Adherence: a concept analysis

Title. Adherence: a concept analysis. Aim. This paper is a report of an analysis of the concept of adherence. Background. The transition in terminology from compliance to adherence, and more recently to concordance, requires re‐clarification of ‘adherence’ as a concept in nursing practice. Differences exist in the use of the term adherence and how or if it differs from compliance or concordance. Data sources. Using the Medical Subject Headings terms adherence, non‐adherence and treatment refusal, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsychINFO and Cochrane library databases were searched for publications between 1970 and 2007. Method. The evolutionary analytic method was used to identify and explore transitions in the concept of adherence over time and across healthcare disciplines. A representative sample of papers was identified from the disciplines of nursing, medicine, psychology and pharmacy. Results. We identified 114 papers: 27 from nursing, 39 from psychology, 33 from general medicine and 15 from pharmacology sources. The final sample included eight from pharmacy and 15 from mental health, medicine and nursing. We found no distinct differentiation between adherence and compliance. The surrogate terms serving as manifestations of adherence are concordance, agreement, cooperation and partnership. The most common definition found was as follows: ‘Adherence can be defined as the extent to which patients follow the instructions they are given for prescribed treatments’. No definition of adherence exists that reflects a patient‐centred approach, the dynamic nature of adherence behaviour and the power imbalance implied by these terms. Conclusion. This concept analysis of adherence is a preliminary step towards broadening nurses’ appreciation of the complexity of patient adherence behaviour.     

Fever: a concept analysis

AIM: The purpose of this paper is to critically analyse the current state of the science literature in order to develop an accurate conception of fever. RATIONALE: The measurement of body temperature and treatment of fever have long been considered to be within the domain of nursing practice. What body temperature constitutes 'fever', however, is often not clear from nursing protocols or the literature. METHODS: Literature for this concept analysis was obtained by computerized searches of PubMed, CINAHL and BIOSYS for the years 1980-2004. Additional sources were obtained after reviewing the bibliographies of the literature identified by the initial search. The Wilsonian method of concept analysis provided the framework for the analysis. FINDINGS: Fever has characteristically been recognized as a cardinal sign of illness and has traditionally had negative connotations for patient well-being. Substantive advances over the past 20 years in immunology and neurophysiology have expanded understanding of the process of fever. This new knowledge has shifted the perception of fever as part of the acute-phase response to one of an adaptive nature. This knowledge has yet to be fully translated into changes in the fever management practices of nurses. CONCLUSIONS: Consistent usage of terminology in relation to fever should lead to improved and evidence-based care for patients, and to fever management practices consistent with current research. It is important to use clear language about fever and hyperthermia in discussions and documentation between nurses and among disciplines. By creating clarity in our language, we may help to achieve praxis.     

Postoperative recovery: a concept analysis

AIM: This paper presents a concept analysis of the phenomenon of postoperative recovery. BACKGROUND: Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. METHOD: Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. FINDINGS: The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. CONCLUSION: The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.     

Teamwork: a concept analysis

AIM: This paper is a report of an analysis of the concept of teamwork. BACKGROUND: Teamwork is seen as an important facilitator in delivering quality healthcare services internationally. However, research studies of teamwork in health care are criticized for lacking a basic conceptual understanding of what this concept represents. A universal definition for healthcare settings and professionals is missing from published literature. METHOD: Walker and Avant's approach was used to guide this concept analysis. Literature searches used bibliographic databases (Medline, CINAHL, Web of Science, Proquest CSA), internet search engines (GoogleScholar), and hand searches. Literature published between 1976 and 2006 was reviewed but only material in English was included. FINDINGS: Based on the analysis undertaken, teamwork is proposed as a dynamic process involving two or more healthcare professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision-making, and generates value-added patient, organizational and staff outcomes. CONCLUSION: Praising the value of teamwork without a common understanding of what this concept represents endangers both research into this way of working and its effective utilization in practice. The proposed definition helps reconcile discrepancies between how this concept is understood by nurses and doctors, as well as allied health professionals. A common understanding can facilitate communication in educational, research and clinical settings and is imperative for improving clarity and validity of future research.     

Barriers to nursing advocacy: a concept analysis

Advocacy for clients is viewed as an essential function of nursing; however, to be effective advocates for patients, the nurse must often overcome barriers to being an effective advocate. This concept analysis of barriers to nursing advocacy uses the Walker and Avant method of concept analysis. By analyzing the barriers to effective nursing advocacy for clients, nursing can then find strategies to manage those barriers and maximize the nurse's advocacy efforts.     

Energy: A concept analysis from a nursing perspective

The term “energy” is common in day‐to‐day language and denotes a myriad of different meanings depending on context. Energy is one of the most significant concepts for nearly all of the sciences including nursing, and yet it continues to be ambiguously defined. This article utilizes a modified version of Walker and Avant's framework for concept analysis (2011) to identify the characteristics, attributes, and antecedents of the concept of energy and provides a practical and theoretical application to nursing. The defining attributes discussed are power, productivity, effort, and activity. Model and contrary cases are presented to better provide a representation of the concept of energy. Empirical referents or a proper measurement or assessment of energy are nonspecific and poorly defined. Opportunities for future research related to the concept of energy in nursing include implementation of new terminology or theory development.     

Whistleblowing: A concept analysis

The concept of whistleblowing, which began to emerge in the 1970s, has gained significant traction over time and across disciplines, including law, management, public administration, sociology, psychology, and health sciences. Interestingly, nurses and nursing students account for the majority of the participants in studies pertaining to whistleblowing. Nursing research conducted in the past two decades provide a good foundation on which to build a better understanding of the context in which whistleblowing takes place, the process of whistleblowing itself, and the repercussions experienced by whistleblowers, but major conceptual gaps remain. In fact, limited attention has been given to the conceptual underpinnings and the use of the concept of whistleblowing in nursing. The goal of the present conceptual analysis was to start addressing this gap and raise some critical questions about the future application of this concept in nursing, including potential opportunities and limitations. Our analysis allowed us to identify a number of antecedents, attributes, and consequences of whistleblowing in nursing. It also revealed three areas needing more attention: the concept itself, organizational culture, and research into the complexities of whistleblowing.     

Advanced practice nursing: A principle-based concept analysis

Purpose: To analyze and clarify the conceptual basis of advanced practice nursing to determine the state of the knowledge from the perspective of four overarching principles derived from the philosophy of science: epistemological, pragmatic, linguistic, and logical.
Data sources: Written discourse regarding advanced practice nursing from refereed journals published between 2000 and 2007.
Conclusions: Conceptualization of a core definition of advanced practice nursing will enhance external legitimacy and recognition; understanding advanced practice nurse (APN) roles, sub-roles, and competencies will enhance internal cohesion. The outcome of this concept analysis is a greater understanding of the conceptual basis of advanced practice nursing and a current best estimate of the probable truth surrounding advanced practice nursing.
Implications for practice: A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions.     

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.     

Help-seeking behaviour: a concept analysis

The concept 'help-seeking behaviour' has gained popularity in recent years as an important vehicle for exploring and understanding patient delay and prompt action across a variety of health conditions. The term is used interchangeably with health seeking and is described as part of both illness behaviour and health behaviour. Concept clarification is required to aid nurses and other health-care professionals understanding of the attributes of help-seeking behaviour and to guide theory development, practice and research. The Walker and Avant method of concept analysis was used to guide the analysis. Help-seeking behaviour was shown to be a complex decision-making process instigated by a problem that challenges personal abilities. According to the literature, the process is characterized by the following attributes: problem focused, intentional action and interpersonal interaction. Help-seeking behaviour for a health problem can therefore be defined as a problem focused, planned behaviour, involving interpersonal interaction with a selected health-care professional.     

Pain catastrophizing: a dimensional concept analysis

Title.  Pain catastrophizing: a dimensional concept analysis.
Aim.  This paper is a report of a concept analysis of pain catastrophizing.
Background.  The importance of pain catastrophizing in the experience of pain and development of chronic pain has been demonstrated. It has been described as a tendency to have a fixation about pain and to feel unable to deal with pain.
Data sources.  Fifty-one papers containing the keyword 'pain catastrophizing' were selected from the Medline, Embase and Psycinfo indexes between 1996 and 2008. Dimensional analysis methodology was used to make explicit the ways in which the concept is constructed and used. The themes of this approach seem to contribute to the understanding of both nurse and client perspectives.
Results.  The literature on 'pain catastrophizing' seems to reach a level of middle-range explanatory theory. The focus is on specifying relationships between pain catastrophizing and two or more concepts, and on validating the theoretical hypotheses of 'communal coping' as opposed to 'hypervigilance'. The predominance of correlational and cross-sectional studies testifies to this. The concept's definition includes the curative and preventive approaches. However, only the professional perspective seems to be reflected in the concept's terminology.
Conclusion.  Nursing theories and qualitative research seem to be avenues for the comprehension of the phenomenon and the broadening of perspectives. They may bring not only a new but also a unique perspective. Nevertheless, the current state of knowledge on pain catastrophizing is important to nurses as they could influence greatly the timing of interventions and prevention of chronic pain.     

Harmony: a concept analysis

AIM: This paper is a report of a concept analysis of harmony. BACKGROUND: Historically, harmony has been poorly defined in nursing research. Harmony has been typically associated with music, but this concept also has a place in nursing. The term is used in current literature in various contexts, including the environment, and relating to mind, body, and spirit. Use of the term harmony is also evident in describing physical characteristics and connections between subjects or ideas, and as an adjective. METHODS: A literature search was conducted using the CINAHL, MEDLINE, PubMed, and OVID data bases from 1998 to 2003 with the keyword 'harmony'. The reference lists of the identified papers were then searched for further sources and 29 papers were identified for inclusion into the paper. Wilson's process was used to conduct the concept analysis. FINDINGS: Harmony is a major aspect of personal relationships, working relationships, and nurse-patient relationships. Both patient-clinician and clinician-clinician relationships are affected by the three attributes of harmony: balance, peace and rhythm. This balance is also an important factor in the incidence of disease and for optimal health. Five consequences of the concept are identified as pleasant environment, sense of satisfaction, positive self-concept, beautiful sound, or effective programme. CONCLUSION: Harmony is potentially relevant to many aspects of nursing. In order for a nurse to have a positive relationship with a patient, harmony must be present in terms of a pleasant environment, feelings of satisfaction, positive self-concepts, and effective nursing intervention programmes.