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J Adv Nurs. 2019 Jul 30. doi: 10.1111/jan.14165. [Epub ahead of print]

Understanding context: A concept analysis.

Author information

1
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
2
Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
3
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
4
University of Toronto, Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.
5
University of Ottawa, School of Nursing, Faculty of Health Sciences, Ottawa, Ontario, Canada.
6
Department of Clinical Epidemiology & Biostatistics, McMaster University Hamilton, Ontario, Canada.
7
McMaster Health Forum, Hamilton, Ontario, Canada.
8
School of Health Sciences, City, University of London, London, United Kingdom.
9
IWK Health Centre, Halifax, Nova Scotia, Canada.
10
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
11
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
12
Medicine, University of Ottawa, Ottawa, Ontario, Canada.
13
Women's College Research Institute, Toronto, Ontario, Canada.
14
Family Physician, Women's College Hospital, Toronto, Ontario, Canada.
15
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
16
Psychology Department, University College London, London, United Kingdom.
17
Executive Director, Information Management, Data, and Analytics, Ontario Ministry of Health and Long-term Care, Toronto, Ontario, Canada.
18
British Columbia Academic Health Science Network.
19
School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia.

Abstract

AIMS:

To conduct a concept analysis of clinical practice contexts (work environments) in healthcare.

BACKGROUND:

Context is increasingly recognized as important to the development, delivery and understanding of implementation strategies; however, conceptual clarity about what comprises context is lacking.

DESIGN:

Modified Walker and Avant concept analysis comprised of 5 steps: 1) concept selection; 2) determination of aims; 3) identification of uses of context; 4) determination of its defining attributes; and 5) definition of its empirical referents.

METHODS:

A wide range of databases were systematically searched from inception to August 2014. Empirical articles were included if a definition and/or attributes of context were reported. Theoretical articles were included if they reported a model, theory, or framework of context or where context was a component. Double independent screening and data extraction was conducted. Analysis was iterative, involving organizing and reorganizing until a framework of domains, attributes and features of context emerged.

RESULT:

We identified 15,972 references, of which 70 satisfied our inclusion criteria. In total, 201 unique features of context were identified, of these 89 were shared (reported in 2 or more studies). The 89 shared features were grouped into 21 attributes of context which were further categorized into 6 domains of context.

CONCLUSION:

This study resulted in a framework of domains, attributes and features of context. These attributes and features, if assessed and used to tailor implementation activities, hold promise for improved research implementation in clinical practice. This article is protected by copyright. All rights reserved.

KEYWORDS:

concept analysis; context; healthcare; implementation; knowledge translation; work organization

PMID:
31359451
DOI:
10.1111/jan.14165

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