A literature review on the concept of intimacy in nursing

AIM: This paper explores the concept of intimacy in nursing. RATIONALE: Intimacy is an increasingly important concept in nursing and feature of the nurse-patient relationship, which is perceived to be intrinsic to the proposed therapeutic potential of nursing. The introduction to the paper highlights the theoretical enthusiasm and endorsement of intimacy, the apparent lack of conceptual clarity from a nursing perspective and little published research investigating intimacy in practice. METHOD: Literature is reviewed from nursing and a variety of health-related disciplines. FINDINGS: The paper traces the historical background of the nurse-patient relationship and intimacy and highlights the change in value from detachment and distancing to intimacy, commitment and involvement. The nature of intimacy is examined and a concept analysis based on literature from psychology and psychiatric medicine is critically analysed. Intimacy is suggested to have psychological, emotional and physical aspects, which are explored. An ethnographic research study on intimacy in nursing is reviewed, which also recognizes physical and emotional dimensions of the concept and the importance of sufficient resources to allow the close relationships advocated. Attention is drawn to the constraints on intimacy imposed by the current market-led health service. Literature and research on the implications and consequences of intimacy for the nurse are discussed. These report practical difficulties of maintaining close relationships with individual patients and the potential for over-involvement and emotional labour. CONCLUSION: The paper concludes with the increasing importance attached to intimacy in nursing and its complex, ill-defined nature. This serves to highlight the importance of research aimed at exploring and clarifying intimacy and further illustrating the therapeutic potential of nursing.     

A concept analysis of stress

Stress formation, which depends on an individual's perception of a situation, can lead to changes in physiology, emotions, or behavior, and cause damage to one's physical and/or mental health. Nurses can help their patients reduce the impact of stress by teaching some essential stress attributes. Applying concept analysis, the authors provide information on definition, critical attributes, antecedents, and consequences, and presents both references for empirical research and construct demonstration examples. The article concludes with a discussion of potential applications to nursing practices.     

A concept analysis of autonomy

Clinical and policy developments in health care have recently created demand for a professional response in terms of the development of advanced roles for nurses, notably 'nurse practitioner' roles. Such roles demand the exercise of autonomy, a term which eludes succinct definition despite the fact that the preparation of practitioners for these roles relies on a clear understanding of its nature. Utilizing an approach described by Wilson, this paper undertakes a concept analysis of autonomy, each step illustrated with examples taken from clinical practice, with the ultimate aim of offering an operational definition of autonomy.     

A concept analysis of otherness

Otherness is an important concept in understanding the health provider-patient relationship and in creating insights into how to be more present with patients and families. This is an analysis of the concept of Otherness that leads to a definition of the construct.     

A concept analysis of self-monitoring

AIM: This paper reports a concept analysis delineating and clarifying the concept of self-monitoring to facilitate development and evaluation of interventions to enhance self-monitoring. BACKGROUND: The concepts of self-monitoring, self-management, self-care and symptom management are often used in similar or interchangeable ways. Clarification of the concept of self-monitoring is needed for research and theory development. METHOD: Rodgers and Knafl's evolutionary concept analysis process was used to delineate and clarify the concept. The PubMed and CINAHL databases were searched using keywords 'self-monitoring', 'self-management' and 'self-care' (with and without the hyphen) for the years 1998-2005, to update a previous study (not published). Later, searching was refined and the keyword 'self-monitoring' was paired with 'awareness' and 'self-regulation' was added. Approximately half the papers were from nursing (n = 34) and half from other disciplines (n = 32). The sample from 1998 to 2005 was further stratified by chronic condition. Definition, exemplars, usage, attributes, antecedents/consequences and implications for further study were identified. FINDINGS: Self-monitoring was composed of two complementary components (attributes): (1) awareness of bodily symptoms, sensations, daily activities, and cognitive processes and (2) measurements, recordings and observations that inform cognition or provide information for independent action or consultation with care providers. CONCLUSION: Self-monitoring may be an important concept for understanding how people self-manage chronic conditions. This concept analysis may be useful for researchers who wish to measure this dimension and to develop nursing theory in this area.     

A concept analysis of self-efficacy

Over the past decade, self-efficacy has become one of the most measured variables in studies on health behaviors and patient education. The concept was originally proposed in 1977 by Bandura, who initially promoted its use in social science research, especially psychology. It is now considered one of the most important determinants of health-related behaviors. Using Walker and Avant's concept analysis methods, the authors clarify the attributes and characteristics of self-efficacy. Refinement of this concept is proposed as a prerequisite for application to nursing research and practice.     

A concept analysis of health

Health, the reason for the nursing profession's existence, is the core purpose behind all nursing knowledge. The nature of nursing care is determined by the appreciation of health concepts. For a long time, the multidimensional, complex and changing characteristics of health have not been completely analyzed in Taiwan. The purpose of this article is to define health in terms of the concept analysis method of Walker and Avent (1995). The results show that: health is a process and outcome that involves subjectivity, individuality, objectivity, culture, dynamics, self-control, external control, changeability, and development. The clarification of health concepts will be important and useful to the theoretical basis of nursing practice, to the development of both theory and research, and especially for the development of instruments.     

A concept analysis of empathy

The concept of empathy lies amid much confusion This analysis addresses that confusion using Walker and Avant's model of concept analysis, and looks at what empathy is is it trait or state, is it dynamic or static, and how is it recognized and measured' Implications of these findings are discussed, limitations of the study are acknowledged and areas for further work suggested     

A concept analysis of empowerment

In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research.     

A concept analysis of consent

This paper considers the meaning of consent for nursing. Consent had traditionally been looked at in relation to the medical profession. The paper argues for patient advocacy and discusses issues of competency and advocacy and implications for practice. The paper then goes on to critique the process of concept analysis and suggests ways of proceeding with this vital development for nursing.     

A concept analysis of spirituality

According to the holistic model of care, nurses must consider their patients' spiritual needs in order to provide total patient care (Govier, 2000). There is growing awareness of the contribution that spiritual wellbeing can make to a patient's actual and perceived health and quality of life (Chibnall et al, 2002; Mount, 2003). Spirituality and spiritual care has gained much momentum in the current nursing arena. Draper and McSherry (2002) assert that it has emerged from the shadows to occupy a prominent part of contemporary health care. Moreover, within the nursing profession, a focus on individuals as biopsychosocial-spiritual beings is gaining recognition. This notion is based on the premise that there should be balance of mind, body and spirit for the maintenance of health in a person (Stoll, 1989; Stooter, 1995). However, there is evidence that many nurses, including nurse educators, have difficulty with the concept of spirituality and consequently, may neglect this aspect of care (Greenstreet, 1999; McSherry, 2000). The aim of this article is to contribute towards clarifying the concept of spirituality.     

A concept analysis of power

Using Walker and Avant's theory construction strategy, a concept analysis of power was conducted. Within the nursing literature, there exists a dialectic between types of power: power to vs. power over. This dialectic covers a wide range between goal attainment and powerlessness. The aim of this concept analysis was to examine power to for its potential fit with the phenomenon of nurses' lack of participation in professional organizations and on governing boards. The assumptions of this concept analysis are that power to is good, and that as humans with cognitive abilities, nurses have sufficient power to, whether they engage it or not. The Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, Business Source Elite, Google Scholar, ABI/INFORM Complete, Education Research Complete, Historical Abstracts, and PsychINFO were searched using the keywords power, nursing, and group. Peer-reviewed, scholarly journal articles from 1957 to 2019 were considered. The derived definition of power to is largely unchanged from its 17th century definition: the knowledge, freedom, and intention to do or to effect something. Self-assessing and nurturing knowledge, freedom, and intention, and identifying risk-preference among nurses may yield potential candidates for participation in professional nursing organizations and on governing boards.     

A concept analysis of trust

Trust is an important and pervasive concept In nursing, it has been considered primarily from two perspectives Clinically, it is an important aspect of the nurse-patient relationship Organizationally, trust is associated with various outcomes and levels of effectiveness Much of the nursing literature that discusses trust relies upon vague conceptualizations or borrows from other disciplines The absence of a clear conceptualization of trust has been cited A core concept of trust is presented which is applicable to nursing in both clinical and organizational settings Established methods for concept analysis are supplemented by a sequential step model developed by the author The concept is developed as both process and outcome, and the relationships of the two states to measurement of the concept are identified The utilization of the core concept in context-specific instances is discussed, and suggestions are made for further research     

A concept analysis of autonomy

Holistic care is the primary focus of today's health care system. Nurses are encouraged to maintain good relationships with their patients and to be sensitive to patient autonomy. Furthermore, patients are increasingly demanding and enjoying the right to join in decision-making processes concerning their treatment plans. The importance of patient autonomy is emphasized in the nursing literature on ethics, but no articles focus on the specific situation in Taiwan. The authors review definitions of and concepts tied to autonomy in the literature, redefine the concept to incorporate additional attributes, and construct example cases. Finally, they list empirical references on the application of the concept and the development of appropriate measures.     

Shepherding: A concept analysis

The purpose of this analysis was to explore the concept of shepherding as it applies to nursing. Shepherding is a term used in chaplaincy literature to describe the guidance and protection a chaplain offers. While this term may be appropriate to the relational work of nurses, it has yet to be defined in the nursing literature. Walker and Avant's eight-step method for concept development was utilized. An electronic search using “shepherd/shepherding and nursing or health or inpatient” was performed in eight databases related to nursing, medicine, health, social sciences, and chaplaincy. Scholarly articles, in English, with substantive references to shepherding were included. Four defining attributes related to shepherding were identified: relational interaction, safety and comfort, reciprocal guidance, and transformation through possibilities and actualization. The operational definition of shepherding was thus identified as a relational interaction between the nurse and a patient or family during a transformational crisis. The nurse accompanies the patient, ensuring safety, and comfort and, through reciprocal guidance, the nurse supports the patient to understand possibilities and actualize possibilities based on the patient's preferences.     

Self-care: A concept analysis

ObjectivesThere is extensive literature from various disciplines on self-care, an important aspect of nursing intervention via evaluation and education, but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines. Therefore, it is vital to clarify the meaning of self-care and formulate the defining attributes, antecedents, and consequences to self-care.MethodsWalker and Avant’s concept analysis approach was used to analyze the concept of self-care. A search of the literature was completed using the databases CINAHL, PubMed, and EBSCOhost for years 1975–2020; literature search included peer-review articles, full-text publications, and available in English. A total of 31 articles were reviewed, and saturation was reached.ResultsAn extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept. Guided by Walker and Avant’s method, three defining attributes emerged as common themes: awareness, self-control, and self-reliance.ConclusionsA clarified definition was identified: the ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being.