Productive engagement in older adults: A concept analysis

This study aimed to clarify the concept of productive engagement as it applies to older adults. The concept analysis was based on Walker and Avant's eight‐step method. A literature review of articles published in English between 1990 and 2011 (n = 37) was conducted, using an electronic search of multiple sources. Results revealed that four defining attributes for productive engagement include continuing to work either paid or unpaid, caring for others, engaging in social activities, and growing spirituality. The antecedents of productive engagement are sociocultural factors as well as individual and institutional capacities. Meanwhile, the consequences are increased feelings of usefulness, improved health and well‐being, aged successfully, and enhanced quality of life. Model, borderline, and contrary cases are presented to illustrate the concept's defining attributes. Defining the concept of productive engagement provides a basis for nurses and other health professionals to better understand productive engagement in older adults, thus effective strategic plans or programs for promoting productive roles among older adults can be further developed.     

Nurse manager engagement: a concept analysis

AIM. This concept analysis examines the visibility of nurse manager engagement in the healthcare work environment. BACKGROUND. The term employee engagement was derived from studies of morale or the willingness of a group to accomplish objectives in the 1920s. "Following World War II group morale scores were used as predictors of speed, quality, and militancy by US Army researchers. The goal was to identify star, or high performers. A term was needed to describe emotional attachment of an individual to the organization, fellow associates, and the job" ("Employee engagement origins," 2010, p. 1). DATA SOURCES. The CINAHL, MEDLINE, ABI INFORM, PsycINFO, and Ovid databases and the Internet were searched for the period of 2005-2010 for literature published in English with a focus on peer-reviewed journals from disciplines of health sciences, health administration, business, and psychology. METHODS. The Walker and Avant method was used for this analysis. The experience of the author as a current and previous nurse manager was also used for this analysis. RESULTS. Nurse manager engagement was assumed to be present based indirectly on empirical referents and consequences, such as low or high vacancy rates for staff nurses. CONCLUSION. Further research is needed to explore the identity of the nurse serving in the role of manager/leader who is able to demonstrate the skills and talents necessary to visibly demonstrate engagement and facilitate a culture of engaged nurse managers.     

Patient approaches to clinical conversations in the palliative care setting

AIM: The aim of this paper is to report a study exploring patients' understanding of their discussions about end-of-life care with nurses in a palliative care setting. BACKGROUND: It is assumed that nurses are central players in patients' major decisions about their care, yet minimal information is available about the complexity of patient-nurse interaction in palliative care, and patients' views of the impact of such interactions on decisions that are made. METHOD: A modified version of grounded theory was used to collect and analyse interview data collected in 2001-2002 with a convenience sample of 11 patients in a palliative care setting. Interviews focused on each patient's selection of two decisions they had made in the past 6 months that had involved nurses in the decision-making process. FINDINGS: Processes were identified between nurses and patients that facilitated or blocked open discussion and discernment of patients' preferences for care. Six approaches that patients used in their conversations with nurses about their care: wait and see, quiet acceptance, active acceptance, tolerating bossiness, negotiation and being adamant. These approaches are described in terms of how they assisted or impeded autonomous decision-making. CONCLUSION: Palliative care patients often adopt passive roles and tend not to engage in important decision-making, for various reasons. Professionals need to be made aware of this, and should facilitate an open, trusting relationship with patients in order to ensure that important information passes freely in both directions. Professionals should learn to prioritize patient participation and negotiation in their work. With further research, it should be possible to identify the factors that will allow patients to take a more pro-active role in making decisions about their care, where desired.     

Patient acuity: a concept analysis

Title.  Patient acuity: a concept analysis.
Aim.  This paper is a report of a concept analysis of patient acuity.
Background.  Patient acuity is a widely-used term in the health sciences literature, but often without specification of its exact meaning. Concept clarification is therefore needed to delineate the meaning of patient acuity.
Data sources.  A review of the Pubmed, CINAHL, MEDLINE and PsychInfo databases for the keyword 'acuity' in the title or abstract of papers in English language journals, as well as searches for the term 'acuity' and 'acute' in the Merriam-Webster and Oxford English Dictionaries were the data sources for this concept analysis. Papers were excluded if 'acuity' was not present in the title or abstract. Publication dates of the literature included in the review ranged from 1974 to 2008.
Findings.  The attributes of acuity are severity, intensity and the pairing of acuity measurements with another concept. These attributes were organized according to Holzemer's Outcomes Model for Health Care Research as patient-, provider- or system-related. The sub-categories of attributes identified were physical, psychological, nursing care needs, workload, complexity, case-mix, patient classification systems, urgency/triage scales and other uses.
Conclusion.  Researchers are encouraged to specify which attribute of acuity they are studying and to develop measurement tools specific to that attribute, in order to move the science towards standardization of the concept of acuity and its measurement.     

Patient safety culture in nursing: a dimensional concept analysis

Title.  Patient safety culture in nursing: a dimensional concept analysis.
Aim.  This paper is a report of a dimensional concept analysis of patient safety culture in nursing.
Background.  Patient safety is an important issue in healthcare organizations. As the release of Institute of Medicine reports in the United States of America, substantial interest has arisen in studying patient safety culture; however, the concept remains poorly defined.
Data sources.  Multiple databases, including CINAHL, MEDLINE, PsycINFO and Anthropological Index Online, were searched from 1970 to 2006. A keyword search method was employed followed by a combined key word search.
Review methods.  A concept analysis based on Caron and Bowers' method was carried out using 45 papers, three books and three theses after examination of the abstracts to identify definitions, dimensions, perspectives and consequences needed for content and dimensional analyses.
Findings.  Nurses' shared values, beliefs and behavioural norms towards patient safety were identified as the overarching dimensions of the patient safety culture. The four sub-dimensions of patient safety culture were synthesized as system, personal, task-associated and interaction. Two main philosophical perspectives, functional and interpretative, were added to the analysis and further clarification was provided.
Conclusion.  It is expected that understanding the nature, as well as the key elements of the concept, would assist with analysing the existing safety culture and help to determine the strategies to build or shape the safety culture.     

Partnership: an analysis of the concept within the nurse-client relationship

BACKGROUND/RATIONALE: Current nursing literature that describes the nurse-client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners. AIMS OF THE PAPER: This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio-political and economic contexts that illuminate how and why nurse-client partnership emerged. Temporal changes in the concept of partnership are also examined. FINDINGS: The nurse-client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf. CONCLUSIONS: The paper concludes with suggestions for further development of the concept of partnership through empirical research.     

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.     

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.     

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.     

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.