Concept Analysis and Its Role in Nursing Theory

Concept Analysis and its Role in Nursing Theory

Valerie Smith

Chamberlain College of Nursing

NR502: Theoretical Basis for Advanced Nursing Practice

January 2018

Concept Analysis and its Role in Nursing Theory

        The role of concept analysis in theory development is similar to that of brick making. Before a structure or theory can be built, the bricks must first be formed, honed, and polished. For the purpose of concept analysis this means to reduce the concept to its simplest terms so that it can be more specifically defined and uniformly understood (Foley & Davis, 2017). This paper will define and analyze the concept of usability and consider its role in Roy’s Adaptation Model (Shultz & Hand, 2015). A literature review of six journals will be discussed followed by the attributes, antecedent, consequence and empirical referents analyzed. Three construct cases were developed, and theoretical application will expand on the learned data followed by a conclusion and reflection.

Definition of Usability

        The International Organization for Standardization (ISO) (as cited in Nassar, 2012) defines usability as “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.” In the case of medical information technology, the user can be patients or healthcare providers. The context of use will be a personal healthcare application or an electronic health record (EHR). The goal is disease management/treatment or meaningful use. Usability is accomplished when the user is easily able to understand and use a tool, and to achieve the goals of said tool in a cost effective, productive manner (Nassar, 2012).

Literature Review

        Usability is a relatively new concept and as such is minimally studied and applied. Now that electronic health records (EHR) have been in use for several years their lack of usability is becoming more evident. Un-usability results in work-arounds and loop holes that lead to medication errors, missed information, and even patient death. These sentinel events, coupled with physician complaints, are driving the movement to examine and define usability. One role of the informatics clinician is to document usability-related sentinel events, interview physicians and staff, and review staff complaints and requests related to EHR use. Armed with this data, the informaticist can petition the organization to begin redesigning more usable EHRs. (Staggers, 2012).

        Updated meaningful use requirements now include usability standards to assure effectiveness and efficiency. Marcilly, Vasseur, Ammenwerth, & Beuscart-Zephir (2014) reviewed usability studies in an effort to understand what methods are used to evaluate usability and what usability problems were found. Some methods test usability during development of an application, while other methods study the after-market usability of the product. They propose a “usability checklist’ (Marcilly, Vasseur, Ammenwerth, & Beuscart-Zephir, 2014, p. 888) adapted from previous after-market research to aid in the development of new usable products.

        With the increase in mobile technology, operating systems (OS) are creating mobile health applications called mHealth. An important element in the development of mHealth is usability.  As noted by Zapata, Fernandez-Aleman, Idri, & Toval (2015), the IOS lists four principal qualities of usability: understandability, learnability, operability, and attractiveness. While attractiveness is the least studied, it is influential in one’s decision to first try a new application and has a bearing on their continued use. Operability was listed as the most studied feature but cannot be overshadowed by understandability and learnability. It matters not how operable a system is if the user cannot understand or learn it.

        Usability evidence-based practice research is still in its early stages. In the available data, usability deficits go largely unreported.  During development, variable limitations restrict the usability research results. Long-term clinical use studies should be conducted to allow for variables such as user, data, and work-flow. Marcilly, Peute, Beuscart-Zephir, & Jaspers (2015) propose a usability database to collect and disseminate usability limitations and deficiencies for developers to reference during application development.

        Clark et al. (cited by Zahabi, Kaber, & Swangnetr, 2015) recognized four common deficits of EHRs. They are poor visual display, sensory overload, difficult navigation, and workflow inconsistencies. Zahabi, Kaber, & Swangnetr (2015) cite still more issues including lack of customizability, inconsistent design, inadequate language, and lack of appropriate error messages. To meet usability standards, the EHR interface should closely match nurse workflow. Computer order entry needs to be compatible with physicians’ processes. Common commands such as exit and save buttons should consistently be placed in the same location on each screen. Ideally, the EHR would have patient safety parameters and alert healthcare workers to data outside those parameters, whether it is real data documented about the patient, or order entry by the physician. The EHR should be easily navigable, allowing users to move from screen to screen without losing data. Lastly, EHRs must be customizable in order for facilities to modify them to suit individual workflow needs.

        Creating applications and EHRs that correctly document and disseminate data is not enough. These systems and applications must be usable so that users can employ them easily while ensuring patient safety and information accuracy. Researchers are now looking more closely at usability and updating the criteria used to develop new applications and systems. To design for usability one must consider the user, the task being performed, and employ a design-evaluation continuum where usability is fine-tuned (Pribeanu, 2017).

Defining Attributes of Usability

        Usability is defined by three specific attributes: effectiveness, efficiency, and satisfaction. Effectiveness means that the tool has accomplished the task for which it was created. Efficiency is the amount of time and effort put into accomplishing the task. Satisfaction occurs when the user completes the task effectively with minimal effort. Usability is reached when a user learns a new tool quickly and easily, and satisfactorily completes the task the tool was designed for with little effort and few, if any mistakes (Nassar, 2012).