Janice M. Morse
CONCEPTS IN CONTEXT
… the important innovations in social science are conceptual, a way of seeing the social world, and that the most important innovations that matter will be at that level.
—Michael Agar (2011, p. 18)
We learned in Chapter 1 that concepts were important components of science, and that concepts relevant to nursing were in urgent need of development. It is ironical that developing concepts is the one part of our research programs that, at least in nursing, is not directly supported by funding agencies. In Chapter 2, we reviewed the development of traditional nursing theory in nursing thus far, their contributions, and their limitations. In this chapter, we examine context and how concepts emerge within contexts. We commence with a brief overview of the components of concepts, work through a very simple example using our own general knowledge, and then revisit all of the components in greater depth.
How do you know a concept when you see one?
Suddenly we have reached the point at which you need to know everything at once. You need to know what a concept is, and how it is structured, what it has to do with the context, how it sorts and guides nursing knowledge, how it links with theory and enables us to move forward, further developing nursing knowledge.
WHAT IS CONTEXT?
Context is the setting in which the behavior(s) of interest, or phenomenon, occurs. It is simply the environment and circumstances—and sometimes the participants—in which the behavior or action occurs. The context should have standard features that are present in every setting where the action of interest takes place. Think of it as the “container” for the phenomenon in which you are interested or perhaps as the setting on the stage and the “actors” involved in a particular scene. Each scene has particular features that enable certain behaviors, which may be evident in persons in the setting and which allow certain other behaviors to occur.
Phenomenon of Interest
A phenomenon is an incident, an event, or a collection of behaviors that occurs within a particular context. The phenomenon may consist of patterned behavior and reoccurring behavior; it may contain a concept or several concepts, or even be a concept in itself. It may be a one-time incident, or a random or coincidental occurrence. Thus, we think of a phenomenon as simply clusters of behaviors that occur within a particular context. These behaviors may be patterned, run sequentially, or occur haphazardly. They may consist of a single concept; multiple, unrelated concepts; or allied (similar, related) concepts that are not exactly the same as the first concept, and differ in some important way. These context-bound concepts contain various amounts of “noise” (i.e., random actions that are not integral to the concept). At this point in our inquiry, we usually select and focus on a “phenomenon of interest” to study.
Just because it is a phenomenon with a recurring pattern of behavior, does not mean that it is (or contains) a concept. The behavior that interests you may not have been developed into a concept—or even given a name. Douglas Adams has an example of such a phenomenon: “the vaguely uncomfortable feeling that you get from sitting on a seat which is warm from somebody else’s bottom” (Adams, 2002, p. 11). This concept is silent: It has not been given a label, nor is even spoken about very often.
One more point: Concepts may occur at various levels of abstraction from the data from microanalytical concepts that are very close to the data and which explain these data in detail. Or, we may find a broad concept that is relatively abstract and removed from the data, has a broad level of explanation, and may even encompass several lower level concepts.
What is meant by “encompassing several levels of concepts?” A good high-level concept may encompass lower level concepts, which are more particular, closer to the data, or further subdivide our main concept. Compare this with a broader concept that may extend laterally and encompass several more tightly integrated concepts existing at approximately the same level of abstraction. These concepts may even be “types of” the main concept. For instance, “interaction” may be the primary, broad concept, and types of interactions (such as, “intimate interaction” or “argumentative interaction”) the concepts encompassed within the concept of interaction.
WHAT IS A CONCEPT?
A concept is a mental image, a “conceptualization” of a thing, a collection of behaviors, or an idea. It is a representation of reality in one’s mind. It is abstract. The concept may be the image in its entirety—or an image of some of the characteristics of the actual thing. In an empirical sense, definitions are neither true nor false, but only a basic descriptor for the phenomenon.
A concept needs a label, or name—we must identify what we are talking about—and it must have a generally accepted definition. This is important, because a concept allows us to communicate with others. And a concept must have attributes, that is, characteristics that are common to every instance of a particular concept. It is, therefore, the attributes that define the concept—that make the concept what it is. However, these attributes may be present in different “strengths” and this patterning leads to different forms and uses of a concept.
Each concept has a boundary—a limit beyond which a case is no longer an example of that particular concept. Near the boundary, the attributes become weak or are shared with other concepts, and become difficult to recognize.
Concepts have antecedents, or conditions that precede and give rise to the concept. All behavioral concepts have outcomes—behaviors that necessarily follow the occurrence of the concept of interest.
Let us start with an easy example that illustrates a concept and its components and functions:
If I speak of a table, we envision a piece of furniture with a flat top and legs that allow you to sit comfortably at the table. Tables usually have four legs, but this is not always so. Some, such as a table with a pedestal, may have only one, and other tables, such a conference table, may have more than four legs. The flat top and the legs are the attributes of a table, as they are present in all instances.
Now, a table is used to put things on. But we may have a table in our article. In this case it is a frame for us to put things “on” or into—we have borrowed one of the attributes from furniture, and use it to name a tool for our writing. Or we may have a tabletop mountain, that is, a mountain with a flat top, borrowing that attribute of the tabletop to describe the top of the mountain. Note we are using the attribute as a concept—in the mental image sense—not as an attribute of components of articles or of mountains.
Where do concepts come from? They are developed in everyday life in the course of conversation. These we call lay concepts. Often, new concepts are developed as slang or as trade names. Eventually, as their use becomes more common and familiar, these names are formally adopted into the dictionary. You may think of any number of new concepts concerning computers, cell phones, and software (or the ways they are used) that may not yet have a definition. These lay concepts reveal the dynamic nature of language, of ideas, of changing society, and so forth. We will discuss this further, later in this chapter.
Another type of concept is scientific concepts, which are developed in the course of science as operational definitions, or terms that are needed to conduct research. These are introduced into the scientific literature deliberately and cautiously, along with a formal definition.
But language is dynamic and fluid. As lay concepts become more important to science, they are “developed,” usually through qualitative inquiry, and then used as scientific concepts in research. Qualitative researchers develop detailed descriptions of a concept in context; they identify its attributes, explore its forms, refine its definitions, and describe its boundaries, antecedents, and outcomes. Alternatively, this may be done using the literature or via philosophical inquiry. Think of the number of articles developing such lay concepts as caring or trust over the past few years.
Scientific concepts become increasingly used on a daily basis; in the everyday context, they may “move” from the scientific to the lay lexicon. For instance, social support is one of these concepts—developed in science and now used in everyday language.
Concepts appear in various forms—some are very close to the data, quite narrow in scope, and referring to specific things. Others are more abstract (“higher level”) and very broad in scope, encompassing other more local concepts. For instance, suffering is a broad concept, encompassing the lower level concepts of bereavement, grief, sorrow, and despair. A concept may be horizontal, encompassing a large number of concepts. Stress is an example of a horizontal concept; that may be applied to metals or bridges (as a deforming force), to physical exercise (as its high levels negatively affect the individual), or to emotions (when the individual cannot conceal them). Incidentally, stress is a concept that was once in the lay lexicon, and later moved into the scientific arena.
Another interesting thing about concepts is that they cluster, and we call the concepts that are similar to—but not the same as—the first concept, allied concepts. Allied concepts may share some of the attributes as the first concept, but not all. They may overlap with the first concept, near the boundary where the attributes are weak. Two concepts may also merge, changing the nature of both original concepts (for instance, when hope “seeps in” to emotional suffering, it changes the nature of suffering to form the reformulated self in the Praxis Theory of Suffering [Morse, 2011]). Finally, the attributes within a concept may vary in strength, giving the concept a different appearance, but really the concept remains the same, only just in a stronger or weaker form. For instance, a strong form of hope, referred to as “high hopes” by lay persons or even as “false hopes,” is still a type of the concept of hope.
TO DO 7.1. BUILD A LIST OF CONCEPTS THAT ARE ENCOMPASSED UNDER THE CONCEPT OF SUFFERING
Consider, which of these concepts are scientific concepts and which are lay concepts? Which are transitioning from lay to scientific? Or from scientific to lay? Create it as a three-column chart.
When communicating about behavior we largely use behavioral concepts—terms that have been given to a set of behaviors, terms that are used by others, and that others recognize, therefore, enabling us to communicate.
As with all concepts, behavioral concepts must be defined, and the definition must be shared and common to others. Language provides an essential basis for our descriptions of phenomena and the communication of these concepts, but that is only a part of the game. Context may vary the meaning, and as meaning is developed in use. However, scientific concepts used professionally may be discipline-specific. Therefore, it is our responsibility, as nurses, to identify nursing phenomena and from those phenomena, to create and define concepts relevant to our practice, that is, scientific concepts. We need to build pertinent explanatory theory that will enable us to perceive and understand patient behavior in a consistent way so that care may be targeted, compassionate, therapeutic, and so that interventions will be evidence-based. We need concepts that are of interest to nursing, that explain nursing, and that allow us to communicate nursing. We need solid theory, not only to explain patient behaviors and necessary nursing care, but which also will enable us to test and expand our interventions. This way, our discipline will mature, and our care will become optimal, effective, and efficient.
A lay (everyday) concept is something that refers to a “thing” or a behavior with particular attributes: The concept may be simple or complex; it may be close to reality, or abstract; it may be narrow and particular, or broad and encompass other concepts. Lay concepts are in the common lexicon; they are used in everyday discourse; and they are not fixed—new cases may appear, old cases fade and disappear.
Definitions for lay concepts may sometimes be found in the dictionary, but as such definitions do not usually provide any information about the properties (attributes) of the item. Dictionaries are rather a crude tool for discerning concepts. Dictionary meanings, providing lay definitions, are usually semantically ambiguous; they describe by providing the base from which a meaning may be derived within the context of a sentence. The purpose of the dictionary is to define words, not to develop concepts. If information about a concept that you are interested in cannot be found in the nursing literature, an encyclopedia may be a better source.
The dictionary meanings and labels are inadequate and superficial because they include only minimal descriptors. Think of a lemon: it has a particular shape, color, taste, and flesh—those we will call defining attributes. Now look up lemon the dictionary: the dictionary definitions are: (a) yellow or green citrus fruit; (b) tree that bears lemons; (c) pale yellow color; (d) defective product.
Lay behavioral concepts are integral to language, but are often not developed adequately for professional use in nursing practice or for scientific use in research. A lay definition is inadequate for the use of the concept in clinical nursing, and it is the role of qualitative inquiry to investigate and develop the concept, hence helping to develop the theoretical foundations of nursing. An example of a lay concept that is developing is trust; this concept is now increasingly appearing in the nursing research literature and maturing into a scientific concept (Hupcey, Penrod, Morse, & Mitcham, 2001). Therefore, the correspondence between the definition and the defining attributes of the concept is one of logic and fit. This means there may be “better” or “poorer” examples of the definitions. Recall that observing the concept usually derives definitions. If they are not based on observation (i.e., on reality), the likelihood that the concept is meaningful (that it contains attributes and has relationships) is considerably impaired. The concept name is always standardized—for lay concepts, standardization occurs from use in everyday speech; these terms (labels) are usually used consistently in language.
One more example: Although there is general agreement about the definition, the dictionary definition is usually inadequate for use within a discipline for professional purposes. For instance, if we look at the definition of privacy (meaning 3 in the dictionary is: “A private or personal matter” [Determinant, 2014, p. 2359], we do not learn anything that we did not know, and the definition is not useful clinically. It does not tell us what kind of information is private, and therefore should not be shared. On the other hand, we may think about the differences between privacy and secrecy when, in Downton Abbey (Fellowes, 2010, Season 1) a lady’s maid was found to be hiding a typewriter on the top of her closet. There was a general inquiry in the household about why she was hiding it and keeping it a secret. Anna, a fellow maid, said, “She is not keeping it secret, she is keeping it private: there is a difference.”
TO DO 7.2. RELATIONSHIPS AND DIFFERENCES
Consider: What is the difference in relationship between private and secret? List the characteristics of each concept, private and secret.
Techniques of developing and assessing concepts are discussed throughout this book. Once a concept is developed qualitatively, quantitative research may then explore the concept in use, and further develop and confirm its correlates and theoretical applications.
A scientific concept is one that is developed by a researcher and is defined and labeled as an operational definition in the process of doing science. Scientific concepts are therefore standardized by the researcher who developed the operational definition, as the concept was created, introduced, or “invented.”
The concept meaning of scientific concepts is fixed by the operational definition that clearly indicates which instances are to be considered within the class of the concept and which are not. Therefore, scientific concepts are clear and concise. Except for a few instances, scientific concepts are significant or meaningful only when they have referents. That is, there are phenomena in the real world that correspond to their definition—in philosophical terms, their class is not empty. Most of the physiological concepts in nursing are scientific concepts. They are stable and used consistently, having been tested using the scientific process of debate and consensus.
Therefore, scientific definitions are not usually found in the dictionary (at least initially); you may have better luck searching in an encyclopedia or online in Wikipedia.
The names of scientific concepts are simply labels. Although they are the purview of the person first suggesting or creating the concept, their definitions may be challenged or modified in subsequent investigation. Problems occur when they are overtly used as originally proposed, but deviate from the original meaning in the conduct of research. Hupcey’s (1998a, 1998b; see Chapter 19) analysis of the original definition of social support, is an excellent example of such unnoticed, undocumented transition, in which the actual definitions continued to be used by researchers, but the operationalization of the concept changed over time, until it no longer matched the definition.
In this way, scientific concepts are formulated for research purposes according to the needs of the scientist’s research. Concept definitions are specific, precise, and do not usually exist in ordinary language until they have been transferred there through general use, and eventually becoming a part of the general lexicon of common speech.
Comparing Scientific and Lay Concepts
Unfortunately, the distinction between scientific and lay concepts is not always clear, and this results in several problems. First, occasionally scientists use definitions that are ambiguous. The same concept label may be shared for a scientific and an ordinary language lay concept, yet, implicitly or explicitly, the scientists or lay persons use different definitions for the concept. Care is such a concept: In everyday language we talk about “caring for you,” which may mean “feelings of affection” or “looking after,” as in “caring for my baby.” The scientific meaning of the term “care” refers to professional care, as in the nurse–patient relationship of “providing care.”
Second, not all definitions created by scientists are “good” definitions in that they have not clearly defined their concepts. In these situations, as the frequency of use of the concepts increases, these concepts become “muddled.” Clarity is lost, and confusion abounds.
A further problem is that the language of science is not always particular to science: Scientists often use labels of lay concepts to designate their scientific concepts. This is commonplace when the researcher wants to explore patient experiences, for example, as it directly links experience as perceived and experienced by the patient, to those of interest to the researcher; qualitative methods are then useful. When terms from ordinary language are used to designate scientific concepts, the scientific definition may be clear and fixed, but this definition may or may not resemble the dictionary definition. Unless the concept is clearly defined in each context, the use of concept labels shared between science and ordinary language may cause much confusion.
Another condition for the concept to be meaningful is that it must have relations with other concepts. Indeed, a concept can only be used in a theory if relationships with other concepts are suggested or actually exist. Scientists choose or define concepts in such a way that relevant relationships are likely to exist. Further, concepts used in disciplines such as nursing are meaningful only if they provide labels for the phenomena of concern to the profession.
In the provision of nursing care, we are generally interested in behavioral concepts, which refer to a cluster of behaviors, labeled and defined. These may be lay concepts, referred to as psychosocial concepts, such as dignity or dependence, emotional states, such as anxiety, or scientific concepts such as social support, or physiological concepts such as electrolyte balance.
Concepts that originate from science, even those with operational definitions, are also dynamic and initially not usually stable. As a scientific term becomes increasingly communicated, it becomes known, accepted into, and used in everyday speech, and it takes on a dual existence as both a lay and a scientific term. Thus, pyrexia, a scientific term, may be found in Oxford Dictionaries (2014, p. 2430), and fever, its roughly equivalent lay term, may both be found in medical texts.
THE STRUCTURE OF CONCEPTS
If a concept is simply a mental image, how could it possibly have a structure? This “structure” is simply a framework conceived to organize the essential components of a concept. This framework and components consist of what we metaphorically call the anatomy of the concept (i.e., the label, definitions, and the antecedent, boundary, attributes or characteristics, and the outcomes) and the physiology, that is, how the concept functions within different contexts and situations, and in the presence of other concepts.
THE “ANATOMY” OF CONCEPTS
When talking about the anatomy of concepts, we are referring to their structures: their labels, definitions, attributes, boundaries, antecedents, and outcomes. That is, we are referring to the perceived constituents, structures, or components that we use to describe the collections of behaviors that make up the concept. To summarize, the antecedents are the conditions that must exist to give rise to the concept; the boundary delineates what is and is not a part of the concept; the antecedents are the characteristics that are present in all cases of the concept, and the consequences are the outcomes. We also include the definition and the concept label as a part of the concept when evaluating its anatomy.
To make things a little more complicated, concepts are not actual entities. Rather, they are names for ideas—for instance, labels for ideas and even images for what behaviors we consider that occur together and signify a particular purpose. Concepts do not exist in empirical reality; only their referents do, that is, the concepts refer to representations of behaviors that signify the attributes that cluster or co-occur, and form the concept. Concepts, by definition, are abstractions of reality; they are not concrete entities in themselves. They are labels for clusters of behaviors that have common characteristics, which we call attributes.
Antecedents are the conditions that always precede the concept and give rise to the concept; without these conditions and circumstances—and behavioral response—the concept could not occur. The antecedent may be described relatively abstractly. Although antecedents may be directly linked to a particular type of context, it is not always the case that antecedents are tied to the particular setting being explored. For instance, in order to hope, there must be and always is, something to hope against. It is a perceived threat to the self. The concept of hope commences when the person perceives the threat and then hopes against that threat (hopes that it will not occur), and begins to plan for alternative actions to avoid the threat (Morse & Doberneck, 1995, p. 278).
Identifying the attributes of the concepts expands our understanding and raises the level of abstraction to include all instances of the concept. The label given to the characteristics changes form as they are rewritten and decontextualized as formal attributes. For instance, references to local conditions are removed and they are made more general, and they are succinctly formatted so that they apply to all contexts. Thus, decontextualization is the stripping of the local features attached to the attributes, and the identification and retention of the features that are present in all instances of the concept in any context. Think of it as identifying the “bones,” the essential features, without any particular “noise” associated with a certain situation or setting.
This is the first step in abstraction, and the first step in making the concept generalizable. The most common way to move from characteristics to attributes is to decontextualize by comparing the concept in different settings. In context #1, list the characteristics of the concept. Then do the same in a second context or situation, in the third context, and so forth. Once you have listed the characteristics of the same concept in each setting, examine your chart: Those features that are common to all contexts or settings are probably the attributes of the concept. Those features that appear in one or two settings are local features. It is this process of identifying attributes that enables abstraction. Once abstracted, the attributes (and therefore the concept) are not tied to any particular setting, context, or circumstance.
At the center of the concept, the attributes are the strongest, and these may provide the optimal exemplar of a particular concept, as a clear and undisputed example (see Figure 7.1). But as we move toward the boundary of the concept, these characteristics become weaker, and the attributes of other allied or similar concepts may be present, causing analytic confusion.