An analysis of the concept of risk

The challenges and necessity of situating 'illness narratives' in recovery and mental health treatment

In mental health services, recovery constitutes a guiding principle that is endorsed in professional medical guidelines and has become central to mental health policies across the world. However, for many clinicians, it can be a challenge to effectively embed recovery concepts into professionally directed treatment of disease without distortion, and ostensibly away from what matters to those who use the services. We discuss the evolving and multifaceted concept of 'recovery', including illness narratives to frame our discussion. We demonstrate how integration between a person-directed management of illness and a professionally directed treatment of disease can converge, resulting in positive outcomes for people with mental illness.

A Constructivist Grounded Theory of Staff Experiences Relating to Early Mobilisation of Mechanically Ventilated Patients in Intensive Care

Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.

Communicating Air Quality Index Information: Effects of Different Styles on Individuals' Risk Perception and Precaution Intention

Air Quality Index (AQI) is information about atmospheric pollutants, which is essential for governments to inform the public about the current air quality and potential health risks. By analyzing the AQIs from 11 countries (regions), we discovered considerable variations in the design of AQI information, which may open up room for unintended interpretation from the public. Therefore, as an attempt to address the inefficiency of some common styles of AQI information in promoting the public's precaution against bad air and better design such information, an online experiment with a 2 (descriptor: neutral vs. negatively valenced) × 2 (target groups in AQI warning messages: vague vs. specific) factorial design was conducted to test the effects of such information on individuals' risk perception and precaution intention. The results indicated that AQI information with a neutral descriptor was associated with lower self-risk perception and precaution intention levels than with a negatively valenced one. Among the individuals not included in the at-risk groups, those who read the warning messages with vague target groups had a higher third-person perception toward smog risk than those targeting specific population groups. Practical and theoretical implications are discussed.

A Critical Caring Theory of Protection for Migrants and Seasonal Farmworkers

Pesticide exposures represent inequities among a vulnerable population of migrant and seasonal farmworkers. A social justice theory synthesized from an environmental health research framework, a middle range theory of critical caring, and literature on pesticide exposure is presented as a situation-specific public health practice theory. Concepts from the physiological, epistemological, vulnerability, and health protection domains are related to concepts of critical caring revealing protective strategies for vulnerable populations exposed to pesticides. The key concepts are risk exposure, community assessment, transpersonal health promotion, community competence, and controllability. Protection from exposure involves raising awareness, critically assessing communities, educating for empowerment, building capacity, and advocating to ensure social justice. Critical caring protection is provided in a mutually respectful relationship that promotes responsibility at the individual and population levels.

Risk perception in pregnancy: a concept analysis

AIM

To report an analysis of the concept of risk perception in pregnancy.

BACKGROUND

Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women.

DESIGN

Walker and Avant's method was selected to guide this analysis.

DATA SOURCES

Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied.

METHODS

Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified.

RESULTS

The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept.

CONCLUSION

Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.

Psychosocial risks: is risk management strategic enough in business and policy making?

BACKGROUND

In times of continuous change and volatile markets, organizations are increasingly characterized by downsizing, work intensification, and resource rationalization. This has resulted in diversification, and the emergence of new risks within the field of occupational health and safety, with an important impact. This paper focuses on one such type of risk in the modern workplace-psychosocial risks. The current study aimed to explore stakeholder perspectives, regarding the extent to which psychosocial risks are incorporated into strategic risk management practices, at both the business and policy level.

METHODS

Semi-structured interviews were conducted with 14 professionals, representing employer, expert, policy maker, and trade union stakeholder perspectives.

RESULTS

It was found that the majority of organizations do not sufficiently, if at all, understand and incorporate psychosocial risks into strategic decision making, whereby the key barrier related to practical difficulties of not knowing how to manage psychosocial risks adequately.

CONCLUSION

The study found that there is a need to close the gap between policy and practice on a number of levels. Future recommendations comprise a policy framework and infrastructure underpinned by educational initiatives, partnerships, and networks to drive a shift in attitudes toward recognizing the duality of the concept of risk (including both potential negative and positive outcomes) and moving beyond simple regulatory compliance.

Risk in Maternity Care: A Concept Analysis

AIM: To analyze the concept of risk in maternity care.

DATA SOURCES: MEDLINE (1966–2010), CINAHL (1980–2010), EMBASE (1980–2010), PsycINFO (1980–2010), and Social Science Citation Index were searched. Key text books were sourced. Media literature was reviewed by perusal of newspaper articles, health supplements, and popular Internet health care websites.

REVIEW METHODS: The principle-based method of concept analysis was used to guide the analysis of risk in maternity care.

RESULTS: The epistemological principle identified the ambiguous nature of the risk concept, with risk having diverse meanings for different individuals. The pragmatic principle demonstrated that the current systematic approach to risk assessment often fails to identify those who succumb to risk issues. The linguistic principle portrays the ambiguity of risk perception with “risk” considered according to past experiences, knowledge, and individual attitudes. The logical principle identified a strong link between safety and uncertainty revealing that the risk concept lacks integrity and may not “hold its own.”

CONCLUSION: The concept of risk in maternity care is concerned with risk assessment, risk perception, and notions of safety and uncertainty. Risk in maternity care is diverse and dynamic. What constitutes as a risk today may not necessarily be viewed in the same light tomorrow.

Concept analysis of risk in relation to coronary heart disease among Filipino-Americans

PURPOSE

To analyze the concept of risk in relation to coronary heart disease (CHD) among Filipino-Americans (FAs) and provide a new definition of risk.

SOURCE

Published literature.

CONCLUSION

This concept analysis provided a new meaning of risk in relation to CHD among FAs and shed light on further understanding of risk. Risk has been laced with negativity in health care, but based on the current literature, risk can be conceptualized in a positive perspective, especially in the area of chronic health disease such as CHD. However, further research is needed in the conceptualization of risk related to CHD for consistency, adequacy, and meaning.

An integrative model of adolescent health risk behavior

Nursing research in adolescent health risk behavior is lacking because there are few comprehensive nursing models to guide it. Nurses need to understand what influences adolescents to engage in health risk behavior or to refrain from it. The Integrative Model of Adolescent Health Risk Behavior was developed to guide adolescent nursing research using existing theoretical and empirical data. Components include protective/escalatory factors, risk stimulus, maturity of judgment (as a meditational influence), and the risk decision (dichotomized into risk avoidance and taking). The model will facilitate development of nursing interventions to increase health protection by discouraging adolescents from making unhealthy choices.

Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study

BACKGROUND

Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival.

METHODS

We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294) attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI)), and survival (to December 2005).

RESULTS

2827 patients (45%) were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001). Risk-prone patients were more likely to have CABG surgery in unadjusted (Odds Ratio [OR] = 1.21; 95% CI 1.08-1.36) and adjusted (OR = 1.18; 95% CI 1.02-1.36) models, but were no more likely to have PCI or any revascularization. Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66-0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77-1.10).

CONCLUSION

These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

Risk prediction: a review of the literature

This review of risk assessment and prediction literature briefly describes the historical and philosophical influences on the construct of dangerousness; chronicles the advances in research associated with the reconceptualization of dangerousness as risk; and describes current practice and research related to risk assessment, with particular attention to commonly used risk assessment tools and to existing issues and controversies. This cannot be considered a systematic review of the literature but a reflection of some of the key issues found in the literature.

"Why take it if you don't have anything?" breast cancer risk perceptions and prevention choices at a public hospital

BACKGROUND

Despite advances in breast cancer risk assessment and risk reduction technologies, little is still known about how high-risk women make sense of their risk and assess prevention options, particularly among minority and low-income women. Qualitative methods explore the complex meanings and logics of risk and prevention that quantitative approaches overlook.

OBJECTIVE

This study examined how women attending a high risk breast cancer clinic at a public hospital conceptualize their breast cancer risk and think about the prevention options available to them.

METHODS

Semi-structured interviews were used to gather data from 33 high-risk women (75% African American) between May and August 2004. Interview transcripts were analyzed for recurrent themes and patterns.

RESULTS

Despite general awareness of their objective risk status, many women in this study reported they did not feel "high risk" because they lacked signs and symptoms of cancer. Risk was described as an experienced acute problem rather than a statistical possibility. Women also frequently stated that thinking about cancer might cause it to happen and so it is better not to "dwell on it." While screening was welcomed, women were generally skeptical about primary prevention. In particular, preventive therapies were perceived to cause problems and were only acceptable as treatment options for a disease.

CONCLUSIONS

The body of ideas about risk and prevention expressed by this population differ from the medical model. These findings have implications for risk perception research as well as for the efficacy of risk communication and prevention counseling in clinical contexts.

Health/Illness transition and telehealth: a concept analysis using the evolutionary method

TOPIC

Telehealth as an alternative to hospitalization.

PURPOSE

Exploring the health/illness transition that occurs when an acutely ill client may be discharged into the home with telehealth in place of hospitalization or in an effort to promote an earlier discharge from the hospital.

SOURCE

Published literature.

CONCLUSION

The concept of the health/illness transition using telehealth has not been researched. Qualitative methods of research using interviews could enhance the knowledge in selecting appropriate individuals and nursing interventions to enhance the clients' transition from the hospital to the home with telehealth.

Modifying Cancer Risk Factors: The Gene-Environment Interaction

OBJECTIVES

To examine the concept of risk modification in the context of cancer prevention.

DATA SOURCES

Published articles and research studies on genetic and environmental factors.

CONCLUSION

How the environment is defined frames how the gene-environment interaction is studied and understood. The development of a workable model for risk modification flexible enough to be individualized for a patient is an important step in making primary prevention the goal in cancer care.

IMPLICATIONS FOR NURSING PRACTICE

Nurses working in cancer care are well placed to advise patients on risk-management strategies, and to increase public awareness of the interdependence of environment and genomics on cancer risk.

The Effect of Experiential Knowledge on Construction of Risk Perception in Hereditary Breast/Ovarian Cancer

The purpose of this study was to explore the connection between experiential knowledge of hereditary breast/ovarian cancer and understandings of personal cancer risk. Using a qualitative research design, the investigator conducted in-depth interviews with 53 individuals (45 female, 8 male) from families at high-risk for hereditary breast/ovarian cancer. Study results showed that two forms of experiential knowledge, empathetic and embodied knowledge, were integral to participants' constructions of their cancer risk. They also illustrated that knowledge derived from experience often took precedence over objective clinical estimates of risk. The paper discusses the clinical implications of these findings and suggests that counseling strategies, which expand upon patient's lived experience and knowledge of the disease, may enhance communication of genetic risk. Assessment of experiential knowledge promises to suggest new ways to frame genetic information that will enable people to better understand their objective risk or to modify exaggerated and/or inaccurate risk perceptions.

Risk: a concept analysis

TOPIC

Concept analysis of risk.

PURPOSE

To analyze the concept risk and provide a new definition of risk.

SOURCES

Published literature.

CONCLUSIONS

A new definition of risk that emerged from this concept analysis can provide clarity and direction for future research. Nurse researchers can look to this definition to expand what is known about health-seeking behaviors as opposed to "risk" behaviors and seek to further our understanding of the cognitive and experiential process of risk identification.

A concept analysis of susceptibility: application of the hybrid model

TOPIC

Choosing to obtain a screening mammogram is often determined by a woman's perceived susceptibility.

PURPOSE

To establish the importance of susceptibility to breast cancer in rural women in southeast Louisiana, using concept analysis as the hybrid model.

SOURCES

Through this analysis, findings from the literature were compared to women's actual perceptions from the field.

CONCLUSIONS

The author concludes that rural women in Louisiana do not view breast cancer as a potential harm, nor is there a belief that they have control over the decision to have a screening mammogram; therefore, rural women do not perceive themselves susceptible.