The dissection of risk: a conceptual analysis

Recently, patient safety has gained popularity in the nursing literature. While this topic is used extensively and has been analyzed thoroughly, some of the concepts upon which it relies, such as risk, have remained undertheorized. In fact, despite its considerable use, the term 'risk' has been largely assumed to be inherently neutral - meaning that its definition and discovery is seen as objective and impartial, and that risk avoidance is natural and logical. Such an oversight in evaluation requires that the concept of risk be thoroughly analyzed as it relates to nursing practices, particularly in relation to those practices surrounding bio-political nursing care, such as public health, as well as other more trendy nursing topics, such as patient safety. Thus, this paper applies the Evolutionary Model of concept analysis to explore 'risk', and expose it as one mechanism of maintaining prescribed/ proscribed social practices. Thereby, an analysis of risk results in the definitions and roles of the discipline and profession of nursing expanding from solely being dedicated to patient care, to include, in addition, its functions as a governmental body that unwittingly maintains hegemonic infrastructures.     

'A good person does not feel envy': envy in a nursing community

The definition of envy is commonly based on psychoanalytical views of organizational culture. The purpose of this paper is to describe envy in a nursing community. The population study consisted of random sample of 120 subjects drawn from among the employees of one central hospital in Finland. The study material consisted of data collected by questionnaires (response rate 65%). The data were processed by various statistical methods. Open-ended questions were analysed by inductive content analysis. The results of this study indicated that the employee's view of his/her official position in the nursing community, his/her relationships with his/her fellow workers and the management as well as relationships with other nursing communities are all related to envy. The employee's view of his/her official position intensified his/her feelings of envy, if he/she had other negative feelings, anxiety, dissatisfaction with him/herself, and negative feelings towards fellow workers. The major object of envy was fellow workers' salaries. Envy towards other nursing communities was generated by alleged differences in the amount of labour, or by the charge nurse's greater interest in other sections. Employees coped with envy by hiding these feelings and being modest. Women coped with envy by being silent, while men denied the value of the object of envy.     

Collaborative childcare health consultation: a conceptual model.

PURPOSE: This study explored the nature of consultation between childcare providers and nurse childcare health consultants and identified factors that promote a collaborative relationship. DESIGN AND METHODS: A qualitative study using semistructured, individual interviews of five collaborative and five conflicted pairs of nurse childcare health consultants and childcare center directors. Data were analyzed following principles of grounded theory and applying the constant comparative method of analysis. RESULTS: Establishing a collaborative relationship was influenced by previous experiences and four themes in the relationship: open and active communication, commitment, respect, and congruent philosophies. PRACTICE IMPLICATIONS: Preparation in developing collaborative relationships should be incorporated into the education of nurse consultants and childcare directors and providers.     

Coping and stress: a conceptual analysis

BACKGROUND: Much work has been done towards the classification of clinical concepts in nursing. However, there is a comparative lack of analysis of non-technical terms, which nevertheless bear closely on professional practice in nursing. Within nursing classifications, the term 'coping' functions as an element in more complex conceptual structures, the term itself being left relatively undefined. The case is similar for the term 'stress'- the set of circumstances with which the individual is attempting to cope. AIMS: The aim of this paper is to arrive at grounds for consensus over the use and meaning of the widely used terms 'stress' and 'coping'. METHODS: A conceptual analysis of the terms 'stress' and 'coping' was carried out, looking at etymology, ordinary usage and theoretical contingencies, in order to generate paradigmatic cases. A range of nursing and non-nursing literature was examined in order to illustrate further the range of the terms. CONCLUSIONS: 'Stress' and 'coping' are terms which are widely used in nursing; their significance has varied overtime and in the literature, and there continues to be lack of clarity over their precise meaning and use.     

'No suicide contracts' in community crisis situations: a conceptual analysis

'No suicide contracts' are commonly used in community crisis situations with suicidal people in New Zealand. These take the form of a 'guarantee of safety', along with a 'promise' to call specified persons if the suicidal ideation becomes unmanageable. This article describes the use of 'no suicide contracts' in community crisis situations, analyses the use of the tool within this context, and, in particular, argues that the theoretical base (transactional analysis) of the 'no suicide contract' is likely to be deleterious in the community crisis situation.     

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.     

The application of a vulnerable populations conceptual model to rural health

BACKGROUND: This article describes the application of the vulnerable populations conceptual model to rural health. Vulnerable populations are social groups who have an increased susceptibility to adverse health outcomes. Evidence of this differential in vulnerability or increased risk includes premature mortality, comparative morbidity, decreased functional status, and diminished quality of life. ORGANIZING FRAMEWORK: The vulnerable populations conceptual model postulates that there are interrelationships among resource availability, relative risk, and health status. Resource availability speaks to socioeconomic and environmental resources that are operationalized in this model as income, jobs, education, housing, availability of health care, quality of health care, and patterns of family and community life. Relative risk addresses the likelihood of exposure to risk factors and is reflected in lifestyle behaviors and choices and exposure to stressful events. Health status is operationalized as morbidity and mortality. FINDINGS: This review of the literature supports the utility of the vulnerable populations conceptual model in working with rural populations. IMPLICATIONS: This model has potential utility to inform nursing research, practice, and policy about the opportunities and resources needed to achieve and maintain health in rural communities.     

Risk factors for pressure ulcer development in critically Ill patients: a conceptual model to guide research

This paper presents a proposed conceptual model to guide research on pressure ulcer risk in critically ill patients, who are at high risk for pressure ulcer development. However, no conceptual model exists that guides risk assessment in this population. Results from a review of prospective studies were evaluated for design quality and level of statistical reporting. Multivariate findings from studies having high or medium design quality by the National Institute of Health and Clinical Excellence standards were conceptually grouped. The conceptual groupings were integrated into Braden and Bergstrom's (Braden and Bergstrom [1987] Rehabilitation Nursing, 12, 8-12, 16) conceptual model, retaining their original constructs and augmenting their concept of intrinsic factors for tissue tolerance. The model could enhance consistency in research on pressure ulcer risk factors.     

Towards a conceptual evaluation of transience in relation to palliative care

AIM: This paper is a report of a concept evaluation of transience and its relevance to palliative care. BACKGROUND: A qualitative study into palliative care patients' experiences of transition revealed a gap between current definitions of transition and their expression of the palliative care experience. Transience appears to offer a better definition but remains conceptually weak, with limited definition in a healthcare context. METHODS: A qualitative conceptual evaluation of transience was undertaken using two case examples, interview data and the literature. Multiple sources were used to identify the literature (1966-2006), including a search on Cumulative Index to Nursing and Allied Health Literature Medline, and Ovid and Arts and Humanities Index using the keywords 'transience' and 'palliative care'. Thirty-one papers related to transience were retrieved. Analysis and synthesis formulated a theoretical definition of transience relative to palliative care. FINDINGS: Transience is a nascent concept. Preconditions and outcomes of transience appear contextually dependent, which may inhibit its conceptual development. Transience depicts a fragile emotional state related to sudden change and uncertainty at end-of-life, exhibited as a feeling of stasis. Defining attributes would seem to include fragility, suddenness, powerlessness, impermanence, time, space, uncertainty, separation and homelessness. CONCLUSIONS: Transience is potentially more meaningful for palliative care in understanding the impact of end-of-life experiences for patients than current conceptualizations of transition as a process towards resolution. As a nascent concept, it remains strongly encapsulated within a framework of transition and further conceptual development is needed to enhance its maturity and refinement.     

Contributions of team climate in the study of interprofessional collaboration: A conceptual analysis

The concept of team climate is widely used to understand and evaluate working environments. It shares some important features with Interprofessional Collaboration (IPC). The four-factor theory of climate for work group innovation, which underpins team climate, could provide a better basis for understanding both teamwork and IPC. This article examines in detail the common ground between team climate and IPC, and assesses the relevance of team climate as a theoretical approach to understanding IPC. There are important potential areas of overlap between team climate and IPC that we have grouped under four headings: (1) interaction and communication between team members; (2) common objectives around which collective work is organised; (3) responsibility for performing work to a high standard; and (4) promoting innovation in working practices. These overlapping areas suggest common characteristics that could provide elements of a framework for considering the contribution of team climate to collaborative working, both from a conceptual perspective and, potentially, in operational terms as, for example, a diagnostic tool.     

Engaging with nature to promote health: new directions for nursing research

Title.  Engaging with nature to promote health: new directions for nursing research.
Aim.  The aim of this paper is to offer a conceptual framework for nature-based health promotion in nursing and provide related recommendations for future nursing research.
Background.  Empirical data suggest that interaction with nature has direct health benefits. When people attend to outdoor habitats, gardens and other forms of nature, they are more likely to engage in physical activity and other behaviours that improve health. Engaging with nature can even cultivate ecological sensibilities that motivate us to protect the health of our planet.
Data sources.  Multidisciplinary theoretical and research publications from 1985 to 2008 were examined in the development of the framework.
Discussion.  As the health of our planet continues to deteriorate, there is a pressing need for theoretically informed, ethical, sustainable ways of engaging with nature to promote human and environmental health. We adapt principles and socio-ecological thinking from the fields of nursing, health promotion and ecological restoration to delineate the essential elements of the proposed framework.
Implications for nursing.  Although evidence-based knowledge about nature-based health promotion is not readily used in nursing and health care, its development and application are critical to designing effective strategies to strengthen both human and environmental health.
Conclusion.  Nurses can use nature-based health promotion concepts to work with citizens, health practitioners and policymakers to explore and optimize reciprocal, health promoting relationships among humans and the natural environment. To the extent that nurses integrate nature-based health promotion into their research efforts, we can expect to contribute meaningfully to both environmental and human health in communities across the globe.     

Liminality as a framework for understanding the experience of cancer survivorship: a literature review

blows e., bird l., seymour j. & cox k. (2012)?Liminality as a framework for understanding the experience of cancer survivorship: a literature review. Journal of Advanced Nursing 68(10), 2155-2164. ABSTRACT: Aims. To report a narrative review of literature that drew on the concept of liminality as a framework for understanding the cancer experience. In doing so, we explored the utility of liminality for guiding research on experiences of cancer survivorship. Background. The 'rites of passage' model uses the concept of liminality to explore transition. Taking cancer survivorship as a process, liminality may facilitate our understanding of this phenomenon. Data sources. Searches of Medline, PsycInfo, British Nursing Index, Cinahl, ASSIA, Web of Science, Cochrane Library and British Library databases were conducted, covering 1985-2011. Search terms were cancer and liminal* or rite* of passage. Design. A narrative review, using a textual narrative approach, was undertaken to provide a comprehensive overview of the topic. Review methods. Studies were arranged into groups according to the stage of the cancer trajectory on which they focused. Findings from each study were presented to highlight facets of the liminal experience at each stage. Results. Ten studies were included for review. Liminality depicts the ambiguity and uncertainty often experienced by people affected by cancer. Although liminality appears useful for understanding experiences of cancer risk, diagnosis, treatment and the period following active treatment, little research has explored the concept with respect to long-term survivorship. Conclusion. Gaps in current evidence highlight the need for additional research to ascertain the utility of liminality for understanding experiences of long-term survivorship. Research exploring the personal and social implications of living a liminal life, at all stages of the cancer trajectory, is also warranted.     

Experiences and constructions of art: a narrative-discourse analysis

A narrative-discourse analysis was conducted to study the narratives of mental health service users talking about their engagement with art. The sample was drawn from a group of people who had attended arts workshops organized by a mental health service provider. Eleven people were interviewed and were asked to tell the story of their involvement in art and its significance to their lives. The data were analysed using a discourse analysis approach. Art is constructed as therapeutic within an illness repertoire. Emotions are inseparable from creative expression and identity claims are made in relation to being an artist.