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Concept building: Applying rigor to conceptualize phenomena for nursing research
Available online at www.sciencedirect.com
Applied Nursing Research 25 (2012) 65 – 67 www.elsevier.com/locate/apnr
Guest Editorial
Concept building: Applying rigor to conceptualize phenomena for nursing research Concept building is a process that provides a rigorous structure for moving beyond traditional concept analysis as the starting point for the research endeavor. For the past 8 years, we have used this concept-building process to guide PhD students. The process offers a logical and creative approach that brings depth and meaning to the beginning phase of conceptualizing a phenomenon for research. Prior to the introduction of the concept-building process, concept analysis was used within early doctoral study to help students clarify their central ideas for research. Most often, the strategies proposed by Walker and Avant (1983) were introduced. However, alternative approaches, including those that are based in literature (Steis, Penrod, Adkins, & Hupcey, 2009) and those based in qualitative evidence (Morse, 1995), have been proposed. In a seminal article criticizing traditional concept analysis, Paley (1996) suggested that concepts emerge within theory niches and that concept analysis processes were limiting rather than enabling. With the recognition that it was important to provide guidance for doctoral students wishing to build conceptual structures for research, Liehr and Smith (2008a) proposed a rigorous concept-building process that begins where nursing lives, in a practice situation; incorporates both literature and evidence; and places idea development within a theoretical niche expressive of the disciplinary perspective. Students have used it to build concepts for research based on ideas such as catastrophic cultural immersion (Wands, 2008), yearning to be recognized (Ramsey, 2008), bridging cultural disparities (Millender, 2011), and potentiating a chosen path (Pate, 2011). Although the process was developed to support learning within doctoral study, it has merit for any nursing scholar wishing to systematically approach building concepts for research. The 10-phase process is based on the assumption that nursing practice informs research through a repository of disciplinary knowledge that can be accessed through patient stories. The 10 phases are as follows: (1) write a meaningful practice story; (2) name the central phenomenon in the practice story; (3) identify a theoretical lens for viewing the phenomenon; (4) link the phenomenon to existing literature; (5) gather a story from someone who has lived the 0897-1897/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.apnr.2012.01.001
phenomenon; (6) reconstruct the shared story (from Phase 5) and create a mini-saga that captures its message; (7) identify the core qualities of the phenomenon; (8) use the core qualities to create a definition; (9) create a model of the phenomenon; and (10) write a mini-synthesis that integrates the phenomenon with a population to suggest a research direction. The process, which provides the scaffolding for beginning scholars to move from the familiarity of practice to the unfamiliarity of phenomena for research, will be shared with brief examples that demonstrate potential and lessons learned in nearly a decade of use. In the first phase, the scholar is asked to write a story about a significant practice experience that holds deep interest; this practice experience is grounded in a nursing situation where the nurse and the patient have been touched in a meaningful way. Deep interest is crucial to holding on to the phenomenon when the concept-building process goes at a seemingly slow pace and the scholar has a sense of “not-knowing” that naturally comes with clarifying the meaning of a phenomenon for research. At this stage, we have learned to trust the intuitive wisdom of nurses who express complex patterns of knowing when they write their practice story. The kernel of “deep interest” is in the story to be uncovered with ongoing dialogue and reflection. In the second phase, the scholar is asked to draw inferences about what is going on in the story and then name the phenomenon. While reading and re-reading the written practice story, the question for focus is “What is this about?” We have learned that it can be helpful to write down possible names, read and re-read the practice story, and go back and forth between potential names until the name for the phenomenon seems right for now. Implicit here is the idea that the name, at this point, is a snapshot of complexity. Although the first name may be somewhat simplistic, it is an essential starting point, creating groundwork to continue the concept-building process. When working with scholars who are naming their phenomenon of interest, we strive to keep the name at the middle-range level of discourse, high enough that it could apply across multiple populations but low enough that scholars can “get their arms around it” for continuing development. In the third phase, the scholar will identify a theoretical lens for viewing the phenomenon. The lens might be at the
66
Guest Editorial / Applied Nursing Research 25 (2012) 65–67
grand or the middle-range level of discourse as long as the theory creates a niche for viewing the phenomenon of interest. We have learned that nurses practice with guiding structures of knowledge even if they do not recognize the structures. This phase asks them to become familiar with the theory niche that resonates with their practice values. It is possible that more than one theory could serve as a niche and scholars are asked to compare and contrast the view from each niche before selecting a theoretical lens and moving on. It is important to note that the scholar is not developing theory at this point; rather, the phenomenon of interest is niched within an existing theory, thereby enriching the existing theory and strengthening the developing phenomenon. In the fourth phase, the scholar begins to review the literature related to the phenomenon of interest. Clues to appropriate literature may come from the theoretical lens, from the practice story, or from considering the distinct words that comprise the phenomenon name. For instance, when exploring the literature related to catastrophic cultural immersion, the scholar will search the literature on cultural immersion as well as catastrophe. We have learned that it is wise to keep the practice story in focus as the literature search ensues. The values in the practice story often direct exploration of the literature in a way that contributes to clarity and, possibly, a refinement of the phenomenon name. In the fifth phase, the scholar gathers a story from someone who has lived the phenomenon of interest. Now that there is a rudimentary grasp of the phenomenon as it has been studied and reported in the literature, it is time sit down with a person who has experienced it, gathering a story that allows a reality check of what has been learned thus far. We have learned that scholars can use guidance about story gathering to ensure that they engage in dialogue that contributes to the concept-building endeavor. A systematic story-path approach (Liehr & Smith, 2008b) has most often been used for story gathering. In this approach, the mindful presence of the nurse creates an atmosphere for querying the present experience of the phenomenon, followed by past experience leading up to the present, and extending into future hopes and dreams. It is best to audio-record story gathering so that it can be revisited by the scholar. In the sixth phase, the scholar reconstructs the story collected in the previous phase by writing a narrative with a beginning, middle, and end. Although this sounds simplistic, these are basic dimensions of a story. Ensuring description of each dimension facilitates the creation of the mini-saga, the important culminating activity of this sixth phase. Pink (2005) describes the mini-saga as a 50-word short story. He contends that story is “context enriched by emotion” that exists where “high concept and high touch intersect” (p. 101). We have learned that the exercise of writing the minisaga is a disciplined experience of synthesizing that serves the scholar well in future writing endeavors. In the seventh phase, the scholar identifies the core qualities of the phenomenon of interest. The core qualities
are just enough ideas to capture the essence of the phenomenon. The scholar begins by re-reading the reconstructed story, asking the following question: What are the major ideas that can be extrapolated? These ideas are the defining points or core qualities of the phenomenon. It is likely that the core qualities can be found explicitly in the reconstructed story, but sometimes, they emerge implicitly and are corroborated by the literature. We have learned, at this point in the concept-building process, that somewhere between two and four core qualities best enable the scholar to build a structure for research. We encourage scholars to begin to familiarize themselves with literature relevant to each core quality. In the eighth phase, the scholar organizes the core qualities into a definition of the phenomenon. The placement of core qualities and choice of connecting words in the definition require thoughtful consideration of changes in the meaning of the phenomenon when one core quality is placed before another and connecting words like through, to, or from are used. We have learned that it is best for the scholar to use an “is” statement to formulate the definition. For example, “catastrophic cultural immersion is the abrupt displacement of persons into sudden unfamiliarity from which they struggle to transcend” (Wands, 2008, p. 52). This structure forces the scholar to articulate meaningful connections between the core qualities rather than stringing them together as a list. Thoughtful organization of the core qualities in a definition contributes to successful completion of the next phase of the concept-building process. In the ninth phase, the scholar creates a model of the relationships among the core qualities. The model represents how the core qualities come together in a picture. It can be challenging for the scholar, but the picture often becomes the guiding structure for research, enabling others who work with the scholar to visualize the phenomenon in a simplistic way. We have found that scholars often have difficulty with the technological skills to create the picture that they have in their mind's eye. Doing the model building as a group endeavor can be helpful, teaching scholars to stick to their mind's eye when colleagues suggest a representation that is not consistent with what they know about their phenomenon. At this point, the scholar begins to recognize self as a beginning expert in their phenomenon of interest, and dialogue with colleagues about each of the models provides an opportunity to assert and honor expertise. In the tenth phase, the scholar generates a mini-synthesis that ties together all phases of the structure building process. The mini-synthesis is a 50-word, three-sentence statement that describes the significance of the phenomenon for a particular population, the name and definition of the phenomenon, and a way for moving the phenomenon to a possible research study. We have learned that the minisynthesis emerges rather naturally as this concept-building process evolves. The concept-building process is not meant to be linear, where one phase is completed and then the next.
Guest Editorial / Applied Nursing Research 25 (2012) 65–67
Rather, the process begins, moves through, and touches back to previous phases, always creating a work in progress with care to maintain correspondence between the phases and ongoing clarification of the meaning of a phenomenon. Developing a phenomenon requires intellectual discipline and a respect for all levels of abstraction. Logical reasoning implicitly underpins the process of creating and describing the phenomenon of interest. The process is logical when it makes sense, is coherent, and can be understood by others, including practicing nurses who work with patient populations where the phenomenon of interest applies. Implicit in applied nursing research is guidance for meaningful practice. In a recent report from the Carnegie Foundation, Benner, Sutphen, Leonard, and Day (2010) suggested the importance of nursing practice narratives for enhancing the relevance of real-world solutions for patients. The proposed rigorous 10-phase process described here incorporates nursing practice narrative as a critical dimension in the process of developing structures for applied research. The process guides the budding scholar to root research in significant practice situations. A grounding of research in practice ensures that research evidence can be applied directly to practice. Mary Jane Smith, PhD, RN (Professor and Associate Dean) Graduate Academic Affairs West Virginia University School of Nursing, WV, USA E-mail address: [email protected]
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Patricia R. Liehr, PhD, RN (Professor and Associate Dean) Nursing Research and Scholarship Florida Atlantic University Christine E. Lynn College of Nursing, FL, USA References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass. Liehr, P., & Smith, M. J. (2008a). Story theory. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 205–224. Liehr, P., & Smith, M. J. (2008b). Building structures for research. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 33–54. Millender, E. I. (2011). Using stories to bridge cultural disparities, one culture at a time. The Journal of Continuing Nursing Education 42(7), 37–42. Morse, J. (1995). Exploring the theoretical basis of nursing using the advanced techniques of concept analysis. Advances in Nursing Science 17(3), 31–46. Paley, J. (1996). How not to clarify concepts in nursing. Journal of Advanced Nursing 24, 572–578. Pate, C. M. (2011). Phenomenon development from practice to research. Nursing Science Quarterly 24, 331–336. Ramsey, A. (2008). Yearning to be recognized. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 39–46. Pink, D. H. (2005). A whole new mind: Moving from the information age to the conceptual age. New York: Penguin Group. Steis, M. R., Penrod, J., Adkins, C. S., & Hupcey, J. E. (2009). Principlebased concept analysis: Recognition of the context of nurse-patient interactions. Journal of Advanced Nursing 65(9), 1965–1975. Walker, L. O., & Avant, K. C. (1983). Strategies for theory construction in nursing. Norwalk, CT: Appleton Century-Crofts. Wands, L. M. (2008). Catastrophic cultural immersion. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 46–53.
Applied Nursing Research 25 (2012) 65 – 67 www.elsevier.com/locate/apnr
Guest Editorial
Concept building: Applying rigor to conceptualize phenomena for nursing research Concept building is a process that provides a rigorous structure for moving beyond traditional concept analysis as the starting point for the research endeavor. For the past 8 years, we have used this concept-building process to guide PhD students. The process offers a logical and creative approach that brings depth and meaning to the beginning phase of conceptualizing a phenomenon for research. Prior to the introduction of the concept-building process, concept analysis was used within early doctoral study to help students clarify their central ideas for research. Most often, the strategies proposed by Walker and Avant (1983) were introduced. However, alternative approaches, including those that are based in literature (Steis, Penrod, Adkins, & Hupcey, 2009) and those based in qualitative evidence (Morse, 1995), have been proposed. In a seminal article criticizing traditional concept analysis, Paley (1996) suggested that concepts emerge within theory niches and that concept analysis processes were limiting rather than enabling. With the recognition that it was important to provide guidance for doctoral students wishing to build conceptual structures for research, Liehr and Smith (2008a) proposed a rigorous concept-building process that begins where nursing lives, in a practice situation; incorporates both literature and evidence; and places idea development within a theoretical niche expressive of the disciplinary perspective. Students have used it to build concepts for research based on ideas such as catastrophic cultural immersion (Wands, 2008), yearning to be recognized (Ramsey, 2008), bridging cultural disparities (Millender, 2011), and potentiating a chosen path (Pate, 2011). Although the process was developed to support learning within doctoral study, it has merit for any nursing scholar wishing to systematically approach building concepts for research. The 10-phase process is based on the assumption that nursing practice informs research through a repository of disciplinary knowledge that can be accessed through patient stories. The 10 phases are as follows: (1) write a meaningful practice story; (2) name the central phenomenon in the practice story; (3) identify a theoretical lens for viewing the phenomenon; (4) link the phenomenon to existing literature; (5) gather a story from someone who has lived the 0897-1897/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.apnr.2012.01.001
phenomenon; (6) reconstruct the shared story (from Phase 5) and create a mini-saga that captures its message; (7) identify the core qualities of the phenomenon; (8) use the core qualities to create a definition; (9) create a model of the phenomenon; and (10) write a mini-synthesis that integrates the phenomenon with a population to suggest a research direction. The process, which provides the scaffolding for beginning scholars to move from the familiarity of practice to the unfamiliarity of phenomena for research, will be shared with brief examples that demonstrate potential and lessons learned in nearly a decade of use. In the first phase, the scholar is asked to write a story about a significant practice experience that holds deep interest; this practice experience is grounded in a nursing situation where the nurse and the patient have been touched in a meaningful way. Deep interest is crucial to holding on to the phenomenon when the concept-building process goes at a seemingly slow pace and the scholar has a sense of “not-knowing” that naturally comes with clarifying the meaning of a phenomenon for research. At this stage, we have learned to trust the intuitive wisdom of nurses who express complex patterns of knowing when they write their practice story. The kernel of “deep interest” is in the story to be uncovered with ongoing dialogue and reflection. In the second phase, the scholar is asked to draw inferences about what is going on in the story and then name the phenomenon. While reading and re-reading the written practice story, the question for focus is “What is this about?” We have learned that it can be helpful to write down possible names, read and re-read the practice story, and go back and forth between potential names until the name for the phenomenon seems right for now. Implicit here is the idea that the name, at this point, is a snapshot of complexity. Although the first name may be somewhat simplistic, it is an essential starting point, creating groundwork to continue the concept-building process. When working with scholars who are naming their phenomenon of interest, we strive to keep the name at the middle-range level of discourse, high enough that it could apply across multiple populations but low enough that scholars can “get their arms around it” for continuing development. In the third phase, the scholar will identify a theoretical lens for viewing the phenomenon. The lens might be at the
66
Guest Editorial / Applied Nursing Research 25 (2012) 65–67
grand or the middle-range level of discourse as long as the theory creates a niche for viewing the phenomenon of interest. We have learned that nurses practice with guiding structures of knowledge even if they do not recognize the structures. This phase asks them to become familiar with the theory niche that resonates with their practice values. It is possible that more than one theory could serve as a niche and scholars are asked to compare and contrast the view from each niche before selecting a theoretical lens and moving on. It is important to note that the scholar is not developing theory at this point; rather, the phenomenon of interest is niched within an existing theory, thereby enriching the existing theory and strengthening the developing phenomenon. In the fourth phase, the scholar begins to review the literature related to the phenomenon of interest. Clues to appropriate literature may come from the theoretical lens, from the practice story, or from considering the distinct words that comprise the phenomenon name. For instance, when exploring the literature related to catastrophic cultural immersion, the scholar will search the literature on cultural immersion as well as catastrophe. We have learned that it is wise to keep the practice story in focus as the literature search ensues. The values in the practice story often direct exploration of the literature in a way that contributes to clarity and, possibly, a refinement of the phenomenon name. In the fifth phase, the scholar gathers a story from someone who has lived the phenomenon of interest. Now that there is a rudimentary grasp of the phenomenon as it has been studied and reported in the literature, it is time sit down with a person who has experienced it, gathering a story that allows a reality check of what has been learned thus far. We have learned that scholars can use guidance about story gathering to ensure that they engage in dialogue that contributes to the concept-building endeavor. A systematic story-path approach (Liehr & Smith, 2008b) has most often been used for story gathering. In this approach, the mindful presence of the nurse creates an atmosphere for querying the present experience of the phenomenon, followed by past experience leading up to the present, and extending into future hopes and dreams. It is best to audio-record story gathering so that it can be revisited by the scholar. In the sixth phase, the scholar reconstructs the story collected in the previous phase by writing a narrative with a beginning, middle, and end. Although this sounds simplistic, these are basic dimensions of a story. Ensuring description of each dimension facilitates the creation of the mini-saga, the important culminating activity of this sixth phase. Pink (2005) describes the mini-saga as a 50-word short story. He contends that story is “context enriched by emotion” that exists where “high concept and high touch intersect” (p. 101). We have learned that the exercise of writing the minisaga is a disciplined experience of synthesizing that serves the scholar well in future writing endeavors. In the seventh phase, the scholar identifies the core qualities of the phenomenon of interest. The core qualities
are just enough ideas to capture the essence of the phenomenon. The scholar begins by re-reading the reconstructed story, asking the following question: What are the major ideas that can be extrapolated? These ideas are the defining points or core qualities of the phenomenon. It is likely that the core qualities can be found explicitly in the reconstructed story, but sometimes, they emerge implicitly and are corroborated by the literature. We have learned, at this point in the concept-building process, that somewhere between two and four core qualities best enable the scholar to build a structure for research. We encourage scholars to begin to familiarize themselves with literature relevant to each core quality. In the eighth phase, the scholar organizes the core qualities into a definition of the phenomenon. The placement of core qualities and choice of connecting words in the definition require thoughtful consideration of changes in the meaning of the phenomenon when one core quality is placed before another and connecting words like through, to, or from are used. We have learned that it is best for the scholar to use an “is” statement to formulate the definition. For example, “catastrophic cultural immersion is the abrupt displacement of persons into sudden unfamiliarity from which they struggle to transcend” (Wands, 2008, p. 52). This structure forces the scholar to articulate meaningful connections between the core qualities rather than stringing them together as a list. Thoughtful organization of the core qualities in a definition contributes to successful completion of the next phase of the concept-building process. In the ninth phase, the scholar creates a model of the relationships among the core qualities. The model represents how the core qualities come together in a picture. It can be challenging for the scholar, but the picture often becomes the guiding structure for research, enabling others who work with the scholar to visualize the phenomenon in a simplistic way. We have found that scholars often have difficulty with the technological skills to create the picture that they have in their mind's eye. Doing the model building as a group endeavor can be helpful, teaching scholars to stick to their mind's eye when colleagues suggest a representation that is not consistent with what they know about their phenomenon. At this point, the scholar begins to recognize self as a beginning expert in their phenomenon of interest, and dialogue with colleagues about each of the models provides an opportunity to assert and honor expertise. In the tenth phase, the scholar generates a mini-synthesis that ties together all phases of the structure building process. The mini-synthesis is a 50-word, three-sentence statement that describes the significance of the phenomenon for a particular population, the name and definition of the phenomenon, and a way for moving the phenomenon to a possible research study. We have learned that the minisynthesis emerges rather naturally as this concept-building process evolves. The concept-building process is not meant to be linear, where one phase is completed and then the next.
Guest Editorial / Applied Nursing Research 25 (2012) 65–67
Rather, the process begins, moves through, and touches back to previous phases, always creating a work in progress with care to maintain correspondence between the phases and ongoing clarification of the meaning of a phenomenon. Developing a phenomenon requires intellectual discipline and a respect for all levels of abstraction. Logical reasoning implicitly underpins the process of creating and describing the phenomenon of interest. The process is logical when it makes sense, is coherent, and can be understood by others, including practicing nurses who work with patient populations where the phenomenon of interest applies. Implicit in applied nursing research is guidance for meaningful practice. In a recent report from the Carnegie Foundation, Benner, Sutphen, Leonard, and Day (2010) suggested the importance of nursing practice narratives for enhancing the relevance of real-world solutions for patients. The proposed rigorous 10-phase process described here incorporates nursing practice narrative as a critical dimension in the process of developing structures for applied research. The process guides the budding scholar to root research in significant practice situations. A grounding of research in practice ensures that research evidence can be applied directly to practice. Mary Jane Smith, PhD, RN (Professor and Associate Dean) Graduate Academic Affairs West Virginia University School of Nursing, WV, USA E-mail address: [email protected]
67
Patricia R. Liehr, PhD, RN (Professor and Associate Dean) Nursing Research and Scholarship Florida Atlantic University Christine E. Lynn College of Nursing, FL, USA References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass. Liehr, P., & Smith, M. J. (2008a). Story theory. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 205–224. Liehr, P., & Smith, M. J. (2008b). Building structures for research. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 33–54. Millender, E. I. (2011). Using stories to bridge cultural disparities, one culture at a time. The Journal of Continuing Nursing Education 42(7), 37–42. Morse, J. (1995). Exploring the theoretical basis of nursing using the advanced techniques of concept analysis. Advances in Nursing Science 17(3), 31–46. Paley, J. (1996). How not to clarify concepts in nursing. Journal of Advanced Nursing 24, 572–578. Pate, C. M. (2011). Phenomenon development from practice to research. Nursing Science Quarterly 24, 331–336. Ramsey, A. (2008). Yearning to be recognized. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 39–46. Pink, D. H. (2005). A whole new mind: Moving from the information age to the conceptual age. New York: Penguin Group. Steis, M. R., Penrod, J., Adkins, C. S., & Hupcey, J. E. (2009). Principlebased concept analysis: Recognition of the context of nurse-patient interactions. Journal of Advanced Nursing 65(9), 1965–1975. Walker, L. O., & Avant, K. C. (1983). Strategies for theory construction in nursing. Norwalk, CT: Appleton Century-Crofts. Wands, L. M. (2008). Catastrophic cultural immersion. In: Smith MJ, & Liehr P, editors. Middle range theory for nursing. New York: Springer. pp. 46–53.