Running head: APPLICATION OF CONCEPT ANALYSIS

Application of Concept Analysis to Clinical Practice Betty Cronier Grand Canyon University Theoretical Foundations for Nursing Roles and Practice NUR 502 Carrie O'Reilly PhD, MSN, RN January 29, 2012

APPLICATION OF CONCEPT ANALYSIS Application of Concept Analysis to Clinical Practice Concepts are defined by McEwen and Wills in Theoretical Basis for Nursing as an abstract term and a symbolic description of a phenomenon (2011). They have varying characteristics ranging from enumerative connoting presence and universality to summative representing the entire complex of the phenomenon. Further exploration of the term concepts shows them to be variable or non-variable and either operational or theoretical in design. This lends them to be a source in nursing practice, a process for research and profitable for study and application across the continuum of disciplines (McEwen & Wills, 2011). With the understanding of the term concept, the deduction that a concept analysis is the process of inquiry to explore, develop, establish and understand selected phenomenon can be clearly drawn. Walker and Avant in 1983 set forth a method of concept analysis which

expounds on Wilsons existing process of concept analysis (McEwen & Wills, 2011). This paper will focus on Walker and Avants concept analysis (2005). The author will include a description of their method of concept analysis which employs an eight step process. This process includes the selection of a phenomenon, the determination of purpose, the identification of uses, the definition of attributes, the identification of model and borderline cases, the recognition of antecedents and consequences and the references to empirical methods (McEwen & Wills, 2011). An application of Walker and Avants (2005) process including the steps and the results of the process will be identified and discussed in light of Lawrette Axleys (2008) article, Competency: A Concept Analysis published in the professional journal, Nursing Forum obtained from Grand Canyon University eLibrary utilizing Proquest Central. Finally, application of the concept analysis to nursing practice related to the identified phenomenon will be presented.

APPLICATION OF CONCEPT ANALYSIS Description of Method Walker and Avant (2005) have developed a methodology to analyze, synthesize and derive concepts for use by theorists, researchers and clinicians. The analytical phase, concept

analysis, is designed to clarify meanings of terms and define terms (McEwen & Wills, 2011, p. 54). Concept analysis employs an eight step process which guides the exploration of a phenomenon. It allows for common language to be developed so that whether used in theory, research or practice an understanding can be clearly established (Walker & Avant, 2005). Clear determination of the area of interest is the first stage of Walker and Avants process (2005). At this point useful research or theoretical development is confirmed. As discussed by Axley (2008) in Competency: A Concept Analysis a phenomenon was explored in the legal, industrial and healthcare venues. In the 1990s the use of this phenomenon of competency was introduced and implemented in healthcare education. Since that time healthcare and related disciplines have utilized this concept. With the wide spread use identified, Axley (2008) validates the need for further research related to the concept of competency in the nursing profession. The second step in the analysis is to determine the purpose. It is intended to focus the results on the intention of analysis. The concept then begs the question from Walker and Avant Why am I doing this analysis?(2005, p. 66). Axleys stated purpose for the analysis establishes the aim to define the importance of competency in nursing practice (2008). Stage three utilizes the definitions penned to the phenomenon. Through the use of dictionaries, thesauruses and other literature, multiple use of the concept is exposed. A comprehensive review of defining literature was undertaken during the research of this article. Axley (2008) cited the Oxford English Dictionary, Merriam-Webster online dictionary, The Joint

APPLICATION OF CONCEPT ANALYSIS

Commission (JCAHO) as well as various boards of nursing and college professors publications. This review validates the ambiguous meaning of the concept and the lack of a standardized measurement to evaluate the phenomenon. Additional uses of the concept are examined in light of technical skills, educational level, and practice expertise (Axley, 2008). Defining the attributes of the concept is acknowledged by Walker and Avant (2005) as the heart of the concept analysis. This fourth step clusters the attributes most congruent points with the concept and provides the broadest introspective view of the phenomenon. A clear focus needs to be derived so that a more concise view of the purpose is established. The attributes of knowledge, action, professional standards, internal regulations and dynamic state (Axley, 2008, p. 218) were identified in the article. This draws a clear view that the concept of competency needs further research. In step five a model case is identified either through practice knowledge, case literature or best case scenario. The concept being analyzed should be positively chronicled with defining criteria. Axleys model of SB registered nurse (RN) demonstrates the clinical, ethical and educational skills and substantiates the criteria to present the model case (2008). Borderline, related, contrary and illegitimate cases are analyzed in step six. As alternative cases are reviewed, a better definition of attributes can be established. Walker and Avant stated in Strategies for Theory Construction in Nursing, that the basic purpose of these cases are to decide what counts (2005, p. 70). Axley meets the analytical criteria by utilizing a borderline case which demonstrates that although the RN met didactical requirements, she lacks the judgment to demonstrate the competency to evaluate findings (2008). In step seven antecedents and consequences are set forth. Antecedents provide insight about the attributes (McEwen & Wills, 2011). Those described in this article allude to

APPLICATION OF CONCEPT ANALYSIS educational knowledge and the ability to demonstrate competency through accountability and responsibility to nursing practice (Axley, 2008). Consequences on the other hand are those events that are results of an occurrence of the phenomenon (McEwen & Wills, 2011). The

article articulates the criteria related to the safety of care, core knowledge of theory and desire to develop professionally. This validates that competency is directly related to safety and quality of nursing care (Axley, 2008). Step eight defines the empirical referents, emphasizes the categories that exist and demonstrates the phenomenon. As presented by Axley (2008) the referent of continuing education demonstrates that the nurse is committed to fulfill the requisites for competency as a professional nurse. With the use of Walker and Avants eight step procedure, the completion of these steps clarifies and directs the critical components of concept analysis (2005). The process shows that the article displays mastery of the critical components of the process and provides a clear understanding of the phenomenon (Axley, 2008). Application to Practice Competency in nursing is grounded in as stated by Axley knowledge, skills, ability and behavior that a person possesses (2008, p. 217). Many times in the long term care setting professional nurses although having these attributes lack the ability to function independently to insure quality patient care. The ability to perform the skill, display the knowledge or exhibit the behavior of competence should equip the nurse to make clear decisions to ensure patient care and safety. Without the expertise in a clinical setting the nurse is only minimally equipped to deliver competent care. Acting as house supervisor, LR, RN assessed patient X without any clinically

APPLICATION OF CONCEPT ANALYSIS significant findings. The assigned certified nurse assistant (CNA) reported that the patient refused her evening meal, continually complained of a headache and was significantly different from the prior day. Instead of questioning the CNA more fully in relation to patient X, LR dismissed the encounter. LR instructed the licensed practical nurse (LPN) to administer a basic

analgesic for the complaint of the headache. Before the end of shift LR was called to patient Xs room to find her unresponsive. Although the physical assessment was completed, LR failed to analyze, synthesize and evaluate all of the available findings. Patient Xs quality of care and outcome were diminished due to poor critical thinking skills. This is an example of a borderline case. As seen in the step seven of Walker and Avants (2005) concept analysis, the consequences related to lack of competency of LR directly impacted the quality of care and outcome of patient X. Axley (2008) confirmed that the nurse must be able to synthesize skills and knowledge with clinical expertise and judgment as well as critical thinking skills to assure patient care and safety. This can be accomplished through critical thinking expertise guided by advanced skills in a clinical milieu. Conclusion As espoused by the author in the overview of Walker and Avants (2005) concept analysis, the process follows a logical method. It serves to address phenomenon across the continuum of disciplines. It also develops a construct for the analysis of the concept. By utilizing the eight steps of concept analysis presented by Walker and Avant (2005) validation to continue research is established. As the author looked at the process of clinical analysis Lawrette Axleys article, Competency: A Concept Analysis (2008) demonstrates a clear need for further evaluation of the concept of competency in nursing practice. Through correlations drawn from the collected data

APPLICATION OF CONCEPT ANALYSIS and literature review, a validated and measureable method to insure competency in nursing practice is needed. With that said, a true definition of competency can be developed when the

nursing profession incorporates the concept of competency into theory. This will allow for more emphasis on patient-centered quality of care and the achievement of more optimum patient outcomes.

APPLICATION OF CONCEPT ANALYSIS References Axley, L. (2008). Competency: A concept analysis. Nursing Forum, 43, 214 - 222. Retrieved January 27, 2012 from GCU eLibrary http://proquest.com.library.gcu.edu.2048/docview/195031400/fulltextpdf? account=7374 McEwen, M., & Wills, E. M. (2011). Concept development: Clarifying meaning of terms. In Theoretical basis for nursing (3rd ed., pp. 46-64). Philadelphia, PA: Wolters Kluwer | Lippincott Williams & Wilkins. Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.