[Positive deviance: concept analysis using the evolutionary approach of Rodgers]

Positive deviance is a relatively new concept in healthcare. Since 2006, it has been applied to infection control in order to increase the awareness to good hand hygiene practices. This article focus on presenting analytical results of this concept using the evolutionary approach of Rodgers based on the philosophical postulate that concepts are dynamical and changing with time. For doing so, a census of the writings in nursing, medicine and psychology was carried out. By going through the CINAHL, Medline and PsyclNFO databases using positive deviance as a keyword for the time period: 1975 to May 2012, and in accordance with the method of Rodgers, ninety articles were retained (30 per discipline). The analysis enables one to notice that positive deviance described as an individual characteristic at first, is now used as a behavioral changing approach in nursing and medicine as well. At the end of the analysis and apart from this article, positive deviance will be used in order to study the practice of nurses that adheres to hand hygiene despite limiting constraints within hospital. We will then be able to continue the development of this concept in order to bring it, as Rodgers recommends, beyond the analysis. It would then be an important contribution to good nursing practices in the field of infection control and prevention.

[Nursing in prison: inmates as patients]

There are very few studies investigating the work nurses do in prisons. Based on data stemming from a research in Psychodynamics of Work and a literature review, this paper describes nursing practices in a Canadian penitentiary institution. Three male nurses and two female nurses participated in three two-hour long focus group sessions. Central sources of pleasure that emerged from the focus groups were the scope of nursing care practice ; the autonomy and collaboration with physicians; nursing care practices devoid of moral value judgments, the humanitarian approach, caring and the wish to make a difference in the lives of the inmates ; the pride connected to this unusual professional context, and the recognition by peers and inmates. The main sources of suffering on the other hand were the feeling that rehabilitation was more an ideal than reality ; the paradox of providing both care and safety ; the scary characteristics of working alone ; the fear of lawsuits, and the feeling of being observed continuously. The resulting data we discuss show the issues of a certain dissociation that exists between the patient and the inmate, the fear of contamination of a healthcare nursing identity by the place of practice, but also the feeling of plenitude and sublimation. The conclusion stresses the tension that exists between security and caring, distance and proximity.

[An evolutionary analysis of the concept of self-care]

The nursing community seems to agree on the general meaning of "self-care" as a concept allowing the individual to take care of his health. Yet the terms self-care and other "self-concepts" are often used interchangeably. Since this concept is central to nursing, it appeared crucial to lead an effort to clarify and to deepen the understanding of its development within the field of nursing. The objective of this evolutionary concept analysis was to identify the state of precision or clarity of the concept in the available nursing literature. The identification of attributes, antecedents and consequences has highlighted the characteristics as it has been used by various authors and ultimately provides a basis for further research. After this analysis, it is possible to propose that the concept of self-care refers to an activity initiated, consciously and following learning, which is appropriate to the situation and focused on a goal. Furthermore, this concept is widely used in contexts of long-term illnesses and much less so in contexts of acute diseases. In conclusion, work remains to be done to better differentiate the concept of self-care from other self-concepts when used in situations where a third party is involved in the realization of self-care.

[Physiologic stability: a concept analysis]

Physiologic stability is a omnipresent concept in the scientific literature. However, there is a limited number of conceptual definition of this concept in the literature. A concept analysis about physiologic stability is a way to set the theoric basis of this multidimensional concept. Mutilidimension illutrated by the multiples utilisations of the concept in a various way. In this meaning, the identification of the attributes, the antecedents and the consequences of the physiologic stability concept conduct to the elaboration of a conceptual definition for the concept. The aim of this scientific contribution is also to develop a reflexion about the utilisation of the concept physiologic stability without defining it at first.

[Towards understanding human ecology in nursing practice: a concept analysis]

Human ecology is an umbrella concept encompassing several social, physical, and cultural elements existing in the individual's external environment. The pragmatic utility method was used to analyze the "human ecology" concept in order to ascertain the conceptual fit with nursing epistemology and to promote its use by nurses in clinical practice. Relevant articles for the review were retrieved from the MEDLINE, CINAHL, PsycINFO, and CSA databases using the terms "human ecology," "environment," "nursing," and "ecology." Data analysis revealed that human ecology is perceived as a theoretical perspective designating a complex, multilayered, and multidimensional system, one that comprises individuals and their reciprocal interactions with their global environments and the subsequent impact of these interactions upon their health. Human ecology preconditions include the individuals, their environments, and their transactions. Attributes of this concept encompass the characteristics of an open system (e.g., interdependence, reciprocal).

[Emotional labour of nursing care: an evolutionary concept analysis]

Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing.

DATA SOURCES

A literature search using keywords 'emotional labour', 'emotional work' and 'emotions' was performed in CINAHL, psycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour.

REVIEW METHODS

We followed Rodgers' evolutionary method of concept analysis.

RESULTS

Emotional labour is a process whereby nurse adopt a 'work persona' to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient-nurse encounters, and which consist of three elements : organization (i.e.social norms, social support), nurse (i.e.role identification, professional commitment, work experience and interpersonal skills) and job (i.e.autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions : nurses' autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e.productivity, 'cheerful environment') and nurse aspects (i.e. negative or positive)

CONCLUSION

the concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for 'difficult' patients to deflate the dominant discourse about 'problem' patients.

Work structure in the chronic care setting: possible consequences for nurses' mental health

The purpose of this study was to add to the body of knowledge on nurses' work environment in order to better understand their collective experience and the reasons for their mental health issues. A psychodynamic approach to work was used. The results show that the main source of nurses' dissatisfaction with their work is the perceived failure of management and other professionals to accord them due recognition, autonomy, and professional power. This situation is largely the result of an inappropriate organization of nurses' work, with nursing responsibilities unmatched by their degree of recognition, autonomy, and power. The author concludes that the organization of nursing must be transformed, not only to lower the rate of absenteeism but also to improve nursing care and enhance the professionalization of nursing.

[Psychodynamic analysis of nurses' work in long term care units: between pleasure and suffering]

Motivated by the constant increase in nurses'mental health problems, the study of Alderson (2001)--using the psychodynamic approach of work ("Psychodynamique du travai")--looks at the subjective and collective experience of nursing in a chronic care facility. The results of the study show that the major source of suffering in the nurses'work experience is their perceived lack of recognition, of autonomy and of professional power, deficits that are largely maintained by an inadequate organization of the nurses'work. Suggested solutions, according to the nurse subjects, include a necessary transformation of work and its context.

La psychodynamique du travail et le paradigme du stress : une saine et utile complémentarité en faveur du développement des connaissances dans le champ de la santé au travail

Cet article fait état des principales similitudes et divergences entre les approches de la psychodynamique du travail et du stress. Il démontre comment la psychodynamique du travail (PDT) constitue une approche complémentaire intéressante au paradigme du stress en termes de développement des connaissances en santé mentale au travail.

La psychodynamique du travail : objet, considérations épistémologiques, concepts et prémisses théoriques 1

L’article définit l’approche de la psychodynamique du travail qui a été développée en France au début des années 1970 par Christophe Dejours. Il s’agit d’une approche interdisciplinaire qui s’intéresse à l’organisation du travail comme source de plaisir et de souffrance et comme lieu d’émergence de stratégies défensives permettant aux individus de transiger avec les exigences de leur situation de travail afin de demeurer en santé. La psychodynamique du travail s’inscrit dans le paradigme subjectiviste d’approche compréhensive et réfère à la philosophie herméneutique. L’auteur vise à mieux faire connaître cette approche dans l’espoir qu’elle soit davantage utilisée par les chercheurs qui s’intéressent à une meilleure compréhension des problèmes de santé mentale vécus par les personnes dans le cadre de leur activité de travail.