Peer support within a health care context: a concept analysis

Peer support, and the integration of peer relationships in the provision of health care, is a concept of substantial significance to health scientists and practitioners today, as the focus shifts from the treatment of disease to health promotion. If the nursing profession is to effectively incorporate peer relationships into support-enhancing interventions as a means to improve quality care and health outcomes, it is essential that this growing concept be clearly explicated. This paper explores the concept of peer support through the application of Walker and Avant's (Strategies for Theory Construction in Nursing, 3rd Edition, Prentice-Hall, Toronto, 1995) concept analysis methodology. This analysis will provide the nursing profession with the conceptual basis to effectively develop, implement, evaluate, and compare peer support interventions while also serving as a guide for further conceptual and empirical research.     

Health promotion and health education: advancing the concepts

BACKGROUND: Health education and health promotion activities are a fundamental requirement for all health professionals. These two paradigms are closely related but are not inter-dependent. Despite this, it is known that many nurses confuse the terms and use them interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an attempt to bring them to a current form of 'maturity'. AIM: The aim of the paper is to provide an up-to-date analysis of health promotion and health education that serves as a conceptual and operational foundation for clinicians and researchers. METHOD: A concept analysis following the criterion-based methods described by Morse and her colleagues was applied to the terms health education and health promotion, using generic and nursing-related literature. RESULTS: The conceptual literature on health education is consistent between generic and nursing-related sources. On the contrary, earlier nursing literature on health promotion is now at odds with more recent socio-political and community action models of health promotion, in that it focuses on individualistic and behavioural forms of 'health promotion'. A significant proportion of later nursing-related literature, however, suggests a maturing of the concept that brings it further in line with a socio-political health promotion agenda. CONCLUSION: While the theoretical and conceptual literature surrounding health education has remained relatively constant and unchanged over the last decade or so, the same cannot be said for the health promotion literature. The evolving dominance of socio-political action in health promotion has overtaken individualistic and behaviourally-related forms. While the recent nursing literature addresses and acknowledges the place of socio-political activity as the mainstay of health promotion interventions, this is largely from a theoretical stance and is not applied in practice.     

Getting evidence into practice: the meaning of 'context'

AIM OF PAPER: This paper presents the findings of a concept analysis of 'context' in relation to the successful implementation of evidence into practice. BACKGROUND: In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998) Quality in Health Care 7, 149]. One of the key elements of the framework was 'context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content. METHODS: Morse's [Morse J.M. (1995) Advances in Nursing Science 17, 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996) Scholarly Inquiry for Nursing Practice. An International Journal 10, 253] approach to concept analysis was used as a framework to review semi-nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of 'context' in relation to its importance in the implementation of evidence-based practice. FINDINGS: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means 'the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of 'measurement' is better articulated through the broader term of 'evaluation'. CONCLUSIONS: There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept of context lacks clarity because of the many issues that impact on the way it is characterized. Additionally, there is limited understanding of the consequences of working with different contexts. Thus, the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown. The concept of context is partially developed but in need of further delineation and comparison.     

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.     

压力知觉在研究生健康关注度和生活习惯间的中介调节效应

目的 探讨压力知觉在健康关注度与生活习惯间的中介和调节效应。方法 采用分层抽样的方法,对我国3省的414名研究生进行调查,采用线性回归模型分析压力知觉对健康关注度与生活习惯关系的中介和调节效应,并采用结构方程模型验证。结果 健康关注度得分越高,各项生活习惯得分越高,差异有统计学意义（P<0.001）;压力知觉越高,各项生活习惯得分越低,差异具有统计学意义（P≤0.01）。压力知觉在健康关注度与早餐习惯、熬夜习惯之间起到调节效应（P<0.05）。压力知觉在健康关注度与早餐习惯、饮酒习惯、运动习惯和总习惯之间起到部分中介作用,标准化直接效应及95%CI分别为0.422（0.332~0.511）、0.199（0.108~0.290）、0.481（0.395~0.567）、0.645（0.572~0.718）。结论 健康关注度较低、压力知觉较高的研究生易出现不健康的生活习惯,压力知觉在一定程度上影响健康关注度对部分生活习惯的效应。     

Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics.

OBJECTIVE: This study assesses the effects of competing demands, such as poor health habits or new medical problems, on health-habit counseling during a primary care visit. METHODS: We surveyed a consecutive sample of 1,259 patients visiting primary care clinicians at an academic VA medical center. Before the visit, patients reported their health status, health habits, and sociodemographics; immediately after the visit, patients reported reasons for the visit and whether they had been counseled about specific health habits. We scored visit acuity ranging from visits for unscheduled walk-in care or new medical problems to scheduled visits for check-ups or old problems. We defined counseling "triggers" as clinical indications for counseling about particular health habits (e.g., smoking). We developed a logistic model predicting primary care provider counseling during a visit. RESULTS: Over two-thirds of patients (68.9%) received some health habit counseling. Controlling for other independent variables, patients with more triggers were more likely to report being counseled. Counseling rates went up as visit acuity went down; patients with the lowest visit acuity having 67% greater odds of being counseled than patients with the highest visit acuity. CONCLUSIONS: Physicians set priorities for health-habit counseling during a visit based on patients' health habit problems or triggers; whether the visit is scheduled or walk-in; and whether the patient has new or acute problems. Future research about primary care performance of health habit counseling should account for these patient and visit characteristics, and prevention-oriented health care organizations should ensure access to scheduled "check-up" visits.     

The Friction Model – a dynamic model of functioning,disability and contextual factors and its conceptual and practical applicability

Purpose. The purpose of this article is to reflect on the concept of habit as an under-explored, but critically important factor that might help explain the lack of uptake of new, scientifically sound practices by rehabilitation clinicians.

Method. The complexity relating to being a scholarly practitioner is first presented. The transtheoretical model of behaviour change, developed to better understand behaviour change such as stopping a ‘bad’ habit or implementing a ‘good’ one for health improvement purposes, is used to foster reflection on factors involved in uptake of best practices in rehabilitation. To illustrate simply the different scenarios relating to uptake of best practices, such as the use of a standardised tool over a home-grown one, two well known approaches to assessment (use of thermometer versus hand on forehead) that could be used to assess the same construct (body temperature) are contrasted.

Results. As rehabilitation clinicians, we are potentially blocked in our uptake of best practices by our habits. Although habits are often comfortable, and change is less so, we need to move away from our comfort zone if we are to adopt best practices.

Conclusions. Given the extensive literature suggesting that there are major gaps between best practice and actual practices, it behoves us to explore the impact of habits to a greater extent.     

Understanding healing: a conceptual analysis

The practice of the healing arts has been a part of human history since ancient times Despite the development of related scholarly concepts in nursing such as caring, healing remains an enigma Using conceptual analysis a clear definition of healing within a Rogerian/Newmaman framework is explicated Case development assists in the understanding of healing as a concept, and questions arising from this definition provide focus for further scholarly work A result of this process of concept analysis was the development of a definition of healing which is clear and which fits the theoretical underpinnings of the unitary-transformative paradigm Healing, as a core variable of interest in the study of health, provides important parameters for study The definition of healing which arose from the concept analysis is Healing is an experiential, energy-requiring process in which space is created through a caring relationship in a process of expanding consciousness and results in a sense of wholeness, integration, balance and transformation and which can never be fully known     

口腔卫生习惯与口臭关系的调查研究

目的 探讨口腔卫生习惯与口臭的关系,了解患者口腔卫生认知的状况,为护士对口臭患者进行个性化口腔卫生宣教提供指导依据,提高口臭的预防和治疗效果,从而提高国民在国际上卫生文明的形象.方法 对牙周科202例患者进行口腔卫生习惯问卷调查,并用感官法(鼻闻)评价口臭程度,将202例患者分为口臭组112例和无口臭组90例,比较口臭组和无口臭组在口腔卫生认知上的差别.结果 2组患者在每日的刷牙次数、时间及是否使用牙缝刷方面比较差异明显.结论 良好的口腔卫生习惯可以减少口臭的发生.

Abstract：

Objective The aim of this study was to assess the relationship between the oral health habit and halitosis. It can provide an advisory basis for nurse giving individualized oral health instruction to patients of halitosis and can improve the result of prevention and treatment for halitosis accordingly. Methods 202 patients with periodontal disease were chosen to participate in this study. The study included the questionnaire of oral health habit and the halitosis diagnosis by organoleptic assessment.Comparisons of difference in the knowledge of oral health habit between the subjects with and without halitosis were conducted. Results Brushing times in subjects without halitosis were significantly more than that in subjects with halitosis. Brushing teeth in evening and interproximal brush usage were much better in subjects without halitosis than that in subjects with halitosis,respectively. Conclusions Good oral health habits could decrease the incidence of halitosis.     

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.     

Feeding difficulty in older adults with dementia

Aims and objectives. To use concept analysis to identify characteristics of feeding difficulty and its antecedents and consequences that provide direction for assessment and management. Background. Feeding difficulty is often recognised as a common problem for older adults and is associated with weight loss, poor nutrition and risk for aspiration pneumonia. The cognitive impairment found in persons with dementia impairs the ability of these adults to complete motor and perceptual tasks required for eating and often prevent the older adult from accepting help with feeding from caregivers. Design. Systematic review. Methods. In 2006, literature searches using keywords (feeding, eating, nutrition, malnutrition, feeding assessment, dementia, ageing and concept analysis, dementia and feeding and excluding enteral feeding, tube feedings, PEG and enteral nutrition) were done in Medline, CINHAL, AGELINE and Social Science Full Text. Seventy relevant articles in English were found. After a review of the relevant articles, concept analysis was used to develop a definition of feeding difficulty, its defining characteristics and to delineate feeding difficulty from its antecedents and consequences. Results. Feeding difficulties arise at the interface between the caregiver strategies to assist the older adult with getting food into the mouth and chewing and swallowing food. A model of feeding difficulty delineates the antecedents and consequences of feeding difficulties. Conclusions. The conceptual model of feeding difficulties provides a strong and clear organising structure for research that can be used to developed evidence based guidelines for practice. Relevance to clinical practice. The conceptual model provides directions for assessment of feeding difficulties and their antecedents. The model can be used to identify interventions that address antecedents of feeding difficulty (risk factors) and different types of feeding difficulties.     

Clarifying self‐harm through evolutionary concept analysis

Scand J Caring Sci; 2010; 24; 610–619
Clarifying self‐harm through evolutionary concept analysis Clarification of the concept self‐harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self‐harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words ‘self‐harm’, ‘self‐harming’, and ‘psychiatric care’. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers’ evolutionary concept analysis process was used to delineate and clarify the concept’s context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self‐harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self‐harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self‐harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter‐professional collaboration and postgraduate education is needed in order to provide better care and treatment for self‐harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self‐harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field.     

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.     

A conceptual foundation for human suffering in nursing care and research

Suffering is a significant, yet elusive, phenomenon in nursing and health care. Despite the importance and prevalence of suffering, there is only a small body of substantive literature on this topic. Some of the difficulty in expanding this knowledge base undoubtedly is related to the lack of a solid conceptual foundation for exploration of this phenomenon. Although there have been appempts to provide neede conceptual clarity, these efforts typically have not been based on systematic inquiry. In this study, the method of concept analysis was used to inductively generate a definition of the concept of suffering and to clarify various contextual aspects of the concept. Suffering is defined as an individulized, subjective, and complex experience that involves the assignment of an intensely negative meaning to anevent or a perceived threat. Implications of these findings and additional contextual aspects of the concept for nursing practice and inquiry are presented. These results help to provide the conceptual foundation needed to enhance recognition and understanding of the human experience of suffering.     

Conceptual parameters of acculturation within the Asian and Pacific Islander American populations: applications for nursing practice and research

TOPIC. Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health‐seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population. OBJECTIVE. The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities. METHODS. Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications. RESULTS. The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research. CONCLUSION. While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health.     

Person‐centred care: clarifying the concept in the context of inpatient psychiatry

This paper reports an analysis of the concept of person‐centred care in the context of inpatient psychiatry. It has been suggested that person‐centred care in inpatient psychiatry might differ from person‐centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health‐related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person‐centred care was defined as cultural, relational and recovery‐oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person‐centred care. The results of this analysis can provide a framework for such research.     

Deconstructing Pain Disability through Concept Analysis

ObjectivePain disability is a complex and challenging problem that impacts the daily lives of individuals living with persistent pain. Although this concept is measured throughout pain populations, conceptual clarity is needed to identify the defining characteristics and further understand what comprises this experience for clinical translation.DesignWe completed a concept analysis to identify major attributes and provide a broad framework of pain disability for improved recognition throughout the discipline of nursing.Data SourcesLiterature searches in PubMed, CINAHL, PsychINFO, and Scopus identified 39 relevant cross-disciplinary articles published between January 1990 and November 2017.Review/Analysis MethodsWe implemented Avant and Walker's method of concept analysis to establish the attributes, antecedents, and consequences of pain disability.ResultsTwo major attributes of pain disability are discussed, including (1) physical and/or psychological responses leading to a functional loss; and (2) the degree of ability to fulfill role expectations. The antecedent to the development of pain disability is a painful trigger. Three leading consequences are identified as suffering, pain reactivity, and secondary loss.ConclusionsPain disability is a fluid concept that is characterized by the subjective experiences of the individual. A new conceptualization of pain disability is offered as the inability to maintain role expectations due to the result of a painful trigger and subsequent physical and/or psychosocial dysfunction.     

Health promotion: a concept analysis

Health promotion is a concept which is frequently used, but is often ill defined Current health care trends, and the emphasis on the nurse of the future as a promoter of health suggest that it would be useful to attempt to clarify the concept This paper develops a conceptual analysis of health promotion using the process developed by Rodgers (1989) Attributes, antecedents, consequences and references are described following an examination of the ongoing debate in the literature surrounding the meaning of the concept Empirical work is also reviewed which suggests that nurses'understandings of the concept are firmly embedded in the more traditional approach rather than the more modern or new paradigm approach to health promotion A model case is described, and the analysis results in a proposed definition of health promotion which it is hoped will stimulate further discussion     

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.     

Caregiver burden: a concept analysis

The development of the concept of burden for use in research lacks consistent conceptualization and operational definitions. The purpose of this article is to analyze the concept of burden in an effort to promote conceptual clarity. The technique advocated by Walker and Avant is used to analyze this concept. Critical attributes of burden include subjective perception, multidimensional phenomena, dynamic change, and overload. Predisposing factors are caregiver's characteristics, the demands of caregivers, and the involvement in caregiving. The consequences of burden generate problems in care-receiver, caregiver, family, and health care system. Overall, this article enables us to advance this concept, identify the different sources of burden, and provide directions for nursing intervention.