Fieldwork Phase Research Articles

A Hybrid Concept Analysis of Frailty Among Older Adults Living in the Community.

To analyse the concept of frailty through a literature review and in-depth interviews. A hybrid model of concept analysis. The theoretical phase identified 43 articles for reviewing the definition and measurement of frailty. Seven frail older adults were invited in the fieldwork phase for in-depth interviews. In the final analysis phase, results from the fieldwork and theoretical phases were integrated to obtain a final definition of frailty. Attributes of frailty were heterogeneous, involving dynamic/bidirectional, multidimensional and multiple systems. The antecedents of the concept were exposure to various stimuli and challenges in responding to these stimuli. Consequences included losing autonomy and adverse health outcomes. Four themes of frailty were identified based on the fieldwork data: 'accumulation of functional decline', 'powerlessness of coping with', 'vicissitudes of lived experience' and 'loss of autonomy and positivity'. The final definition of frailty was 'a dynamic and fluctuating process of powerlessness to manage biopsychosocial and environmental stimuli, involving functional decline and vicissitudes of life, which results in losing autonomy and positivity or adverse health outcomes'. Characterising the definition of frailty is essential for nurses to address the lived experiences of older adults when providing person-centred care and for developing interventions that meet the needs of frail older adults. Since some discrepancies existed in the definition of frailty from individual perception of older adults, combined in-depth interviews with a theoretical literature review were used to provide comprehensive insight. This concept analysis provides guidelines of training for nurses and opportunities to improving quality of life for community dwelling older adults. N/A. No Patient or Public Contribution.

Perceived Ageism in Health Care: A Hybrid Concept Analysis.

Identifying perceived ageism is a critical step in eliminating ageism. This hybrid concept analysis aims to describe the concept of perceived ageism in health care. In the theoretical phase, a scoping review was conducted. In the field phase, semi-structured interviews were conducted with nine community-dwelling older adults. In the final analytical phase, results from the theoretical phase were integrated with those from the fieldwork phase. The perceived ageism in health care includes four dimensions: self-internalization (self-denial, a sense of unease, and passivity of behavior in seeking health care), interpersonal interaction (perceived negative perceptions, neglected attitudes, and unfair care behaviors), organization system (perceived strangeness caused by unfamiliar technology, unsupportive environment, and inadequate resources), and procedure policy (perceived uniformity of healthcare process and lack of targeted practice policies). Research related to this concept has contributed to developing measurement tools for assessing perceived ageism in healthcare practice and subsequent research.

Incivility in Nursing Education: A Concept Analysis.

Incivility in nursing education is a complex concept that is not exactly defined in nursing. The purpose of this study was to clarify the concept of incivility in nursing education in the Iranian cultural context. Concept analysis was performed based on hybrid model in three steps. In the theoretical phase, a review of studies was conducted from 2000 to 2020. During the fieldwork, 7 nursing faculty members and 9 nursing students were interviewed. The third phase included the comparison of the themes that were extracted from the two previous phases. From the 1250 titles, 45 articles were analyzed. Review of literature showed that incivility has several attributes: unconventional communication, irresponsible and disrespectful behavior. The fieldwork phase added unmanaged behavior and being contrary to academic goal. Defining the concept of incivility in nursing education refers to an unconventional, disrespectful, unmanaged behavior that is contrary to the academic goal of nursing education and results from individual differences, stress, improper application of technology, and inappropriate role models which, by creating an unsafe learning condition leads to harming the individual, organization and profession. Here, this study provides a comprehensive understanding of the incivility in nursing education that can be used in instrumentation, model building, and development of theory.

Development and psychometric evaluation of the sexual satisfaction questionnaire for postmenopausal women (PWSSQ): an exploratory mixed method study protocol

BackgroundThe concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Therefore, the first step in discovering methods for assessing sexual satisfaction in postmenopausal women is to develop a measurement instrument. This study was conducted to develop and evaluate the psychometric properties of a sexual satisfaction instrument for postmenopausal women.MethodsThe current study is an exploratory-sequential mixed-methods research project that will be divided into two parts: qualitative and quantitative. Aligned with the primary objective of the research, which is to elucidate the concept of sexual satisfaction in postmenopausal women, the hybrid concept analysis model developed by Schwartz and Kim will be employed. This model comprises three key phases: the theoretical phase, the fieldwork phase, and the final analytical phase. Those who met the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, and menopausal duration were recruited. The conventional content analysis will be carried out following the steps proposed by Graneheim and Lundman. Second, in the quantitative phase, the psychometric properties of the instrument were evaluated, including the content, face and construct validity and reliability via internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument.DiscussionA valid and reliable scale for evaluating the sexual satisfaction of postmenopausal women should be developed, and educational content should be designed to improve the sexual satisfaction of this group of women.

Empty nest syndrome: A concept analysis.

Empty nest syndrome (ENS) is parents' experience to their children leaving home. Considering the lack of a clear definition of this concept and its context-based nature, this study aimed to define the ENS concept. A three-phase concept analysis using a hybrid model was used. In the theoretical (first) phase, a literature review was conducted using Scopus, WOS, PubMed, ProQuest, Irandoc, Research.idml, Magiran, and SID, with the search terms "empty nest syndrome," "aged," and "middle-aged," and their synonyms, with no time and language restrictions until the end of 2021. After the screening, 29 relevant articles entered the study. According to the findings of the first phase, the fieldwork (second) phase was directed using the qualitative content analysis approach, and semi-structured interviews were conducted with nine elderly and middle-aged individuals with an open-ended question. Results from both were included in the final (third) phase. The theoretical phase created an operational definition to guide the fieldwork phase. The fieldwork phase resulted in the emergence of six themes. The final analysis phase formulated a comprehensive definition of this concept: "ENS is a subjective phenomenon that occurs as a result of parents' reaction to their children leaving home." This transition from crisis to self-regaining includes the stages of mourning or resistance reaction, feelings of loss or passive behaviors, sublimation or impulsive behaviors, adaptation, and relief. It initiates with the last child's departure and continues until two years. Exploration of the concept of ENS can be the basis for designing a model or theoretical framework, devising measurement instruments for the concept and its consequences, and developing programs to increase the healthcare team's awareness to identify the problem and conduct appropriate preventive or therapeutic measures.

A concept analysis of ageism from older adults' perspective: a hybrid model.

Iran follows global trends with a growing aging population. To better understand ageism in Iranian context, the present study explores the concept using a hybrid model with both inductive and deductive approaches. A hybrid concept analysis model was used to further define the concept of ageism. In the first step, databases such as PubMed, Web of Knowledge, Science Direct, and Google Scholar were searched for studies up until August 2019. Key terms used in the search included "ageism", "stereotype", "discrimination", "age", "aging" "old", and "elder". Subsequently, semi-structured interviews were conducted with 10 community-dwelling older adults chosen through purposive sampling. Data from the theoretical and fieldwork phases presented a definition of ageism: "Ageism engrained into older adults (no other age groups) is associated with personal, psycho-social, economic, and especially cultural factors that impose an acceptance of limitations based on chronological age or being perceived as old". Ageism is a multi-faceted experience composed of psycho-social, economic, and cultural dimensions. While the present study has further clarified ageism, more research is needed, particularly in relation to diverse cultural contexts.

The coronavirus disease 2019 infodemic: a concept analysis.

This study aimed to analyze the coronavirus disease 2019 (COVID-19) infodemic phenomenon in the medical field, providing essential data to help healthcare professionals understand it. This study utilized a hybrid model for concept analysis. In the theoretical phase (first phase), a literature review was conducted using ScienceDirect, PubMed, CINAHL, ProQuest, Scopus, Web of Science, DBpia, RISS, and KISS. Semi-structured interviews, involving eight physicians and six nurses, were used in the fieldwork phase (second phase). In the final analysis phase (third phase), the results of the preceding phases were combined. Based on the findings of these phases, the COVID-19 infodemic can be defined as "the phenomenon of information flood, reproduction, dissemination, and asymmetry, which occurred during the pandemic through social networks among the public lacking essential knowledge of infectious disease, and is associated with negative and positive effects." Our findings can help the Ministry of Health and Welfare and healthcare professionals to understand the phenomenon of the infodemic and prepare necessary strategies and education programs for the public. Therefore, the provision of basic data is important for developing influential roles for healthcare professionals during infectious disease outbreaks.

Concept analysis of self-neglect in the elderly: a hybrid model.

Clarifying the concept of elder self-neglect. Researchers investigated the concept of elder self-neglect using a hybrid approach, including theoretical, fieldwork, and final analysis phases. After an extensive review of related literature to define the concept of self-neglect and describe its characteristics, the fieldwork phase was carried out to illustrate its empirical features. Accordingly, it led to the extraction of the elder self-neglect attributes from the first two phases. Elder self-neglect includes "subjective and objective high-risk behaviors pertinent to physical and spiritual health as well as restricted social interactions, disregarding the living environment, and a lack of compliance to personal hygiene routines that the elderly demonstrate deliberately or unintentionally. Various factors can contribute to such behaviors, including individual features, poor physical performance, elderly-oriented psychological disorders, financial challenges, detrimental stressors, unsuccessful social interactions, inaccessible supportive resources, inadequate educational resources, and inappropriate cultural norms. Consequently, such behaviors result in impaired physical and psychological health status, higher risk of misbehavior, poor quality of life, extra caregiving-treatment burden, and affected mental security in society." Given that elder self-neglect is considered a relatively unknown concept in Iran, the study findings can pave the way for future extensive research in the Iranian context by clarifying the concept. It can play a significant role in developing related tools to design more efficient interventions and improve the quality of nursing care services. The elder self-neglect concept can lead to numerous health-related disorders among the elderly in society. Nurses cannot deal with an unknown phenomenon without exploring and identifying its exact meaning. It is, therefore, imperative to illustrate the different dimensions of this concept to help create a deep understanding among the nurses and perform timely diagnosis and interventional procedures.

"Interprofessional Collaboration" among Pharmacists, Physicians, and Nurses: A Hybrid Concept Analysis.

"Interprofessional Collaboration" is associated with improving the quality of care. The objective of this study was the analysis of the concept of "Interprofessional Collaboration" using a hybrid model. A hybrid model was used in order to analyze the concept of "Interprofessional Collaboration." The first phase was the scientific search of texts in all valid electronic databases. The second phase includes fieldwork in which medical, pharmaceutical, and nursing staff were interviewed. Data were collected, reviewed, and analyzed in the third phase. The four main themes extracted in the theoretical phase included: "attributes of individual, team, organizational, and system." In the fieldwork phase, three themes and seven sub-themes were identified: "Dynamism/effectiveness of collaboration, uncertain boundaries of collaboration, advanced organizational culture." In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented: "A process that brings together systems, organizations and individuals from various professions to achieve common interests and goals. Achieving common goals and interests is influenced by individual, team, organizational, and system attributes." Defining the concept of interprofessional collaboration and identifying its various aspects can be a practical guide for creating and evaluating it in educational and clinical settings.

Family engagement in the care of infectious patients in intensive care units: A hybrid concept analysis.

This study aims to define and investigate characteristics, antecedents, and consequences of the concept of family engagement in caring for patients with infectious diseases hospitalised in intensive care units. This is a three-phase hybrid model study (theoretical, fieldwork, and analytical phase). The York University Guidelines were used in the theoretical phase, and ultimately, 16 pieces of literature related to the subject under study from 2011 to 2021 were reviewed. The content analysis was used for fieldwork phases; eight participants were interviewed. Then, the theoretical and fieldwork findings were compared, integrated, and analysed. This concept has characteristics such as; awareness, belief, perception, and willingness of the nurse to engage the family; a sense of responsibility, willingness, and sacrifice of the family; the physical or virtual presence of the family; triangular interaction between the nurse, patient, and family; perception and identifying the goals; education and information transfer; team collaboration; delegation of responsibility to the family; decision making; and protection of the family. Antecedents include the availability of infrastructure; patient, family, and nurse conditions; and the quality implementation of engagement. The consequences include positive consequences related to the patient, family, nursing, and society, as well as some negative consequences. This study provided a comprehensive perception of family engagement in the care of patients with infectious diseases in intensive care units and defined it more clearly, showing its characteristics, antecedents, and consequences. Eight participants were interviewed, including five nurses, two family caregivers, and one patient.

Concept analysis of end-of-life care competency of long-term-care-hospital nurses: Using a hybrid model

Purpose: This study identified the attributes and indicators of end-of-life nursing competency in long-term-care-hospital nurses and clarified the definition of the concept. Methods: The Competency Outcomes Performance Assessment model was used as a conceptual framework, and conceptual analysis was performed using the hybrid model presented by Schwartz-Barcott and Kim. In the theoretical phase, the attributes of end-of-life care competencies were explored through a literature review. In the fieldwork phase, focus group interview data were analyzed to derive the attributes of nursing competency at the end of life. In the final analysis phase, the attributes and indicators of end-of-life care competency were compared, analyzed, and integrated. Results: The attributes of end-of-life care competency among nurses in long-term care hospitals included comprehensive symptom management, effective communication, situational response, patient-centered care, information provision and education, resource management, demonstrating leadership, and professional development. Conclusion: End-of-life care competency in long-term-care-hospital nurses can be defined as a comprehensive set of competencies that includes symptom management, situational adaptation, effective communication, resource utilization, leadership, patient-centered care, meeting the needs of patients’ families through adequate information provision and education, and enhancing individual nursing capabilities through professional development. These results can serve as a foundation for developing tools to measure end-of-life care competencies among nurses in long-term care hospitals.

Activities of Daily Living in Patients with Chronic Obstructive Pulmonary Disease: A Hybrid Concept Analysis

Background: Limitations of activities of daily living (ADLs) are well-known in chronic obstructive pulmonary disease (COPD) patients. However, a lack of consensus regarding the concept of ADL in COPD patients causes problems in their measurement. This study was conducted to clarify and conceptualize the concept of ADLs in COPD. Methods: The hybrid model of concept analysis consisting of a literature review phase, a fieldwork phase, and an analytical phase was applied. In the first phase, an extensive literature review was performed by searching the accredited databases for relevant articles published within 2000-2022. In the second phase, 18 in-depth interviews with COPD patients were carried out in Tehran, Iran. Field observational notes were transcribed verbatim, and qualitative content analysis was performed. In the analytical phase, attributes of ADLs were derived from the previous two phases. Results: Based on the attributes derived from the final analytical phase, ADLs in COPD patients are complex and multifactorial and are affected by dyspnea and factors influencing it. The pattern of daily activities, communication, and self-care in COPD patients changes toward living normally and independently. Conclusions: The concept analysis of ADLs in COPD patients revealed some key attributes. The results might be useful for designing nursing models, developing theories and measurement tools, and increasing the capacity to perform ADLs in COPD patients.

Developing the concept of maternal in teenage mothers: a hybrid model.

Maternal transition is a challenging developmental process requiring physical, mental, social, and cognitive preparedness. Therefore, the transition to motherhood is even more challenging for teenagers who are exposed to both the maturation process and adaptation to the parenting role. Therefore, the present study was conducted to provide a deeper understanding of the maternal role in Iranian teenage mothers. A three-phase hybrid model was adopted for concept analysis. In the theoretical phase, 50 articles were analyzed. In the fieldwork phase, 10 participants were interviewed. In the final phase, the findings of the previous two stages were analyzed. This study was conducted between October 2021 and November 2022. After determining the attributes, antecedents, and consequences, a final definition was presented for parenting in teenage mothers. The concept of motherhood for teenage mothers was described as "a process-oriented phenomenon in nature," "complex, challenging and multidimensional," "development with immature transition," "a turning point in life," "a stressful event," "affected by several factors," and "bidirectional effects on life" according to antecedents, including "the level of received social support," "reaction to teenage motherhood," "teenage mother's characteristics," and "family structure" leading to "positive psychological consequences," "negative psychological consequences," and "loss of educational and career opportunities." This study provides a suitable ground for evaluating the concept of motherhood in teenage mothers and employing it in nursing care of teenage mothers and children by identifying this concept.

A CONCEPT ANALYSIS OF SHARED DECISION MAKING FOR OLDER PATIENTS WITH DEMENTIA IN ACUTE CARE HOSPITALS

Abstract Background Dementia patients often have comorbidities like Diabetes Mellitus, kidney disease, and cardiovascular disease that require patient decision-making about care, despite the challenges in judgment that stem from dementia. The study aimed to determine what Shared Decision-making is for older patients with dementia in acute care hospitals. Methods The study used the Hybrid Model of concept analysis method. This comprises a theoretical phase, a fieldwork phase, and an analytical phase. In the initial phase, the concept is selected. The fieldwork phase collects qualitative data to further analyze the selected concept. The third phase analyzes the empirical observations and writes up the findings. We searched Pub-Med, CINAHL, and PsycINFO for the keywords: “shared decision-making” and “patients with dementia.” Results We identified 14 articles that gave rise to over 100 codes. We defined shared decision-making for older patients with dementia in acute care hospitals as “The older person with dementia can be involved in collaborative activities in the care network, including delegation of authority as active decision-making. Open-minded communication based on person-centered care can be the foundation for considering feasible options. Clarify the role of family caregivers and identify decision-making participants in the care network to view the best alternative for the patient’s subsequent life”. Conclusions We developed a working definition of shared decision-making for patients with dementia. We clarified critical elements of the decision-making process, like based as person-centered care, open-minded communication, and collaborative decision-making activities between the person and the care network members, including delegation of authority.

Vicarious trauma in nursing: A hybrid concept analysis.

Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context. The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context. The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords "nurs*"and "vicarious trauma*", resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing. Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development. The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field. Nurses contributed to the conduct of the study by participating in the data collection via interviews.

임상간호사의 학습민첩성에 대한 개념분석

This is a conceptual analysis conducted to identify the concept and properties of clinical nurses' learning agility using a hybrid model. The concept is identified through a reviewing of literature in the theoretical phase, andthen, we conducted in-depth interview using focus group interview to using of fieldwork phase. As a result of this study, nurses' learning agility was classified into four dimensions: sensitivity to change, applicability of experiential learning, responsiveness in relationships, and cognitive flexibility, and was defined by four attributes and 11 indicators. In conclusion, the learning agility of clinical nurses was defined as the ability to quickly recognize situations, to flexibly respond, and to interactively perform nursing practice based on experiential learning in newly and challenging situations. The significance of this study is that it provides a basis for understanding and promoting learning agility by identifying conceptual attributes of learning agility in clinical nurses. Based on the findings of this study, it is suggested to develop a learning agility measurement tool that reflects nurses' learning agility attributes and indicators.

A concept analysis of cultural competence in nursing: A hybrid model approach.

Cultural competence is considered one of the criteria for high-quality nursing care. This study aimed to analyse cultural competence in nursing. This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi-structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated. The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient- and justice-oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices. Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care.

Development of the “living well” concept for older people with dementia

BackgroundAn important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of “living well” that is suitable for older people with dementia and then develop this conceptualization from the perspectives of both older people and caregivers. This study analyzed the concept of “living well” among older people with dementia.MethodsFollowing Schwartz-Barcott and Kim’s hybrid model, this study comprised theoretical, fieldwork, and final analytic phases. In the theoretical phase, we reviewed the extant literature. In the fieldwork phase, we conducted in-depth interviews with 12 participants (five older people with dementia, two family members, and five nurses), followed by qualitative content analysis. In the final analytic phase, we defined the concept of “living well” by comprehensively analyzing the data from the theoretical phase and results from the fieldwork phase.ResultsWe derived physical, mental, and social relationship dimensions of the conceptualization of “living well” for older people with dementia. The physical dimensions were “ability for daily living” and “symptom management.” The mental dimensions were “psychological health,” “psychological stability,” “maintaining identity and growth,” and “human dignity.” Finally, the social relationship dimensions were “maintaining social relations and community connectivity” and “government support.”ConclusionsOur analysis of the concept of “living well” can be used for developing tools and interventions to improve the ability of older people with dementia to live well.

Analysis of the concept of nurses' autonomy in intensive care units: A hybrid model.

To analyze the concept of autonomy of nurses in Intensive Care Units (ICU). The hybrid model approach proposed by Schwartz-Barcott and Kim, which includes theoretical, fieldwork and analytical phases, was used for this study. For the theoretical and fieldwork phases, the Graneheim and Lundman stages and the CORE-Q checklist were used, and the results were combined in the final analysis phase. For the theoretical phase, 46 related articles, two instruments and four books were identified after using a search strategy in 7 bibliographic databases in English and one in Persian with the terms MESH: 'nursing', 'autonomy' and 'intensive care'. The information extracted in the theoretical phase served as the basis for the design of the questions used in the semi-structured interviews in the fieldwork phase. Eight nurses with ICU experience working in hospitals affiliated to Isfahan University of Medical Sciences (Iran) participated in the fieldwork phase. The antecedents of the concept of nurse autonomy in ICUs were: empowerment of the workforce, organizational platform, and social and individual views of the profession. Its attributes were professionalism and high personal capabilities. Finally, increased personal competencies, promotion of quality of care, improved attitudes towards the profession and professional outcomes were noted as consequences. The autonomy of nurses in the ICU can facilitate their empowerment, which translates into the promotion of their caring behaviours, followed by the improvement of patient outcomes and quality of care.

Concept Analysis of Nursing Surveillance Using a Hybrid Model.

This study aims to analyze the concept of nursing surveillance among nurses caring for patients in acute care hospitals in Korea. The conceptual analysis was conducted using the hybrid model proposed by Schwartz-Barcott and Kim. In the theoretical phase, the attributes of nursing surveillance were explored through a literature review. In the fieldwork phase, the attributes of nursing surveillance were derived by analyzing interview materials. In the final analysis phase, nursing surveillance attributes and the related factors were integrated and confirmed. The attributes of nursing surveillance were systematic assessment, pattern recognition, the anticipation of problems, effective communication, decision-making, and performing nursing practice. Based on the theoretical basis of the nursing surveillance concept, this study identified the nursing surveillance concept as perceived by Korean nurses, and examined strategies to promote nursing surveillance.