Compassion fatigue within nursing practice: A concept analysis

“Compassion fatigue” was first introduced in relation to the study of burnout among nurses, but it was never defined within this context; it has since been adopted as a synonym for secondary traumatic stress disorder, which is far removed from the original meaning of the term. The aim of the study was to define compassion fatigue within nursing practice. The method that was used in this article was concept analysis. The findings revealed several categories of compassion fatigue: risk factors, causes, process, and manifestations. The characteristics of each of these categories are specified and a connotative (theoretical) definition, model case, additional cases, empirical indicators, and a denotative (operational) definition are provided. Compassion fatigue progresses from a state of compassion discomfort to compassion stress and, finally, to compassion fatigue, which if not effaced in its early stages of compassion discomfort or compassion stress, can permanently alter the compassionate ability of the nurse. Recommendations for nursing practice, education, and research are discussed.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

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.     

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.     

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.     

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.     

Missed nursing care: a concept analysis

Title.  Missed nursing care: a concept analysis.
Aim.  This paper is a report of the analysis of the concept of missed nursing care.
Background.  According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.
Method.  An 8-step method of concept analysis – select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents – was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008.
Findings.  Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided.
Conclusion.  Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.     

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.     

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.     

Knowing in nursing: a concept analysis

Title.  Knowing in nursing: a concept analysis.
Aim.  This paper is a report of an analysis of the evolution of the concept of knowing in nursing.
Background.  Following the seminal contribution of Carper in 1978, knowing has been discussed with increasing frequency in the nursing literature with reference to the development of nursing knowledge. Various patterns of knowing, as well as research focused on reflection on experience, have been the foundation for activities and research designed to improve practice as well as patient care in clinical, community, education, cultural and administrative settings.
Methods.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. The data source was a search of literature published from 1978 to 2007. Three aims guided the analysis: to understand how the concept of knowing is used in nursing, how it is used in other health-related disciplines and how the concept has evolved into the current interpretation.
Discussion.  Analysis revealed that knowing in nursing refers to a uniquely personal type of knowledge constructed of objective knowledge interfaced with the individual's subjective perspective on personal experience. Knowing is a dynamic process and a result of personal reflection and transformation as the individual lives and interacts in the world. Its antecedents are experience, awareness and reflection. The consequences are understanding, finding meaning and transformation.
Conclusion.  This analysis illuminates an area in which nursing has carved out its own niche in healthcare research. The concept of knowing in nursing practice and research reflects a focus on the individual experience of health and illness.     

Defining and measuring nursing productivity: a concept analysis and pilot study

AIMS: The purpose of this article is fourfold. First we report a concept analysis of nursing productivity to show the complexity of the concept and its measurement. We then show how the concept analysis was used to design a method for measuring nursing productivity. Third, we describe how we used this measure in a pilot study of the impact of a differentiated Registered Nurse (RN) practice model on productivity. Finally, we identify the challenges encountered and present recommendations for nurse executives and researchers based on our findings. RATIONALE: We believe our experience can be useful to nurse executives and researchers who are interested in studying the impact of care delivery models on nursing productivity. DESIGN: We defined productivity as the ratio of output (patient care hours per patient day) to input (paid salary and benefit dollars). We conducted a pilot test using the productivity measure developed from the concept analysis to determine the effects of a differentiated RN practice model on patient, staff, and organizational outcomes. The purpose of the pilot study was to determine whether the data needed to measure productivity could be obtained from administrative databases and to develop the steps and process for the analysis. We analysed data by 2-week pay periods for two quarters prior to implementation of the differentiated nursing practice model and for two quarters after implementation to assess for changes in nursing productivity. RESULTS: Pilot testing showed that we could detect changes in productivity using this measurement approach. It also revealed several challenges in using administrative databases to measure productivity. CONCLUSIONS: We discuss these challenges with recommendations for both nurse executives and researchers. The most reasonable approach for operational decision-making is longitudinal monitoring of productivity by organizational units combined with indicators of quality of patient care.