Walker Method Research Articles (Page 1)

Online nursing education has emerged as a prevalent learning mode, offering flexibility and accessibility to students worldwide. Effective communication between instructors and students promotes engagement and connects learning outcomes to coursework in this virtual environment. The U.S. Department of Education's (DoE) regulations, which state that “regular and substantive interaction” between the instructor and student must occur, further reinforce the need for effective communication. This article examines the pivotal role of instructor presence in online nursing education, highlighting its importance in maintaining effective communication, fostering student success, and promoting civility in the virtual classroom. Drawing from the Community of Inquiry (CoI) Framework and the Walker and Avent Method for Concept Analysis, the analysis explores how teaching, social, and cognitive presence contribute to a supportive and dynamic learning environment. The purpose of this analysis is to examine how accessibility, responsiveness, and active engagement by instructors facilitate communication, promote civility, and support academic student success. Significant findings indicate that strong instructor presence enhances student engagement, satisfaction, and academic performance by fostering open communication and modeling civil behavior. Evidence-based strategies such as timely feedback, clear guidance, active participation, and the use of instructional videos strengthen instructor presence while enhancing the overall learning experience. Thus, allowing educators to establish a respectful, collaborative online classroom environment that supports student growth and preparation for the professional demands of practice.

School connectedness encompasses protective elements that enhance students' academic and health outcomes. Its importance spans healthcare and education, yet clarity of the concept is needed as it relates to school nursing services. Using the Walker and Avant concept analysis method, this investigation aims to clarify the meaning of school connectedness, describe its uses, attributes, and characteristics in relation to school nursing services, and provide sample cases. The following definition emerged with relevance to school nursing services: School connectedness alludes to a student's perception of having a meaningful relationship with adults and peers within an inclusive and respectful school environment that supports the student's well-being, regardless of the student's health challenges. The goal is to cultivate a sense of fitting in for each child within their school community. Empowering school nurses to promote school connectedness can help identify at-risk students and foster a supportive, inclusive environment.

Cultural centers play a crucial role in European sociocultural life, yet remain under-researched as their diverse nature has hindered consistent analysis and policymaking. A key challenge is the absence of a clear definition, leading to inconsistent categorization and making it difficult to assess their visibility in statistics, funding allocations, and cultural policy frameworks. This gap limits researchers, communities, and policymakers from fully understanding and supporting these institutions. Without clear definitions and standardized data collection, cultural centers struggle to secure funding, and underserved communities risk losing access to vital cultural and social resources. This is crucial, especially for rural and sparsely populated areas, where cultural centers often serve as key cultural infrastructure that supports social cohesion, cultural participation, and regional equity. To address this gap, this study develops a structured framework to define and classify cultural centers, aiming to enhance conceptual clarity and support evidence-based policymaking. Focusing on Finland as a case study, this study employs the Walker and Avant concept analysis method to identify four defining attributes of the concept cultural center: provider and creator, experience and active participation, diversity and multidisciplinary, and interaction and community orientation. Through a systematic and descriptive approach, these attributes are operationalized and applied to a dataset from Statistics Finland on Cultural halls and centers by region 2023, which reflects the current landscape of cultural centers in Finland. By systematically examining 259 facilities, the study traces the presence of these attributes in practice. The combination of conceptual analysis and empirical investigation results in a refined typology that allows for a clearer distinction between cultural centers and other facilities. This structured approach not only advances theoretical clarity but also supports cultural policymakers in recognizing and categorizing cultural centers more effectively. The findings emphasize the need for improved data collection to better capture the diversity and roles of cultural centers, both in Finland and beyond. Although this research focuses on Finland, the developed typology may offer a useful framework for cross-country comparisons and could support policy alignment within the EU cultural sector, provided that local adaptations are made.

Healthy Diet Consumption Among Chronic Pain Populations: A Concept Analysis.

Although "Failure to Rescue" (FTR) has been widely studied in general healthcare contexts, and a few clinical specialties, its definition and implications remain underexplored within maternal health, particularly given the heightened risks for marginalized women. The quality measure was retired as a national quality metric before formal adoption into obstetric care, leaving significant gaps in maternal patient safety. High rates of preventable maternal morbidity and mortality, highlight the urgent need to explore and define this concept specifically within maternal health. To conduct a concept analysis of FTR in obstetrics, examining systemic patient safety failures using both Charles Vincent's patient safety framework and Reason's Swiss Cheese Model of human error, and propose strategic improvements for maternal care delivery. A comprehensive literature search guided by Walker and Avant's concept analysis method was performed, synthesizing evidence from multidisciplinary sources on failure to rescue, and maternal morbidity, and mortality on national patient safety. A systematic review of obstetric and patient safety literature was conducted using PubMed, CINAHL, MEDLINE, Google Scholar, and The Cochrane Library. In total, 30 articles met the inclusion criteria, including those outside of U.S. health systems. Key themes relating to system failures, nurse staffing, and obstetric complications were extracted to refine FTR's defining attributes, antecedents, and outcomes for maternal care. Analysis revealed FTR in obstetrics involves multiple, intersecting system-level breakdowns rather than isolated provider errors. The failure to rescue factors identified include inadequate recognition of clinical deterioration, delayed escalation of care, fragmented interdisciplinary communication, and biases exacerbating health disparities. Amber Rose Isaac's model case exemplified intersection of the following factors: critical lab results were missed, warnings of severe complications were ignored, and pandemic-induced care constraints further compromised and compounded timely intervention. Although the formal FTR measure was retired prior to adoption in obstetrics, addressing many of the underlying systemic failures described in this analysis is essential. Integrating proactive, standardized maternal early-warning systems, surveillance monitoring systems, and robust policies to ensure equitable care is crucial. Re-envisioning maternal safety through the lens of FTR not only addresses immediate clinical gaps, but also aligns healthcare practice with its fundamental ethical duty to protect every woman, family, and community from preventable harm.

In light of the growing ageing population, the World Health Organization called for special attention to the age-friendliness of hospitals. Despite the concept of 'age-friendly hospitals' promising to enhance health care, there is no consensus within the field regarding its definition. The aim of this concept analysis was to clarify the attributes, antecedents, and consequences of age-friendly hospitals, thereby fostering a deeper understanding of the concept. Walker and Avant's eight-step concept analysis method was employed. A systematic review of the Literature on age-friendly hospital settings was conducted across 11 electronic databases, including PubMed, Scopus, Web of Science, CINAHL (EBSCO), Cochrane Library, Embase, CNKI, Wanfang Data, VIP Database, Airiti Library, and SinoMed. The original search covered publications from each database's inception to November 2022. An updated search (December 2023) captured studies published after the initial search and up to December 2023, with duplicates excluded. Two researchers independently screened the literature and cross-checked it against the inclusion and exclusion criteria. A qualitative content analysis was conducted for data synthesis. A total of 5,489 records were identified through the initial and updated searches. After removing duplicates and screening titles and abstracts, 56 articles were included in the final analysis. The defining attributes of age-friendly hospitals were identified as adapting to the developmental needs, promoting the autonomy and engagement, and a sense of ease and burden-free for older adults. Antecedents included recognizing the unique needs of older adults, a discrepancy between needs and hospital services, and a transformation of health care. The consequences of implementing age-friendly hospitals can be categorized into three themes: promoting the health, function, and well-being of older adults, improving satisfaction with the hospital experience, and advancing levels of hospital services. By providing a clear understanding of what an age-friendly hospital entails, our theoretical definition allows for a more systematic approach to evaluating and improving hospital facilities for older adults. The theoretical definition proposed in this paper can be used as a starting point for operationalizing the concept, which will facilitate the optimization of future age-friendly hospital standards and the development of empirical studies.

Artificial Intelligence (AI) is increasingly integrated into healthcare, offering transformative potential for nursing practice by enhancing efficiency, accuracy, and patient outcomes. Despite growing interest, the concept of AI-assisted nursing care lacks clear consensus, hindering its clinical operationalization. This study aims to clarify this concept through a concept analysis to inform future research and practice. The Walker and Avant concept analysis method was utilized to examine 'AI-assisted nursing care.' A literature review was conducted across databases including PubMed, Scopus, ScienceDirect, and Embase, with no temporal limits, yielding 20 relevant records for analysis. The process identified the concept's uses, attributes, antecedents, consequences, and empirical referents. Five defining attributes of AI-assisted nursing care emerged: data-driven decision support, automation of routine tasks, enhanced predictive capabilities, personalization of care, and continuous learning and adaptability. Antecedents included availability of advanced technology, integration into healthcare systems, nursing competence and acceptance, patient data availability, and ethical and regulatory frameworks. Consequences encompassed improved patient outcomes, increased nursing efficiency, enhanced nurses' satisfaction, potential cost savings, and ethical and social challenges. Model, borderline, and contrary cases further illustrated the concept's application. AI-assisted nursing care holds significant promise for revolutionizing clinical practice by improving care quality and nursing workflows. However, its implementation demands addressing technological, ethical, and systemic challenges. Future research should prioritize empirical validation of these findings and promote equitable access to AI technologies across diverse healthcare settings to fully realize its potential.

Existential uncertainty dominates the patient experience in cardiac inherited diseases due to unpredictable disease course and the risk of sudden cardiac death. Traditional uncertainty theoretical models inadequately capture the unique facets of uncertainty associated with these diseases. Using Walker and Avant's theory derivation method, an uncertainty theory for nursing practice was developed by adapting concepts from self-organized criticality and grounding them with Parse's Human Becoming Theory within the Unitary Transformative Paradigm. This innovative synthesis enhances the understanding of uncertainty factors among vulnerable patients, potentially improving nurses' capacity to provide holistic, person-centered care and develop targeted clinical interventions addressing existential concerns.

This paper proposes Technology-Enhanced Wisdom (TEW), a middle-range theory to guide nursing practice in the age of artificial intelligence. Building on Nelson's Data-to-Wisdom continuum and developed using Walker and Avant's theory synthesis method, TEW identifies 6 mediating concepts - context, perception, veracity, trust, usability, and competency - that shape how nurses integrate artificial intelligence (AI)-enhanced insights. TEW provides a framework for synthesizing internal knowledge with machine-generated information to support ethically grounded, human-centered decisions. As AI transforms health care, TEW offers a timely theoretical foundation for wisdom-driven, technologically informed nursing care, positioning technology not as a replacement for human wisdom but as a co-pilot in advancing it.

Despite decades of research, we still know surprisingly little about how best to bring about lasting recovery from anorexia nervosa (AN). Furthermore, there is a lack of consensus in the research and treatment communities about what constitutes recovery from AN, or whether "recovery" is even an appropriate term to use in this context. The aim of this study was to analyse the concept of AN recovery from the perspectives of various stakeholders. Concept analysis. Walker and Avant's eight-stage concept analysis method. There continues to be a lack of consensus around the defining criteria for AN recovery. However, there are certain clinical, psychological and quality-of-life attributes that are recurrent in those defined as being in recovery. Though BMI and rate of weight gain are the primary criteria used to define recovery from AN, in recent years it has become clear that the definition of healthy weight varies and that weight alone is insufficient to fully define recovery. With recent advancements in biomarker and genetics research, there is hope that more objective measures of recovery will be defined. Quality of life as defined by both patients and caregivers is also critical to recovery; however, it is often not adequately assessed in studies of AN. Though the path to recovery is highly individualised, and there are risks in implementing strict criteria for recovery, in research, consensus is needed for adequate comparison of studies evaluating different treatment modalities. Additionally, such criteria are needed to help clinicians with decision-making authority, including advanced practice nurses, provide the most effective treatment options to their patients. Future research should focus on better defining recovery from AN and on facilitating nurse-led system-level advocacy to educate and equip advanced practice nurses in helping those with AN move toward recovery. This concept analysis provides an overview of recovery from AN from the perspectives of a wide array of stakeholders and the last 20 years of published data. This study did not include patient or public involvement in its design, conduct, or reporting.

Aim: To delineate a precise definition of job crafting within the nursing profession to deepen comprehension and stimulate progress in clinical practice and scholarly investigation.Background: In the context of contemporary workplaces, job crafting is recognized as a multifaceted strategy for aligning employee roles with their capabilities and preferences. Nevertheless, its application in nursing, a field marked by high stress and complex demands, remains underexplored and lacks tailored assessment tools.Method: We used Walker and Avant's systematic concept analysis method, which encompasses eight distinct steps. An exhaustive search for relevant English-language literature was performed across various databases, including PubMed, Web of Science, Wiley, CINAHL, and Scopus.Results: Our review of 67 selected studies revealed the following defining attributes of job crafting in nursing: (1) proactive challenge engagement; (2) experience-informed and/or innovative behavior; (3) task, cognitive, and/or relational adjustments; and (4) demand–resource balance achievement. Antecedents were identified as intrinsic personal attributes and extrinsic organizational and societal influences. Conversely, while job crafting predominantly yielded positive outcomes, it could also sometimes result in adverse effects.Conclusion: Through rigorous concept analysis, we established a well-defined understanding of job crafting in nursing, laying a solid conceptual foundation for future advancements in clinical applications and research endeavors.Implications for Nursing Management: In light of this lucid concept, nursing managers can better comprehend the work behaviors and mechanisms of nurses. Accordingly, they can then develop tailored assessment tools to evaluate nurses' job crafting and devise appropriate strategies to facilitate it.

To analyze a theoretical framework that incorporates incivility among healthcare teams in relation to diagnostic safety, and to assess its potential utility for advancing research and practice. A structured literature review was conducted across PubMed, Web of Science, and CINAHL using search terms such as "diagnostic safety," "team dynamics," "theoretical framework," "incivility," and "diagnostic framework". A theoretical framework was selected for analysis. Walker and Avant's six-step theory analysis method was applied to assess the framework's origins, meaning, logical adequacy, usefulness, generalizability, parsimony, and testability. The literature review yielded 144 articles after screening and applying inclusion criteria. Ten articles were reviewed, and the Model of Ward Team Dynamics in Diagnosis by Choi etal. was selected for analysis, as it was the only framework that explicitly addressed unacceptable behaviors (i.e.,incivility) in diagnostic team settings. The Choi etal. framework uniquely integrates unacceptable behaviors as a mediating factor in diagnostic team performance, distinguishing it from other diagnostic models. The analysis found the framework to be conceptually well-grounded, with several constructs operationally defined and empirically measurable. However, gaps were identified in parsimony and the clarity of relational statements, indicating opportunities for refinement and empirical testing. The framework offers a valuable theoretical foundation for studying the impact of incivility on diagnostic safety. Its integration of behavioral constructs supports its relevance for empirical research and intervention development aimed at improving team dynamics and diagnostic outcomes.

Care is a multidimensional concept that includes spirituality as a dynamic and integrative aspect of human experience. Integrating spirituality into clinical practice enables a more comprehensive response to the full spectrum of human needs, which is why spiritual care competence emerges as an aptitude that fits the profile and skills to be developed by those working on care provision. Regrettably, not enough attention has been paid to spiritual care competence largely due to the lack of knowledge of professionals and what this entails. Therefore, this study aims to define the main attributes of the concept of Spiritual Care Competence in Palliative Care, identify its antecedents and consequences, examine its empirical referents, and clarify the conceptual boundaries. The concept analysis method of Walker and Avant was used. Main attributes were organized into three main domains:(1) intrapersonal resources, such as spiritual awareness, humility, sensitivity, confidence, wisdom, and intuition; (2)interpersonal resources, such as presence, active listening, compassion, and empathy; and(3) transpersonal resources, such as the ability to establish meaningful connections, assist in finding meaning, and explore hope. These domains can be nurtured over time but ultimately require professional maturity and experience. Antecedentsof spiritual care competence include active engagement in care, formal training in spiritual care, and recognition of the individual's spiritual dimension. Consequenceswere identified for the person being cared for, the professional and the care environment and include suffering relief, reduced stress and anxiety, enhanced spiritual well-being, and lower healthcare costs. When spiritual care competence is intentionally cultivated and continuously developed, professionals advance toward the ideal of person-centered humanistic care, fostering better at the End-of-Life patient/family outcomes and contributing to professional satisfaction and personal fulfillment.

Background/Objectives: Collaboration in mental health care is essential for implementing a model oriented towards the psychosocial rehabilitation of people based on multifaceted interventions involving different actors and sectors of society to respond to demands. Despite the benefits presented by the scientific evidence, there are still many barriers to collaborative care, and professionals continue to struggle in reorienting their conduct. The current situation demands organization and the framing of well-founded action plans to overcome challenges, which in turn requires a detailed understanding of collaborative practices in mental health care and their conceptual boundaries. A concept analysis was undertaken to propose a working definition of collaborative practices in mental health care (CPMHC). Methods: This paper used the Walker and Avant concept analysis method. This includes identifying the defining concept attributes, antecedents, consequences, and empirical referents. A literature search was carried out from November 2024 to February 2025 in three databases (Medline, CINAHL, and LILACS), considering studies published between 2010 and 2024. Results: The final sample of literature investigated consisted of 30 studies. The key attributes were effective communication, building bonds, co-responsibility for care, hierarchical flexibility, articulation between services, providers and community, monitoring and evaluating of care processes, and attention to the plurality of sociocultural contexts. Conclusions: This comprehensive analysis contributes to guiding future research and policy development of collaborative practices in mental health, considering the individual, relational, institutional, and social levels. Further research is possible to deepen the understanding of the production of collaborative practices in mental health in the face of the complexity of social relations and structural inequities.

Processing Speed in Patients with Cancer: A Concept Analysis.

Dementia friendly communities: A concept analysis.

As adults age, most aspects of their living environment, physical and mental health, personal relationships and perspectives on life change. The ability of older adults to adapt to this myriad of physical and social changes, known as environmental press, is important for maintaining autonomy and well-being as they age. Understanding the concept of environmental press for older adults could improve person-centred care provided by gerontological nurses. To analyse the concept of environmental press in relation to aging older adults and gerontological nursing. Walker and Avant's 8-step method of concept analysis was used to examine and understand the theoretical framework of Environmental Press for older adults as it applies to gerontological nursing. A search of databases (PubMed, Library of Congress, WILEY Online Library, EBSCO, ProQuest and Scopus) with the key words "environmental" and "press" and "older" and "person" in titles and abstracts identified 169 studies. Removal of duplicates and screening of 139 abstracts produced 15 full-text articles. A total of eight articles related to environmental press were analysed for this study. Three defining attributes for the concept of environmental press were identified that could help gerontology nurses provide person-centred care for aging older adults: (1) their internal and external environments; (2) their social and physical environments; and (3) their physical and psychological competence. These attributes can positively or negatively influence environmental press and outcomes of well-being and quality of life for aging older adults. Attributes of environmental press can influence the ability of older persons to meet the demands of aging. Understanding the concept of environmental press can help gerontological nurses provide person-centred care that includes strategies for addressing changes in the lives of older adults and improving outcomes, which could improve quality of life.

Therapeutic inertia, the failure to act when clinical care needs adjustment, has been explored in medicine but remains underdeveloped in nursing, limiting its practical and theoretical application. To clarify the concept of therapeutic inertia in nursing by identifying its defining attributes, antecedents, consequences, and empirical referents. This concept analysis was conducted using Walker and Avant's eight-step method: select a concept, determine the purpose of analysis, identify all uses of the concept, determine defining attributes, construct a model case, identify borderline and contrary cases, identify antecedents and consequences, and define empirical referents. A total of 49 articles published between 2000 and 2024 were reviewed, along with other sources. Key attributes of therapeutic inertia in nursing include delayed clinical decision-making, failure to escalate or adjust treatment despite clinical indicators, insufficient utilization of evidence-based practices, inadequate advocacy, and the presence of systemic and organizational barriers. Antecedents comprise ambiguity in clinical judgment, limited professional autonomy, absence of clear escalation protocols, and organizational constraints such as high workloads and hierarchical structures. The consequences of therapeutic inertia encompass compromised patient outcomes including worsened disease progression and increased readmissions alongside heightened clinician frustration, professional burnout, and ethical distress. This analysis provides a clarified definition of therapeutic inertia in nursing, supporting its future measurement, theoretical exploration, and integration into evidence-based practice.

To clarify the concept of disempowerment in adults with chronic illness. The Walker and Avant approach to concept analysis was used. A systematic literature search was performed on 14 February 2024, using the following databases: CINHAL, PubMed, PsycINFO, Sociological Abstracts and ProQuest Dissertations & Theses Global A&I: The Humanities and Social Sciences Collection. Studies examining adults' experience of individual disempowerment stemming from chronic illness were included. Definitions and descriptions of the concept in the included studies were extracted and synthesised into defining attributes, antecedents, and consequences. Forty-five articles were included. Two defining attributes were identified: (1) diminishing opportunities to take control and (2) clients' dissatisfaction with diminishing control. Antecedents were changes in health status related to chronic illness and expectation mismatch within the client, or between clients and their care partners. The consequence of disempowerment was disengagement in the context of disempowerment. Disempowerment was found as the state of dissatisfaction with diminishing opportunities to control personal lives, which stems from changes in health status and expectation mismatch and leads to disengagement in the context of disempowerment. Contrary to prior studies, where disempowerment was often considered an outcome of an imbalanced relationship between clients and care partners, the present findings showcased disempowerment as a holistic illness experience, involving changes in health status. The understanding of disempowerment as the dissatisfaction with the situation of diminishing opportunities to take control differentiates this concept from the opposite of empowerment, which is conceptualised as clients' ability to make decisions or manage diseases. Findings further highlight the importance of understanding clients' illness experience comprehensively and providing care in a manner that is matched with clients' abilities, expectations and needs. It is suggested that operationalising the concept based on this understanding is necessary in order to understand correlations between disempowerment, its causes and consequences. Disempowerment has been applied to describe interruptions in their states of being, perceived role performances, and independence in adults with chronic illness from diverse perspectives in the extant literature, such as the opposite of empowerment, action to take away control over personal lives and a state of diminishing ability to tackle problems. Through clarifying the concept, this article will guide the communication, measurement tool development and response in clinical practice. No patient or public contribution.

To clarify the concept and connotation of subjective memory complaints. A total of 89 papers were retrieved from CNKI, Wanfang Database, VIP database, MedLine, Web of Science, OVID and Scopus. The search time limit was from January 1, 1982 to December 31, 2024. Walker and Avant's conceptual analysis method was applied. Through in-depth analysis, the defining attributes of the subjective memory complaints were memory dysfunction, cognitive decline risk, low help-seeking intentions, and notable memory-related negative emotions. Antecedents involve demographic, lifestyle, psychological, and health-related factors. Consequences include neurodegenerative diseases, anxiety, depression, and reduced quality of life. Multiple assessment tools such as the Subjective Memory Complaints Questionnaire and Memory Assessment Complaint Questionnaire were presented, providing means for measuring SMC in research and clinical practice. Defining this concept aids early screening and intervention for MCI and AD, helping clinical staff develop strategies to improve cognitive function, quality of life, and mental health.