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A Grounded Theory Approach to Explore the Experience of Involuntary Childlessness in Couples with Infertility

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A Grounded Theory Approach to Explore the Experience of Involuntary Childlessness in Couples with Infertility A GROUNDED THEORY APPROACH TO EXPLORE THE EXPERIENCE OF INVOLUNTARY CHILDLESSNESS IN COUPLES WITH INFERTILITY A Dissertation Presented to the Faculty of the School of Nursing Widener University In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy by Taylor L. Grube School of Nursing May 2019 School of Nursing Title of Dissertation: A Grounded Theory Approach to Explore the Experience of Involuntary Childlessness in Couples with Infertility Author: Taylor Grube Approved by: Dr. Anne Krouse, Chair Dr. Barbara Patterson, Member Dr. Deborah Zbegner, Member Dr. Normajean Colby, Reader Dr. Karen May, Reader Date: April 8, 2019 Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Copyright by Taylor L. Grube 2019 Dedication This dissertation is dedicated to my children Ronan and Everly; my dreams that came true. iv Acknowledgments I am forever grateful for the people in my life who have supported and encouraged me throughout my doctoral education. I would like to extend my sincere gratitude to my committee members, Drs. Anne Krouse, Barbara Patterson, and Deborah Zbegner, whose guidance and expertise have been invaluable contributions to this dissertation. Thank you for inspiring me and challenging me as an educator and a researcher. I would also like to thank my readers, Drs. Normajean Colby, Susan Mills, and Karen May for their constructive feedback, which further influenced this work. Thank you to all of my supportive colleagues, who have become dear friends, in the Department of Nursing and Public Health at Moravian. Your constant encouragement has been a source of motivation for me over the years. Drs. Kerry Cheever, Lori Hoffman, and Susan Scholtz, thank you for seeing my potential and always steering me forward. Elise Colancecco, thank you for encouraging me to set deadlines. I would like to extend my love and appreciation to my family who have provided me with unwavering love and support throughout my doctoral journey and always. To my parents, Randy and Gayle Diehl, thank you for being the best ones! To my husband, Jason, thank you for never questioning my (crazy) ideas and staying by my side to see them through. To my children, Ronan and Everly, who were the inspiration for this work before they even existed. I hope that I, too, inspire the both of you to always be curious and never stop learning so that you can move your own mountains. v Last, but certainly not least, I would like to express my utmost appreciation for all of the couples in this study who shared their experiences with me. Without you all, this study would not be possible. vi Abstract Couples who experience involuntary childlessness as a result of infertility are challenged to manage the biological, sociological, and psychological implications of the situation. Furthermore, they are confronted with a variety of options regarding infertility management and resolution of involuntary childlessness. Nurses play a key role in supporting couples as they manage infertility and involuntary childlessness. Since infertility and subsequent involuntary childlessness is a couple’s experience, nursing care should aim to meet the needs of both partners. However, there is a lack of evidence to suggest how couples experience and manage this phenomenon. Therefore, the purpose of this study was to describe and explain the basic social process used by couples with infertility experiencing involuntary childlessness. The grounded theory approach of Strauss and Corbin was used to guide this study. Data were collected from 13 couples who experienced involuntary childlessness despite trying to conceive for at least one year using semi-structured Zoom© interviews. Data analysis revealed the basic social process of Enduring Involuntary Childlessness. The process is comprised of three stages starting with the initial loss of not being able to conceive a biological child. Next, couples enter the emotionally and physically demanding stage of managing. In this stage, they navigate alternative family-planning options, experience recurrent grieving, and cope with loss, stigma, and pressures to conceive. Eventually, the couple redirects life goals and finds contentment in life by taking on their new normal. During this stage, couples begin to define themselves less on vii their ability to parent and instead, place more emphasis on other aspects of life. In doing so, couples are able to find peace within their lives. This research developed knowledge that nurses can use to guide nursing care of couples with infertility who are experiencing involuntary childlessness. This research supports the notion that infertility and involuntary childlessness is a couple’s experience; and therefore, health care providers should consider the physical and emotional needs of both partners when caring for this population. viii Table of Contents Abstract ............................................................................................................................. vii Table of Contents ............................................................................................................... ix List of Tables ................................................................................................................... xiii List of Figures .................................................................................................................. xiv Chapter 1: Introduction ....................................................................................................... 1 Background ......................................................................................................................... 2 Infertility ......................................................................................................................... 3 Resolution ....................................................................................................................... 5 Options for Couples ........................................................................................................ 5 Psychosocial Effects on the Individual ........................................................................... 7 Psychological Effects on Couples ................................................................................... 9 Statement of the Problem .................................................................................................... 9 Purpose .............................................................................................................................. 10 Research Question ............................................................................................................ 11 Definition of Terms........................................................................................................... 11 Researcher’s Background ................................................................................................. 12 Researcher’s World View ................................................................................................. 12 Methodologic Approach ................................................................................................... 13 Philosophical Underpinnings ........................................................................................ 15 Considerations for Family Research ............................................................................. 16 Assumptions ...................................................................................................................... 16 Biases ................................................................................................................................ 17 Significance of the Study .................................................................................................. 17 Nursing Science and Research ...................................................................................... 18 Nursing Education ........................................................................................................ 19 Nursing Practice ............................................................................................................ 19 Chapter Summary ............................................................................................................. 20 Chapter 2: Literature Review ............................................................................................ 22 Purpose of the Literature Review ..................................................................................... 22 ix Meanings and Experiences of Infertility and Involuntary Childlessness.......................... 23 Psychosocial Implications of Infertility and Involuntary Childlessness ........................... 35 Grief Processes.............................................................................................................. 36 Quality of Life............................................................................................................... 39 Coping with Infertility and Involuntary Childlessness ................................................. 43 Potential Resolutions for Involuntarily Childless Couples ............................................... 50 Synthesis of the Literature ................................................................................................ 52 Chapter Summary ............................................................................................................. 53 Chapter 3: Methods
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