Enhancing methodological clarity: principle-based concept analysis

AIMS: The aim of this paper is to operationalize the principle-based method of concept analysis. BACKGROUND: While nursing has embraced the use of concept analysis as a valid and significant entree into an area of research, methodological development has created strategies of inquiry that vary in purpose and in the nature of their findings. DISCUSSION: We propose that, as the primary utility of concept analysis is to determine the existing state of the science so that further work may be strategically and appropriately planned, the method described as principle-based concept analysis is superior in providing evidence to support subsequent inquiry into the concept of interest. Three problematic issues are discussed in an effort to clarify and procedurally explicate the strategies employed in this approach: selecting disciplinary literatures for inclusion in the analysis; conceptually-driven sampling issues; and within- and across-discipline analytic techniques. CONCLUSION: In this form of concept analysis, each principle contributes to an understanding of the strengths and limitations of the present state of the concept in the scientific literature. We believe that this perspective will enable nursing to begin to harness the power of concept analysis for advancing science rather than simply imagining what a concept could be or constructing what we believe it should be.     

Attitude: a concept analysis

This paper presents a concept analysis conducted as a beginning step to developing research on nurses' attitudes toward advancing formal education. A literature review, conducted by the author, confirmed that the term attitude is used prolifically in nursing research; however, the findings were inconclusive as to a definition and the attributes of an "attitude." Often this concept was either not defined or vaguely defined. Few operational definitions, required for accurate measurement of a concept, were found. An adequate definition and understanding of a concept is required for critical reflection and utilization of the term and development of measurement procedures .     

Risk: a concept analysis

TOPIC: Concept analysis of risk. PURPOSE: To analyze the concept risk and provide a new definition of risk. SOURCES: Published literature. CONCLUSIONS: A new definition of risk that emerged from this concept analysis can provide clarity and direction for future research. Nurse researchers can look to this definition to expand what is known about health-seeking behaviors as opposed to "risk" behaviors and seek to further our understanding of the cognitive and experiential process of risk identification.     

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.     

Community health: an evolutionary concept analysis

Title.  Community health: an evolutionary concept analysis.
Aim.  This paper is a report of a concept analysis of community health.
Background.  Community health is a term that has been broadly used in both research and practice. Although local communities are invested in community health improvement, this process often occurs without a clear definition of the concept of community health .
Data sources.  Data sources included a sample of 537 papers covering the period 1990 to 2004 and representing the disciplines of nursing, public health, medicine and sociology and landmark works concerning community health, six community health assessment instruments and interviews with seven key community health informants.
Review methods.  Rodgers' Evolutionary Method of Concept Analysis was used to design the study and analyse the data. The professional literature was analysed and compared with the use of the concept of community health in community health assessment instruments and by key informants.
Results.  Dynamic and contextual, community health is achieved through participatory, community development processes based upon ecological models that address broad determinants of health. The primary focus of this collaborative work is population-based health promotion and disease prevention.
Conclusion.  The definition derived from the concept analysis of community health makes explicit the importance of community-based participatory action in local health improvement processes. Identification of the attributes of community health will enhance communication across disciplines involved in community health practice, research and education.     

Dilemma: a concept analysis

In nursing practice we find different kinds of difficult situations. What is the difference between such kinds of situations? It is important to know what kind of situation one is confronting because the answer and solution depend on it. In the literature the term ‘dilemma’ has different meanings. I am therefore interested in what constitutes a dilemma, and have conducted a concept analysis. The defining attributes were engagement, equally unattractive alternatives, awareness of alternatives, need for a choice and uncertainty of action.     

Analysis of Integration in Nursing Science and Practice

PURPOSE: To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care. DESIGN: An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical. METHODS: Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health. FINDINGS: A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance. CONCLUSIONS: Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.     

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.     

Symptom perception: a concept exploration

The topic of this paper is a concept analysis of symptom perception using the theoretical phase of the Schwartz-Barcott Hybrid Model. The purpose of this paper is to explore symptom perception and related concepts and formulate a working definition. Sources of information include symptom perception and related concepts models and studies using the concepts as well as sources pertaining to related measurement tools. The conclusion of this exploration reveals several overlapping concepts. These concepts are synthesized into a working definition of symptom perception.     

Health literacy: a concept/dimensional analysis

Abstract   The terms "health" and "literacy" form a powerful concept that has evolved from the 1970s to one that has garnered the attention of a wide range of disciplines; most notably, education and health care, but also library science, public health, and the mental health arena. There are many definitions of health literacy, but none that encompass the totality by which the concept is constructed. This paper presents an analysis of the concept of health literacy using the technique of concept/dimensional analysis. A clear understanding of the concept is essential as health literacy has implications that are far-reaching and impact both the individual and society.     

Loss: an analysis of a concept of particular interest to nursing

The term 'loss' is used frequently in the nursing literature and by nurses in the clinical setting. However, loss as a concept has not been defined comprehensively. In this paper, an attempt will be made to analyse the concept. The paper will begin with an overview of approaches to concept analysis. Subsequent sections include a literature review examining current and classic usage of the concept. General and specific definitions of loss provide a template for discussion. The paper will conclude with the identification of critical attributes for the concept which will form the basis for an exploration of explicit empirical referents.     

Adherence: a concept analysis

Title. Adherence: a concept analysis. Aim. This paper is a report of an analysis of the concept of adherence. Background. The transition in terminology from compliance to adherence, and more recently to concordance, requires re‐clarification of ‘adherence’ as a concept in nursing practice. Differences exist in the use of the term adherence and how or if it differs from compliance or concordance. Data sources. Using the Medical Subject Headings terms adherence, non‐adherence and treatment refusal, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsychINFO and Cochrane library databases were searched for publications between 1970 and 2007. Method. The evolutionary analytic method was used to identify and explore transitions in the concept of adherence over time and across healthcare disciplines. A representative sample of papers was identified from the disciplines of nursing, medicine, psychology and pharmacy. Results. We identified 114 papers: 27 from nursing, 39 from psychology, 33 from general medicine and 15 from pharmacology sources. The final sample included eight from pharmacy and 15 from mental health, medicine and nursing. We found no distinct differentiation between adherence and compliance. The surrogate terms serving as manifestations of adherence are concordance, agreement, cooperation and partnership. The most common definition found was as follows: ‘Adherence can be defined as the extent to which patients follow the instructions they are given for prescribed treatments’. No definition of adherence exists that reflects a patient‐centred approach, the dynamic nature of adherence behaviour and the power imbalance implied by these terms. Conclusion. This concept analysis of adherence is a preliminary step towards broadening nurses’ appreciation of the complexity of patient adherence behaviour.     

Fever: a concept analysis

AIM: The purpose of this paper is to critically analyse the current state of the science literature in order to develop an accurate conception of fever. RATIONALE: The measurement of body temperature and treatment of fever have long been considered to be within the domain of nursing practice. What body temperature constitutes 'fever', however, is often not clear from nursing protocols or the literature. METHODS: Literature for this concept analysis was obtained by computerized searches of PubMed, CINAHL and BIOSYS for the years 1980-2004. Additional sources were obtained after reviewing the bibliographies of the literature identified by the initial search. The Wilsonian method of concept analysis provided the framework for the analysis. FINDINGS: Fever has characteristically been recognized as a cardinal sign of illness and has traditionally had negative connotations for patient well-being. Substantive advances over the past 20 years in immunology and neurophysiology have expanded understanding of the process of fever. This new knowledge has shifted the perception of fever as part of the acute-phase response to one of an adaptive nature. This knowledge has yet to be fully translated into changes in the fever management practices of nurses. CONCLUSIONS: Consistent usage of terminology in relation to fever should lead to improved and evidence-based care for patients, and to fever management practices consistent with current research. It is important to use clear language about fever and hyperthermia in discussions and documentation between nurses and among disciplines. By creating clarity in our language, we may help to achieve praxis.     

Empathy: a literature review and concept analysis

• ? Empathy appears to be an important concept in the interpersonal repertoire of the nurse. There are a number of definitions and models of empathy available in the literature.
• ? These definitions and models are explored and analysed using Walker & Avant's (1983) approach to concept analysis. A model case of the concept is described and the relevant defining attributes identified. A borderline case and an example of ‘not the case’ are also examined.
• ? This concept analysis may assist practitioners to develop the behavioural skills of empathy and to recognize and coach it in their students and colleagues.

     

Family-centred care: a concept analysis

Family-centred care would seem to be a central element of children's nursing, but there is no consensus about its meaning. This paper uses a combination of Rodgers' evolutionary model of concept analysis and Schwartz-Barcott and Kim's hybrid model of concept development to facilitate a dispositional approach to analysing this concept. Data from a qualitative survey undertaken during 1994/1995 was used in conjunction with data obtained through a questionnaire, to provide the field-work element for the process of analysis. The process resulted in the identification of the antecedents and attributes of family-centred care, and the identification of a lack of clarity related to the consequences of family-centred care. Two alternative models of family-centred care emerged, both of which demonstrate strong associations with the concepts of partnership with parents, parental participation and care by parents. The paper does not conclude with any definition of family-centred care, but rather explores its usefulness in practice and considers how the concept might be operationalized. The tentative proposals for a hierarchy of family-centred care will require exploration, testing and evaluation by practitioners in the real world of children's nursing.     

Enablement in health care context: a concept analysis

Rationale, aims and objectives The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patient's capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecedents and consequents. Method A concept analysis was performed according to the method of Rodgers. The literature was reviewed from 1980 to June 2008, using search strategies adapted to the databases Cinahl, Medline, Embase, PsycInfo and Social Works Abstract, and hand searching. All articles contributing to a deeper understanding of the concept were included. The analysis was carried out according to a thematic analysis procedure, as described by Miles & Huberman. Results The search identified 1305 citations. After in‐depth assessment of 148 potentially eligible citations, 61 articles were included in the review. Five articles were added with hand searching. Sixty‐seven per cent of these articles were related to nursing. The attributes of the enablement concept included: contribution to the therapeutic relationship; consideration of the person as a whole; facilitation of learning; valorization of the person's strengths; implication and support to decision making; and broadening of the possibilities. Conclusion These attributes could be used as a basis for other studies on enablement. Conceptual and empirical work is still needed to better position this concept among others such as patient‐centred care, shared decision making and patient's participation.