- Email: [email protected]
Radiography – A conceptual approach
Radiography (2008) 14, 288e293
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
Radiography e A conceptual approach Sanna-Mari Ahonen* Department of Nursing Science and Health Administration, University of Oulu, P.O. Box 5000, FIN-90014, Finland Received 2 March 2007; revised 8 June 2007; accepted 30 June 2007 Available online 31 August 2007
KEYWORDS Concept; Concept analysis; Evolutionary method; Radiography
Abstract Aim: The purpose of this article is to describe interdisciplinary comparison of the attributes of the concept of radiography in health sciences, physics and technology on the grounds of concept analysis. Background: The concept of radiography is widely used in health sciences, physics and technology. However, the content of the concept may vary. In order to clarify the concept of radiography, the concept must be systematically examined and defined in linguistic form. Method: The concept of radiography was analysed by using the evolutionary method of concept analysis. The data were collected through discretionary sampling and consisted of literature and Internet pages. Qualitative content analysis was employed for analysing the data. Findings: As a result of concept analysis, the concept of radiography in health sciences was determined as expertise of radiographers in the use of radiation, which is dual, dynamic, social and situation-related in nature, and typically based on versatile synthesis. Regarding the attributes identified, the concept of radiography has both similarities and differences between health sciences, physics and technology. Conclusions: The concept of radiography was found to be more abstract, wider, more complex and more radiographer-centred in health sciences than in other disciplines. The content of the concept of radiography seems to vary according to the discipline. ª 2007 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction The concept of radiography is widely used in many disciplines and fields of practice. In addition to health sciences, it is generally utilized in physics and technology. These fields are tightly collaborative, providing health care customers with services of medical imaging and radiotherapy, and the concept of radiography is included in the basic
* Tel.: þ358 8 5375628; fax: þ358 8 5375606. E-mail address: [email protected]
terminology in this collaboration. It may, however, be possible that the content of the concept varies somewhat according to discipline. Despite universal and generalized use of the concept of radiography, it has so far been studied from a conceptual or theoretical point of view only in individual studies.1,2 Due to this, the concept has remained poorly determined and lacking a firm theoretical foundation. This may severely limit its use and development, especially in terms of theoretical applications and effective communication between and within disciplines. This article aims to describe the interdisciplinary comparison of the concept of radiography in health sciences,
1078-8174/$ - see front matter ª 2007 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2007.06.002
Radiography physics and technology. This article is based on a study2 conducted as a masters thesis at the University of Oulu, Finland, as part of master’s degree in radiography.3 The term ‘‘concept’’ usually means a mental impression of a certain object or phenomenon. First the object is observed, then mentally formulated in the human mind into a mental impression, and finally expressed in linguistic form (words or expressions). Concepts may be abstract or concrete.4e7 Each concept should be provided with a written definition, describing the whole meaning of the concept, because concepts are separated and developed on the grounds of definitions. Definition is formulated on the grounds of the concept’s ‘‘prime characteristics’’, which may be designated, for example, as ‘‘attributes’’. Depending on the concept’s abstraction level, the definition may be considered theoretical (abstract) or operative (concrete) one.4,8,9 Nowadays, concepts are considered dynamic and transient by nature, tending to change according to context and over time.5,10 For example, the definition of ‘‘radiography’’ may vary, and no inclusive definition exists at the moment. In radiography, like in any other field, concepts play a significant role in education, research and practice.8,11e13 They are used for communication and information transmission, and they affect the effectiveness of communication.5,7,11 Concepts are also information storages and ‘‘building blocks’’ of theories, connecting research and theory to practice. This is demonstrated, for example, when theoretical concepts are operationalized for empirical testing, or a concrete concept, identified in practice, is further developed for theoretical use.4,11,14,15 Both theory development and theory testing require concepts to be clearly determined.6,16,17 Concepts also manifest the research focus and perspective of a field (e.g. the concepts of nursing, environment, human being and health in nursing science).8,11,18 In radiography, concepts and conceptual models from nursing have been applied,13 but on the other hand, need for own research, theory development and identity clarification have also been emphasized.13,19e21 The role of concept development may, therefore, be considered justifiable and significant, especially within fields undergoing active professional development, like radiography. Concept analysis is a research strategy, which is aimed to clarify concepts that are undefined or poorly understood.22 Several methods have been presented, but the general goal for concept analysis is to identify the ‘‘prime characteristics’’ of the concept and to separate them from non-essentials. Thus, concept analysis can be used to point out the essence of a concept, as well as to formulate theoretical or operational definitions.4e6,23
Concept analysis of the concept of radiography: determining the attributes Aim The aim of the study was to manifest the attributes of the concept of radiography in health sciences and to compare them to the attributes identified in physics and technology. This means, the study aimed to clarify the similarities and
289 differences in the meaning of ‘‘radiography’’ between these disciplines. Research questions were addressed to clarify (1) the attributes of the concept of radiography, and (2) the similarities and differences of ‘‘radiography’’ between health sciences, physics and technology. In addition, the study aimed to define the concept in health sciences theoretically, on the grounds of attributes. ‘‘Radiography’’ can be categorized as a high abstraction level concept, and it is not possible to perceive or measure it directly in its entirety. Therefore, theoretical definitions have no direct measurability in practice.6
Method The evolutionary method was considered most appropriate for this study. The method was presented by Rodgers in the 1980s,24 and it is considered suitable for examination of both abstract and concrete concepts. The evolutionary method emphasizes concepts as dynamic and developing abstractions, which constantly interact with their context. Concept analysis implemented by this method typically includes comparison of concepts temporarily or between different contexts5,24 (e.g. disciplines, as in this study). Emphasis lies on results directly concluded from the data. Method consists of (1) formulation of data collection plan, (2) data collection, (3) identification of related concepts, (4) analysis of prime characteristics of the concept, (5) comparisons, (6) identification of ‘‘a model case’’ (if appropriate) and (7) formulation of hypotheses for further development of the concept.23,24
Data collection In the evolutionary method, data collection must be conducted according to a detailed plan in order to secure the quality of the data.5,24 In this study, data were collected separately for all three disciplines under study. The data consisted of scientific material (in physics and technology), or scientific and popular material (in health sciences) in Finnish and English. Literature was searched by using databases as follows: Medline (Ovid), Cinahl and Medic (health sciences), Inspec and Elsevier Science Direct (physics), and BioEngineering (technology). The keywords used were ‘‘radiografia’’ (Finnish for radiography) and ‘‘radiography’’. In health sciences, the data also comprised dictionaries and websites. Total number of data was 56 references in health sciences and 30 references in physics and technology. In the evolutionary method, popular material should be included in order to catch the attributes as widely as possible, and the data should consist of at least 30 references from each discipline.5,24 In health sciences, the search resulted in a massive amount of references, dealing mainly with medical use of radiation (e.g. modalities and examinations), but also with education, radiographers, radiography profession, scholastic issues and research (e.g. radiography as a science). Medical use of radiation was also widely represented in references originating from a physics database, while other issues included weld radiography, geochemical investigations, petrophysics, space programmes, micro-organism detection, and bomb detection. Many of these issues
290 were also represented in the data searched from the technology database, which dealt with matters such as industrial radiography, non-destructive evaluation of objects, computer modelling of processes, in addition to medical issues.
Data analysis Analysis was implemented according to inductive qualitative content analysis, through reduction and categorization towards the most abstract level possible.25,26 Attributes were searched for by asking the following data questions: ‘‘What seems to be typical for radiography?’’ and ‘‘Which qualities seem to appear frequently or repeatedly?’’ According to the evolutionary method, attributes were first identified separately for each discipline, and after that, systematically compared in order to identify similarities and differences.5,24
Findings Health sciences The term ‘‘radiography’’ was found to be formulated from the Latin word ‘‘ra’dius’’, which stands for a ray, and the Greek word ‘‘grap’hein’’, which stands for writing or drawing. On this ground, the term ‘‘radiography’’ could be determined to stand for ‘‘drawing with rays’’. In dictionaries, the term was typically determined as ‘‘image production of inner body structures by using ionizing radiation’’, although more limited definitions also existed (e.g. radiography as ‘‘fluorescence’’ or ‘‘transillumination’’). Attributes identified for the concept of radiography in health sciences were named as duality, dynamics, sociability, synthesis, situation-relatedness, and expertise in the use of radiation among radiographers. Duality was based on qualities existing as a pairing, and often being contrary to each other. Radiography was found to be similar to and, on the other hand, very different from other fields in health care, for example, in terms of legislation, ethics and facilities. Radiography also seemed to have both useful and harmful effects on health and people. Radiography has both a practical and theoretical (or scientific) nature, consists of both diagnostic and therapeutic qualities, and may be both autonomous and dependent in relation to other fields or professions. Due to constant changes taking place, as well as the fast pace of development in the field, radiography was found to be dynamic by nature. The active movement of radiographers towards higher professional level and expertise was also part of this dynamism. Sociability was based on interaction and communication as central qualities of radiography within health sciences, which were observed to take place on many levels, from energyetarget interaction to communication on individual and community level. Other qualities indicating the social nature of radiography were collaboration (e.g. between radiographer and patient, within radiography team, or between education and clinical practice), and control (e.g. official supervision, management, and profit responsibility). Technical and human elements were identified as central qualities in radiography in terms of knowledge base, ethics and values, and practice. Radiography seemed
S.-M. Ahonen to consist of processes (e.g. imaging process, radiotherapy process) and to require several actions, responsibilities and goals to be coordinated as functional entities; often as compromises representing the best possible solution. These qualities were considered to illustrate synthesis as an attribute of radiography. Definition of ‘‘radiography’’ was found to vary in different contexts; for example, the actual content of people’s work was found to be different in one context compared to another, despite the fact that they all worked within ‘‘radiography’’. Moreover, the goal of the work may vary from a very concrete one (e.g. a high-quality radiograph) to one of very abstract level (e.g. human health). On this basis, situation-relatedness was identified as an attribute of radiography. Radiographers were identified as a central group of professionals in radiography within health sciences, especially on grounds of their expertise in the use of radiation. It consisted of high-quality services, safety in the use of radiation, and specialized education related to the profession of radiographers. On the grounds of these attributes, the concept of radiography in health sciences was determined as expertise of radiographers in the use of radiation, which is dual, dynamic, social and situation-related in nature, and typically based on versatile synthesis. The term ‘‘radiography’’ was found to be used in various meanings in health sciences. It was used to denote radiographers’ work, the education of radiographers, and the radiography science (discipline). The term was also used in the names of journals, examinations and modalities (e.g. ‘‘dental radiography’’, ‘‘digital radiography’’). The term also stood for the whole field related to medical use of radiation or imaging. In general, it was often necessary to conclude the meaning of the term on the grounds of the context in question. Physics In physics, radiography was typically theoretical by nature: ‘‘radiography’’ was often examined from the perspective of scientific and technological knowledge base and theory, computational parameters and other theoretical factors. Other focal attributes were image production, irradiation and radiation protection, which were considered to occur as a result of interactions between energy and technology in a non-destructive manner. Radiography was conceived as a constantly changing phenomenon, and on the grounds of versatile modalities and non-destructive effects, suitable for a wide range of applications in many fields. The term ‘‘radiography’’ typically stood for a nondestructive method of examining matter and the structure of items. Another typical meaning for the term was production of x-ray images by using ionizing radiation. In physics, the term ‘‘radiography’’ was used to describe the whole field of radiation use (e.g. ‘‘radiography equipment’’), and as part of the name of a radiation procedure or modality (e.g. ‘‘neutron radiography’’), typically connected to a term describing the target of radiation (e.g. ‘‘weld radiography’’). Technology Theoretical nature was also typical for the concept of radiography in technology, as was constant change and image production. On top of that, image modification and
Radiography comparison between modalities were also emphasized in the data. Modalities were typically separated and compared with each other on the grounds of advantages, disadvantages, appropriateness, and the energy used (e.g. ultrasound, X-ray, MRI.). Non-destructive nature and exposure to radiation were often dealt with in the comparison of modalities. Another attribute identified in technology was radiation protection. In technology, the term ‘‘radiography’’ was typically determined as a method for visualizing the internal structure of macroscopic specimens and objects. The term was used both alone (for describing the whole field of radiation use), and as part of the names of modalities or examinations. Interdisciplinary comparison The concept of radiography was found to have both similar and different attributes within different disciplines. Regardless of the discipline, radiography was seen as a phenomenon undergoing constant changes, especially in terms of practices and technical facilities. A technical and scientific perspective was present in every discipline as a part of knowledge base and practical level (e.g. technical parameters). The concept of radiography was seen to deal with interactions between energy and target, and radiation protection was emphasized as a central issue in every discipline. In all disciplines, the term ‘‘radiography’’ was used alone, as a ‘‘principal concept’’ describing the whole field of radiation use. Another typical way of using the term was in connection with another term in order to name an examination or a modality (e.g. ‘‘chest radiography’’, ‘‘conventional radiography’’). A theoretical perspective and a connection with theory were found to be attributes separating ‘‘radiography’’ in health sciences from other disciplines: a seamless and creative connection between theory and practice seemed to exist in physics and technology, but not to the same extent in radiography. Computational and comparative perspectives in terms of modalities were also found to be attributes that mostly characterize radiography in other disciplines than health sciences. On the other hand, the concept of radiography in health sciences consisted of many attributes not identified in any other discipline. These attributes were named as duality, situation-relatedness, and expertise of radiographers in radiation use. It was notified that in health sciences, the concept of radiography was often in some way linked to radiographers; in contrast, radiographers did not emerge to the same extent in physics and technology, and radiography was regarded as a more general issue with no connection to a particular group of professionals. Besides professional perspectives, also the perspectives of education, health and wellbeing, human being and socio-caring nature characterized radiography only in health sciences. Meanings related to a radiographer were primary to the term ‘‘radiography’’ merely in health sciences (e.g. radiographer’s work and education).
Rigour and ethical considerations The reliability of this study was evaluated with the criteria of credibility, dependability, confirmability, and transferability.27,28 Special attention was paid to quality of the
291 data, management of the evolutionary method and content analysis, minimization of researcher subjectivity, and truthful reporting. Some of these issues are also taken into account by the evolutionary method itself: for example, the quality of the data is pursued by a detailed data collection plan and instructions concerning data sources and the number of references.5,24 In order to increase the reliability of the results, the researcher endeavoured deliberately to examine all disciplines equally and as objectively as possible. However, it was found especially challenging to interpret the data from physics and technology due to the language of the material (scientific papers in English) and the researcher’s unfamiliarity with terminology of these disciplines. The abstraction level of analysis and the credibility of interpretation may, therefore, not be of equal reliability. Another focal limitation is the data selected for the study; it should be criticized due to the fact that it only represents a very small specimen of all the material available, and it is therefore possible that it is biased or limited in respect of reality. These facts may undermine the credibility and confirmability of the results, as well as limit their transferability and dependability. It should also be noted that the method one uses for concept analysis may have some effect on the results, as methods differ from each other.23 The reliability of a study is often related to ethical considerations, and solutions concerning the data, analysis and reporting often have an effect on both reliability and ethicality of the study.29,30 In this study, ethical considerations consisted mainly of general research ethics due to the theoretical nature of the study and the data. On top of all the effort made by the researcher to increase the reliability and ethicality of the study, a significant issue is reporting: it alone provides readers with essential information needed for evaluating the study and the results.29,30
Discussion The aim of this article was to describe the interdisciplinary comparison of the concept of radiography in health sciences, physics and technology on the grounds of concept analysis.2 A theoretical definition of the concept in health sciences was also presented. Results presented here may be considered as results of theoretical basic research in radiography science.3 On the basis of the results, the concept of radiography appears to be more abstract, wider, and more complex in health sciences than in physics and technology. This seems to result from combination of patient-centred care and technical performance, as well as socio-humanistic and scientific-technical knowledge. This ‘‘duality’’ has also been previously presented by several authors (e.g. Bowman,31 Castle,19 Valtonen32 and Walta33), and in this study, it was found to characterize ‘‘radiography’’ only in health sciences. Due to this, ‘‘radiography’’ in health sciences may also be considered ‘‘softer’’ or ‘‘more human’’, or more concrete and unambiguous in physics and technology. This seems understandable with respect to the perspective of these disciplines. The radiographer may be one of the central elements differentiating ‘‘radiography’’ in health sciences from ‘‘radiography’’ in physics and technology.
292 Thus, these results support the focal role of radiographers among radiography professionals. The results of this study suggest that the meaning of the concept of radiography may vary between disciplines, and that the term ‘‘radiography’’ may stand for different contents depending on the context and professional in question. This seems to be the case in multiprofessional interaction, in particular, but also within health sciences, and may cause misunderstandings and confusion if not taken into account. Therefore, it is important to always determine the concept to make sure it is correctly understood, and by this means, make communication more effective. This also relates to significance of radiographers’ professional identity within multiprofessional health care.13,19 Movement towards a higher professional level among radiographers (e.g. in forms of research activity and research-based practice) emerged also in this study, and it was recognized as one source of dynamics within the field. Some of the attributes which characterize ‘‘radiography’’ only in health sciences (e.g. humanity, processorientation, coordination, situation-relatedness, and complexity), may facilitate the clarification of radiographer’s professional identity, and emphasize the need for more holistic approach. They seem to support certain issues previously presented in research results and theoretical modelling of radiographer’s work (e.g. Bowman,31 Culmer,13 Dowd and Durick,34 Carney,35 Reeves36 and Walta33), and can be further established by research-based approach to professional development. This study supports the conception of concepts as dynamic phenomena that change according to context and time.5,10 Studies on concepts should, therefore, be considered as temporary reviews of concepts that describe the content and use of concepts in a certain context and point in time. However, even if the concept cannot be determined completely and for good, some additional information on the concept is revealed as the result of each study.5,17 On this account, it is necessary to examine the concept of radiography on a continual basis, in different contexts and at different times, in order to clarify the essence of the concept little by little.
Conflicts of interest
S.-M. Ahonen
6.
7. 8.
9.
10. 11. 12.
13.
14.
15.
16. 17.
18. 19. 20. 21.
22.
The author has no conflict of interest. 23.
References 1. Laukkala P. Radiografian ammattisanasto: Radiografian keskeisia¨ ka¨sitteita¨. Ammattisanasto-tyo¨ryhma¨n ehdotus. In: Radiografia, vol. 1. Helsinki: Suomen Ro ¨ntgenhoitajaliittory; 1998. p. 11e19. 2. Sorppanen S. The concept of radiography in health sciences: a concept analysis. Masters thesis. University of Oulu, Faculty of Medicine, Department of Nursing Science and Health Administration; 2002. 3. Pakarinen R, Jussila A-L. Radiography e a new field among health sciences in Finland. Radiography 2007;13:210e3. 4. Walker LO, Avant KC. Teoria e avain hoitotyo¨ho¨n. Vammala: SHKS; 1992. 5. Rodgers BL. Philosophical foundations of concept development. In: Rodgers BL, Knafl KA, editors. Concept development in
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nursing: foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders Company; 2000. p. 7e37. Wills E, McEwen M. Concept development: clarifying meanings of terms. In: McEwen M, Wills EM, editors. Theoretical basis for nursing. Lippincott Williams & Wilkins; 2002. p. 48e68. Chinn PL, Kramer MK. Theory and nursing: a systematic approach. 4th ed. Mosby Year Book; 1995. McEwen M. Overview of theory in nursing. In: McEwen M, Wills EM, editors. Theoretical basis for nursing. Lippincott Williams & Wilkins; 2002. p. 23e47. Hardy ME. Theories: components, development, evaluation. In: Reed PG, Shearer NC, Nicoll LH, editors. Perspectives on nursing theory. 4th ed. Lippincott Williams & Wilkins; 2004. p. 75e86. Morse JM, Mitcham C, Hupcey JE, Taso ´n MC. Criteria for concept evaluation. J Adv Nurs 1996;24:358e90. Meleis AI. Theoretical nursing: development & progress. 3rd ed. Philadelphia: J.B. Lippincott Company; 2005 [revised reprint]. McEwen M. Application of theory in nursing education. In: McEwen M, Wills EM, editors. Theoretical basis for nursing. Lippincott Williams & Wilkins; 2002. p. 415e33. Culmer PJ. Models of radiography practice. In: Paterson A, Price R, editors. Current Topics in Radiography Number 3. W.B. Saunders Company; 1997. p. 87e95. Morse JM. Constructing qualitatively derived theory: concept construction and concept typologies. Qualitative Health Research 2004;14:1387e95. Higgins PA, Moore SM. Levels of theoretical thinking in nursing. In: Reed PG, Shearer NC, Nicoll LH, editors. Perspectives on nursing theory. 4th ed. Lippincott Williams & Wilkins; 2004. p. 55e62. Moody LE. Advancing nursing science through research, vol. 1. Sage Publications; 1990. Rodgers BL, Knafl KA. Introduction to concept development in nursing. In: Rodgers BL, Knafl KA, editors. Concept development in nursing: foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders Company; 2000. p. 1e6. Fawcett J. Analysis and evaluation of conceptual models in nursing. 2nd ed. Philadelphia: Davis Company; 1989. Castle A. Radiography: nature of knowledge and academic tribe. Radiography 2000;6:261e8. Nixon S. Professionalism in radiography. Radiography 2001;7: 31e5. Gambling T, Brown P, Hogg P. Research in our practice e a requirement not an option: discussion paper. Radiography 2003; 9:71e6. Avant KC. The Wilson method of concept analysis. In: Rodgers BL, Knafl KA, editors. Concept development in nursing: foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders Company; 2000. p. 55e64. Knafl KA, Deatrick JA. Knowledge synthesis and concept development in nursing. In: Rodgers BL, Knafl KA, editors. Concept development in nursing. Foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders Company; 2000. p. 39e54. Rodgers BL. Concepts, analysis, and the development of nursing knowledge: the evolutionary circle. J Adv Nurs 1989;14: 330e5. Kynga ¨s H, Vanhanen L. Sisa ¨llo ¨n analyysi. Hoitotiede 1999;11: 3e12. Ryan GW, Bernard HR. Data management and analysis methods. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Sage Publications; 2000. p. 769e802. Lincoln YS, Guba EG. Naturalistic inquiry. Sage Publications; 1985. Holloway I, Wheeler S. Qualitative research for nurses. Blackwell Science; 1996.
Radiography 29. Polit DF, Beck CT. Nursing research: principles and methods. 7th ed. Lippincott Williams & Wilkins; 2004. 30. Christians CG. Ethics and politics in qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. 2nd ed. Sage Publications; 2000. p. 133e55. 31. Bowman S. The radiographer/patient relationship e a short term but vital interaction. Radiography Today 1993;59:17e8. 32. Valtonen M. Expertise in radiography e the radiographer’s work and the professional skills required. Faculty of Education, University of Oulu, Finland. Acta Univ Oul E 41. Oulu: Oulu University Press; 2000.
293 33. Walta L. Radiographer’s work as action e content and structure of action of clinical radiography at one Finnish University Hospital. Licentiate’s dissertation, University of Turku; 2001. 34. Dowd SB, Durick D. Addressing the needs of elderly radiology patients. Radiologic Technology 1995;66:299e304. 35. Carney D. Patient focus in radiography e the challenges. In: Paterson A, Price R, editors. Current topics in radiography, vol. 1. W.B. Saunders Company; 1995. p. 39e51. 36. Reeves PJ. Chronic disease and independence in old age: a case study. Radiography 2006;12:253e7.
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
Radiography e A conceptual approach Sanna-Mari Ahonen* Department of Nursing Science and Health Administration, University of Oulu, P.O. Box 5000, FIN-90014, Finland Received 2 March 2007; revised 8 June 2007; accepted 30 June 2007 Available online 31 August 2007
KEYWORDS Concept; Concept analysis; Evolutionary method; Radiography
Abstract Aim: The purpose of this article is to describe interdisciplinary comparison of the attributes of the concept of radiography in health sciences, physics and technology on the grounds of concept analysis. Background: The concept of radiography is widely used in health sciences, physics and technology. However, the content of the concept may vary. In order to clarify the concept of radiography, the concept must be systematically examined and defined in linguistic form. Method: The concept of radiography was analysed by using the evolutionary method of concept analysis. The data were collected through discretionary sampling and consisted of literature and Internet pages. Qualitative content analysis was employed for analysing the data. Findings: As a result of concept analysis, the concept of radiography in health sciences was determined as expertise of radiographers in the use of radiation, which is dual, dynamic, social and situation-related in nature, and typically based on versatile synthesis. Regarding the attributes identified, the concept of radiography has both similarities and differences between health sciences, physics and technology. Conclusions: The concept of radiography was found to be more abstract, wider, more complex and more radiographer-centred in health sciences than in other disciplines. The content of the concept of radiography seems to vary according to the discipline. ª 2007 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction The concept of radiography is widely used in many disciplines and fields of practice. In addition to health sciences, it is generally utilized in physics and technology. These fields are tightly collaborative, providing health care customers with services of medical imaging and radiotherapy, and the concept of radiography is included in the basic
* Tel.: þ358 8 5375628; fax: þ358 8 5375606. E-mail address: [email protected]
terminology in this collaboration. It may, however, be possible that the content of the concept varies somewhat according to discipline. Despite universal and generalized use of the concept of radiography, it has so far been studied from a conceptual or theoretical point of view only in individual studies.1,2 Due to this, the concept has remained poorly determined and lacking a firm theoretical foundation. This may severely limit its use and development, especially in terms of theoretical applications and effective communication between and within disciplines. This article aims to describe the interdisciplinary comparison of the concept of radiography in health sciences,
1078-8174/$ - see front matter ª 2007 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2007.06.002
Radiography physics and technology. This article is based on a study2 conducted as a masters thesis at the University of Oulu, Finland, as part of master’s degree in radiography.3 The term ‘‘concept’’ usually means a mental impression of a certain object or phenomenon. First the object is observed, then mentally formulated in the human mind into a mental impression, and finally expressed in linguistic form (words or expressions). Concepts may be abstract or concrete.4e7 Each concept should be provided with a written definition, describing the whole meaning of the concept, because concepts are separated and developed on the grounds of definitions. Definition is formulated on the grounds of the concept’s ‘‘prime characteristics’’, which may be designated, for example, as ‘‘attributes’’. Depending on the concept’s abstraction level, the definition may be considered theoretical (abstract) or operative (concrete) one.4,8,9 Nowadays, concepts are considered dynamic and transient by nature, tending to change according to context and over time.5,10 For example, the definition of ‘‘radiography’’ may vary, and no inclusive definition exists at the moment. In radiography, like in any other field, concepts play a significant role in education, research and practice.8,11e13 They are used for communication and information transmission, and they affect the effectiveness of communication.5,7,11 Concepts are also information storages and ‘‘building blocks’’ of theories, connecting research and theory to practice. This is demonstrated, for example, when theoretical concepts are operationalized for empirical testing, or a concrete concept, identified in practice, is further developed for theoretical use.4,11,14,15 Both theory development and theory testing require concepts to be clearly determined.6,16,17 Concepts also manifest the research focus and perspective of a field (e.g. the concepts of nursing, environment, human being and health in nursing science).8,11,18 In radiography, concepts and conceptual models from nursing have been applied,13 but on the other hand, need for own research, theory development and identity clarification have also been emphasized.13,19e21 The role of concept development may, therefore, be considered justifiable and significant, especially within fields undergoing active professional development, like radiography. Concept analysis is a research strategy, which is aimed to clarify concepts that are undefined or poorly understood.22 Several methods have been presented, but the general goal for concept analysis is to identify the ‘‘prime characteristics’’ of the concept and to separate them from non-essentials. Thus, concept analysis can be used to point out the essence of a concept, as well as to formulate theoretical or operational definitions.4e6,23
Concept analysis of the concept of radiography: determining the attributes Aim The aim of the study was to manifest the attributes of the concept of radiography in health sciences and to compare them to the attributes identified in physics and technology. This means, the study aimed to clarify the similarities and
289 differences in the meaning of ‘‘radiography’’ between these disciplines. Research questions were addressed to clarify (1) the attributes of the concept of radiography, and (2) the similarities and differences of ‘‘radiography’’ between health sciences, physics and technology. In addition, the study aimed to define the concept in health sciences theoretically, on the grounds of attributes. ‘‘Radiography’’ can be categorized as a high abstraction level concept, and it is not possible to perceive or measure it directly in its entirety. Therefore, theoretical definitions have no direct measurability in practice.6
Method The evolutionary method was considered most appropriate for this study. The method was presented by Rodgers in the 1980s,24 and it is considered suitable for examination of both abstract and concrete concepts. The evolutionary method emphasizes concepts as dynamic and developing abstractions, which constantly interact with their context. Concept analysis implemented by this method typically includes comparison of concepts temporarily or between different contexts5,24 (e.g. disciplines, as in this study). Emphasis lies on results directly concluded from the data. Method consists of (1) formulation of data collection plan, (2) data collection, (3) identification of related concepts, (4) analysis of prime characteristics of the concept, (5) comparisons, (6) identification of ‘‘a model case’’ (if appropriate) and (7) formulation of hypotheses for further development of the concept.23,24
Data collection In the evolutionary method, data collection must be conducted according to a detailed plan in order to secure the quality of the data.5,24 In this study, data were collected separately for all three disciplines under study. The data consisted of scientific material (in physics and technology), or scientific and popular material (in health sciences) in Finnish and English. Literature was searched by using databases as follows: Medline (Ovid), Cinahl and Medic (health sciences), Inspec and Elsevier Science Direct (physics), and BioEngineering (technology). The keywords used were ‘‘radiografia’’ (Finnish for radiography) and ‘‘radiography’’. In health sciences, the data also comprised dictionaries and websites. Total number of data was 56 references in health sciences and 30 references in physics and technology. In the evolutionary method, popular material should be included in order to catch the attributes as widely as possible, and the data should consist of at least 30 references from each discipline.5,24 In health sciences, the search resulted in a massive amount of references, dealing mainly with medical use of radiation (e.g. modalities and examinations), but also with education, radiographers, radiography profession, scholastic issues and research (e.g. radiography as a science). Medical use of radiation was also widely represented in references originating from a physics database, while other issues included weld radiography, geochemical investigations, petrophysics, space programmes, micro-organism detection, and bomb detection. Many of these issues
290 were also represented in the data searched from the technology database, which dealt with matters such as industrial radiography, non-destructive evaluation of objects, computer modelling of processes, in addition to medical issues.
Data analysis Analysis was implemented according to inductive qualitative content analysis, through reduction and categorization towards the most abstract level possible.25,26 Attributes were searched for by asking the following data questions: ‘‘What seems to be typical for radiography?’’ and ‘‘Which qualities seem to appear frequently or repeatedly?’’ According to the evolutionary method, attributes were first identified separately for each discipline, and after that, systematically compared in order to identify similarities and differences.5,24
Findings Health sciences The term ‘‘radiography’’ was found to be formulated from the Latin word ‘‘ra’dius’’, which stands for a ray, and the Greek word ‘‘grap’hein’’, which stands for writing or drawing. On this ground, the term ‘‘radiography’’ could be determined to stand for ‘‘drawing with rays’’. In dictionaries, the term was typically determined as ‘‘image production of inner body structures by using ionizing radiation’’, although more limited definitions also existed (e.g. radiography as ‘‘fluorescence’’ or ‘‘transillumination’’). Attributes identified for the concept of radiography in health sciences were named as duality, dynamics, sociability, synthesis, situation-relatedness, and expertise in the use of radiation among radiographers. Duality was based on qualities existing as a pairing, and often being contrary to each other. Radiography was found to be similar to and, on the other hand, very different from other fields in health care, for example, in terms of legislation, ethics and facilities. Radiography also seemed to have both useful and harmful effects on health and people. Radiography has both a practical and theoretical (or scientific) nature, consists of both diagnostic and therapeutic qualities, and may be both autonomous and dependent in relation to other fields or professions. Due to constant changes taking place, as well as the fast pace of development in the field, radiography was found to be dynamic by nature. The active movement of radiographers towards higher professional level and expertise was also part of this dynamism. Sociability was based on interaction and communication as central qualities of radiography within health sciences, which were observed to take place on many levels, from energyetarget interaction to communication on individual and community level. Other qualities indicating the social nature of radiography were collaboration (e.g. between radiographer and patient, within radiography team, or between education and clinical practice), and control (e.g. official supervision, management, and profit responsibility). Technical and human elements were identified as central qualities in radiography in terms of knowledge base, ethics and values, and practice. Radiography seemed
S.-M. Ahonen to consist of processes (e.g. imaging process, radiotherapy process) and to require several actions, responsibilities and goals to be coordinated as functional entities; often as compromises representing the best possible solution. These qualities were considered to illustrate synthesis as an attribute of radiography. Definition of ‘‘radiography’’ was found to vary in different contexts; for example, the actual content of people’s work was found to be different in one context compared to another, despite the fact that they all worked within ‘‘radiography’’. Moreover, the goal of the work may vary from a very concrete one (e.g. a high-quality radiograph) to one of very abstract level (e.g. human health). On this basis, situation-relatedness was identified as an attribute of radiography. Radiographers were identified as a central group of professionals in radiography within health sciences, especially on grounds of their expertise in the use of radiation. It consisted of high-quality services, safety in the use of radiation, and specialized education related to the profession of radiographers. On the grounds of these attributes, the concept of radiography in health sciences was determined as expertise of radiographers in the use of radiation, which is dual, dynamic, social and situation-related in nature, and typically based on versatile synthesis. The term ‘‘radiography’’ was found to be used in various meanings in health sciences. It was used to denote radiographers’ work, the education of radiographers, and the radiography science (discipline). The term was also used in the names of journals, examinations and modalities (e.g. ‘‘dental radiography’’, ‘‘digital radiography’’). The term also stood for the whole field related to medical use of radiation or imaging. In general, it was often necessary to conclude the meaning of the term on the grounds of the context in question. Physics In physics, radiography was typically theoretical by nature: ‘‘radiography’’ was often examined from the perspective of scientific and technological knowledge base and theory, computational parameters and other theoretical factors. Other focal attributes were image production, irradiation and radiation protection, which were considered to occur as a result of interactions between energy and technology in a non-destructive manner. Radiography was conceived as a constantly changing phenomenon, and on the grounds of versatile modalities and non-destructive effects, suitable for a wide range of applications in many fields. The term ‘‘radiography’’ typically stood for a nondestructive method of examining matter and the structure of items. Another typical meaning for the term was production of x-ray images by using ionizing radiation. In physics, the term ‘‘radiography’’ was used to describe the whole field of radiation use (e.g. ‘‘radiography equipment’’), and as part of the name of a radiation procedure or modality (e.g. ‘‘neutron radiography’’), typically connected to a term describing the target of radiation (e.g. ‘‘weld radiography’’). Technology Theoretical nature was also typical for the concept of radiography in technology, as was constant change and image production. On top of that, image modification and
Radiography comparison between modalities were also emphasized in the data. Modalities were typically separated and compared with each other on the grounds of advantages, disadvantages, appropriateness, and the energy used (e.g. ultrasound, X-ray, MRI.). Non-destructive nature and exposure to radiation were often dealt with in the comparison of modalities. Another attribute identified in technology was radiation protection. In technology, the term ‘‘radiography’’ was typically determined as a method for visualizing the internal structure of macroscopic specimens and objects. The term was used both alone (for describing the whole field of radiation use), and as part of the names of modalities or examinations. Interdisciplinary comparison The concept of radiography was found to have both similar and different attributes within different disciplines. Regardless of the discipline, radiography was seen as a phenomenon undergoing constant changes, especially in terms of practices and technical facilities. A technical and scientific perspective was present in every discipline as a part of knowledge base and practical level (e.g. technical parameters). The concept of radiography was seen to deal with interactions between energy and target, and radiation protection was emphasized as a central issue in every discipline. In all disciplines, the term ‘‘radiography’’ was used alone, as a ‘‘principal concept’’ describing the whole field of radiation use. Another typical way of using the term was in connection with another term in order to name an examination or a modality (e.g. ‘‘chest radiography’’, ‘‘conventional radiography’’). A theoretical perspective and a connection with theory were found to be attributes separating ‘‘radiography’’ in health sciences from other disciplines: a seamless and creative connection between theory and practice seemed to exist in physics and technology, but not to the same extent in radiography. Computational and comparative perspectives in terms of modalities were also found to be attributes that mostly characterize radiography in other disciplines than health sciences. On the other hand, the concept of radiography in health sciences consisted of many attributes not identified in any other discipline. These attributes were named as duality, situation-relatedness, and expertise of radiographers in radiation use. It was notified that in health sciences, the concept of radiography was often in some way linked to radiographers; in contrast, radiographers did not emerge to the same extent in physics and technology, and radiography was regarded as a more general issue with no connection to a particular group of professionals. Besides professional perspectives, also the perspectives of education, health and wellbeing, human being and socio-caring nature characterized radiography only in health sciences. Meanings related to a radiographer were primary to the term ‘‘radiography’’ merely in health sciences (e.g. radiographer’s work and education).
Rigour and ethical considerations The reliability of this study was evaluated with the criteria of credibility, dependability, confirmability, and transferability.27,28 Special attention was paid to quality of the
291 data, management of the evolutionary method and content analysis, minimization of researcher subjectivity, and truthful reporting. Some of these issues are also taken into account by the evolutionary method itself: for example, the quality of the data is pursued by a detailed data collection plan and instructions concerning data sources and the number of references.5,24 In order to increase the reliability of the results, the researcher endeavoured deliberately to examine all disciplines equally and as objectively as possible. However, it was found especially challenging to interpret the data from physics and technology due to the language of the material (scientific papers in English) and the researcher’s unfamiliarity with terminology of these disciplines. The abstraction level of analysis and the credibility of interpretation may, therefore, not be of equal reliability. Another focal limitation is the data selected for the study; it should be criticized due to the fact that it only represents a very small specimen of all the material available, and it is therefore possible that it is biased or limited in respect of reality. These facts may undermine the credibility and confirmability of the results, as well as limit their transferability and dependability. It should also be noted that the method one uses for concept analysis may have some effect on the results, as methods differ from each other.23 The reliability of a study is often related to ethical considerations, and solutions concerning the data, analysis and reporting often have an effect on both reliability and ethicality of the study.29,30 In this study, ethical considerations consisted mainly of general research ethics due to the theoretical nature of the study and the data. On top of all the effort made by the researcher to increase the reliability and ethicality of the study, a significant issue is reporting: it alone provides readers with essential information needed for evaluating the study and the results.29,30
Discussion The aim of this article was to describe the interdisciplinary comparison of the concept of radiography in health sciences, physics and technology on the grounds of concept analysis.2 A theoretical definition of the concept in health sciences was also presented. Results presented here may be considered as results of theoretical basic research in radiography science.3 On the basis of the results, the concept of radiography appears to be more abstract, wider, and more complex in health sciences than in physics and technology. This seems to result from combination of patient-centred care and technical performance, as well as socio-humanistic and scientific-technical knowledge. This ‘‘duality’’ has also been previously presented by several authors (e.g. Bowman,31 Castle,19 Valtonen32 and Walta33), and in this study, it was found to characterize ‘‘radiography’’ only in health sciences. Due to this, ‘‘radiography’’ in health sciences may also be considered ‘‘softer’’ or ‘‘more human’’, or more concrete and unambiguous in physics and technology. This seems understandable with respect to the perspective of these disciplines. The radiographer may be one of the central elements differentiating ‘‘radiography’’ in health sciences from ‘‘radiography’’ in physics and technology.
292 Thus, these results support the focal role of radiographers among radiography professionals. The results of this study suggest that the meaning of the concept of radiography may vary between disciplines, and that the term ‘‘radiography’’ may stand for different contents depending on the context and professional in question. This seems to be the case in multiprofessional interaction, in particular, but also within health sciences, and may cause misunderstandings and confusion if not taken into account. Therefore, it is important to always determine the concept to make sure it is correctly understood, and by this means, make communication more effective. This also relates to significance of radiographers’ professional identity within multiprofessional health care.13,19 Movement towards a higher professional level among radiographers (e.g. in forms of research activity and research-based practice) emerged also in this study, and it was recognized as one source of dynamics within the field. Some of the attributes which characterize ‘‘radiography’’ only in health sciences (e.g. humanity, processorientation, coordination, situation-relatedness, and complexity), may facilitate the clarification of radiographer’s professional identity, and emphasize the need for more holistic approach. They seem to support certain issues previously presented in research results and theoretical modelling of radiographer’s work (e.g. Bowman,31 Culmer,13 Dowd and Durick,34 Carney,35 Reeves36 and Walta33), and can be further established by research-based approach to professional development. This study supports the conception of concepts as dynamic phenomena that change according to context and time.5,10 Studies on concepts should, therefore, be considered as temporary reviews of concepts that describe the content and use of concepts in a certain context and point in time. However, even if the concept cannot be determined completely and for good, some additional information on the concept is revealed as the result of each study.5,17 On this account, it is necessary to examine the concept of radiography on a continual basis, in different contexts and at different times, in order to clarify the essence of the concept little by little.
Conflicts of interest
S.-M. Ahonen
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The author has no conflict of interest. 23.
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