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.     

Chinese values, health and nursing

PURPOSE: To describe the roots of Chinese values, beliefs and the concept of health, and to illustrate how these ways have influenced the development of health care and nursing among Chinese in the Republic of China (ROC) and the People's Republic of China (PRC). Scope. Based on the literature and direct observation in the PRC and ROC, this is an introduction to Chinese philosophies, religion, basic beliefs, and values with a special meaning for health and nursing. Chinese philosophies and religion include Confucian principles, Taoism, theory of "Yin" and "Yang", and Buddhism. Beliefs and values include the way of education, practice of acupuncture, herbal treatments and diet therapy. How people value traditional Chinese medicine in combination with western science, and the future direction of nursing and nursing inquiry are also briefly addressed. CONCLUSION: Chinese philosophies and religions strongly influence the Chinese way of living and thinking about health and health care. Nurses must combine information about culture with clinical assessment of the patient to provide cultural sensitive care. A better way may be to combine both western and Chinese values into the Chinese health care system by negotiating between the traditional values while at the same time, respecting an individual's choice. The foundation of China's philosophical and aesthetic tradition, in combination with western science is important to the future advancement of nursing research that will be beneficial to the Republics, Asia, and the world.     

Hmong American Women Living With Diabetes

Purpose: To understand how to better care for Hmong women with diabetes using nursing theory praxis.
Design: Qualitative phenomenologic design, specifically community-based collaborative action research based on Margaret Newman's theory of health as expanding consciousness (HEC).
Methods: Five Hmong women with Type 2 diabetes and HgbA1c levels over 7.0 were recruited from a community-health clinic. Audiotaped in-home interviews were conducted and data were analyzed to identify common patterns and then developed into a play by the research team with the help of a female Hmong playwright. Community dialogue about the findings generated meaningful actions for health.
Conclusions: This study indicates the value of nursing praxis rooted in the theory of health as expanding consciousness and the importance of engaging communities to identify meaningful patterns of health and needed actions.
Clinical Relevance: Evidence-based practice is lacking in the care of Hmong women with diabetes. Community-based collaborative action research rooted in the HEC perspective is a new way to envision models of care.     

Treading lightly: spirituality issues in mental health nursing

ABSTRACT: Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, ‘What does spirituality mean for people with a mental illness?’ Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life‐sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients’ spiritual needs in the context of their health concerns.     

A review of lay health beliefs research: insights for nursing practice in health promotion

• ? Recent sociological research in the field of lay health and illness beliefs is reviewed and discussed in the light of nursing practice in health promotion.
• ? How the findings might deepen nurses' understanding of difficulties in adhering to desired health behaviours is outlined.
• ? The distinctions between ‘public’ and ‘private’ accounts of health, the ‘taken-for-grantedness’ of health, the emotive nature of health and the difficulty of accessing ‘unpolluted’ lay views of health is considered. The implications for nurses working in health promotion are discussed.
• ? There is a need for further research into the relationship between health beliefs and behaviour, the health beliefs of various groups within society and a need to examine how health beliefs arise and change.

     

Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review

Viewing mental illness as an ‘illness like any other’ and promoting biogenetic causes have been explored as a stigma‐reduction strategy. The relationship between causal beliefs and mental illness stigma has been researched extensively in the general public, but has gained less attention in more clinically‐relevant populations (i.e. people with mental illness and mental health professionals). A systematic review examining whether endorsing biogenetic causes decreases mental illness stigma in people with mental illness and mental health professionals was undertaken using the preferred reporting items for systematic reviews and meta‐analyses guidelines. Multiple databases were searched, and studies that explored the relationship between biogenetic causal beliefs and mental illness stigma in people with mental illness or mental health professionals were considered. Studies were included if they focussed on depression, schizophrenia, or mental illness in general, were in English, and had adult participants. The search identified 11 journal articles reporting on 15 studies, which were included in this review. Of these, only two provided evidence that endorsing biogenetic causes was associated with less mental illness stigma in people with mental illness or mental health professionals. The majority of studies in the present review (n = 10) found that biogenetic causal beliefs were associated with increased stigma or negative attitudes towards mental illness. The present review highlights the lack of research exploring the impacts of endorsing biogenetic causes in people with mental illness and mental health professionals. Clinical implications associated with these results are discussed, and suggestions are made for further research that examines the relationship between causal beliefs and treatment variables.     

A concept analysis of health-related quality of life in young people with chronic illness

Aims. To critique existing concept analyses of quality of life and develop a definition applicable for young people with chronic illness. Background. Quality of life is a commonly used phrase but there is no universal definition. Five perspectives of quality of life have been proposed: sociological, economic, psychological, philosophical and ethical. However, health has emerged as an important but distinct perspective. The nursing profession has made a substantial contribution to the understanding of the interrelationship of health and quality of life. Design. Literature review. Methods. A search on electronic databases to April 2007 was made using the terms ‘quality of life’ and ‘concept analysis’. Papers were included in the review if they used a recognised method of concept analysis and were conducted by nurses. A new concept analysis was then performed specifically focusing on young people’s experiences of living with chronic illness. Results. Eight concept analyses were identified, all of which had limitations. All the concept analyses were based on adult literature so did not take into consideration developmental changes, language level, or young people’s construction of health and illness. The new concept analysis found that young people living with chronic illness generally view themselves and their lives in the same way as their healthy peers. While their aspirations are often constrained by illness and treatment the relationship between illness and life cannot be seen in isolation of development. Conclusion. Previous definitions of quality of life derived from concept analyses with adult populations do not adequately represent the experience of young people with chronic illnesses, but can be made more specific by incorporating important attributes such as developmental stage and the importance of peer group and family. Relevance to clinical practice. The current analysis provides a clear definition of quality of life from the health perspective which is specific for use with young people with chronic illness to guide practice and research.     

Encounters with difference: Mental health nurses and Indigenous Australian users of mental health services

This article presents findings from the multi‐sited ethnography of mental health nursing practice as it relates to the care of Indigenous users of public mental health services in Australia. It provides an analysis of mental health nurses beliefs and ideas about Aboriginal and Torres Strait Islander people encountered over the course of this research. The Indigenous service user was positioned as Other to the non‐Indigenous mental health nurse, and to non‐Indigenous service users. Cultural difference and the legacy of colonization, including its impact on the health of Aboriginal and Torres Strait Islander peoples, contributed to these beliefs of alterity. Despite emphasizing the differences with Aboriginal and Torres Strait Islander people in mental health services, nurses did not clearly relate this to Indigenous ways of understanding ill health. While cultural differences were recognized, what they meant for the nurses or their nursing practice was interpreted in different ways. In these circumstances, approaches towards care for Aboriginal and Torres Strait Islander people varied between nurses.     

Mental illness and Egyptian families

ABSTRACT:  People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians' beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians' experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others' beliefs, values, and practices.     

The International Classification of Functioning, Disability and Health (ICF) and nursing

Background.  Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care.
Aim.  The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing.
Method.  The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing.
Conclusion.  The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses' thinking and practice by increasing awareness of the social, political and cultural dimensions of disability.     

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.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

The concept of health scale: developed for Chinese people with chronic illness

BACKGROUND: As the concept of health in Chinese people with chronic illness had not been previously explored, a scale to measure this concept in this client group was developed. OBJECTIVE: To develop and test the psychometric integrity of the Concept of Health Scale (CHS) for use with Chinese people. METHODS: Previous nursing experience and a literature review were used to inform the initial development of the CHS. It was revised following scrutiny by a panel of experts. Two studies tested the psychometric integrity of the scale. In Study One the data gathered from 80 Chinese people with a chronic illness were subjected to item analysis and exploratory factor analysis. In Study Two, with a convenience sample of 372 chronically ill Chinese people, confirmatory factor analysis was conducted. RESULTS: Instrument analysis in Study One resulted in a 34-item scale with a Cronbach alpha of 0.94. The results of an exploratory factor analysis showed that physical, psychosocial, and spiritual factors were represented by the CHS. The hypothesized model of the CHS was tested in Study Two using confirmatory factor analyses. The results of this study indicated that the concept of health was comprised of six first-order and three second-order factors. CONCLUSION: The results of this study demonstrated that Chinese people with chronic illness held a broad frame of reference in gauging the concept of health. The development of the CHS brings us one step closer to understanding how Chinese people with chronic illness regard the concept of health.     

Psychosocial support as a counselling in improving health-related quality of life in patients with recent multiple sclerosis in Finland

Aim.  The aim of the study was to describe and explain psychosocial support provided by nursing personnel as experienced by people with multiple sclerosis.
Background.  The goal of providing psychosocial support is to understand and improve patients' health, self-care, initiative, commitment to care, resources, deal with emotions, social interaction and circumstances.
Design and methods.  Informants were individuals ( n  = 204) diagnosed using multiple sclerosis between the years 2003–2005 in Finland. Data were collected in 2005 by a posted questionnaire. The data were analysed with cross-tabulations, correlation coefficients, mean tests, a factor analysis and multiple regression analysis.
Results.  People with multiple sclerosis need psychosocial support from nursing personnel to promote health and self-care, strengthen emotional and mental resources and maintain social relationships. The support was to include information on multiple sclerosis and related treatment options, as well as discussion, listening to the patient and supporting them in the new situation in life caused by the illness.
Conclusion.  The psychosocial support received by the patients was sufficient and corresponded to their needs. Nursing personnel have the skills to improve the health-related quality of life of people with multiple sclerosis.
Relevance to clinical practice.  The results of this research may be applied in practical nursing, such as in planning of program of neuropsychosocial rehabilitation, in developing of home care and institutional care and in planning of content of nursing education.     

Reconciling voices

There is a lack of nursing research in relation to how people with mental health problems make sense of their experiences of mental distress. Furthermore, few nursing related studies have conveyed service user's understandings and meanings for their experiences of mental 'disorder'. Narrative psychology claims that people make sense of the world and their lives by using narrative structures to organize diverse experiences. By sharing these stories with others, interpretations are negotiated and personal and cultural meanings are formed. This study used a tried and tested approach to narrative analysis to analyse the transcribed narrative of one man, Gary, who was experiencing mental health problems. The study explores Gary's process of meaning making as it appears in his narrative; the frameworks and metaphors that he uses to help him make sense of his experiences. The tensions between Gary's internal voices and beliefs and the external voices of surrounding culture and psychiatry are highlighted. Emphasis is placed on the importance of attending and responding to personal meanings embedded in narratives as a means of developing sensitive nursing care and enriching nursing research.     

多元文化视野下人文护理的内涵与实践

从多元文化的角度探讨护理人文关怀的内涵及实践,不同的文化背景导致价值观、信仰的不同,对病痛的理解、治疗方式的选择也各不相同。护理人员应该理解社会文化环境对疾病和健康的影响、对疾病治疗的影响以及护患关系中以病人为主、以人为中心的理念,在护理人文关怀实践中,遵循尊重平等、有效沟通、需求对等和适度关怀的实践原则,使人文精神与医学技术在不同文化间相互渗透与融合,真正实现“以人为本”的护理。     

The Interaction Model of Client Health Behavior: a model for advanced practice nurses

Purpose: To present the Interaction Model of Client Health Behavior (IMCHB) as a model to guide nurse practitioners (NPs) in their practice.
Data sources: Selected research-based articles on Cox's IMCHB and selected text and writings on the NP movement and nursing practice models.
Conclusions: Many NPs practice in a medical setting where the boundaries between medicine and nursing are blurred. The IMCHB offers a nursing model to guide NPs in their practice.
Implications for practice: A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.