Conceptual Relationships and Assumptions

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

· Review Chapter 8, “Frameworks” (pp. 138-154)

McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.) Philadelphia, PA: Wolters Kluwer Health.

· Review Chapter 2, “Overview of Theory in Nursing”

· Section, “Nursing’s Metaparadigm” (pp. 41–45)

· Review Chapter 4, “Theory Development: Structuring Conceptual Relationships in Nursing” (pp. 72–92)

Nursing’s metaparadigm, described in Chapter 2, presents four core concepts (i.e., patient, health, nurse, and environment), which you consider in this week’s Discussion. Chapter 4 presents information on conceptual relationships and assumptions.

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall.

· Chapter 5, “Statement Derivation” (pp. 88-98)

· Chapter 8, “Statement Synthesis” (pp. 127-148)

· Chapter 11, “Statement Analysis” (pp. 194-206)

· Review Chapter 13, “Assessing the Credibility and Scope of Nursing Knowledge Development: Concepts, Statements, and Theories” (pp. 237-239)

Concept Analysis-Motivation

Mariana Tsucuneli

PhD in Nursing -Walden University

NURS 8250 NURS 8250N:Advanced Theoretical and Scientific Perspectives in Nursing

Dr. Susan Fowler , PhD.

September 27, 2020

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Concept Analysis-Motivation

Introduction

Motivation is attributed willingness to attain or achieve something though goal-directed behavior. In simple terms, motivation encompasses processes that consider a person’s intensity, direction, and persistence of effort toward meeting a goal or objective. The three vital aspects of a person’s willingness are intensity, direction, and persistence. With the intensity aspect, it implies the level at which an employee works to attain the goal. On the other hand, it directly benefits the organization as persistence determines how long a worker maintains his efforts or commitments. Under the context of Maslow’s Pyramid, meeting needs such as physiological needs (sex, hunger, and thirst), a person’s safety, social (friendship, acceptance, and affection), esteem (self-respect and autonomy), and self-actualization (self-fulfillment), trigger motivation . Conceptual Relationships and Assumptions

Synopsis of Analysis

Aim

The research paper explains and presents the concept analysis of motivation.

Background: The current healthcare system is dynamic and requires accurate adjustment to ensure positive general organizational performance. Challenges of attending to the aging population, high demand for care services, patients with severe diseases such as cancer, and limited resources to solve future care issues demoralize healthcare providers’ efforts. With increasing demands for healthcare services, nurse leaders and nurse executives are forced to set specific goals that their team members should work to achieve them. Without motivation, it becomes challenging to attain such goals; thus, the organization’s performance decreases. Primarily, motivation is an internal process that triggers and makes a person move toward improving the quality of services provided. Conceptual Relationships and Assumptions

Data Sources

A literature search will be critical in exploring the motivation concept. Sources such as electronic literature indexes, textbooks, Internet search engines, and scholarly research articles can provide evidence-based information concerning motivation. Mostly, literature not older than five years will give more evident findings to study motivation.

Method

Eight concept-analysis steps of Walker and Avant (2019) to carry out a motivation analysis related to work engagement in healthcare.

Findings from Review of The Literature

In Ethiopia, motivation is attached to job satisfaction among healthcare providers in public hospitals. In research by Ayalew et al. (2019), the findings show that resources’ availability determines the level of job motivation. Poor working conditions and limited resources demoralize nurses, thus reducing the level of their job satisfaction. However, this issue of decreased motivation is prevalent in developing countries and continues to negatively impact the quality of care. Among female nurses, job satisfaction is higher compare to their male counterparts. Female nurses attribute their motivation at the workplace with recognition, remuneration (equitable salary and fringe benefit), work experience, career development opportunities, and job features.

Furthermore, adequate competent clinical staff motivates nurses since incidences of burnout are zero since the tasks assigned to every nurse are manageable within the official eight working hours. Across the world, there is a problem of critical shortage of nurses. Nurse are migrating to other countries looking for better pay and working conditions, career development, and personal safety (Freeman, Baumann, Blythe, Fisher, & Akhtar‐Danesh, 2012). The reason behind shortage and migration is due to lack of motivation, so the hospitals cannot retain nurses for long time. According to Riahi (2011), role stress is a major problem among physicians and has led to increased distress contributing to burnout in the nursing profession. It is crucial to analyze role stress concept and its impact on nurses’ motivation.

A 2016-2025 strategic plan launched by the Federal Ministry of Health of Ethiopia aimed to enhance the country’s commitments for developing, recruiting, deploying, and motiving healthcare workers. Ayalew, Kibwana, Shawula, Misganaw, Abosse, Van Roosmalen, & Mariam, 2019). Intrinsic and extrinsic motivation factors mainly drive overall job satisfaction. For instance, the researchers found that intrinsic motivation elements such as recognition for good performance, features of the job itself, and personal career development enhance job satisfaction and motivation. On the other hand, polices and administration, working conditions, salary, promotions, supervisions, and job security are extrinsic motivational factors of job satisfaction.

In Iran, the concept of motivation among nurses is anchored based on encouragement. According to Esfahani & Afshin (2019), work engagement makes nurses feel motivated to give empathetic and safe healthcare services in a complex healthcare setting. Among Iranian healthcare centers, nursing work motivation among nurses and physicians is between medium to high. A s a result, hospital management, through their nurse managers and policymakers, need to focus on serious attraction to improve the job motivation that will make nurses achieve greater performance.

The motivation of nurses and performance outcomes are directly related. The level of motivation affects satisfaction, retention, organizational performance, commitment, wellbeing, and engagement. In the perspective of wellbeing, nurses gain a feeling of happiness, also called an advanced psychological experience of individuals. In research conducted by Baljoon, Banjar, & Banakhar (2018), motivation is the product of interactions between people, their work setting, the match between these interactions, and the social context. Extrinsically motivated nurses find their work interesting, fun and challenging (Baljoon et al., 2018). The extent to which nurses are happy relies on how well they get motivated and the availability of personal sources of happiness.

The connection between motivation and burnout is crucial when determining the level of emotional, physical, and mental tiredness resulting from long-term engagement in the work environment that appears to be emotionally demanding. In a Baljoon et al., (2018) study, motivation relates to work holism, work engagement, and burnout. Burned-out nurses do not view their work activities as satisfying and enjoyable. The findings showed that the encouragement of autonomous motivation contributes to increased job engagement and a decline in work holism and burnout. In Canada, among healthcare providers, burnout negatively impacts commitment and their work performance.

Work motivation is essential for healthcare specialists’ performance. It has been established that it influences work performance among nurses. For instance, in quantitative research that examined the link between motivation and performance among healthcare providers employed at European Gaza Hospital, the most motivated care workers attain excellent performance outcomes compared to low-motivated care providers (Baljoon et al., 2018). This research findings raise the need for ensuring adequate training programs and an equitable working schedule to improve motivation and improve job performance. Further, the research findings indicated that highly-motivated nurses smile and initiate friendly discussions with patients and residents.

Antecedents, Attributes, and Consequences

Motivation antecedents are classified as intrinsic and extrinsic motivation . Like personal attributes, these two categories involve clinical experiments that relate to educational-creativity setting or work environment context. When a person is intrinsically motivated, he engages in an activity solely because he enjoys it and gets personally satisfied with it. Similarly, when he gets extrinsically motivated, he does something to receive or gain an external reward (Bakay & Huang, 2010). The self-determination level and capability, and features of the work itself are critical elements (concepts) of extrinsic motivation. In general, the main attribute of intrinsic motivation loves what you do. On the other hand, the work performance results and nature of the work allude to extrinsic motivation. However, the negative relationship existing between intrinsic and extrinsic motivation undermines intrinsic motivation. Within the creativity context, the combination of intrinsic and extrinsic enhances the overall performance.

Antecedents	Defining Attributes (with citations)	Consequences
Personally rewarding (intrinsic)	Engagement	Satisfaction
Desire to earn a reward (extrinsic)		Stay

A Model Case

According to Maslow’s five-model of the hierarchy of needs, motivation is a procedural process containing basic needs that must be met before proceeding to the next level of motivation. A nurse should first meet biological and physiological needs such as food, sleep, sex, shelter, and warmth before meeting safety needs. In the second stage of motivation and satisfaction, a nurse must have protection, stability, and security (Montag, Sindermann, Lester, & Davis, 2020). The third step of the model being belongingness and affection needs, requires a nurse to have a healthy relationship and teamwork. The fourth last need is esteem. A nurse has already built his image, status and achieved better results. The last need is self-actualization, that involves nurses’ need to seek career advancement opportunities to become motivated .

Empirical Referent

The empirical referents for motivation include decreased performance, higher employee turnover, engagement’s low levels, poor communication, inability to overcome adversity, and lack of apathy for the job are problems that proliferate and contribute to the workplace become a toxic environment. Unmotivated nurses do not seem to care if they have a job or not. Also, they are unlikely to accept challenges and changes and cannot stick with the problem to allow for finding a long-term solution.

Implications

Motivation in the workplace will lead to increased productivity due to a high level of performance among employees. As a result, the implication of hospitals’ motivation is finding what triggers motivation, especially among frontline workers such as nurses. Instead of focusing on monetary motivation, hospitals can improve working conditions, hire enough staff, and provide adequate work resources.

Influence of Motivation Concept Analysis

From the above concept analysis, I have realized that the best motivation is not only based on giving attractive compensation packages but using non-monetary rewards. Previously, I perceived motivation to be an aspect that is not much important in determining workers’ and organizations’ performance in general. Now, based on the finding, I can justify that motivation is the backbone of workforce performance and increased productivity. I will use the findings to frame comprehensive research questions to research on broad motivation area of interest. Conceptual Relationships and Assumptions

References

Ayalew, F., Kibwana, S., Shawula, S., Misganaw, E., Abosse, Z., Van Roosmalen, J., … & Mariam, D. W. (2019). Understanding job satisfaction and motivation among nurses in public health facilities of Ethiopia: a cross-sectional study. BMC nursing, 18(1), 46.

Bakay, A., & Huang, J. (2010). A conceptual model of motivational antecedents of job outcomes and how organizational culture moderates. Available at SSRN 1722048.

Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting it: a scoping review. International Journal of Nursing & Clinical Practices, 2018.

Esfahani, P., & Afshin, M. (2019). Job Motivation among Iranian Nurses; a Systematic Review and Meta-Analysis Study. Health Research Journal, 4(1), 30-37.

Freeman, M., Baumann, A., Blythe, J., Fisher, A., & Akhtar‐Danesh, N. (2012). Migration: a concept analysis from a nursing perspective. Journal of advanced nursing, 68(5), 1176-1186.

Montag, C., Sindermann, C., Lester, D., & Davis, K. L. (2020). Linking individual differences in satisfaction with each of Maslow’s needs to the Big Five personality traits and Panksepp’s primary emotional systems. Heliyon, 6(7), e04325.

Riahi, S. (2011). Role stress amongst nurses at the workplace: concept analysis. Journal of nursing management, 19(6), 721-731.

�Incomplete sentence

�This is OK but defining attributes are determined from ALL uses of motivation –

Motivation in nurses

 

Motivation in students trying to get into college

 

Motivation of hunters to find food

 

Motivation of animals to find food

 

Etc.

 

 

�Rather than using the words motivation, use the definition of intrinsic motivation and extrinsic motivation

 

You need to create a table based on your review of the literature and words or phrases that are REPEATED by at least 2 authors

See below

 

 

�Create a model case with the defining attributes and call out the defining attributes

 

 

�These are outcomes or consequences of NO motivation

 

Motivation could be observed

 

Motivation could be assessed with a survey

Can you?  Pick please ONE out repost statement from the article.

Then apply Walker and Avant (2019) chapter 11, statement analysis, to this statement:

Classify (existence, definition, relational)

If it is relational:

Type – is is causal, probabilistic, concurrent, conditional, time ordered, necessary, sufficient, etc. (see Gray et al. text too, page 145)

Sign – positive or negative

Symmetry

Logic

Testability

 

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Prentice Hall.

 

 

Week 5 Learning Resources

Gray, Grove, & Sutherland (2017)

Chapter 8 – see week 1

McEwen & Wills (2014)

Chapter 2 – see week 1

Chapter 4 – see week 1

Walker & Avant (2011)

Chapter 5 – statement derivation

· A declarative sentence in which a relationship is posited between 2 or more concepts

· Concepts share a common strength or content within the existing strategy for statement derivation

· Example: when X is reached, further Y leads to reduced Z

· We do this is there is not a lot of data, it currently is outdated, or existing data is not sufficient to capture the phenomenon

· Direct research to test them

Chapter 8 – statement synthesis

· Specify relationship between 2 or more concepts based on evidence

· 2 steps: 1) evidence results in inferences and 2) generalize from specific

· When to do a statement synthesis: 1) there is no conceptual or empirical work on the topic, 2) concepts and evidence are available so link them, or 3) research is published but it is not organized into a meaningful conclusion

· Qualitative, quantitative, or mixed methods

Chapter 11 – statement analysis

· Focus on classifying each concept, relationships between them, and the role the statement has in the whole picture

· If statements are nonrelational they exist or provide a definition

· If there is a relationship they could be causal, probabilistic, concurrent, conditional, time ordered, necessary, or sufficient

· Steps include select the statement, simplify it, classify it, examine the concepts, specify relationships, examine the logic, and determine testability

Chapter 13 – see week 3

Cowden & Cummings (2012)

· Employee job satisfaction is related to thinking about leaving which is related to turnover (3 concepts linked)

· Behavioral intentional statements have the strongest prediction

· The key concept is intent to stay – previous research has focused on cognitive behaviors not affective ones – we need both

· Many variables affect intent to stay including organizational commitment, job satisfaction, leadership practices, work environment, individual nurse characteristics, and career development opportunities

· A model was created a model with manager, organizational, work, and nursing characteristics as independent variables, cognitive and affective behaviors as mediators, and the outcome or dependent variable, intention to stay – this model can create evidence-based nurse retention strategies. Conceptual Relationships and Assumptions

· Future research should include desire to stay

DeGuzman & Kulbok (2012)

· Built environment – physical like sidewalks and social networks

· Outcomes of the built environment can be negative like obesity, HTN, and heart disease

· A framework to study this would be the social determinants of health and environmental health promotion

· The built environment influences our walkability which affects outcomes such s health behaviors, social integration, and social support

· Bottomline is that the built environment, mediated by physical activity and diet, affects health outcomes

Vanderheide, Moss, & Lee (2013)

· Workplace adversity is a burden of workplace environment and moral complexities

· Is workplace adversity ‘uninhabitable? – nurses stay or leave; a habitable environment can shape moral identity

· Authors followed a process: 1) concept map with 4 domains of moral climate, moral agency, moral distress, and more sensitivity followed by identification of relevant concepts and outcomes (both positive and negative); 2) integrative review of the literature using Kirkevolds’ quality appraisal

· A moral climate is an ethical climate

· A moral climate is tied to a moral agency

· A moral climate is related to moral distress

· A mismatch of values between people and the organization or organizational constraints that interfere with how we enact our values results in moral distress

· Moral stress is predicted by moral climate and or moral sensitivity but ethical sensitivity replaces moral sensitivity

· Ethical sensitivity is a big definition including intelligence and compassion, uncertainty, critical understanding, ethical codes, academics, learning, self-knowledge and other abilities to anticipate consequences and courage to act!!

Laureate Education

· Concepts interact with one another

· Look for gaps

· Proposed relationships lead to assumptions which include outcomes (ex. We assume participates will answer questionnaires truthfully)

· Tools should be reliable and valid and measure the concept

 

DISCUSSION (5 parts)

· Post a synopsis of an article that features conceptual relationships related to your phenomenon of interest

· Explain insights you gained from applying Walker and Avant’s steps for statement analysis

· Compare information in the article with your current thinking about theoretical foundation for research, including relationships and assumptions

· Describe implications of the metaparadigms for your theoretical foundation. Conceptual Relationships and Assumptions

 

 

 

 

 

I copy and attached one of my colegue post as sample for you.

Synopsis

Medication Adherence is the phenomenon of interest for this post; The theoretical framework is based on the Theory of Self-care of Chronic Illness. Concepts utilized are medication adherence, self-care maintenance, self-care monitoring, self-care management, behaviors, and perspective. The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012 (Riegel, Jarrsma, & Lee, 2019). They now propose a revision of the theory, which includes symptoms integrated with the self-care behaviors of self-care maintenance, monitoring, and management (Riegel, Jarrsma, & Lee, 2019). This article states symptoms interact most directly with self-care monitoring and self-care management (Riegel, Jarrsma, & Lee, 2019). Conceptual Relationships and Assumptions

Symptoms are both an antecedent and a consequence of self-care (Riegel, Jarrsma, & Lee, 2019). The article states the experience of having symptoms can build skills in self-care maintenance, monitoring, and management (Riegel, Jarrsma, & Lee, 2019). As an antecedent, symptoms often motivate individuals to engage in self-care behaviors (Riegel, Jarrsma, & Lee, 2019). Other antecedents include experience, skill, and self-care confidence or self-efficacy influenced by the symptom experience (Riegel, Jarrsma, & Lee, 2019).

The article states that the consequences of self-care are illness stability, health, well-being, quality of life, and perceived control (Riegel, Jarrsma, & Lee, 2019). Perceived health, well-being, and quality of life are primarily a function of symptoms (Riegel, Jarrsma, & Lee, 2019). Although many people with chronic illness tolerate symptoms, severe symptoms were associated with poor quality of life (Riegel, Jarrsma, & Lee, 2019). In another sample, symptoms were the primary reason patients sought acute care (Riegel, Jarrsma, & Lee, 2019).

In conclusion, the article stated the perspectives-self-care and symptoms are clearly related (Riegel, Jarrsma, & Lee, 2019). By integrating the two, the authors hope for further development of symptoms theory to self-care theory, and the ability of self-care to mitigate symptoms will be appreciated (Riegel, Jarrsma, & Lee, 2019). Both perspectives are central to a holistic approach to patient care (Riegel, Jarrsma, & Lee, 2019). Conceptual Relationships and Assumptions

Statement analysis

Select the statement –Behaviors taught for self-care, observation taught for recognizing changes in signs and symptoms, and teaching how to respond if changes occur will result in adherence to a medication regimen. Medication adherence results in three concepts that consist of self-care maintenance., self-care monitoring, self-care management.

Clarify statement – none required

Classify the statement -This statement is classified as a relational statement because it specifics relationships between concepts (McEwen & Willis, 2019).

Examine concepts within the statement for definition and validity – Medication adherence is the extent to which a patient continues an agreed-on treatment mode without close supervision ( Medical -Dictionary-Adherence, 2020). ). Behaviors to maintain physical and emotional stability are utilized in self-care maintenance (Riegel, Jaarsma, & Stromberg, 2012). Self-care monitoring involves observing changes in signs and symptoms (Riegel, Jaarsma, & Stromberg, 2012). If changes occur, then the response to signs and symptoms is known as self-care management (Riegel, Jaarsma, & Stromberg, 2012). Behavior is the way in which someone conducts oneself (Behavior, 2020). Perspective is the capacity to view things in their true relations or relative importance (Perspective, 2020). The ontological approach of the nature of truth can be divided into two parts. Realism is a verifiable reality outside of the research (Burkholder, Cox, & Crawford, 2016). The assumptions are that there is one truth, the perception and nature of objects are independent of the researcher’s perception, and truth corresponds to observable and knowable facts (Burkholder, Cox, & Crawford, 2016). Relativism (antirealism) is a nontraditional interpretive method of knowing (Burkholder, Cox, & Crawford, 2016). The assumptions are that knowledge is determined by historical, subjective, cultural, or institutional circumstances. There are no objective viewpoints to evaluate truth, and reality is from a person’s particular perspective (Burkholder, Cox, & Crawford, 2016). Truth is subjective and is created through individuals’ interactions (Burkholder, Cox, & Crawford, 2016).

Specify relationship among concepts by type sign and symmetry – The specific relationship among the concepts is a causal statement because one set of concepts causes the other set of concepts (McEwen & Willis, 2019). Patients who continue on an agreed-on treatment mode (medication adherence) develop behaviors to maintain stability (maintenance), observing changes in oneself (monitoring) and take action if changes occur (management). Conceptual Relationships and Assumptions

Example logic – In examining the logic, the statement is inductive because its logic cannot be judged except by the amount of empirical support it has and by comparison to existing knowledge (Walker & Avant, 2019). After a literature review was completed, specific themes emerged with the concept of medication adherence. A patient who adheres to a medical regimen in certain studies produces certain behaviors that could be observed and assessed.

Determine testability – The statement can be tested with self-reporting tools (Walker & Avant, 2019). Medication adherence results in self-care maintenance, monitoring, and management. The hypothesis is if a patient is taught behaviors for self-care maintenance, how to observe for changes in signs and symptoms, and then how response if changes occur, then the patient will adhere to the medication regimen.

Compare article

This author believes it is behaviors and perspective that influences medication adherence. Symptoms may dictate when self-care will occur, but this author believes behaviors and perspective are the driving forces for medication adherence. The article frequently addressed the perception of symptoms (Riegel, Jarrsma, & Lee, 2019). The article states symptoms are based on the perception of the individual experiencing the symptoms and self-report (Riegel, Jarrsma, & Lee, 2019). The article defines the symptom experienced as the perception of the frequency, intensity, distress, and meaning of symptoms concerning interpreting bodily changes as symptoms (Riegel, Jarrsma, & Lee, 2019).

Relationships among concepts

If a patient is taught behaviors for self-care maintenance, how to observe for changes in signs and symptoms, and how to respond if changes occur, the patient will adhere to the medication regimen. Behaviors to maintain physical and emotional stability are utilized in self-care maintenance (Riegel, Jaarsma, & Stromberg, 2012). Self-care monitoring involves observing changes in signs and symptoms (Riegel, Jaarsma, & Stromberg, 2012). If changes occur, then the response to signs and symptoms is known as self-care management (Riegel, Jaarsma, & Stromberg, 2012). Conceptual Relationships and Assumptions

Nursing metaparadigm

The nursing metaparadigm consists of four concepts (person, health, environment, and nursing) that serve as an organizing framework for conceptual development to proceed (McEwen & Willis, 2019)

Medication adherence and person- Medication adherence affects a person’s well-being and perceived control.

Medication adherence and health- Medication adherence affects illness stability.

Medication adherence and environment- Medication adherence affects the quality of life.

Medication adherence and nursing – Medication adherence affects practice to enhance behaviors associated with medication adherence.

References

Behavior. (2020). Retrieved from Merriam-Webster: https://www.merriam-webster.com/dictionary/behavior

Burkholder, G., Cox, K., & Crawford, L. (2016). The scholar-practitioner’s guide to research design. Laureate Publishing.

McEwen, M., & Willis, E. (2019). Theoretical basis for nursing (5th ed.).  Wolters Kluwer Health.

Perspective. (2020). Retrieved from Merriam-Webster: https://www.merriam-webster.com/dictionary/perspective

Riegel, B., Jarrsma, T., & Lee, C. (2019). Integrating Symptoms into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42, 206-215. doi:10.1097/ANS.0000000000000237

Riegel, B., Jaarsma, T., & Stromberg, A. (2012). A Middle-Range Theory of Self-Care on Chronic Illness. Advances in Nursing Science, 35(3), 194-204.

Walker, L., & Avant, K. (2019). Strategies for theory construction in nursing (6th ed.). Prentice Hall.