interviews/documents suggest? From whose perspective is the data presented? What theoretical category does these specific data indicate?

The hallmark of constructivist grounded theory lies in the acknowledgment that researchers “construct codes, define what they consider significant in the data, describe what they believe is occurring, and interpret participants’ implicit meanings” (Charmaz, 2014).

Charmaz (2014) also recommends varying coding methods depending on the data source. In this regard, for interviews, line-by-line coding will be used as it stimulates ideas that may not emerge with broader coding, allowing for the identification of details and patterns. For document analysis, word-by-word coding will be applied, while for observations, incident-by-incident coding will be employed, as these records are subject to selection and interpretation.

Focused Coding

Focused coding operates at a higher level of abstraction, comparing initial codes to select those with the greatest analytical utility or to identify new codes. Charmaz (2014) advises researchers to consider the following: Which codes best represent the data? What insights emerge from comparing these codes? Do specific codes reveal gaps in the data? What theoretical categories do these codes indicate?

Memo Writing

Memos are described as the researcher’s notes documenting their analyses, reflections, interpretations, questions, and guidelines for additional data collection (Strauss & Corbin, 2002). These may take various forms, including coding notes, theoretical notes, operational notes, and their variations. During open coding, memos are exploratory, tentative, and suggestive of potential directions or thoughts, whereas in focused coding, memos are fewer but more developed and inclusive (Corbin, 2016).

Theoretical Sensitivity

Theoretical sensitivity refers to the capacity to interpret relevant data through a theoretical lens, which is developed by utilizing existing theories and models (Kelle, 2019). Recommendations include utilizing existing models and theories to construct categories and derive fruitful ideas, avoiding excessive commitment to a specific preconceived theory to prevent imposing “favorite” theoretical categories onto the data.

Holt et al. (2022) emphasize that no single technique guarantees theoretical sensitivity, advocating for diverse strategies to conceptualize data theoretically. Charmaz (2006) suggests achieving theoretical sensitivity through observing life from multiple perspectives, making comparisons, following leads, and capitalizing on ideas. Therefore, in the context of the present project, the principal investigator’s familiarity with the phenomenon, prior experiences, knowledge gained from previous studies, and insights acquired through reading articles and books in the field will be instrumental in analyzing and interpreting the collected data, while maintaining an open stance toward other ideas.

Theorizing

Theorizing refers to the process of constructing a theory by formulating ideas within a logical, explanatory, and systematic framework (Strauss & Corbin, 2002). It involves selective, abstract analysis and the reduction of data into patterns (Corbin, 2016).

According to Charmaz (2014), CGT highlights five critical points: Theorizing as a continuous activity; constructive approaches to theorizing; use of abduction as induction; influence of the research problem and researchers’ evolving interests on theorizing; the products of theorizing reflect researchers’ active engagement with these points.

Category Saturation

Category saturation represents “the point in category development where no new properties, dimensions, or relationships emerge during analysis” (Strauss & Corbin, 2002). Charmaz (2006) emphasizes that CGT saturation involves identifying recurring patterns in events, actions, or statements rather than mere repetition. Researchers should inquire: What patterns? Do these patterns inform theoretical categories?

Corbin (2016b) advises practicality in GT development to avoid perpetual data collection, where additional data yield diminishing explanatory contributions (Strauss & Corbin, 2002).

Central Category and Social Process

Grounded Theory aims to develop a theory based on a Basic Social Process (BSP) (Charmaz, 2006, 2014; Polit & Beck, 2018; Strauss & Corbin, 2002). While all BSPs are central categories, not all central categories qualify as BSPs. The distinction lies in BSPs’ procedural nature, encompassing two or more emergent stages, unlike some central categories that lack such stages (Glaser, 1978). Glaser and Holton (2005) provide criteria for central categories, including their frequency, meaningful relationships with other categories, significant implications, transferability, variability, and alignment with the core phenomenon studied. A rich central category is grounded in data rather than deductive interests, ensuring its relevance and explanatory power.

Ethics

This project adheres to the Chilean legal framework (Ministerio de Salud & Subsecretaría de Salud Pública, 2006), the international ethical guidelines for biomedical research involving human subjects issued by the Council for International Organizations of Medical Sciences (CIOMS) (Organización Panamericana de la Salud, & Consejo de Organizaciones Internacionales de las Ciencias Médicas, 2017). In its development, the principles proposed by Ezekiel Emanuel (Emanuel, 2000; Emanuel et al., 2004) were considered, including collaborative partnership, social value, scientific validity, fair participant selection, favorable risk-benefit ratio, independent review, informed consent, and respect for participants.

The project was reviewed and approved by three ethics committees in Chile: the Scientific Ethics Committee (SEC) of the Faculty of Nursing at Universidad Andrés Bello under the code “L4/CECENF/01-2024”, the SEC of the Western Metropolitan Health Service under the code “10/2024” (a public institution), and the ethics committee of a private institution under the code “162-11-24.”

Informed consent will be obtained from each participant before their involvement in the study. The consent form, specifically designed for this research, was approved by the ethics committees. It outlines study details, confidentiality, anonymity, potential benefits, and risks.

Data confidentiality will be maintained at all times. Each participant will be assigned a code based on the order of participation, the unit, and the institution of origin, for example, the interview with Nurse 1 from the intensive care unit of Hospital 1 will be assigned the following code: Interview_Female nurse 1_ICU_H1. The data will be digitized and stored in the personal computer of the responsible researcher for a period of 5 years, under a password that only he will handle.

A thorough risk analysis identified emotional distress as a potential risk during in-depth interviews. To mitigate this, a psychologist will be available throughout the study. If participants experience emotional distress, the principal investigator (a trained nurse) will provide immediate psychological first aid and refer them to the project’s psychologist for further support. Depending on whether the individual is a worker or a family member, follow-up measures will differ. Workers requiring additional psychological support will be referred to their institution’s protocols, while family members will be directed to healthcare facilities based on their health insurance coverage.

Rigor

The present project adheres to the guidelines proposed by Charmaz and Thornberg (2021) for the development of a CGT, which include 13 key elements that will be explicitly referenced upon publication of the results. The principal investigator will maintain methodological self-awareness, explicitly documented in memo-writing. The research team, composed of experienced CGT researchers, will adhere to recommendations from the classic literature in the field. An analytical, critical, and open perspective toward the existing literature will be adopted, as demonstrated by the review of prior studies cited in this manuscript. Valuable data will be collected, focusing on the primary stakeholders involved in the work-family interaction of ICUs nurses. Methodological decisions have been transparently outlined in this protocol, and those relevant to the results will be reported in the corresponding publication. Data collection will follow an iterative process, with researchers moving between the data and analysis. Ambiguity will be tolerated as researchers deepen their understanding of the empirical world and develop an analytical foundation. Progressively refined questions will be formulated, and researchers will engage creatively with the data and emerging ideas. Sufficient data will be gathered to achieve theoretical saturation, and questions will be posed about the categories. Codes, categories, and theoretical frameworks will be treated as provisional, and, once the analysis is complete, the results will be compared with relevant material from the existing literature.

The final criterion for concluding the grounded theory process will be theoretical transferability (Morse & Clark, 2019). This criterion emphasizes that the concepts and theories developed must have applicability beyond the specific context and situation in which they were initially identified. Given the level of abstraction achieved in the findings, the results transcend particularities, allowing abstract insights to be applied to other situations with similar characteristics (Morse & Clark, 2019).

Discussion

Strengths/Limitations

This research project is the first known study to explore the work-family interaction in the context of ICUs among nurses. It presents several strengths. First, it is one of the few projects employing qualitative methodology for its study, made even more unique by its data collection methods, such as observations in the settings where nurses experience the phenomenon. Second, it highlights the inclusion of a diverse range of participants, encompassing not only the perspectives of the nurses themselves but also those of their supervisors and family members, thereby presenting insights from the key stakeholders involved.

Implications for Practice, Education, Policymaking

This research project has various implications. First, its findings will be useful for practice, enabling nurses to recognize the elements involved in the work-family interaction process. Additionally, nursing supervisors and associated coordinators will be able to identify and effectively manage the phenomenon by understanding how it occurs, and the factors involved. Second, the findings will contribute to education by providing a more detailed description of the phenomenon, enhancing its understanding, which will be beneficial across different levels of training and research. Finally, third, the results have applications in public policy, as they will support the development of necessary and responsible work-life balance policies aimed at improving workers’ quality of life from the perspective of occupational health and safety.

Conclusion

The present constructivist grounded theory will provide deeper insights into the work-family interaction process among nurses in ICUs, capturing the specific characteristics of the phenomenon experienced by a profession with a significant female representation in a context of high occupational stress exposure. The results are expected to be valuable for education in the field and serve as a foundation for decision-making, thereby contributing to the effective management of the phenomenon of interest.

Footnotes

Acknowledgments

We would like to express our gratitude to Carla Fardella Cisternas, PhD, Sandra Valenzuela Suazo, PhD, and Maria Lucia do Carmo Cruz Robazzi, PhD, for their thorough review and invaluable feedback on the project.

ORCID iD

Miguel Valencia-Contrera

Statements and Declarations

Author Contributions

Miguel Valencia-Contrera: Made substantial contributions to the manuscript design; drafting and critical revision of the manuscript; final approval of the version to be published; and responsibility for all aspects of the work to ensure that any issues related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Lissette Avilés: Made substantial contributions to the manuscript design; drafting and critical revision of the manuscript; final approval of the version to be published; and responsibility for all aspects of the work to ensure that any issues related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Naldy Febré: Made substantial contributions to the manuscript design; drafting and critical revision of the manuscript; final approval of the version to be published; and responsibility for all aspects of the work to ensure that any issues related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by National Agency for Research and Development; Ministry of Science, Technology, Knowledge, and Innovation of Chile. Folio Number: 21231184.

Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Theorizing the Work-Family Interaction Process in Nurses in Intensive Care Units: A Constructivist Grounded Theory Research Protocol

Abstract

Keywords

Introduction

Background

Knowledge Gap

Method

Paradigm, Ontological, and Epistemological Stance of the Study

Positionality

Design

Setting and Participants

Sampling

Recruitment

Data Collection

Non-Participant Observation

In-Depth Interviews

Documents

Data Analysis

Constant Comparison

Initial Coding

Focused Coding

Memo Writing

Theoretical Sensitivity

Theorizing

Category Saturation

Central Category and Social Process

Ethics

Rigor

Discussion

Strengths/Limitations

Implications for Practice, Education, Policymaking

Conclusion

Footnotes

Acknowledgments

ORCID iD

Statements and Declarations

Author Contributions

Funding

Conflicting Interests

References