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PubMed2006

Theoretical model of coping among relatives of patients in intensive care units: a simultaneous concept analysis.

UNLABELLED: This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area. BACKGROUND: When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery. METHOD: Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home. FINDINGS: The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated. CONCLUSION: This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used.

Adaptation, Psychological↗
PubMed2007

Developing a mid-range theory of patient advocacy through concept analysis.

AIM: The aim of this paper is to clarify and refine the concept of patient advocacy through synthesizing the advocacy literature in nursing and to establish a theoretical basis for future studies on patient advocacy in nursing. BACKGROUND: Patient advocacy is an essential component of the Registered Nurse professional role. During the past 30 years, the patient advocacy role has become more important, but the concept of patient advocacy lacks a consistent definition and research into nurses' patient advocacy roles is limited. There have been few quantitative empirical studies on patient advocacy in nursing. METHOD: Walker and Avant's method of concept analysis was used as a guideline in examining the concept of patient advocacy through synthesizing the advocacy literature in English (1974-2006). FINDINGS: A mid-range theory of patient advocacy emerges during the process of synthesizing and analysing the advocacy literature. Three core attributes of the concept of patient advocacy are identified: (1) safeguarding patients' autonomy; (2) acting on behalf of patients; and (3) championing social justice in the provision of health care. They reflect nurses' patient advocacy roles at both macro- and micro-social levels. Antecedents of patient advocacy occur at both macro- and micro-social levels and call for nurses' advocacy roles in the healthcare system. Consequences produced by nurses' patient advocacy behaviours are contextual. Nurses' patient advocacy behaviours not only can positively influence the patients, other nurses and the nursing profession, but also can cause negative consequences for nurses who take action to advocate for patients. CONCLUSION: The proposed mid-range theory may be useful in guiding advocacy practice in nursing and in guiding research in the advocacy area. The proposed theory needs to be furthered refined and tested in the future.

Ethics, Nursing↗
PubMed2005

Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views.

AIM: The purpose of this study was to explore nurses' conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace. BACKGROUND: The use and comprehension of the term 'evidence-based practice' in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept 'evidence-based medicine'. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients. METHOD: Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. RESULTS: Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine. CONCLUSIONS: Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. RELEVANCE TO CLINICAL PRACTICE: The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients.

Attitude of Health Personnel↗
PubMed1995

An analysis of the concept of participation within the context of health care planning.

This paper analyses the concept of participation using the model of concept analysis developed by Walker and Avant (1988). The concept was chosen for analysis because of its extensive but often unqualified use in literature associated with the reform of the British National Health Service. The Walker and Avant model was chosen because of its capacity to identify the empirical referents of the concept. The analysis considers the use of the concept in the health and social policy literature from the 1960s to date, identifies the defining attributes prior to creating a model, a borderline and a contrary case, summarizes the antecedents and consequences of participation and offers three empirical referents which could be used in the construction of instruments for nursing research. The paper concludes with an assessment of the limitations of the analysis, an example of the use of the empirical referents in a research review and the identification of issues for those who manage or develop nursing services.

Health Care Reform↗
PubMed2006

A review of the shortened dental arch concept focusing on the work by the Käyser/Nijmegen group.

The aims of this paper were to review the literature on shortened dental arches with special focus on publications of the Käyser/Nijmegen group, and to evaluate the discussions on the shortened dental arch concept found in the literature. A MEDLINE (PubMed) search was conducted for articles in English published in the dental literature from 1966 to November 2005. The search revealed epidemiological, cross-sectional and longitudinal clinical studies as well as opinion papers, the majority of which were published by the Dutch group. The studies found in general no clinically significant differences between subjects with shortened dental arches of three to five occlusal units and complete dental arches regarding variables such as masticatory ability, signs and symptoms of temporomandibular disorders, migration of remaining teeth, periodontal support, and oral comfort. The findings from cross-sectional studies were corroborated longitudinally. No systematic clinical study with conflicting results was found. The shortened dental arch concept was accepted by a great majority of dentists but not widely practised. The studies reviewed showed that shortened dental arches comprising anterior and premolar teeth in general fulfil the requirements of a functional dentition. It may therefore be concluded that the concept deserves serious consideration in treatment planning for partially edentulous patients. However, with ongoing changes, e.g. in dental health and economy, the concept requires continuing research, evaluation and discussion. Patients' needs and demands vary much and should be individually assessed but the shortened dental arch concept deserves to be included in all treatment planning for partially edentulous patients.

Attitude of Health Personnel↗
PubMed1990

The application of basic science concepts to clinical problem-solving.

This study looks at the relationship between anatomical concepts held by medical students and their clinical application, and develops a testable model of how students use basic science concepts for clinical problem-solving. According to the model, the essential prerequisites to solve a clinical problem using basic science information include the appropriate basic science knowledge, the ability to collect and interpret clinical information, with the key concept being the link that must then be made between clinical data and basic science. A detailed analysis of the individual components of the model should help to clarify and resolve some of the debate about the nature and balance of basic science and clinical education. A neurological diagnostic problem was used to test the assumptions of the model in a group of medical students who had minimal clinical experiences. There was no demonstrable relationship between anatomical knowledge as assessed by conventional tests and the diagnosis. There was a powerful relationship between measures of organization of knowledge and diagnosis, suggesting that the organization and development of concepts is the key to correct diagnosis. The findings have significant implications for assessment purposes and suggest that standard methods as generally practised may not measure the appropriate conceptual development and are not congruent with curricular objectives. Through the examination of its different learning outcome measures, the model may also be used to provide a profile of individual students or classes, which should help teachers and students deal with difficulties that may be experienced in learning to link clinical and basic science concepts.

Clinical Competence↗
PubMed2004

The importance of knowing how to talk about illness without applying the concept of illness.

The paper explores consequences of applying the view that illness is negative first-person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness--patients' experiences like the state of being in pain--and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse-patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice.

Communication↗
PubMed1997

How specific are "specific developmental disorders"? The relevance of the concept of specific developmental disorders for the classification of childhood developmental disorders.

The concept of "specific developmental disorder" (SDD) refers to delays in developmental domains such as language and speech development, motor coordination or the development of scholastic skills, in the absence of sensory deficits, subnormal intelligence or poor educational conditions. The key element in this concept is the notion of a discrepancy between observed and expected level of development. In DSM-III-R and ICD-10, SDD serves as a conceptual umbrella, suggesting that the subsumed disorders are of the same type. In DSM-IV, the SDD umbrella is not used explicitly, but the notion of a discrepancy is present in the categories of Learning Disorders, Motor Skill Disorder and Communication Disorders, suggesting a close relationship between these disorders. One of the advantages of the use of SDD as a unifying concept is that it contributes to the standardisation of the description of the various disorders. However, based on reviews of research regarding the reliability and validity of the SDD categories, we argue that the application of a unifying SDD concept has been premature. For each of the categories for disorders in scholastic skills, language, speech and motor coordination, the notion of a discrepancy between observed and expected level of development should be elaborated and tested more thoroughly, before SDD can be used as a unifying concept in classification.

Adolescent↗
PubMed1982

Beyond homeostasis: toward a concept of coherence.

The concept of homeostasis has served as a major building block, if not the cornerstone, of family theory and family therapy. Designed to account for the perceived stability of systems (and symptoms), homeostasis is an epistemologically flawed concept that has repetitively been used in the service of dualistic, animistic, and vitalistic interpretations of systems. Accordingly, homeostasis has led to quirky clinical formulations and a great deal of fuzzy theorizing. This paper contends that the notion of homeostasis is fundamentally inconsistent with systemic epistemology and should be replaced with the more compatible concept of coherence. Whereas homeostasis is a heuristic concept that is not part of a more encompassing theory, the concept of coherence is inseparable from the epistemology in which it is embedded.

Cybernetics↗
PubMed1992

Simultaneous concept analysis of spiritual perspective, hope, acceptance and self-transcendence.

This paper seeks to clarify four previously elusive concepts of concern to nurses: spiritual perspective, hope, acceptance and self-transcendence. Simultaneous concept analysis (SCA), a method developed by the authors, was used to generate a process model of antecedents, critical attributes and outcomes of all four concepts. This resulted in refined theoretical definitions for each concept. Interrelationships that became apparent among the concepts are discussed and implications of these interrelationships for theory and measurement are presented.

Behavior↗
PubMed1990

Concept analysis of decision making.

Concept analysis allows us to examine the attributes and characteristics of a concept. The concept of decision making is central to the practice of nursing. Decision making occurs at all levels of human thought and action, so it has been explored in many disciplines. It is important to explore this concept from the perspective of the discipline of nursing, so that we can determine how definitions and theories apply to our practice. Investigating a concept adopted from other disciplines will eventually provide the profession with a basis for knowledge development.

Decision Support Techniques↗
PubMedDate not supplied

A critical analysis of the cumulative rainfall departure concept.

Evaluation of trends in time-series, such as precipitation or ground water levels, is an essential element in many hydrologic evaluations, including water resource studies and planning efforts. The cumulative rainfall departure (CRD) from normal rainfall is a concept sometimes utilized to evaluate the temporal correlation of rainfall with surface water or ground water levels. Permutations of the concept have been used to estimate recharge or aquifer storativity, and in attempts to explain declining ground water levels. The cumulative departure concept has hydrologic meaning in the short term, as a generalized evaluation of either meager or abundant rainfall, and when utilized in connection with a detailed water budget analysis can be used in a predictive fashion. However, the concept can be misapplied if extended over lengthy periods. Misapplication occurs because of several factors including the separation of the mean and median in nonnormal distributions, how the choice of beginning and end points of the data can affect the results, the lack of consideration that above-average rainfall can reset the hydrologic system without mathematically eliminating the accumulated deficit, and the lack of support for the necessary inference that rainfall events and hydrologic levels widely separated in time are linked. Standard statistical techniques are available to reliably determine trends and can provide rigorous statistical measures of the significance of conclusions. Misuse of the CRD concept can lead to erroneous and unsupported conclusions regarding hydrologic relationships and can potentially result in misguided water resource decision-making.

Decision Making↗
PubMedDate not supplied

Extending the concept of primary and scatter separation to the condition of electronic disequilibrium.

A major deficiency of current photon calculation methods that are based on the concept of primary and scatter separation is their inability to handle the condition of electronic disequilibrium. This deficiency is examined and it is shown that the limitation is not inherent in the algorithms themselves but is, at least in part, in the data which the algorithms use. A new concept of primary and scatter separation is developed to cover the condition of electronic disequilibrium. This new concept requires little change to the existing algorithms and only additional data are required, which are generated using Monte Carlo calculation methods. The new concept is tested using programs in the Theratronics Theraplan treatment-planning system, and two calculation examples illustrate the ability to model electron transport and also the improvement over the existing algorithms. Close analogy of the extended concept with the convolution/superposition method of dose calculation is also indicated.

Algorithms↗
PubMed1997

Reporting and analyzing dose distributions: a concept of equivalent uniform dose.

Modern treatment planning systems for three-dimensional treatment planning provide three-dimensionally accurate dose distributions for each individual patient. These data open up new possibilities for more precise reporting and analysis of doses actually delivered to irradiated organs and volumes of interest. A new method of summarizing and reporting inhomogeneous dose distributions is reported here. The concept of equivalent uniform dose (EUD) assumes that any two dose distributions are equivalent if they cause the same radiobiological effect. In this paper the EUD concept for tumors is presented, for which the probability of local control is assumed to be determined by the expected number of surviving clonogens, according to Poisson statistics. The EUD can be calculated directly from the dose calculation points or, from the corresponding dose-volume distributions (histograms). The fraction of clonogens surviving a dose of 2 Gy (SF2) is chosen to be the primary operational parameter characterizing radiosensitivity of clonogens. The application of the EUD concept is demonstrated on a clinical dataset. The causes of flattening of the observed dose-response curves become apparent since the EUD concept reveals the finer structure of the analyzed group of patients in respect to the irradiated volumes and doses actually received. Extensions of the basic EUD concept to include nonuniform density of clonogens, dose per fraction effects, repopulation of clonogens, and inhomogeneity of patient population are discussed and compared with the basic formula.

Cell Division↗
PubMed1999

Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study.

OBJECTIVES: To assess whether bacterial vaginosis affects the rates of conception and miscarriage in the first trimester. DESIGN: Cohort study. SETTING: Assisted conception unit of a teaching hospital in Leeds. PARTICIPANTS: 867 consecutive women undergoing in vitro fertilisation. INTERVENTIONS: Screening for bacterial vaginosis with a Gram stained vaginal smear before egg collection. MAIN OUTCOME MEASURES: The presence of bacterial vaginosis or normal vaginal flora, and the rate of conception and miscarriage in the first trimester. RESULTS: 190 of 771 (24.6%) women had bacterial vaginosis. No difference in conception rate was found between those women with bacterial vaginosis and those with normal vaginal flora: 61 women (32.1%) and 146 of 493 women (29.6%) respectively (relative risk 1. 08, 95% confidence interval 0.85 to 1.39; odds ratio 1.12, 0.77 to 1. 64). However, 22 women (31.6%) with bacterial vaginosis who conceived had a significantly increased risk of miscarriage in the first trimester compared with 27 women (18.5%) with normal vaginal flora (crude relative risk 1.95, 1.11 to 3.42; crude odds ratio 2.49, 1.21 to 5.12). This increased risk remained significant after adjustment for factors known to increase the rate of miscarriage: increasing maternal age, smoking, history of three or more miscarriages, no previous live birth, and polycystic ovaries (adjusted relative risk 2.03, 1.09 to 3.78; adjusted odds ratio 2.67, 1.26 to 5.63). CONCLUSIONS: Bacterial vaginosis does not affect conception but is associated with an increased risk of miscarriage in the first trimester in women undergoing in vitro fertilisation, independent of other risk factors.

Abortion, Spontaneous↗
PubMedDate not supplied

Representing nursing activities within a concept-oriented terminological system: evaluation of a type definition.

OBJECTIVE: A type definition, as a component of the categorical structures of a concept-oriented terminology, must support nonambiguous concept representations and, consequently, comparisons of data that are represented using different terminologies. The purpose of the study was to evaluate the adequacy and utility of a proposed type definition for nursing activity concepts. DESIGN: Nursing activity terms (n = 1039) from patient charts and intervention terms from two nursing terminologies (Home Health Care Classification and Omaha System) were decomposed into the attributes of the proposed type definition-Delivery Mode, Activity Focus, and Recipient. MEASUREMENTS: Attributes of the type definition were coded as present or absent for each term by multiple raters. In addition, Delivery Mode was rated as Explicit or Implicit and Recipient was rated as Explicit, Implicit, or Ambiguous. The data were summarized using descriptive statistics. Inter-rater reliabilities were calculated for each attribute of the type definition. RESULTS: All attributes of the type definition were present in 73.9 percent of the chart terms, 91.3 percent of Home Health Care Classification intervention terms, and 63.5 percent of Omaha System intervention terms. While Delivery Mode and Activity Focus were almost universally present, Recipient was problematic. It was rated as ambiguous in 4.8 percent of the chart terms, 8.7 percent of Home Health Care Classification intervention terms, and 36.5 percent of Omaha System intervention terms. CONCLUSIONS: The study findings supported the adequacy and utility of the type definition. Further research is needed to refine the type definition and its use for representing nursing activity concepts within a concept-oriented terminological system.

Evaluation Studies as Topic↗
PubMed2005

Illness, disease, and sickness absence: an empirical test of differences between concepts of ill health.

OBJECTIVES: In studies of public health and morbidity different concepts of ill health are often seen as interchangeable alternatives. With the help of extensive population information this research intends to show how different concepts and measurements produce very different pictures of health and ill health. The concept trilogy of "illness," "disease," and "sickness" is used to capture different aspects of ill health. DESIGN: Cross sectional data were obtained through comprehensive interview surveys 1988-2001 and registers of sickness absence. Because of lack of data some years had to be excluded. SETTINGS: Swedish population. PARTICIPANTS: Annual data for around 3500 employed and self employed persons. MAIN RESULTS: Most people have some sort of illness or complaint. Fewer could be registered with a disease. Even fewer had been on sick leave. The overlap was fairly low. There also was an obvious discrepancy between reporting having a disease and a subject's rating of general health. It was shown that the different concepts showed different trends over time. CONCLUSIONS: The discrepancies between the concepts imply that you have to be very careful when using public health data to illustrate different aspects of morbidity. The comparatively low degree of overlap between them shows that they represent different realities. There is a need to do further empirical research about how different aspects of morbidity are interrelated. Their lack of interrelation seems to be an important research area worth developing further.

Adolescent↗
PubMed2006

Influence of family type and parenting behaviours on teenage sexual behaviour and conceptions.

BACKGROUND: Longitudinal data were used to explore relations between teenage pregnancy, sexual behaviour, and family type. The study examined whether students from lone parent and/or teenage mother initiated families more commonly report sex, lack of contraception at first sex, and/or conceptions by age 15/16, and whether such associations can be explained by low parental strictness, difficult parent-child communication, and/or low parental input into sex education. Up to date longitudinal UK research on family influences on conceptions is lacking, as is longitudinal research on family influences on sexual behaviour. No previous studies have comprehensively examined effects of parenting behaviours. Unlike previous research, this study tested theories suggesting that parenting deficits among lone parent and teenage initiated families increase risk of teenage pregnancy among their children. METHODS: Secondary analysis of data from a trial of sex education. RESULTS: Girls and boys from lone parent families or having mothers who were teenagers when they were born were more likely to report sex but not lack of contraception at first sex by age 15/16. Girls and boys with mothers having them as teenagers, and boys but not girls from lone parent families, were more likely to report being involved in conceptions by age 15/16. Only the association between teenage mother family and girls' conceptions was reduced by adjusting for a parenting behaviour measure. CONCLUSIONS: Students from lone parent families or having mothers who were teenagers when they were born are more likely to report early sexual debut and conceptions by age 15/16, but this is not generally explained by parenting style.

Adolescent↗