Problematic Concept Analysis in Literature - Research Paper Example

? Concept analysis Concept Analysis A concept relates to an idea or a complicated mental depiction of a phenomenon. Concepts are regarded as essential and pivotal components of theory. Concept analysis is used as an approach to develop a concept. It is often seen to embody concept development and concept clarification. The notion is represented by various approaches which differ primarily in their procedure and rationale. For instances these can be due to different perceptions of an object in literature or the different vantage points it is seen from (Powers & Knapp, 1995). In the field of nursing, a number of variations of Wilson’s model of concept analysis are adopted to explain concepts. Wilson’s model of concept analysis is an 11-step approach to permit its users to gain a relative degree of clarity in thinking and perception and to cogently express a concept which may prove to be tricky. The technique is of great usefulness when it is employed to analyse a concept which may have multiple meanings. Wilson’s technique is followed to get to the root of the problem and the solution is reached when the results of the concept analysis can be displayed in language (Thompson, 2005). This paper will attempt to carry out a critical analysis of a problematic concept in literature. For this purpose, an empirical research article will be selected from a scientific journal and two major concepts in it will be identified. Then one of the major concepts will be analyzed using the 11-step technique proposed by Wilson. The article chosen for concept analysis is an empirical research article written by McCabe, Ricciardelli and Banfield (2009). The article, titled ‘Depressive symptoms and psychosocial functioning in preadolescent children’, was retrieved from Depression Research and Treatment. The aim of the study was to find out the fraction of children who are at-risk of depression or clinically depressed and to see what effects depression has on them. The authors selected a group of 510 children (270 boys 240 girls) and inspected them for signs of depression. The authors focus on a specific set of variables to find out their relation. There are two major concepts used in the paper. These are depression and at risk. In order to carry out a concept analysis, the concept is thoroughly examined and its meaning probed from a variety of sources. This paper will discuss the concept of depression and analyze it critically. The aim of the concept analysis will be to come to a clear and concise meaning for depression and its use in routine life. The word depression does not have a clear definition and people have differing views regarding it. The expression and perception of depression is influenced by a number of factors such as culture, context, social gatherings etc. According to Wilson, the first step in the process of concept analysis is the identification and isolation of the questions relating to the concept. These questions can be grouped into three main categories: facts, values and meanings. When analyzing depression, various questions regarding its nature and meaning arise. For example how is depression defined? What are the signs and symptoms of depression? Is depression different than unhappiness? Should depression of every kind be treated? According to Wilson, factual questions regarding the concept should be tackled by focusing on the existing literature. Questions relating to value and encompassing ‘shoulds’ are to be answered by considering the perception of influential figures or the society. The third set of questions is those concerned with meaning and is best dealt with when the questions are analyzed in the context of the concept behind them (Meleis, 2007). Having formulated the questions, the next step in Wilson’s technique of concept analysis is to identify the correct answers to the questions and discuss the important elements in them (Meleis, 2007). Depression has various uses depending on the context it is used. For example it is used in medicine to define a clinical disorder which is classified as a mental problem in the DSM-IV system. The word is also used to define the weather and the economic situation and assumes a different meaning when used in common speech (Risjord, 2008). The contexts in which psychology and metrology use depression are contradictory to each other since it does not make sense if the “tropical depression” is used interchangeably with the psychological depression (Risjord, 2008). This means that the different use of the term depression range from medical and economical to meteorological and lingual. When looking at the psychological context of depression, there is extensive literature documenting its effects on different age groups as well as its epidemiology and physiology. In their attempt to explain depression and its various stages, Greydanus, Patel and Reddy (2010) observe that depression is increasingly used for a condition which requires medical attention. However Greydanus, Patel and Reddy (2010) contend that there are different stages and kinds of depression, of which some do not necessitate medical intervention. The clinical condition which is termed depression is defined as “abnormal or unpredictable changes in mood, thinking and behaviour, as well as high levels of emotional distress and impairments in functioning” as seen in the signs and symptoms of the condition (Greydanus, Patel & Reddy, 2010). On the other hand, in economics, depression is used to define a period of decreased economic activity coupled with rising rates of unemployment (Merriam-Webster, 2011). In common speech, it is used to refer to a lowered part whereas tropical depression is an alternative term for a tropical cyclone, defined as a storm system. The next step in Wilson’s model for concept analysis is to research into exemplars that are ideal cases, contrary cases, borderline cases etc. Perusing literature related to depression, it can be seen that it has certain attributes. When looking at depression from a medical perspective, the salient features that define it serve to make it distinct from other similar disorders. Psychology books have provided a relatively objective way of defining depression since subjective descriptions vary from person to person and are largely responsible for the ambiguity regarding the exact definition of the concept. Health care professionals generally diagnose and label patients depressed when they meet certain signs and symptoms typical of the disease. These include depressed or irritable mood, loss of interest, feelings of guilt, nervousness, feelings of worthlessness, suicidal thoughts, decreased energy, sleep disturbances and decreased ability to think (Greydanus, Patel & Reddy, 2010). Symptoms are not the only criterion used for diagnosing depression. The intensity and extent of the symptoms along with their effect on the routine activities of the patient is also taken into consideration. A model case of depression would therefore present with at least five of the aforementioned symptoms, with one of them being depressed mood or loss of interest. Moreover these symptoms should have had duration of two weeks at least. If a person meets these criteria, he is diagnosed with major depression (Institute of Medicine (U.S.). Committee on Nervous System Disorders in Developing Countries, 2001). A contrary case for the concept is one where the exemplars do not apply to the attributes of the concept. In this case the exemplars do not meet the criterion for establishment of the concept and thereby are complete opposites of the features of the concept (Meleis, 2007). When looking at depression, a contrary case can be mood changes caused by work-related stress. A woman working from 9am in the morning to 11pm in the evening in a hectic job may experience some of the signs and symptoms of depression. The excessive amount of stress can make her feel tired and fatigued, irritable, lose interest in other activities due to tiredness, weight loss or weight gain due to lack of proper attention to diet or lack of exercise respectively, decreased energy and reduced psychomotor capacities due to fatigue. In such a case, it is not right to label this woman as a depressed person. This is because in this case, the properties of the concept are not applicable. The woman is in an irritable mood because of fatigue and a tiring job. The next step in Wilson’s concept analysis is to identify related cases. This means the identification of concepts which have some features similar to the concept of depression. There are several cases that are related to depression. These include bipolar, affective disorders etc. Generally the DSM-IV classifies mood disorders into depressive disorders and bipolar disorders. Bipolar disorders are those which have depressive symptoms but also show symptoms of mania. On the other hand, depressive disorders include major depressive disorder (MDD), dysthymic disorder (DD) and depressive disorder not otherwise specified (DDNOS). In depressive disorders, there are no signs and symptoms are history of manic, mixed or hypomanic episodes. If patient presents with signs and symptoms of mania such as being very optimistic or very irritable, unrealistic notions about one’s abilities, high energy levels despite very little sleep, talking very fast, racing thoughts, impaired judgment, inability to concentrate and hallucinations, he is diagnosed of a bipolar disorder. There is a category of bipolar disorders, referred to as Bipolar II Disorder (Smith, 2011). Such disorders are characteristic of both hypomania and depression. The person may not experience intense manic episodes but the disease shows signs of hypomania and extreme depression. The sixth step in Wilson’s concept analysis is to identify borderline cases. This pertains to those exemplars which have some features common to the concept but there is ambiguity whether the case should be considered an example of the concept or not. For example the mother of a hypothetical person, James, dies. James was very attached to his mother and feels very depressed at her death. It is the third day after her death and James exhibits some of the features of depression. He has decreased appetite since he has only eaten one meal per day for the past three days. He feels alone and worthless and expresses that he could have done more to prolong his mother’s life. He feels tired and his head is heavy, and he did not feel like coming out of bed in the morning. However he dresses up, feeds the dog and goes to his work despite the lowered energy levels. When looking at James’ condition, one can see that it is not necessary to administer medical treatment. Ellverton (2004) asserts that it is normal for people to be sad or upset at the death of a loved one. These are normal and appropriate feelings and do not demand medical attention. He observes that periods of sadness are important and treatment is not required unless the depression has an impact on the social functioning and daily activities of the person or unless the person is not thinking of suicide. The next step is to invent a case that depicts the concept. Wilson observes that one way of doing this is through poetry. In Sri Chinmoy’s words, a state of depression is portrayed as (Poet Seers, n.d.): A wild depression Has stolen away the hope Which he claimed as his only friend Here on earth. Alas who will now flash A rainbow of hope Across his heart Sunk deep? In this case, the poet presents depression as a growing presence in his life. He sees depression as a thing that has taken away all hope. The poet regarded hope to be his friend and depression has taken that hope away. Devising a case from it, the depressed person feels the typical symptoms of depression except that he sees depression to be something more than a medical disease. When a person shows signs and symptoms of depression, he or she may seek medical attention. The family of the person may be concerned and ask questions like is the person truly depressed, what are the consequences of such a condition if left untreated etc. The various social contexts that cause people to seek medical attention vary from culture to culture. Social circumstances are essential in the course of depression. There is a strong link between poverty and depression with low-income people feeling greater degrees of depression. Moreover the inability of people to gain control or change the social circumstances that they are in makes them feel helpless and hence more prone to depression. The degree to which social contexts impact the person are also an important element in the progression of depressive symptoms (Depression Sociology,2007). The next step is to analyze the underlying anxiety associated with the concept. People with depression often fail to voluntarily seek treatment because of the stigma associated with it. For example people who have a debilitating disease and live in a disadvantaged society where the cultural norms are not supportive of the disease are not likely to seek medical treatment for depression. They may also not open up and give an honest history of their condition to the doctor. There are also perceptions rife that people with depression are typically characteristic of extreme levels of depressive episodes and are completely dysfunctional. Therefore healthcare professionals should be aware of the underlying anxiety and the debates that are associated with it. It can be gleaned from the above condition that depression has different meanings depending on the context that it is used. In relation to the medical aspect, depression is classified as a condition where the person has been experiencing either low mood or loss of interest associated with other signs and symptoms of the disease. These conditions should have persisted for at least two weeks. It is necessary to distinguish between clinically-relevant forms of depression from the normal feelings of depression that a person experiences. The patient is also not labelled depressed until his social context, history and genetic factors are not considered. In the final step, Wilson states that the concept should be articulated clearly. Therefore, depression, in the context of psychology, is a disorder whereby the person experiences signs and symptoms of depression as put forth in DSM-IV for at least two weeks. Other factors influencing the progression of depressive symptoms such as genetic tendencies, social contexts and history, are also taken into consideration. Therefore in conclusion, the concept analysis of depression is necessary for differentiating between the clinical forms of the condition and other irrelevant, non-pathological forms. This has implications for health care since it is necessary to diagnose people correctly. Reference List Depression Sociology. (2007). Retrieved from http://www.studentdepression.org/depression_sociology.php Ellverton, P. (2004). Taming the Black Dog. Oxford: How To Books Ltd. Greydanus, D. E., Patel, D. R. & Reddy, V. N. (2010).Handbook of Clinical Pediatrics: An Update for the Ambulatory Pediatrician. World Scientific. Institute of Medicine (U.S.). Committee on Nervous System Disorders in Developing Countries (2001). Neurological, psychiatric, and developmental disorders: meeting the challenge in the developing world. National Academies Press. Meleis, A. I. (2007). Theoretical nursing: development and progress (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Merriam-Webster. (2011). Depression. Retrieved from http://www.merriam-webster.com/dictionary/depression Poet Seers. (n.d.). Poems about Depression. Retrieved from http://www.poetseers.org/poem_of_the_day_archive/poems_depression/ Powers, B. A. & Knapp, T. R. (1995). Dictionary of nursing theory and research (2nd ed.). London: Sage. Risjord, 2008, M. (2008). Rethinking Concept Analysis. Retrieved from http://userwww.service.emory.edu/~mrisjor/documents/Rethinking.pdf Smith, M. (2011). Understanding Bipolar Disorder. Retrieved from http://helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm Thompson, H. J. (2005). Fever: a concept analysis. Journal of Advanced Nursing,51(5), 484-492. Read More