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What are the advantages of concept analysis in relation to theory development? Are there disadvantages? Why or why not? Concepts are the basic building blocks of scientific knowledge or theoretical frameworks for any discipline. The strength of the theories that guide a discipline is dependent on the quality of the concept analysis. Thus, the utilization of poorly understood concepts in research and theory development will result in questionable reliability and validity. Concept analysis is associated with the research design of philosophical inquiry. The purpose of philosophical inquiry is to perform research using intellectual analysis to clarify meaning. Concept analysis is applicable and relevant to terms that have been used across disciplines, for long or short periods of time, and in emerging and evolving areas of research (Risjord, 2009). Traditionally, no empirical (qualitative or quantitative) investigations were used to clarify the meaning of concepts. The lack of empirical investigation to clarify concepts, results in certain limitations in the methodology of concept analysis. It seems that methodological innovations for enhancing concept analysis are urgently required. Many methods of concept analysis presuppose that the meaning of a concept depends on context. This context has epistemological and ontological consequences. Epistemologically, justifying a proposed set of defining attributes requires showing that the attributes explain the contextual pattern of use. Ontologically, concepts change their meaning as the theoretical contexts change. This means that concepts can only be developed as part of larger theories. Theory development requires a commitment to moderate realism and so, concept development also presupposes moderate realism. There are two forms of concept analysis: theoretical and colloquial. Each has its own purpose and evidence. The two forms can be used together and some theoretical developments will require both. Concept analysis must be based either on scientific literature or on colloquial usage. Concept analysis is not prior to theory development, but it must be part of theory development. It makes the meaning of a concept explicit, so that it can be part of testable and practical nursing theories. Risjord, M. (2009). Rethinking concept analysis. Journal of Advanced Nursing 65(3), 684 691.Retrieved October 1, 2013, from http://www.ncbi.nlm.nih.gov. RESPONSES While nursing has embraced the use of concept analysis as a valid and significant opportunity into an area of research, methodological development has created strategies of inquiry that vary in purpose and in the nature of their findings. Although multiple methods of concept analysis are available, all methods are not equal in producing analytic results that serve researchers in processing subsequent methodological decisions for research that extends the science of nursing. Concepts may be described as ordinary or everyday (meaning a cognitive formation that results through natural human processes that occur through being in the world with others) or scientific (meaning abstractions that are developed into more precise meaning units that, when linked together, propositionally form a theoretical representation of empiricallyexperienced reality). Concept analysis methods might focus on quantitative techniques, qualitative techniques, or a mix of these techniques. For example, a concept could be analyzed using quantitative meta analysis or psychometric testing of measurement tools. www.researchgate.net/...concept_analysis/.../d912f506e33ca90c12.pdf As in most forms, the first phase of principlebased concept analysis is to determine the concept of interest and to collect the scientific literature from disciplines that are considered applicable to the inquiry. Then, this literature is treated as data that are assessed according to the criteria espoused by the epistemological, pragmatic, linguistic and logical principles. Finally, these assessments are integrated into a unified perspective on the current state of the scientific literature. Epistemological principle is the concept clearly defined and well differentiated from other concepts. Pragmatic principle is the concept applicable and useful within the scientific realm of inquiry. Linguistic principle is the concept used consistently and appropriately within context. Logical principle: does the concept hold its boundaries through theoretical integration with other concepts. Which theories—less conceptual and more factual—are more userfriendly in the practice setting? Why? Comfort Theory is presented as a pattern for providing holistic care to patients and families in all health care settings. For nurses who are working on clinical ladders or small research proposals in school, Comfort Theory provides a framework to design their study. Comfort Theory is easy to understand and learn because we all are familiar with our own needs for comfort, how comfort strengthens us for difficult tasks ahead, and what kinds of things or actions make human beings more comfortable compared to a previous state. Once the theory is understood, it becomes an intuitive part of nurses' assessment, intervention, and evaluation for either practice or research. The concept of valuebased health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Valuebased purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the bestperforming providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved. In a system based on value based purchasing, employers and other purchasers gather and analyze information on the costs and quality of various competing providers and health plans. They contract selectively with plans or provider organizations based on demonstrated performance, or at least proposed approaches for improving performance. Ideally, quality information becomes a factor in the setting of plan prices, and employee contributions vary with each plan's "score," which reflects a combination of quality and cost indicators. In this manner, the best performing plans and providers are rewarded with greater volume of enrollees or patients. http://www.ahrq.gov/legacy/qual/meyerrpt.htm RESPONSES Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific interrelationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing. Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study. Theoryguided, evidencebased practice is the hallmark of any professional discipline. Nursing is a professional discipline and almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts. A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline. A general system theory describes how to break whole things into parts and then to learn how the parts work together in systems. These concepts may be applied to different kinds of systems, such as molecules in chemistry, cultures in sociology, organs in Anatomy and health in Nursing. Adaption theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. The progress and behaviors of an individual within each stage are unique. Nursing, with its historical roots in practice, has tended to have an uneasy relationship with theory. Whilst the benefits of theory to nursing have been propounded by many commentators, it remains that theory all too rarely informs nursing practice. Grounded theory is explained as a package of research methods, which includes data collection, coding and analyzing through memos, theoretical sampling and sorting to writing, using the constant comparative method. It uses a variety of data sources, including quantitative data, review of records, interviews, observation and surveys. Group theory has origins in sociology, emphasizes the importance of developing an understanding of human behavior through a process of discovery and induction. A grounded theory approach provides nursing with a viable means of generating theory grounded in the realities of everyday clinical practice. Grounded theory is increasingly being used in research practice, particularly in nursing research. Nolan, M. and Grant, G. (2002). http://www.ncbi.nlm.nih.gov/pubmed/1556330 Whether theories are grand or mid range (MR), they organize disciplinary thinking and influence practice and research. By definition, grand theories are abstract, complicated, and removed from practice. They are not meant to be easily grasped or tested. Compared with grand theories, MR theories contain fewer concepts and relationships, are adaptable to a wide range of practice and experience, can be built from many sources, and are concrete enough to be tested. For these reasons, MR theories are particularly cogent as nursing science addresses the challenges of the 21st century. MR theories are helpful for meeting numerous challenges because they are concrete, adaptable, and easy to use. MR theories also direct the questions to be asked and facilitate significant, positive outcomes because of the congruency that working within a theory necessitates. The theory states that, in stressful health care situations, unmet needs for comfort are met by nurses. Nursing interventions are successful if enhanced comfort is achieved by patients compared with a previous baseline. The immediate patient outcome of enhanced comfort is theoretically strengthening. Kolcaba, Katharine. (2000). http://thecomfortline.com/files/pdfs/2001%20%20Evolution%20of %20the%20Mid%20Range%20Thoery%20of%20Comfort%20for%20Outcomes %20Research.pdf Nurses trust American Nurses Association (ANA) because of our dedication to standards, guidelines, and principles. They work hard to elevate the nursing profession by defining the values and priorities for registered nurses across the nation. Through this work, ANA can provide direction to nurses across the nation, influence legislation, and implement a framework to objectively evaluate nursing excellence. The public has a right to expect registered nurses to demonstrate professional competence throughout their careers. ANA believes the registered nurse is individually responsible and accountable for maintaining professional competence. The ANA further believes that it is the nursing profession’s responsibility to shape and guide any process for assuring nurse competence. Regulatory agencies define minimal standards for regulation of practice to protect the public. The employer is responsible and accountable to provide an environment conducive to competent practice. Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders. American Nurses Association. (2008). http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingS tandards/ProfessionalRoleCompetence.html. Medical and health care is one of the most dynamic human disciplines, and large amounts of money are spent annually on highquality and sophisticated research, resulting in an exponential growth in health care literature. Regularly, new and more effective medicines, medical devices, and procedures are invented. One major objective behind all these efforts is to help doctors, nurses, and medical technicians provide the best possible care and treatment to patients. In addition to using traditional and wellestablished procedures and practices, health care practitioners are adopting innovative interventions that are based on best practices as well as solid researchbased evidence. Evidencebased practice (EBP) is one such technique and is quickly gaining popularity due to its potential to effectively handle clinical issues and provide better patient care. A number of studies investigating nurses' perceptions show that nurses generally view EBP positively and consider it important to better patient care. Nevertheless, it is a fact that the pace of accepting and implementing EBP is rather slow. Several previous studies have tried to investigate possible barriers to adopting EBP. One barrier that some studies revealed was the enormous amount of health care literature, published in a variety of sources, which makes it almost impossible for individual medical professionals to keep up to date. Shaheen, Majiid. (2011). Adopting evidencebased practice in clinical decision making: nurses' perceptions, knowledge, and barriers. Retrieved October 7, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901. What are some theorists’ views on theorydriven, evidencebased practice? How do their views compare? To appreciate nursing theory and understand its benefits, it is necessary to take an overview of sampled theories. Nursing theories for individuals consideration can include human caring theory by Jean Watson, PhD, RN, AHNBC, FAAN; caring theory by Anne Boykin, PhD, RN, and Savina O. Schoenhofer, PhD, RN; the human becoming school of thought by Rosemarie Rizzo Parse, PhD, RN, FAAN; selfcare deficit nursing theory by Dorothea Orem, MSN, Ed, RN; and the science of unitary human beings by Martha Rogers, MPH, RN. Caring is the most important aspect of nursing. Watson's caring model is based on characteristics, caritive processes, which formulate a path in the discipline of nursing that provides guidance to the nurse and the discipline as a whole toward a fundamental focus on caring. According to Watson, caring occurs when the nurse enters into the experience of another person, and another can enter into the nurse's experiences. Boykin & Schoenhofer's caring theory takes caring to the direct relationship between the nurse and the nursed. The nursing as caring theory focuses on nursing as a discipline and profession that consists of nurturing people living and growing in caring. Parse's theory focuses on the individual's lived experiences and the environment. The human becoming theory emphasizes that nursing is a human science that should stress the process, meaning and value of human experiences. Orem's selfcare theory guides nurses to assist in meeting deficits whether based only on the cognitive or also on the technical. Orem focused on capabilities or action and selfmanagement.8 Rogers' theory of unitary human beings is filled with ideas and abstract concepts that take the nurse's knowledge beyond situational practice. Rogers challenges nurses to view nursing as understanding and caring for human beings in the wholeness and mutuality of the person environment process rather than as isolated actions and responses in a limited cause and effect manner. Gonzalez, Roxana. (2008). Practice with Meaning. Advance Health Network. Retrieved October 10, 2013, from http://nursing.advanceweb.com. How do conceptual models and theories apply to research practice? Researchers use conceptual models or theoretical frameworks to provide an organizing structure for their studies, to guide the development and testing of hypotheses, and to place research finding within the context of science. Selection of an appropriate and useful framework is an essential step in the development of a research project. Conceptual models are composed of abstract and general concepts and propositions that provide a frame of reference for members of a discipline. This frame of reference determines how the world is viewed by members of a discipline and guides the members as they propose questions and make observations relevant to the discipline (Fawcett, 1994). The concept models and theories of nursing represent various paradigms derived from the meta paradigm of the discipline of nursing. Therefore, although each of the conceptual models might link and define the four metaparadigm concepts differently, the four metaparadigm concepts are present in each of the models. Many conceptual models have developed from the meta paradigm of nursing. Subsequently, multiple theories have been derived from each conceptual model in an effort to describe, explain, and predict the phenomena within the model. Fawcett, J. (1994). Analysis and evaluation of conceptual models of nursing. Philadelphia, PA: F. A. Davis. The theoretical foundation of the Nursing Service Delivery Theory (NSDT) is Open System Theory as applied to largescale organizations by Katz and Kahn (2001). In their view, an organization constitutes an energic input–output system. An organization depends on its supporting environment for continued inputs to ensure its sustainability and processes these inputs through the recurring and patterned activities and interactions of individuals to yield outputs. An organization is therefore essentially a social system. As such, an organization and its subsystems strive to achieve a dynamic steady state whereby regularities in energy flow preserve the character of the system and disturbances prompt system adaptation (Katz & Kahn, 2001). To survive, an organization needs to counteract entropy, which is an inevitable process of disorder and dissolution caused by loss of inputs or by inability to transform energies. An open system must acquire negentropy (i.e. negative entropy), usually through some form of storage capacity, to ensure its continued existence (Katz & Kahn, 2001). For organizations, negentropy can involve renewing inputs, storing energy, creating slack resources, or maximizing imported energy relative to exported energy. Organizations can also counteract entropy by adapting system functioning in response to informational signals and feedback from the environment. Katz, D. & Kahn, R. L. (2001). The Social Psychology of Organizations. 2nd edn. New York: John Wiley and Sons. Retrieved October 12, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017742/. Qualitative Research: Empirical and Analytical Methods Research can be classified into two broad categories: qualitative and quantitative. The choice depends on the type of research question. Both research categories are designed to build knowledge, and can be used in a complementary fashion. Qualitative research describes methodologies that use an inductive process to explore issues, investigate phenomena, and understand peoples’ interpretations in a holistic fashion. Inductive reasoning is reasoning from small observations to general principles or a larger theory. This method of inquiry generates rich, detailed comprehensive information. Using a flexible design, it investigates variables under natural conditions in the setting in which they are found. The goal is to capture a phenomenon as it naturally unfolds. It is a nonstatistical method of inquiry, in which themes and categories emerge and data are categorized into patterns. Samples are small and purposively selected. The researcher is the primary data collection instrument. Quantitative research, on the other hand, gathers and analyzes numerical data, using deductive reasoning. Deductive reasoning starts with a general principle and moves to the particular. This method of inquiry investigates phenomena using precise objective measurement and quantification, often with a rigorous and controlled design. It is characterized by a deductive approach, standardized measures, highly structured instruments, and large samples to collect data for hypothesis testing and constructing statistical models. Grounded theory is a systemic process for discovering, developing, refining, or testing theory using any kind of data. This is in contrast to quantitative research, which seeks to verify hypotheses, rather than generate theory. This methodology combines both theory and research, in that it fundamentally seeks explanations for phenomena. This type of qualitative research can produce substantive theory (limited areas of inquiry) or formal theory (more abstract concepts) using patterns, themes, and common categories derived from the data. The theory should be grounded in the research and backed by the data. The ultimate goal of grounded theory is to move from substantive to formal theory. http://allnurses.com/researchnursing/qualitativeresearchempirical757691.html Nursing theory refers to the body of knowledge that supports nursing practice. In practical terms, nursing theory helps nurses think about what they do and why they do it. Without a theoretical framework to guide practice, a profession is like a ship without a rudder, randomly changing course and not always reaching its destination. Most importantly, individual members of a profession need to have a unified view of what comprises the heart of their practice. A theoretical framework provides nurses with clarity of purpose, strengthens professional identity and guides research and professional development. Nursing research studies that continue to build an evidence base for nursing practice are designed using a nursing theoretical model. Many nursing theories have been developed in the past several decades, and today’s nursing scholars continue to propose new models that promote nursing practice excellence. Theory development helps nurses view their practice in a deeper and more insightful way, organizes nursing knowledge and results in discovering important new ways to advance nursing practice. Theoretical works in nursing can be classified as philosophies, grand theories or conceptual models, middle range theories and practice theories. A nursing philosophy describes personal beliefs or a worldview. Examples of nursing philosophies include Jean Watson’s Philosophy and Theory of Transpersonal Caring and Patricia Benner’s Philosophy of Caring, Clinical Wisdom and Ethics in Nursing Practice. Grand theories consist of conceptual frameworks that provide broad practice perspectives. A theory can have a specific focus or be used in a broad range of practice settings. For example, Madeleine Leininger’s Culture Care Theory of Diversity and Universality focuses on human cultural care and has broad applicability to all nursing practice settings. Habel, Maureen. (2013). Nursing Theory. http://ce.nurse.com/content/ce632/nursingtheory/ Middle range theories are concerned with an area of interest within a discipline. A middle range theory is not as broad as that of a grand theory. Middlerange theory fills the gaps between abstract grand theories and nursing practice. Examples of middlerange nursing theories include Ramona Mercer’s Theory of Maternal Role Attainment, which focuses on the maternal role through pregnancy, and Katherine Kolcaba’s Theory of Comfort. Practice theories that nurses use to address specific patient problems are the least abstract of nursing’s theoretical works. Practice theories can focus on specific elements of specialty practice, e.g., pediatric nursing. The development of additional theories at the middlerange and practice level that can be readily incorporated into practice is a challenge facing the profession of nursing today. SelfCare Deficit Nursing Theory Dorothea Orem’s SelfCare Deficit Nursing Theory consists of three interrelated theories, the theory of selfcare, the theory of selfcare deficit and the theory of nursing systems. Selfcare comprises activities performed independently by a person to sustain life, health and wellbeing. Selfcare agency refers to a person’s ability to perform selfcare activities. Selfcare deficit occurs when the person is unable to perform selfcare activities. The nurse then meets selfcare needs by acting or doing for, guiding, teaching, supporting or providing an environment to promote patient selfcare abilities. Selfcare deficit is the basic reason people need nursing care. The theory of nursing systems describes a composite of the nurse’s actions on behalf of the patient, ranging from total care to education and advocacy. In a wholly compensatory system, the patient is dependent on the nurse to meet all selfcare needs. In a partially compensatory mode, the patient can meet some of his or her needs for selfcare agency, but needs assistance from the nurse to maintain health and well being. As the patient regains more ability to engage in selfcare activities, the nurse functions in a supportiveeducative mode. For example, when a patient has a large burn injury, he or she may be unable to perform any of the selfcare activities necessary for health. The level of care and type and extent of injury can be correlated to Orem’s systems. When nurses provide total selfcare to a patient in an intensive burn care environment, the nurse is functioning from within Orem’s wholly compensatory framework. Minor burns are treated with less intense nursing intervention. As the patient and family members, as appropriate, are encouraged to take part in dressing changes and other care activities, the nurse is functioning in a partially compensatory mode. Nurses who care for patients who have experienced burns may also follow the care of patients after hospital discharge through wound centers and support groups. Some burn nurses provide postburn education to schools and industry as patients return to preburn activities. This level of care is consistent with the educativedevelopment system within Orem’s framework. Orem’s SelfCare Model is useful for patients with multiple chronic health conditions and has been used in many practice settings. Her theory can help the nurse focus on the strengths and challenges of the selfcare agent rather than on the disease process. For more information on Orem’s theory, go to the website of the International Orem Society for Nursing Science and Scholarship (www.oremsociety.com). http://prezi.com/jzq0yhxqqm5n/grandnursingtheories/ Adaptation Model Sister Callista Roy’s Adaptation Model views a person as comprising interrelated biological, psychological and social systems. The person continuously seeks to maintain a balance between each of these systems and the external environment. The person is an open, adaptive system who uses coping skills to deal with stressors. The goal of nursing is to promote the person’s adaptation during health and illness during using four adaptation modes: the physiological mode, the selfconcept mode, the role function mode and the interdependence mode. The focus of the physiologic mode is on basic survival needs such as nutrition, oxygen, fluids and temperature regulation. The selfconcept mode includes psychological integrity, including perceptions of the physical and personal self. The nurse assesses the degree to which patient and family actions in each mode are leading to positive adaptation to the focal stimuli. Three types of stimuli, focal, contextual and residual, influence a person’s ability to cope with environmental demands. Focal stimuli are those that immediately confront the individual in a particular situation. Contextual stimuli are those that influence the situation. Residual stimuli include the individual’s beliefs or attitudes that may influence the situation. Adaptation occurs when the total stimuli falls within the person’s/family’s adaptive capabilities. The nurse assesses the contextual and residual stimuli associated with the focus stimulus to evaluate whether positive coping can occur and to predict when the nurse needs to intervene to promote adaptation. Roy also proposes two types of coping mechanisms, known as regulator and cognator subsystems. The regulator subsystem responds automatic physiological processes while the cognator subsystem responds through innate and acquired processes, including cognitive and emotional reactions that include perceptual and information processing, learning, judgment and emotion. If coping and adaptation are inadequate to achieve and maintain health, the nurse assesses the types of stimuli and the effectiveness of the regulator subsystems in order to plan nursing interventions that increase adaptation. The Roy Adaptation Model has had a great influence on nursing. http://www.researchgate.net/post/What_is_most_useful_to_clinical_nursing_practice_grand_spe cific_or_midrange_theories2 Philosophy and Science of Caring The main focus of Jean Watson’s Philosophy and Science of Caring is human caring. Watson proposes seven assumptions about nursing. First, caring is effectively demonstrated and practiced through an interpersonal relationship between the nurse and the patient. Second, caring consists of caring factors that help satisfy human needs. Third, effective caring promotes health and individual growth or family growth or both. Fourth, the nurse’s caring responses accept the patient not only as he or she is in the present, but as what he or she may become. Fifth, a caring environment promotes the development of human potential while allowing the person to choose the best action for him or herself at a given time. Sixth, caring is more “healthogenic,” i.e., producing human health, than curing; a science of caring is complementary to the science of curing. Last, the practice of caring is central to nursing. In Watson’s view each person is a human being to be valued, cared for, respected, nurtured, understood and assisted within his or her environment. Health is described as complete physical, mental and social wellbeing and functioning. Nursing’s focus is to promote and restore health. Watson describes 10 factors which relates to care that nurses use in their relationships with patients: forming a humanisticaltruistic value system, instilling faith and hope, cultivating sensitivity to self and others, developing healthtrust relationship, promoting expression of feelings, using problemsolving for decision making, promoting teachinglearning, promoting a supportive environment, assisting with gratification of human needs and allowing for existential phenomenological forces. The first three caring factors form the philosophical basis for the science of caring. Watson points out that the caring behaviors that are the essence of nursing are being threatened by the tasks and technology demands of curative factors. Many healthcare organizations have adopted Watson’s model as their theoretical practice framework. http://www.conursing.uobaghdad.edu.iq/uploads/others/conursing/leacture/theory.pdf What is the link between concepts and theories? Theories require a prior conceptual model that expresses a particular philosophical view about how concepts and theories are related. Concepts would be prior to, and independent of, theories. This idea conflicts with another tendency within nursing thought. The content of a concept, it is often said, depends on the context. If concepts are contextual, then they are neither prior to nor independent from theories. One way to phrase the dilemma is whether concepts are theory formed or theory forming. The problem is more than an issue about levels of theory; it has consequences for the way in which theories are developed in nursing. If concepts are theory forming, then it makes sense to articulate concepts prior to (or as an initial phase of) developing theories, advice which is often given in textbooks on theory development in nursing. On the other hand, if concepts are contextual, concepts could only be developed as parts of theories, and the textbook advice to begin by inventing concepts would make no sense. http://userwww.service.emory.edu/~mrisjor/documents/PartV.pdf How are theories tested? Theory testing is an important phase in nursing theory development. Testing of theory is intended to give more information about concepts and their usefulness in nursing practice. Confirmatory factor analysis is commonly used in instrument development in nursing science studies, but also in theory testing. However, there has been little discussion of its use in theory testing in nursing science research. The aim of confirmatory factor analysis is to test nursing theory that has already been established, i.e. researchers have an a priori hypothesis based on theoretical knowledge or empirical indications. Analysis is represented as three phases: preparation, model testing and reporting the results. Preparation involves data screening and preliminary analyses. Model testing is divided into model specification, model identification, model estimation, model evaluation and model modification. The results are reported with standardized regression coefficients of the items related to the latent variables, squared multiple correlations (R2) related to error terms and the model’s goodness of fit indexes. Testing of theory is intended to give more valid information about the concepts and their usefulness in nursing practice. Confirmatory factor analysis is a good method to test the structure of theory, for example to test the concepts built by concept synthesis or analysis. Tested theories are needed to develop nursing science itself. http://www.internationaljournalofcaringsciences.org/docs/Vol1_Issue1_02_Theofanidis.pdf Improvement Science The Improvement Science Research Network (ISRN) aims to accelerate the development and dissemination of interprofessional improvement science in a systems context across multiple sites. Across the country, healthcare experts, administrators, researchers, and clinicians are devising and testing new strategies to improve the safety and quality of patient care. Yet, while patient safety and quality improvement in bedside care are clearlystated national priorities, improvement science remains in a nascent stage, particularly in the area of multidisciplinary care processes within the hospital setting. The need for a largescale and multisite Improvement Science Research Network has long been evident to healthcare practitioners. While a solution in the form of a national research network seemed logical and desirable, the resources required to develop human capacity and collaborative technology infrastructure were largely unavailable. The unprecedented availability of sizable funding through the American Recovery and Reinvestment Act (ARRA) presented the unique opportunity to form such a network. On May 29, 2009, a plan was submitted to, accepted, and subsequently funded by the National Institute of Nursing and the National Institutes of Health, and the Improvement Science Research Network was created. http://www.isrn.net/https%3A/%252Fimprovementscienceresearch.net/about Theory Development in Informatics The lack of theorydriven research may not be surprising because nursing informatics is a young specialty that is just beginning to build a science. The discipline continues to struggle with definitions and has not yet prepared the critical mass of researchers to develop and test theory. In the United States, the list of informatics research priorities defined by the National Institute for Nursing Research (NINR) encourages research on particular problems, but does not (and appropriately so) provide a conceptual framework for that research. Nursing informatics is a combination of computer science, information science, and nursing science, designed to assist in the management and processing of nursing data, information, and knowledge to support nursing practice, education, research, and administration. Theories in Nursing Informatics A. Change Theories Computerization of information system involves change, moving from paperbased environment to a completely paperless environment. It can be minor or major change depending on the maturity of the previous system, most importantly the users of the information system. B. Information Theories 1. Blum's Theory Blum stated in 1986 that computer functions can be categorized into 3 groups: *data is processed *information is processed *knowledge is processed C. Cognitive Theory Cognitive science includes mental models, skills acquisition, perception and problem solving that adds an understanding of how the brain perceives and interprets a computer screen. June Kaminski. (2010). Retrieved October 17, 2013, from http://cjni.net/journal. Parsimony Theory While it appears that the term parsimony has been used in the context of qualitative research and qualitative research methodology, there is a distinct absence of writing that actually explores, seeks to define, understand, critique, apply and/or evaluate the concept in qualitative research literature. While there are currently no definitive criteria for determining the parsimony of qualitative research findings, it would be epistemologically inappropriate and philosophically incongruent to import and translate quantitative notions of parsimony. However, the ideas, principles and epistemological functions that parsimony serves can and should be applied to the qualitative paradigm. Cutcliffe and Harder suggest that more than one type of qualitative parsimony is required (2009). The authors advance the argument that there is a relationship between the degree of parsimony and the elegance, ease of accessibility and straightforwardness (some might say beauty) of the writing/findings; the level of expertise of the researcher; and the quality of the data collection interview (Cutcliffe and Harder, 2009). They also assert that there are a number of practices which, when adhered to, can enhance the parsimony of the findings and that here are a number of major implications arising from qualitative findings that lack parsimony. Cutcliffe, J. R. and Harder, H. G. (2009). The perpetual search for parsimony: enhancing the epistemological and practical utility of qualitative research findings. http://www.ncbi.nlm.nih.gov/pubmed/19523627 Environmental Model The environmental model of health emerged with modern analyses of ecosystems and environmental risks to human health. In this model is defined in terms of the quality of a person’s adaptation to the environment as conditions change. This model includes the effects in personal health of socioeconomic status, education, and multiple environmental factors. Unlike the medical model, which focuses in diseased organs and biological abnormalities, the environmental model focuses on conditions outside the individual that affect his or her health. This conditions include the quality is air and water, living conditions, exposure to harmful substances, socioeconomic conditions, social relationships, and the health care system. In many respects the environmental model of health is similar to ancient Asian and Native American philosophies that associate health with harmonious interactions with fellow creatures and the environment. In particular, as the environment changes, one’s interaction with it must change to remain in harmony. Illness is interpreted as disharmony of human and environmental interactions. http://www.thecommunityguide.org/social/socAJPMcmodellinksocenvrhealth.pdf Intellectual Standards for Reasoning Practitioners in nursing who are critical thinkers value and adhere to intellectual standards. Critical thinkers strive to be clear, accurate, precise, logical complete, significant and fair when they listen, speak, read and write. Critical thinkers think deeply and broadly. Their thinking is adequate for their intended purpose (Scriven, Norris & Ennis). All thinking can be examined in light of these standards and as we reflect on the quality of our thinking we begin to recognize when we are being unclear, imprecise, vague or inaccurate. As nurses, we want to eliminate irrelevant, inconsistent and illogical thoughts as we reason about client care. Nurses use language to clearly communicate indepth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant. Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas. Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest Publications, Critical Thinking Press. Elements of Reasoned Thinking Reasoning in nursing involves eight elements of thought. Critical thinking involves trying to figure out something; a problem, an issue, the views of another person, a theory or an idea. To figure things out we need to enter into the thinking of the other person and then to comprehend as best we can the structure of their thinking. This also applies to our own thinking as well. When I read an author I'm trying to figure out what the author is saying; what problem or issue the author is addressing, what point of view or frame of reference he is coming from, what the goal or purpose is of this piece of writing, what evidence, data or facts are being used and what theories, concepts, principles or ideas are involved. I want to understand the interpretations and claims the author is making and the assumptions that underlie his thinking. I need to be able to follow the author's lines of formulated thought and the inferences which lead to a particular conclusion. I need to understand the implications and consequences of the author's thinking. As I come to understand the author indepth I will also begin to recognize the strength and weakness of his reasoning. I will be able to offer my perspective on the subject at hand with a clear understanding of how the author would respond to my ideas on the subject. Paul, R.W. (1990). Critical Thinking: What Every Person Needs to Survive in a Rapidly Changing World. Rohnert Park, California: Center for Critical Thinking and Moral Critique. Enhancing the Effectiveness of Nurse Preceptors More than half of new graduate nurses start their careers in the hospital setting. Once there, they need an orientation that will help them make the transition from student to novice professional. It is just as important for experienced nurses transferring into another unit or hospital to be acculturated into the new work environment. Professional preceptor immersion courses (capstone) have become the standard as a means to prepare senior nursing students to enter the workforce. Preceptors have a significant role in developing the student nurse, yet exactly how to prepare preceptors for this role has been an ongoing discussion. This qualitative inquiry explored the educational needs of clinical registered nurse (RN) preceptors who work directly with senior nursing students in a professional precepted immersion (capstone) course. A descriptive qualitative design was used to examine preceptors responses to a prepared set of questions about their educational needs. Results showed that preceptors have three distinct sets of learning needs: the need to know the expectations of their role, wanting to know how best to role model for the student, and knowing how to socialize the student into the profession of nursing. Overall, preceptors communicated their desire and commitment to doing the best job possible. They also clearly stated their expectation of faculty to have a physical presence on the nursing unit that included being proactive in resolving mismatches and exposing the student to the roles of provider of care, leader and manager of care, and member of profession. Alspach, Grif. (2008). Calling All Preceptors: How Can We Better Prepare and Support You? Critical Care Nurse. Retrieved November 10, 2013, from http://ccn.aacnjournals.org/content/28/5/13.full. General education must emphasize the importance of feelings and thoughts related to the symptoms. Healthcare providers should focus on taking a thorough history when the common symptoms of ovarian cancer are voiced by women and acknowledge their health concerns. Consideration of women's thoughts and feelings in regard to the severity and onset of symptoms provides subjective data in the patients' history. Finally, education also should include empowerment strategies that promote confidence in women's knowledge of their bodies. A woman needs to have the confidence to be an advocate for herself. The nurse at the bedside or in the clinic can be the advocate for this woman by empowering her to verbalize her thoughts and feelings and by reminding the healthcare provider that common, benign symptoms can be the vague symptoms of ovarian cancer. Providers need to listen to the woman who voices her concern and investigate further if necessary. Healthcare providers need to tell women that getting older does not necessarily mean constant bloating, incontinence, and fatigue and investigate the symptoms further if they are a new onset or prolonged. Future research should include evaluation of education campaigns tailored for the public and healthcare providers. Evaluation is necessary for diverse populations. As evidenced by breast cancer awareness in the United States, public education campaigns can be effective if continuously marketed to the public. Therefore, the early signs and symptoms need to be broadcast to the general public. Smith, Anita. (2012). Signs of Aging or the Vague Symptoms of Ovarian Cancer? Oncology Nursing Forum. Retrieved November 10, 2013, from http://www.ncbi.nlm.nih.gov/pubmed.
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