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Posts from the ‘Concept Analysis’ Category

Art Making as Health Intervention

The current ANS featured article is titled “Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions” by Kyung Soo Kim, PhD, RN and Maichou Lor, PhD, RN. You can download this article at no cost while it is featured! Here is a message sent by D. Kim about this work:

Kyung Soo Kim

Hello, my name is Kyung Soo Kim, a junior nurse researcher at the University of Iowa, College of Nursing. My program of research focuses on chronic pain in older persons and chronic pain management using art making intervention. I am currently designing an art making intervention using visual art making activities for older persons with chronic pain. If you want to know more about and/or you are interested in my research, please contact me (! I am delighted to introduce my recent article entitled, “Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions”.

Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant’s approach. In this article, we reviewed 85 studies and found four defining attributes, four antecedents, and physical and psychological consequences. In addition to these findings, we provided several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making as a health intervention.

Heart-Focused Anxiety

The current ANS featured article is titled “Heart-Focused Anxiety: An Evolutionary Concept Analysis” authored by Pamela Barthle, MSN, RN, APRN-CNP (available for download at no cost while it is featured). In this video, the author gives

Guidance on Concept Analysis

Beth Rodgers

For the current issue of ANS, I invited Beth Rodgers, PhD, RN, FAAN, to share her thoughts and guidance for nurse scholars embarking on this important work! Dr Rodgers is Professor Emeritus, University of Wisconsin Milwaukee, Nursing Alumni Endowed Professor, Department of Adult Health and Nursing Systems. Her work defining quality in concept analysis work as enabling conceptually sound research to improve clinical care was recently explicated in the Journal of Nursing Scholarship.1 In this Guest Editorial, Dr Rodgers further explains the importance of this necessary intellectual challenge for the discipline. Access her Guest Editorial “Confronting Conceptual Challenges in Nursing Scholarship” and share your comments and responses here!

  1. Rodgers BL, Jacelon CS, Knafl KA. Concept analysis and the advance of nursing knowledge: state of the science. J Nurs Scholarsh. 2018;50(4):451–459. doi:10.1111/jnu.12386.

Cancer Survivorship

The current featured article in ANS is titled “Transition to Cancer Survivorship: A Concept Analysis” by Sylvia K. Wood, DNP, ANP-BC, AOCNP. This article is available for download at no cost while it is featured. The author explains that ” . . .  it is when treatment ends when life as a new cancer survivor can fall apart. It is during this time of transition, a time of “in-between” having completed therapy, entering a new life in survivorship that both patients and providers are not well prepared” (p. 145).  Dr. Wood provided this background about her work:

Throughout my nursing career, I have always been in awe of my patients.  More than any one thing, patients have been my best teachers, witnessing their intimate struggles, their triumphs,

Sylvia K. Wood

supporting them through living with and surviving cancer.

Research has come so far in changing our prognostic expectations as precision medicine and symptom science are guiding therapeutic approaches with improved response rates. However, knowing how to care for survivors after cancer treatment ends, a distinct phase in the continuum of care throughout the rest of one’s life is developing survivorship science.

There is a wealth of knowledge about the early effects of cancer treatment, yet much more needed for late effects. There is knowledge of survivorship needs for some cancer types but much less for others.

Due to the heterogeneity of cancer disease states, and the diverse populations it affects opens unchartered territory for further research in the personal, sociopolitical and cultural aspects of cancer survivorship to promote health and well-being.

Transition to survivorship is lexicon commonly describing a timeframe, although the richness of past research that can illuminate a holistic understanding of this concept is lost without definition. Weaving together diverse strands of prior research and knowledge uncovers the depth of meaning, context, and gives voice to the multidimensional and temporal nature of this concept.

I hope that interested researchers can use this concept analysis to build theory and new knowledge adding to the growth of survivorship science that will improve the care we give enriching the lives of cancer survivors.

“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”    ~ Marcel Proust

Futago-no-baka. (2013) Traveler [Photograph]. Copyright [2018] by Zerochan Anime Images. Retrieved from


Concept Analysis of “Calling to Nursing”

The current featured article in ANS is titled “Calling to Nursing: Concept Analysis” by Christie Emerson, MSN, RN. The article is available at no cost while it is featured, and I join the author in inviting you to share your responses and thoughts about this concept, and the information provided in the article!  Here is Emerson’s message sharing background about her work:

Throughout my nursing career in the United States (US), my colleagues and I have had regular discussions about our belief that nursing is a calling. In 2009, I began working with nursing colleagues and students in the United Arab Emirates and the Sultanate of Oman, an area of the world where nursing is not a particularly well respected profession.  I found that the concept of a calling to

Christie Emerson

nursing was unfamiliar to them; however, they often described the same strong desire to enter nursing as my US colleagues, despite the poor image.

I am fascinated by this seemingly global phenomenon in our profession, and therefore, decided to explore the concept of a calling to nursing in my doctoral studies. I had many ideas for research topics, such as:

  • Can a calling to nursing develop after someone has been educated and is already engaged in nursing practice?
  • What is the relationship between a calling to nursing and the quality of nursing care?
  • What is the relationship between a calling to nursing and the character of nursing care?
  • Do patients perceive a difference between nurses with a calling to nursing versus without a calling?
  • Does a calling to nursing affect the length of a nursing career?
  • Is there a relationship between nurses with a calling and leadership?
  • How is a calling to nursing conceptualized across diverse cultures?
  • What is the difference between a calling to nursing and a calling to medicine?

I was ready to begin research regarding this concept, but I found that while considerable research on calling has been done in the social science disciplines, there is no consensus on how a calling is defined. There is very little nursing literature that addresses the concept, and no nursing studies that attempt to define it. My goal in this article was to analyze the concept of calling as it relates to nursing and develop a definition with the detail needed to guide reliable research.

I look forward to ideas and feedback from my nursing colleagues around the world about the concept of a calling to nursing.

Learner-Centered Clinical Growth

In the current ANS featured article, author Jessica Barkimer, MSN, RN, CNE illustrates the value of evolutionary concept analysis to understand a dynamic, changing phenomena – clinical growth.  The article, titled “Clinical Growth: An Evolutionary Concept Analysis” is available at no charge while it is featured on the ANS website!  Here is Ms. Barkimer’s description of her work that led to this article:

As an educator who teaches nursing students in various clinical learning environments, I embrace the student-centered approach.  Each student brings forth unique previous experiences that contribute to his or her own construction of knowledge.  Years ago, while working on my degree, Masters of Science in Nursing Education, I encountered students who were functioning at various levels in the same cohort of students.  Learning objectives

Jessica Barkimer

Jessica Barkimer

often guide educators, however, in an attempt to facilitate the learning of each student, I often wondered, “how can an educator determine if a student demonstrates an appropriate amount of growth to progress to the next level?”  This multifaceted topic requires examination to benefit nurse educators, students, and patients.  Currently, I am working towards my PhD in nursing and have had the opportunity to work with faculty at Marquette University who have helped guide me in this process of knowledge discovery.

This article presents the findings of the conceptual analysis of clinical growth, using Rodger’s evolutionary method.  These findings represent a holistic approach, focusing on cognitive, affective, and psychomotor domains of each learner, requiring growth in all three areas.  This concept analysis and model lay the foundational groundwork for examining relationships among the antecedents, attributes, and consequences, which are essential for a nurse educator to understand and implement in practice, moving nursing education forward.  This examination of the literature also allowed me to consider various instruments designed to capture the aspects of clinical growth.  I look forward to continuing my research in this area.

Examining the meaning of “relationship power”

The latest ANS featured article is authored by Valerie Halstead, BSN; Joseph De Santis, PhD, ARNP, ACRN; Jessica Williams, PhD, MPH, APHN-BC, and is titled “Relationship Power in the Context of Heterosexual Intimate Relationships: A Conceptual Development.” The article is available to download at no cost while it is featured, and we welcome your comments in response!  Ms Halstead shared this information about this work:

It is a great pleasure to have our article featured on the ANS blog. The need for this article was identified while I was

Valerie Halstead

Valerie Halstead

enrolled in an epistemology class. Within this class we discussed the importance for concepts to be clearly defined to advance nursing knowledge, research, and theory development. Though this is the case, when reading literature focused on relationship power, inconsistencies were revealed in how this concept has been examined and defined. Because of this, a need for clarification of this concept was identified.

Therefore, with the guidance and collaboration from co-authors Dr. DeSantis and Dr. Williams, we are pleased to offer this conceptual development of relationship power in the context of heterosexual intimate relationships. We conducted a concept analysis on the basis of the guidelines

Jessica Williams

Jessica Williams

provided by Walker and Avant to assist in understanding this concept. As specified in this article, we propose the definition of relationship power to be the relative perceived, and actual ability to influence a relationship partner.

Many of the identified consequences of relationship power were found to have health care implications. Because of

Joseph De Santis

Joseph De Santis

this, it is extremely important for nurses in the clinical setting to be aware of what this concept entails. Doing so will help ensure they provide appropriate and comprehensive care to patients. Therefore, we hope that this article assists nurses with this. Furthermore, it is hoped that this article will assist nurse researchers in increasing consistency in their use of conceptual definitions and operational uses of relationship power. Doing so will allow for more directed future research in this particular area of science. We want to thank ANS for giving us the opportunity to share our developing work in this important area of nursing research.

Nursing Partnership with Parents of Technology-Dependent Children

It is our pleasure to feature an article by Michele A. Mendes, PhD, RN, CPN, titled “Partnership With Parents of Technology-Dependent Children: Clarification of the Concept.” As with many of the articles in this issue of ANS, Dr. Mendes focuses on ways in which technology influences the caring relationship that is central to nursing. You can download this article at no charge while it featured by visiting the ANS website! Here is a message in which Dr. Mendes describes more about her work in this area of practice:


Michele A. Mendes, PhD, RN, CPN

It is a pleasure to be able to share my work and my passion for children dependent on technology, their parents and their nurses.  This manuscript is the third describing my program of research that aims to explore nursing practice with children dependent on technology and the broader group of children with special health care needs. The first focused on understanding the delivery of home nursing care to these children from the perspective of the people responsible for their care, their parents and home care nurses.  Initially, I examined home nursing care practice from the perspective of the parents.  Next, in a follow-up study, I examined home nursing care practice from the perspective of home care nurses.  These two studies told two separate parts of the story of home care nursing, but did little to explain how parents and nurses work together in partnership to provide the care the children need to survive and thrive.

As I discovered when reviewing the literature on partnerships between nurses and parents of child patients, the term partnership is used loosely and is poorly defined.  A concept analysis of partnership would certainly have provided increased understanding of the concept, but would lack the richness of data from the perspective of the partners involved.  A secondary analysis of the data from the previous two studies would have provided rich data describing how parents and nurses work together to provide home care, but would have lacked the depth of understanding that came with an analysis of the concept.  An adaptation of the Hybrid Model of Concept Development1 Allowed me to combine strategies of concept analysis and a secondary analysis of the data from the two previous studies to bring the richness of first-person accounts and the depth of concept analysis to the clarification of the concept of partnerships between parents of children dependent on technology and home care nurses.

  1. Schwartz-Barcott D, Kim HS. An expansion and elaboration of the hybrid model of concept development. In: Rodgers BL, Knafl KA, eds. Concept development in nursing: Foundations, techniques, and applications. 2nd ed. Philadelphia, PA: Saunders; 2000:129-159.



Lisa Karhe

Our featured article starting January 27th is titled “Patient Experiences of Loneliness: An Evolutionary Concept Analysis,” authored by Liisa Karhe, RN, MNSc and Marja Kaunonen, RN, MNSc, PhD.  Their analysis provides useful insights about patient loneliness in relationships with healthcare professionals. Visit the ANS website to download this article at no cost while it is featured!   Ms. Karhe provided this background about her work that resulted in this article:

Loneliness is an old and much used concept but its content is often not understood. My interest in the phenomenon of loneliness began during my master studies years ago. I made a concept analysis of the concept of presence in a nursing relationship context and I found loneliness as the opposite concept of loneliness. I had recognized the phenomenon of presence and loneliness in my patients in Liisa-Karheintensive care units. There was a clear difference in how the nurse was present at a patient bedside. My professors recommended that I read the philosophy of Martin Buber. I found theoretical confirmation that this philosophy is applicable to the context of a nursing relationship between a patient and a professional nurse. I decided to explore this phenomenon in my dissertation. I was surprised that this topic was not found in other studies. Many nursing studies included loneliness without explanation, or the authors described loneliness using classical loneliness theories. I thought that the different dimensions of loneliness had quite different meanings in nursing context. So I had no other option than to pursue an evolutionary concept analysis and to find out the uses of the concept of loneliness in the nursing and health care context. As well, from a nursing point of view, it is very significant to understand  dimensions of loneliness in the context of nursing relationships. This evolutionary analysis served as the basis for my qualitative and quantitative research, which I have continued together with my dissertation supervisor Marja.

I hope you will read this interesting article, then return here to share your comments!


Understanding Survivor Guilt

Our current featured article addresses the meaning of survivor guilt, and by understanding this experience, seek effective ways to alleviate the suffering that comes to those who experience it.  The article is titled “Survivor Guilt: Analyzing the Concept and its Contexts”  The authors, Sadie Pauline Hutson, PhD, RN, WHNP, BC, Joanne M Hall, PhD, RN, FAAN, and Frankie Lane Pack, BA have provided the following commentary about their work, including a digital story video for ANS readers!

Survivor guilt, as presented in our analysis, is not monolithic. It manifests in many diverse temporal and situational contexts. It may be anticipatory or emerge years after the loss was experienced. The manifestation of survivor guilt is complex, in part, because the response is highly individualized. The following digital story demonstrates anticipatory and

“loss-in-process” forms of survivor guilt. After the video, Sadie Hutson offers a reflection on the nature of her survivor guilt, and how it is, presently, to remember the events surrounding the death of her mother, Joy.

“On its surface, this digital story may not seem like a characterization of survivor guilt; yet it underscores the expansion of this concept to include varied contexts. As a child, I remember feeling isolated and alone. I polished my mom’s toes as she lay dying as if to say, “this is no longer a luxury my mom will be able to enjoy.” I anticipated

events that she would miss and sometimes even imagined what I might feel when that time came. As I approach and experience various life milestones, feelings of guilt reinforce that my mother was cheated. I was cheated. Yet, I survived to tell the story.

This concept analysis relates to our scholarship in varied ways. First, the authors of this paper are also study team members on a National Institute of Nursing Research funded R21 (5R21NR014055-02) aimed at exploring end-of-life care and service needs of persons living with HIV/AIDS in Appalachian Tennessee and Alabama. In conducting this mixed-methods study, we noted the importance of survivor guilt when individuals discussed the guilt they felt for

Sadie Hutson

Sadie Hutson

surviving decades longer than many of their close friends, relatives, and significant others who lost their lives at the height of the AIDS epidemic. In Hutson’s work as the director of a hereditary cancer risk assessment program in Pikeville, KY, survivor guilt continues to be pervasive (as it was when the concept first became a focus for Hutson in 2001) among individuals who test negative for the known hereditary cancer gene present in their family. Rather than feeling relief for being spared, these individuals experience guilt for being the “lucky one,” citing that the result often drives a wedge in the relationships between mutation-positive and mutation-negative family members. Survivor guilt is also relevant to Dr. Hall’s work with female survivors of childhood maltreatment (R01NR07789). In these data, often the thriving survivor of a chaotic and abusive situation expressed feelings of guilt for leaving behind siblings who did not become successful in life and were still “stuck” in the trauma, sometimes still living with the perpetrators or abusive partners.

Nurses encounter the trauma of survivor guilt in many situations, yet they may not always see it, if the lens through which it is viewed is too narrow. Nurses must first see survivor guilt. After we have seen it in a particular context,

Joanne Hall

Joanne Hall

situation-specific theory can be developed to better characterize the survivor guilt and guide interventions to mitigate the fallout in that context. Perhaps, digital storytelling is one such strategy. It is salient that the same strategies will not work for all. Survivor guilt can be highly damaging, or wilted to being merely a form of nostalgia. We need to understand the process by which individuals resolve their own survivor guilt, as well as therapeutic strategies that fend off traumatic guilt that can be paralyzing, isolating, and disempowering. This will mobilize sufferers to move forward into the fulfilling lives they deserve.

While their article is featured, you can download it at no cost.  So visit the ANS web site now to get your copy, read the article, and return here to share your thoughts and ideas about this very thought-provoking article!

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