The present study addressed a fundamental gap between research and clinical work by advancing complex explanatory conceptualizations of coping action patterns that trigger and maintain daily negative affect and (low) positive affect. One hundred ninety-six community adults completed measures of perfectionism, and then 6 months later completed questionnaires at the end of the day for 14 consecutive days to provide simultaneous assessments of appraisals, coping, and affect across different stressful situations in everyday life. Multilevel structural equation modeling (MSEM) supported complex explanatory conceptualizations that demonstrated (a) disengagement trigger patterns consisting of several distinct appraisals (e.g., event stress) and coping strategies (e.g., avoidant coping) that commonly operate together across many different stressors when the typical individual experiences daily increases in negative affect and drops in positive affect; and (b) disengagement maintenance patterns composed of different appraisal and coping maintenance factors that, in combination, can explain why individuals with higher levels of self-critical perfectionism have persistent daily negative affect and low positive mood 6 months later. In parallel, engagement patterns (triggers and maintenance) composed of distinct appraisals (e.g., perceived social support) and coping strategies (e.g., problem-focused coping) were linked to compensatory experiences of daily positive affect. These findings demonstrate the promise of using daily diary methodologies and MSEM to promote a shared understanding between therapists and clients of trigger and maintenance coping action patterns that explain what precipitates and perpetuates clients' difficulties, which, in turn, can help achieve the 2 overarching therapy goals of reducing clients' distress and bolstering resilience.
The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team's understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.
The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patient's capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecedents and consequents.
A concept analysis was performed according to the method of Rodgers. The literature was reviewed from 1980 to June 2008, using search strategies adapted to the databases Cinahl, Medline, Embase, PsycInfo and Social Works Abstract, and hand searching. All articles contributing to a deeper understanding of the concept were included. The analysis was carried out according to a thematic analysis procedure, as described by Miles & Huberman.
The search identified 1305 citations. After in-depth assessment of 148 potentially eligible citations, 61 articles were included in the review. Five articles were added with hand searching. Sixty-seven per cent of these articles were related to nursing. The attributes of the enablement concept included: contribution to the therapeutic relationship; consideration of the person as a whole; facilitation of learning; valorization of the person's strengths; implication and support to decision making; and broadening of the possibilities.
These attributes could be used as a basis for other studies on enablement. Conceptual and empirical work is still needed to better position this concept among others such as patient-centred care, shared decision making and patient's participation.