Fuzzy thinking

Much of the existing literature on lecturer practitioners to date is comprised of the perspectives of individuals within the role and how they function in their specific setting. It is surprisingly difficult from this work, however, to define the role of lecturer practitioner. The authors were commissioned by a regional health authority to undertake a study of lecturer practitioners within that region. In the process of undertaking this study, a literature review was carried out. Whilst the authors found an abundance of literature surrounding the theory and practice gap, and the development of the lecturer practitioner role as one possible solution, they were not able to find a comprehensive review of the multifaceted aspects of the lecturer practitioner role. This paper is an attempt to provide such a review, and will address the following aspects: the need for lecturer practitioners; their origin within nursing and midwifery education; the development of the lecturer practitioner role; the debate surrounding academic and clinical credibility; and finally, the current situation for lecturer practitioners.     

Flexibility: a concept analysis

Flexibility is a quality that is deemed essential for nursing as the healthcare environment escalates into greater complexity. The word "flexibility" appears in nursing literature addressing the need to prepare for the next millenium, yet the concept of flexibility is rarely defined. Other disciplines, such as engineering, have struggled for years and continue to struggle to achieve conceptual clarity with regard to flexibility. A concept analysis using Rodgers' evolutionary method was undertaken to understand the meaning of flexibility.     

Hope in terminal illness: an evolutionary concept analysis

AIMS: to clarify the concept of hope as perceived by patients with a terminal illness, to develop hope as an evidence-based nursing concept, to contribute new knowledge and insights about hope to the relatively new field of palliative care; endeavouring to maximize the quality of life of terminally ill patients in the future. METHOD: utilizing Rodgers' (2000a) evolutionary concept analysis methodology and thematic content analysis, 17 pieces of research-based literature on hope as perceived by adult patients with any terminal illness pathology, from the disciplines of nursing and medicine have been reviewed and analyzed. An exemplary case of the concept in action is presented along with the evolution of the concept hope in terminal illness. RESULTS: Ten essential attributes of the concept were identified: positive expectation; personal qualities; spirituality; goals; comfort; help/caring; interpersonal relationships; control; legacy; and life review. Patients' hopes and goals are scaled down and refocused in order to live in the present and enjoy the time they have left with loved ones. CONCLUSION: By completing all the steps to Rodgers' (2000a) evolutionary view of concept analysis, a working definition and clarification of the concept in its current use has been achieved. This provides a solid conceptual foundation for further study.     

Self-awareness: a review and analysis of a basic nursing concept

Self-awareness has long been addressed as fundamental for the professional nurse with the accepted view that self-awareness will lead to greater competence. Therefore, it is important to understand the historical evolution of the concept, attributes, antecedents, and consequences. Rodgers' evolutionary method was used for critical analysis of nursing, social sciences, and education literature. Analysis indicates that self-awareness is a dynamic, transformative process of self. Ultimately, self-awareness is the use of self-insights and presence knowingly to guide behavior that is genuine and authentic to create a healing interpersonal environment. Future research areas within practice and education are identified.     

An evaluation of lecturer practitioners in Ireland

Nursing continues to struggle to integrate the theoretical and clinical aspects of nurse education for the development of competent practitioners. Collaborative approaches to nurse education as well as the development of joint clinical-academic roles have had questionable success to date on merging the theoretical and clinical components of nursing. Lecturer practitioners' posts are new in Ireland. These posts were created as nurse educators were cognizant of the need for students to integrate theory to practice. The aim of the lecturer practitioner role was to increase the support forstudent nurses in both academia and practice. An evaluation of the impact of the lecturer practitioner role from three key perspectives was conducted in three Irish teaching hospitals in 2007. The results of this study suggest that as lecturer practitioners have both a clinical and academic remit they can integrate theory to practice through collaborative practice.     

A concept analysis of renal supportive care: the changing world of nephrology

AIM: This paper is a report of a concept analysis of renal supportive care. BACKGROUND: Approximately 1.5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity. METHOD: Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806-2006) using, 'renal' and 'supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase 'renal supportive care'. RESULTS: Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making. CONCLUSION: Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice.     

An evaluation of critical care lecturer practitioners

The aim of this study was to evaluate the educational value and impact upon staff of critical care lecturer practitioners. Data were collected through three staff focus groups (n=21) and a questionnaire completed by 70 members of trust or university staff. A majority of respondents felt that the lecturer practitioner roles had considerable effect upon adult critical care services. Six main categories of findings were derived from analysis and integration of both focus group and questionnaire data--development of knowledge; staff support; being a teacher; developing and maintaining the workforce; role improvement plus removal of the lecturer practitioner role. Many of these findings concur with the limited quantity of evaluative literature on the lecturer practitioner role. The authors produced a report recommending continued funding for existing lecturer practitioner posts; introduction of more lecturer practitioner posts should be considered, and further role evaluation should be conducted at both a local and national level.     

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.     

Fatigue in children with long-term conditions: an evolutionary concept analysis

Title.  Fatigue in children with long-term conditions: an evolutionary concept analysis.
Aim.  This paper is a report of a concept analysis of fatigue in children with long-term conditions.
Background.  There is little research focused on the experience of fatigue in children. Previous work has focused primarily on children living with cancer. It is necessary to clarify and refine the concept, and add to the knowledge base that supports ongoing theoretical work in order to improve the clinical care of children with long-term conditions who experience fatigue.
Method.  English language literature published from 1989 to 2007 was searched using the CINAHL, Medline and PsychINFO data bases. Sixty-two papers and two book chapters were used in this concept analysis. Rodgers' method of evolutionary concept analysis was used. This inductive method helps us to view the concept in a sociocultural and temporal context.
Findings.  The number of publications focusing on fatigue in children is increasing. The analysis yielded two surrogate terms, five attributes, three antecedents and seven consequences. Based on this analysis, fatigue in children with long-term conditions appears to be a subjective experience of tiredness or exhaustion that is multidimensional and includes physical, mental, and emotional aspects.
Conclusions.  Evidence suggesting children with long-term conditions experience fatigue is increasing, but conceptual gaps remain. This analysis has yielded a view of fatigue in children that illustrates healthcare professionals' limited yet growing awareness of the symptom. Ongoing study as a means to refine our understanding of the concept could potentially lead to important contributions to clinical care of children with long-term conditions.     

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.     

The Art of Nursing: A Concept Analysis

That nursing is a science and an art is commonly accepted. While much emphasis has been placed on the science in nursing, the art of nursing is less well-understood. A concept analysis using Rodgers' evolutionary perspective was conducted to examine the meaning of the art of nursing. Through the analysis, a definition emerged suggesting that the art of nursing is the intentional creative use of oneself, based upon skill and expertise, to transmit emotion and meaning to another. It is a process that is subjective and requires interpretation, sensitivity, imagination, and active participation.     

Nursing lecturer/practitioners: can lecturer/practitioners be music to our ears?

The value of the recently emerging role of the lecturer/practitioner (LP) in nursing is examined by reflecting on the experience of the authors Within the evolutionary development of nursing education there appears to be separate branchings into theory and practice Much effort has been spent on trying to lessen this so called theory-practice gap Examination and reflection with reference to the LP led to the conclusion that there is a paradoxical nature to nursing The whole which is nursing comprises of seemingly incongruent aspects, theory and practice which can be integrated This paper argues that nursing knowledge is complementary in nature It consists of 'knowing how' and 'knowing that' These two aspects cannot exist independently but are integrated through practice It is experience and reflection that integrate these through the embodiment of the LP It is within this context that the evolution of the role of the LP is reviewed from a theoretical and historical perspective     

Lecturer practitioners in UK nursing and midwifery: what is the evidence? A systematic review of the research literature

Background. Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory–practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. Aims and objectives. This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. Conclusions. Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the ‘grey literature’, totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed‐methods studies. Relevance to clinical practice. Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful.     

Knowing in nursing: a concept analysis

Title.  Knowing in nursing: a concept analysis.
Aim.  This paper is a report of an analysis of the evolution of the concept of knowing in nursing.
Background.  Following the seminal contribution of Carper in 1978, knowing has been discussed with increasing frequency in the nursing literature with reference to the development of nursing knowledge. Various patterns of knowing, as well as research focused on reflection on experience, have been the foundation for activities and research designed to improve practice as well as patient care in clinical, community, education, cultural and administrative settings.
Methods.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. The data source was a search of literature published from 1978 to 2007. Three aims guided the analysis: to understand how the concept of knowing is used in nursing, how it is used in other health-related disciplines and how the concept has evolved into the current interpretation.
Discussion.  Analysis revealed that knowing in nursing refers to a uniquely personal type of knowledge constructed of objective knowledge interfaced with the individual's subjective perspective on personal experience. Knowing is a dynamic process and a result of personal reflection and transformation as the individual lives and interacts in the world. Its antecedents are experience, awareness and reflection. The consequences are understanding, finding meaning and transformation.
Conclusion.  This analysis illuminates an area in which nursing has carved out its own niche in healthcare research. The concept of knowing in nursing practice and research reflects a focus on the individual experience of health and illness.     

Continuing education in nursing: a concept analysis

The importance of continuing education for nurses has been increasingly emphasized in the nursing literature since the beginning of the profession. The concept of continuing education is often used as a substitute for associated terms such as continuing professional development and lifelong learning, thus highlighting a need for its clarification. The purpose of this article is to explain and describe continuing education, in order to encourage a broader understanding of the concept among nurses. The concept analysis is directed by Rodgers' [Rodgers, B.L., 1989. Concept analysis and the development of nursing knowledge: the evolutionary cycle. Journal of Advanced Nursing 14, 330-335] 'evolutionary approach' which is viewed as an ongoing dynamic process, and one that identifies the shared meaning of concepts. Examining everyday discourse used in the nursing literature identified the critical attributes, antecedents and consequence of continuing education in nursing. As a result, the emerging attributes of the concept are synthesised into a conceptual model. The article concludes with an exploration of the application of the concept of continuing education within nursing and its implications for professional development.     

Lecturer practitioners in six professions: combining cultures

Background. Whilst research has been undertaken in relation to the lecturer practitioner role in nursing, there have been no cross‐professional studies. There is an explicit political agenda in the United Kingdom on interprofessional education and enhancing the status of those who provide practice‐based teaching. Aim. This paper reports a study to investigate the commonalities and differences between lecturer practitioners across professions and to generate hypotheses about the role, which follows different models of practice in the different professions. Methods. An exploratory research design was adopted, using semi‐structured interviews with a purposive sample of lecturer practitioners from six professions (architecture, clinical psychology, law, medicine, nursing and social work). A grounded theory approach was used. Findings. All lecturer practitioners perceived a clear dichotomy between their professional practice role and their university role. All used similar strategies to adapt to and deal with combining two very differently perceived cultures. There were striking similarities in response to the consequences of serving ‘two masters’ in the areas of time management and role identity/definition. Conclusions. The role not only bridges theory and practice, but has to operate within very different organizational cultures. Further research is needed to test the generalizability of the findings. Relevance to clinical practice. This investigation aims to inform higher education and health service policy on lecturer practitioners, and also provide support for those undertaking this challenging role. The study poses challenging questions for policymakers in the current climate of interprofessional learning, which need to be addressed if future initiatives in this area are to be successful.     

A concept analysis of holistic nursing care in paediatric nursing

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care.     

A concept analysis of reflective practice: determining its value to nurses

Reflective practice has been welcomed into nursing education with open arms. However, practitioners are cautious of its perceived benefits and limitations considering the evidence-based literature has not been adequately tested. Concepts are well established as the building blocks of theory. It therefore follows that a primary step in building a theoretical base is undertaking a concept analysis. While there is an abundance of anecdotal literature available on reflective practice, it was deemed necessary to analyse the concept, define the attributes, antecedents and consequences, in order to identify a model case of reflective practice for clinical practice. This article uses Rodgers' (1989) methodology to gain a better understanding of what reflective practice actually is, and whether the concept is in fact useful to the practising nurse.