Answer

Application of Concept Analysis to Clinical Practice

The below is this author’s evaluation of a peer reviewed concept analysis article relevant to the Nursing and Healthcare Profession.  This author has completed the below analysis that includes an introduction and overview to the article, an assessment of the method and how it is applicable in clinical nursing practice. The subtitles below divide the aforementioned topics with a broken down explanation of the process and the issues at hand.

Article Overview

The article addresses racism and culturally competent care in the nursing profession. According to Yin, Naomi, Jehonathan, Mandy, Arpana, Alex, Margaret & Gilbert (2013), different health variables can impact patient care outcomes and in the modern climate it is evident that racism is a detriment to patient health as “epidemiological evidence shows strong associations between self-reported racism and poor health outcomes across diverse minority groups in developed countries”.  The goal of the article review is to develop reliable and thorough evidence based research to continue to support the needs of patients in the communities serviced by healthcare systems and organizations; furthermore, stronger assessments and evidenced based research supporting the negative correlation between racism and patient outcomes will improve future nursing research, policies impacting hospital operations and clinical practices, as well as reducing mortality and morbidity in a wide range of racial and\or ethnic minority groups (Yin et. Al, 2013).

 Method of Analysis Applied

The research collected and being reviewed was a retrospective, systematic review of quantitative data supporting the correlation of the impact of racism on the health and safety of various patient populations, including but not limited to adults, young adults, and children from a variety of different background, ethnicities and cultures (Yin et. Al, 2013).  The assessment was qualitatively measured by assessing overall patient perception of health status, clinician assessment of patient health status inclusive of a mental health grading, healthcare utilization and appropriateness of said utilization, as well as overall health behaviors (Yin et. Al, 2013).   The aforementioned studies were then compiled into a meta-analysis summarizing the findings of the research and studies. The article reviewed took the data collected and assessed the associations between reported occurrences of racism in the healthcare setting and patient health outcomes.

Process and Results

The very first step of the analytic process in this research was a descriptive summary of all the data that met the inclusion criteria (McEwen & Wills, 2014). The result of this step was that a number of literature reviews that focused on racism and health, including specific meta-analyses which have focused on specific population groups, nations and other discrimination clusters were included. The earlier data were those that predominantly focused on the associations between racism and negative mental health and health related behaviors (Yin et. Al, 2013). The data also included recent analyses whose primary focus was on racism and racial discrimination experienced by a number of specific population groups like Asian-Americans, African-Americans and young people from various ethnicities. In general then, the descriptive summary of data was focused on literature reviews that found correlations between racism and various health outcomes. Such data were described and used to form the basis of the findings of the study.

The next step in this regard was the statistical analysis of the data described. This was essentially one through the use of the statistical software Comprehensive Meta-Analysis (CMA) Version 2 (Yin et. Al, 2013). This comprehensive process involved the conversion of regression coefficients with standard deviations, odds ratios and dichotomous measures into correlation coefficients in case the correlation coefficients were the ones used. Analyses on the association between racism and health were also conducted for different health outcomes and the heterogeneity of effect sizes were assessed among studies whose focus were similar outcomes. The result of this analysis was that the reviews in which the sample size was larger were given more prominence compared to those with comparatively smaller sample sizes. Furthermore, the analysis offered data to back up the assertions that racial discrimination leads to a number of negative health outcomes, the most common of which is negative mental health outcomes. Other negative mental health outcomes showed significant association to racial discrimination as well. The sensitivity and subgroup analyses conducted in this regard also showed significant associations between racism and negative mental health outcomes with regard to children and young people of the races for whom racial discrimination is a problem.

The final step in the analysis was the bias assessment. The writers felt that it was necessary to conduct a bias assessment of the collected (and uncollected) data so that a more objective conclusion could be reached. These assessments aimed at assessing the symmetry, examining the number of unlocated studies with an average zero effect size required to substantively change the results (Yin et. Al, 2013).  The mean effect sizes of published and unpublished sources were also done. Finally, the researchers used the trim and fill method to estimate for missing studies. The result was that it was realized that apart from the small scale studies and reviews that tended to focus on negative physical and mental health, a comprehensive meta-analysis that focused on racism and health outcomes had not been done (Yin et. Al, 2013).

It is also important to note that in the course of the meta-analysis, the writers made use of a conceptual diagram that essentially guided the meta-analysis based on the current literature review. This diagram that showed the pathways between racism and health had racism in the starting point and the physical and mental health outcomes in the final analysis.

Figure 1

Pathways between racism and health (Yin et. Al. 2013)

Application

In case one wants to find the correlation between the prevalence of a certain opportunistic infection with regard to different population groups, this concept analysis can be applied. They would begin by collecting all the relevant data needed for the study. They would then do a systematic review of all the relevant data and in the process determine the articles that could be used for the research and those that cannot. Using the discriminated data, they would provide a descriptive summary in which the inclusion criteria would be specified. A systematic analysis of the data would then be done to see how belonging to a certain population group predisposes a person to the chances of getting the specified opportunistic infection. To make the data more objective, a bias assessment of the data would be done by the researchers to identify gaps in the reviewed research.

Conclusion

In conclusion, concept analysis in healthcare is demonstrated in the above analyzed article by Yin et. Al. The article delves into a deep systematic review of data collected to demonstrate the relationship between racism and different physical and mental health outcomes. This review systematically selects, describes and analyzes the collected data with a view of reaching an objective conclusion. In addition to the bias assessment conducted on the collected data, these processes of data collection and analysis offer a sound foundation upon which the conclusion that racism negatively influences health can be based. This concept analysis can be applied to a variety of health situations.