Leadership, Management and Research p[1]

Passive Aggressive Assertive

Self-denying Self-enhancing at the expense of others

Self-enhancing (self & others)

Inhibited Expressive Expressive

Puts down self;low self-worth and

confidencePuts down others Feels good about self

Allows others to choose Chooses for others Chooses for self

Does not achieve goalAchieves desired goal by

hurting others Achieves desired goal

Far Eastern university-Institute of NursingIn-House Nursing Review Hand-out

LEADERSHIP, MANAGEMENT and RESEARCH

Overview:

Part I. LEADERSHIP AND MANAGEMENTI. Concepts of Nursing LeadershipII. Nursing ManagementII. Nursing Management ProcessIV. Code of Ethics for Nurses

Part II. RESEARCHI. Research in NursingII. Types of ResearchIII. Research Process

a. Phases of Nursing Researchb. Steps in Nursing Research

PART 1. LEADERSHIP AND MANAGEMENT

I. CONCEPTS OF NURSING LEADERSHIP

A. Behaviors of Leaders

B. LEADERSHIP ROLES AND MANAGEMENT FUNCTION ASSOCIATED WITH DELEGATION

LMR by Mrs. Honey Chille S.Tolentino214

LEADERSHIP ROLES AND MANAGEMENT FUNCTION ASSOCIATED WITH DELEGATION

Leadership Roles Management Functions

1. Responsible for delegation of task to subordinates.

1. Generates job description /scope of practice statement for all personnel

2. Acts as a role model, supporter and resource person

2. Knows legal liabilities of supervision

3. Influences subordinates to utilize delegation to facilitate team building and time management strategies

3. Aware of capabilities and level of motivation of subordinates during task delegation

4. Guides subordinates in determining appropriate situations for delegation

4. Generates and implements a periodic review for each delegated task.

5. Ensures patient safety as minimum criteria in determining most appropriate person to accomplish the delegated task.

5. Provides incentives and recognition to show appreciation for the delegated task completed.


C. LEADERSHIP ROLES AND FUNCTION RELATED TO PRELIMINARY STAFFING FUNCTION

LEADERSHIP ROLES AND FUNCTION RELATED TO PRELIMINARY STAFFING FUNCTION

Leadership Roles Management Functions

1. Plan activities for future staffing needs. 1. In charge of getting and maintaining adequate skilled work team to meet the goals of the organization.

2. Knowledgeable and aware of current and historical staffing events.

2. Shares responsibility in terms of staff hiring

3. Capable of knowing and encouraging qualified and competent individuals to join the organization

3. In charge of planning and structuring needed interviews.

4. Serves as a role model 4. Uses techniques that would ensure a more valid and reliable interview process

5. Fully aware of possible personal biases during the time of pre-employment process or hiring.

5. Knows the legal requirements needed in interview and selection of individuals to maintain firmness in the hiring practices.

1. Uses the interview process as a chance to promote and enhance the image of the organization.

1. Generates a selection criteria

2. Designates position to new personnel that can ensure success.

2. Uses information about organizational needs and employee’s strength to make wise decisions regarding placements.

3. Regularly reviews programs and holds orientations and meetings to ensure needs of the unit are being met.

3. Uses expertise to guide new employees and lead a certain program

4. Ensures understanding of the organizational policies by new employees.

4. Always involved in conducting orientation for employees

EARLY LEADERSHIP THEORIES

A. Trait/ Individual Characteristic Theory

Some people have certain characteristics or personality traits that make them better leaders than others

B. Great Man Theory

Some people are born to lead, whereas others are born to be led.



C. Behavioral Theories

1. Autocratic

Self-centered leader A type of leadership wherein obedience to authority is strongly enforced Favors strict rules and established authority Well-defined group actions High productivity, low creativity, self-motivation and autonomy

2. Democratic

People-oriented leader (“We”) A type of leadership characterized by free and equal participation in decision-making Promotes autonomy and growth Less efficient quantitatively than authoritative leadership

3. Laissez-faire

Permissive leader (“You”) A type of leadership that is permissive with little or no control and motivates by

support when requested by the group of people Frustrating due to over freedom Appropriate when problems are poorly defined Creativity and productivity will result if members are highly motivated and self-

directed

D. Situational and Contingency Theories

Requires the performance of both the leader and the followers Requirements of the leader differs according to varying situations A person may be a leader at one time and a follower in another

E. Contemporary Leadership Theories

1. Bureaucratic

Rule-centered (“They”) An institutional method for applying general rules to specific cases, making the actions of

management fair and predictable introduced by Max Weber.

2. Management Process by Henri Fayol’s

First identified the management functions of planning, organization, command, coordination, and control.

Introduced the following principles:

a. Principle of division of workb. Authority and responsibilityc. Unity of commandd. Remuneration of personnele. Establishment of tenuref. Communicationg. Centralizationh. Equity and Justicei. Esprit de corps

F. Theory X and Theory Y by Douglas McGregor

Theory X Assumptions:

1. The average individual has an inherent dislike for work and will avoid it whenever possible.2. The average individual prefers to be directed, hopes to avoid responsibility, and is more

interested in financing incentives than in personal achievement.3. Because people dislike work, they must be controlled, threatened and coerced to put forth

sufficient effort to meet the organization’s objectives.



Theory Y Assumptions:

1. The expenditure of physical and mental effort is as natural as rest or play.2. Man will exercise self control and self direction in the service of objectives to which he is personally committed.3. The average person learns, under proper conditions, both to seek and to accept responsibility.4. The capacity to apply imagination and creativity to the solution of organizational problems is widely, rather than narrowly, distributed among workers.

Douglas McGregor’s Theory X & Theory Y and W. G. Ouchi’s Theory Z

Theory X Employees Theory Y Employees Theory Z

Avoid work if possible Like and enjoy work Quality circles

€Dislike work Fitting employees to their jobs

Must be directed Self-directed Consensus decision making

Have little ambition Imaginative and creative Guarantee of lifetime employment; Job security

Avoid responsibility

Need threats to be motivated

Seek responsibility Examining the long-term consequences of management

decision making

Need close supervision Have underutilized intellectual capacity

Slower promotions

Are motivated by rewards and punishments

Need only general supervision Establishment of strong bonds of responsibility between superiors and subordinates

Encouraged to participate in problem solving

A holistic concern for the workers

II. NURSING MANAGEMENT

SCIENTIFIC MANAGEMENT

A. Frederick Winslow Taylor Taylor’s System for Work Improvement Consisted of the following steps:

Controlled observation of the worker’s performance through time and motion study Scientific selection of the best man to perform each job Training the selected worker to perform job tasks Paying the worker to according to a differential piece rate Appointing a foreman for each aspect of the work and making the production worker

responsible for reporting to a different functional foreman for each aspect of his job



B. Lillian Gilbreth - First Lady of Management

Benefits of job simplification and the establishment of work standards Effects of incentive wage plans and fatigue on work performance. Two of their children, frank and ernestine, wrote Cheaper by the Dozen

C. Henry Gantt

Development of task and bonus remuneration plan Emphasis on service rather than profit objects

CLASSIC ORGANIZATION

A. Henri Fayol - Father of the Management Process School

Developed the following management principles:

division of work and task specialization authority commensurate with the degree of his responsibility each employee should receive orders from only one supervisor A single person should direct the activities that are directed towards a single objective The interest of the individual worker should be subordinated to the interest of the whole

group There should be an unbroken scalar chain of authority and communication All employees of the organization should be treated with equity and justice Efforts should be made to develop teamwork and esprit de corps among workers in the

organization

B. Max Weber - (1864-1920), known as the Father of Modern Sociology / Father of Organizational Theory

He advocated that the ideal form of organization is bureaucracy. Emphasis is on rules.

Bureaucracies are founded on legal or rational authority which is based on law, procedures, rules, and so on. Positional authority of a superior over a subordinate stems from legal authority. Charismatic authority stems from the personal qualities of an individual.

Efficiency in bureaucracies comes from:

(1.) clearly defined and specialized functions; (2.) use of legal authority; (3.) hierarchical form; (4.) written rules and procedures; (5.) technically trained bureaucrats; (6.) appointment to positions based on technical expertise;(7.) promotions based on competence; (8.) clearly defined career paths.

C. James Mooney - he advocated that the management is the technique in directing people.

D. Lyndall Urwick - he advocated that the managerial process consists of planning, coordinating and controlling

HUMAN RELATION

A. Mary Parker Follett

Keypoints: a successful leadership was more of a result of training in leadership skills than

possession of specific personality traits suggested that a manager should not give orders to an employee, rather, the two should

together analyze the situation and then take orders from the situation



B. Elton Mayo - Hawthorne Experiments

concluded that much more than the physical environment affected worker productivity other factors which influence productivity by modifying the worker’s social and

psychological satisfactions

C. Kurt Lewin

Revived the study of group dynamics developed the field theory of human behavior proposed that a worker’s behavior is influenced by interactions between the worker’s

personality , the structure of the primary working group, and the socio-technical climate of the workplace.

D. Jacob Moreno - developed sociometry, psychodrama, socio drama and role playing techniques

E. Chester Bernard - cooperation depends on non-financial inducements

BEHAVIORAL SCIENCE

A. Douglas McGregor - Theory X and Theory Y

B. Chris Argyris

during maturation, the individual moves to a condition of greater independence, increased productivity, more varied activity, longer time perspective and increased self control.

Proposed that the rigid structure and stringent rules of the typical bureaucracy block normal maturational changes

Flexibility within organization Employee participation in decision making

C. Frederick Herzberg - factors associated with dissatisfaction are different from the factors which cause satisfaction

D. Abraham Maslow

Hierarchy of Needs

OTHER MANAGEMENT THEORIES

A. Herbert Simon views business and service institutions as network of decision makers

B. ALVIN TOFFLER suggests that the only way that people will be able to maintain a sense of equilibrium is

for them to design personal and social change regulators.



C. Henry Mintzberg

The manager’s job encompasses ten roles of which

3 are interpersonal figurehead leader liaison

3 are informational monitor disseminator spokesperson

The manager’s job encompasses ten roles of which

4 are decisional enterpreneur disturbance handler resource allocator negotiator

D. Rensis Likert

System 4 Superiors and subordinates demonstrate trust in each other Information is solicited in setting goals Decisions are made at all levels uses democratic process Training is provided

III. THE NURSING MANAGEMENT PROCESS

A. PLANNING- a pre-determining course of action in order to arrive at a desired result.

CHARACTERISITICS OF A GOOD PLAN: Have clearly worded objectives, including desired results and methods for evaluation Be guided by policies and or procedures affecting the planned action indicate priorities Develop actions that are flexible and realistic in terms of available personnel, equipment,

facilities and time. Develop logical sequence of activities Include the most practical methods for achieving each objective

ELEMENTS OF PLANNING:

1. Forecasting – estimating the future mission, vision, objectives2. Establishing Objectives (SMART)

a. Specificb. Measurablec. Attainabled. Realistice. Time-bound

3. Scheduling – setting a timeframe GANTT chart PERT diagram (Performance Eval Review Technique)

4. Budget- numerical description of expected income and planned expenditures for an organization for a specific period of time.

a. Approaches Centralized De-centralized

b. Components of an Institutional Budget

Capital Expenditure Personnel Budget



Operating Budget

Capital Expenditure

A large capital outlay for buildings or equipment that commits the institution to a particular path for sometime in the future

Includes physical changes such as replacement or expansion, major equipments and inventories.

Personnel Budget

Estimates the cost of direct labor necessary to meet the agency’s objectives. Determines recruitment, hiring, assignment, lay off and discharge of personnel.

Operating budget

Input-output analysis of expected revenues and expenses Includes personnel salaries, employees benefits and insurance, medical-surgical

supplies, office supplies, rent, heat, light, housekeeping, laundry service, drugs, pharmaceuticals, repairs, maintenance, in-service trainings, books etc

TYPES OF BUDGET:

A. Fixed-ceiling - Uppermost spending limit is fixed by the organization before subordinate managers are asked to develop budget proposals for their individual units.

B. Open-ended - operating manager presents a single cost estimate for what she considers the optimal activity level, without indicating how that plan should be scaled down if less funding is available.

C. Flexible - can be adjusted or manipulated, consists of several financial plans, each for a different level of activity of different operating conditions

D. Sunset - designed to “self-destruct” within a prescribed period to ensure cessation of the funded program by a predetermined date.

E. Zero-based - expenses have to be justified to determine profit or loss, forces managers to set priorities and justify resources, based on previous year’s expenditure

F. Contingency - can be used in case of emergency; if not used, can be part of savings.G. .Performance - based on functions, such as direct nursing care, supervision, in-service

education, quality control, nursing audit, procedure revision and development, nursing research etc

H. Program - costs are computed for an entire program, as for ambulatory surgery program, both old and new, with every annual budget preparation.

DIRECT AND INDIRECT EXPENSES Direct: directly associated with patient care such as medical and surgical

supplies, medicines, etc. Indirect: for items like utilities- gas, electricity, communication facilities etc.

FIXED AND VARIABLE COSTS FIXED - expenses that are constant and are not related to productivity and

volume. Examples: building and equipment depreciation, utilities, fringe benefits, admin salaries

VARIABLE - fluctuates depending upon the volume or the census or the types of care required. Example: medical-surgical supplies, medicines, laundry and food costs.

5. Formulation of Policies, Procedures, Methods, and Courses of Action

Assignment Patterns for Delivery of Nursing Care FUNCTIONAL NSG – emphasis is on getting the job done, assignments are divided among staff members according to job descriptions and how much work must be completed.

TOTAL CARE - or the case method of assignment, refers to giving of all direct care to the patient by an RN, maybe task-centered or patient-centered, the nurse provides all the care her patients need while she is on duty, work is not fragmented.



TEAM NURSING – devised to be used when teams would be composed of care providers who had diversity in education and abilities.

Based on: Every patient has the right to receive the best care possible with the available staff

and time Planning nursing care is basic in providing this care All nursing personnel have the right to receive help in doing their job A group of care providers with the leadership of a professional nurse can provide

better patient care than those same people working as individuals.

PRIMARY NURSING

RN is responsible and accountable for the care of the patient 24 hours a day. The responsibility includes assessing, planning, implementing, and evaluating nursing

care from the time the patient was admitted to the nursing unit until the patient is discharged from that unit.

Designed to return the RN to their original role of giving direct patient care, which would improve the quality of care given.

Ways to Address Patient Care Needs Direct nursing care Indirect Nursing Care NPI

Patient Care Classification System Level I – minimal care Level II – Intermediate or moderate care Level III – Intensive Care Level IV – Highly specialized Intensive Care (critically ill)

TIME MANAGEMENT

3 Basic Steps in Time Management Time for planning & establishing priorities Completion of the task with the highest priority & ensuring that a task is finished before

beginning with another one. Reprioritization according to tasks left and new found information

Managing Time at Work Gather all equipment and supplies needed beforehand Group activities with similar locations. Use time wisely Record all nursing interventions immediately after each activity is finished Finish all work on the designated time.

B. ORGANIZING

The way a group is formed, including lines of communication, channeling of authority, span of control, & making decisions.

Formal structure of the organization which reflects official arrangement of positions & working relationships.

ORGANIZATIONAL PROCESSES

Delegation - creates an obligation to perform.

Basic concepts in Delegation: Authority is legitimized power. Power is the ability to influence others. Delegation is distribution of authority.

Delegation of authority is guided by several key principles and concepts:

a. Exception principle - Someone must be in charge. A person higher in the organization handles exceptions to the usual. The most exceptional, rare, or unusual decisions end up at the top management level because no one lower in the organization has the authority to handle them.



b. Scalar chain of command - The exception principle functions in concert with the concept of scalar chain of command - formal distribution of organizational authority is in a hierarchial fashion. The higher one is in an organization, the more authority one has.

c. Decentralization - Decisions are to be pushed down to the lowest feasible level in the organization. The organizational structure goal is to have working managers rather than managed workers.

d. Parity principle - Delegated authority must equal responsibility. With responsibility for a job must go the authority to accomplish the job.

e. Span of control - The span of control is the number of people a manager supervises. The organizational structure decision to be made is the number of subordinates a manager can effectively lead. The typical guideline is a span of control of no more than 5-6 people. However, a larger span of control is possible depending on the complexity, variety and proximity of jobs.

f. Unity principle - Ideally, no one in an organization reports to more than one supervisor. Employees should not have to decide which of their supervisors to make unhappy because of the impossibility of following all the instructions given them.

Responsibility - is work assigned to a position.

Authority - gives the one delegated the right to command subordinates with the latter having the obligation to obey or perform the duties carried by his position.Accountability - is a moral responsibility. A manager may delegate responsibility but always remains accountable.

Communication - the transmission of information, opinion, and intention between and among individuals

MAJOR TYPES OF ORGANIZATION:

a. formal organizationb. informal organization

Line authority - is authority within an organization's or unit's chain of command. Staff authority - is advisory to line authority.

ACTIVITES OF ORGANIZING: a. communicating with peopleb. conducting meetingc. coordinating activitiesd. developing job descriptions

meaning of job description job description performance appraisal

ORGANIZATIONAL CHART: A graphic representation of the chain of authority from chief executive to each member of

the organization.

Uses: Outlines administrative control For policy making & planning Evaluates the weaknesses and strengths of the present structure Shows the relationships with other departments and agencies Orients new personnel

ADVANTAGES: Shows formal line of organization Helps identify roles and expectations Maps the lines of decision-making authority. Helps in understanding people’s

assignments

DISADVANTAGES: Only shows formal relationships Does not indicate level of authority Possible confusion of authority with status



TYPE OF ORGANIZATIONAL STRUCTURES

1. Bureaucratic Commonly called line structures or staff organizations seen in large healthcare facilities

Advantage: Clearly defines authority and responsibilityDisadvantages:

Alienates workers Produces monotony Restricts upward communication

2. Ad hoc Used on a temporary basis to complete a particular project Usually disbanded after a project is completed

Advantage: Serves as a way for professionals to handle increasing amount of available informationDisadvantages: Decreases strength in the formal chain of command Decreases employees' loyalty to the parent organization

3. Matrix Focuses on both product and function, with emphasis on the required task and the end-

result of the function Focuses on both product and function, with emphasis on the required task and the end-

result of the function

Advantages: Centralizes expertise Less formal rules Fewer levels of hierarchy

Disadvantage: Slow decision-making can produce confusion and frustration

C. STAFFING

Determine the type and number of personnel needed Starting With A Self-Assessment

The following guidelines can help a manager evaluate his or her recent staffing efforts and improve in the future:

Know yourself, Know your focus, and Know the strengths and weaknesses of employment.

The following eight-step process increases the chances of hiring success:

1. Determine the business' labor and management needs 2. Develop a current job description 3. Build a pool of applicants 4. Review applications and select those to be interviewed 5. Interview 6. Check references 7. Make a selection 8. Hire

STAFFING ACTIVITIES:

A. Interviewing A method for selecting employees Resumes and references are verified to determine the applicant’s qualifications.

**The open-ended questions should be geared toward the following general areas: previous job accomplishments and achievement; non-job accomplishments and achievements; motivation and ambition; hobbies and use of leisure time; and "what if" Some examples are:

What has been your most important accomplishment in your current position? What are you looking for in an ideal job? When you are working on a project, how do you know you are doing a good job?



Do’s for the Interviewer:

1. Make sure the applicant does most of the talking. 2. Make the interview fun.3. Listen!!! 4. Be attentive. 5. Concentrate on the interview and what the applicant is saying 6. Show enthusiasm throughout the interview. 7. "Read" nonverbal messages. 8. Show appreciation for the person being interested in the position. 9. Show pride in the Profession10. Stay in control of the interview.

B. Recruitment Uses ads, career days, and literature Managers share the responsibility for recruitment with nurse recruiters.

C. Selection

Based on job requirements Notification of the results is given

D. Placement

Confirmation of the applicant’s acceptance in writing E. Indoctrination

Consists of induction, orientation and socialization of employees Needs complete employee handbook

JOB DESCRIPTION Specification of duties, conditions, and requirements of a particular job prepared through

job analysis Purposes:

For recruitment, placement or transfer For guidance, direction, evaluation and performance Helps reduce conflict, frustrations and overlapping duties To determine working relationships Basis for salary range

D. DIRECTING

Delegation - transferring of responsibility from higher to lower authority Policy utilization, revision, & updating Supervision - guides, directs motivates, teaches, and facilitates

Frequent Mistakes in Delegating: Under delegation Over delegation Improper delegation

E. CONTROLLING

Performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

1. Performance Appraisala. Individual performance (70%)b. Personal traits (30%)

Types of Rating ScalesA. Trait Rating ScaleB. Job Dimension ScaleC. Behaviorally-anchored Rating ScaleD. ChecklistE. Peer ReviewF. Self-Appraisal



2. Accreditation Evaluation of the quality of nursing education provided

3. Development of Standards

Predetermined level of excellence that serves as a guide to practice 4. Audit

measurement tools used to provide quality care 5. Goal-Setting

consider the availability of resources

Principles Of Management

A. Command Responsibility

B. Chain of Command (hierarchical level)

3 Levels of Management Top level management - ADMINISTRATOR Middle management - SUPERVISORS 1st line management – HEAD NURSES, SENIOR NURSES Operational Level – STAFF NURSES, NURSING ATTENDANT

IV. CODE OF ETHICS FOR PHILIPPINE NURSES

The Philippine Nurses Association Special Committee, under the chairmanship of Dean Emeritus Julita V. Sotejo, developed a Code of Ethics for Filipino nurses (1982)

The Code of Ethics promulgated by the Philippine Nurses Association (PNA) was approved by the Professional Regulation Commission and through Board Resolution No. 1955 was recommended for use (1989) and approved by the General Assembly of the PNA last October 25, 1990.

Amended Code of Ethics for Nurses

Pursuant of Section 3 of R.A. 877 (Philippine Nursing Law, Section 6 of P.D. No. 223) Recommended and endorsed by the PNA Adopted to govern the practice of nursing

A. Nurses and People Values, customs, and spiritual beliefs held by individuals are to be respected. Nurses hold in strict confidence personal information acquired in the process of giving

care.

B. Nurses and Practice Nurses maintain or modify standards of practice within the reality of any given situation. Nurses are aware that their actions have professional, ethical, moral, and legal

dimensions.

C. Nurses and Co-workers Nurses maintain collaborative working relationship with their co-workers and other

members of the health team D. Nurses and Society

Nurses are contributing members of the society. They assume responsibilities inherent in being members and citizens of the community in which they work.

E. Nurses and the Profession Nurses are expected to be members of professional organization of nurses. Nurses help to determine and implement desirable standards of nursing practice and

nursing education.

SANCTION A nurse found, after due process, to have violated any provision of this Code of Ethics,

shall be guilty of unprofessional and unethical conduct and shall suffer the sanction of censure or reprimand, suspension and revocation of her/his certificate of registration.



I. STANDARDS OF NURSING PRACTICE

A. Qualification of Nursing Practice Must be a graduate of Bachelor of Science in Nursing Must have a license to practice nursing in the country Must be physically and mentally fit to work

B. Personal Qualities & Professional Proficiencies

Should be interested and willing to work and learn with individuals /groups in a variety of settings

Should have a warm personality and concern for people Must be resourceful and creative Must have a capacity and ability to work cooperatively with others Must take the initiative to improve self and service Must be competent in performing work through the use of nursing process Should have a skill in decision-making, communicating, and relating with others Must be active in participating in issue confronting nurses and nursing

C. Duties and Responsibilities

Utilization of nursing process, assessment, planning, implementation and evaluation of care.

Establishment of linkage with community resources and coordination of services with other members of the health team

Motivation of individuals, families, and communities to accept primary responsibility for their own health care; the utilization of indigenous resources and appropriate technology in bringing about improvement in the quality of their lives.

Participation in teaching, guidance, and supervision of the students in nursing education programs; administration of nursing services in varied settings.

Undertaking nursing and health manpower development, training and research and soliciting finances

D. Problems Encountered in the Practice

Negligence – acting or non-acting causing injury or harm to another person or to propertyMalpractice – improper or unskillful care of a patient by a nurseIncompetence

lack of ability, legal qualifications or fitness to discharge the required duty One of the grounds for revocation or suspension of certificate of registration

Liability of Nurses for the Work of Nursing Aides – delegation of duties to nursing aidesLiability of the Work of Nursing Students - students should not perform professional nursing

duties

PART II. R E S E A R C H

Why do research?“There must be a better way…”

Purpose of Research to answer questions, whether they arise from a simple need or curiosity.

1. Professionalism2. Accountability3. Social relevance of Nursing4. Research and Decision making in Nursing

Why do research?

The value and usefulness of the scientific approach for making real world decision about nursing practice are clearer if you realize that:

A. Science doesn’t have to be dogmatic an mechanisticB. Science involves a process of discovery as well as process of proofC. Science requires an interpretation of acts and these interpretation can changeD. Most of the principles and topics for nursing research exist in the practice of

clinical nursing.



Alternative Ways of knowing:

Use of trials and error combined with common sense Use of authority and tradition Use of inspiration and intuition Use of logical reasoning

Basic Assumptions that Underpin the Scientific Approach:

It is better to be knowledgeable of the world than to be ignorant of it Observes of the world are able to relate observation conceptually and make meaning out

of them.

SCIENTIFIC INQUIRY

A process in which observable, verifiable data are systematically collected from the world through our senses to describe, explain and predicts events.

Characteristics of Scientific Inquiry that other ways of knowing don’t have:

SELF CORRECTION OR OBJECTIVITY THE USE OF SENSORY, EMPIRICAL (based on observation and experience)

EVIDENCE

Basic Aims of Scientific Inquiry: DEVELOP EXPLANATIONS OF THE WORLD [THEORIES] FIND SOLUTIONS TO PROBLEMS

I. RESEARCH IN NURSING

Nursing research, according to the ANA Commission on Nursing Research, is research that develops knowledge about the following:

Health and promotion of health over the full life span Care of persons with health problems and disabilities Nursing actions to enhance people’s ability to respond effectively to actual or potential

health problems

Nursing research includes investigation into:

Health promotion and health restoration of individuals, families, groups, and communities Issues related to nursing education, administration, and the profession’s role in health

policy formation

The ANA’s Standards of Clinical Nursing Practice states that all nurses should select nursing interventions that are substantiated by research and, further, that all nurses may participate in research activities based on their level of education, their position, and their practice setting. The nurse is expected to:

Have some awareness of the process and language of research Be sensitive to issues related to protecting the rights of human subjects Participate in identifying significant researchable problems Be a discriminating consumer of research findings

Nurses who participate in research or who practice in settings where research is conducted with human subjects play an important role in safeguarding the following rights:

A. Right not to be harmed subjects should be free from exposure to the possibility of injury going beyond

everyday situationsB. Right to full disclosure

subjects should be given complete information about their participation in the studyC. Right of self-determination

subjects should feel free from constraints, coercion, or any undue influence to participate in a study

D. Right to privacy and confidentiality subjects should be able to participate in a study without worrying about later

embarrassment



II. RESEARCH

systematic, controlled and empirical investigation that aims to develop general knowledge about natural phenomena

Systematic: progresses through a series of steps according to a pre-specified plan of actionControlled: involves imposing conditions on the situation so that errors are minimized and

validity is maximizedEmpirical: evidence is on hand to support the study findings and is used as the basis for

generating knowledge

General Purposes:

Description Explanation Exploration Prediction and Control

Steps in the Research Process:

1. Identification of a problem 2. Review of related literature 3. Development of a study framework 4. Formulation of hypothesis5. Selection of the study design 6. Selection of population, sample and setting 7. Data collection 8. Analysis and interpretation of data

What is a research question?

Explicit query about a problem, or issue that can be challenged, examined, and analyzed, and that will yield useful or new information.

A reflection of the opinions and ideas of the researcher

Where to look for research topics?

Thoughts Personal experiences Experiences Observations Previous researches Literature sources Existing theories

What are the basic requirements for selection?

a. Knowledge on the topicb. Being interested in it

What is a researchable question?

One that yields hard facts to help solve a problem, produce new research, add to theory, or improve nursing practice.

One that provides answers that explain describes, identify, substantiate, predict or qualify.

Nursing research must be:

Usable Now questions Clear

Two basic components to every question:

a. Stem b. Topic



How to ask research questions?

Start with a simple question Ask an active question

LEVELS OF QUESTIONS:

Level I: There is little to no literature on either the topic or the population Purpose: to describe what is found as it exists naturally

Level II: There is knowledge about the topic and about the population but the intent of the

researcher is to do a statistical description of the relationships among variables

Level III: There is a great deal of knowledge or theory about the topic, to test the theory through

direct manipulation of variables. All level 3 questions lead to experimental designs

Finding the level of knowledge according to topic:

Level I: questions have one variable in one population Level II: questions have two or more variables in one population Level III: questions have cause and effect

Elements of a research problem:1. Review of related literature2. The rationale for developing the question3. The theoretical or conceptual framework

VARIABLES Independent: “cause”, the variable which is thought to influence the dependent variable.Dependent: “effect” or the variable that is influenced by the researcher’s manipulation (control) of

the independent variable.

OTHER TYPES:

Attribute- preexisting characteristics of the study participants, which the researcher simply observes or measures

Continuous- a variable that can take on an infinite range of values along a specified continuum (ex. Height)

TYPES OF NURSING RESEARCH

1. BASIC, OR PURE RESEARCH Directed to develop theories that can increase the state of knowledge

2. APPLIED RESEARCH Directed to solve problems or make decisions for what are considered practical

purposes. Also directed at clinical trials aimed at developing and valuating new program,

program, product, method or procedure.

According to Diers: All nursing research are applied research There are 3 distinguish characteristics of a nursing problem:

1. MUST INVOLVE A “DIFFERENCE THAT MATTERS” IN TERMS OF ITS CONSEQUENCES IN IMPROVING PATIENT CARE

2. MUST HAVE A RELATIONSHIP TO MORE CONCEPTUAL ISSUES AND THEREFORE HAS THE POTENTIAL FOR CONTRIBUTING TO THEORY DEVELOPMENT AND OUR BODY OF SCIENTIFIC NURSING KNOWLEDGE

3. NURSES MUST HAVE ACCESS TO OR CONTROL OVER THE PHENOMENON BEING STUDIED



3. PURE / APPLIED RESEARCH Classifying types of nursing studies based on how relevant

- the subjects - the content - the conditions

are to the real world nursing problems and decisions

Stage I. Not Directly RelevantExample:

studying the mechanism of wound healing using guinea pigs not directly relevant to the practice of nursing, uses animals in testing.

Stage II. Relevant Topics or SubjectsExample:

a researcher interested in the concept of hunger conducted his study by making college students drink through a tube from behind screen with no visual cues about what they are taking in.

it is being conducted with people instead of animals but the topics of hunger and satiation are not specifically related to nursing activity

Stage III. Relevant Topics and Subjects Example

study to determine whether infants placed in different body positions consumed different amounts of energy

it involves people as subjects and compares different positioning choices have direct concern to nursing practice

Stage IV. Relevant Topics, Subjects and Trial ConditionsExample:

This is an example of research in nursing intervention under a special condition.Stage V. Normal Field of ConditionsStage VI. Advocacy and Adoption

Research that demonstrate the applicability of primary nursing – in which one nurse is totally responsible for a case load of patients.

Types of Nursing Research according to purpose or design:

RESEARCH DESIGN Provides a plan, or blueprint, for answering the research question Specifies control mechanisms to be used in the study The more knowledge there is about the topic and the higher the control of variables, the

stronger the design.

The following are to be considered in selecting the research design:

The setting for the study a) Laboratory study – designed to be more highly controlled in relation to both the

research environment and the extraneous variables b) Field study – done in natural settings (e.g.: wards, communities, homes) or somewhere

other than in a controlled laboratory setting Timing of data collection

a) Looking into the past Historical – descriptive studies that ask people to recall events or people from

the past, or refer to written historical documents and artifacts to reconstruct the past

Retrospective – a phenomenon that occurs in the present is linked to a phenomenon in the past

Ex Post Facto – essentially the same as retrospective studies (Note: In some books, ex post facto studies, considered to be the same as correlational studies, are classified into retrospective and prospective studies)

Gauging the present Cross-Sectional – designed to obtain a “cross-section” of the population at a

given point in time

Predicting the future Prospective – a phenomenon existing in the present is linked to a

phenomenon predicted to happen in the future Longitudinal – designed to follow the subjects for a period of time, obtaining

repeated measurements and establishing changes in the variables over time



Types of Nursing Research according to purpose or design:

a. Exploratory To obtain a richer familiarity with a phenomenon and clarify concepts as a basis for

further research. Methods: INTERVIEWING, PARTICIPANT OBSERVATION, DOCUMENT ANALYSIS,

EXPLORATORY

b. Exploratory collects in-depth data on a single concept or variable

Examples:1. What are the reactions of patients to being cared for by student nurses?2. What are the administrative characteristics of nurses?

c. Descriptive to obtain complete and accurate information about the phenomenon studies known variables that have not been studied in a particular population

METHODS: INTERVIEWS, QUESTIONNAIRES, DIRECT OBSERVATION, ANALYSIS OF RECORDS

d. Explanatory TO PROVIDE CONCEPTUAL ANALYSES GROUNDED IN OBSERVATION OF

HUMAN BEHAVIORMETHODS: INETRVIEWS, PARTICIPANT OBSERVATIONS CONSTANT COMPARATIVE ANALYSIS

e. Correlational – studies the relationship of two or more variables

f. Experimental and quasi experimental To test hypothesis about relationship studies the effect of a manipulated variable on another variable

METHODS: EXPERIMENTS, QUASI-EXPERIMENTS

1. True experiment Manipulation of independent variable Imposing control on at least one group (meaning, there should be at least two groups) Randomization of subjects to assigned groups

2. Quasi-experiment Manipulation of independent variable May have a non-equivalent control (comparison) group No random assignment

GENERAL STEPS IN THE RESEARCH PROCESS

5 Phases:1. Conceptual Phase2. Design & Planning Phase3. Empirical Phase4. Analytic Phase5. The Dessimination Phase

Steps in Research Process1. Formulating & Delimiting the problem2. Review of Related Literature3. Defining the Theoretical Framework4. Formulating Hypothesis and Defining variables5. Selecting Research Design6. Identifying the Population to be Studied7. Specifying Methods to Measure the Research Variables8. Designing the Sampling Plan9. Finalizing and Reviewing the Research Plan10. Conducting the Pilot Study and Making Revisions11. Collecting Data12. Preparing Data for Analysis13. Analyzing Data14. Interpreting Results15. Communicating the findings



16. Utilizing the findings

Phase I: THE CONCEPTUAL PHASE Includes thinking, reading, conceptualizing, reconceptualizing, theorizing, and

reviewing ideas with colleagues or advisers. The researcher calls on such skills as creativity, deductive reasoning, insight, and

firm grounding on previous research on the topic of interest.

Step 1: Formulating and Delimiting the Problem In developing a research question, nurse researchers must consider the following:

a. Substantive dimensions (e.g. Is this research question of theoretical or clinical significance?)

b. Methodological dimensions (e.g. How can this question be best studied?)

c. Practical dimensions (e.g. Are adequate resources available to conduct a study?)

d. Ethical dimensions (e.g. Can this question be studied in a manner consistent with guidelines for the protection of subjects?)

How to state a research problem stated in the form of a question an explicit query of about a problem or issue that can be challenged,

examined, analyzed and will yield useful new information. Defining the purpose of research

The researcher’s statement on why the question is important and what use the answer will serve

Step 2: Reviewing Related Literature Provides the researcher with ideas for defining concepts and instruments Provides full awareness of the facts, issues, prior findings, theories and instruments, that

may be related to the study question. Provides a foundation upon which to base new knowledge and generally is conducted

well before any data are collected in a quantitative study Familiarization with previous studies can be useful in suggesting research topics or in

identifying aspects of a problem.

Step 3: Defining the Theoretical Framework Previous theory is used as a basis for generating predictions that can be tested through

empirical research

Step 4: Formulating Hypothesis and Defining Variables A statement of the researcher's expectations about relationships between the variables

under investigation A prediction of expected outcomes States the relationships that the researcher expects to find as a result of the study Hypotheses are statements of the relationship between two or more variables or

concepts. Variables should be operationally defined

Phase II: THE DESIGN AND PLANNING PHASES The investigator decides on the method to be used to address research questions and

plans for the actual collection of data.Step 5: Selecting the Research Design

Research design is a well-thought-out, systematic and even controlled plan for finding answers to study questions.

Experimental Research - Researcher actively introduces some form of interventionNon-experimental Research - Researcher collects data without trying to make any changes or

introduce any treatment.

Step 6: Identifying the Population to be studied

Population - group to be studiedSample - those elements of a population from whom data will be actually collected and from

whom generalizations from the population will be made.Selecting the population and sample:

Arises from the need to specify the group to which the results of a study can be applied



Population refers to the aggregate or totality of all the objects, subjects, or members that conform to a set of specifications.

Sample selection: a) Randomness – the distribution of distinguishing characteristics in the sample should approximate that in the population as closely as possible

b) Accessibility – refers to whether the researcher can reasonably expect to find enough elements or units of the population

c) Generalizability d) Representative

Types of data to be collected: 1. Qualitative study – data collected have names or labels 2. Quantitative data – data collected reflects the measurement (numerical) of variables or

attributes

Issues of control:

a. Internal validity – the extent to which the results of the study can actually be attributed to the action of the independent variable and not to any other; the degree to which unwanted influences* are controlled

a.1 Extraneous variables – interferes with the action of the variables being studied a.2 Bias – influencing the outcome of a study in any way, even unconsciously a.3 Hawthorne effect – the subjects’ awareness of being studied affects their responses

b. External validity – the degree to which the findings of the study are generalizable to the population; depends on the degree to which the sample represents the population

Step 7: Specifying Methods to Measure the Research Variables Research variables are first identified to clarify exactly the meaning of each before

selecting an appropriate method of collecting the data.

Data Collection Approaches:

1. Biophysiologic Measure 1.a Self-reports: Subjects are asked about their feelings, behaviors, attitudes, and personal

traits. 1.b Observation: Researcher collects data by noting people's behavior as well as the relevant

aspects of it.

Step 8: Designing the Sampling Plan A sample refers to the small fraction of the population. It is more practical to use a sample in order to minimize cost rather than collecting data

from a population. Selected sample may not adequately reflect the behaviors, traits, symptoms, or beliefs of

the population.

Types of sampling method:

a. Probability sampling – use of random selection process to select elements of a populationb. Simple random sampling – is a type of probability sampling that ensures that each element

of the population has an equal and an independent chance of being chosen. (use table of numbers or assign numbers)

c. Stratified random sampling – divide population into strata (age, gender, educational background), determine the number of cases desired in each stratum, random sample the groups.

d. Cluster random sampling – groups, rather than people are selected from the population. Successive steps of selection are done (state, country, city) then samples are randomly selected from clusters.

e. Systematic random sampling – involves selecting the kth element in the population. Uses sampling interval.



Types of Nonprobability sampling:

a. Convenience sampling – accidental, incidental sampling; choosing readily available subjects/ respondents for study

b. Snowball sampling- involves the assistance of the study subjects to get other subjects.C. Quota sampling – divides the group into strata then use convenience sampling to select respondents/ subjectsd. Purposive sampling- handpicking of subjects who are representatives of the whole

population.

SAMPLE SIZE – between 30 – 500, statistically accepted accdg to Roscoe (1975).

Step 9: Finalizing and Reviewing the Research Plan To generate support for financial resource To ensure that the plan does not violate ethical principles

Step 10: Conducting the Pilot Study and Making Revisions Provides the strengths and weaknesses of your larger project’s intended design, sample

size and data collection instrument. Done to assess the adequacy of the data collection plan Carried out as much as the major study so that any detected weakness will be truly

representative of inadequacies inherent in the major study. Pilot subjects should be chosen from the same population as subjects for the major

study. Revisions and refinements are done after the pilot study to reduce or eliminate problems

encountered. Second trial is advisable if extensive revisions are required.

Phase III: THE EMPIRICAL PHASE Involves the collection of research data and the preparation of those data for analysis

Step 11: Collecting the Data

Data sources: people, documents, laboratory materials.Data collection instruments: interviews, questionnaires, physiological test, and psychological tests

Enough materials should be available to complete the study. Participants should be informed on the schedule of the activities. Research personnel, e.g. interviewers, should be conscientious in keeping their

appointments. Suitable system of maintaining confidentiality of information should be implemented.

Analyzing the data: Taking the data that have been collected apart and reorganizing them so that the

researcher can make some sense of them in relation to the study question, research objectives or study hypothesis.

Step 12: Preparing the Data for Analysis Questionnaires should be checked for the completeness of answers. Coding should be done. It is the process of translating verbal data into categories or

numeric form. Research information should be transferred from written documents to the computer

files for analysis.

Phase IV: THE ANALYTIC PHASE

Step 13: Analyzing the Data Data are processed and analyzed in an orderly, coherent fashion to determine the

relationship among the variables. Quantitative information is generally analyzed through statistical procedures.

Classification of statistics:

a. Descriptive – allows researcher to examine the characteristics, behaviors, and experiences of study participants

b. Inferential – helps the researcher determine the likelihood that the sample that is chosen is actually a representative of the population



Statistical Techniques:

1. Measure to condense data

Frequency distribution - all values are listed and the number of times each one appears is recorded, values may be listed from highest to lowest

2. Measures of central tendency

Mode – value that occurs most often in a set of data under considerationMedian – middle score or value in the data.Mean – average sum of values divided by the total number of values

3. Measures of variability Describe how values are spread out in a given set of values

Range – the distance between the highest and the lowest value in a group of values.Percentile – datum point below which lies a certain percentage of the values in frequency

distributionStandard Deviation – measurement that indicates the average deviation or deviation of all

values in a set of values from the mean of value of those data. - Used in testing the hypothesis

t-Test Used to analyze difference between two means

Chi-square Test (X2) Used to assess whether a relationship exists between two nominal-level variables

Analysis of Variance (ANOVA) Tests mean differences among 3 or more groups by comparing the variability within

groupsAnalysis of Covariance (ANCOVA)

Tests mean differences among groups on a dependent variable, while controlling for one or more extraneous variable (covariates)

Spearman Rank-Order Correlation Coefficient Tests an association between two ranked variables

Step 14: Interpreting the Results Interpretation is the process of making sense of the results and examining the

implications of the findings within the broader context. It provides the answer to the questions posed in the first phase of the project. Begins with an attempt to explain the findings, within the context of the theoretical

framework, prior knowledge in the area, and the limitations of the study.

Phase V: THE DESIMINATION PHASE

Step 15: Communicating the Findings Research report in the form of term papers, dissertations, journal articles, papers for

presentation at professional conferences, books, etc. is prepared to present the results to others.

Step 16: Utilizing the Findings Recommendations as to how the results of the study can be incorporated into the

practice of nursing Disseminating findings to practicing nurses.


Leadership, Management and Research p[1]

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