Nursing Concept Analysis
Applications to Research and Practice
1: Concept Analysis
The basis of theoretical thinking in nursing lies in delineation of the concepts that are relevant to the discipline. While the metaparadigm concepts of persons, environment, health, and nursing are central to the disciplinary perspective, it is important for nurse scholars and clinicians to draw from these four basic concepts and thus further explicate nursing knowledge to guide research and professional practice.
The concepts that are chosen for further explication and refinement are often the result of the background of the nurse scholar, whether in direct patient care with specific patient populations or in nursing administration, attending to system designs and processes. The challenge of the broad disciplinary perspective of nursing is in further refining the knowledge base so that it can practically guide research and practice. While concept labels may be the same across disciplines, it is important to distinguish any specific disciplinary perspective on the concept. Once this disciplinary perspective is made explicit, it will guide further development of nursing research and professional practice. In the chapters that follow, it is apparent that some of the concepts could be used in a range of disciplines. As an example, anxiety is a concept that has relevance to a wide range of disciplines, perhaps all of the biobehavioral disciplines. In the explication within the discipline of nursing, each of the concepts is considered within one of the key concepts in the metaparadigm of nursing (persons, environment, health, nursing) or the interrelationships among these concepts. In the case of anxiety in the concept analysis included here, the defined cases serve to embed the concept within the nursing discipline through the relationship to the metaparadigm concepts. Several of the chapters also can be used to illustrate this disciplinary perspective.
The basic purpose of concept analysis methodology is to distinguish between concepts, and thus to clarify the relationships and the distinguishing characteristics between concepts. For example, anxiety and fear are often used interchangeably within general discourse, and in fact some of the consequences of both anxiety and fear may be the same (e.g., increased blood pressure due to vasoconstriction). Yet, the essential characteristics of anxiety and fear are not the same, and the two concepts are defined differently both in the scientific literature and in general use. For both scientific and professional practice interventions, it is important to more precisely define the concepts that are important for understanding and interventions.
Concept analysis provides the methodology for this evaluation. Concept analysis serves to clarify overused concepts, and provides a standard language for mutual understanding within a discipline. Furthermore, concept analysis leads to a specific measurable definition of a concept and/or identifies the gaps in knowledge and in measurement that should be undertaken in future theoretical work.
Methods of Concept Analysis
A number of different concept analysis methodologies are described in the scientific literature. The methodology for concept analysis can be traced to the work of Wilson (1963), who delineated the methodology as an important step to gain scientific and conceptual clarity to guide research. Within the nursing discipline, concept analysis began in the early 1990s, and included the models developed by Rodgers and Knafl (1993), Walker and Avant (1994), Morse (1995), and Chinn and Kramer (1995). All of these methods of concept analysis appear in the nursing science literature, as do a wide range of nursing concept analysis papers.
The Walker and Avant (1994) method of concept analysis is the most frequently used method in nursing and was chosen as the basis for analyzing the core concepts selected for analysis. The Walker and Avant method includes several steps, each of which is described here. The first step is to select a concept. This is followed by a review of the recent literature to determine all of the uses of the concept. An important next step is to identify the defining attributes of the concept: those characteristics that are essential to the concept. A definition of the concept is derived from the critical defining attributes. This definition includes all of the defining attributes and specifically excludes other elements related to the concept. Then, a number of cases are constructed to illustrate how the concept is used. Within this book, it was deemed important for the cases to be explicitly related to nursing professional practice. The additional types of cases that are included in each of the chapters include related cases, borderline cases, and contrary cases. Following the description of the various types of cases, both the antecedents and the consequences of the concept are delineated. Antecedents are those factors, derived from the literature, that precede the occurrence of the concept. The consequences also are derived from the literature and represent those factors that result from the concept. The last step in the process of concept analysis is the identification of empirical referents, or ways to measure the concept.
It is important to further describe the types of cases that are used in the concept analysis process. The model case describes a real-life example of the use of the concept that includes all of the critical attributes of the concept. In the model cases described in each of the chapters, there is specific notation of each of the defining attributes within the case. That is, in the specific component of the case that illustrates each of the defining attributes, a notation of that defining attribute is made in parentheses. The related cases are cases that are related to the concept but do not necessarily include the defining attributes. Related cases may include some of the defining attributes, but also may include some attributes that are commonly mistaken for the defining attributes of the concept. The borderline case includes some, but not all, of the defining attributes. In the examples in the chapters that follow, in each borderline case each of the defining attributes that is present is identified in parentheses. One or more of the defining attributes is missing. In each case, this is identified by the term failed for each of the attributes that is not present. Contrary cases do not include any of the defining attributes of the concept. In related and contrary cases described in each of the chapters, the authors have noted the defining attributes that are present. The defining attributes that are not present are indicated as failed attributes.
In this book, each of the cases described in the concept analyses are embedded in nursing science development (research) or professional nursing practice. Further, the concepts are categorized as to whether they are presented with specific reference to the recipient of care, the individual patient/client, the carer (nurse), or the organization in which the nurse works. The specific categorization is reflected most explicitly in the cases provided.
Summary
The concept analysis process is an important stage in theory development. It helps the scientist refine the concepts under study and thus further refine the disciplinary content. Such deliberative analysis of nursing content helps to move both the science and professional practice to a new stage of development.
References
- Chinn, P. L., & Kramer, M. K. (1995). Theory and nursing: A systematic approach. St. Louis, MO: Mosby.
- Morse, J. M. (1995). Exploring the theoretical basis of nursing using advanced techniques of concept analysis. Advances in Nursing Science, 17, 31–46.
- Rodgers, B. L., & Knafl, K. A. (Eds.). (1993). Concept development in nursing: Foundations, techniques, and applications. Philadelphia, PA: Saunders.
- Walker, L., & Avant, K. C. (1994). Strategies for theory construction in nursing (3rd ed.). Norwalk, CT: Appleton & Lange.
- Wilson, J. (1963). Thinking with concepts. Cambridge, UK: Cambridge University Press.