Living with uncertainty: concept advancement

Aim. This paper reports a study to demonstrate how the scientific understanding of the concept of uncertainty was advanced through a phenomenological study of living with uncertainty. Background. Techniques for concept analysis have evolved to subsume strategies for advancing a concept towards greater clarity and utility for research and practice. Recently, it has been argued that a clear delineation of techniques for concept analysis as separate and distinct from techniques of concept advancement is warranted. This article applies such delineated processes to demonstrate the advancement of the concept of uncertainty. Method. Concept analysis was used to establish an integrated understanding of the state of the science. Gaps in understanding were carefully analysed, resulting in the research question guiding the next phase of concept advancement: what is the nature of the lived experience of uncertainty? A phenomenological investigation of the experience of uncertainty among family caregivers was conducted. Then, using methods of template comparison, the conceptual attributes identified through the phenomenological study were compared and contrasted with the theoretical definition derived through concept analysis. Finally, a new conceptual definition of higher order abstraction, with greater pragmatic utility, was derived. Findings. Uncertainty is rooted in the individual's perception of outcomes or meaning of a situation. Such perceptions challenge one's sense of confidence and/or control to yield varied types and modes of uncertainty. Uncertainty is present oriented. Both cognitive and precognitive ways of knowing are influential in ascribing meaning, anticipating outcomes and adapting strategies. Conclusions. One's sense of confidence and sense of control are primary essences that determine the nature of the experience of uncertainty. The experience of living with uncertainty is dynamic, with fluctuations in the types and modes of uncertainty in response to precognitive and cognitive ways of knowing. Probabilistic paradigms preclude existential and situational modes of uncertainty for which probabilities cannot be appreciated.     

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.     

Ethical sensitivity in professional practice: concept analysis

Title.  Ethical sensitivity in professional practice: concept analysis
Aim.  This paper is a report of a concept analysis of ethical sensitivity.
Background.  Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis.
Data sources.  A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and women's studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007.
Findings.  Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery.
Conclusion.  The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations.     

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.     

Spirituality and child development: a concept analysis

BACKGROUND: If children are to be given the opportunity to develop to their full potential, fostering spiritual growth must be part of the process of caring for them. However, the meaningful application of spiritual care in everyday practice is fraught with difficulties. In addition to a lack of understanding of the term itself and of the expression of spirituality, in child health these difficulties are further compounded by the stage of a child's development. AIM: The aims of this paper are to explore spiritual awareness in children by providing examples of the expression of spiritual beliefs in relation to the developmental stage of the child, and to identify the implications of the findings for clinical practice. METHOD: A model of concept development, using the cyclical process of 'significance', 'use' and 'application' was applied, and formed the philosophical underpinnings for the paper. This framework is particularly relevant to child health, as there is little evidence to draw on, particularly in relation to a child's spiritual needs. FINDINGS: Five primary research papers which met the inclusion criteria were reviewed, and provided examples of spiritual beliefs and their manifestations in children. The examples highlighted the diversity and complexity of children's thinking. CONCLUSIONS AND RECOMMENDATIONS: Health care professionals working with children should receive education about the spiritual needs of children. Assessment tools should be developed to facilitate detailed assessment of children's spiritual needs. Professionals need to listen to and communicate with children at different stages of development if spiritual distress is to be identified. Families' health care beliefs should be respected and considered when planning care.     

Comfort: exploration of the concept in nursing

BACKGROUND: Comfort is a substantive need throughout life. However, the rise of technological influence coupled with a desire to embrace the medical concept of cure has frequently relegated the importance of nursing comfort interventions to simple tasks that can be provided by non-professional caregivers rather than an integral part of health promotion at all levels. DEFINITION: Comfort is a concept that has been explored by a number of authors. Various definitions have included comfort as an outcome of nursing, a function of nursing, a basic human need, and a process. No consensus on a definition of comfort was found in the literature. THEORY: This investigation attempts to link the ideas of comfort presented in the literature with the theories of Watson (Human Care) and Leininger (Culture Care), and discovers the existence of an integral locus for comfort in both. IMPLICATIONS: Theory-based strategies for nursing education are offered. Further research is clearly required, research methodologies based on Watson and Leininger would be appropriate for additional exploration of this concept. Practice implications include reflecting on the meaning of comfort to the patient in the context of his/her cultural values, and using this one as one of the factors in planning and implementing nursing care. CONCLUSION: Given the current emphasis on health promotion and the importance of comfort to the process of healing, comfort is an indispensable element of holistic, culturally congruent human care.     

An analysis of the concept of pain

This paper presents a conceptual analysis of the phenomenon of pain. The strategic process of developing a conceptual analysis is a cognitive exercise of critical thinking applied to a very common, but complex and poorly understood, experience. Within the classic framework developed by Walker & Avant (1995), pain is analysed and critical attributes are distilled. A model case, a related case and a contrary case are constructed in the course of creating conceptual clarity. Empirical referents that exemplify the concept of pain are identified. The concept analysis provides a forum for dialectics, offering one defensible interpretation of a complex human occurrence. Nursing implications are discussed in the conclusion.     

Acute – an ambiguous concept in healthcare

The aim of this study was to explore the concept acute semantically. The concept is being used both in clinical and theoretical contexts, without questioning whether a clear meaning of the concept has been established. The analysis has been applied according to the semantic analysis strategy of the philosopher (and pedagogue) Koort (1975). First, the results show that the concept of acute has had an unclear meaning and perception in the Norwegian language. Second, the synonyms indicate two different contents. The experiences and events that occur acute might be experienced as 'sharp' and 'intense'. The synonyms point also at time, such as quick, rapid and swift. Third, it reveals that the shortlived experience as synonym does have a very little binding to the concept acute. The occurence that began suddenly is not meant to subside the same way as it began.     

试论科学发展观对护理文化建设的指导作用

通过对科学发展观内涵的理解,介绍了科学发展观对护理文化发展、护理服务文化、护理安全文化、护理核心价值文化等方面的指导作用。阐明在新形势下医院护理文化建设必须坚持科学发展观这一重要主题,不断提升以人为本的护理服务理念,提高护理管理水平,培育高素质的护理团队。     

Impersonal trust and professional authority: exploring the dynamics

AIM: The aim of the study was to explore the relationship between impersonal trust, governmentality and professional activity through an analysis of professional discourse. BACKGROUND: This study emerged from an earlier paper that described a four-dimensional model based on Luhmann's definition of trust as "reducing complexity and managing expectations". Linking trust with the Foucauldian notion of governmentality develops this further. Governmentality raises the question of how professional authority is constituted through the practice of nurses and other health and welfare professionals. METHOD: Discourse analysis was used to explore the text from two genres--academic literature and interview material (n = 17)--in the context of community residential services for people with learning disabilities. Findings. The study provided evidence to support claims that trust is produced through impersonal systems. Trust is contested in a dynamic process where there are gains and losses. Professionals in organisations actively promote trust, often through systems of distrust. The study also built on the four-dimensional model of impersonal trust--trust, mistrust, abuse and hope--and re-conceptualized the trust-hope dimension. CONCLUSION: There are theoretical links between governmentality and trust. Similarly, in order to understand trust nurses need to understand the dynamic nature of the systems in which they operate. The proposition that trust could frustrate hope adds an element of controversy to the discussion of hope in the nursing literature.     

Exploring the concept of 'information need'

Identifying information needs is frequently espoused in textbooks, policy documents and reports of research studies; provision of health-care is also now described as 'needs-based', rather than 'service-based'. Yet, there is little understanding or clear definitions of this construct in the literature on the topic. The purpose of this paper is to explore the concept of information need, using concept analysis, with the aim of providing greater clarity. Rodgers' evolutionary approach to concept analysis was used to identify common attributes, antecedents and consequences, of the term information need. Information need emerged as a want or desire for information to be shared by professionals using appropriate communication skills. Information-seeking behaviour manifests in individuals as a response to a stimulus that is perceived as either a challenge or a threat. This attempt to provide a greater clarification of the term was prompted by the ubiquitous use of the term with little consistent definition. It is hoped that this conceptual clarification will guide further study in this area, particularly in relation to the subjective nature of contemporary information needs and its role in coping behaviours of individuals and groups.     

Complex adaptive systems and their relevance for nursing: An evolutionary concept analysis

This study aimed to analyse the concept of “complex adaptive systems.” The construct is still nebulous in the literature, and a further explanation of the idea is needed to have a shared knowledge of it. A concept analysis was conducted utilizing Rodgers evolutionary method. The inclusive years of bibliographic search started from 2005 to 2015. The search was conducted at PubMed©, CINAHL© (EBSCO host©), Scopus©, Web of Science©, and Academic Search Premier©. Retrieved papers were critically analysed to explore the attributes, antecedents, and consequences of the concept. Moreover, surrogates, related terms, and a pattern recognition scheme were identified. The concept analysis showed that complex systems are adaptive and have the ability to process information. They can adapt to the environment and consequently evolve. Nursing is a complex adaptive system, and the nursing profession in practice exhibits complex adaptive system characteristics. Complexity science through complex adaptive systems provides new ways of seeing and understanding the mechanisms that underpin the nursing profession.