Understanding the role of concept analysis in theory development is one of the most ambiguous issues in nursing. On the one hand, concepts are seen as the building blocks of theories so that analyzing them is one of the ways to generate new knowledge and develop new theories. On the other hand, it is claimed that concept analysis is of no use because it does not create knowledge that can evolve into a theory (Bergdahl & Berterö, 2016). Still, concept analyses are critical for nursing practice, as they significantly improve the quality of provided care due to the improved understanding of nursing theories and concepts so that they are the foundation of nurses’ personal growth (Bousso, Poles, & da Cruz, 2013).
Commonly, all nursing theories are based on four major concepts: human, health, nursing, and environment. However, concept analysis should focus on analyzing one concept only. Therefore, the objective of this paper is to pay specific attention to the concept of the environment, as viewed in the energy theory of health and nursing developed by Carl Helvie. The paper will include the following sections: definition and explanation of the nursing concept, literature review, defining attributes, antecedents and consequence, empirical referents, model case, alternative cases, and conclusion.
Definition and Explanation of the Nursing Concept
In general terms, the environment is a combination of all things that surround a person. At the same time, it may be supplemented by the changes in one’s mood and perception of the world that are individual for each human. From this perspective, the environment is the internal and external surroundings of an individual (Masters, 2015). The external environment stands for the physical objects surrounding a person and serving for their habitat, comfort, and other similar needs. As for the internal environment, it is associated with the personal development of an individual and the specificities of their characters (Maville & Huerta, 2013).
It means that there are such types of environments as social, spiritual, physical, cultural, psychological, etc. (Smith, Turkel, & Wolf, 2013). In addition to the abovementioned aspects of the concept, Helvie (1998) believes that the environment should be viewed within a broader context – from the perspective of a community, not an individual. It means that the environment is the combination of subsystems – both internal (health, education, recreation, and economy) and external (state, nation, and the global community) – that affect the development of an individual and their welfare (Helvie, 1998). From this perspective, the environment is a constantly evolving energy system that has a direct influence on people exposed to it and their health.
The concept of environment is a common issue that is focused on when assessing community health. However, as a system, it is usually perceived from different perspectives. One of the stances on the environment is developed by Helvie (1998), focusing on the environment as energy. Except for this position, there is a view that the environment is one of the areas of health. Supplemented with lifestyle, organization of the health care system, and human biology, the environment is among the major factors that determine the health potential of a human and predetermine risks of diseases (Kumar & Preetha, 2012). According to Patrick and Williams (2012), the environment is one of the health contexts. In this case, it includes both interpersonal and health care aspects that affect an individual’s wellbeing.
Another opinion about the environment is that expressed by Serrano-Sanchez, Lera-Navarro, Dorado-Garcia, Gonsalez-Henriquez, and Sanchis-Moysi (2012), who as well see it as a combination of internal and external developments that affect health and wellbeing of a person. In this way, there are two types of environment – cognitive and physical (Serrano-Sanchez et al., 2012).
Still, not all researchers support the existence of a cognitive or emotional environment. For instance, Bircher and Kuruvilla (2014) claim that only the physical environment should be focused on when assessing one’s health. In this case, an emphasis is made on external factors, such as biological, chemical, and physical. The same position is taken by Corsi et al. (2012). That being said, the concept of environment is a broad one. Because it incorporates numerous different elements, it can be viewed from different perspectives based on the objectives of a particular research and author’s worldview.
Attributes stand for the specific features of any concept. Because there are numerous specificities of the concept mentioned above, it has several attributes. The first one is physical. It involves different aspects of the environment, such as biological and chemical features of a particular surrounding (Corsi et al., 2014). Another aspect of the physical environment is the combination of opportunities for assessing and protecting health, education, employment, leisure, etc. These groups of attributes make up the external environment (Kumar & Preetha, 2012).
On the other hand, there is a group of internal attributes of the environment. They include cognitive (behaviors) and emotional (feelings) environment as well as social interactions and culture (Serrano-Sanchez et al., 2012). Still, the attributes mentioned above – physical, cognitive, emotional, social, and cultural – are just some of the features of the concept under consideration. It means that the whole list of attributes is longer due to the very fact that the environment is a complex phenomenon that can be viewed from different perspectives.
Antecedents and Consequence
An antecedent is an occurrence that results in an event or the emergence of the concept. Because the environment is a broad concept, its antecedents can be viewed from different perspectives. For instance, the emergence of the social environment can be perceived as a result of creating a community and determining the rules of its operation.
As for the physical environment, its occurrence is associated with particular activities of the community, such as developing an existing health care system, building health care facilities, managing operational systems, etc. (Kumar & Preetha, 2012). Speaking of the cognitive environment, it is predetermined by interactions with other people as well as the specificities of one’s personal development (Bircher & Kuruvilla, 2014). That being said, antecedents of the environment are different if the concept itself is described from differing perspectives.
Unlike an antecedent, the consequence is an outcome of a particular occurrence. Still, just like the antecedent, consequences may differ when the environment is viewed from different perspectives. For instance, a poor social environment (commonly represented in limited bonds and ineffective relations) may result in self-esteem issues (Patrick & Williams, 2012).
The ineffective operation of physical environment may lead to impaired health outcomes due to the impossibility to conduct timely health assessments and address common health concerns (Kumar & Preetha, 2012). Finally, negative changes in ecological environment (for instance, the increased level of air or water pollution) or having some unhealthy habits (for example, smoking, uncontrolled alcohol or food intake, and any other kinds of addictions) – cognitive environment – are commonly associated with the emergence of health-related problems (Corsi et al., 2014). However, in this case, it is essential to mention that the overall consequence is the change in one’s health, but it may vary based on positive or negative alterations in one’s environment.
Empirical referents stand for ways used for measuring environments. In this case, it is essential to point to the fact that these ways should be objective. Based on the existence of both internal and external environment, empirical referents may as well differ. That is why this concept analysis will focus on referents of two types of environment – internal and external (Serrano-Sanchez et al., 2012). Speaking of the internal environment, it is commonly associated with personal development. That being said, education (for instance, certificates and grades) can be viewed as empirical referents.
They are pointed to because they are not connected to one’s perception of self. Therefore, it is assumed that they are objective due to the external assessment of a person and their effort. Speaking of the external environment, it is easier to measure it objectively. In this case, it is possible to calculate the number of health care or educational facilities, statistics of health outcomes, the level of air, soil or water pollution, etc. (Kumar & Preetha, 2012). It means that, compared to internal environment, the measurements of external surrounding are easier to estimate due to their relative visibility and the existence of numerous techniques for assessing them.
L.C. is a 27-year old woman. She is an active participator of all community-based initiatives. Even though she has a husband and a small child, L.C. pays special attention to personal development, as she studies foreign languages, takes online courses, and has hobbies. She is the supporter of healthy lifestyle. That is why she avoids junk food and jogs every morning. L.C. is a positive and friendly person with many friends and a talent of making new acquaintances. Moreover, her family lives in a rural area close to the river so they spend a lot of time outdoors.
It is evident that L.C. is an open person. Being active and positive, she exchanges her energy with the community. In this way, her social environment is positive. Furthrmore, she is constantly developing. It proves that emotional environment is as well positive. More than that, due to healthy lifestyle and living in the rural area, cognitive and physical environments are also favorable. From the perspective of Helvie’s theory (1998), this case is model because it involves not only all of the attributes but also active energy exchange and dynamic personal development that make up the foundation of the theory.
C.D. is a 10-year old girl living with her family on the lakeshore. She is friendly and makes new acquaintances easily. Her mother pays special attention to daughter’s nutrition and exercising. C.D.’s family is friendly and active, as they spend a lot of time together in the open air. However, C.D. does not attend school because she has cancer. That is why her mother decided to focus on home education while C.D. undergoes treatment. That is why the girl does not have friends and sometimes feels sad and depressed.
In this case, the most notable attributes of the girl’s environment are social (limited interactions), emotional (negative feelings), and biological (her disease). As for the physical attributes of the environment, they are positive due to having access to clean water and fresh air. However, from the perspective of Helvie’s theory (1998), it is complicated to perceive the girl’s environment as positive because she is always isolated so that she cannot feel the bound energy of the local population. In this way, it is connected to significant mental health issues. Still, she does have access to positive energy because she is supported by her parents and treated by community nurses. It means that she partially exchanges her energy with them (Helvie, 1998). This case is borderline because only some of the attributes of environment are visible and measurable.
A.B. is a 45-year old man living in one of the urban areas. For twenty-five years, he has been working at a plant specializing in manufacturing plant fertilizers. After the death of his wife, he avoids communicating with people and going out. All of his relatives are dead as well. He does not have any hobbies. Unlike other people from his neighborhood, he does not celebrate any holidays, such as Christmas or Thanksgiving Day.
Every evening, A.B. spends in front of a TV set with either beer or whiskey. As for his diet, it consists of semi-processed meals or take-outs from local cafés. That is why A.B. is commonly silent and depressed. In addition to the evident emotional issues, he notices some health concerns, including pain in the abdomen and common headaches. They may be associated with the exposure to chemicals in the workplace as well as failing to adhere to healthy nutrition patterns.
The case of A.B. involves all of the attributes of environment mentioned and described earlier in the paper: physical (working at a plant), cognitive (unhealthy habits), emotional (depression), social (avoiding interactions), and cultural (ignoring traditions). Negative changes in his environment are associated with impaired health outcomes (Kumar & Preetha, 2012). Due to them, there are both physical and mental health issues. It is evident that physical health issues are connected to his professional activities and dieting.
As for mental health issues, they derive from the changes in his social environment – the death of his wife and relatives – that made him isolated and depressed. Nevertheless, from the perspective of Helvie’s theory of energy (1998), it is a contrary case. It is connected to the fact that A.B. cannot cope with the negative energy (his internal characteristics) because he ignores the positive energy coming from the community due to being isolated. In this way, there is no exchange of energies that is the foundation of the energy theory (Helvie, 1998). It means that improving health outcomes is complicated due to ignoring the criticality of energy exchange.
Summing up, environment is one of the most complex concepts of nursing theories because it involves numerous aspects and can be perceived from different perspectives. Regardless of the generally acceptable classification of environment – internal and external – Helvie (1998) perceives it as energy that is as well external (coming from the community) and internal (deriving from personal development). From this perspective, energy-based environment is one of the main factors affecting individual’s health.
For me, this theory was appealing because of the extraordinary perception of environment and the ability to improve nursing practice by applying the investigated concept. In this way, it may be helpful for enhancing patients’ health outcomes due to the opportunity of seeing each patient as an individual with particular environment and, therefore, treat them individually. Moreover, as a person involved in nursing practice, I realized the role of exchanging positive energy with my patients, thus contributing to the overall improvement of their health.
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