Professional Documents
Culture Documents
NURSING RESEARCH
Nursing Research
• Kerlinger - the systematic, empirical, controlled and critical investigation of a
hypothetical proposition in relation to a natural phenomena/ problem
• Conducted to affirm or deny a hypothesis
Phenomenon.
• everyday phenomenon that affects the nurse (eg. bacteria, drugs, physician)
Florence Nightingale
• Birthplace – Italy
• Training Ground – Germany
• Greatest Contribution – environmental Theory, training RNs in Crimean
War 1
• School – Saint Thomas School of Nursing
Ethics of a Researcher
• S – Scientific Objective – conductive research for a good purpose or object for
your pt
• C – Cooperation and Consent. Do not conduct data/experiment w/o a consent
(legally the patient owns the chart. However the hospital owns the chart)
• I – Integrity – worked hard on the research
• E – Equitable – acknowledging works or contribution of others
• N – Nobility – protect the rights of your subjects
o Right not to be harmed
(physical, mental, moral harm) usually done during experimental
research
Physical Harm/ Negligence - undeliberate physical harm
• Commission – done outside the standard practice of
nursing (eg. urinary catheter placed on the nose of the pt)
• Omission – from the very start, you did not do something
about it.
Moral Harm
• Assault – mental fear/threat without physical harm
• Battery – physically you harm the pt
Restraint is never an independent nursing order
• physical restraint – eg. Jacket
• chemical restraint – eg. use of psychotropic drug
Moral harm
• Slander – oral defamation
• Libel – published or placed in the newspaper
o Right to self-determination
o Right to privacy
Anonymity – identity of subject may not be disclosed. Privacy of
the Informant (pt) eg. conduct a study on HIV pt. but the pt wants
his name to be written in the newspaper as Mr. X, Mr. Y or Mr. W
Confidentiality – information acquired must be disclosed. Privacy
of the information eg. conduct a study on HIV pt. but the pt wants
the nurse should only know
• T – Truthfulness – put only the data you have collected
• I – Importance – importance to the nursing profession
• F – Factual – facts or data
• I – Ideal (follow the 11 steps of research)
• C – Courage
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N – Nursing problems
T – theories
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Dependent variable : income
Research:
1. Identify the Problem
2. Purpose – objective using SMART (Systematic, Measurable, Attainable,
Realistic, Time Bounded)
3. Define Terms
a. Conceptual Definition – dictionary definition
b. Operational Definition – defined in accordance on how the researcher
used the word
4. Revision of Terms
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Complex hypothesis
• this shows a relationship between two or more
independent variable from two or more dependent
variable.
• Eg. “Filipino nurses who worked for 5yrs and passed the
CGFNS, TORFL, TSE, NCLEX has greater opportunities in
NY as compared to those in Manila
Directional hypothesis
• specifies the direction of the relationship between variables
• Eg. “Filipino Nurses working in the USA has more
professional opportunities than those working in the Phils.”
Non-directional
• only predicts the relationship, but has no specific direction
between variables.
• Eg. “There is a big difference between a Filipino Nurses
working in USA than those working in the Phils.”
• Selecting research design
o Systematic controlled plan for finding the answer to a problem
o Roadmap, blueprint of the study
o Should have a proper resign design
o If improper research design, there will be improper collection of data
o Purpose : key or tool for proper collection of data
o Types
According to Application
• Basic/ Pure
o For personal knowledge, curiosity
• Applied
o Based on problem solving approach
According to Methods
• Experimental
o performing active manipulation, observe and record
the result.
o Types of Experimental Reseach
control
• divide grp into 2.
• Group a – control/comparison grp –
will use the same soap everyday
• Group b – experimental grp – those
who will use the sample soap
randomization
• using sample by chance.
• Choose randomly to avoid
redundancy of result
Manipulation
• Performing intervention
Validation
• comparison of the effects
Quasi-experimental
• false experiment.
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• No control sample.
• Non-experimental
o No manipulation is done. Only observation,
describe and record down the result.
o Types of non-experimental research design
base on time element
Retrospective (Ex Post Facto)
• Getting actual experience
• Studies a group of people after its
occurrence, experience or facts.
• Experience of people in the past
Descriptive
• Observe, describe & record.
• Study of current events.
Prospective
• Study of research about future
occurrence or future events.
Historical
• Past that is written, documented,
published and recorded
• Primary Data
o Observe
o 1st hand information
o person himself
• Secondary Data
o 2nd Hand Information
• About the past using records,
journals, books.
• Study of the dead people thru his
written materials, facts
o according to data
quantitative
• data base on numerical
interpretation, datas that are
measurable, using your senses, data
that are observable.
qualitative
• subjective data, feelings, perception,
beliefs, culture, attitude
o Survey Research Design
Group
• Small
• Face to face
• Large – not good result
Methods
• Mailed survey
• Face to face
• Telephone survey
o According to Time Orientation
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Cross Sectional
• Applicable to 2 or more identical
group
• Short term
• For comparison
Longitudinal
• 1 group only
• with initial and follow up survey
• long term study
• for developmental study
• Selecting your population and samples
o sample
part of population, data is collected.
The recipient of the experimental treatment in experimental design
or the individuals to be observed in a non-experimental design
o Types of sampling
Probability - equal presentation/ chances in the population.
• Simple random technique
o Used a single/identical group.
o Fish bowl technique
• Stratified random sampling
o You will first going to create a sub population from
the whole population before doing randomization.
o One population, you divide it.
• Cluster random sampling
o You will first create a sub area in a population
before doing the randomization. In one population,
you make it smaller
• Systematic random sampling
o choosing a sample every nth name in the
population.
o Multiple of 100 names
o Sampling frame – list of names appearing as your
population
Non-probability sampling – you are not choosing by chance.
• Accidental/ convenience sampling
o Base on the accessibility/availability of your
sample.
o Kung sino pinakamalapit syo, yun ang kukunin mo.
• Purposive/judgmental sampling
o base on the common knowledge or popular
knowledge.
• Snow-ball sampling
o get sampling base on last referral
• Quota Sampling
o Setting criteria and getting samples fitting the
criteria
• Conducting pilot studies
• Collecting data
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o types :
questionnaires – use of pen and paper method
• dichotomous – divided into two. Eg. true orfalse. Yes or no
• rating scale – poor 1, good 2, better 3, best 4
• multiple choice
Interview – use of oral method of collection of data. Use of active
listening
• Structured – with checklist, formal talk, list of question
• Unstructured – informal talk, no pattern, anything goes
records – pre existing data
observation – use of ocular method using your senses
• participant observation
• non-participant observation
• Problems :
o Hawthorne’s effects
The data you get from your sample is not
accurate.
The sample has a problem
Solution : double blind research – they
should not be conscious that they are being
studied
o Halo effect
The researcher has a problem.
He is manipulating the data collection.
It is affected by special feelings/treatment
between the researcher and the sample.
• Analysis of Data
o part of research when the researcher is forming a body of knowledge out
of data collected for the purpose of affirming or denying your hypothesis
o Methods
Nominal method
• get data by means of categories.
• eg. male, female, income
Ordinal method – base on rank eg. mild, moderate, severe
Interval
• base on the distance between 2 numerical values
• eg. BP – 150/100 – 120/80, wt, circumference, ht
ratio – 3:10 children are malnourish
• Interpretation of Data
o 2 Methods
quantitative method – base on numerical or graphical standards
qualitative method – use of narrative words
• Communicating your conclusion
o Explaining the results of your work to the public
o Conclusion – final answer to your research
o Recommendation – suggestion to others
o Dissemination of Information
Methods :
• thesis/book – written form
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• symposia/symposium – oral presentation
• publish – a lot will be able to read your research
Nursing Leadership
• style or process whereby a person is called by a nurse leader were influence of
group of people called his followers for the purpose of attaining only one
goal/objective.
Leadership styles
• Authocratic/Authoritarian/dictatorial/”hard” leader
o unilateral style of leadership. Only the leader here performs the decision
making without getting the inputs from his members.
o One sided style of leadership Behavior :
A – apathy – insensitive to others
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B – Boisterous speech
C – consistency
D – Dominating
E – Exploitative behavior
F – ferocious behavior, to coerce or compel the group to follow him
o not a good style of leadership but only best style during emergency or
intensive crisis
• Permissive, ultra-liberal, laissez faire, free-rein
o Loose style of nursing leadership.
o Giving excess freedom or liberality towards your subordinates if to lenient
in your subordinates, there will be ↓ control and power = ↑ negligence
• Democratic/participative
o best style of leadership. Mutual style of nursing leadership
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• C – Crimes
o Child Abuse 48 hours, Baranggay, NGO
• E – ethics
• C – Communication skill
o transfer of information with understanding
o Communication barriers/communication backlog – eg. Dialect differences,
noise, deaf, high level of anxiety, hallucinating
• D – Decision making skills
o Steps
identify the problem
identify person affected
gather options/alternative
• brainstorming
• delphitechnique – gathering solutions outside the group
(eg. specialized nurse)
choose and implement
Evaluation
• E – Ethics
o Principles
o Principle of Autonomy
independent judgment or decision making
in all situation the pt himself is the one who should decide for his
own care
Consent
• respect the decision of the pt
• explain the risk to the patient/SO
• waiver - a legal doc when the pt refuse for treatment.
o Principle of Veracity
telling the truth to the patient
#1 the patient has the right to know from the PHYSICIAN (not the
nurse)
o Principle of Double Effects
if the pt is made to choose between 2 equal danger and he only
needs to choose one, choose the one that will produce one good
effect and less evil effect.
o Principle of Beneficence
doing good to the patient (eg. providing therapeutic
communication, providing privacy)
o Principle of Non-Maleficence
do no harm
3 types of Harm
• Physical – negligence by commission
• Mental – assault and battery
• Moral – slander and libel
o Principle of Justice
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Prioritize the needs of the patient.
To be able to provide nursing care to the patient, provide the
nursing process.
Nursing Process characteristics :
• A – acceptable universally
• B - based patients assessment needs
• C – client focused
• D – dynamics – base on the ever changing needs of the pt
• E – equitable care
• F – familiarity/rapport to the patient
• G – goal directed towards solving the assess needs of the
patient (SMART)
o Principle of Respect/Inviolability of life
Suicide and abortion is violation of this principle
• F – Face/solve Conflicts
o any clash of ideas resulting to crisis
o Methods of resolving conflict
avoidance – by paying attention
smoothing – appealing to ones conscience and kindness
unilateral action – use of forced fear or threat
negotiation – best method in resolving conflict. The head nurse
should offer negotiation between conflicting parties.
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NURSING MANAGEMENT
NURSING MANAGEMENT
choosing the right person and giving them the appropriate task for the purpose of
achieving their goal/objective in achieving total care
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Command responsibility/Respondeat Superior – let the superior answer the
fault of his subordinates even harm or death
Balance between centralization and decentralization
Security tenure
Delegation of responsibility
Proper Compensation of workers
o RA 7305 (Magna Carta Law) – salary grade 50 P13,000/month
o Overtime pay – additional of 25%/hr
o Night Differential – additional of 10%/hr
o Legal holiday – x 2
o Philhealth - Benefit of worker both related and non-related work
(aesthetic, dental and cosmetics are not included)
o Maternity leave – 60days leave is NSD, 78days if CS only to first 4
pregnancy only to legitimate spouse
o Paternity leave – 7day/1week leave
o Senior Citizen’s Act – 20% discount
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• long term use equipment (MRI, CT
Scan, hospital beds, hospital
buildings)
Organizing
o 4 stages
Organize your team RN Subordinates
• Duties of the RN
• Only assessment can perform the nurse
• Only the nurse can perform HT
• Only the nurse should explain the procedure to the patient
• Preparation, administration, treatment of drugs to the
patient
• The nurse can only perform evaluation
• The nurse can only do judgment
Delegate Task
• They can only delegate to subordinates the Routinary task
(standard, unchanging procedure) eg. monitoring of I&O,
bathing, ambulating, toileting, shampooing, transporting,
feeding, clothing, wiping
• Stable patient - predictable outcome (eg. postmortem care
with direct supervision of the nurse only)
• Supervision – need guidance
Staff Schedule/ Staffing
• Schedules (How many hours)
o Traditional – 8hrs a day/40hrs/wk
o Ten hour shift/4 days a week
o Baylor plan – it consist of two shifting nurses
traditional – mon-fri 8hrs
2nd shift – 12hr shift during weekends
o Part-time work – fewer working hours per day and
may choose the day or work. Less than 8hrs job
o On – call – during shortage of nurses/staff but
increase in the number of patients.
Methods of Nursing care Delivery
• Different Methods
o Primary – 24hrs a day
Primary nurse is the only nurse who is
responsible to make a care plan of the
patient from the moment of admission till the
moment of discharge. (eg. private duty
nurse or special nurse)
o Functional Method
DOH format/government hospitals
Assign nurse :
• Duty/task
• One nurse, one task
• Highly recommended during a
period of shortage of nurses and
budget
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poorest method of delivery because
communication is hindered
o Case Method/Case Nursing
provide total care within your shift. Used in
ICU department
C – Case Method
T – total care to the patient
O – one is to one ratio
Directing/Delegation stage
o a job or a task is done or performed by another perform for you
o What you cannot delegate:
you cannot delegate total control of the procedure
you can’t delegate discipline of subordinates or staff members.
Confidential task
Technical task
Medical task performing surgical procedure is done by the doc not
the nurse
Coordination/Collaboration
o the nurse needs to collaborate to other members of the health care team.
o Multi-interdisciplinary approach – to be able to provide holistic approach
to the patient.
o Types of Collaboration
Interpersonal/Intradepartmental
• One patient, one unit.
• Collaboration between one nurse to another healthcare
team in one unit/department
• Eg. MI patient - nurse, dietary, specialized in cardio
Interdepartmental
• 4 units in one hospital.
• Coordination of the patients care between 2-more
units/departments but still under one same hospital or
institution
• Eg. patient due for appendectomy is transferred to the OR
Inter Agency/Institutional
• Coordination of patient’s care between 2 or more
hospitals/health care institution for the benefit of the patient
• Eg. lying – in due for C/S and was transferred to a hospital
Evaluation/Controlling
o stage wherein you determine whether or not your plans for your patient is
met or achieved
o Methods of evaluating staff performance
Checklist
• it is being evaluated higher than you. (eg. nurse
manager/supervisor or head nurse)
Nursing rounds
• it is being evaluated higher than you. (eg. Nurse
manager/supervisor or head nurse)
• Psychiatric ward is not done by nursing rounds
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Peer review
• same rank or level is being evaluated you
• poor method
Performance appraisal
• the patient evaluates you
• best method in evaluation
Professional
A calling in which its members profess to have acquired special values,
knowledge, training or by experience so that they may guide others in that
special field.
Nursing is a profession
• Calling – service oriented
• Others – patients
Characteristics by profession
• A – accountability/liability for the result
• C – caring profession Central Focus
• C – competent
• E – ethics
• S – service oriented
• S – specialized scientific body of knowledge and skills
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A doctor’s order is valid when giving medication is when it is put into writing and signed
by the physician. Whatever is not put into writing is considered not ordered by the
physician.
4. Clinical Instructor
o Qualifications :
A – accredited nursing Org
M – MAN in nursing or other health courses
O – One yr clinical experience
R – R.N.
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Contracts and Consents
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• Respectful death
• Direction/ instruction of the patient in advance
• DNR, donate organ, cremation
Professional Negligence
Negligence
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• failure to do something which are reasonable and prudent nurse should have
done something under a particular situation. (eg. failure to raise side rales when
the pt is unconscious)
• 3 elements of negligence
o duty on part of the nurse
o failure to do said duty
o injury, harm, death – most important negligence
Malpractice
• injury, harm or death is not important in malpractice
• The nurse is allowed to perform episiorrhapy
• with proper training but not episiotomy
• The nurse is allowed to perform IE but with 2 conditions :
o fetal aberration/ abnormal delivery
o prior to complete delivery
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• That person who is in authority is asking for a sexual favor in an exchange of
another favor.
Types of Rape
• Ordinary rape
o a forcible penetration of an organ for copulation to another organ for
copulation. (eg. women are only the victim)
• sexual assault
o anything that is forcible inserted to a body orifice with sexual malice.
o Also form of rape (eg. hand or an object is being inserted in the anal.
Committed in both female or male)
o Intervention :
S – safety (emotional or physical safety)
R – report (↓ 18 – report to brgy.)
R – referral (if father is the rapist, refer to DSWD)
Abortion
• is the expulsion or termination of a product of conception before the stage of
viability. (3-6month/12-24weeks)
Infanticide
• kill the person in less than 3days or 72hrs of life.
Parricide
• killing another person to whom you have a relationship (mother, father, husband)
Homicide
• unintentionally killing another person without any relationship (eg. negligence in
giving meds)
Murder
• intentionally killing another person without any relationship
Simulation of birth
• committed by any person who shall substitute one child to another child or alter
his identities for the purpose of losing his civil status. (eg. the midwife failed to
report the birth of the baby, giving wrong information of the gender of the baby)
PD 651 (Birth registration act)
• law any person who assist in giving birth to report within 30 days to the Local
Civil Registration Office
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• 1st college of nursing (4years) – UP
• RA 7164 (1991)
• RA 9173 (Oct 21, 2002)
o Board of Nursing
Old
o M – MAN
o A – Accredited Nursing Org (PNA)
o F – five MAN team (1 chairman, 4 members)
o S – 65 y/o – 1 year interim period
o N – Not convicted of any crime
o P – Pecuniary interest (Absence)
o T – 10 years nursing practice
o C- Citizen of R.P.
New
o M – MAN
o A – Accredited Nursing Org (PNA)
o S – 7 MAN team (1 chairman, 6members)
o I – immediately resigned upon appt.
o N – Not convicted of any crime
o P – Pecuniary interest (Absence)
o T – 10 years nursing practice but 5 yrs must be in the
Phils.
o C- Citizen & resident of R.P.
Who formulates the question of the Board Exam? – Board of
Nursing
In having a license it is a Privilege not a Right
Board of Nursing issues the license
PRC issues the certificate of registration
CHED are the ones who has the power to open and close a
nursing school
BON just inspects 5 consecutive years of below 80% passing rate,
the school will be closed
Powers and Functions of BON
o L – Licensure exam
o I – Issue COR
o M – Monitor standards of nursing practice
o E – Education
o C – Code of ethics
o H – Hear and decides cases of negligence and malpractice
o A – Accredits different organizations
o G – Guides Nursing Practice in the phils
o Dean
R.N.,MAN
5 years nursing experience
o Clinical Instructor
A – allied in nursing or any allied health courses
M – member of PNA
O – 1 yr experience
R – R.N.
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o Nursing Administrator
• B – BSN RN
• A – Accredited Org
• N – 9 units
• T – 2 yrs
Chief/Director
RN + MAN + Add only MAN +
5 yrs supervisor master’s in GSC
experience PHN or (Gen.
(N.B. if primary CHN Staffing
hosp) Course)
o Examinees
CGM (Good Moral Character)
Proofs of Valid Holder of Filipino Citizenship
Proofs of valid holder of a BSN Degree only from schools whose
curriculum is approved by the CHED
3 docs sub to PRC
RLE certificate
TOR with Scanned picture
List of cases
Examination fee is P900
Last day Is :
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o acquire the required ratings
o In order to pass the examination, an examinee must obtain a general
average of at least 75 % with a rating of not below sixty percent (60%) in
any subject
o An examinee who obtains an average rating of 75% or higher but gets a
rating below 60% in any subject must take the examination again but
only in the subject or subjects where he/she us treated below 60 %
(60%). In order to pass the succeeding examination, an examinee must
obtain a rating of at least 75% in the subject or subjects repeated.”
• RA 8981 –Modernization Act.
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