Concept Analysis




Aconcept is perceivable as a complex mental picture of a particularphenomenon or an idea (Powers and Knapp, 2010: 25). Thus, conceptanalysis can be defined as a &quotconcept development strategy&quotthat is manifested in a myriad of approaches that differ procedurallyor purposefully (coming up with an operational definition). Forexample, illustrative cases may be emphasised in different ways toexplain the existence of a particular phenomenon: procedural. Simplyput, concept analysis can be defined as an approach where particularconcepts, their characteristics, and how these concepts relate toother concepts is clarified (Nuopponen, 2010: 4). In nursing,therefore, concept analysis facilitates abstract thinking. Throughconcept maps, nursing students gain the capacity to visualise theirknowledge on particular topics (Anita and LeRae, 2007). This paperdiscusses Transformational leadership and how concept analysis isapplicable in this field.

Graduateschool gives nursing students the opportunity to take courses thatfocus on the development of the nursing theory. In essence, theorycourses help students learn and analyse a number of theories asopposed to a particular theory/theorist. Students are exposed tovarious theories that relate to nursing and disciplines that have anorientation that is almost similar to that of nursing. In the end,each student is allowed to select a single concept, which he studiesin-depth and analyses its attributes, antecedents, consequences, andempirical referents (Anita and LeRae, 2007). This paper uses Walkerand Avant`s (1995) process of concept analysis to discuss the conceptof transformational leadership in nursing.


Walkerand Avant (1995) defined the steps involved in concept analysis:

Theselection of a concept

Thedetermination of the purpose or aims of analysis

Theidentification of all possible uses of the concept

Thedetermination of defining attributes

Constructinga model case

Constructingadditional cases

Identifyingconsequences and antecedents

Definingempirical referents


Leadershipencompasses a myriad of reflections, thoughts and images. Conceptssuch as influence, power, followership, charisma, dynamicpersonality, innovation, etc., can be associated with leadership.Many definitions of leadership have been advanced over the years.However, a common theme usually emerges through the many definitions:influencing the beliefs, attitudes, and feelings of other people(Curtis, Vries, and Sheerin, 2011).

Asizeable amount of theory and research has been generated as a resultof interest in leadership. Usually, different classifications areused to describe the theories (Curtis, Vries, and Sheerin, 2011), aspointed out below:

Thetrait approach. This approach is concerned with individual aspectsthat contribute to effective leadership.

Thebehavioural approach. This approach is somewhat like the traitapproach. It concentrates on the behaviour of the leader, that is,the behaviours that society and organisations deem desirable in aleader.

Thecontingency approach. This leadership approach asserts that goodleadership is dependent on the interaction between an individual, hisbehaviour, and the circumstances or situation.

Theleader-member exchange approach. Also understood as thetransformational approach, this leadership strategy concentrates onthe subordinate-supervisor relationship.

Nursingcan be viewed as both a practice and a political act. Leadership innursing entails action, critical thinking, and advocacy – ithappens in all roles and domains of the nursing practice. Nursingleadership is pivotal in the lives of nurses, and, by extension, theentire health system. As a result, the health sector requires anabundant supply of energetic and visionary nursing leaders. Theseindividuals should be courageous, credible, inspiring, and visible totheir colleagues and members of society. Also, access to resourcesand the authority to support innovative, modern, and professionalpractices in nursing should be availed to nursing leaders (CANADIANNURSES ASSOCIATION, 2009).

Theabove considered, it is prudent to note that leadership differs frommanagement. In essence, management is perceivable as doing thingsright however, leadership is viewed as doing what is right.Perceived differently, management is ensuring efficiency is put intoconsideration when it comes to going up the ladder of success whileleadership is concerned with taking the time to ensure the ladderleans against the wall as it should. Thus, management primarilyconcerns itself with tasks, and leadership concentrates on judgement,perception, philosophy and skill. Inferring from thebefore-mentioned, being an effective leader is more challenging thanbeing an effective manager (Middleton, 2011).

Nurseleaders, therefore, should be able to adjust their thinking to thedynamic healthcare environment, and accommodate changes to the localand national policies, in addition to organisational expectations.Recent years have realised a change in the role of nursing: they havebecome more specialised, accountable, autonomous, and focused onpositive outcomes, which comes with both positive and negativeoutcomes for the profession. The before-mentioned has beenexacerbated by higher standards and greater expectations byconsumers, especially regarding nursing care (Middleton, 2011). Thus,senior nurses are now expected to find ways of involving themselvesin decision-making in issues concerning clinical care: workforceplanning, developing policies, corporate and clinical governance, anddepartmental business planning.


Figure1.1: ConceptMap revealing the role of Transformational Leadership in Nursing

Structural Empowerment

Transformational Leadership

Exceptional professional practice

Empirical Outcomes

Modern innovation, knowledge, and improvements

Transformationalleadership can be viewed from the viewpoint of the leaderconcentrating on the values of the follower(s) and helping him (thefollower) align his values to those of the organisation (Givens,2008: 4). Transformational leadership is founded on four components:inspirational motivation, idealised influence, individualisedconsideration, and intellectual stimulation. Thus, thetransformational leader and his follower(s) motivate each other toachieve higher goals, which, by extension, results in value systemcongruence between the follower and his leader.

Transformationalleaders in nursing concern themselves with ensuring issues such asjob satisfaction, nurse empowerment, organisational commitment andproductivity, increasing retention, bolstering organisationalcollaboration, and improving work outcomes have been considered. Inessence, frontline leaders of all nursing institutions are expectedto act as transformational leaders (Wicker and Kelly, 2007).

Therefore,according to Walker and Avant`s approach to concept analysis, a modelcase in transformational leadership can be discussed as follows:

Theselection of a concept

Accordingto Walker &amp Avant (1995), selecting a concept is always the firststep in the process of concept analysis. In this paper, the conceptof transformational leadership in nursing is chosen. The nursingprofession has been the centre of a lot of criticism in the pastyears (Chu and Galang, 2013). As described earlier transformingleadership in nursing is a vital approach for the healthcare system.Thus, developing or using an approach that has been proven to workwill definitely lead to an outcome or outcomes that are desirable.Since efforts to address the case of leadership in the healthcaresystem are thwarted by the lack of understanding of the leadershipconcept, selecting the concept will essentially help one tounderstand the way a concept related to the health system can beanalysed.

Thedetermination of the purpose or aims of analysis

Thesecond step in the process of analysing leadership in nursing asdefined by Walker &amp Avant (1995) is defining the purpose or theobjective of the analysis. In this context, the primary purpose ofthis concept analysis is to show clearly the impact of transformingthe leadership function in the healthcare system. This analysisdefines the problems associated with nursing and suggests somesolutions to them. In this case, transformational leadership changeshow things are usually done in healthcare institutions: nurses aregiven the opportunity to contribute to the way things are done inhospitals. This approach helps solve issues such as the feeling ofbeing unappreciated in the workplace. The analysis is also set toshow the impact of leadership transformation on the future of thehealthcare system.

Theidentification of all possible uses of the concept

Walker&amp Avant (1995) state that the third step in the analysis of theconcept of transformational of leadership in nursing is theidentification of the different uses of the concept in the area ofinterest. In analysing the transformational leadership concept, oneshould identify many uses of the concept as a source of informationthat will be helpful to the healthcare system. For example,transformational leadership as the concept in this paper can be usedto strengthen the healthcare system through inspiring a morecollaborative approach to solving problems facing the healthcareindustry. On the other hand, transformational leadership can also beused as a platform to mentor young nurses to become even betterleaders in the future. Since transformational and leadership can beviewed as independent variables in the nursing context, this analysisbrings to bear the notion that the two can be used to make healthcaremore effective and efficient.

Thedetermination of defining attributes

Thefourth step in the concept of transformational leadership in nursinganalysis is defining the attributes. Walker &amp Avant (1995)defined attributes as the characteristics of a concept that one willnote again and again on the subject of the concept being analysed.Attributes will help one in making the subject broader. Leadershiphas two main attributes the behavioural aspect of the leader and aswell as the character traits of the leader. Defining thebefore-mentioned attributes in greater detail helps maketransformational leadership more applicable to nursing. Through theconcept, the healthcare industry can be made more efficient byapplying concepts that have been proven to work in the business andother industries.

Constructinga model case

Inthis step, analysing the leadership concept in nursing will requireone to construct a model case. The model case is a pure illustrationof the purpose of the concept and the use of the concept. Moreover,the model constructed will include critical attributes. To a betterunderstanding, the concept model case will cover all the aspect ofthe concept from step one to the final step.

Example:Upon being attached to the New York Presbyterian Hospital as aclinical coordinator, Miss Meyer realised that most clinicalpersonnel were always exhausted and lacked the passion for working.Since she was not certain that this was the case every day, shedecided to observe the nurses as they did their work for a few daysbefore making her final decision. After a few weeks, she was certainthat her observation was correct. Therefore, she called a nursemeeting and requested all the nurses to air their grievances or whatthey desired to be changed. A majority of the nurses stated that theyfelt unappreciated and that despite their being on the ground, theywere never involved in the decision-making process and leadership ofthe healthcare institution. After noting all their grievances, Meyerpromised the nurses that she would forward their suggestions to thetop management. During the next board meeting, Meyer went before theboard and addressed the grievances of the nurses and suggestedpossible solutions to their predicament. Strange enough, the Boardagreed to all her suggestions and ordered for their implementation. Afew weeks later, the majority of nurses had improved attitude towardtheir work and treated their patients extremely well.

Constructingadditional cases

Inanalysing the transformational leadership concept, additional caseswill be necessary. As such, the additional case for this concept willinvolve constructing borderline and differing cases. According toWalker &amp Avant (1995), borderline cases contain elements thatdefine the attributes of a case, but with certain limitations:identifying consequences and antecedents and defining empiricalreferents.

Identifyingborderline, related, contrary invented and illegitimate case

Illegitimate,invented, contrary, related and borderline cases have often beenassociated with the clarification of what the concept is like andsimilar to. Quite often the concept of borderline cases has beenidentified to contain some of the essential or critical attributes inleadership, whereas the related cases are not associated with thecritical attributes. A borderline case is noted to be one of theexamples of the use of concept where some but not all criticalattributes are brought fourth. With regards to this, contrary casesare at times perceived not to be actual concepts, with the inventedcases being a contracted case that does not exist in real life. Anillustration of aspect and concept of safety can be perceived to be aclear example of a contrary case based on the concept of risk. Allin all, illegitimate cases come into play when there is an improperuse of concepts by the practitioners in the field of nursing. It isalso known that an illegitimate case is one of the examples ofinappropriate use of the concept (Shatell, 2004).

Identifyingantecedents and consequences

Onthe other hand, antecedents and consequences are noted to be eventsthat are facilitated or influenced by an occurrence or event. In thiscase, it is noted that antecedents tend to be events that take placebefore the occurrence of the concept, whereas the consequences arethe events that take place as a result of the occurrence of theconcept. A consequence based on the concept of risk can be noted tobe a behaviour or thought. It is often noted that the managementshould be able to take note of the antecedents that precedes aconcept in order to ensure that positive consequences are broughtfourth. This is essential because the two elements tend to shape thewhole aspect of concept analysis. With regards to the concept ofrisk, an antecedent is known to be the cognitive ability todistinguish between choices (two or more). Essentially the ability ofabstract thought or specifically cognitive reasoning is noted to bean antecedent to the whole concept of risk. For the risk-basedconcept to apply to this particular context, one must have theknowledge or perceived knowledge of the overall potential risk. Nurses can use These two concepts (Antecedents and consequences) inmaking the right or relevant decisions that will result in less harmto their patients (Shattel, 2004).

Definingempirical referents

Withthe definition of the empirical referents come the categories orclasses of the actual phenomena, that through their presence orexistence, the occurrence of the concept is demonstrated. Thisparticular concept in nursing has often been identified to beimportant in instrument development. This is essential because theconcept guides the managerial concept analysis in making the corrector expected decisions. With the definition of empirical referents, itis expected that the concept will actually contribute to constructand content validity of any new instrument applied. In measuring theconcept of risk based on the empirical referents, it will includeanalysing behaviour that can be perceived to be a consequence.Empirical referents basically, must include a decision-making processand cognitive recognition in the identification of the key riskfactor (Shattel, 2004).


Thenursing industry has had its fair share of challenges. Over the pastfew years, various efforts have been advanced to change thesituation. The implementation of transformational leadership is oneof the efforts. Walker and Avant`s (1995) approach has been advancedto help assess the impact of transformational leadership on healthcare, as discussed above.


Anita,C., &amp LaRae, I. (2007). Serial Concept Maps: Tools for ConceptAnalysis. Retrieved from

Chu,&nbspC.,&amp Galang,&nbspA. (2013). Hospital Nurses` Attitudes towardPatients with a History of Illicit Drug Use | Canadian Nurse.Retrieved from


Curtis,E., Vries, J., &amp Sheerin, F. (2011). Developing leadership innursing: exploring core factors. Retrieved from

Cutliffe,J., &amp McKenna, H.(2005). ed.). New York, NY: Elsevier CHURCHILL LIVINGSTONE.

Middleton,J. (2011). Leadership Skills for Nurses. Nursing Times. Retrievedfrom

Nuoponnen.(2010). Methods of concept analysis – a comparative study.Professional Communication Knowledge Management Cognition, 1(1).Retrieved from

Powers,B. A., &amp Knapp, T. R. (2011). Dictionary of nursing theory andresearch. New York: Springer Pub. Co

Shattel,&nbspM.(2004). Risk: A .&nbspBlackwellPublishing.Retrieved from

Wicker,&nbspT.,&amp Kelly,&nbspL. (2007). Ready to Lead? DescribingTransformational Leadership in Frontline Nurse Leaders.&nbspBANNERHEALTH.