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 Research1. 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 RESEARCHD – 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: GermanyGreatest contribution: environmental theory & training of RNs in Crimean WarSchool: St. Thomas School of Nursing

Patient –nursing focus on research

10 MAJOR STEPS

1. Identification or formulation of research problem2. Review of related literature3. conceptualization of conceptual/ theoretical framework 4. Formulation/ Adapting hypothesis5. Choosing the appropriate design6. Choosing sample from pop7. Conducting final study or pilot study8. Collection of data base9. Analysis & interpretation of data base10. Disseminating the conclusion & recommendation.

Problem: in res – requires a solution

Sources (CLIENT) of good problemC – conceptsL – literaturesI – issuesE – essaysN – nursing problemsT – theories

Char of good problem (GRIFINS)G – general applicability – result should be helpful or applicable to all.

a.) basic/ Pre – for personal knowledgeb.) Applied – focus is solving problems of others

Re – researchable – collectable & abundant dataF – feasible or measurable

a.) timeb.) money/ costc.) participantsd.) instruments

e.) experiencef.) proper ethics of good researcher

I – importantN – novelty – original to avoid plagiarism.S – significant

ETHICS OF A PROPER RESEARCHER: (SCIENTIFIC)

S – scientific objective always (good faith) C – consentI – integrityE – equitable (appropriate acknowledgments) liable forN – noble – Respect 3 basic rights of research sampleT – truthfulnessI – importance of topic to nursing professionC – courage to look for data.

Legal owner of chart: HospitalLegal owner of data in the chart: PatientPlagiarism – illegal replication: no consent & acknowledge

3 rights of sample/ pt1.) Right not to be harmed2.) Right to self determination – get consent & right to withdraw consent3.) Right to privacy

a.) anonymity – privacy of identity of informantb.) confidentiality – name given but privacy of info/ data

Harm that can happen to sample/pt1.) right from physical , mental & moral harm2.) Right to self determination

Negligence1.) Commission – unacceptable in standard of practice2.) Owrission – didn’t do anything. No intervention done.

Mental Harm:1.) Assault – threatened. Mental fear2.) Assault & Battery – with mental fear & physical harm3.) 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 intervention2.) Dependent variable – response DV – response measured

Independent variable(stimulus)

Place of work

Target Population(Organism)

Filipino RNsReviewers

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/ resultsEx. Male or Female

Polychotmus – multiple choices/ multi variables

Preferred food – Japanese, Chinese, Filipino, American

Research1.) Identity Problem2.) Purpose – objective (SMART)3.) Define terms4.) Revision of terms

S – smartM – measurableA – attainableR – realisticT – time bound (limit)

Conceptual definition – dictionary meaningOperational definition – based on use of research char of problem

Toxic – conceptual – waste productsOperational – very busy day for RNs

Review of related literaturePurpose: for proper formulation of conceptual & theoretical framework.

Theory – relationship bet conceptsConceptual framework. Illustration showing relationship between variables

Paradigm- diagrammatic presentation / illustration of conceptual framework.

Source of review literature1. 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 anotherex. 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 variablesEx. Filipino RNs working in USA have more prof opportunities than those in Phil

5. Non directional Hypothesis – no specific directionThere 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 motiveAccording 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 Qualitative

(majority answer) facts (single pt)

Survey Case study

Non experimental 1.) Observe sample subject, Research has 2.) Massive participation3.) Describe & record4.) Natural setting – where pop exists

Experimental:1.) Active manipulation – treatment or intervention done2.) Active participation to sample pop3.) 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 chartex. 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 happeningFocus: 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 variablesex. Environmental pollution between variables

b.) Correlatonal – relationship between variablesex. Environmental pollution & increased TB cases

c.) Evaluative – effects/ resultsex. Effects of environmental pollution

d.) Survey type – data collection based on majority result

Types or survey research1.) groups – small group2.) Face to face method - can get response/ feed back right away b.) Mailed survey method Problem; data collection3.) Time orientation

Cross sectional & longitudinal – extend period of time. 2 or more # of groups – 1 core group/ long term studyunidentical groups - purpose: dev’t/ study- purpose: comparison - initial & fallow up survey- short term study # of time

Steps in experimental type of research design1. controlled stage – discipline/ direction a controlled group – will not be subjective experimental – group will be manipulated2. Randominization – choose your sample by chance3. Manipulation - intervention4. Measurements of effect – determine the result

Quasi experimental- when you lack in steps in experimental

Pop – group where you get your sample

Types of sampling1.) 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 footingb.) Stratified random sampling – create subdivided population (divide into 4 levels in school) or substrata before doing randominizationc.) Cluster random sampling – create sub areas MNL hospitals – UST – 3rd floord.) 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, favoritisma.) 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 infoc.) 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 data1.) 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 wrongb.) 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, newspapers3.) Interviewer – use oral communication

1.) Structured – with checklist formal2.) Non structured – anything goes answer open ended questions. The sample will expand on topic researcher will illicit answers their ACTIVE LISTENING.

4.) observation – ocular approacha.) Participant – journeyb.) Non-participant – passive observer but uses tools to determine results of data.

2 main problems in colleting data1. 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 analysis1.) 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

LEADERSHIPDissemination of Finding/ Core/ Recommendations Importance of core – conc is final result of studyHow can conc affect others – recommendation

Methods of dissemination of Findings/ Resulta.) Bookb.) Symposia – oralc.) Publication

LEADER will influence

LEADERSHIP

S P T R

1 Y O L 4 C 2

E group E Called S Followers S

5 goal/ objective– patient – recipient of care

RNs implementor, assistant to dentist, Not leader

Principles for effective leadership1. Unity of command – all will receive orders, command from nurse manager/ supervisor2. 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 patientsA – alert fire alarmC – confine fire in / areaE – 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 – abilityPersonality – + attitude/ trait/ knows to adjust to pt – adaptability

a.) acceptability – can cope, adjust to needs of ptb.) independentc.) creative/ assertived.) advocate

Char of nurse if you are defender of patient against harm/ negligence – advocate

Intelligence – proper judgmentProper decisionFluency of speech

Ability – influence others – most effective way to influence pt – HI optimum level of is attain OLF Command of othersRespect othersParticipateCooperate

3. Charismatic theory – charm, charisma, inspirational quality4. situational theory – a person can be a good leader in 1 situation & a follower in another situation.

Case to caseAdv – can get best person to the jobDisadvantage – 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 sensitiveB – boisterous speechC – consistentDemanding – E – egoisticF – 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 patients will suffer control malpractice 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 – authorityB – behaviorC – Communication skillsD – decision makingE – ethicsF – face conflict

A – ability – basis of a leader to unsure / demand task, obligation & resp to his subordinates.

2 types1. 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 rationaleP – patient cettered/ client focusA – accountability – liable for result of actionsC – confidentialityE – 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 consentI – inform/ report to other members of HC team for precautionary measureC – common dse (report) – DOH/ WHOC – crimes – within 48h – report child abuse

RA 3573 – Law on notifiable diseaseWithin 24h report disease like – polio & measles1 week – HIV/ tetanus/ severs acute diarrhea

Priority for child – rape – sexual abuse, domestic abuse, all kinds of abusea.) report to barangay officialb.) report to policec.) provide safe environment – focus on pt 1st – reporting can be done within 48hd.) call med legal

Rule!! (in order)1. S – safety2. R – report3. R – referral – DSWD, NGO

C – communication skills - transfer of ideas / info with understanding

Without understanding barrier/ backlogSender – 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 messagesD –decision makingE – ethics

Principle:1. Autonomy – independent judgment & decision making who should decide for care of patient.

a.) docb.) attending ptc.) ptd.) relatives

Pt refuses to remove lucky bracelet before surgery Bt due- Jehovah’s witnessa.) respect decision of pt – respect cultural diversityb.) 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 mensDiaphragm – removed after 6h Toxic shock syndromeVasectomy – after 2 negative sperm count, 1st is probable 2nd is confirmatoryBTL – can do coitus anytime. When pain & bleeding ceases.

Principles in leadershipVeracity – truth don’t give false reassurance- all med prognosis, dx, sex of baby – given by MD!

Beneficence – doing good to ptNon malefience – do no harm

3 type of harm1. Physical – negligence by commission – performed wrong action negligence by omission – neglect of care2. Mental – assault – mental threat/ fear

battery – physical harm3. Moral – slander – verbal

libel – written, published picturesTolality – 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 effectJustice of care – priority coz @ pt has unique needs.

Basic char or nursing processA – acceptance universableB – based on pts needsC – client focusD – dynamic – update nursing process depending on clients needsE – equitable careF – familiarityG – goal oriented toward solving problem

Inviolability of life – respect of life (promote H & prevent disease)- no abortion!

Conflict – clash of ideas resulting to crisisMethods to solve conflict.

A – avoidance – putting in one corner – dedma – not good methodS – smoothing – appealing to conscience/ kindnessU – unilateral – force fear, threats correctionN – negotiation – best method – both parties will mutually decide & participate to solve problem.

Nsg managementMgt – 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’sTao – get rt person/ taoTrainingToolTx

3. Douglas McGregor mgt theory - Theory Y Theory XPositive worker Negative worker- efficient - inefficientdiligent negligenttrustworthy non trustworthyreliable don’t love joblove their job for the money only= minimal supervision 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 workersb.) Unity of direction – whole team should have one goal, objective, direction towards pt. c.) Subordination – personal general interest – pt 1st before selfd.) Esprit de corp – team spirit – all (-) & (+) output credited to the groupe.) Chain of command – heiarchy of commandGet appropriate orders from MD

f.) Channels of communication – MD orders

SN SNg.) Respondent supervisor – command responsibility - let master answer for negligence conduct of subordinate

- liable: bothHN liable for damages – due resp supervisor

SN – negligence - jail

h.) Security of tenure – i.) Re-numeration of workers – compensation

- probationary – 6 months- regular employeePrivate – RA 4901 – 40% work 8h a day 5 days a weekGov’t – RA 7375 – magna carta for public HWorker 15kOvertime = + 25% Night shift differential = +10%Special non working holiday + 30%Legal Holiday= X2 +100%Occupational Hazard – work related disease

Private – SSS – employees compensationGov’t – GSIS

National health Insurance Act – PhilHealth- Provide for unemployed/ employed- Aesthetic, cosmetic, dental not includedMaternity leave – 60 days NSD

78 days C/S1st 4 pregnancies to legit spouse

4. Abortions 5th pregnant - & delivered – not entitled to maternity leavePaternity leave 7 days

Stage/ Steps in nursing management processP – planningO – organizingS – staffing

D – directing/ delegating

Co – coordinatingCo – controlling/ eval

Planning stage – conceptualizing/ product of mind/ looking at future/ looking prospectivelyTypes: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 establishedex. DOH – to five quality health

Philosophy – values. Besides org (members) Goal – gen statement of missionObjective – specific statement of mission

Goal- nursing form St. Lukes should provide quality care to ptObjective – nursing from St Lukes should have IV training (specific)

Policies – set of rules/ regulation of org

3 types of plan1.) Short term – for every day ordinary activityex. NCP2.) Contingency plan – for emergency or acute crisis, stand by plan3.) 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 important3.) Capital budget – long term use equipment - MRI equipment, beds

Budget – asks “How”Organizing stage – answers the question ‘WHO”

Nurse Mgr

RN

SubordinateNsg personnel – nurse aid

RN will do: (for stable & unstable pt)

A – assessmentT – health teaching – when best time start discharge E – explain proc to pt health teaching – start during admission of ptP – preparation – computation of dosageA – adm – give meds or treatmentT – treatment – oral, IV, IDE – evaluation – nursing care planJ – 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 outcomesS – stable ptsS – supervision of RN

Styles/ method delivery care1. Primary nursing – private duty nurse – from admission to d/c!

D – direct plan of care to ptA – 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 nurse2. Functional – most useful type

D – duty task – 1 RN all patientsO – one taskH – highly recommended

RNS budget

3. Case Method – ICU critical caseresp 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/ 5dTraditional – 8h/40h/5d

10h shift – 10h/ 4d Monday – ThursdayOn call – emergency scheduleBaylor 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 stage1. 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 planPsyche ward – contraindicated nurse rounds in psych ward

2. Checklist – Nurse mgr – evaluates/ rates member3. Gam H chart – used to evaluate nurses , multiple plan at same time4. 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.