Perception: A Concept Analysis 1

PERCEPTION: A CONCEPT ANALYSIS

by

SUSAN MARY MCDONALD

A manuscript submitted in partial fulfillment

of the requirements for the degree of
Doctor of Philosophy
Department of Nursing

Gloria Duke, Ph.D., Committee Chair

College of Nursing and Health Sciences

The University of Texas at Tyler

May 2011
Perception: A Concept Analysis 2

Abstract

Purpose: Concept analysis methodology by Walker and Avant (2005) was used to define,

describe, and delimit the concept of perception.

Data Source: Nursing literature in the Medline data base was searched for definitions of

“perception”.

Data Synthesis: Definitions, uses and defining attributes of perception were identified; model

and contrary cases were developed; and antecedents, consequences, and empirical referents were

determined.

Conclusions: An operational definition for the concept was developed.

Implications for Nursing Practice: Nurses need to be cognizant of the how perceptual

differences impact the delivery of nursing care. In research, a mixed methodology approach may

yield a richer description of the phenomenon and provide useful information for clinical practice.

Keywords: concept analysis, perception, nurses and perception

Perception: A Concept Analysis 3

As nurses, the only perceptions we are privy to are our own. This often comes to light as

nurses encounter ethnically diverse clientele in their everyday practice. Conflict between nurse

and client perceptions can lead to miscommunication and suboptimal outcomes. Understanding

self and client perceptions are important for nurses to effectively meet clients’ unique needs in

this global health arena.

Perception is a key component of several theoretical frameworks used in nursing

research. A well-known conceptual structure for understanding what drives persons’ health

decisions is the Health Belief Model. This model proposes that the key elements to taking

health actions are the individual’s perceptions of susceptibility, severity, benefits, and barriers in

regard to their health (Daddario, 2007). Perceived benefits of action, barriers to action, and self-

efficacy are elements of the behavior-specific cognitions and affect component of the Pender

Health Promotion Model (Pender, Murdaugh, & Parsons, 2002).

The notion of perception as a driver of health actions makes this concept of particular

importance to nurses as they attempt to manage health outcomes by encouraging positive actions.

To improve health outcomes, it is critical appreciate the uniqueness of an individual’s

perceptions and to understand how perceptions are formed. An operational definition is needed

to assist disciplinary knowledge and improve nursing care. This paper will attempt to define,

describe, and delimit the concept of perception.

Background

Perception involves the way one sees the world. Nurses use tools that attempt to uncover

and perhaps reframe the perceptions of a client or group. The wide variety of subjective

instruments to measure perceptions has resulted in a lack of global consensus on any singular

best practice. Instruments are usually situation-specific or population-directed which makes

Perception: A Concept Analysis 4

finding a general measure of perception challenging. Visual analog scales have been used with

success to measure perceived pain. Satisfaction surveys attempt to capture patient perceptions

about the health care they received. The health-related quality-of-life instrument, the SF-36®

Health Survey purports to examine respondents’ perceptions of eight domains of health: physical

functioning, role-physical, bodily pain, general health, vitality, social functioning, role-

emotional, and mental health. In addition, the instrument asks respondents to report how they

perceive their current health compared with their health one year ago. These are a few examples

of the instruments used to assess patient perception. However, the issue of identifying the

elements of perception and understanding exactly what is being reported remains elusive.

Baldwin (2008) describes concept analysis as a rigorous and pragmatic approach to

define concepts that can significantly contribute to knowledge and can be applied to nursing

practice. Walker and Avant’s (2005) concept analysis method was used to examine the structure

and function of the concept “perception”. This method uses eight steps to capture the essence of

the concept: (1) selecting a concept; (2) determining the aim of the analysis; (3) identifying all

possible uses of the concept; (4) determining the defining attributes; (5) identifying a model case;

(6) identifying additional cases; (7) identifying the antecedents and consequences; and (8)

defining empirical referents. The aim of the study was to develop an operational definition of

“perception” in order to provide a linguistic basis for what is being evaluated with the various

measures of patient perceptions about health and actions.

Data Sources

The Medline data base was used to conduct a literature search of the term “perception”.

Only articles in the nursing literature from 2006 to 2011 were included. Both quantitative and

qualitative articles that focused on participant perceptions were viewed. In the 449 articles, there
Perception: A Concept Analysis 5

were no articles that defined the term “perception”. A possible explanation for why none of the

articles clearly defined perception may be an underlying assumption that the reader simply

understood the term.

Results

Uses of the Concept

Walker and Avant (2005) recommend using dictionaries, thesauruses, available literature,

and other sources to identify uses of the concept which revealed subtle differences in how

perception is described. The term perception is a noun. Wikipedia (2008) defines perception as

“the process of attaining awareness or understanding of sensory information.” The Collins

Essential English Dictionary (2006) describes perception as: “1. insight or intuition 2. way of

viewing [Latin perceptio comprehension].” The Merriam-Webster (n.d.a) lists these definitions:

“1 a: a result of observation; b: a mental image; 2. obsolete: consciousness; 3 a: awareness of the

elements of environment through physical sensation; b: physical sensation interpreted in the light

of experience; 4 a: quick, acute, and intuitive cognition appreciation; b: a capacity for

comprehension.” The Merriam-Webster Online Thesaurus (2009) adds this: “1. the ability to

understand inner qualities or relationships; 2. the knowledge gained from the process of coming

to know or understand something.” Synonyms in Roget’s II: The New Thesaurus (1995) include

awareness, cognizance, consciousness, sense, concept, conception, idea, image, notion, and

thought. Other related terms are: attention, cognition, heuristic, information, intelligence, mental

model, and understanding (Wikipedia, 2008).

Perception is a uniquely individualized experience. One can only draw from what is

known to oneself. In literature, the poem “The Blind Men and the Elephant,” written by John

Godfrey Saxe in the 19th century, exemplifies the need to be exposed to something in order to
Perception: A Concept Analysis 6

have any perception of it. The poem tells the tale of six blind men. They encounter an elephant

and try to identify appropriate comparisons for this unknown entity. Each man touches the

elephant and the limited area within each man’s reach influences his conclusion. Each has a

different mental image based on past experiences. They debate that an elephant is like a wall,

snake, spear, tree, fan, or rope. Each man is confident in his own perception. A heated argument

ensues. To quote W. Paul Young (2007) from the novel The Shack: “Paradigms power

perception and perceptions power emotions” (p.197).

The interdisciplinary concept of perception is complex and has many layers. In

physiology, perception is examined on the basis of the neurons that enact it (Freeman, 1991).

The neural pathway is affected by both the mind and the body as exemplified in a study on the

effectiveness of placebo analgesia on relieving pain (Roche, 2007). Patients’ beliefs, attitudes,

and expectations shaped their perception of pain before and after using placebo analgesia.

Placebo analgesia and pain are two functions of the same neural network. The effectiveness of

placebo analgesia may be dependent on brain components involving affective and emotional

processes. Evidence exists to show that suggestion/expectation cognitively triggers powerful

neurohumeral mechanisms in patients’ brains, bodies, and behaviors that will either relieve or

exacerbate pain.

Perception is also discussed at length in psychology. A general internet search for the

keyword “perception” directs the reader to numerous psychology and cognitive websites where

awareness and understanding of sensory information is discussed. These sites address the

mechanics of vision and hearing, touch, taste, and smell. All of these are stimuli that are

presented to an individual and interpreted in a specific and personal way.

Perception: A Concept Analysis 7

Perception of objects in the visual world is influenced by features such as shape and color

as well as the meaning and semantic relations among them (Hwang, Wang, & Pomplun, 2011).

In psychiatry, there are often distortions in sensory informational processing. When studying the

perception of body image among dancers and anorexic girls, digital pictures were taken of the

participants in street clothes. The images were then cropped and resized on the computer. The

participants were asked to adjust their image to correspond with how they perceived they

actually looked. The participants perceived themselves to be heavier than they were. This

distortion can lead to maladaptive eating (Urdapilleta, Cheneau, Masse, & Blanchet, 2007).

Kuhn, Amalani, and Resnick (2008) postulate there is a shared interest between

magicians and cognitive scientists in understanding human perception and cognition. Magicians

perform acts that are perceived to defy the laws of nature and induce a sense of wonder. When

performing, magicians use misdirection and illusion to control attention, distort perception, and

influence choice. The authors propose the development of a “science of magic”. This science

would explain all known magical effects in terms of known perceptual and cognitive

mechanisms. All known magic effects may be reduced to a set of basic, relatively well-

understood operations. Any effects that are not reducible would indicate the existence of an

unknown perceptual or cognitive mechanism which may have existential or religious

underpinnings.

Religions portray the perception of God or the Supreme Being differently which impacts

how the individual views God. Chara and Gillett (2004) published a study examining possible

synesthetic perceptions of God. One hundred eighty-seven college students were surveyed about

their sensory image of God and found the religious experience was one of high individuality.

Religious orientation influenced these sensory images: hearing, smelling, seeing, tasting, and
Perception: A Concept Analysis 8

touching God. The majority described God as speaking quietly and in prose and having a

pleasant aroma. The most frequent color choice for God was yellow. Nearly 80% reported they

tasted God and saw that God was good. Those who identified their primary value as “spiritual

growth” were twice as likely to report being very close or close to God compared to those who

reported “money” or “pleasure” as their core value. The researchers found participants' images of

God were frequently correlated with biblical revelation of God and that this agreement may

reflect influences that are phenomenological. Peoples’ experiences in a biblically influenced

culture color their perceptions.

Social influences may affect one’s perception, including gender and socioeconomic

status. Research by Kimura (2004) and Geary, Gilger, and Elliott-Miller (1992) show a gender

difference in cognition. Socioeconomic status influences where you live, what you eat, what you

wear, and how you are educated. All of these are the basis for the formation of memories and life

experiences. A child from a housing project and a billionaire’s child would have two very

different views of a mansion.

Perception is a personal manifestation of how one views the world which is colored by

many sociocultural elements. Markus and Kitayama (1991) concluded that people in different

cultures have strikingly different perceptions of self and others. These differences can be seen

when comparing two distinct cultures. The nature of the individual experience can also be

influenced when two cultures meet. Perception of pain in childbirth was found to be increased

when the ethnicity of the laboring woman was different than that of the predominant ethnicity of

the attendants (Olayemi, Morhason-Bello, Adedokun, & Ojengbede, 2009).

The act of perceiving has been pondered by philosophers for centuries. In the philosophy

of perception, the metaphysics of the mind is explored looking to answer the questions of what is
Perception: A Concept Analysis 9

perception, what is the nature of perceptual consciousness, and how can one fit an account of

perceptual experience into a broader account of the nature of the mind and the world (Noë &

Thompson, 2002). BonJour (2007) discusses the evolution of the epistemological issues

concerning perception. The author notes that philosophers such as Descartes and Locke

attempted to answer the question of the root of our awareness in sensory or perceptual

experiences. Many theories have been debated over the centuries including the sense-datum

theory, the adverbial theory, phenomenalism, representationalism, and direct realism. When

describing perception, the phenomenological philosopher, Merleau-Ponty (1947/1964) states:

“ By these words ‘primacy of perception’, we mean that experience of perception is our

presence at the moment when things, truths, values are constituted for us; that perception

is a nascent logos; that it teaches us, outside of all dogmatism, the true conditions of

objectivity itself; that it summons us to tasks of knowledge and action. It is not a question

of reducing human knowledge to sensation, but of assisting at the birth of this knowledge,

to make it as sensible as the sensible, to recover the consciousness of rationality” (p. 25).

The conclusion that can be drawn is that perception is a multifaceted concept that is as complex

as the human mind itself.

Defining Attributes

Walker and Avant (2005) use defining attributes to describe those factors which must be

present in order for the concept to be identified. The definitions, synonyms, and related terms of

perception were examined. Perception utilizes sensory and cognitive processes to appreciate the

world around us. It is a unique way of understanding phenomena by interpreting sensory

information based on experience, processing information, and forming mental models. In order

for perception to occur, these defining attributes must be present:

Perception: A Concept Analysis 10

1. Sensory awareness or cognition of the experience.

2. Personal experience.

3. Comprehension that can lead to a response.

Model Case

Model cases are used to exemplify all of the defining attributes of a concept (Walker &

Avant, 2005). This model case is simple and contains all of the defining attributes for perception.

Janice had been a nurse in the skilled nursing facility for 5 years. She enjoyed her contact

with the residents. She was especially fond of Mrs. Hudson, a lively 83-year-old widow,

who enjoyed sharing her opinion about what she read in the paper and viewed on

television. One morning, when Janice made rounds, Mrs. Hudson was sitting in her

armchair, gazing out of the window. She barely acknowledged Janice’s entrance. When

Janice inquired how Mrs. Hudson was doing, the response was a brief “fine”. Janice was

puzzled by the change in Mrs. Hudson, who was far from her usual, cheerful self. Janice

drew up a chair, sat next to Mrs. Hudson, and noticed tears in her eyes. A newspaper was

lying on the windowsill. Janice told Mrs. Hudson that she did not appear to be “fine” and

asked what was bothering her. With a tearful voice, Mrs. Hudson told Janice that she had

just read the obituary of her best high school friend. With Mrs. Hudson’s consent, Janice

called the resident’s son and requested he come to the facility to be with his mother.

In this case, Janice had a sensory awareness of the situation by observing the verbal and body

language of Mrs. Hudson. What she saw did not correlate with previous personal experiences

she had in the past with this resident. Her comprehension of the situation enabled her to assess

that her resident was in need of emotional support which led to her to respond and call Mrs.

Hudson’s son.
Perception: A Concept Analysis 11

Contrary Case

This case exemplifies a lack of any of the defining attributes. Walker and Avant (2005)

advocate the use of these cases as a part of the internal dialogue used to examine the defining

attributes. Contrary cases exemplify what is “not the concept”.

John, an 85-year -old widower, lived alone. Due to a severe hearing deficit, he used

bilateral hearing aids. At bedtime, he removed his aids and placed them in a case on his

nightstand after which he fell asleep quickly. A strong storm struck during the night

causing considerable wind damage to the large pine tree in his front yard. Upon

awakening, he was shocked to see a hole in the roof over his bedroom and debris

scattered across his property.

In this case, John had no perception of the event that occurred during the night. His hearing

deficit did not allow sensory awareness of the weather which eliminated the possibility of

personalizing the experience. Further, his lack of comprehension interfered with his ability to

take action to protect him from potential harm.

Antecedents and Consequences

Antecedents must occur prior to the concept and must be present for the concept to

happen (Walker & Avant, 2005). With perception, processing information and coming to an

understanding is complex. Before perception occurs, intact neurons are required. In addition, the

person must have the capability to interact with the environment through at least one of the five

senses.

Consequences are what happen as a result of the occurrence of the concept. It involves

what one will do with the information that was just processed. It can result in increasing one’s

knowledge, understanding, and comprehension. The consequence of perception is formulation of

Perception: A Concept Analysis 12

a mental image which contributes to the decision to act or not. In healthcare, if the individual

draws on unique experiences and views a situation as normal, the likelihood of taking action is

minimal. Even if the understanding is in error, it is still the individual’s understanding of the

situation based on perception. Perception does not necessarily result in “truth” or perhaps even

“knowledge,” but it does culminate in the individual’s comprehension of the situation.

Empirical Referents

Walker and Avant (2005) define empirical referents as ways to measure the concept in

the real world. There is a proliferation of articles describing tools or instruments to measure the

perceptions of groups or individuals. Tools have been shown to be successful in some attempts,

but fail in others.

In health care, quality indicators have been developed to capture the patient’s perceptions

regarding the hospital experience, especially about the quality of nursing care they received.

Dozier et al. (2001) developed a 15-item tool, Patient Perception of Hospital Experience with

Nursing (PPHEN), based on the Swanson-Kauffman framework of caring. It does not require

patients to compare their expectations of care with the care received, as do patient satisfaction

surveys, but only whether their needs were met. The authors concluded their tool was internally

consistent and represented a single construct best described as feeling “cared for.”

Since no reliable body size perception instrument for children had yet been identified, a

pilot study was conducted to validate the use of photographs from the Centers of Disease Control

(CDC) Web site as a tool to assess maternal perceptions of children’s weight (Reifsnider et al.,

2006). These photographs are used by the CDC for professional Body Mass Index (BMI)

training. The authors looked at Hispanic mothers’ perception of children’s body size and

explored their views of child growth, diet, activity, and health. The mothers and their preschool
Perception: A Concept Analysis 13

children were weighed, measured, and their BMIs calculated. Using CDC photographs of

children of various body sizes, the authors found no congruence between the mothers’

perceptions of body size in the pictures and their children’s sizes. Regardless of their children’s

BMIs, what the mothers perceived were happy, active children accomplishing normal childhood

activities. Their children were not viewed as overweight. The authors concluded that the use of

standardized pictures would not be an effective tool to educate these mothers about BMI.

Perception is more than matching a photograph with a mental image.

In qualitative research, contextual descriptions are a way to arrive at perception. One

such method is descriptive narrative analysis. This method serves as a tool to ask a person to

describe perceptions of a phenomenon. Comparing the description to norms can be valuable in

developing a treatment plan. The use of descriptive narrative analysis enabled the researchers to

explore the anorexic voice experienced by 21 women with anorexia nervosa (Tierney & Fox,

2010). The inner voice was very real to these women. The participants described the voice as

changing from positive to negative over time. The voice was a comfort at times but would

change to a voice that was loud, forceful, and demanded obedience. The study gave the

researchers insight into the dilemma faced by the participants. When contemplating life without

the seduction of the anorexic voice, the participants revealed the voice still had some attraction

for them. The authors concluded acknowledging the presence of the voice could assist anorexic

patients in their recovery.

Discussion

Study Limitations

Perception is described by numerous disciplines. Both space and time limit the

identification of all of its uses. This review is in no way exhaustive.

Perception: A Concept Analysis 14

Study Strengths

This concept analysis is limited to the concept in relation to nursing science. By

analyzing the concept, one develops an appreciation of its complexity. The only “real”

perception is self-perception, but that does not negate the need to acknowledge that another

person may have a different way of comprehending the same phenomenon. “Perception of

experience is what matters, not what in reality may appear to be contrary or more ‘truthful’”

(Munhall, 2007, p.161).

Theoretical Implications

According to Walker and Avant (2005), a theorist introduces the reader to the critical

defining attributes by using theoretical definitions, which are usually abstract and may not be

measureable. In order to be able to measure a concept, an operational definition is employed.

An operational definition of perception includes:

 an individual’s or group’s unique way of viewing a phenomena

 involving the processing of stimuli

 incorporating memories and experiences in the process of understanding

The concept of perception plays a role in both descriptive and explanatory middle-range

theories. In qualitative research using phenomenology, the individual’s unique way of viewing a

phenomenon is explored. This methodology can use a descriptive approach, where the emphasis

is on describing universal essences, or an interpretive (explanatory) approach, emphasizing

understanding the phenomenon in context. Quantitative studies have been done using the Health

Belief Model and the Health Promotion Model to examine what is perceived by the target

population to explain health behaviors.

Perception: A Concept Analysis 15

Conclusions

Perception is an individual’s view making it a powerful driving force for action.

Processing sensory information and relating to past experiences enables one to create a lens in

which to view the world through a filter of sociocultural influences. In the clinical setting, each

individual comes with personal life experiences that influence perceptions. Nurses need to be

cognizant of the how these differences can impact the delivery of nursing care.

As has been stated, the only perceptions we know are our own and a conflict between

nurse and client perceptions can lead to miscommunication and suboptimal outcomes. Rather

than label a client or parent as “non-compliant”, the nurse needs to explore what is influencing

the individual’s perceptions, identify what the client and nurse share in common, and utilize

these findings to develop strategies to positively impact health.

Perception is never objective. It is an individual’s or group’s unique way of viewing a

phenomenon that involves the processing of stimuli, and incorporates memories and experiences

in the process of understanding. In nursing research, valuable information is gained through

studies that incorporate conceptual models such as the Health Belief Model and Health

Promotion Model. Often, these studies do not give nurses insight into what influences

perceptions. Quantitative research methods can sometimes answer the question “what” but not

give voice to the question “why”. Qualitative methods use “different ways of seeing to uncover

and discover understanding” (Munhall, 2007, p.xv).Because perception is a unique experience, a

mixed methodology approach may yield a richer description of the phenomenon, enhance

understanding, contribute to the body of nursing knowledge, and provide useful information for

clinical practice to improve client outcomes.

Perception: A Concept Analysis 16

References

Baldwin, M.A. (2008). Concept analysis as a method of inquiry. Nurse Researcher, 15(2), 49-58.

BonJour, L. (2007). Epistemological problems of perception. Standford encyclopedia of

philosophy. Retrieved from http://plato.stanford.edu/entries/perception-episprob/

Collins essential English dictionary (2 nd ed). (2006) New York: HarperCollins.

Chara, P.J., & Gillett, J.N. (2004). Sensory images of God: Divine synesthesia? Journal of

Psychology and Christianity, 23(3), 234-248.

Daddario, D.K. (2007). A review of the use of the health belief model for weight management.

Medsurg Nursing, 16(6), 363-366.

Freeman, W. J. (1991). The physiology of perception. Scientific American, 264(2), 78-85.

Geary, D. C., Gilger, J. W., & Elliot-Miller, B. (1992). Gender differences in three-dimensional

mental rotation. Journal of Genetic Psychology, 153(1), 115-117.

Hwang, A. D., Wang, H., & Pomplun, M. (2011). Semantic guidance of eye movements in real-

world scenes. Vision Research, 51(10), 1192-1205. doi:10.1016/j.visres.2011.03.010

Kimura, D. (2004). Human sex differences in cognition, fact, not a predicament. Sexualies,

Evolution, and Gender, 6(1), 45-53.

Kuhn, G., Amlani, A. A., & Resnick, R. A. (2008). Towards a science of magic. Trends in

Cognitive Sciences, 12 (9), 349-354.

Markus, H.R. and Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion,

and motivation. Psychological Review, 98(2), 224-253.

Merleau-Ponty, M. (1964). The primacy of perception and its philosophical consequences In J.

M. Edie (Ed. & Trans.), The primacy of perception and other essays on
Perception: A Concept Analysis 17

phenomenological psychology, the philosophy of art, history, and politics (pp. 12-42).

Chicago, IL: Northwestern University Press

Merriam-Webster. (n.d.a.) Perception. Retrieved from www.merriam-

webster.com/dictionary/perception

Merriam-Webster. (n.d.b.). Perception. Retrieved from www.merrium-

webster.com/thesaurus/perception

Munhall, P. L. (2007). A phenomenological method. In P. L. Munhall (Ed.), Nursing research:

A qualitative perspective, (4th ed.) (pp.145-210). Sudbury, MA: Jones and Bartlett.

Olayemi, O., Morhason-Bello, I. O., Adedokun, B. O., & Ojengbede, O. A. (2009). The role of

ethnicity on pain perception in labor among parturients at the university college hospital

Ibadan. Journal of Obstetrics & Gynaecology Research, 35(2), 277-281.

doi:10.1111/j.1447-0756.2008.00937.x

Noë, A., & Thompson, E. (2002). Vision and mind: Selected readings in the philosophy of

perception. Cambridge, MA: MIT Press.

Olayemi, O., Morhason-Bello, I. O., Adedokun, B. O., & Ojengbede, O. A. (2009). The role of

ethnicity on pain perception in labor among parturients at the University College Hospital

Ibadan. Journal of Obstetrics and Gynecology Research, 35(2), 277-281.

Doi:10.1111/j.1447-0756.2008.00937.x

Pender, N. J., Murdaugh, C.L., & Parsons, M. A. (2002). Health promotion in nursing practice

(4th ed). Upper Saddle River, NJ: Prentice Hall.

.
Perception: A Concept Analysis 18

Reifsnider, E., Flores-Vela, A.R., Beckman-Mendez, D., Nguyen, H., Keller, C., & Dowdall-

Smith, S. (2006). Perceptions of children’s body sizes among mothers living on the

Texas-Mexico border (LaFrontera). Public Health Nursing, 23(6), 488-495.

Roche, P. (2007). Pain and placebo analgesia: two sides of the same coin. Physical Therapy

Reviews, 12(3), 189-198. doi 10.1179/108331907X222985

Rogets’s II: The new thesaurus (3rd ed.) New York: Houghton Mifflin.

Saxe, J. G. (n.d.). The blind men and the elephant. Retrieved from

http://www.constitution.org/col/blind_men.htm

Tierney, S., & Fox, J. R. E. (2010). Living with the ‘anorexic voice’: A thematic analysis.

Psychology and Psychotherapy: Theory, Research, and Practice, 83, Part 3,243-254.

Urdapilleta, I., Cheneau, C., Masse, L., & Blanchet, A. (2007). Comparative study of body image

among dancers and anorexic girls. Eating and Weight Disorders, 12(3), 140-146.

Walker, L.O., & Avant, K.C. (2005). Strategies for theory construction in nursing (4th ed.)

Upper Saddle River, NJ: Pearson/Prentice Hall.

Young, W. P. (2007). The shack. Newberry Park, CA: Windblown Media.

Wikipedia. (2008). Perception. Retrieved from http://en.wikipedia.org/wiki/List_of_perception-

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