Application and challenges of using a Constructivist Grounded Theory methodology to address an undertheorized clinical challenge: A discussion paper

Background: The benefits of nurse-led therapeutic patient education regarding wound healing and the prevention of recurrences for individuals living with a venous leg ulcer remain unclear. Obtaining the individuals perspective could offer an in depth understanding of why and how they engage or not, in self-management strategies following nurse-led patient education. Despite strong evidence indicating the need for further investigation into the benefits of therapeutic patient education in this population there is a lack of research into how individuals cope with chronic venous insufficiency or resulting ulceration. With this discussion paper we therefore explore the challenges associated with employing a Constructivist Grounded Theory methodology to gain a deeper insight into the experiences of patients with venous leg ulcers receiving individualized nurse-led patient education programs focused on the self-management of their condition. Objective: To identify and analyse the specific methodological and practical challenges encountered when applying a Constructivist Grounded Theory methodology to gain a better understanding of how patients with venous leg ulcer experience an individualised nurse-led patient education programme concerning the self-management of their condition. Design: discussion paper Results and Discussion: The constructivist approach to Grounded Theory methodology allows for the investigation of understudied phenomena such as nurse-led patient education for individuals living with venous leg ulcers. This methodology values the co-construction of a theory taking into consideration the inherent value of participants' and researchers' experiences. However, the specificities of constructivist epistemology challenge certain methodological aspects of Grounded Theory methods, such as how and when to use existing literature, conduct interviews to generate data and engage in the coding and theoretical sampling process for conceptualizing and proposing a theory. Conclusions: The constructivist paradigm of grounded theory methodolgy resonates with the art and science of nursing through its collaborative 'real-world' reflective approach, offering a unique way to explore understudied complex clinical nursing practice. Registration: This methodological paper is derived from a PhD study embedded in a clinical trial (NCT04019340) were the recruitment started on February 2020, approved by ethical committee of Geneva (CCER: 2019-01964) Tweetable abstract: Constructivist Grounded Theory Methodologies could support an in depth understanding of the impact of nursing interventions