RESEARCH – (Kerlinger) systematic, empirical, controlled & critical investigation of a hypothetical proposition related to natural phenomenon. PHENOMENON – anything that affects human life - disease, signs & symptoms, procedures, MD, RNs HYPOTHESIS – educated guess, scientific guess, tentative statement of a supposed answer. - not known yet if true of false, right or wrong RESEARCH - must be conducted to affirm or deny a hypothesis. 4 major Characteristics of a Scientific Research 1. Systematic – follow step by step process. Fr identification of problem to conclusion. 2. Empirical – proper objective. To collect data, facts & evidence to support hypothesis. 3. Controlled – proper planning/ direction. Research design. 4. Critical investigation – fact finding investigation. (synonym) PURPOSE OF ASIENTIFIC NURSING RESEARCH D – descriptive purpose. Gain richer familiarity regarding a phenomena. Observation. 100% known to RN. E – exploratory purpose. 50% still unknown to RN. E – experimental purpose. Perform manipulation. Perform intervention. What to find out cause & effect. D – developmental purposes. Fro improvement of system of care. F Nightingale – birthplace. Italy Training ground: Germany Greatest contribution: environmental theory & training of RNs in Crimean War School: St. Thomas School of Nursing Patient –nursing focus on research 10 MAJOR STEPS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Identification or formulation of research problem Review of related literature conceptualization of conceptual/ theoretical framework Formulation/ Adapting hypothesis Choosing the appropriate design Choosing sample from pop Conducting final study or pilot study Collection of data base Analysis & interpretation of data base Disseminating the conclusion & recommendation.
Problem: in res – requires a solution Sources (CLIENT) of good problem C – concepts L – literatures I – issues E – essays N – nursing problems T – theories Char of good problem (GRIFINS) G – general applicability – result should be helpful or applicable to all. a.) basic/ Pre – for personal knowledge b.) Applied – focus is solving problems of others Re – researchable – collectable & abundant data F – feasible or measurable a.) time b.) money/ cost c.) participants d.) instruments
e.) experience f.) proper ethics of good researcher I – important N – novelty – original to avoid plagiarism. S – significant ETHICS OF A PROPER RESEARCHER: (SCIENTIFIC) S – scientific objective always (good faith) C – consent I – integrity E – equitable (appropriate acknowledgments) liable for N – noble – Respect 3 basic rights of research sample T – truthfulness I – importance of topic to nursing profession C – courage to look for data. Legal owner of chart: Hospital Legal owner of data in the chart: Patient Plagiarism – illegal replication: no consent & acknowledge 3 rights of sample/ pt 1.) Right not to be harmed 2.) Right to self determination – get consent & right to withdraw consent 3.) Right to privacy a.) anonymity – privacy of identity of informant b.) confidentiality – name given but privacy of info/ data Harm that can happen to sample/pt 1.) right from physical , mental & moral harm 2.) Right to self determination Negligence 1.) Commission – unacceptable in standard of practice 2.) Owrission – didn’t do anything. No intervention done. Mental Harm: 1.) Assault – threatened. Mental fear 2.) Assault & Battery – with mental fear & physical harm 3.) Battery – with physical harm. Moral harm – Slander – Oral defamation – Libel Restraint – dependent with doctors order - physical – vest or jacket - chemical – valium A study in the difference in the financial income of Filipinos working in NYC & QC (comparative & basic) Variables – anything that is subject t change on manipulation. 1.) Independent variable – target population IV – stimulus intervention 2.) Dependent variable – response DV – response measured Independent variable (stimulus)
Target Population (Organism)
Place of work
Filipino RNs Reviewers
Dependent Variable (Response) Financial income early review Jan
Pavolovian Theory (SOR) Stimulus Organism Response Intervening variables comes between independent & dependent ex. Organismic variable internal factors age, sex, gender, color. Extraneous variable – ext influences can be changed Allure, citizenship, educational status Dichotomus variable – 2 choices/ results Ex. Male or Female Polychotmus – multiple choices/ multi variables Preferred food – Japanese, Chinese, Filipino, American Research 1.) Identity Problem 2.) Purpose – objective (SMART) 3.) Define terms 4.) Revision of terms S – smart M – measurable A – attainable R – realistic T – time bound (limit) Conceptual definition – dictionary meaning Operational definition – based on use of research char of problem Toxic – conceptual – waste products Operational – very busy day for RNs Review of related literature Purpose: for proper formulation of conceptual & theoretical framework. Theory – relationship bet concepts Conceptual framework. Illustration showing relationship between variables Paradigm- diagrammatic presentation / illustration of conceptual framework. Source of review literature 1. Conceptual Sources – authors & conceptualists ( DOH book, Lippincott, Mosbys) - for general use, can be sold. 2. Research sources – researchers cant be sold. Types of Hypothesis: 1. NULL hypothesis (-) no relationship, no difference bet 1 variable to another ex. There’s no diff regarding prof Opportunities in US & RP 2. Alterative, simple or operational hypothesis – (+) show a relationship bet 1 variable to another ex. Filipino RNs has more prof opportunities un US 3. complex hypothesis – shows a relationship bet 2 or more variables to another. Ex. Filipino RNs who worked for 5 yrs & passing all CG tests have opportunities to acquire starting salaries, insurance. 4. Directional Hypothesis – specifies the direction of relationship bet variables Ex. Filipino RNs working in USA have more prof opportunities than those in Phil 5. Non directional Hypothesis – no specific direction There is a big difference between all Filipino RNs working in the USA
5 Choosing appropriate design: - skeletal framework of research Research Design: According to application or motive According to approach According to data Method used applicable to quantitative research: survey Case study – focus 1 patient only or 1 family Research Design Application motive Basic / pure
Approach
Data
Applied
Quantitative (majority answer) Survey
Qualitative facts (single pt) Case study
Non experimental 1.) Observe sample subject, Research has 2.) Massive participation 3.) Describe & record 4.) Natural setting – where pop exists Experimental: 1.) Active manipulation – treatment or intervention done 2.) Active participation to sample pop 3.) Controlled setting – lab research units Types of non experimental res design. 1. Historical research design – happened in the past - collect written, published, circulated or archived - pt’s chart ex. Health practices during Crimean War 2. Expost Facto (after facts) (Retrospective) - Antecedent facts happened Study a group of people who have naturally experienced a particular phenomena related to a problem & has something to do with present study - Interview only, no manipulation! Subject is related to present problem. 3. Prospective – focus; future time to look for a data existing subject with future happening Focus: weekend review in pentagon Result: of board exam this coming June Present future 4. Descriptive – no intervention but merely observe & collect data. Ex. Study on absentism in St Lukes Study on environmental pollution in Quezon Types: a.) comparative study – similarity & difference of variables ex. Environmental pollution between variables b.) Correlatonal – relationship between variables ex. Environmental pollution & increased TB cases
c.) Evaluative – effects/ results ex. Effects of environmental pollution d.) Survey type – data collection based on majority result Types or survey research 1.) groups – small group 2.) Face to face method - can get response/ feed back right away b.) Mailed survey method Problem; data collection 3.) Time orientation Cross sectional & longitudinal – extend period of time. 2 or more # of groups – 1 core group/ long term study unidentical groups - purpose: dev’t/ study - purpose: comparison - initial & fallow up survey - short term study # of time Steps in experimental type of research design 1. controlled stage – discipline/ direction a controlled group – will not be subjective experimental – group will be manipulated 2. Randominization – choose your sample by chance 3. Manipulation - intervention 4. Measurements of effect – determine the result Quasi experimental- when you lack in steps in experimental Pop – group where you get your sample Types of sampling 1.) Probability – choose sample by chance Types of probability Incidental sampling – these present in coffee shop a.) Simple random sampling – equal chance/ opportunity to be chosen - done if identical or equal footing b.) Stratified random sampling – create subdivided population (divide into 4 levels in school) or substrata before doing randominization c.) Cluster random sampling – create sub areas MNL hospitals – UST – 3rd floor d.) Systematic random sampling – sampling frame 3,000 HIV patients in Phil – write list of names appearing in pop uses multiple number in choosing. 2. Non probability sampling – not by chance - with pre-selected group, with braised group, favoritism a.) Accidental or convenience sampling. Criteria – immediate availability/ accessibility of sample. b.) Purposive/ judgmental sampling. - based on personal knowledge/ info ex. Research on prostitution I know location of prostitution – Ermita Prostitution also in Pasay & Makati I will not choose Pasay & Makati only Ermita because I have personal info c.) Snowball sampling – based on last referral d.) Quota sampling – setting a certain criteria, with favoritism will choose only who he likes. Collection of Data Base: - time & budget consuming – 70 –80% time Methods of collection of data 1.) Questionnaire – source of collection f data - pen & paper type of data 3 Major type of Q
a.) Dichotomasis – (2) – answerable by T/F, Y/N, right or wrong b.) Checklist style – rating scale 1,2,3,4,5 poor, fair, average. . . c.) Multiple choice – a) man b) dog c) cat d) all of the above 2.) Records – easiest – get pre existing data – journals, essays, documents, newspapers 3.) Interviewer – use oral communication 1.) Structured – with checklist formal 2.) Non structured – anything goes answer open ended questions. The sample will expand on topic researcher will illicit answers their ACTIVE LISTENING. 4.) observation – ocular approach a.) Participant – journey b.) Non-participant – passive observer but uses tools to determine results of data. 2 main problems in colleting data 1. Hawthorne’s effect – problem in experimental design inaccurate due to consciously being observed (PAASCU accreditation – management keeps school clean before PAASCUA comes to school. 2. Halo Effect – special relationship inaccurate due bias - solution of researcher to avoid halo effect do double blind res method Double blind research – no bias or prejudice on treatment blind folded - gives accuracy due not conscious & biased Analysis & Later pultation of data phase - research is forming a body of knowledge for the purpose providing an answer 2 Methods in presenting your analysis 1.) Qxuantitative – using numerical or graphical presentation of answer ex. 50% of q 500 Filipinos becomes 75% richer - or use pie chart, bar graph, line graph 2.) Quantitive – narrative approach using words (text) & facts ex. Majority of all graduating students prefer to nursing course than PT
LEADERSHIP Dissemination of Finding/ Core/ Recommendations Importance of core – conc is final result of study How can conc affect others – recommendation Methods of dissemination of Findings/ Result a.) Book b.) Symposia – oral c.) Publication LEADER will influence LEADERSHIP S T Y
1 L E
P R 4 group Called Followers
O C 2 E S S
5 goal/ objective– patient – recipient of care RNs implementor, assistant to dentist, Not leader
Principles for effective leadership 1. Unity of command – all will receive orders, command from nurse manager/ supervisor 2. Unity of direction – whole group leader &newborns will have goal – towards patient. 3. Subordination of personnel to the general interest - save patient 1st before self (ex fire in pt room) R – remove/ rescue patients A – alert fire alarm C – confine fire in / area E – extinguish fire R – run 4. Esprit de corps – team spirit fault of one is fault of all credit of 1 is credit of all 5. Chain of command - hierarchy Patient reacted to meds given, allergy. Inform MD he will give anti-histamine. Incident report – for purpose of risk management - Report of sudden occurrence - Go to Head nurse Pt has appendicitis. Pain in RLQ who is primarily responsible for patient – Head nurse. HN can delegate to staff nurse pt died. Head Nurse is liable Command responsibility – Respondia Superior Theories of effective leader. 1. Great man theory – to be a good leader, leader must be born. Leaders cant be developed. Some are born a follower. 2. Trait theory – behavior/ characteristic P – personality I – intelligence A – ability Personality – + attitude/ trait/ knows to adjust to pt – adaptability a.) acceptability – can cope, adjust to needs of pt b.) independent c.) creative/ assertive d.) advocate Char of nurse if you are defender of patient against harm/ negligence – advocate Intelligence – proper judgment Proper decision Fluency of speech Ability – influence others – most effective way to influence pt – HI optimum level of is attain OLF Command of others Respect others Participate Cooperate 3. Charismatic theory – charm, charisma, inspirational quality 4. situational theory – a person can be a good leader in 1 situation & a follower in another situation. Case to case Adv – can get best person to the job Disadvantage – there’s no continuity of leadership
Styles of leadership:
1. Autocratic – authoritarian, dictatorial, bureaucratic traditional or “Hard leader” - Unilateral style of nursing - Leader is only 1 performing without input from other staff. - Not getting opinion, recommendations Char – unilateral from style of staff leadership – leader does decision making without. A – apathy – not sensitive B – boisterous speech C – consistent Demanding – E – egoistic F – ferocious Putting self in shoes of pet recognize & sensitive to pt. – empathy Not good style in leadership but good in emergency cases. Or during acute crisis. 2. Laizzes Faire/ Frierein/ Loose - excess freedom / or liberates to members - authority neglect control malpractice discipline
patients will suffer
3. Democratic / Participative - gets input from members (decision making) - Mutual participation - Members makes mistake – member will get notice/ hearing before discipline = due process Quality/ Skills/ Abilities of good nursing leader: A – authority B – behavior C – Communication skills D – decision making E – ethics F – face conflict A – ability – basis of a leader to unsure / demand task, obligation & resp to his subordinates. 2 types 1. Centralized – top to bottom for proper management of whole hospital - to problems of whole institution 2. Declaralized – bottom (delegation) - to manage directly pts or concerns B. Behavior of good nurse leader: S – specific body of knowledge & skills to do safe care to patient. RN should be competent with scientific rationale P – patient cettered/ client focus A – accountability – liable for result of actions C – confidentiality E – ethics General rule: RN: can be charged with : Invasion of privacy, breach of confidentiality Exemption to gen rule (RN cant be charged with breach of confidentiality ) P – patients consent I – inform/ report to other members of HC team for precautionary measure C – common dse (report) – DOH/ WHO C – crimes – within 48h – report child abuse RA 3573 – Law on notifiable disease Within 24h report disease like – polio & measles 1 week – HIV/ tetanus/ severs acute diarrhea
Priority for child – rape – sexual abuse, domestic abuse, all kinds of abuse a.) report to barangay official b.) report to police c.) provide safe environment – focus on pt 1st – reporting can be done within 48h d.) call med legal Rule!! (in order) 1. S – safety 2. R – report 3. R – referral – DSWD, NGO C – communication skills - transfer of ideas / info with understanding Without understanding barrier/ backlog Sender – message – (idea/ info which sender would like to transmit Encoding – verbal or non verbal method Receiver – recipient of communication Decoding – manner of interpretation after receiving messages Feedback – response of receiving after interpreting messages D –decision making E – ethics Principle: 1. Autonomy – independent judgment & decision making who should decide for care of patient. a.) doc b.) attending pt c.) pt d.) relatives Pt refuses to remove lucky bracelet before surgery Bt due- Jehovah’s witness a.) respect decision of pt – respect cultural diversity b.) refer to doc – let doc explain risks involve c.) let pt sign a waver Doctrine of assumption or risk - pt given risks & signed waver - pt will assume all the risks/ danger Pills IUD - string should be checked during & after mens Diaphragm – removed after 6h Toxic shock syndrome Vasectomy – after 2 negative sperm count, 1st is probable 2nd is confirmatory BTL – can do coitus anytime. When pain & bleeding ceases. Principles in leadership Veracity – truth don’t give false reassurance - all med prognosis, dx, sex of baby – given by MD! Beneficence – doing good to pt Non malefience – do no harm 3 type of harm 1. Physical – negligence by commission – performed wrong action negligence by omission – neglect of care 2. Mental – assault – mental threat/ fear battery – physical harm 3. Moral – slander – verbal libel – written, published pictures Tolality – let pt feel like a whole being even if a part is removed. - offer wigs, bandana – CA pt prosthesis, casts, w/c – amputation
Double effect – if made to choose between 2 evils, choose the one that will have les bad effect. More good effect Justice of care – priority coz @ pt has unique needs. Basic char or nursing process A – acceptance universable B – based on pts needs C – client focus D – dynamic – update nursing process depending on clients needs E – equitable care F – familiarity G – goal oriented toward solving problem Inviolability of life – respect of life (promote H & prevent disease) - no abortion! Conflict – clash of ideas resulting to crisis Methods to solve conflict. A – avoidance – putting in one corner – dedma – not good method S – smoothing – appealing to conscience/ kindness U – unilateral – force fear, threats correction N – negotiation – best method – both parties will mutually decide & participate to solve problem. Nsg management Mgt – MAN+ TASK = GOAL (pts) Theories: 1. Human relations theory – must focus on proper relationship If needs provided to member (rest day, leave) Achievement of organization 2. Frederick Taylors scientific mgt theory 4 t’s Tao – get rt person/ tao Training Tool Tx 3. Douglas McGregor mgt theory Theory Y Positive worker - efficient diligent trustworthy reliable love their job = minimal supervision only
Theory X Negative worker - inefficient negligent non trustworthy don’t love job for the money only = increase cases of negligence affecting pts. = use cozf I d power to discipline workers
4. Max Weber’s burocaratic (autocratic) theory - whoever is on top would perform mgt functions - centralized - not good style of management 5. Elton Mayo’s behavioral theory - overtime pay, rest day, day off - provide physical needs of worker like rest & recreation - HAWTHORNE’S EFFECT – if worker knows that they are being observed, workers will have better output. 6. Henry Fayol’s principles of mgt a.) Unity of command – one person given instructions to workers b.) Unity of direction – whole team should have one goal, objective, direction towards pt. c.) Subordination – personal general interest – pt 1st before self d.) Esprit de corp – team spirit – all (-) & (+) output credited to the group e.) Chain of command – heiarchy of command Get appropriate orders from MD
f.) Channels of communication – MD orders SN SN g.) Respondent supervisor – command responsibility - let master answer for negligence conduct of subordinate - liable: both HN liable for damages – due resp supervisor SN – negligence - jail h.) Security of tenure – i.) Re-numeration of workers – compensation - probationary – 6 months - regular employee Private – RA 4901 – 40% work 8h a day 5 days a week Gov’t – RA 7375 – magna carta for public HWorker 15k Overtime = + 25% Night shift differential = +10% Special non working holiday + 30% Legal Holiday= X2 +100% Occupational Hazard – work related disease Private – SSS – employees compensation Gov’t – GSIS National health Insurance Act – PhilHealth - Provide for unemployed/ employed - Aesthetic, cosmetic, dental not included Maternity leave – 60 days NSD 78 days C/S 1st 4 pregnancies to legit spouse th 4. Abortions 5 pregnant - & delivered – not entitled to maternity leave Paternity leave 7 days Stage/ Steps in nursing management process P – planning O – organizing S – staffing D – directing/ delegating Co – coordinating Co – controlling/ eval Planning stage – conceptualizing/ product of mind/ looking at future/ looking prospectively Types: Vision – what org likes to achieve in future Ex. Health for all by 2000 Heath in the hands of the people by 2020 Mission – focus in present - reason why org was established ex. DOH – to five quality health Philosophy – values. Besides org (members) Goal – gen statement of mission Objective – specific statement of mission Goal- nursing form St. Lukes should provide quality care to pt Objective – nursing from St Lukes should have IV training (specific) Policies – set of rules/ regulation of org
3 types of plan 1.) Short term – for every day ordinary activity ex. NCP 2.) Contingency plan – for emergency or acute crisis, stand by plan 3.) Long term plan – duration of care is linger for chronic pts. Ex. CVA pts Budgeting – performed in planning stage - proper allocation of resources - Money, manpower, machine 1.) Operati0nal budget – cheapest – everyday ordinary activities (gloves, gown, goggles – OR, LR, DR,ER) 2.) Personal/ labor budget – used to compensate & re-numerate labor – most important 3.) Capital budget – long term use equipment - MRI equipment, beds Budget – asks “How” Organizing stage – answers the question ‘WHO” Nurse Mgr RN Subordinate Nsg personnel – nurse aid RN will do: (for stable & unstable pt) A – assessment T – health teaching – when best time start discharge E – explain proc to pt health teaching – start during admission of pt P – preparation – computation of dosage A – adm – give meds or treatment T – treatment – oral, IV, ID E – evaluation – nursing care plan J – judgment – PRN meds – nursing will decide when to five Subordinates can perform: (comfort measures only not VS) R – routine tasks – standard procedure, monitor I & O ambulating, bathing bed making - stable pts – predictable outcomes S – stable pts S – supervision of RN Styles/ method delivery care 1. Primary nursing – private duty nurse – from admission to d/c! D – direct plan of care to pt A – active participation/ consent of pt. M – mgt of care – from basic to complex PD will do 24h – from admission t o discharge tip = answer is primary nurse 2. Functional – most useful type D – duty task – 1 RN all patients O – one task H – highly recommended RNS budget 3. Case Method – ICU critical case resp for: T – total care (from basic care to most complex) O – one RN: 1 patient In extreme cases 1:2 pts Staffing stage – “how many” - nurse manager will determine correct # of patients/ RN Staffing pattern – Phil – 40h/ wk/ 5d Traditional – 8h/40h/5d
10h shift – 10h/ 4d Monday – Thursday On call – emergency schedule Baylor plan – M – F (traditional) Sat-Sun (skeletal force) Directing/ Delegation stage – job/ task is done by another pt for you. Gen rule: RN can delegate any task to another RN Except: disciplinary task (this is done by higher person) : confidential task (charting) : technical task (expertice should be done by same expert) : official medical task Coordinating/ collaboration stage 1. canned food – highest purine content (uric) 2. Anchovies – next highest purine content 1. Interpersonal/ intra departmental – collaboration bet 1 nurse to another nurse - under 1 ward - ex. Endorsement 2. Interdepartmental – collaboration between two or more hosp for benefit of pt. Why RN needs to collaborate to others in HC team? - pt is entitled to continuous care. Evaluation stage – determine whether, plan goal, objective where met or achieved Types” 1. Nurse rounds – 2 x rounds/ day - short term plan Psyche ward – contraindicated nurse rounds in psych ward 2. Checklist – Nurse mgr – evaluates/ rates member 3. Gam H chart – used to evaluate nurses , multiple plan at same time 4. Peer evaluation – co workers – poorest type of eval – cause might be effected by halo effect due to special relationship. Performance Appraisal – pt or client evaluates most reliable coz --------- or care evaluates.
