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.     

Creativity: a refinement of the concept for nursing practice

AIMS: This paper seeks to remove some of the ambiguity surrounding the conceptual meaning of creativity using techniques of concept refinement to advance the concept. BACKGROUND: Creativity is an essential component of nursing practice that occurs daily in nurse's interactions with clients, families and other nurses. Failure to acknowledge and encourage creativity in beginning nurses may hinder future development and innovations in nursing practice and in nursing science. In order to promote the development of creativity it is first necessary to clarify and refine the concept as it applies to nursing. DESIGN/METHODS: A comprehensive review of a variety of computer and online databases resulted in thousands of articles on creativity between the years 1966 and 1999. The final sample (n = 48) was obtained using both stratified random and purposive sampling techniques. A content analysis of the literature was conducted using methods identified by Morse and illustrated in the work of Hupcey et al. Having determined the concept to be partially mature, the concept was advanced using techniques of concept refinement. FINDINGS: Content analysis of the literature yielded three differing definitions for creativity: revelation, birth and reincarnation. Creativity occurs in the presence of intrinsic motivation and a nurturing environment. While value is often used to identify whether a product is creative, the value of the product cannot determine whether the process has occurred. The product produced determines evidence of the process of creativity. LIMITATIONS: Limitations of this investigation are the use of secondary sources and the relatively small sample size (n = 48). CONCLUSIONS: Refinement of the concept of creativity indicates that it is a process that may be developed and influenced by the environment and is recognized by the product produced. Further investigation is needed to explore methods and techniques for developing creativity in nursing.     

Capacity building: a concept analysis of the term applied to research

Recent policy developments in Ireland have led to a focus on research capacity building as a means of consolidating nurse and midwifery education in the Irish academic setting. This follows similar initiatives in the United Kingdom and Australia. However, sparse literature and a lack of clarity of the term 'research capacity building' leads to some confusion. A concept analysis using Rodgers' framework was conducted. The literature examined included 'grey' literature, policy documents and indexed papers across a range of disciplines, derived from CINAHL/PubMed searches. The concept of research capacity building was deemed to imply a funded, dynamic intervention operationalized through a range of foci and levels to augment ability to achieve objectives in the research field over the long-term, with aspects of social change as an ultimate outcome. This is presented as an interim statement because of the evolutionary nature of the concept and the limitations of the exercise.     

A concept analysis of dignity for older adults

BACKGROUND: Human dignity is an essential value of professional nursing education as well as a component of the American Nurses Association Code of Ethics. Nurses are exhorted to treat patients with dignity, and older adults want to be treated with dignity and die with dignity. Although dignity, particularly the dignity of older adults, is often discussed in the health care literature, its meaning is not always clear. AIM: The aim of this paper is to describe a concept analysis to develop a definition of dignity in older adults. METHODS: Data were collected using a literature review and five focus groups composed of older adults. The literature provided data about professionals' ideas of dignity and the focus groups provided qualitative data about the nature of dignity in older people. The literature review and focus groups were carried out concurrently, followed by synthesis of the findings. FINDINGS: Dignity is an inherent characteristic of being human, it can be subjectively felt as an attribute of the self, and is made manifest through behaviour that demonstrates respect for self and others. Dignity must be learned, and an individual's dignity is affected by the treatment received from others. CONCLUSIONS: A behavioural definition of dignity was constructed and this could provide the theoretical basis for nurses to develop interventions that foster dignity for older people.     

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.     

胚胎移植术后卧床的最佳证据应用

目的:收集有关胚胎移植后卧床的最佳证据并应用于临床实践,以优化胚胎移植后的护理规范,改善病人临床结局。方法:采用PIPOST格式构建循证问题,并进行证据检索,最终纳入指南1篇、系统评价5篇,在对证据进行质量评价后,依据最佳证据,制定5条审查指标,遵循分析障碍、构建策略、采取行动3个步骤实施变革,在变革前后进行基线审查和证据应用后的再审查,并比较两次审查数据。结果:基线审查时病人离院前休息时间为(36.93±20.09)min,首次排尿时间为(18.54±10.00)min,回家后平均增加卧床时间为(3.75±3.01)h,证据应用后再审查阶段,病人离院前休息时间为(26.25±24.33)min,首次排尿时间为(12.18±10.48)min,回家后平均增加卧床时间为(2.26±2.89)h,证据应用前后比较,差异均有统计学意义(P<0.05)。证据应用前后胚胎着床率分别为45.57%、57.50%,临床妊娠率分别为58.70%、75.00%,证据应用前后比较差异有统计学意义(P<0.05)。结论:胚胎移植术后任何时长的卧床均无益于病人结局,延长卧床时间反而不利于提高妊娠成功率。表明循证护理实践可促进证据向临床实践转化,优化护理规范,提高护理质量,改善病人结局。     

Rethinking concept analysis

Title.  Rethinking concept analysis.
Aim.  This study reports ways to strengthen the epistemological foundation of concept analysis and to clarify its ontology.
Background.  Nursing methods of concept analysis were derived from philosophy. In applying the philosophical ideas to nursing, changes were made that weakened the method. As a result, concept analyses often do not produce meaningful results.
Data sources.  Essays in nursing journals that critique or develop methods of concept analysis and philosophical writing about language.
Findings.  Many methods of concept analysis presuppose that the meaning of a concept depends on context. This 'contextualism' has epistemological and ontological consequences. Epistemologically, justifying a proposed set of defining attributes requires showing that the attributes explain the contextual pattern of use. Ontologically, concepts change their meaning as the theoretical contexts change. This means that concepts can only be developed as part of larger theories. Theory development requires a commitment to moderate realism and so, concept development also presupposes moderate realism.
Conclusion.  There are two forms of concept analysis: theoretical and colloquial. Each has its own purpose and evidence. The two forms can be used together and some theoretical developments will require both. Concept analysis must be based either on scientific literature or on colloquial usage. Concept analysis is not prior to theory development, but it must be part of theory development. It makes the meaning of a concept explicit, so that it can be part of testable and practical nursing theories.     

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.     

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.     

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.     

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.     

Developing a concept analysis of control for use in child and adolescent mental health nursing

The need to help children and young people with significant mental health problems develop a sense of personal control in their everyday lives, in a manner which does not endanger themselves or others, was recognized by nurse practitioners working in an English regional multidisciplinary child and adolescent mental health residential unit. A concept analysis of control was undertaken and used to develop a framework for analysing control. This deductive framework was modified iteratively by nurses who developed new knowledge from a qualitative exploration of current practice and the application of the evolving framework to practice problems. The paper describes this process and highlights three main findings: (i) the evolving attributes of the concept analysis helped nurses steer a course through the complexities of practice; (ii) the research highlighted and enabled nurses to confront the paradoxical nature of control; (iii) the process enabled nurses to recognize the mutuality of feelings aroused simultaneously when both the nurse and the child are challenged to maintain personal control.