Concept Analysis

Presented by
Dante V. Ricaforte Jr.
Sofia Cosette P. Monteblanco
Johann Macapar

CONCEPT ANALYSIS

DEFINITION & DESCRIPTION

conceptum (L) something

conceived
Concept is a mental image of a
phenomenon, an idea, or a
construct in the mind a thing or an
action.
Concepts are the basic building
blocks in theory construction
Concept are mental construction

Concept

example

Abstract

Hope, love, desire

Concrete

Painting, Body temperature, pain

Word

Grief, empathy, power

Two-words

Patient outcome, job satisfaction, role strain

Phrase

Maternal role attachment, health-promoting behavior

CONCEPT ANALYSIS

Concept Analysis is a process of

examining the basic elements of a
concept.
Yields basic understanding attributes
of the concept.
Concept analysis can be useful in
refining ambiguous concept in a
theory.
It must clearly name the thing to
which it refers, It must be clearly
define (structure) and its uses in
theory should be clear (function).

CONCEPT ANALYSIS

Concept Analysis is a process of

examining the basic elements of a
concept.
Yields basic understanding attributes
of the concept.
Concept analysis can be useful in
refining ambiguous concept in a
theory.
It must clearly name the thing to
which it refers, It must be clearly
define (structure) and its uses in
theory should be clear (function).

CONCEPT ANALYSIS

Developing standardized language

to describe nursing practice.
Useful in construction research
instrument or interview guides
Concept Analysis contributes also to
instrument development and theory
testing.

Why conduct concept Analysis?

To define ambiguous concepts
Clarifies symbols.
To distinguish similarities and
differences
To fully understand a concept
and apply it to theory
Develop research instrument
Enhance validity of the study.

To define concepts so
clearly that their truth
value in respect of any
situation or object could
be defined.

 It is essential that the concept to be explored / measured should

clearly defined, failure to do so could lead to a poorly designed study
that compromised the validity of the findings.

Without clear conceptual foundation, the quality of research and

theory construction of any discipline is weakened and its maturity is
compromised.

CONCEPT ANALYSIS
(MELEIS, 2012)

Concept Analysis is a strategy for further

developing concepts.
The assumption is made that the concepts have
been introduced in the literature, that they have
been identified and clarified, but are in need of
further analysis.
Analysis implies a breaking down to well-defined
components.
The goal of analysis is to bring the concept close to
being used for research or for clinical practice.
Concept Analysis is interchangeable with concept
development

PURPOSE OF CONCEPT ANALYSIS

Identifying gaps in nursing knowledge
Determining the need to refine or clarify a
concept when it appears to have multiple
meanings
Evaluating the adequacy of competing
concepts in their relation to other
phenomena
Examining the congruence between the
definition of the concept and the way it has
been operationalized
Determining the fit between the definition
of the concept and its clinical application

STRATEGIES IN CONCEPT ANALYSIS

Concept
Analysis Method
/ Strategy

Description

Author

Year

Wilson Method

11 steps Concept Analysis

John Wilson

1963 / 1969

Interpretative
research concept

Interpret meanings and definitions of

concepts presented in written, textual form
from theoretical perspective
4 element of concept Analysis

Nasi, Takala, and

Lamsa

1980

Concept Analysis
Method / Strategy

Description

Year

Author

Simultaneous Concept
Analysis

Based on value system of

connectedness and collaboration.

2000

Haase, Leidy, Coward, Britt

and Penn.

The Hybrid Strategy

3 phase strategy ( Theoretical,

Field work, Analytical)

1986 / 2000

Schwartz-Barcott, Kim

Rodgers Evolutionary
method of concept
analysis

The content of a concept depends

on the context of use, as
contextualism holds, then when
the context of use changes, the
meaning must change too.

2000

Rodgers B.

Concept Analysis
Method / Strategy
Walker and Avant
Process Model Concept
Analysis

Description
8 steps model.
Distinguish between
the defined attributes
to a concepts and its
irrelevant attributes

Year
1994

Author
Walker and Avant

 Concepts are
categories of information
that contain defining
attributes and concept
analysis is the formal,
linguistic exercise that
enables delineation of
these defining
characteristics or
attributes

Lorraine O.
Walker

All Strategies and process

for concept development or
analysis are based on the
ability of the developer to
use critical thinking skills.

Peggy Chin

8. Define Empirical
Referents
7. Identify antecedent
and consequences
6. Identify Cases
5. Identify a model case
4. Determine the
defining attributes
3. Identify all uses of
concept discovered
2. Determine the purpose
1. Select a concept

Walker and Avant

8 Steps Process Model
Conceptual Analysis

WALKER AND AVANT 8 STEPS CONCEPTUAL

ANALYSIS
Step 1
SELECT A CONCEPT

Interesting
Relevant
Important
useful

 Spirituality
Patient Outcome
Holistic practice
Professional Growth
e-Health
Trust
Companion
Self-healing
Interconnectedness
client-participation

Concepts that have been

identified but are yet
underdeveloped in nursing
literature.
Term used vaguely in nursing
practice

Example:

Concept of Patient Outcome

Result
Goal
Evaluation
Safety
Wellness
Quality
Productivity
Satisfaction
Improvement
Expectation
Quality

Step 2

Determine the aims or

purposes of the analysis
Distinguish between ordinary and
scientific usage of the same concept.
Clarify meaning of the existing concept
Develop operational definition
To add to existing theory

Why am I
doing
this ?

Accreditation
Recommendation
Evaluation
Provide Quantitative basis for
making clinical decisions.
Measure Efficacy of Care
Determine areas for care
improvement

The purpose of concept

analysis could be
distinguished between
ordinary and scientific
usage of the same
concept, to clarify
meaning of an existing
concept, to existing
theory, to develop
operational definition
or something similar.

Step 3

Identify all uses of

concepts you can
discover
Sources:
dictionary
thesaurus
colleagues
available literature
All Uses of term in all fields
Scientific
Ordinary
Slang

 Identify all uses of

concepts when collecting
materials for the analysis.
Collect all actual and
possible uses of words that
convey concept meaning.

 Do not limit your search to just

nursing or medical literature
as this may bias understanding
of the true nature of the
concept (walker & Avant, 2016)
Include implicit and explicit
uses of concepts, even slang
expression can be helpful

Lets take an example on

PATIENT OUTCOME

 Patient Outcome does not appear in

dictionaries as one term, however Patient
and Outcome can be found separately.
Patient + Outcome = Patient Outcome

Patient
Outcome

DEFINING PATIENT OUTCOME

PATIENT
1. is a person received medical care or treatment (Merriam-Webster, 2009)
2. Person receiving or registered to receive medical treatment (Oxford
Illustrated Dictionary, 2005)
3. Someone who is receiving medical treatment from a doctor or in a
hospital ( Longman
Dictionary, 2009)

OUTCOME
4. Something that happens as a result of an activity or process (MerriamWebster, 2009)
5. A result or visible result (Oxford Illustrated Dictionary, 2005)
6. A result or an effect of an action ( Cambridge Dictionary, 2004)

Collection of terms in
Patient Outcome
DEFINITION OF PATIENT OUTCOME IN LITERATURE

Patient Outcome

Reference

The end result or the results from some actions

Lang and Merek, 1990

Consequences of the provision of healthcare

Duffy and Hoskiness, 2003

Ends point of care, substantial changes in health condition of a

patient, and changes in patient behavior caused by medical
intervention

Harris, 1990

Patient Outcomes as the changes in the present and future health

condition of a patient that could be linked to previously provided
health

Donabedian,1985

Attributes of Patient
Outcome in Medicine
PATIENT OUTCOME IN VIEW OF MEDICINE
(TARLOV, GREENFIELDS, 1989)

INDICATORS

Attributes

Clinical End Point

Symptoms, Sign &
Symptoms,
Laboratory values,
death

Functional Status
Physical, Mental,
Social Role

General Well-being
Health Perception,
energy, fatigue,
pain, life
satisfaction, quality
of life

Satisfaction
with Care
Access,
convenience,
financial coverage,
quality

Attributes of Patient Outcome in

Nursing
Patient Outcome in view of Nursing

Author / Proponent

Normal fluid hydration

Mobility,
Absence of decubitus ulcer and injury to mucosal
membrane.

McCormick. 1991

Patient or family Education

Facilitation of Self-Care, Symptoms distress management
Patient Safety
Patient Satisfaction

Gillette and Jenko, 1991

Functional Status
Mental status,
Stress level,
Satisfaction with Care
Caregiver burden,
Cost of Care

Brooten and Naylor, 1995

Absence of Pressure Ulcer

Nosocomial infection,
Patient falls in addition to patient satisfaction with nursing
care,
Pain management
Educational information and overall care

American Nurse Association,

1995

Cluster of Attributes of
Patient Outcome in Nursing
Discipline

Patient Functional Status (Health

Status,
Well being and Self-Care Abilities)
Patient Safety (medical error, patient
falls, pressure ulcer, 30day mortality,
nosocomial infection)
Patient Satisfaction with nursing care
Pain Management

Educational Information

Patient
Outcome
within
Nursing
Discipline

The Operational Definition

based on Concept of Patient
Outcome

Patient Outcome - is the result of nursing care

that patients receive in hospital including
maintenance of patient functional status,
maintenance of patient safety and patient
satisfaction. (Avant & Liu, 2014)

Conceptual definition

Cluster of
attributes

Operational definition

Refining attributes

Define

Step 4

Determine the defining

attributes
Cluster of attributes frequently
associated
Refine the defining attributes to the
fewest number that will still
differentiate the concept of interest
in the surrounding concepts.

Make decision to accept among all

attributes associated.

 Attributes are those

characteristics that appear in
the concept repeatedly and
help researchers differentiate
the occurrence of a specific
phenomena from a similar
one. (Walker and Avant, 2011)

Attributes of Patient Outcome

from various literature
(social science, medicine, nursing)
Patient Functional
Status

Patient Safety

Patient Satisfaction

Individual ability to perform daily Avoidance of injuries or damage to

life activities required to satisfy
patients from care or treatment
basic needs (Leidy, 1994)
provided to heal them (Institute of
Medicine, 2006)

Individual perception of pleasure

or contentment (Seago et
al.,2006)

Actual performance of functional

status and the level or degree of
performance (Knight, 2000)

Absence of patient harm due to the

process of Care (Simpson, 2006)

Patient opinion on the care

received from nursing staff during
hospital stay as determined by
scaled responses to uniform series
of question designed to elicit
patients views regarding
satisfaction with key elements of
nursing care services (Burns,
2005)

Functional Outcome are

measures how well patient can
do the task required for
everyday life (Kaplan, 2007)

Freedom from accidental injury

(AHRQ,
2006)

Patient satisfaction with pain

management, education and
patient satisfaction with nursing
care (Avant, 2011)

Indicators of
Patient Outcome

Patient
satisfaction

Patient
Outcome
( Liu & Avant,2014)

Patient
safety

Patient
functional
status

At the end
I was only suggesting
all the possibilities,
but the decision is for
you to decide, your
honor!

Step 5
Identify a model
Case
Pure case of concept
Paradigmatic example or
Pure Exemplar
Constant comparative
reflection

Walker and Avant (2011)

describes concepts as one
formulated and presented by
the best of the examiners
ability and understanding of the
topic
if this is not x, then nothing
is. (Chin & Kramer, 2010)

 Compare personal
experience. Do they
match? If not, Why not?

Battery cycle model

Model case may be

actual examples from
real life, found in the
literature or selfconstructed.

Aid to understand the

concept

this just a part

of our
adjustment
period.

Compare experience to the defining

attributes collected in a concept. (E.g.
battery cycle)
What are missing or additional in defining
attributes or the model case makes them
inconsistent?

Step 6

Identify Borderline,
related, contrary,
invented and
illegitimate cases
Same element as a model case but one or
more attributes differs in some way
Analysis cannot be completed until there is
no overlapping attributes and no
contradiction between the defining attributes
and the model case.

Types of case attribute in defining Concept

RELATED - Derived from a single word that can be
used in several different contexts. (Chin and Kramer,
2010)

BORDELINE - Derived from a single word that can

be used in several different contexts. (Chin and
Kramer, 2010)

example

QUALITY OF LIFE VS. SATISFACTION OF LIFE

FEAR VS. ANXIETY

Types of case attribute in defining Concept

CONTRARY is one that may be similar in some
aspects, however they represent a significantly
different concept from the one being analyzed (chin
and Kramer, 2010)

INVENTED are concrete concepts from ideas

outside of ones own experience to further
understand the concept being analyzed (Walker &
Avant, 2011)

ILLIGITIMATE concept term used improperly or

out of context (Avant, 2011)

example
UPSET VS. COPING

(FICTITIOUS SCENARIO) a woman is floating in the

air when she is frightened as her coping
mechanism

Meaning for a term that is completely different, It

may have one or two critical attributes but most
attributes does not apply.
Attachment (sewing) vs. touch

BORDERLINE CASE: FEAR VS. ANXIETY

Fear is a defensive response to

perceived threat or the result of
exposure to a single cue
presented in the environment

Anxiety is a heightened sense

of uneasiness to a potential
threat which is inconsistent with
the expected event and results
when there is mismatch between
the next likely event and actual
event

FEAR VS. ANXIETY

RELATED: QUALITY OF LIFE VS. SATISFACTION OF LIFE

Invented cases : contains ideas outside ones experience, fictitious and

invented ideas.

 Contrary are clear examples

of not the concept. (Wilson,
1963)
It is easier to identify what
something is not that what it is
(Avant, 2011)

ILLEGITIMATE: BUTTON ATTACHMENT VS. TOUCH

Step 7

Identify antecedent
and consequences

Events or incidents that

happened prior to or result of the
occurrence of the concept

 Antecedent are particularly useful in

helping the theorist identify underlying
assumptions about the concepts being
studied.

Consequences are useful in determining

often neglected ideas, variables or
relationship that may yield fruitful new
ideas

ANTECEDENT events or incidents that must occur

or be in place prior to the occurrence of the concept.

CONSEQUENCE events or incidents that occur as a

result of the occurrence of the concept.

OVULATION

SPIRITUALITY
self

PREGNANCY

Meaning of life, hope,

transcendence, trust, creativity, religiosity and

health.

Defining Attributes

Sample question

ATTRIBUTES

Are concrete examples of the concept described in the

data materials?

ANTECEDENT

Which events or phenomena have been associated with

the concept in the past?

CONSEQUENCES

What happened after or as a result of the concept?

Concept

Attributes

Antecedents

Consequences

Reference

Cancer
Survivorship

Complex
individualized process;
unique relational
dynamic

Cancer Diagnosis

Physical; psychosocial,
spiritual; socioeconomic

Doyle, 2008

Transition to
motherhood

Time-dependent
process; psychoemotional swirling;
hovering around the
edge of mothering

Unexpected outcome of
pregnancy, awareness of
the situation; motherinfant separation

Delayed motherhood;
developing a sense of
meaning concerning family
and life

Shin and WhiteTraut, 2007

Self-monitoring

Awareness of
symptoms;
sensations; activities
cognitive processes,
measurement;
recording, observation

Knowledge of disease
process and symptoms;
social support for
wellness; skills for
problem solving and
measurement /
recordings; goals for living
with chronic condition

Self-management improved
through; better recognition
of symptoms, improved
disease regulation, more
realistic goals, contributing
to quality of life.

Wilde and Garvin,

2007

Step 8

Empirical Referent

Classes or categories of actual

phenomena that by their existence or
presence demonstrate occurrence of the
concept itself.
Serves as means to recognize or measure
the defining characteristics or attributes

DEFINE EMPIRICAL REFERENTS

Determining the empirical

referents for the defining
attributes is the final step in a
concept analysis

EMPIRICAL REFERENTS

Empirical Referents, once identified are

extremely useful in instrument development
because they are clearly linked to the
theoretical base of the concept
Contributing to the content and construct
validity of a new instrument.
Provides clinician with clear, observable
phenomena by which to determine the
existence of the concept.

EMPIRICAL REFERENTS

Concept

Empirical Referent

Affection

Kissing

Coping

Ability to solve the problem in as stressful

situation

Patient Outcomes
(Avant, Liu ,2014)

Patient functional status

Patient Satisfaction
Patient Safety

Empirical referent in
instrument development for
Patient Outcome
Indicator

Measure

Outcome

Patient Functional
Status

Can you take care of yourself ?

Can you participate in moderate recreational
activities?

Maintained / Improved

Patient Safety

Is
Is
Is
Is
Is

an incidents of patient fall?

an incident of injury ?
a presence of Decubitus Ulcer?
incidence of medication error?
prevalence of nosocomial infection?

Maintained / Unharmed

Patient Satisfaction

Patient privacy implemented?

Patients needs are addressed?
Patients feels comfortable with the nurses
and staffs?
Nurses manage information to ease patients
anxiety related to illness?

Patient reporting of
Pleasure / contentment

there
there
there
there
there

Procedure for
conceptual analysis is
a process not a linear
activity, you will be
moving back and
fourth among the
steps more frequently,
revising as you go,
circling back through
some steps more than
once is common. This
movement is too
normal.

Kaye C. Avant

Advantage and Limitation of Conceptual

Analysis

Advantage
1. Renders precise theoretical and operational
definition.
2. Clarifies term in nursing that have become
catchphrases and hence lost their meaning.
3. Utility for tool development and nursing
language development.
4. Intellectual exercise is good practice in
thinking.

Pitfall
1. The tendency to moralize when the concept
being analyzed has some value implications
2. The feeling of being absolutely in over your
head
3. The feeling that concept analysis is too easy
4. The compulsion to analyze everything, or the
how do you turn it off syndrome

Pitfall
5. The need to protect oneself from others
criticism or debate during the process of
analysis

A sense of proportion, a little risk

taking, a sense of humor and low
anxiety level are helpful in the
process of analysis

6. The feeling that verbal facility equals thinking

7. The attempt to add superfluous defining
attributes

UTILIZING THE RESULTS OF CONCEPT ANALYSIS

Uses
1. Refining ambiguous terms in theory,
education, research and practice
2. Providing an understanding of the underlying
attributes of a concept
3. Facilitating instrument development in
research
4. Providing assistance in the development of
nursing language

AIM OF THE ANALYSIS

1.

If one of the aims is to develop an instrument:

construct items that would reflect the defining
attributes of the concept, based on empirical
referents

2.

If the aim is to propose a nursing diagnosis,

intervention or outcome name: clinically validate
the defining attributes

3.

If the aim is to construct an operational definition:

attempt to find a research instrument that
accurately reflects the defining attributes of the
concept

RESPONSE TO CRITICISM OF THIS METHOD

The intent of this book is for the introduction of theoretical methods to
the novice developing a theory
Intended to be kind of primer in the theory development and not to be
used in the absence of other material

References
Avant K, Liu Y. (2014) Patient Outcome in the field od nursing: A concept
Analysis.
International journal of Nursing Science,
p69-74
Meleis A. (2011) Theoretical Nursing; Development and Progress 5 th ed,
USA, LWW
Octaviano, E, Balita, C. (2008) Theoretical Foundation in Nursing; the
Philippine nursing perspective,
Manila, Ultimate learning Series,
Walker L., Avant K, (2011) Strategies for theory Construction 5 th Ed., USA.,
Prentice hall