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Quality of life in head and neck cancer survivors: A concept analysis
Qiao-Miao Zeng, Yao Liao, Wen-Feng Chen
3TMR Integrative Nursing    2018, 2 (1): 34-41.
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Objective: To identify and clarify the existing definitions of quality of life in head and neck cancer survivors. This concept analysis will inform healthcare professionals of promoting nursing care for head and neck cancer survivors and eventually improve their quality of life. Method: Concept analysis based on Walker and Avant’s framework. Results: Quality of life is a subjective and personally derived cognitive evaluation of global well-being by perceiving a feeling of overall life satisfaction in his/her own value, happiness, and the independence to manage daily activities and life experience. Three defining attributes for quality of life were identified: a feeling of overall life satisfaction in his/her value, global personal well-being, and independence. An improvement of quality of life means an improvement of clinical outcome. However, the variety of instruments for measuring life quality makes it difficult for healthcare professionals to select a standard one for head and neck cancer survivors. Conclusion: By proposing a comprehensive definition of the concept, this analysis contributes to the advancement of knowledge about quality of life in the context of head and neck cancer survivorship. Through a sound understanding of the phenomenon, healthcare professions will recognize or measure head and neck cancer survivors’ life conditions in a more accurate way and to implement intervention where necessary, eventually, improve patients’ life quality in survivorship.

Coping: a concept analysis in the cancer context
Hua Yang
3TMR Integrative Nursing    2018, 2 (1): 27-33.
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Objectives: The aim of this paper is to analyse the concept of coping in the cancer context. This concept analysis will provide a theoretical framework for oncology nurses to help patients cope with the influences of cancer and adapt to their new situations. Methods: The concept analysis of coping was conducted according to Walker and Avant's method. Results: Coping is defined as a process of dealing with stressful events by means of cognitive appraisal, purposeful efforts, and use of available supports and resources in order to achieve physiological and psychological adjustment. Antecedents to coping involve stressful events, individual personality, individual experience, and available supports and resources. Different coping strategies based on patients’ responses to suffering from cancer bring about positive or negative results. Effective coping means being well-adapted, which is conducive to patients’ health and optimum quality of life. Roy’s middle range theory of coping and adaptation processing provides a theoretical framework for the study of coping.The Mental Adjustment to Cancer scale and the 15-item Coping and Adaptation Processing Scale are considered practical and effectual instruments to measure coping in the cancer context. Conclusions: This concept analysis contributes to understanding the process of coping with cancer. Oncology nurses should identify cancer patients’ coping patterns, provide timely and proper professional support and educate effective coping strategies in order to help patients adapt to their new situations both physiologically and psychologically.

Self-management A concept analysis of self-management for cancer patients’ home-basedrehabilitation
Dong-Lan Ling, Hong-Jing Yu
TMR Integrative Nursing    2018, 2 (1): 4-11.
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Objective: To explore and clarify the concept of self-management in the context of cancer patients’ home-based rehabilitation. This concept analysis will provide a theoretical lens for nurses to help cancer patients to develop self-management strategies and enables them to improve their ability in symptom self-management of home-based rehabilitation. Method: Walker and Avant’s framework (2011) was used to analyse the concept of self-management. Results: Self-management is defined as a dynamic process that involves perception of one’s needs, resource utilisation, problem solving and active participation. Antecedents of self-management include self-efficacy, disease knowledge and social support. Improving cancer patients’ ability in symptom self-management can improve their health outcomes and quality of life and reduce healthcare expenditures. Although Strategy and Effectiveness of Symptom Self-Management scale is perceived as an ideal instrument to measure self-management and thus it is used worldwide, whether this instrument fits to measure this concept for cancer patients in Chinese context has still not yet been verified and thus further research is needed. Conclusion: According to the concept analysis, nurses should encourage cancer patients to involve actively in making a home-based rehabilitation plan and promote their ability in symptom self-management of home-based rehabilitation so as to improve their health outcomes and reduce healthcare expenditures.

Adherence-A concept analysis in the context of cardiac rehabilitation
Hui Liu, Xu Tian
3TMR Integrative Nursing    2018, 2 (1): 12-17.
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Objective: To explore and identify the concept of adherence in the context of cardiac rehabilitation. This concept analysis will provide a framework for clinical decision-making and intervention to improve patients’ adherence to cardiac rehabilitation programme. Method: Walker and Avant’s framework was used to analysis the concept of adherence. Results: Adherence is defined as patients collaboration with health care provider, active involvement in the treatment regimen, and persistence in practice characterized by self-efficacy and relapse-prevention. Defining Attributes of adherence include collaboration relationship; self-efficacy promotion and relapse-prevention. Antecedents of adherence include health care provider’s prescription, illness perceptions, social-economic and environmental factors. Patients adherence to cardiac rehabilitation programme can improve clinical outcomes. However, there is no standard instrument to measure adherence. Conclusion:Based on the concept analysis, in order to improve patients’ adherence to cardiac rehabilitation, health care provider should invite patients active involvement in making rehabilitation plan and promote patients’ self-efficacy and prevention relapse.

ICU Delirium: A concept analysis
Lian-Lian Tang
3TMR Integrative Nursing    2018, 2 (1): 18-26.
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Objective: To explore and analyze the concept of intensive care unit (ICU) delirium. Method: Walker and Avant’s strategy of analysis was adopted to this research. Results: ICU delirium is defined as the presence of an acute cognitive impairment, accompanied by a disturbance of consciousness with fluctuating inattention, and the array of dysfunctions only developed for a short period of time in ICU. The antecedents of ICU delirium include (1) the high severity of illness, (2) pain, (3) sedative use, (4) immobilization, (5) sleep deprivation and (6) unpleasant awareness. The consequences involve (1) promoting the risks of self-extubation and unplanned removal of catheters, (2) prolonging the length of ICU stay, (3) increasing the mortality of critical patients and (4) Some different ICU delirium assessment instruments are gathered. Confusion Assessment Method for Intensive Care Unit assessment tool (CAM-ICU) was the most popular diagnostic tool used by nurses. Conclusion: Concept analysis as an extension and development of nursing theory can create a linkage between practice and theory. It will create a knowledge foundation of ICU delirium and provide a theoretical basis to construct nursing theory. This study can help ICU nurses to understand and recognize ICU delirium. ICU nurses will be enlightened to develop effective interventions of ICU delirium to improve critical patients’ clinical outcomes.


This study identifiedthe attributes of ICU delirium emerged from a number of literature: acute cognitive impairment, acute disturbance of consciousness, fluctuating inattention, and developed for a short period of time.The presentation of a model case and a contrary case has shown the differences related to attributes between effective or invalid ICU delirium.

Editor’s Summary

Though a growing number of research publications made great contributions to understand ICU delirium, serious under-recognized issues still remain in healthcare providers globally. This study carry out an assessment, a professional judgment, and a concept analysis of ICU delirium.

Partnership in nursing care: a concept analysis
Si-Yan Yuan, Joan Murphy
3TMR Integrative Nursing    2019, 3 (1): 21-26.
Abstract HTML PDF (472KB)  


This article critically identified four attributes of partnership in nursing care, namely, capacity, collaboration, trust and confidence in accountability, and empathy. Model and contrary cases were addressed to help readers comprehend what counts or doesn’t count as the defining attributes for partnership. By understanding the concept of partnership in nursing care, nurses can innovate their relationship with their clients and care for people in a more person centered way.

Editor’s summary

As the discipline of nursing continues to evolve, the concept of partnership has been brought into nursing care. In order to promote innovative relationships with clients, nurses should first acknowledge the concept of partnership in nursing care. The purpose of this concept analysis is to inform nurses of the theoretical framework underpinning being a partner in care, and to help them measure the effectiveness of their partnership with their clients.


Objectives: This concept analysis aims to provide a better understanding of the term “partnership” in nursing care. A critical review of empirical studies regarding this area, can lay the groundwork for improving partnership between nurses and clients, as well as person-centered nursing care. Methods: A comprehensive literature search used various “partnership”, “nurse” and “clients” search terms to identify relevant studies published from 2007 to 2017. The selected studies had to focus on partnership and nursing care. Walker and Avant’ (2004) framework was used when synthesizing the evidence from empirical studies in the concept analysis. It helps to distinguish confusing or unclear concepts, and to promote critical thinking through analyzing its attributes, operational definitions, antecedents, consequences, and reference. Results: In nursing care, partnership is the relationship based on collaboration among individuals, who place trust and confidence in accountability, and who have capability and empathy. The antecedents are health problems or requirements, willingness to sign up as partners and ongoing commitment; while the consequences were presented as improvement in quality of service, treatment outcomes, clients’ safety and satisfaction, financial benefit as well as time constraints and professionals’ emotional burden. The Patient Partnership in Care questionnaire can help assess partnership in nursing care. Conclusion: This concept analysis informs the concept of partnership in nursing care by using Walker and Avant’ (2004) framework. By synthesizing the evidence from empirical studies, it provides theoretical and clinical frameworks for nurses to innovate nurse-client relationships - nurses are seen as partners in care instead of experts, which can encourage clients’ self-management and improve person-centered nursing care.

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