The conceptual framework and the iterative elements of doctoral nursing research design.

BACKGROUND: Conceptual frameworks are central to doctoral nursing theses; they include the pragmatic and philosophical elements of the research design and their interrelationships. While the research process may seem to stem in a straightforward, linear manner from the research question, it is a more complex iterative enterprise. AIM: To build on Durham et al ( 2015 ) by reviewing the ostensibly static nature of research design and associated philosophical elements of the conceptual framework, reconsidering these in relation to the iterative nature of the research process, and translating these into implications for presenting the final draft of a doctoral nursing thesis. DISCUSSION: All doctoral nursing theses will have limitations and experience difficulties. They do not follow a rigid, sequential process with a defined start and end, but progress tentatively, with the relationship between the elements of the research design and philosophical assumptions following an iterative process. CONCLUSION: The research design element of the conceptual framework of doctoral nursing theses should reflect the iterative reality of the process and the associated interrelationships that occur. IMPLICATIONS FOR PRACTICE: The absence in doctoral nursing theses of a full description of the philosophical and iterative processes of the research architecture and conceptual framework weakens the transparency of the research. Therefore, doctoral nursing students need to move beyond simple description of their inductive or deductive position and research design to help develop trust and confidence in their research.

Conceptual frameworks and terminology in doctoral nursing research.

AIM: To define conceptual frameworks and their inherent dichotomies, and integrate them with concomitant concepts to help early nursing doctoral researchers to develop their understanding of and engage with discourse further, so that nursing can demonstrate its ability to contribute to the meta-theoretical debate of doctoral research alongside other practices and theory-based disciplines. BACKGROUND: Conceptual frameworks are central to nursing doctoral studies as they map and contextualise the philosophical assumptions of the research in relation to paradigms and ontological, epistemological and methodological foundations. They shape all aspects of the research design and provide a structure for theorising. They can also be a challenge for researchers and are under-discussed in the literature. REVIEW METHODS: Literature review. DISCUSSION: The key aspects of the conceptual framework debate in terms of objectivist, subjectivist paradigms and the wider paradigm debate, including retroduction and abduction, are reviewed here together with consideration of how these apply to nursing doctoral research. CONCLUSION: Conceptual frameworks are pivotal to nursing doctoral research as they clarify and integrate philosophical, methodological and pragmatic aspects of doctoral thesis while helping the profession to be seen as a research-based discipline, comfortable with the language of meta-theoretical debate. IMPLICATIONS FOR RESEARCH/PRACTICE: Conceptual frameworks should form the methodological foundation for all nursing doctoral research.

How to empower patients, and involve the public.

Patient empowerment and patient and public involvement are a focus for NHS policy, with an emphasis on patient decision making and representation as core features of a patient-focused NHS. Patient empowerment and patient and public involvement imply a rebalancing of power in the nurse-patient relationship. In reality this is complicated by wider issues of power and control in a complex health service influenced by professional agendas, healthcare leadership, government targets and a developing business culture. Despite these ideological and organisational constraints, there are many ways in which nurses can support aspects of individual patient empowerment and patient and public involvement.

Effect of simulated learning on blood pressure measurement skills.

AIM: To explore whether additional teaching and simulated learning of one-hour duration could improve the blood pressure measurement skills of nursing students. METHOD: A post-test experimental method was used to measure the outcome of additional, targeted simulated learning of blood pressure monitoring beyond normal curriculum content in adult branch nursing students in module one of a three-year nursing programme. RESULTS: One hour of additional teaching and simulated learning improved the ability of nursing students to measure blood pressure accurately, with the data revealing a statistical difference between experimental and control groups in the systolic and diastolic accuracy of blood pressure monitoring. CONCLUSION: In a changing practice environment with fewer opportunities to develop clinical skills under supervision, there is a need for nurse educators and mentors to reconsider and research further methods used for blood pressure monitoring and other skills teaching using simulation for effective learning and skills acquisition.

Community empowerment for health visiting and other public health nursing.

This paper explores the community empowerment aspect of health promotion, where social experience is a key indicator of health, from the perspective of health visiting and other public health nursing. This contemporary model of practice is put into a health promotion context by use of a slightly modified framework and by the inclusion of examples of methods and outcomes of practice that link conceptually with the health assets model and aspects of 'Big Society' thinking. Community development, social capital and capacity building are discussed as key elements of community empowerment with a 'bottom-up' agenda driven by community members. This concerns micro-population health gain, where the process, the quality of the public health nurse-community relationship, is as important as outcome.

Patient empowerment: emancipatory or technological practice?

OBJECTIVE: To describe the meaning of the theme of empowerment from research on health promotion in nursing from the perspective of nurses participating in the study. METHODS: Manual data analysis and QSR NUD*IST Vivo were used to analyse the data generated by individual and focus group interviews and the critical incident technique with 32 qualified nurses working in an acute hospital setting in the UK. RESULTS: The participants identified a number of issues related to the theme of empowerment. These included the nurse as patient informer, psychological supporter and rapport builder and the concepts of informed choice/decision making, gatekeeping, coping, patient assertiveness, self-esteem and confidence. CONCLUSION: Empowerment is a complex, multi-dimensional, contested concept which can reflect a broad socio-political agenda, a radical emancipatory process or, as the findings from this qualitative study suggest, pragmatic interventions operating within the confines of a slightly modified medical model. PRACTICE IMPLICATIONS: If the reader deems the findings are transferable to their clinical milieu then the implications for practice relate to the need for careful consideration about empowerment in relation to operational definitions for practice, how terminology and related intervention is contextualised and the relationship between pragmatic empowerment and the medical paradigm.

A qualitative study exploring the relationship between nursing and health promotion language, theory and practice.

The definitions and meaning qualified nurses employed in an acute NHS hospital setting in the UK gave to health education and health promotion practice and how these fitted established language and theory were investigated qualitatively. These concepts, and the concomitant frameworks and models of practice, have been the subject of considerable debate in the literature. While unresolved both in general and in nursing, a degree of theoretical convergence was established in the 1990s [Bunton, R., Macdonald, G., 1992. Health promotion: disciplines and diversity. Routledge, London; Maben, J.M., Macleod Clark, J. 1995. Health promotion: a concept analysis. Journal of Advanced Nursing 22, 1158-165] helped by The Ottawa Charter [WHO, 1986. Ottawa Charter for Health Promotion. http://www.who.int/hpr/archive/docs/ottawa.html]. For many of the participants in this study however, the meanings given to these concepts and the predominant use of health education were inconsistent with much of the language of the wider debate and this has potential implications for nurse education. For, if the findings are considered transferable then there is a need to develop education strategies and curricula that articulate the ideological foundations of policy and practice and to use mainstream terminology to assist nurses both to understand and contribute to the contemporary health promotion debate.

Patient empowerment within a coronary care unit: insights for health professionals drawn from a patient satisfaction survey.

The aim of this exploratory study was to investigate coronary care patients' perceptions of their care and interventions related to empowerment and strengthening patient choice. The study, conducted in one acute National Health Service (NHS) Trust in Cambridgeshire, England, and completed in 2002, employed a prospective survey design. The research used a self-completion, pilot, postal questionnaire, including closed, open and scaled questions as the main method of data collection. From a total of 200 eligible patients, an unselected, consecutive sample of 142 in-patients consented to participate, of whom 103 returned the questionnaire--a response rate of 73%. In contrast to much published literature, this study demonstrated that empowerment issues involving the rights of coronary care patients to be primary decision makers, managers of their illnesses and ultimate arbiters of their treatment and care were of minimal concern to all but a few. Almost 90% of patients were content to entrust their care exclusively to health professionals based on their confidence in the clinical expertise of the medical and nursing staff. Findings suggested that, while respondents were well-satisfied with their care, the ethos of patient empowerment was of peripheral concern and readily abdicated in the face of acute illness.