Concept analysis is a method of defining a concept, which may be laden with assumptions and where a demonstration is needed of how the concept is applied to the clinical setting. The method of concept analysis provides a logical and analytical approach to the complex, and often, abstract language that is mental health nursing (McKenna, 1997; Walker & Avant, 1988). This article undertakes a concept analysis in an attempt to identify and explain the concept of “self-sacrifice”, in order to assist nurses’ understanding of the term.
We also hope to raise awareness of what it is nurses are undertaking when they become involved in mental health nursing practice. Concept analysis in nursing can be traced back to the influence of John Wilson’s little book, Thinking With Concepts (1963). Wilson intended to popularize some methods that were common among analytic philosophers in the middle of the twentieth century. By the time that Lorraine Walker and Kay Avant published Strategies for Theory Construction in Nursing (2005, first edition published in 1983), philosophers had already stopped using methods like Wilson’s.
Concept analysis fell from favor because philosophers rejected some of its key presuppositions. Nurses became aware of these philosophical arguments when Janice Morse (1995), and John Paley (1996) critiqued the Walker and Avant method of concept analysis. Morse suggested modifications of the standard method. The attitude of those who publish concept analyses today seems to be that all the alternative methods are viable, and that choice among them is a matter of personal preference. Concept analysis in nursing is thus in a rather awkward position.
Philosophers no longer do concept analyses in the Wilson style because the method has flawed presuppositions. Nurse scholars have adopted the method, nominally recognized the flaws, and yet continue to use it. Do the contemporary methods of concept analysis escape the criticism that led philosophers to reject concept analysis? To address this question, this essay will begin by reviewing the philosophical arguments critical of traditional concept analyses. We will then turn to the methods suggested by Rodgers and Morse to see whether, and to what extent, their methods avoid the criticism.
The goal of the essay will be to distinguish the sound techniques of concept analysis from those that are unsound. The last section will make some positive suggestions for reorienting nurse scholars toward the process of concept analysis The film “One Flew Over The Cuckoo’s Nest” by director Milos Forman was selected for analyzing the concept of “self-sacrifice” in the setting of a mental health institution during the mid seventies, when the baby boomers’ counter-culture was ripe for a film dramatizing rebellion and insubordination against oppressive bureaucracy and an insistence upon rights, self-expression, and freedom.
Nurse Mildred Ratched is the head administrative nurse at a mental hospital, where she exercises absolute power over the patients’ access to medications, privileges, and basic necessities. When patient Randle McMurphy arrives at the hospital her dictatorial rule is nearly brought down; he not only defies her rules, but also encourages the other patients to follow his example. Her attempts to intimidate him are unsuccessful. The last straw is when McMurphy sneaks two prostitutes into the asylum to relieve Billy of his virginity.
Nurse Ratched threatens to tell Billy’s mother about the transgression. Since Billy fears his mother as much as he fears Nurse Ratched he commits suicide. Infuriated, McMurphy attacks and nearly chokes Nurse Ratched to death. In retribution, Ratched has McMurphy lobotomized. Another patient, Chief Bromden, later smothers McMurphy as a kind of mercy killing. However, while McMurphy has been removed, her control over the patients is gone. She can no longer speak, at least not very well—McMurphy had damaged her vocal cords—and the other patients can now think for themselves.
This theme demonstrates through McMurphy’s self-sacrifice that the patients realize that they are able to obtain rights and freedoms by becoming self-reliant and independent. Being self-dependent and self-reliant is important in order to be a strong individual. Brief Review of the Literature on the Concept The interactive dictionary Visual Thesaurus creates a word map that branches to related words to better understand the meaning of the word. “Self-sacrifice” is often referred to as “selflessness”
The Wikipedia Encyclopedia defines self-sacrifice as the act of deliberately following a course of action that has a high risk or certainty of suffering or death (which could otherwise be avoided), in order to achieve a perceived benefit for certain others, is a powerful theme with a well established place in many cultures, myths, and societies. Examples include: ? Warfare – an act of bravery for a soldier to lay down their lives for others, both companions on the battlefield and the civilian population at home.
Antecedents and Consequences of the Concept Historically, the concept of self-sacrifice is central to Christianity, often found in Catholic and Orthodox Christianity as the idea of joining one’s own sufferings to the sacrifice of Christ on the Cross. Thus one can “offer up” involuntary suffering such as illness, or purposefully embrace suffering in acts of penance, such as fasting. Consequently, self-sacrifice or selflessness will influence the social relationships of individuals by determining their level of commitment to family and friends.
The more one sacrifices for others the more rewarding our lives will be if the concept does not literally mean death. If death if involved as in scenarios of warfare, protesting or duty compliance the person becomes a martyr and is remembered by the society in years to come. Self-sacrifice is an expression of courage and love for the fellow man. Critical Attributes of the Concept The noblest sacrifice is self-sacrifice: to dedicate one’s body, mind, and spirit in the service of God and humanity. In time of persecution and oppression, self-sacrifice may mean to willingly give up one’s life as a martyr.
In times of relative ease, self-sacrifice means to be a living sacrifice, dedicating everything to the divine purpose. Self-sacrifice is also the supreme expression of love for others. Self-sacrifice is in some sense the perception of the truth. To truly perceive the truth, there must be some kind of self-sacrifice, because perceiving the truth is realizing that the truth is something bigger than the self, beyond the self, which ultimately abolishes the self. Self-sacrifice may not a matter of suffering. In fact, if we see self-sacrifice as painful, we are still not seeing the truth completely.
Self-sacrifice is an impulse that arises out of love for reality. When it becomes truly understood, it is a joyful thing to sacrifice to the truth. Cases that Show Defining Attributes Model Case McMurphy represents sexuality, freedom, and self-determination, characteristics that clash with the oppressed ward, which is controlled by Nurse Ratched. His loud, free laughter stuns the other patients, who have grown accustomed to repressed emotions. The novel establishes that McMurphy is not, in fact, crazy, but rather that he is trying to manipulate the system to his advantage.
His belief that the hospital would be more comfortable than the Pendleton Work Farm, where he was serving a six-month sentence, haunts McMurphy later when he discovers the power Nurse Ratched wields over him—that she can send him for electroshock treatments and keep him committed as long as she likes. McMurphy’s sanity contrasts with what an insane institution implies. Whether insane or not, the hospital is undeniably in control of the fates of its patients. McMurphy’s self-sacrifice on behalf of his ward-mates echoes Christ’s sacrifice of himself on the cross to redeem humankind.
McMurphy’s actions frequently parallel Christ’s actions in the Gospels. McMurphy undergoes a kind of baptism upon entering the ward, and he slowly gathers disciples around him as he increases his rebellion against Nurse Ratched. When he takes the group of patients fishing, he is like Christ leading his twelve disciples to the sea to test their faith. Finally, McMurphy’s ultimate sacrifice, his attack on Ratched, combined with the symbolism of the cross-shaped electroshock table and McMurphy’s request for “a crown of thorns,” cements the image of the Christ-like martyrdom that McMurphy has achieved by sacrificing his freedom and sanity.
Despite he is a convict—who might represent a negative, invaluable person—he shows compassion for his inmates. Contrary Case Nurse Ratched’s values as a person are questionable. She is able to act like “an angel of mercy” while at the same time shaming the patients into submission; she knows their weak spots and exactly where to peck. She maintains her power by the strategic use of shame and guilt, as well as by a determination to divide and conquer her patients. Far from helping the patients Nurse Ratched keeps them in the darkness of their mental condition.
In this way the nursing profession is portrayed as a non-fulfilling career but the underlying cause of this behavior goes beyond any professional self-realization into a social conflict where women are protesting for equality. Borderline Case Chief Bromden, a tall American-Indian mute is the central character that symbolizes the change throughout society. This character that is subject to change is used as the narrator even though his perceptions cannot be fully trusted.
The person who is objective to listen to McMurphy’s teachings at first is Chief Bromden, but then he realizes that he is there to save the other patients and joins McMurphy in the protest against Nurse Ratched. Chief Bromden hallucinates the fog machine and Air Raids. They represent his mental clarity, it comes when he is less stable and recedes when he is more coherent. When Chief Bromden realizes he wants the ability of rational and joins the other men in protest of Nurse Ratched, his hallucinations of the fog machine disappear.
In the final part McMurphy is lobotomized and Bromden cannot stand to see what has happened to him and smothers him with a pillow to put him out of his misery. It is then Bromden is told he has to leave; he escapes by lifting the control panel and throwing it through the window. The story’s end culminates in a fantastic victory for Nurse Ratched but an ultimate triumph for the martyred McMurphy. It is through McMurphy that Bromden gains strength and freedom to make the independent choices that McMurphy proposed. Clinical Relevance The roots of nursing are in military and religious settings, where self-sacrifice is expected and encouraged.
Altruism is certainly admirable, but nurses who insist upon giving their all to others are headed for burnout or injury. Despite the negative image of Nurse Ratched for the nursing profession her role hints at the importance of this career. If Ratched really sacrificed and cared about the patients’ well-being, their mental condition may have improved with a different therapeutical approach. The fear and feeling of guilty she makes them bear keeps them “locked” in their mental state. Compassion and self-sacrifice are the most important weapons in a nurse’s armamentarium. Suggestions for Research
Self-sacrifice constitutes an effective tool for measuring the level of commitment and devotion of nurses in the nursing profession. The development of new and objective tools to measure self-sacrifice will have an impact on health care as more compassionate and selfless nurses are trained to serve the community. However, self-sacrifice can be deteriorating since nurses sometimes tend to neglect their own well-being, which can backfire on the quality of service. Hence, new approaches must be developed to inculcate self-sacrifice at the same time nurses are taught to take care of themselves.
January 9, 2018
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