Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

Critical access health care: a concept analysis

PURPOSE. The purpose of this paper is to provide a concept analysis of critical access health care. A common understanding of critical access health care would benefit those who legislate, provide, and consume health care. METHODS. A review of the literature was conducted using an identical set of search terms that yielded a variety of sources; however, none were specifically related to critical access health care. FINDINGS. No literature of concept analysis of critical access health care could be found. CONCLUSIONS. A concrete and measurable understanding of the concept will provide a common foundation to assist public and private entities in developing viable methods to understand healthcare policies, problems related to access, disparities in health care, and ways to increase health promotion and disease prevention.     

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.     

Nursing Care: A Concept Analysis

TOPIC. The term nursing care is widely used throughout nursing and allied health literature; however, the meaning of the term is not clear. PURPOSE. The purpose of this analysis is to explore the essence of the term nursing care and to develop an operational definition of the concept. SOURCES OF INFORMATION. Using the Walker and Avant (2005 ) method, dictionaries, thesauruses, and current nursing literature are studied for meanings, usages, and attributes. Model, borderline, and contrary cases are also presented. CONCLUSIONS. Intended as a preliminary exploration of nursing care, this work serves as the foundation for further study of the concept.     

Abuse in health care: a concept analysis

Scand J Caring Sci; 2012; 26; 123–132 Abuse in health care: a concept analysis Aims and objectives: To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat. Background: Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. Design: Concept analysis as developed by Walker and Avant. Method: The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat. Results: Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon. Conclusions: Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.     

Convenient care clinics: Making a positive change in health care

Abstract
Purpose: To discuss the impact of retail health clinics, also known as convenient care clinics (CCC), on the changing landscape of health care in the United States.
Data sources: Selected articles from the scientific literature and data from the industry literature.
Conclusions: The concept of the CCC has been well-received by the public, and nurse practitioners (NPs) have been intimately involved in the development and expansion of these clinics. The professional association of CCCs has been instrumental in promoting operational standards for CCCs to insure a high quality of service. Some resistance to the concept from physicians remains but the convenience for consumers appears to drive the high levels of satisfaction reported.
Implications for practice: Collaboration among all healthcare providers is essential to expand access to care for everyone. NPs are crucial to the operation of CCCs and provide care that is well-received by consumers.     

Concept analysis: awareness of discrimination based on genetic information

PROBLEM. All nurses have the responsibility to deliver nondiscriminatory genetic health care. Patients perceive discriminatory nursing practices when they are being treated differently and unfairly. Nurses are expected to integrate genetic information about their patients into their clinical decision making. Thus, it is both timely and imperative that nurses have an operational definition of the concept “awareness of discrimination based on genetic information.” METHOD. An operational definition of the concept was derived and Wilson's method of concept analysis was utilized to show how the operational definition may be applied in three different case models. FINDINGS. Awareness of discrimination based on genetic information can be operationally defined as “to know differences against people or distinguish between people based on the ancestral, heritable, communicated facts or knowledge”. CONCLUSION. This concept analysis of words and terms used in genetic health care may serve as a framework for further genetic/genomics healthcare concepts under exploration.     

Gender differences of parental distress in children with cancer

AIMS: The aim of this paper is to provide an in-depth analysis of the concept of equity in the British health visiting service and thus facilitate understanding of the term. An attempt has been made to apply the analytical process to the context of health visiting. BACKGROUND: Equity has been discussed at some length in the health literature. Much of this including the health visiting literature discusses inequality and inequalities in health at the same time as discussing equity. Increasingly, poverty and inequalities have become accepted as determinants in poor health. It seemed appropriate therefore to analyse these topical and seemingly related concepts. METHODS: A well established method of concept analysis has been utilized to facilitate the process of analysis. RESULTS: Confusion between the meaning and application of the concepts of equity and equality was found. Much of the health visiting and health care literature related to addressing the needs of groups who experience inequality in terms of service provision, and access to services. Following an in-depth critical analysis of the literature three critical attributes of the concept were identified: equal opportunity of access to services; a high standard of service for everyone; and unequal distribution of services to meet unequal need. These relate to two distinct forms of equity: horizontal and vertical equity. A definition of equity has been proposed. Maxwell's (1992) framework is suggested as a means to evaluate equity in service provision and uptake. CONCLUSIONS: Most of the literature examines equity at a macro level, that is service level. Nurses and health visitors are urged to examine the services that they are involved in to determine the level of equity that is achieved or not attained. Suggestions have been offered as to how this task may be undertaken. A definition has been proposed to stimulate debate and discussion about the concept within nursing contexts.     

Re‐examining definitions of spirituality in nursing research

Aim

To discuss the definition of spirituality and its limitations for nursing research. It proposes a definition that will capture more accurately the role of spirituality in health outcomes.

Background

Studies have increasingly examined spirituality in nursing research as a coping mechanism attenuating the negative impact of traumatic stress on mental health. Existing definitions of spirituality in nursing research include elements of positive emotional states (meaning, purpose, general well‐being) which confound mental health outcomes.

Data sources

Medline and CINAHL databases were searched from 2007–2011 for research articles examining spirituality definitions and measures used by nurse researchers.

Discussion

An analysis of the definitions of spirituality in nursing research reveals inconsistencies and confounding mental health concepts. The authors propose defining spirituality in the context of religious involvement when conducting research, while using a broader definition of spirituality when providing spiritual care. They argue such definition provides a more appropriate method of measuring this concept in research aimed at evaluating mental health outcomes while preserving the currently used patient‐defined definition of spirituality when providing spiritual care.

Nursing implications

A consistent definition of spirituality in nursing research evaluating mental health outcomes, distinct from ‘spiritual care’ in a clinical setting, is essential to avoid tautological results that are meaningless. Appropriate definitions will enable nursing researchers to more clearly identify resilience mechanisms and improved health outcomes in those exposed to traumatic stress.

Conclusion

A definition of spirituality that focuses on religious involvement provides a more uniform and consistent measure for evaluating mental health outcomes in nursing research.     

What is protocol‐based care? A concept analysis

AIM: To define protocol-based care to make this way of delivering health care amenable to theoretical and empirical studies. BACKGROUND: Although protocol-based care is associated with the evidence-based practice and standardization movements, it is an ill-defined and understood concept. METHOD: A multiphase concept analysis, inspired by an evolutionary view was used to clarify 'what is protocol-based care'. The inductive, five-phase process drew upon content analysis of policy documents and the literature, plus interviews with a purposive sample of 35 opinion leaders. RESULTS: The term was used interchangeably with protocols, pathways and guidelines in policy and guidance documents. A search of seven databases produced only 57 references to protocol-based care. The concept analysis revealed a continuum of scope and specificity and also distinguished specialist and generic applications of protocol-based care. CONCLUSIONS: Managers need to take cognizance of the significance and complexity of protocol-based care when introducing this way of working.     

Compliance: A Concept Analysis

Compliance can be defined in many ways. The meaning of the concept is directly dependent upon the discipline and the context in which it is used. Lacking a gold standard for its measurement, a clear definition for the concept of compliance in nursing and other health-related professions should be explored. This article explores the definitions of the concept as it relates to various disciplines, and examines its true meaning as it relates to the nursing profession. Nurses are encouraged to take a patient-centered approach to patient care, thereby forming alliances and empowering patients and family members to take an active role in their health care.     

A concept analysis of home and its meaning in the lives of three older adults

gillsjö c. & schwartz‐barcott d. (2010) A concept analysis of home and its meaning in the lives of three older adults. International Journal of Older People Nursing 6 , 4–12
doi: 10.1111/j.1748‐3743.2010.00207.x Aim. To identify and define the concept of home and its meaning in the lives of three older women. Background. For many older adults home is the centre of daily life and increasingly important as a place where health care is delivered. Yet, as a concept, home remains theoretically and empirically underdeveloped. Methods. The Hybrid Model of Concept Development was used to interface theoretical analysis and empirical observation with a focus on definition. A comprehensive, interdisciplinary literature review, semi‐structured interviews with three older women and case and cross‐case analysis were completed. Results. Interviewees spoke of childhood, community, residential, church and heavenly homes. Feelings of comfort and security were associated with residential homes, peace and quiet with church homes, safety and pleasure with heavenly homes. The experience of home as being taken for granted, unselfconscious and unrecognized, became obvious when one woman tried to consciously establish a sense of being at home in her new residence. Conclusion. No single comprehensive and measurable definition was found. However, three major components were identified (place, relationship and experience) and used to define home as a place to which one is attached, feels comfortable and secure and has the experience of dwelling. Relevance to clinical practice. Every day assumptions about the meaning of home and home as just another place where health care is provided are called into question. Increased awareness and dialogue is needed among health‐care providers working with older adults in their homes. Future research needs to explore the impact of home care on the older adult’s meaning of home and its potential impact on recovery.     

Discharge planning in mental healthcare settings: A review and concept analysis

To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty‐nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient‐centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.     

Improving Access to Health Care for Uninsured Elderly Patients

ABSTRACT The purpose of this article is to explore the barriers that the uninsured elderly population encounter when accessing health care in the United States. These barriers include, but are not limited to lack of transportation, insurance, or family support; the daunting complexity of the health care system; poverty; culture; poor patient‐health care provider communications; race/ethnicity; and lack of health care professionals such as nurses and doctors with adequate geriatric preparation, or generalists who are undereducated in geriatrics. The number of health care professionals currently available to treat elderly persons in the United States is inadequate. The Federal government should take steps to develop solutions to improve access to health care and decrease health disparities for older adults. As a nation, we should be proactive in addressing these concerns instead of waiting for new barriers to arise that further limit access to health care for elderly patients and their families. In this article, we provide an assessment of the barriers that limit access to health care in the uninsured elderly population and suggest recommendations and possible solutions to eliminate or reduce these barriers.     

A Universal Healthcare System: Is It Right for the United States?

The over 45 million Americans who are uninsured speak volumes about the problems with our present healthcare system. Many Americans do not have access to basic health care and it is time to revisit the importance of universal health care for all Americans. PURPOSE: To gain a greater understanding of the facts, figures, and support for universal health care in America. SOURCE OF INFORMATION: A literature review of five research studies. CONCLUSION: The implementation of universal health care in America is a plausible feat, but the support of several facets of society is necessary for this to become a reality.     

Barriers to preventive health care for young children

PURPOSE: To review the literature on barriers to availability, access, and utilization of preventive health care for young children three to five years of age and their families and to discuss the role of nurse practitioners (NPs) in future research, education, and practice in this area. DATA SOURCES: A comprehensive literature search was conducted of online material and CINAHL and Medline (CD-ROM 1990 to present). In addition, experts in this area were asked to recommend extra reading materials. Additional references in textbooks and articles were examined. CONCLUSIONS: The literature review supports that there are major barriers to be addressed in the areas of availability, access, and utilization of preventive health care services for young children and their families. Major concerns include mandatory system for preventative health care, lack of health insurance coverage, cultural issues, and parental effects. IMPLICATIONS FOR PRACTICE: Health professionals in the community will need to work together to reevaluate current preventive health care practices for young children. Alternative methods for approaching and providing preventive health care services may become increasingly important if these services for young children are to be provided at current or increased levels.     

Making the Case

High-risk industries such as transportation, aviation, manufacturing, and nuclear power have much better safety track records than that of the health care industry. It is logical to look to these industries for effective safety practices that may translate to health care. One concept embraced by other industries that demonstrates significant potential for safety improvement in health care is Safety-Specific Transformational Leadership. This article introduces the concept and makes the case for embracing Safety-Specific Transformational Leadership in health care by proposing an operational definition and samples of behavioral assessment items for instrument development.     

Social support: factors to consider when designing studies that measure social support

Research into the area of social support has been associated with confusion and concern. Much of the previous work in this area has inherent and serious difficulties, especially with regard to measurement issues surrounding the concept and with study design. However, it is paramount that social support research is further developed to allow effective interventions by health care professionals to influence positive outcomes in patient care. It is only by adopting a rigorous approach to social support research that its full potential can be achieved, that it can result in the positive promotion of recovery from mental and physical illness and that it can then become an important tool for the health care professional. This paper aims to clarify research issues relating to social support definition, measurement and study design, including methodology, selection of instruments and analysis. Guidance will be provided concerning the important factors to consider to achieve a well-designed study to measure social support.     

Expert: a discussion of the implications of the concept as used in nursing

The concept'expert' has become common in the nursing literature since Benner's (1984) work more than a decade ago Whilst the term has a common meaning, it is apparent that when used in nursing it refers to a multitude of attributes and lacks clear definition This paper uses the strategy for concept analysis developed by Walker & Avant (1988) to seek an operational definition for the concept of 'expert', and suggests the denning attributes of possession of a specialized body of knowledge and skill, extensive experience in a field of practice, highly developed levels of pattern recognition, and acknowledgement by others These are discussed in relation to nursing practice and the circumstances under which the concept is used Development of cases is carried out to exemplify the concept, and the antecedents and consequences of the attributes are discussed, suggesting that the concept lacks clarity, both in conceptualization, and in use A first definition of the concept is posed to open debate concerning the relevance of the term for the future The conclusions reached suggest that whilst an operational definition is unlikely to be found, because of the problems of definition and measurement, it is possible, through various strategies, to recognize expert practice and use it to further develop nursing Furthermore, it is likely to become increasingly important to recognize and reward expert practitioners, given the political and economic constraints in health care today