Middle-range theories as models: New criteria for analysis and evaluation

Finding the person behind caries disease: The dental caregivers' experiences of empowering patients to implement beneficial behavioral changes

OBJECTIVES

This study aimed to elucidate dental professionals' experiences of how to empower patients at risk of developing new or additional caries to promote caries-related preventive behavioral changes.

METHODS

Semi-structured in-depth interviews were conducted, audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. To provide credibility and high-quality data, participant recruitment followed strategic sampling. The 10 participants included nine women and one man; six participants were dentists, and four were dental hygienists. In the data analysis, five descriptive and five strategic themes emerged that formed an overarching theme: Finding the person behind caries disease.

RESULTS

The results indicated that by initially getting to know the person behind the patient, trusting relationships and knowledge can be generated to successfully influence patients' behaviors related to caries. The five descriptive themes included: Building a treatment alliance, Understanding habitual patterns, Motivating for changes, Implementing new behaviors, and Preserving behavioral improvements. The descriptive themes each revealed a strategy theme containing several strategy proposals for initiating and supporting caries-preventing behavioral changes.

CONCLUSIONS

This study highlights the importance of establishing a treatment alliance to improve the patient's skills, knowledge, and motivation. It underscores the significance of recognizing the individual behind the patient, to facilitate optimal behavior change at the lowest possible level of treatment.

CLINICAL SIGNIFICANCE

Our findings could assist in strengthening caries-related health promotion, caries prevention, and understanding of oral health literacy techniques.

(How) Do We Theorize?: A Focused Mapping Review and Synthesis of Theoretical Nursing Research in the German-Speaking Area

There are increasing discussions on theory dynamics in nursing research. We aimed at mapping the theoretical publication output by nursing researchers from the European German-speaking area. We conducted a focused mapping review and synthesis, focusing on nursing journals articles with a theory-related aim. We identified 32 eligible publications, reflecting 2% of the nursing journal articles affiliated with researchers from our target region. Twenty-one articles involved an inductive approach. Eleven articles intended to test or revise a theory. The theoretical publication output with a theory-related aim was low. Theory-building efforts were fragmented and mostly without reference to a meta-theoretical level.

Dyadic relationship, carer role, and resources: a theory-driven thematic analysis of interviews with informal carers focusing on the stability of home-based care arrangements for people living with dementia

BACKGROUND

Most people with dementia live at home and are supported by informal carers. During the care trajectory, the creation of a stable care situation is a guiding principle of informal carers, who often manage complex care arrangements. A recently developed theory - 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem) - conceptualises how such care arrangements develop over time, and it highlights the relevance of the dyadic relationship, carer role, and resources with regard to the continuation of home-based care throughout the course of dementia. To further explore these three concepts, and to provide feedback for a further refinement of SoCA-Dem theory, this study aims to gain a deeper understanding of (1) how informal carers perceive their dyadic relationship, their carer role, and the resources of the care arrangement, and (2) how these concepts are interrelated.

METHODS

This study was a secondary data analysis of n = 11 problem-centred interviews. Data were interpreted by a thematic qualitative text analysis.

RESULTS

The findings distinguished subthemes within the concepts and uncovered their interrelations. The kinship relation, living situation and character of the dyadic relationship shaped informal carers' self-conception of the carer role. This influenced the integration of resources into the care arrangement. Conversely, the quantity and quality of informal and formal support resulted in a feeling of relief or overload in the carer role, that shaped the informal carers' way of living their dyadic relationship. The respective forming of the concepts had a significant impact with regard to the perceived stability or instability of the care situation in the examined care arrangements.

CONCLUSIONS

This study provided valuable evidence for future research alignment and targeted refinement of the SoCA-Dem theory. Scholars should further explore the specifics of spousal versus parent-child-dyads to better understand the dyads' diverse strategies in the creation of stable home-based care arrangements. Furthermore, future research should focus on the complex dynamics of dyads, family networks, and service providers, and all actors' perspectives should be integrated in SoCA-Dem theory. Based on this growing knowledge base, innovative care interventions and structures should be developed to support people with dementia and their informal carers in better living and caring in the place of their choice.

Midrange Theory Evaluation to Advance Nursing Knowledge

The author in this article presents a midrange theory evaluation framework as an update to nursing publications over the past 50 decades on theory evaluation criteria and incorporates recent philosophical perspectives on scientific theory and knowledge development. The intent also is to encourage a theorizing style that advances understanding and explanations of nursing phenomena for nursing practice as well as for the pure joy of knowing why something happens.

Experiences before and after nasogastric and gastrostomy tube insertion with emphasis on mealtimes: a case study of an adolescent with cerebral palsy

Purpose: Adolescents with cerebral palsy may need a feeding tube due to feeding challenges, since nutritional intake and mealtimes may be negatively affected. The purpose of the study was to describe and better understand how one adolescent with cerebral palsy and her parents experienced mealtimes before and after a nasogastric and gastrostomy tube insertion and how the use of these feeding tubes was experienced in daily life.Methods: Individual interviews were performed with one adolescent and each of her parents. In total, six interviews were conducted on two separate occasions. The qualitative approach known as Interpretive Description was used during the analysis.Results: Four thematic patterns were identified within the data: (i) struggling with nutritional intake, (ii) the paradox of using an aid, (iii) being different, and (iv) challenges of public mealtimes.Conclusions: The results showed that four themes influenced daily mealtimes in adolescents with cerebral palsy and a gastrostomy tube. Nutritional intake and mealtimes may be difficult, which is why using a gastrostomy tube can be a relief. However, the gastrostomy tube can also pose a challenge and a paradox. Time of change and acceptance seems necessary in order to meet these challenges.

Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review

BACKGROUND

Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care.

OBJECTIVE

This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings.

METHODS

Electronic databases-MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews-were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed.

RESULTS

e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported.

CONCLUSIONS

To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work.

Guideline for incorporating the Delphi method in the evaluation of nursing theories

Objective:

to describe a guideline for the use of the Delphi method to evaluate nursing theories, from the perspective of internal validation.

Method:

a methodological study, targeted at the development of a guideline for the use of the Delphi method in the evaluation of nursing theories.

Results:

the Delphi method, principles of collective wisdom and levels of proficiency are used in the production of a guideline for organizing, searching, selecting and coordinating the activities of theoretical evaluators in teams. It distinguishes three phases for the theoretical evaluation process: Preparatory Phase (PP); Intermediate Phase (IP) and Theory Evaluation (TE) phase, incorporating Delphi-type selection procedures; search, selection and classification of judges/evaluators for the theory; definition of criteria for carrying out rounds and maintenance or removal of units of the theory evaluated.

Conclusion:

the developed guideline was able to adapt the elements of the Delphi method as a favorable strategy for the internal validation of nursing theories.

Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research

BACKGROUND

Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability?

METHODS

Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis.

RESULTS

99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer.

DISCUSSION

This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice.

OTHER

This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).

The five aspect meal model as a conceptual framework for children with a gastrostomy tube in paediatric care

BACKGROUND

Cancer treatments may induce side effects and cause eating problems. A gastrostomy tube may be required in order to maintain and optimise the child's nutritional needs. Despite the use of a gastrostomy tube, it is important to maintain a natural and attractive mealtime for the child. The Five Aspect Meal Model is age neutral and originally designed to improve restaurant visits. Its five aspects conceptualise what is necessary to ensure a complete meal experience. To date, there is lack of knowledge to guided model development about mealtimes adapted to children and limited knowledge regarding mealtime experiences for children with a gastrostomy tube.

AIM

The aim was to investigate whether the Five Aspect Meal Model could be appropriate to be used for children with a gastrostomy tube in caring science and paediatric care.

METHODS

The design followed steps retrieved from Renjith and colleagues. Seven interviews were performed with the Five Aspect Meal Model as a base in the interview guide. The transcripts were analysed by using a qualitative directed content analysis with a deductive approach, which finally passed into a more inductive one.

FINDINGS

All aspects of the Five Aspect Meal Model were represented in the interviews. There were also experiences related to the gastrostomy tube and the mealtimes that did not fit into any of the five predetermined categories. As a result, the modified version was developed, an adapted prescribing practice model that includes seven aspects, whereof bodily discomfort and time for change and acceptance are specific to children with a gastrostomy tube.

CONCLUSION

Based on children and their parent's experiences, the Five Aspect Meal Model has been developed and adapted into a modified version, which includes seven aspects. The modified version seems to be appropriate to use within caring science and paediatric care.

Concept analysis of nurse burnout

Objective

To explore the concept of burnout among nurses. Through this concept analysis would expect in assisting hospital management departments in establishing supportive programmes to manage burnout of nurses.

Method

Walker and Avant's framework is adopted for the concept analysis of burnout.

Results

Burnout is a syndrome that can happen among helping professions which characterized as emotional exhaustion, depersonalization, and reduced personal accomplishment. The antecedents of burnout are cognitive-competence, role overload, role conflict, lack of social support, and rewards. On the other hand, the consequences of burnout could be both personal and organizational, such as sub-clinical issues, behavioral change, absenteeism, and poor quality of care.

Conclusion

The analysis of burnout on its attributes, together with antecedents and consequences (Appendix A) and presenting with case study, it may help the nurse to gain a better understanding of nurse burnout and build coping strategies.