ANS200193 April 26, 2013 1:46

Advances in Nursing Science

Vol. 36, No. 2, pp. 80–93
Copyright c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Concept Analysis
Method to Enhance Interdisciplinary
Conceptual Understanding
Susan A. Bonis, PhD, RN

This article is a presentation of a method of concept analysis designed to assist in understand-

ing the unique manner in which various disciplines use the same word or group of words
to describe differing conceptual ideas. Nurse researchers often borrow research instruments
developed in other disciplines. However, research instruments are developed in accordance
with the philosophical underpinnings of a specific discipline with the intent to contribute
to the knowledge base of that discipline. Therefore, it is uncertain whether research instru-
ments borrowed from other disciplines actually measure the conceptual phenomenon from a
nursing perspective. Key words: concept analysis, hermeneutic phenomenology, knowing
in nursing, nursing knowledge, research instruments

S ILVA 1 AND CARPER2 introduced the no-

tion of nursing knowledge over 35 years
ago. Nurse scholars have made great strides
over the ensuing years to further nursing
knowledge and describe the unique contri-
bution nurses bring to the health care arena.
However, certain factors continue to blur the
distinction between nursing knowledge and
the contributions of other health care disci-
plines. One of these factors involves the over-
lapping foci of nursing, specifically, the medi-
cal model and the nursing model. The medical
model involves a focus on the disease pro-
cess, including disease identification, treat-
ment, and management.3 Although nurses
must be knowledgeable of the disease process
and perform technical skills to treat disease,
the primary focus of nursing is the human ex-
Author Affiliation: Bryant and Stratton College,
Milwaukee, Wisconsin.
The author has disclosed that she has no significant
relationships with, or financial interest in, any com-
mercial companies pertaining to this article.
Correspondence: Susan A. Bonis, PhD, RN, Bryant and
Stratton College, 10950 W Potter Rd, Wauwatosa, WI
53202 (susanbonis53@gmail.com).
DOI: 10.1097/ANS.0b013e318290d86e
perience of living with the disease process,
specifically health and quality of life.3
Therefore, the primary aim of this method
of concept analysis is to lend a process of
clarification to the distinctive contribution
nursing brings to the health care table. This
adaptation of Rodger’s evolutionary view of
concept can be used to explore and examine
conceptual differences between and within
health care disciplines. Data collection and
analysis are accomplished through 2 phases:
interdisciplinary and intradisciplinary. The
interdisciplinary phase is to gain a general
sense of how the concept is used across var-
ious health-related disciplines. As the health
care arena has evolved in an increasingly
complex manner, new disciplines have been
developed to address specialized areas of
disease prevention and treatment. Although
aspects of all disciplines overlap somewhat,
each discipline has a specific aim and foun-
dation of knowledge to support that aim.1,3
Knowledge from each discipline is shared
through collaborative research and patient
care efforts. Clear communication is criti-
cal to the success of these collaborative ef-
forts, as each team member must understand
what other members imply through use of
language.

80

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ANS200193 April 26, 2013 1:46
One aspect of communication that inter-
feres with the effectiveness of collaborative
efforts is the development of unique idiosyn-
cratic linguistic innuendos within a discipline,
or the unique conceptual use of words or
groups of words to imply some sort of mean-
ing. One example of the unique use of words
in everyday culture involves the evolution of
“street language”: “bad” translates to mean
good, hot translates to refer to someone who
is “cool.” Texting language is also an exam-
ple of potential miscommunication: LOL is
texting shorthand and is meant by teens as
“laughing out loud”—mothers translate LOL
as “lots of love.” Brits use the term “biscuit”
to refer to the sweet treat Americans call
“cookie”; Americans refer to a biscuit as a
small individual portion of bread eaten with
a meal. Certain words used by different cul-
tural groups often depict differing conceptual
meanings. A British child might be sorely dis-
appointed to be given an unsweetened Ameri-
can biscuit when what he asked for and really
wanted was a sweet chocolate cookie. The
same communication discrepancies occur in
health care disciplines.
Carbough refers to these communication
discrepancies as “(in)visible (mis)understand-
ings.”4(pxxii) Members of different cultural
groups come together and share the same
or similar words or actions in a situation.
These words or actions are misinterpreted
to mean something other than what was
intended. Each party continues in apparent
respectful communication; however, a grow-
ing lack of respect develops as motivations
or intents are misread. This same (in)visible
(mis)understanding occurs in collaborative
health care efforts. Members of various
disciplines meet to plan research or patient
care. The same or similar words are used
to address a health care phenomenon or
refer to a research instrument to measure
that phenomenon; however, communication
discrepancies occur. Although health care
disciplines use the same words, subtle or
extreme conceptual interpretations can
lead to misunderstanding, dissension, or
disrespect of the other disciplinary efforts.
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Concept Analysis 81
Nurses often borrow research instruments
from other disciplines to measure phenomena
or concepts of interest, such as contentment,
coping, and empathy. However, it is unclear
whether use of those instruments reflects the
phenomenon or concept from a nursing per-
spective and whether borrowed instruments
contribute to the knowledge base of nursing
or the knowledge base of the borrowed disci-
pline. It is critical to analyze the phenomenon
or concept of interest through a review and
analysis of use of the concept in nursing,
as well as the use in other relevant health
care disciplines. It is particularly critical to
be clear of conceptual discrepancies when
borrowing research instruments from other
disciplines to measure certain concepts or
phenomenon. An in-depth understanding of
how those concepts or phenomenon are used
and described in the borrowed discipline is
critical to ensure that the instrument indeed
addresses the intent of the researcher and
matches use of the concept in the researcher’s
discipline.
The intradisciplinary phase of this method
of concept analysis assists the researcher to
gain an understanding of how the concept
has evolved in the researcher’s discipline, in-
cluding attributes, antecedents, and conse-
quences. The researcher can then determine
whether a potential research instrument is ap-
propriate for use in measuring a concept or
phenomenon from a nursing perspective. The
interdisciplinary and intradisciplinary phases
of this method of concept analysis decreases
communication discrepancies that occur in
interdisciplinary efforts and enhances gener-
ation of nursing knowledge through use of
appropriate research instruments.
PHILOSOPHICAL UNDERPINNINGS
The philosophical underpinnings for this
concept analysis are founded on threads
carried forward from Schleiermacher and
woven together with the hermeneutic and
phenomenological philosophies of Dilthey,
Heidegger, Wittgenstein, Gadamer, and
ANS200193 April 26, 2013 1:46
82 ADVANCES IN NURSING SCIENCE/APRIL–JUNE 2013
Ricoeur, as well as the linguistic philosophies
of Toulmin and Carbaugh. Hermeneutics
refers to both an interpretive phenomenolog-
ical philosophy and a research methodology.
The premise underpinning hermeneutics
is that understanding of written, verbal, or
esthetic forms rises from the perspective of
the reader. The perspective of the reader
is an ongoing process that evolves as the
reader lives and interacts in the world.
Interpretation is affected by perspective.
Understanding affects interpretation.
Hermeneutic phenomenology evolved
from philosophical and theoretical debates
over the relationship between interpreta-
tion and understanding. Schleiermacher, a
philosopher and theologian who lectured
widely from various forms of theological
text, introduced hermeneutics as a method
of interpretation. He acknowledged the
influence of personal understanding of the
historical aspects of a written piece, as well
as the personal background of the reader
as it might influence interpretation of the
words and sentences. Therefore, he argued
that historical and personal influences affect
understanding the text as well as interpre-
tation of the written words. Through his
intentional efforts to avoid misunderstanding
the intent of the authors of chosen texts,
and misinterpreting the words of the text,
his work is recognized as foundational to
modern hermeneutics.
Dilthey’s work emanated from Schleier-
macher’s hermeneutics. Dilthey5 argued
that the foundation of human sciences
lies in understanding human experience—
particularly historical or temporal influences
on perspective—interpretation, and mean-
ing. His philosophical contributions added
an epistemological aspect to Schleiermacher’s
hermeneutic approach. He suggested that
each reader interprets text and develops an
understanding stemming from a perspective
that is shaped with that reader’s own lived ex-
periences, or way of being in the world. He
saw hermeneutics as a relevant way in which
to understand the epistemological and onto-
logical aspects of knowledge as expressed
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
through lived experience, as opposed to the
objective manner in which the natural sci-
ences were studied. He did believe, however,
that lived experience is too personal, sensi-
tive, and overwhelming to be studied directly.
He therefore proposed that interpretations
of lived experience are best studied through
esthetic expressions, such as art and liter-
ary pieces. Dilthey5,6 consequently revived
Schleiermacher’s hermeneutic theory of inter-
pretation and developed hermeneutics into a
methodology to explore and interpret tempo-
ral aspects of humanly lived experiences to
understand more about how knowledge is ac-
quired and meaning evolves.
Heidegger7,8 took issue with Dilthey’s5
epistemological perspective, arguing ontolog-
ically that to interpret is to understand, and
understanding is a fundamental concept of
existence. He suggested interpretations of
lived experiences evolve through an iterative
movement between the implicit and explicit,
or an inherent understanding of experience
in relation to the whole of one’s life patterns,
and the whole of life in relation to each in-
dividual experience. He ultimately modified
the focus of hermeneutics from a method of
study into one of ontology and referred to the
implicit-explicit process of understanding and
interpretation as the hermeneutic circle.9
Wittgenstein’s10 philosophy of concepts
and language aligned with Heidegger’s inter-
pretive view of understanding. Traditionally,
it was believed that words and groups of
groups were used in a universal manner; for
example, all people use the same words to ex-
press the same conceptual meaning. Wittgen-
stein argued that language evolves in a unique
manner within groups of people, such as
cultural or societal groups. As people live
and work together within cultural or soci-
etal groups, they share similar experiences,
traditions, and beliefs. A cultural perspec-
tive grows from those shared experiences
and people interpret and understand those
experiences in a similar manner. They de-
velop a worldview from a cultural or societal
perspective. Language evolves within those
groups so that members are able to share and
ANS200193 April 26, 2013 1:46
describe those experiences. The manner in
which words evolve conceptually develops
through continuing to share experiences and
ideas. Therefore, words are not neutral un-
biased representations of objects; words are
cultural representations of how objects are
understood within societal groups.
Gadamer studied with Heidegger and also
aligned with his interpretive view of un-
derstanding. He elaborated on Heidegger’s
hermeneutic circle and initiated the devel-
opment of hermeneutics as a philosophy of
“being in the world.” He argued that under-
standing is shared through linguistics and ex-
plored language and dialogue in relation to
interpreting and understanding experience.11
The purpose of Gadamer’s hermeneutics was
not to secure objective knowledge from text;
the purpose was to develop an understand-
ing of the meaning of the text for the
reader/interpreter.12 He argued that under-
standing is not limited by immediate interpre-
tation of person-object relationships; rather, it
is based on a process of understanding those
relationships. Knowing more about the pro-
cess of understanding contributes to under-
standing more about how meaning evolves
over time. Central to Gadamer’s contribu-
tion to hermeneutics is that interpretation
and understanding continuously evolve over
time and are continuously shaped, guided,
affect, and are affected by ongoing per-
sonal experiences and prejudices.13 Gadamer
then expanded Schleiermacher’s method of
hermeneutic translation into a scientifically
rigorous method of hermeneutic interpreta-
tion with the phenomenological aim of under-
standing more about human experience. The
method stems from his argument that humans
communicate their understanding of objects
and experience through written and verbal
communication. However, those written ex-
pressions merely capture an individual’s inter-
pretation and understanding in a frozen mo-
ment in time. Understanding is developed and
shaped from understandings gained through
all previous experiences, and shape under-
standing for the future.8,12,13 In other words,
understanding continuously evolves through
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Concept Analysis 83
ongoing interpretation and reinterpretation
of experience.
Ricoeur14-16 artfully integrated phe-
nomenological description with hermeneutic
interpretation. He argued that humans use
symbols such as words and groups of words
to express thoughts and ideas. Meanings
ascribed to symbols, as well as the human un-
derstanding behind these symbols, are shaped
through living as a member of a culture.15,17
Symbols can be studied and interpreted
to understand more about the meaning
of human experiences.15 Thus, Ricoeur
was in agreement with Wittgenstein10 that
members of social cultures modify the use of
words over time to express conceptual ideas
in a socially recognizable manner.
Toulmin18 referred to this modification of
use of words over time as conceptual change
and likened it to Darwin’s model of biologi-
cal evolution. Toulmin’s philosophy of con-
ceptual evolution is in contrast to absolutist
views that concepts are static and universal.
He argued from a relativist epistemology that
perspectives, and therefore conceptual un-
derstandings, are relative to time, place, and
culture. Members of a discipline can be con-
sidered a culture. According to Toulmin,18 a
discipline involves a group of people with a
shared focus and means of addressing that fo-
cus. In health care, that focus is meeting the
health care needs of individuals and popula-
tions. Various disciplines comprise the health
care system. Each discipline has a distinct
knowledge base that defines that discipline’s
unique contribution to health care. Members
of each discipline generate new knowledge
through research. That new knowledge con-
tributes to development of research instru-
ments and methods to study, improve, or en-
hance patient care. As time goes on and new
knowledge transforms the manner in which
research and practice are viewed; members
of a discipline view the world around them
(and their work) in a manner that is differ-
ent from their predecessors. As the discipline
evolves, concepts used within the discipline
evolve as well; words and groups of words
used to express thoughts and ideas evolve
ANS200193 April 26, 2013 1:46
84 ADVANCES IN NURSING SCIENCE/APRIL–JUNE 2013
conceptually in keeping with changing per-
spectives. Some concepts become outdated;
other stronger ones evolve and replace out-
dated or traditional ones. Toulmin’s view of
the evolution of conceptual change is a realis-
tic and practical philosophy of the science of
language: words and their conceptual mean-
ings evolve over time according to the manner
in which they are used in everyday life within
a culture or discipline.
When members of various health care disci-
plines come together in collaborative efforts
it is critical that the language spoken and
the words used are clearly understood by all
participating members. In addition, nurse re-
searchers must clearly understand what the
knowledge base of nursing is, how to de-
sign research projects that generate nursing
knowledge, and how to choose research in-
struments that accurately measure nursing
phenomena. Nurse researchers often borrow
research instruments from other disciplines,
such as behavioral science or public health.
It is questionable whether those research in-
struments actually measure the desired phe-
nomenon from a nursing perspective and
whether the research findings contribute to
nursing knowledge. It is difficult, unless a
study is accomplished, to determine how the
desired concept is used in the discipline from
which the instrument emanates as compared
with how the concept is used in nursing. One
example of this phenomenon of conceptual
discrepancy is related to the term “content-
ment.” A review of nursing literature,19 as well
as a review of more recent publications,20,21
revealed that contentment is viewed in nurs-
ing as a quality of life; human phenomenon
that exists at a level of abstraction is only
determined through reason.22 Contentment
is not a subjective response in the moment,
nor is it an emotional or attitudinal response
to a particular experience. It is a way of
being that evolves over time. Although no
research instruments exist to measure con-
tentment from a nursing perspective, several
research instruments have been developed
in the behavioral sciences: Generalized Con-
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
tentment Scale,23-25 Contentment Index,26,27
Satisfaction With Life Scale,28 and Content-
ment With Life Assessment Scale.29 Although
these instruments present a useful purpose,
they are not designed to gather information
to understand the constructs of contentment
from a nursing perspective. Their purpose is
to gain an understanding of an individual’s
subjective responses to everyday situations
and how they relate to clinical depression.
The responses contribute knowledge toward
a clinical/medical diagnosis. It would not
be appropriate for a nurse researcher seek-
ing to understand more about contentment
as a quality of life, or a way of being that
evolves over time, to use one of these instru-
ments that asks for subjective responses in
the moment. The conceptual understanding
of contentment in each discipline is distinctly
and uniquely different.
METHOD OF ANALYSIS
Activities involved in Rodgers’ method of
concept analysis occur simultaneously and it-
eratively and include identification of the con-
cept of interest as well as surrogate terms,
selection of sources for data collection, identi-
fication of contextual aspects of the concept,
including attributes, antecedents, and conse-
quences, and providing an exemplar as well
as identification of implications.30 This adap-
tation includes those activities, as well as the
addition of activities to lend qualitative and
quantitative support to variations of the con-
ceptual context within and among various
health care disciplines. The process of con-
cept analysis for interdisciplinary conceptual
clarification includes the following activities:
A. Identify the concept of interest
B. Identify surrogate or similar terms
C. Choose sources of data collection,
including time frame and databases
from appropriate disciplines
D. Data collection
E. Thematic analysis
F. Thematic plotting
ANS200193 April 26, 2013 1:46
G. Article source identification
H. Collect data relevant to identify
attributes, antecedents, and conse-
quences of the concept
I. Analyze data regarding attributes, an-
tecedents, and consequences of the
concept
J. Identify an exemplar of the concept
from nursing
K. Identify implications for nursing
L. Identify study limitations
Identify the concept of interest
Several types of knowledge are used in
nursing for the planning and care of patients.
One type is knowledge borrowed from the
research and theories of other disciplines,
such as medicine, behavioral health, pathol-
ogy, physiology, and pharmacology, to name
a few. We use this knowledge to identify and
treat the disease process. This is an impor-
tant aspect of the work we do as nurses;
however, it is not specifically nursing knowl-
edge. It is the knowledge we use in nursing.
Nursing knowledge stems from the research
and theories of nursing with an emphasis on
the human experience of health and quality
of life.3 Although we apply interventions to
treat the disease process, the primary focus
of nursing is the human living with the dis-
ease process. Therefore, concepts of nursing
knowledge are focused on the human experi-
ence, or human responses to health and qual-
ity of life.1-3,31,32 As nurses care for patients
identified with certain disease processes, they
begin to see certain responses patients ex-
perience in living with disease. For example,
an individual living with cancer might expe-
rience hope, fear, uncertainty, or resilience.
The caregiver of a child with a chronic illness
might experience fatigue, stress, chronic sor-
row, denial, hopelessness, frustration, or con-
tentment. The focus is on the human experi-
ence, not on the disease itself. Therefore, the
concept of interest would be on the human
experience. Identification of the appropriate
terminology to describe the concept is com-
plicated, yet critical.
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Concept Analysis 85
Identify surrogate or similar terms
One complicating factor of naming the con-
cept of interest involves the use of various
words or terms to express similar conceptual
ideas. Therefore, determination of surrogate
or similar terms for the concept of interest
is an emergent process33 that develops as the
researcher identifies additional terminological
expressions of the concept during the litera-
ture review. For example, a nurse researcher
interested in studying contentment for in-
dividuals living with chronic illness might
consider borrowing an instrument from an-
other discipline to measure contentment. A
review revealed 4 instruments24,27-29 in the
behavioral science literature that claim to
measure contentment and use the following
terms interchangeably: life satisfaction,29,34-37
well-being,28,38-44 and happiness.38,45 These
are surrogate terms that must be included in
the search of articles to be included in the
database. The process of concept analysis will
reveal whether any of these terms can be used
synonymously in nursing, as well as whether
any of the instruments capture the essence
of contentment from a nursing perspective.
The researcher works iteratively between ar-
ticle search, reading, reflection, and surrogate
term identification until the process of sur-
rogate identification is completed to the re-
searchers’ satisfaction.
Choose sources of data collection,
including time frame and databases
from appropriate disciplines
It is critical to carefully consider sources
of data collection, as the type, breadth, and
depth of data source selections influences
the researcher’s analysis and findings. Data
sources for this method of analysis include
all types of published literature, including es-
thetic, anecdotal, editorial, and research. As a
goal of concept analysis is to “develop a rich
understanding of a phenomenon as it exists in
the real world and as it is constructed by indi-
viduals in the context of that world,”46(p220) a
range of literature within each discipline will
provide a comprehensive sense of the “real
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86 ADVANCES IN NURSING SCIENCE/APRIL–JUNE 2013
world” use of the concept within the disci-
pline. In addition, the researcher must keep
in mind the purpose and goal of the concept
analysis; if the purpose of concept analysis is
to seek and confirm an existing instrument
as appropriate to measure the human expe-
rience of interest, then data collection must
include the disciplines from which said in-
struments are considered. If the purpose of
the analysis is to clarify linguistic usages for
interdisciplinary, multidisciplinary, or trans-
disciplinary participation, then data from all
involved disciplines must be considered.
Another consideration for data collection
must involve some sort of timeframe. As this is
an evolutionary view of how certain concepts
evolved over time across disciplines, a longi-
tudinal approach to data collection would be
appropriate. For example, an analysis of the
use of knowing in nursing3 would include re-
search from 1978 forward, as Carper2 pub-
lished a seminal work on patterns of knowing
in nursing during that year. Carper’s article
is considered seminal; it stimulated an inter-
est and movement to understand more about
nursing knowledge. Therefore, articles from
all appropriate disciplines are collected, be-
ginning with a seminal article or event that
stimulated a disciplinary interest in the phe-
nomenon of interest.
Data collection
The chosen phenomenon is entered as a
key word into appropriate databases, includ-
ing health care, esthetic, and philosophical.
Limiters can be used to distill the number
of articles through determination of inclusion
and exclusion criteria. Inclusion criteria in-
volve such factors as type of literature, lan-
guage limiters, time limitations, key citations,
and clear use of the concept. An example of
exclusion criteria might include doctoral dis-
sertations or articles in which access is lim-
ited to abstract only. It is critical to review
full-length articles to gain a sense of the man-
ner in which the concept was used in the
text. Inclusion and exclusion criteria must be
carefully considered, as together they place
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
parameters on data collection, as well as the
depth and breadth of knowledge that can be
generated through the concept analysis.
Thematic analysis
Thematic analysis is a critical interpretive
phase of concept analysis. Although it is hu-
manly impossible to completely remove bias
in analysis, every attempt should be made to
refrain from identifying the discipline from
which each article originated. Read each arti-
cle in its entirety to gain an understanding of
the manner in which the concept was used,
and also that of the characteristics of the con-
cept. Pertinent passages or phrases that help
to describe the use of the concept of interest
are marked for further review and reflection.
Search for similar patterns in the manner in
which the concept is referred to. This is a
repetitive, iterative, and “distilling” process.
Articles will be read several times; each time
the researcher will reflect on the manner in
which the concept was used, and how that
use compares and contrasts to use of the con-
cept in other articles. Many “themes” or simi-
larities will evolve; however, each article will
be ascribed a primary theme, or manner in
which the author used the concept. Data will
be organized according to these themes. Fur-
ther reflection will reveal that similar themes
might be refined and consolidated, until final
themes are identified. Each article will be read
repeatedly to support thematic development,
refinement, consolidation, and organization.
This is similar to the content analysis and cod-
ing that is employed in descriptive qualitative
research analysis.46
Article source identification
After themes have been identified and the
researcher has developed an understanding
of the various manners in which the concept
has been used throughout the literature, the
originating discipline of the author of each
article must be identified. This information
is often available on the manuscript itself;
however, occasionally the researcher must
ANS200193 April 26, 2013 1:46
search for the discipline of the author. This
information is readily available on the Inter-
net or by written request.
Thematic plotting
Once themes are finalized and the origi-
nating discipline of each article is identified,
the ascribed theme of each article must be
plotted. Articles are grouped on a graph ac-
cording to the originating discipline, and then
a mark is placed under the appropriately as-
cribed theme (Table). Structuring the data in
this manner enables the researcher to tabu-
late the most common theme for use of the
concept within each discipline.
Collect data relevant to identify
attributes, antecedents, and
consequences of the concept
This phase involves only articles emanat-
ing from the discipline of interest. Each ar-
ticle is read and reviewed to gain a deeper
understanding of the attributes, antecedents,
and consequences of the concept as it is
used in nursing. Pertinent phrases that are
particularly meaningful or reflective of at-
tributes, antecedents, or consequences are
marked. Attributes are characteristics, ele-
ments, or constructs of the concept that con-
tribute to understanding the concept as it is
used within the discipline. These character-
istics provide a distinguishable description of
the concept.40 For example, 6 attributes of
knowing in nursing include the following:
“knowing is a type of knowledge,” “know-
ing lies in personal experience,” “knowing
is personal knowledge,” “knowing is shaped
through personal perspective,” “knowing is a
dynamic and changing process,” and “know-
ing evolves as one lives and interacts in the
world.”3(pp1333,1334) Antecedents of the con-
cept capture the characteristics of the events
or experiences that precede or lead up to the
concept. Antecedents for knowing in nursing
include the following: “experience,” “aware-
ness,” and “reflection.” Consequences of the
concept describe the human experience fol-
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Concept Analysis 87
lowing occurrence of the concept. Conse-
quences for knowing in nursing include the
following: “understanding,” “finding mean-
ing,” and “transformation.”3(p1334) Attributes,
antecedents, and consequences flow directly
from the literature. They are experiences and
events that are written about by authors who
have used the concept to express certain
thoughts. The researcher reads and reflects on
each article, the manner in which the concept
was used, the events that led up the concept,
and the events that followed the concept.
Identification of attributes, antecedents, and
consequences is an ongoing iterative process
of reflection and understanding. Through-
out the process of reading, marking phrases,
and reflecting, specific wording used to de-
scribe certain attributes, antecedents, or con-
sequences will come to light, be distilled, re-
vised, and refined.
Conceptual definition
The conceptual definition results from
analysis of the concept and incorporates
attributes, antecedents, and consequences
within a short description of the concept as it
is used in nursing. In keeping with the philo-
sophical underpinnings of this method, con-
ceptual definitions are not static definitions
in the true sense of the term. Rather, they are
dynamically changing descriptions that cap-
ture the essence of the concept as its use
has evolved, to this point in time, by mem-
bers of the discipline. In a similar light, words
and terms integrated into the conceptual def-
inition should be linguistic expressions com-
monly used by members of the discipline.
The example of the conceptual defini-
tion of knowing in nursing is that “know-
ing in nursing involves a uniquely personal
type of knowledge, constructed of objec-
tive knowledge interfaced with the individ-
ual’s awareness and subjective perspective
on personal experience; it is a dynamic pro-
cess and result of personal reflection and
transformation.”3(pp1333,1334) It is critical to be
attentive to the choice of linguistic expres-
sion used to describe attributes, antecedents,
 ANS200193

Table. Conceptual Use by Discipline3(pp1131,1332) 88

Knowing as a
Knowing as a Result of Cognitive
Personal Reflection Technical Knowing Process
Personal Knowing Knowing as a Knowing
April 26, 2013

Knowing as Personal Forced Choice on of or About Procedural Cognitive

ADVANCES

Reference Discipline of Patient Reflection Questionnaire Someone Knowing Processes

IN
1:46

1. Ahorlu Public health x

2. Arcury Public health x
3. Iihara Public health x
4. Lordly Public health x
5. MacIntyre Public health x
6. Maudsley Public health x
7. NIH Public health x
8. Suzuki Public health x
9. Vestal Public health x
10. Weltermann Public health x
11. Woodman Public health x
12. Yanowitz Public health x
NURSING SCIENCE/APRIL–JUNE 2013

13. Alcini Medicine x

14. Camellini Medicine x
15. Chen Medicine x
16. Levi-Setti Medicine x
17. Magee Medicine x
18. Miller Medicine x
19. Nadalin Medicine x
20. Okazaki Medicine x
21. Overby Medicine x
22. Picard Medicine x
23. Quadrani Medicine x
24. Raposio Medicine x
25. Rosas Medicine x
26. Suteanu Medicine x

(continues)

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 ANS200193

Table. Conceptual Use by Discipline3(pp1131,1332) (Continued)

Knowing as a
Knowing as a Result of Cognitive
April 26, 2013

Personal Reflection Technical Knowing Process

Personal Knowing Knowing as a Knowing
Knowing as Personal Forced Choice on of or About Procedural Cognitive
1:46

Reference Discipline of Patient Reflection Questionnaire Someone Knowing Processes

27. Thornton Medicine x
28. Younes Medicine x
29. Atkinson Psych x
30. Browne Psych x (intuitive)
31. Hirano Psych x
32. Hofer Psych x
33. Krek-Konig Psych x
34. Martinez Psych x
35. Piolino Psych x
36. Rajaram Psych x
37. Terry Psych x
38. Thomas Psych x x
39. Wardle Psych x
40. Antrobus Nursing x
41. Artinian Nursing x
42. Cody Nursing
43. Fahy Nursing x
44. Fenwick Nursing x
45. Fraser Nursing x
46. Gaydos Nursing x
47. Hattori Nursing x
48. Hinck Nursing x
49. Hockenberry-Eaton Nursing x
50. Holmes Nursing x
51. Howell Nursing x
Concept Analysis

(continues)
89

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 ANS200193

90

Table. Conceptual Use by Discipline3(pp1131,1332) (Continued)

Knowing as a
April 26, 2013

Knowing as a Result of Cognitive

ADVANCES

Personal Reflection Technical Knowing Process

IN

Personal Knowing Knowing as a Knowing

1:46

Knowing as Personal Forced Choice on of or About Procedural Cognitive

Reference Discipline of Patient Reflection Questionnaire Someone Knowing Processes

52. Jackson Nursing x

53. Johns Nursing x
54. Kavanaugh Nursing x
55. King Nursing x
56. Leight Nursing x
57. Little Nursing x
58. Lutzen Nursing x
59. Mentes Nursing x
60. Nolan Nursing x
NURSING SCIENCE/APRIL–JUNE 2013

61. O’Callaghan Nursing x

62. Owen-Mills Nursing x
63. Paley Nursing x
64. Pigg Nursing x
65. Seymour Nursing x
66. Socorro Nursing x
67. Thompson Nursing x
68. Vance Nursing x
69. Volker Nursing x
70. Warelow Nursing x
71. Wilkes Nursing x
72. Wilkin Nursing x
73. Williams Nursing x

Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
ANS200193 April 26, 2013 1:46
consequences, and the conceptual defini-
tion. Through choice of appropriate linguis-
tic expression, the researcher is contributing
to a body of literature that adds to, de-
fines, and reflects the knowledge base of the
discipline.4,18,30
Identify an exemplar of the concept
from nursing
An exemplar is an example that clearly ex-
presses the use of the concept within the
discipline. As this method of analysis is an
inductive approach, data, analysis, and con-
clusions rise from the body of literature. In
a similar light, the exemplar should also rise
from the literature rather than be fashioned
by the researcher. A good exemplar provides
a clear practical real life example that demon-
strates the attributes, antecedents, and conse-
quences of the concept in action.
Identify implications for nursing
A concept analysis provides a stepping-
stone or launching pad toward further discus-
sion and study regarding use of the concept
within the discipline. It can also be used to
compare and contrast use of the concept to
other disciplines. These types of study and
discussion are critical for ongoing develop-
ment of the discipline. Nurses engage in mul-
tidisciplinary patient care planning sessions as
well as collaborative research efforts. It is crit-
ical for nurses to clearly articulate nursing’s
contribution to the health care arena. Lack
of understanding and weak articulation con-
tributes toward misconceptions of the pur-
pose of nursing, as well as nursing’s unique
contribution at the health care table. There-
fore, it is critical to clearly articulate the au-
thor’s intentions for conducting the analysis,
the purpose the analysis will serve for nursing,
and the way this new knowledge contributes
to the knowledge base of nursing.
Identify study scope and limitations
Scope of the study is identified by the inclu-
sion criterion that determines data collection.
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Concept Analysis 91
For example, the scope describes what types
of articles are to be gathered, how articles
are gathered, and how analysis is to be con-
cluded. Description of the scope also assists
to determine and describe limitations of the
study, such as why certain articles or types of
articles were not included in data collection.
A statement of limitations provides informa-
tion about what the analysis does not intend
to cover, what the analysis design does not al-
low, and characteristics that limit the scope of
the study or sets limits on interpretation. Ex-
amples of limitations might include time con-
straints or restrictions, funding controls, or
sample size. In addition, it is important to in-
clude a statement regarding lack of represen-
tation of articles from certain disciplines, or
why certain articles were not included. Most
importantly, the statement of scope and limi-
tations must be clear.
CONCLUSION
This method of analysis is based on
the linguistic and conceptual philosophies
of Wittgenstein, Toulmin, and Carbough
and is accomplished in accordance with a
hermeneutic philosophical methodology that
can be traced through the works of Schleier-
macher, Dilthey, Heidegger, Gadamer, and
Ricoeur. In accordance with this philosoph-
ical lineage, conceptual understandings are
culturally shaped and develop over time
through living and working with other people
who share some sort of commonality, pur-
pose, or goal. Words and groups of words
are used to describe conceptual thoughts and
ideas.10 These words and associated mean-
ings evolve over time through cultural and
societal use. Various health care disciplines
that comprise the health care industry could
be considered cultures.18 As these disciplines
evolve over time, they develop a knowledge
base that defines that discipline’s unique con-
tribution to health care, as well as a unique
contextual language reflective of that knowl-
edge base. Members of various disciplines
often meet to plan interdisciplinary patient
ANS200193 April 26, 2013 1:46
92 ADVANCES IN NURSING SCIENCE/APRIL–JUNE 2013
care plans, or to engage in research. As a re-
sult of the development of unique conceptual
understandings within disciplinary cultures,
silent misunderstandings can occur.
In addition, in the effort to understand
more about certain conceptual phenom-
ena, nurse researchers often borrow re-
search instruments developed in other dis-
ciplines. However, research instruments are
developed in accordance with the philo-
sophical and theoretical underpinnings of a
specific discipline with the intent to con-
tribute to the knowledge base of that dis-
cipline. Therefore, it is uncertain whether
borrowed instruments successfully measure
the concept or phenomenon of interest, and
whether findings from these borrowed instru-
ments contribute to the knowledge base of
nursing.
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