1. Foley, Angela S. MSN-HCSM, RN
  2. Davis, Alison H. PhD, RN, CHSE

Article Content

For the clinical nurse specialist (CNS) engaged in research or evidence-based practice (EBP), a concept analysis can provide guidance when a concept of interest does not have sufficient literature, is vaguely defined, or is not understood clearly or when literature and research do not match.1 Once the concept is more concrete, the CNS can explore and determine a study design or measurement tool. There are several approaches to a concept analysis including, but not limited to, the approaches by Chinn and Jacobs,2 Walker and Avant,3 Rodgers,4 and Sartori.5 The purpose of this article is to provide insight into a concept analysis through definitions, purpose, and procedures and provide an example of a concept analysis on empathy using the Rodgers method of evolutionary concept analysis.



A concept represents a symbol or a building block of a bigger spectrum; it is the basis of what the researcher wants to pursue.6 In nursing, research can be applied through the use of EBP. Research is a methodical and rigorous inquiry, which provides answers to questions surrounding phenomena.7 Evidence-based practice is the gathering, evaluation, and integration of research in combination with clinical expertise to inform nursing practice.6 Research and EBP both rely on a clear understanding of what is being studied or the concept, which has been chosen by the researcher. A concept analysis can be defined as the dissection of a concept into simpler elements to promote clarity while providing mutual understanding within nursing.1 If the researcher notes a lack of clarity surrounding the concept, a concept analysis should be undertaken to achieve a better understanding of the concept. A concept analysis can elucidate the meaning of the concept in current use, which can contribute to the future development of the concept.2



Rodgers4 offered a method of concept analysis referred to as an evolutionary view of concepts, which "addresses contemporary concerns valuing dynamism and interrelationships within reality."4(p332) After the recognition of the concept to be studied, it must be clearly defined. Because concepts for analysis are sometimes vague or confusing to the CNS researcher, simply using 1 definition would be insufficient to the researcher. All associated conceptual descriptions must be uncovered for the CNS researcher to clearly understand the depth of a concept. Rodgers6 stressed that the significance of the concept to nursing should be clearly delineated in other fields, occurrences, and/or professions, as well.


Rodgers'4 approach to concept analysis includes 7 phases, which can be carried out simultaneously and not necessarily in a linear manner. However, for clarity, these phases are described linearly.


The phases of concept analysis are to4


1 identify and name the concept of interest;


2 identify the surrogate terms and relevant uses of the concept;


3 select an appropriate realm (sample) for data collection;


4 recognize attributes of the concept;


5 ascertain the references, antecedents, and consequences of the concept, if possible;


6 identify concepts related to the concept of interest; and


7 generate a model case of the concept.



The Table delineates these phases and provides an example of an abbreviated concept analysis.

Table Rodgers Phases... - Click to enlarge in new windowTable Rodgers' Phases of Evolutionary Concept Analysis

Identify and Name the Concept of Interest

To begin the dissection of the identified concept of interest, the CNS researcher must begin with the meaning to nursing. An initial review of the literature provides insight into an elusive concept because the researcher can discover what is known, not known, or confusing about a concept.


Empathy was chosen as the concept of interest to illustrate the process of concept analysis. Empathy is considered to be at the heart of nursing as a part of caring. One definition says that "an empathetic nurse is sensitive to the patient's feelings and problems, but remains objective enough to help the patient work to attain positive outcomes."8(p462) In addition to patients, family members also benefit from an empathetic nurse. For example, when facing potential loss of a loved one, the CNS understands and is sensitive to the fears of losing a loved one. Clinical nurse specialists recognize and acknowledge the feelings of helplessness in a family member and tailor care to reflect these empathetic feelings. Through this display of empathy, the CNS builds trust with patients and families while building a deeper therapeutic relationship.9


Identify Surrogate Terms and Relevant Uses of the Concept

The dissection of the meaning of the concept will identify surrogate terms. Again, the initial review of literature provides clarity to the researcher because additional terms are sought. Relevant uses for the concept will also surface.


Surrogate terms found in the literature for empathy include caring, sensitive, recognition, awareness, intention, communication, understanding, acknowledgement of feelings, helping attitude, and trusting and therapeutic relationship.


Select an Appropriate Realm (Sample) for Data Collection

To identify an appropriate realm (sample) for data collection, an in-depth review of literature on the concept identifies potential realms in nursing and other healthcare fields. PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, and MEDLINE are appropriate for performing the initial and in-depth review of literature. The key words, which are the identified surrogate terms, should be used for the search. Initially, a multitude of articles may be available on the concept using the identified terms or combinations of terms. The CNS researcher must appraise each article critically to explore and develop the concept.10 This critical appraisal uses the literature as data to discover new knowledge and pose analytic questions about a concept.10 It may be helpful to ask whether the authors are "describing the concept the same" or "using the concept similarly" or "were there any inconsistencies sited in the literature?" This step is invaluable for understanding how other researchers view the concept. Answers to these analytic questions also reveal to the researcher what is known and unknown about the concept.


For this example, the review of literature was performed in PubMed using the following search terms: empathy and the millennial (because this analysis was undertaken by a CNS student representing this demographic), empathy and healthcare, and empathy and CNS students. After a critical appraisal of the literature, confusion, ambiguities, and in consistencies with the concept of empathy became apparent. Empathy was separated into cognitive and affective empathy, with no clear delineation within the literature. In nonnursing literature, empathy was described as mirrored and imaginative self-empathy. Empathy was also labeled as more cognitive rather than affective.11 Empathy does involve some emotional and cognitive capacitates; however, the idea of empathy as more cognitive may hinder emotions from being communicated, which can interfere in nursing therapeutic relationships. Brown et al11 implied that being emotional was not professional and was confusing to the patient. This conceptualization raises the question of "how emotional is too emotional" when communicating empathetically to a patient. These inconsistencies cause one to question whether empathy is a cognitive or an emotional reaction and whether it is even a component of caring in nursing.


Identify the Attributes, References, Antecedents, and Consequences of the Concept

After addressing the inconsistencies in the literature review, it is vital to recognize other terms associated with the concept. These references, antecedents, and consequences are actions that occur or are associated with the concept. This step is essential for dissecting the concept and understanding all associated nuances. This step provides the researchers with a sense of tangibility of the concept. These attributes will lead to the operationalization of the concept, which will lead to the selection of a measurement tool.


Critical attributes associated with the concept of empathy are relationship, communication, and understanding. Ward et al9 explained the nurse-patient relationship as grounded in communication, which incorporates specialized knowledge of the patient's condition or situation, thus promoting a therapeutic bond between the CNS and patient. Understanding the context of the patient's experience and attendant implications is a critical characteristic of empathy and empathetic engagement.9


Antecedents of empathy include intention to help and awareness. Without first having the intention to help, nurses would not seek out situations or position themselves to render help. The intention to help is fundamental to empathy in the context of patient care.9 Moreover, to be helpful, the CNS must be aware of the patient's behaviors and recognize when and what help is needed. Awareness comes into play during the interaction of 2 involved persons. In the case of nursing, the intent to help and awareness of the patient's situation facilitate the therapeutic communication, underpinning concepts of empathy.


Consequences of empathy in nurse-patient relationships could be patient satisfaction and perception of caring. Positive interaction between the patient and nurse during an empathetic encounter may lead to patient perception of caring by the nurse, which in turn leads to patient satisfaction. This positive interaction may also be a source of job satisfaction for the nurse.


Identify Concepts Related to the Concept of Interest

After recognizing what attributes, antecedents, and consequences align with the concept, one must then determine if there are any related concepts that need clarification in the literature. Again, a critical appraisal of the literature will reveal to the investigator what relevant research has been done, any confusion related to the concept, and future research implications.


The concepts of empathy, sympathy, and communication skills are commonly misused in the nursing and healthcare literature and are often used interchangeably by healthcare professionals in clinical practice. For example, Brown et al11 studied empathy using instruments that measure listening and communication in general. Listening was identified as instrumental in communicating empathy. As a result of the study of Brown et al,11 a relationship between listening and communicating empathy was linked. Communication is a very complex and multidimensional concept. Empathy needs to be expressed as a subset of communication to truly understand its meaning.


Lack of empathy in the patient-care process among healthcare professionals is frequently reported as a significant finding in the literature.12 Using empathy and strengthening empathetic relationships in the patient-care process have been shown to lead to better healthcare outcomes for patients, such as increased patient satisfaction.12 Through the development of a better understanding and correct use of the concept of empathy in practice, healthcare providers may also experience greater professional satisfaction.12


Identify a Model Case

The selection of a model case provides the researcher with a clear example, which allows the researcher to gain a more concrete notion of the concept and clarifies the direction of research.10 The following is an example of a model case for empathy. A CNS enters a patient's room to check on the patient's status. The CNS sees the patient crying and asks, "What is wrong? How may I help?" The patient states that she is scared about the surgery scheduled for the next day. The patient further explains that she has not had surgery before and is unsure why the surgery is needed. Empathy allows the CNS to remember a time when faced with an unknown situation and recalls feelings of uncertainty and fear. The CNS is empathetic with the patient, although the CNS has not experienced this surgery. Empathy allows the CNS to understand why a patient would be scared, and in addition, the CNS has the requisite advanced knowledge to understand why the patient requires surgery. The CNS responds by comforting the patient and stating, "I understand why you would be scared. It's normal to feel scared when you are facing a new situation." The CNS then explains the procedure and why it is important that the patient undergoes this surgery. The CNS has displayed empathy through communication with the patient, recognizing the patient's emotions, and understanding the patient's experience.



Concept analysis is a crucial step in providing clarity for a concept that is not well defined or is confusing to a CNS in the researcher role. A completed concept analysis will aid the researcher in the identification of all aspects of the concept. The concept analysis will require the researcher to dissect the concept into several descriptors (antecedents, consequences, and attributes) to transform an abstract idea into a more tangible concept. The concept analysis allows the researcher to progress to subsequent phases of the research process such as operationalizing the concept, selecting a design, and choosing an appropriate measurement instrument.




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