INTRODUCTION TO NURSING RESEARCH

-----------------------------------------------------------------------------------------------------------------------------------------------------------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 didnt 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 Target Population Dependent Variable

(stimulus) Place of work

(Organism) Filipino RNs Reviewers

(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. Theres 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 Applied Approach Data Quantitative (majority answer) Survey 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 - pts 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: Qualitative facts (single pt) Case study

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: devt/ 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. Hawthornes 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 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 theres 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- Jehovahs 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 dont 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 ts 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 dont love job for the money only = increase cases of negligence affecting pts. = use cozf I d power to discipline workers

4. Max Webers burocaratic (autocratic) theory - whoever is on top would perform mgt functions - centralized - not good style of management 5. Elton Mayos behavioral theory - overtime pay, rest day, day off - provide physical needs of worker like rest & recreation - HAWTHORNES EFFECT if worker knows that they are being observed, workers will have better output. 6. Henry Fayols 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 Govt 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 Govt 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.

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 5. Systematic follow step by step process. Fr identification of problem to conclusion. 6. Empirical proper objective. To collect data, facts & evidence to support hypothesis. 7. Controlled proper planning/ direction. Research design. 8. 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 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 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. c.) basic/ Pre for personal knowledge d.) Applied focus is solving problems of others Re researchable collectable & abundant data F feasible or measurable g.) time h.) money/ cost i.) participants j.) instruments k.) experience l.) 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 4.) Right not to be harmed 5.) Right to self determination get consent & right to withdraw consent 6.) 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 3.) right from physical , mental & moral harm 4.) Right to self determination Negligence 3.) Commission unacceptable in standard of practice 4.) Owrission didnt do anything. No intervention done. Mental Harm: 4.) Assault threatened. Mental fear 5.) Assault & Battery with mental fear & physical harm 6.) 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. 3.) Independent variable target population IV stimulus intervention 4.) Dependent variable response DV response measured Independent variable (stimulus) Place of work Target Population (Organism) 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 5.) Identity Problem

6.) Purpose objective (SMART) 7.) Define terms 8.) 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. Theres 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 Approach Data

Basic / pure

Applied

Quantitative (majority answer) Survey

Qualitative facts (single pt) Case study

Non experimental 5.) Observe sample subject, Research has 6.) Massive participation 7.) Describe & record 8.) Natural setting where pop exists Experimental: 4.) Active manipulation treatment or intervention done 5.) Active participation to sample pop 6.) 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 - pts 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 4.) groups small group 5.) Face to face method - can get response/ feed back right away b.) Mailed survey method Problem; data collection 6.) Time orientation Cross sectional & longitudinal extend period of time. 2 or more # of groups 1 core group/ long term study unidentical groups - purpose: devt/ 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 3.) Structured with checklist formal 4.) 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. Hawthornes 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 d.) Book e.) Symposia oral f.) Publication LEADER will influence LEADERSHIP S T Y 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 4. Unity of command all will receive orders, command from nurse manager/ supervisor 5. Unity of direction whole group leader &newborns will have goal towards patient. 6. 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. 3. Great man theory to be a good leader, leader must be born. Leaders cant be developed. Some are born a follower. 4. Trait theory behavior/ characteristic P personality I intelligence A ability Personality + attitude/ trait/ knows to adjust to pt adaptability e.) acceptability can cope, adjust to needs of pt f.) independent g.) creative/ assertive h.) 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 theres 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

patients will suffer

discipline 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 e.) report to barangay official f.) report to police g.) provide safe environment focus on pt 1st reporting can be done within 48h h.) 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. e.) doc f.) attending pt g.) pt h.) relatives Pt refuses to remove lucky bracelet before surgery Bt due- Jehovahs witness d.) respect decision of pt respect cultural diversity e.) refer to doc let doc explain risks involve f.) 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 dont 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 ts 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 dont love job for the money only = increase cases of negligence affecting pts. = use cozf I d power to discipline workers

4. Max Webers burocaratic (autocratic) theory - whoever is on top would perform mgt functions - centralized - not good style of management 5. Elton Mayos behavioral theory - overtime pay, rest day, day off - provide physical needs of worker like rest & recreation - HAWTHORNES EFFECT if worker knows that they are being observed, workers will have better output. 6. Henry Fayols principles of mgt j.) Unity of command one person given instructions to workers k.) Unity of direction whole team should have one goal, objective, direction towards pt. l.) Subordination personal general interest pt 1st before self m.) Esprit de corp team spirit all (-) & (+) output credited to the group n.) Chain of command heiarchy of command Get appropriate orders from MD o.) Channels of communication MD orders SN SN p.) Respondent supervisor command responsibility - let master answer for negligence conduct of subordinate - liable: both HN liable for damages due resp supervisor SN negligence - jail q.) Security of tenure r.) Re-numeration of workers compensation - probationary 6 months - regular employee Private RA 4901 40% work 8h a day 5 days a week Govt 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 Govt 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.