Strategies for Concept Development and Analysis

As indicated in this week’s Learning Resources, concept analysis is an essential step in research and has significant implications for theory development.

Concepts may be abstract (e.g., caring) or relatively concrete (e.g., touch)—yet, in either case, the meaning of a concept depends on context. It is therefore critical to clearly define a concept that serves as a component of research or theory so that a shared language and common understanding can be developed.

For this Discussion, you will select a concept related to a practice problem of interest to you. You will then have an opportunity to explore how concept analysis applies to research involving this practice problem. Next week, you will consider how concept analysis relates to theory development.

To prepare:

• Brainstorm a list of concepts you use or see in practice that pertain to a practice problem of interest to you. Then select one concept to focus on for this Discussion.
• Using the concept analysis strategies presented in the Learning Resources, analyze your selected concept and clarify its meaning.
• With your selected concept in mind, formulate a research topic to address the related practice problem.

By Day 3 post a cohesive response that addresses the following:

• Identify the concept and the related practice problem that you have selected for this Discussion.
• Provide a summary of your concept analysis (sharing your clarified concept) and the related research topic.
• Describe the importance of this concept and research topic to nursing practice.

The patient is a 68-year-old man who sustained a head injury after falling in the bathroom. He arrives in the emergency department (ED) cheerful, alert, and oriented to person. On physical examination, he has a large hematoma on his left forehead. He reports a headache in the left temporal area, which he rates as an 8/10. His wife was present during the incident. Admission vital signs are: blood pressure, 170/92 mm Hg; pulse, 92 beats/min; respirations, 14 breaths/min; and temperature, 98.7° F. The physician orders a one-time dose of acetaminophen 650 mg orally for the patient’s headache, which the nurse promptly administers. The patient reports a pain level of 5/10 at 1 hour after the intervention. 

1. Why is it important to determine the circumstances of the fall for this patient? 

2. Discuss the importance of obtaining baseline behavior and information from the wife. 

3. The ED physician orders computed tomography (CT) of the brain for the patient. What is the purpose of this test, and what are the nursing responsibilities in preparing the patient for this procedure? 

4. Because the patient is at risk for increased intracranial pressure, explain how the patient should be positioned and moved in bed.

5. The CT and other diagnostic results are negative and the patient is diagnosed with a minor head injury and contusion to the right extremity. He is discharged to home. Review the patient teaching instructions that should be given to the patient and his wife. 

6. The wife appears unwilling to take her husband home and she states that she doesn’t understand the discharge instructions. What can the nurse do in this situation? 

7. Use the focus charting method (also known as the DAR method—data, action, response) to document the administration of acetaminophen, including appropriate follow-up. 

 one paragraph response for this post , add comment , information with citation and reference 

One of the opportunities that I see in the clinical setting that needs to be improved is staffing. Of course 2020 and COVID hit us hard for the year but some facilities were already in shambles before the pandemic. Staffing is one of those things that can breakdown a facility to its inner most core. You have to hire and provide the unit with appropriate and knowledgeable staff that can handle the unit and the patient acuity. This helps with providing the best care for the patient and it gives the nursing staff time to provide the best care to the patient they are caring for. When staffing levels aren’t met, patient mortality increases. According to Rebecca Paulsen she stresses quality of care to achieve patient outcomes, which, in turn, can lead to higher reimbursement from the insurance company. Nurse-to-patient ratios are substantially important when trying to keep infection rates, potential drug reactions, and medication errors at a minimum (Paulson, 2018). Hospital reimbursement is based on performance. If units don’t adequately staff enough professionals to provide the care that patients need based on their acuity level, reimbursement may significantly be affected (Ashe, 2018). When units have higher turnover rates, including admissions, discharges, and transfers, additional nursing time isn’t recognized in shift variability when considering staffing needs and nurse-to-patient ratios(Ashe, 2018). This is way having the unit or clinical area staffed accordingly makes the unit and the level of stress, burnout, depression among staff decrease.

References:

Ashe, Leah RN The importance of adequate staffing, Nursing Management (Springhouse): December 2018 – Volume 49 – Issue 12 – p 7 doi: 10.1097/01.NUMA.0000549519.47901.4f

Paulsen, Rebecca A. PhD(c), MS, RN, CPN Taking nurse staffing research to the unit level, Nursing Management (Springhouse): July 2018 – Volume 49 – Issue 7 – p 42-48 doi: 10.1097/01.NUMA.0000538915.53159.b5

As a former emergency department Registered Nurse for over seven years, I recall the most significant complaints were our long wait times.  For some patients, the wait time could be substantial.  Since emergency departments aren’t on a first-come, first-serve basis, wait times were often unpredictable and lengthy.  Patients are triaged based on their level of acuity.  Long Emergency Department (ED) Length of stay (EDLOS) is associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. (Andersson et al., 2020, p. 2)

The method conducted for the concept analysis on EDLOS was the Walker and Avant approach.  They were able to research a way of measuring the concept empirically by identifying all concepts used.  (Andersson et al., 2020) Nurses can use the Walker and Avant approach when there are limited concepts available to a nurse to explain a problem area.  The process of concept analysis for nurses first transpired in 1986. (McEwen & Wills, 2019) Walker and Avant specifically designed an approach to concept analysis to help graduate nurses explain methods to examine phenomena that interests them.  (McEwen & Wills, 2019) The basic concept analysis approach by Walker and Avant is as follows; 1.  Select a concept  2. Determine the aims or purposes of the analysis.  3.  Identify all the concept possible uses possible.  4.  Determine the defining attributes.  5.  Identify the model case.  6.  Identify any borderline, related contrary, invent, and illegitimate cases.  7.  Identify the antecedents and consequences.  8.  Define the empirical referents. (McEwen & Wills, 2019, Tables 3-2)

Authors Aim and Purpose

As a former Emergency Department Nurse, I find it fascinating how the author chose to do the concept analysis on this topic.  According to the author, when patients are forced to stay for extended lengths of time in the emergency department, this leads to poor patient outcomes, overcrowding, and an overall inefficient organization. (Andersson et al., 2020) I recall when a febrile child was left in the Emergency Department for a long time.  The child became so agitated their respiratory status worsened.  The authors aim to clarify the meaning of long EDLOS and identify the root causes of an emergency department length of stay of more than six hours.  (Andersson et al., 2020)

Defining Attributes on the Concept Examined

In the emergency department, length of stay (LOS) is a widely used measurement.  Emergency department length of stay (EDLOS) is defined as the time interval between a patient’s arrival to the ED to the time the patient physically leaves the ED. The defining attributes discovered that waiting in a crowded emergency department was just that, waiting.  Waiting was the most acknowledged attribute associated with EDLOS. (Andersson et al., 2020) If the patients didn’t have to wait, they wouldn’t be a problem/complaint and had no time targets. 

Another attribute that was described as a cause for EDLOS was, crowding.  This led to cause and effect with long EDLOS and crowding. (Andersson et al., 2020)

Benefits

     The problem was that over-crowding and waiting was referred to as an inefficient organization.  This led to the need to search for EDLOS to correct the issues with the system and improve overall patient satisfaction with emergency department visits.  (Andersson et al., 2020)  The benefit of this study is discovering what the root of the cause is for long emergency wait times, therefore improving overall patient outcomes, avoiding overcrowding, and running an efficient organization.  The benefits of completing a concept analysis for nursing theory would be to aim at improvements for better patient outcomes.  This is what we are there for, after all.  As nurses, we are on the front lines of our departments, and we have an opportunity to improve our systems, our organizations, our team, but most importantly, our patients.  When we can all benefit as a team, our profession benefits, and our patients benefit greatly.