Initial Coding

The first coding step in the constant comparative method is initial coding. This coding involves breaking down the data into the basic incidents (an observation, statement or item of text) and assigning a code to these concepts (Charmaz, 2006). By assigning a name or a label to an incident, the researcher can begin to make concrete and isolated incidents abstract (Locke, 2001). By making these incidents abstract, I was able to remain open to new and unanticipated theoretical directions (Charmaz, 2006). For example, I coded Mike’s statement: “What’s care? I don’t know . . . It’s what I do.” (Mike,

interview #2) using the code “definition of care”. I also coded Beth’s description of her work: “I take care of people when they’re in the ICU.” (Beth, interview #1) as “take care”.

In accordance with SI, I was particularly interested in preserving the participants’ understandings. In order to accomplish this, as I coded the data I used in vivo codes (direct words for phrases used by participants) wherever possible. After I used in vivo

codes, I constructed specific codes to represent the meaning elicited from the in vivo codes (Charmaz, 2006).

All data, from field notes, textual analysis notes and transcripts were coded line by line. At the beginning of this study, I coded everything; I often coded the same data incident many times, with many different codes. This was done in order to fully explore the different ways in which each incident could be explored and understood. By the end of my initial coding I had more than 800 different codes. By naming these incidents in many different ways, I was able to think “broadly about the possible meaning of the incident” (Locke, 2001; 48). I then compared codes and merged them into new concepts, and eventually renamed, if necessary, and modified them. All of these codes were conditional at this stage (Charmaz, 2006). Table 3 outlines illustrative examples of five in vivo codes and the data that these codes developed from. These codes all helped form the core category of care developed in the next stages.

Table 2 Initial Coding Examples In vivo code Evidence

80/20 rule “Like, they're thinking about the here and now and we've gotta get this stuff done, we've gotta get today done. So, I think, I went to a conference once and it talked about the 80/20 rule, I think it was called the 80/20 rule, and it was about having 80% of your time for your patient care and what-not and then 20% for learning initiatives.” (Tom, interview #1)

Actual care A staff nurse would work on the unit, so um, they're the ones who provide the actual care to the patients. Where myself, some of the nurse clinicians would do more what we call paperwork or desk work. So, as new initiatives are coming out, new information we try to encourage staff to learn about it, we teach them. However, um, depending on what it is, we would look at that and then sort of decide is it just something, information that needs to be disseminated or is there actual teaching that needs to go on. So, um, but the staff nurses do all the hands-on care. (Carol interview #1)

Desk work A staff nurse would work on the unit, so um, they're the ones who provide the actual care to the patients. Where myself, some of the nurse clinicians would do more what we call paperwork or desk work. So, as new initiatives are coming out, new information we try to encourage staff to

learn about it, we teach them. However, um, depending on what it is, we would look at that and then sort of decide is it just something, information that needs to be disseminated or is there actual teaching that needs to go on. So, um, but the staff nurses do all the hands-on care. (Carol interview #1)

Administration -

positive Yeah, I'm, I'm running a really complicated clinic. I have, right now we have a thousand people on our list. I have 300 active patients whose care I'm coordinating. And its, and at the end of the day, if something doesn't get done for them and they're not ready for surgery, I'm, I'm where the buck stops. So, it's, it's fun, and challenging and, Um, but it's all coordination. It's all traffic directing, it's all

...unfortunately it doesn't have any of the, really doesn't have any of the hands on care, but that's

overshadowed by the amount of responsibility and autonomy . . . (Becky, interview #2)

As can be seen from this table a wide variety of codes were developed as I first explored the data. A variety of perspectives were used to ensure that the codes developed from the data. This stage of coding was not a linear method. Coding and modifications were made throughout the period of analysis. Although a lengthy and labour-intensive process, initial coding performed in this manner was an absolutely necessary first step to ensure the understanding developed was grounded in the data.