leadership management and research

7/27/2019 Leadership Management and Research

http://slidepdf.com/reader/full/leadership-management-and-research 1/24

Passive Aggressive Assertive

Self-denying Self-enhancing at the expenseof others

Self-enhancing (self &others)

Inhibited Expressive Expressive

Puts down self;low self-worth and

confidence

Puts down others Feels good about self

Allows others to choose Chooses for others Chooses for self

Does not achieve goal Achieves desired goal by

hurting others Achieves desired goal

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

LEADERSHIP, MANAGEMENT and RESEARCH

Overview:

Part I. LEADERSHIP AND MANAGEMENTI. Concepts of Nursing LeadershipII. Nursing Management

II. 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 WITHDELEGATION

LMR by Mrs. Honey Chille S.Tolentino214

LEADERSHIP ROLES AND MANAGEMENT FUNCTION ASSOCIATED WITHDELEGATION

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 utilizedelegation to facilitate team building andtime management strategies

3. Aware of capabilities and level of motivation of subordinates during taskdelegation

4. Guides subordinates in determiningappropriate situations for delegation

4. Generates and implements a periodicreview for each delegated task.

5. Ensures patient safety as minimumcriteria in determining most appropriateperson to accomplish the delegated task.

5. Provides incentives and recognitionto show appreciation for the delegated task

completed.




C. LEADERSHIP ROLES AND FUNCTION RELATED TO PRELIMINARY STAFFINGFUNCTION

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 maintainingadequate skilled work team to meet the goalsof the organization.

2. Knowledgeable and aware of current andhistorical staffing events.

2. Shares responsibility in terms of staff hiring

3. Capable of knowing and encouragingqualified and competent individuals to join theorganization

3. In charge of planning and structuring neededinterviews.

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

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

5. Knows the legal requirements needed ininterview and selection of individuals tomaintain firmness in the hiring practices.

1. Uses the interview process as a chance topromote and enhance the image of theorganization.

1. Generates a selection criteria

2. Designates position to new personnel thatcan ensure success.

2. Uses information about organizational needsand employee’s strength to make wisedecisions regarding placements.

3. Regularly reviews programs and holdsorientations and meetings to ensure needs of

the unit are being met.

3. Uses expertise to guide new employeesand lead a certain program

4. Ensures understanding of the organizationalpolicies 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 bysupport 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 ispersonally 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 iswidely, 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 lifetimeemployment; Job security

Avoid responsibility

Need threats to be motivated

Seek responsibility Examining the long-term

consequences of managementdecision making

Need close supervision Have underutilized intellectualcapacity

Slower promotions

Are motivated by rewards andpunishments

Need only general supervision Establishment of strong bondsof responsibility betweensuperiors and subordinates

Encouraged to participate inproblem solving

A holistic concern for theworkers

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 wholegroup

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 theorganization

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 stemsfrom legal authority. Charismatic authority stems from the personal qualities of anindividual.

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 directingpeople.

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 thanpossession of specific personality traits





suggested that a manager should not give orders to an employee, rather, the two shouldtogether 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’spersonality , 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 playingtechniques

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 blocknormal maturational changes

Flexibility within organization Employee participation in decision making

C. Frederick Herzberg - factors associated with dissatisfaction are different from thefactors 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 isfor 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

liaison3 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 andinventories.

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-surgicalsupplies, 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 subordinatemanagers are asked to develop budget proposals for their individualunits.

B. Open-ended - operating manager presents a single cost estimate for what she

considers the optimal activity level, without indicating how that planshould 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 thefunded program by a predetermined date.

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

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 anddevelopment, 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 surgicalsupplies, 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 andvolume. 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 foodcosts.

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 jobdescriptions and how much work must be completed.

TOTAL CARE - or the case method of assignment, refers to giving of all direct care to the patientby an RN, maybe task-centered or patient-centered, the nurse provides allthe 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 providerswho 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 providebetter 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 isdischarged from that unit.

Designed to return the RN to their original role of giving direct patient care, which wouldimprove 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 beforebeginning 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 organizationhandles 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 theorganization. The organizational structure goal is to have working managers rather than managedworkers.

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

e. Span of control - The span of control is the number of people a manager supervises. Theorganizational structure decision to be made is the number of subordinates a manager caneffectively lead. The typical guideline is a span of control of no more than 5-6 people. However, alarger 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 theimpossibility 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 amongindividuals

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’sassignments

DISADVANTAGES:

Only shows formal relationships Does not indicate level of authority

Possible confusion of authority with statusTYPE 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 hierarchyDisadvantage: 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 andimprove 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 needs2. Develop a current job description3. Build a pool of applicants4. Review applications and select those to be interviewed5. Interview6. Check references7. Make a selection8. 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 jobaccomplishments 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 Scales A. 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 DeanEmeritus Julita V. Sotejo, developed a Code of Ethics for Filipino nurses (1982)

The Code of Ethics promulgated by the Philippine Nurses Association (PNA) wasapproved by the Professional Regulation Commission and through Board Resolution No.

1955 was recommended for use (1989) and approved by the General Assembly of thePNA 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 givingcare.

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 legaldimensions.

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 inbeing 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 andnursing 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 withother 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 technologyin bringing about improvement in the quality of their lives.

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

Undertaking nursing and health manpower development, training and research andsoliciting 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 registrationLiability 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 aboutnursing 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 proof C. 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 outof them.

SCIENTIFIC INQUIRY

A process in which observable, verifiable data are systematically collected from the worldthrough 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 researchthat 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 potentialhealth 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 nursinginterventions that are substantiated by research and, further, that all nurses may participate inresearch activities based on their level of education, their position, and their practice setting. Thenurse 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 conductedwith 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 beyondeveryday situations

B. 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 toparticipate 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 generalknowledge 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 problem2. Review of related literature3. Development of a study framework4. 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. TopicHow 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 theresearcher 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 throughdirect 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 simplyobserves 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 practicalpurposes.

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 CARE2. MUST HAVE A RELATIONSHIP TO MORE CONCEPTUAL ISSUES

AND THEREFORE HAS THE POTENTIAL FOR CONTRIBUTING TOTHEORY DEVELOPMENT AND OUR BODY OF SCIENTIFICNURSING KNOWLEDGE

3. NURSES MUST HAVE ACCESS TO OR CONTROL OVER THEPHENOMENON 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 bymaking college students drink through a tube from behind screen with no visualcues 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 differentamounts 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 istotally 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 studya) 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 somewhereother 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 thepast

• Retrospective – a phenomenon that occurs in the present is linked to aphenomenon 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 variableExamples: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 populationMETHODS: INTERVIEWS, QUESTIONNAIRES, DIRECT OBSERVATION, ANALYSIS OF

RECORDS

d. Explanatory

TO PROVIDE CONCEPTUAL ANALYSES GROUNDED IN OBSERVATION OFHUMAN BEHAVIOR

METHODS: 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 findings16. Utilizing the findings

Phase I: THE CONCEPTUAL PHASE

Includes thinking, reading, conceptualizing, reconceptualizing, theorizing, andreviewing ideas with colleagues or advisers.

The researcher calls on such skills as creativity, deductive reasoning, insight, andfirm 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 beststudied?)

c. Practical dimensions (e.g. Are adequate resources available toconduct 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, thatmay be related to the study question.

Provides a foundation upon which to base new knowledge and generally is conductedwell before any data are collected in a quantitative study

Familiarization with previous studies can be useful in suggesting research topics or inidentifying aspects of a problem.

Step 3: Defining the Theoretical Framework

Previous theory is used as a basis for generating predictions that can be tested throughempirical research

Step 4: Formulating Hypothesis and Defining Variables





A statement of the researcher's expectations about relationships between the variablesunder 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 andplans 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 findinganswers 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 thatconform 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 enoughelements or units of the population

c) Generalizability d) Representative

Types of data to be collected:1. Qualitative study – data collected have names or labels2. 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 theaction of the independent variable and not to any other; the degree towhich 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 aregeneralizable to the population; depends on the degree towhich 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 beforeselecting an appropriate method of collecting the data.

Data Collection Approaches:

1. Biophysiologic Measure1.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 relevantaspects 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 datafrom 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 chanceof being chosen. (use table of numbers or assignnumbers)

c. Stratified random sampling – divide population into strata (age, gender, educationalbackground), determine the number of cases desired ineach 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. Usessampling 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, samplesize 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 trulyrepresentative 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 problemsencountered.

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 theresearcher 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 isrecorded, 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 frequencydistribution

Standard Deviation – measurement that indicates the average deviation or deviation of allvalues 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 meansChi-square Test (X2)

Used to assess whether a relationship exists between two nominal-level variablesAnalysis 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 oneor 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 theimplications 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 theoreticalframework, 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 toothers.

Step 16: Utilizing the Findings

Recommendations as to how the results of the study can be incorporated into thepractice of nursing

Disseminating findings to practicing nurses.

leadership management and research

Documents