Community health: an evolutionary concept analysis

Title.  Community health: an evolutionary concept analysis.
Aim.  This paper is a report of a concept analysis of community health.
Background.  Community health is a term that has been broadly used in both research and practice. Although local communities are invested in community health improvement, this process often occurs without a clear definition of the concept of community health .
Data sources.  Data sources included a sample of 537 papers covering the period 1990 to 2004 and representing the disciplines of nursing, public health, medicine and sociology and landmark works concerning community health, six community health assessment instruments and interviews with seven key community health informants.
Review methods.  Rodgers' Evolutionary Method of Concept Analysis was used to design the study and analyse the data. The professional literature was analysed and compared with the use of the concept of community health in community health assessment instruments and by key informants.
Results.  Dynamic and contextual, community health is achieved through participatory, community development processes based upon ecological models that address broad determinants of health. The primary focus of this collaborative work is population-based health promotion and disease prevention.
Conclusion.  The definition derived from the concept analysis of community health makes explicit the importance of community-based participatory action in local health improvement processes. Identification of the attributes of community health will enhance communication across disciplines involved in community health practice, research and education.     

学龄期1型糖尿病患儿疾病知识和自我管理相关性分析

目的通过了解学龄期1型糖尿病患儿对糖尿病的知识水平和自我管理水平,分析患儿的糖尿病相关知识与自我管理水平的相关关系。方法选择2006年11月—2007年2月在复旦大学附属儿科医院内分泌门诊就诊的学龄期1型糖尿病患儿40例,采用糖尿病儿童知识量表、糖尿病患儿自我管理量表和基本资料问卷进行调查。结果①40例患儿中,糖尿病相关知识的答对率为74%,其中,半数患儿的答对率低于50%;依次为运动知识、血糖和尿糖监测知识、高低血糖识别和处理的知识、用药知识、基本知识和饮食知识。②患儿的自我管理的项目平均分为1.49。依次为血糖和尿糖监测的管理、高低血糖的管理、用药管理、运动管理、饮食管理。③患儿的年龄与疾病知识及自我管理水平呈中度正相关（P〈0.01）,而患儿的病程与疾病知识及自我管理水平也分别呈低度或中度正相关（P〈0.05或0.01）。④患儿的疾病知识和自我管理水平呈高度正相关（r=0.72,P〈0.01）,尤其在运动和用药方面。但患儿在饮食控制方面的知识与其相应的自我管理行为不相关（P〉0.05）。结论学龄期1型糖尿病患儿相关知识水平和自我管理水平均较偏低,而患儿的知识水平和自我管理水平多呈正相关关系,提示护理人员应通过一定策略提高患儿的疾病知识,改善其自我管理行为。但在饮食控制方面,患儿可能存在着除疾病知识外的其他一些影响因素,需要我们做进一步探索。     

Chronic fatigue: an evolutionary concept analysis

Title.  Chronic fatigue: an evolutionary concept analysis.
Aim.  This paper is a report of a concept analysis of chronic fatigue.
Background.  Fatigue is a prevalent symptom encompassing both acute and chronic manifestations. It is chronic fatigue that is most problematic because of its duration and impact on life quality. The rise in prevalence of chronic conditions will result in a need to address coexistent symptoms, clarification of which is needed. Chronic fatigue is one of the most common symptoms in chronic illness. Clarification of the concept and an understanding of its use by discipline are needed.
Data sources.  The evolutionary method of concept analysis was used to ascertain the attributes, antecedents, consequences and surrogate terms for chronic fatigue. A review of the literature published between 1966 and 2007 was carried out to determine the contextual use of the concept of chronic fatigue among disciplines. Sources used for this analysis included CINAHL, Medline, PsychINFO and Social Work Abstracts and the search yielded 66 papers.
Results.  The chronic fatigue experience is associated with a multitude of physical, psychological and social factors. The defining attributes of chronic fatigue are constancy, abnormality, whole-body experience, inexplicability and disabling. The antecedents of chronic fatigue are physical disease, psychopathology, female gender and a history of abuse. Consequences found include social isolation and stigmatization, physical inactivity, psychological disturbances and a reduced quality of life.
Conclusion.  Further research is needed to identify the aetiology of chronic fatigue and to address the social context of living with this disabling symptom.     

Fatigue in children with long-term conditions: an evolutionary concept analysis

Title.  Fatigue in children with long-term conditions: an evolutionary concept analysis.
Aim.  This paper is a report of a concept analysis of fatigue in children with long-term conditions.
Background.  There is little research focused on the experience of fatigue in children. Previous work has focused primarily on children living with cancer. It is necessary to clarify and refine the concept, and add to the knowledge base that supports ongoing theoretical work in order to improve the clinical care of children with long-term conditions who experience fatigue.
Method.  English language literature published from 1989 to 2007 was searched using the CINAHL, Medline and PsychINFO data bases. Sixty-two papers and two book chapters were used in this concept analysis. Rodgers' method of evolutionary concept analysis was used. This inductive method helps us to view the concept in a sociocultural and temporal context.
Findings.  The number of publications focusing on fatigue in children is increasing. The analysis yielded two surrogate terms, five attributes, three antecedents and seven consequences. Based on this analysis, fatigue in children with long-term conditions appears to be a subjective experience of tiredness or exhaustion that is multidimensional and includes physical, mental, and emotional aspects.
Conclusions.  Evidence suggesting children with long-term conditions experience fatigue is increasing, but conceptual gaps remain. This analysis has yielded a view of fatigue in children that illustrates healthcare professionals' limited yet growing awareness of the symptom. Ongoing study as a means to refine our understanding of the concept could potentially lead to important contributions to clinical care of children with long-term conditions.     

Type 1 diabetes: children and adolescents' knowledge and questions

Title.  Type 1 diabetes: children and adolescents' knowledge and questions.
Aim.  This paper is a report of a study conducted to describe what children and adolescents who have type 1 diabetes know and want to know about the disease.
Background.  Research indicates that young people's knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence.
Methods.  In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed in 2005 about what they knew and wanted to know about their disease. Through a process of induction, major themes were identified from the data.
Findings.  The six major themes were: (a) Care , including both physical and emotional care, (b) Physiology , (c) Consequences , including both short- and long-term, as well as positive and negative consequences, (d) Cure , (e) Effects on the Family and (f) Experience at Diagnosis . Themes related to the unique challenges associated with type 1 diabetes were also identified.
Conclusion.  Nurses, diabetes educators and parents should provide developmentally appropriate information about diabetes care and management, scaffolding on existing knowledge. They should provide child-centred contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programmes that allow young people to develop coping skills and share experiences could also prove beneficial.     

1型糖尿病儿童及青少年患者生存质量调查分析

目的调查1型糖尿病儿童及青少年患者的生存质量。方法采用儿童生存质量普适性核心量表和应对方式问卷分别对63例1型糖尿病儿童、青少年患者及63名患者家长进行调查。结果 1型糖尿病儿童及青少年患者生存质量总均分为(84.84±11.31)分,糖尿病患者家长的应对方式主要以成熟的应对方式(例如:解决问题、求助)为主,糖尿病儿童及青少年患者的年龄、是否独生子女、测血糖者、胰岛素注射工具和家长自责影响患者生存质量。结论关注非独生子女、青少年糖尿病患者的生存质量,鼓励儿童及青少年患者自己测血糖,以提高其自我管理能力。     

Ⅰ型糖尿病儿童和青少年心理应激应对的研究进展

本文通过文献回顾,探讨了Ⅰ型糖尿病儿童和青少年的心理应激状况及心理应激的应对方式,可以根据影响心理应激应对的因素进行针对性指导,以帮助其采取更合理的应对方式.     

Cancer survivorship: evolutionary concept analysis

Title. Cancer survivorship: evolutionary concept analysis Aim. This paper is a report of a concept analysis of cancer survivorship in adults. Background. The concept of cancer survivorship appears frequently in cross‐discipline literature but does not seem to have any precise definition or meaning. Substantive research into the experience of surviving cancer is long overdue. However, if a concept has not been clearly defined any theoretical work based on that concept will also be unclear. Data sources. The analysis was based on literature published in English between 1994 and 2006 (n = 43) and seminal work in the field. Review methods. Rodgers’ method of evolutionary concept analysis was used, allowing the concept to be viewed within a sociocultural and temporal context and capturing both lay and emic perspectives. Results. Cancer survivorship in adults is a process beginning at diagnosis and involving uncertainty. It is a life‐changing experience with a duality of positive and negative aspects, and is unique to the individual but has some universality. The primary antecedent is a cancer diagnosis and the consequences can be divided into four main themes: physical health, psychological health, social health and spiritual health. Conclusion. Surviving cancer is now an established reality for millions of people worldwide. Nurses can benefit from a deeper understanding of the patient experience, both theoretically and in practice. Clarification of a concept provides a heuristic for further inquiry and a basis for theory generation.     

精神分裂症合并2型糖尿病患者自我管理现状的调查

目的了解精神分裂症合并2型糖尿病患者的自我管理现状。方法采用糖尿病健康知识问卷、治疗态度问卷和糖尿病自我管理量表对门诊复诊的56例精神分裂症合并2型糖尿病患者进行调查。结果患者健康知识总分为（64．82±15．52）分,其中良好10例,占17．86％;中等25例,占44．64％;较差21例,占37．50％。患者治疗态度总分为（12．41±2．09）分。患者自我管理总分为（65．49±13．04）分,其中良好11例,占19．64％;中等24例,占42．86％;较差21例,占37．50％。患者的健康知识与治疗态度呈正相关（r=0．393,P=0．003）,健康知识与自我管理呈正相关（r=0．489,P=0．000）,治疗态度与自我管理呈正相关（r：0．620,P=0．000）。结论精神分裂症合并2型糖尿病患者自我管理行为有待改善,医护人员应有针对性地开展健康教育。     

An evolutionary concept analysis of caring

AIM: The aim of this paper is to identify the core, enduring attributes of nursing caring in order to increase understanding of the concept and to identify its implications for research and practice. BACKGROUND: Caring is considered a core concept in nursing as a practice discipline. During the past 20 years, research into nurse caring has been evolving, but the concept of caring remains ambiguous. METHODS: Using a rigorous evolutionary method of concept analysis, the concept caring was examined for its significance, use and application as it has unfolded over time, between 1988 and 2002. After applying inclusion and exclusion criteria and a sampling method, a total of 61 articles was included in the final analysis. RESULTS: Defining attributes, antecedents, and consequences of caring were identified. Core attributes included relationship, action, attitude, acceptance and variability. CONCLUSION: Identification of the core attributes of concepts, including caring, allows nurses to determine appropriate research questions, develop theory and identify practice priorities at a time of increasing demands and constrained resources.     

Emotional labour underlying caring: an evolutionary concept analysis

Title. Emotional labour underlying caring: an evolutionary concept analysis Aim. This paper is a report of a concept analysis of emotional labour. Background. Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing. Data sources. A literature search using keywords ‘emotional labour’, ‘emotional work’ and ‘emotions’ was performed in CINAHL, PsycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour. Review methods. We followed Rodgers’ evolutionary method of concept analysis. Results. Emotional labour is a process whereby nurses adopt a ‘work persona’ to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient–nurse encounters, and which consist of three elements: organization (i.e. social norms, social support), nurse (i.e. role identification, professional commitment, work experience and interpersonal skills) and job (i.e. autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions: nurses’ autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e. productivity, ‘cheerful environment’) and nurse aspects (i.e. negative or positive). Conclusion. The concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for ‘difficult’ patients to deflate the dominant discourse about ‘problem’ patients.     

Social isolation in older adults: an evolutionary concept analysis

Title.  Social isolation in older adults: an evolutionary concept analysis.
Aim.  This paper is a report of an analysis of the concept of social isolation as experienced by older adults.
Background.  Social isolation is a serious problem with older adults that is expected to increase in the future. Although strong correlations exist between social isolation and negative health consequences, few interventions exist. One contributing factor to this is a lack of conceptual clarity.
Data sources.  The CINAHL, PsycINFO and Medline databases and the Web of Science were searched using the key terms social isolation, social networks, older adults, elderly and social integration for publications between 1983 and 2007.
Review methods.  An evolutionary concept analysis was undertaken. References were read in their entirety and analysed based on the summary of surrogate terms, related concepts, attributes, antecedents and consequences.
Findings.  Five attributes were identified: number of contacts, feeling of belonging, fulfilling relationships, engagement with others and quality of network members. Antecedents included: lack of relationships, psychological barriers, physical barriers, low financial and resource exchange, and prohibitive environment. Roy's Adaptation Model is proposed as a theoretical context into which social isolation fits.
Conclusion.  Numerous definitions are used to describe social isolation, but they lack uniformity, consistency and clarity; this impairs the further development and refinement of the concept. This concept analysis can offer additional understanding and a starting point for future research related to social isolation.     

Respiratory infection recurrence and passive smoking in early atherosclerosis in children and adolescents with type 1 diabetes

Background  Optimal glucose control in juvenile type 1 diabetes mellitus is necessary but not sufficient to reduce the burden of cardiovascular events in later life. This emphasizes the importance of searching for other possible risk factors associated with diabetes. We investigated whether recurrent episodes of acute respiratory infections and exposure to tobacco smoke could influence vascular phenotypes for early atherosclerosis in children and adolescents with type 1 diabetes.
Materials and methods   Common carotid artery elasticity and intima-media thickness along with circulating markers of lipid, inflammatory and glycaemic profiles were investigated in up to 98 children and adolescents with type 1 diabetes. The number of clinically manifest acute respiratory tract infections (RTI) during the past year, and the degree of exposure to environmental tobacco smoke (ETS), were assessed by separate questionnaires.
Results   Carotid artery compliance (CAC) was decreased in patients with high (≥ 4/year; n  = 22) recurrence of RTI compared to the remaining patients ( n  = 40; P  < 0·05). In a multivariate analysis, the number of RTI during the past year and HbA_1C were independently associated with decreased CAC ( P <  0·05 for both). The inverse relationship between RTI recurrence and CAC was strengthened by frequent exposure to ETS.
Conclusions   High recurrence of respiratory infections in young type 1 diabetics is associated with increased stiffening of the carotid artery particularly in those often exposed to tobacco smoke.