Quality of life in children with acute lymphoblastic leukaemia: A systematic review

Quality of life (QOL) in children with acute lymphoblastic leukaemia (ALL) is now considered an important outcome measure of treatment for this disease. The aim of this paper is to systematically review studies on QOL in children during treatment for ALL with consideration to methodological details and quality of studies, empirical findings on QOL as reported by children and parents, and whether children and parents differ in their reports on QOL. Searches were conducted in biomedical, psychological and behavioural science databases. Six papers met inclusion criteria for review: 4 cross-sectional studies and 2 qualitative studies. There was little consistency in how QOL was measured or qualitatively assessed across studies. The quality of most studies was limited by small sample sizes and cross-sectional designs. Children's reports on QOL were represented in 3 studies and discrepancies were found between children's and parent's accounts of QOL. There is a need for ongoing research on QOL in children with ALL that use longitudinal designs, large sample sizes, and child reports of QOL. There is a need for theoretical development of the concept of QOL through concept analysis, grounded theory research and empirical validation of developing theory of QOL. Theoretical development of the concept of QOL will contribute to greater clarification of what is meant by QOL than currently exists which in turn has the potential to advance the methodology of measuring this concept in children.     

What is the evidence on evidence‐based nursing? An epistemological concern

AIM: This paper adopts an epistemological perspective in order to support the assertion that there is very little evidence to support the existence of evidence-based nursing as a distinct construct or process. RATIONALE: This analysis of concept meaning is based on the theory of symbolic interactionism. By adopting this theory the commonalities and inconsistencies in the use of evidence-based symbolism by nurses and other health care professionals can be used to evaluate the perceived meaning of the term. METHODS: A frequency analysis of relevant key words in one publications data-base demonstrates the increasing use of evidence-based terminology and its euphemistic status visa vi research. An epistemological analysis is conducted on a sample of concept clarification statements taken from the popular literature, defining the nature of 'evidence' and 'evidence-based practice'. FINDINGS: The results of the frequency analysis show that the keywords 'evidence-based medicine' revealed 5612 papers, evidence-based practice (EBP) 432 papers, evidence-based nursing 47 papers, evidence-based health care 60 papers, and evidence-based decision making 43. Almost all of these papers have been published since 1995 and the earliest use of the symbol 'evidence-based' is 1992. There is also an increase in papers adopting 'evidence-based' symbolism along with a commensurate decrease in the use of the term 'research' in the nursing context. CONCLUSION: 'Evidence-based practice' is commonly a euphemism for information management, clinical judgement, professional practice development or managed care. There is insufficient evidence to demonstrate that evidence-based nursing is a single construct or process that can be distinguished from its concomitants. The term adds little more to the existing long standing traditions of quality assurance and research-based practice. Nurses must avoid the inefficiency brought about by the 'intense enthusiasm followed by sad disenchantment' that has been associated with other attempts to introduce innovation in health care delivery (Fienstein & Horowitz 1997).     

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.     

Irritability: A concept analysis

Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as ‘unpredictability and lowered emotion control’, ‘lowered threshold for negative emotional stimuli’, ‘being manifested in response to frustrative situations or physiological needs’ and ‘experience of disproportionate and unjustified emotional irritation’. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.     

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study

The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term 'need'. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.     

Clarifying the concept of need: a comparison of two approaches to concept analysis

Meeting needs is the aim of health care 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'. The purpose of this paper is to explore the concept of need, using concept analysis, with the aim of providing greater clarity. Two approaches to concept analysis are compared: the linear model proposed by Walker and Avant and Rodgers'cyclical model. On both a philosophical and practical level, Rodgers'model was felt to be more appropriate for analysis of the concept of need. The rigid divisions which the Walker and Avant model seeks to establish (particularly in relation to the construction of additional cases) were felt to restrict, rather than clarify the concept. The attributes, antecedents, consequences and references of need are described, following stratified random sampling of the available literature, and a model case is presented. The themes of priority and perception of need arose consistently within the literature, highlighting the value-laden nature of the concept and the importance of achieving a common understanding to enable purchasers, providers and consumers to better satisfy health care needs.     

Mid-term report on the project "Disaster nursing in a ubiquitous society" in the academic years 2003 and 2004

Aim: This is the mid‐term report of the project titled “Disaster nursing in a ubiquitous society”, funded by the Japanese Government. The purpose of this project is to develop the self‐care abilities of communities and individuals to independently regenerate and recover from the consequences of disasters. Methods: The methods utilized in this project were questionnaires sent by post or placed on websites, and interviews. The participants in our research were people with special needs in the case of a disaster, nursing professionals, ordinary people, and other professionals. Results: During 2003 and 2004, there were activities that progressed according to the original plans, activities that progressed at a faster rate than foreseen in the original plans, and newly expanded research activities that were conducted. New academic knowledge gained from the project activities includes five factors for disaster preparedness, six common issues related to health, care, training, and others, six categories of necessary factors in nursing activities, the clarification of the support needs of care‐providers, and the clarification of specific groups with unique needs including children, pregnant and postpartum women, elderly people, people with chronic conditions, cancer patients, and care‐providers. Conclusions: The growing recognition of our center as a global base of disaster nursing is indicated by the fact that we receive numerous requests from Japan and abroad, that our suggestions influence some governmental policies, and that we take initiatives in promoting the concept of disaster nursing throughout the world. It is necessary to disseminate the results of this project, to develop further knowledge, to clarify future challenges related to disasters, and to contribute to the preparedness of people and communities.     

The psychosocial needs of patients who have attempted suicide by overdose

This is an exploratory study using qualitative methods to investigate and highlight psychosocial needs as perceived by individuals who have survived an attempted suicide through self-poisoning Respondents consisted of a convenience sample of six people (three male and three female) Data were collected through interviews and analysed using the principles of content analysis devised by Field and Morse Major needs identified include the need to be loved, the need to maintain a high level of self-esteem, the need to have control of one's life and the need to be supported Findings indicate that these needs are not being met by the current mental health care delivery system In addition, nurses must begin to pay greater attention to assessment and planning of care for this group of patients A wider use of psychosocial therapies such as crisis intervention and family therapy are urgently required Above all there is a need for more in-depth understanding and improved communication with patients who have attempted suicide by self-poisoning     

New perspectives on vulnerability using emic and etic approaches

New perspectives on vulnerability using emic and etic approaches The concept of vulnerability has not been developed theoretically from a nursing perspective. It has been viewed epidemiologically as population-based relative risk with little consideration of its experiential qualities. The purpose of this paper is to analyse critically the use of the term vulnerability using elements of concept clarification and a critical literature review. A new perspective of vulnerability is offered based on differentiating between the concepts of risk and experience. Risk consists of assumptions from etic or external evaluation of relative danger while lived experience informs an emic or personal interpretation. Assumptions related to the etic view include normative social values, objective harm and endangerment, and social sanction for intervention. An emic view of vulnerability is based on experiential perception of challenge to personal integrity and the universal and mutual nature of the phenomenon. Questions about the evaluation of harm, potential for growth, subjectivity and objectivity, social sanction and capacity for action, can help clarify the range between these two dimensions.     

Person-centredness: a concept analysis

Person-centred care is a term that has been used frequently in literature since the mid-1990s. This type of care requires health care staff to use person-centredness as a focus for developing relationships and plans of care. In an attempt to define person-centredness, a literature review was undertaken as a means of developing a concept analysis. This led to profiling attributes of person-centredness developed from the work of early theorists and authors as they began to recognise the importance of the ethical and legal rights of people and the importance of holistic care in maintaining wellbeing. However, in the literature, the term person-centred was often interchanged with terms such as patient or client-centred which may lead to confusion. This concept analysis shows that many of the attributes of person-centredness are indeed relevant to patient and client centred care. However, the connotations behind client and patient may appear to shift the balance of power to the health carer by concentrating on the illness rather than the person. Therefore, clarification of the term person-centredness may assist future researchers, practitioners and authors to apply one term only until evolution leads to further definition or change.     

A concept analysis of parent–infant attachment

A concept analysis of parent–infant attachment ¶A concept analysis, the clarification of a concept, is the first step towards building the foundations of nursing theory, research and practice. As a relevant concept for nurses working with childbearing families, parent–infant attachment is an important part of the body of nursing knowledge. Wilson's method of concept analysis was used to generate antecedents, critical attributes and consequences of parent–infant attachment, highlighting the need to refine measurements of this concept.     

The concept of hope revisited for nursing

The development of nursing knowledge and interventions involve understanding human responses and needs The human response of hope was identified as a concept in need of further clarification The purpose of this paper was to review definitions and contextual usage of the word ‘hope’ from the literature and answer the conceptual question ‘What is hope?’Literature from theology, philosophy, psychology and nursing was reviewed for contextual usage of the word ‘hope’ In the literature, hope was viewed as part of human development, a process, a theory and a source of meaning in life In addition, antecendents, attributes and outcomes of hope were identified from the literature that contributed to a clearer understanding of the concept     

Concept analysis of expertise of occupational health nurses applying Rodgers''s evolutionary model

The purpose of this study was to clarify the concept of expertise among occupational health nurses. The material consisted of 24 research articles and one theory article published between 1983 and 1997.These were analysed using Rodgers's concept analysis model. The analysis revealed that the surrogate term was authority, and the related concepts were specialist, professional, practitioner and generalist. The attributes of the concept of expertise were associated with roles, profession, position, title and functions. The antecedents of the expertise were identified as knowledge and skills, education, training, experience, personal characteristics and work-related opportunities. The consequences of the expertise were economic and health benefits. Most commonly, the expertise of occupational health nurses referred to clients, workplaces and health-care units. Changes in the concept of expertise were also examined and a definition of expertise formed. Concept clarification is necessary for the development of occupational health education, practice and theory building.     

Factors affecting genetic testing and decisions about prophylactic surgery

Both of the articles reviewed here as well as the references, suggest that very little is actually known about the impact of many aspects of genetic testing. How decision are made about genetic testing in people who do not have cancer, how the results of testing are used used to guide care, and ultimately how people adjust to prophylactic surgery, which is the most effective form of prevention currently available to those who do have a mutation are not completely clear. This has many implications for practice in general. Oncology nurses who build relationships with those diagnosed with cancer and their families may be one of the best groups of professionals to provide the education and counseling individuals and families need prior to making any decision about genetic testing. Just as many responses to cancer exist, so do many responses to finding out the results of mutation status. Oncology nurses are challenged to help facilitate adjustment to learning that one carries a mutation that significantly increases risk of developing cancer. More nursing research needs to be conducted on how to facilitate this adjustment. Dealing with the unknown can be a frightening experience. Little is known about the long-term effectiveness of prophylactic mastectomy and oophorectomy in unaffected mutation-positive individuals. Most of what is known is based on retrospective review. Nurses are challenged to interpret this information, along with its inherent strengths and weaknesses, to individuals so they can make the best possible decisions. The psychosocial needs of those who undergo prophylactic surgery are not clearly understood. Surgery can have many psychological outcomes, and how individuals adjust to these changes is not clear. More nursing research is needed not only to understand these needs but also to design interventions to facilitate and improve adjustment to not only the information that one is mutation positive but also to prophylactic surgery. People who do not have cancer but have a high risk for cancer because of their genetic background need comprehensive and consistent care by knowledgeable healthcare providers. Although these individuals have not been diagnosed with cancer, they have complex psychosocial needs related to their family history and the decisions being made about prevention strategies. Oncology nurses can help fill this gap in care and provide the necessary support these individuals need.     

Homeless youth: a concept analysis

INTRODUCTION. A variety of terms have been used to describe the homeless youth population. PURPOSE. The purpose of this article is to analyze the conceptual meanings of the term homeless youths by examining the evolution of the concept and its related terms in the current literature. Method. Online databases from 1990-2010 were analyzed using the Rodgers evolutionary approach. RESULTS. The 6 attributes relating to homeless youth were physical location, age, health, behavior, choice, and survival. CONCLUSION. The analysis provided insight and clarification of homeless youth from a variety of related terms in the literature.     

Concept clarification of neonatal neurobehavioural organization

Title. Concept clarification of neonatal neurobehavioural organization Aim. This paper is a report of a concept analysis of neonatal neurobehavioural organization for healthy full‐term infants. Background. The neonatal period is an opportune time for researchers and clinicians to assess and intervene for optimal neurobehavioural organization. Yet there is inconsistency and lack of clarity in a scientifically grounded definition of neonatal neurobehavioural organization. Clarification of the concept will strengthen research findings that influence practice for optimal infant development. Method. A concept analysis of the literature between 1939 and 2007 (n = 57) was conducted using Penrod and Hupcey’s principle‐based concept analysis and Morse’s concept clarification. Findings. The concept analysis within and across multiple disciplines revealed: (1) a view of the concept as a holistic phenomenon with multiple dimensions; (2) no agreement on the ideal instrument to operationally define the concept; and (3) consistency in implied meaning, but great variability in terminology. Neonatal neurobehavioural organization was defined as the ability of the neonate to use goal‐directed states of consciousness, in reciprocal interaction with the caregiving environment, to facilitate the emergence of differentiating, hierarchical, and coordinated neurobehavioural systems, with ever‐increasing resiliency and capacity to learn from complex stimuli. Conclusion. A clear conceptual definition will help the international community to communicate effectively within and between disciplines and to apply evidence‐based research findings. It will encourage the development of valid and reliable instruments to capture the concept’s multiple dimensions and direct attention to the infant’s experience, which sculpts early neurobehavioural organization.     

Concept analysis: abuse of ageing caregivers by elderly care recipients

PURPOSE: The purpose of this article is to clarify the concept of abuse within the context of ageing women who are at risk for or experiencing physical or emotional injury inflicted by elderly family members for whom they provide care. BACKGROUND: The study of abuse of ageing individuals in family caregiving situations has traditionally focused on abuse of the dependent care receiver. However, evidence supports the health risks related to abuse of ageing caregivers as well. Women, usually spouses, daughters, or daughters-in-law, most frequently assume the caregiver role. METHODS: A modification of the strategies for concept analysis proposed by Walker and Avant (1995) is used to clarify the concept of caregiver abuse. Searches of the professional literature reveal that caregiver abuse is rarely addressed; therefore, the broader concept of elder abuse is reviewed and then placed within the general context of family caregiving. Audiotapes of the first session of a community based intervention research study entitled Intervention for the Abuse of Ageing Caregivers (Phillips et al., NIH Grant No. R01 DA-AG11155-01, 1996), in which ageing women caregivers described abusive caregiving situations, were analysed qualitatively using the principles of concept analysis. The audiotapes serve as a second source of data for the concept analysis process. FINDINGS: Antecedents, defining characteristics, and consequences of abuse of ageing caregivers were identified through the process of concept analysis. Model, contrary, and borderline cases are presented to illustrate the findings. CONCLUSIONS: Findings supported the need for awareness that ageing caregivers can be placed at risk by verbally and physically abusive behaviours of the elders for whom they provide care. Use of the term 'abuse' by health care professionals has potentially negative consequences for identification and intervention in cases of potential or actual caregiver abuse.     

Unmet health care needs. Comparison of rural and urban senior center attendees

Rural-dwelling older adults are in poorer health and have less access to health care resources than urban older adults. However, little is known about specific unmet needs which exist for urban and rural populations. This study compared self-reported health status, use of services, and unmet health care needs of 106 elderly individuals residing in rural and urban settings to determine if these variables differed based on geographic location. Data were gathered on the three dependent measures using the Elderly Health Care Needs Assessment Questionnaire. Findings revealed rural older adults were not in poorer self-reported health (chi 2 = 1.85, p = .60). However, a t test showed rural subjects were significantly poorer in objective health as measured by the number of reported symptoms (t = 224, p = .02). Despite having a greater number of specific health complaints, these rural elderly individuals did not use significantly more services (t = 1.16, p = .24) or report more unmet needs (chi 2 = 3.67, p = .055), thereby reinforcing traditional views of rural older adults being in poorer health but also more self-reliant in matters related to health care. The results of this study provide information which will improve nursing practice in rural and urban settings and provide direction for further research.     

Never-ending making sense: towards a substantive theory of the information-seeking behaviour of newly diagnosed cancer patients

Aim. The aim of this paper was to report a study which explored the information‐seeking behaviour of patients newly diagnosed with cancer in the immediate postdiagnosis period. Background. Information is an important tool for cancer patients. There is evidence that patients’ information needs are not being adequately met and, in many cases, patients often do not recall much information at the time of diagnosis. Method. Using a grounded theory approach, a theoretical sample of 27 newly diagnosed patients was interviewed in their own homes. Data were analysed using grounded theory analysis procedures. Results. A substantive theory describing the transitions from ‘being traumatized’ by the diagnosis, through a phase of trying to ‘take it on’, through to ‘taking control’ is tentatively offered. It provides a theoretical framework to understand newly diagnosed cancer patients’ changing, varied and continuing needs and their efforts to regain some control over their lives. Their information‐seeking behaviour seemed a journey of ‘never‐ending making sense’ with ongoing discovery and new information needs as they struggled with the effects of the disease and treatments. Conclusions. The processes and stages identified in this study provide nurses with a framework to assess the readiness of patients to receive information and to assist them in their efforts to regain some control over their disease and their lives. Relevance to clinical practice. Health professionals need to be aware of these stages, to be equipped to assess the need of individuals for information and support.