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RESEARCH & LEADERSHIP MANAGEMENT PNLE Review Top Rank Atty. Capili Scientific Method - informal way to discover new things Research - more formal, intensive, and comprehensive method for the discovering of ne...
RESEARCH & LEADERSHIP MANAGEMENT PNLE Review Top Rank Atty. Capili Scientific Method - informal way to discover new things Research - more formal, intensive, and comprehensive method for the discovering of new knowledge Nursing Research - deals with clinical problems, encountered in the clinical duty ○ Mas used ito Research in Nursing - broader study of nursing and the profession, focuses more on issues that can affect the nursing profession Evidence based practice - the use of the current best evidence "latest findings" Importance of Research in Nursing Professionalism - enhance the profession Accountability - increase accountability Social Relevance - contribute to society Research and Decision Making *Ultimate Goal of nursing research- To improve the practice of NURSING - Client care - Patient Care - Nursing Care - Healthcare Sources of Human Knowledge - TALES Tradition Authority Logical Reasoning Experience and trial and error Scientific Method Phase 1: The Conceptual Phase 1. Formulating and delimiting the problem 2. Reviewing the related literature (RRL) - to get idea and background of the study 3. Undertaking a clinical fieldwork 1 RESEARCH & LEADERSHIP MANAGEMENT PNLE Review Top Rank Atty. Capili Scientific Method - informal way to discover new things Research - more formal, intensive, and comprehensive method for the discovering of new knowledge Nursing Research - deals with clinical problems, encountered in the clinical duty ○ Mas used ito Research in Nursing - broader study of nursing and the profession, focuses more on issues that can affect the nursing profession Evidence based practice - the use of the current best evidence "latest findings" Importance of Research in Nursing Professionalism - enhance the profession Accountability - increase accountability Social Relevance - contribute to society Research and Decision Making *Ultimate Goal of nursing research- To improve the practice of NURSING - Client care - Patient Care - Nursing Care - Healthcare Sources of Human Knowledge - TALES Tradition Authority Logical Reasoning Experience and trial and error Scientific Method Phase 1: The Conceptual Phase 1. Formulating and delimiting the problem 2. Reviewing the related literature (RRL) - to get idea and background of the study 3. Undertaking a clinical fieldwork 1 4. Defining the framework and develop conceptual definitions 5. Formulating the hypothesis Framework of the study : Focus: Conceptual framework: topic Theoretical framework : theory Definition of terms - we define the variables. We utilize Operational definition - define the variables on how they were used in the study Conceptual definition - utilized for highly technical terms (definition found in the book, resource material) Phase 2: The Design and Planning Phase 6. Selecting a research design 7. Developing protocols for the intervention → Optional, used for experimental 8. Identifying the population to be studied 9. Designing the sampling plan 10. Specifying the methods to measure the research variables 11. Developing methods for safeguarding human/animal rights 12. Finalizing and reviewing the research plan → Phase of research the researchers spends most of his/her time Phase 3: The Empirical Phase 13. Collecting data 14.Preparing the data for analysis → Longest phase of research Phase 4: The Analytic Phase 15. Analyzing the data 16. Interpreting the results Phase 5: The Disseminating Phase 17.Communicating the findings 2 18. Utilizing the findings in practice THE PROBLEM Sources of Research Problems: “NITES” Nursing literature Ideas from external sources Theory ★ Experience and clinical fieldwork - one that is rich in information Social issues Scientific research ○ least that is being used because of the criteria of novelty ○ ginagawa lang sia if may need for modification and innovation Criteria of Good Research Problems: “ SALT LIN” S - Significance of the study - To people - To society - To profession A - Availability of the subject L - Limitations of the subjects T - Time allotment and research ability L - Limitations of tools I - Interest of the researcher N - Novelty / newness / freshness of the idea Limitations of tools: Major Types of Data Collection Method Use of existing data Self reports - interview, questionnaire ★ most widely used form of data collection - researcher mismo kumuha → Direct - Flexible Disadvantages: ○ Validity & Accuracy Observation ○ Participant ○ Non-participant - wala kang gagawin but just to observe 3 Biophysiologic measures - use of equipments or gadgets 1. In Vivo - measurement is performed directly on the subject - habang nakakabit sa kanya yung equipments or gadgets you do the measurement - Bp taking, 02 pulse oximeter 2. In Vitro - measurement is performed outside - kuha muna ng specimen, tapos dadalhin sa lab, so gagawin sa laboratory - urinalysis, fecalysis, abg analysis Phenomena Amenable to observations Characteristics and condition of the individual EXAMPLE: ○ Problem sa RH incompatibility: presence of rhogam nagpoproduce ng antibody ○ Problem sa ABO incompatibility → Jaundice (you can observe the characteristics of the skin) ○ Condition: Comatosed → you can observe and use GCS Activities and behavior Behavior Example Autism → temper tantrums (ignore but give ensure safety give helmet) → you can observe the behavior tantrums Activities Example DAT (Dementia of the Alzheimer’s Type) → ○ Remember A → Alzheimers → walang Acetylcholine → Amnesia → Aphasia and so on ○ Apraxia → di na alam gamitin yung mga bagay na alam nia before, unable to perform ○ First initial sign of alzheimer's - Forgetfulness Skill attainment and performance ○ Example : Return demonstration Environmental characteristics ○ Example: PAGASA Verbal communication ○ manner on how a person answer a question Non-verbal communication 4 Criteria used to Known Effectivity Validity - measure what is supposed to be measured ○ kung ano man ang gagamitin mo, or yung tool is masasagot or iaaddress yung research problem mo Reliability - consistency or the repeatability of the tool ○ kahit ilang beses binigay yung tool, same results / same response paren dapat = Reliable Sensitivity - able to detect small variations or find differences Hypothesis - tentative prediction or explanation of the relation between 2 or more variables Parts of Hypothesis “ICD effect” Independent Variables - Cause → fixed = set (by the researcher) Dependent Variables - Effect → vary (kung ano ang nag vavary sa population, pwede mabago) Relationship Population to which it applies ○ most neglected part ○ first thing to IDENTIFY in the population 1. all of their characteristics - * box or encircle the population including all its characteristics 2. Sets → a. if you have 2 or more sets of the population you concentrate on their characteristics that differentiate them ano mang ang characteristics nila that is automatically the independent variable b. if you have 1 set of population → ang characteristic ay wala ng silbi, it will form part of the population, di na gagamitin ang characteristics, eliminate it. - then go back to hypo/study, ask WHAT IS BEING STUDIED? BOX and then used the: - FIXED : independent variable - VARYING : dependent variable 3. for 2 or more sets : to get the dependent variable, check mo ang natitira wag mo na pansinin mga binox mo, check if ano ang pwede mag bago bago, or nag vavary Ex. for 2 sets of population 1. Older patients are more at risk for fall than younger patients 5 Population - older and younger patients Characteristics that differ the pop: AGE → independent variable Nagbabago bago: Risk for fall → dependent variable 2. Girls are less sexually active than boys Population - girls and boys Characteristics that differ the pop: GENDER → independent variable Nagbabago bago: sexually active → dependent variable 3. Full term infants who are breastfeeding weigh more than preterm infants who are mixed fed Population - full term infants breast fed preterm infants who are mix fed Characteristics that differ the pop: ○ TERM & type of feeding → independent variable Nagbabago bago: WEIGHT → dependent variable 4. Depressed patients who are living with significant others have lesser chances of commiting suicide than those depressed patients who are living alone. Population: Depressed patients who are living with significant others and depressed patients who are living alone. Characteristics that differ the pop: ○ Living condition→ independent variable Nagbabago bago: chances of committing suicide → dependent variable Ex. 1 set of population 1. Education attainment is not related to the compliance of PTB patients Population: PTB patients → wala ng kwenta di kasama, eliminate mo na sa options part lang ng population Go back to hypothesis then ask: WHAT IS BEING STUDIED KAY POPULATION? And then used the FIXED and VARY ○ Educational attainment → FIXED → independent variable ○ Compliance → VARY → dependent variable 6 Experimental: There is always manipulation - anything that is given Ang ibibigay sa subject → Fixed / SET all manipulation is automatically independent variable Ex. Music therapy decreases the levels of anxiety among Cancer patients 1. Population: Cancer patients 2. 1 set only → so walang silbi, eliminate 3. Go back and then ask what is being studied a. Music Therapy → given to the patient → Fixed / set by the researcher→ independent variable b. Levels of anxiety → Vary → dependent variable Examples: The Effect of Toprank Nursing Review to the passing rate of nursing students at the licensure exam. What is the independent variable a.) Effect of Toprank Nursing Review b.) Toprank Nursing Review c.) Nursing Review d.) Review What is dependent variable a.) Passing rate of nursing students b.) Passing rate of nursing students at the licensure exam c.) passing rate Additional notes: QUALITATIVE RESEARCH DESIGN: 1. Phenomenological - experiences 2. Grounded Theory - researcher develops a theory, there is no theory – the first to create is the researcher 3. Case study 4. Ethnographic - studying beliefs, practices, cultures and traditions 7 TYPES OF RESEARCH: ACCORDING TO MOTIVE PURE / BASIC RESEARCH - to increase knowledge APPLIED RESEARCH - use the knowledge into practice ACCORDING TO LEVELS OF INVESTIGATION LEVEL I EXPLORATORY - wanted to identify the variables, (wala kang alam may gusto kang malaman) → PURE / BASIC RESEARCH LEVEL II DESCRIPTIVE - wanted to find out whether the variables are associated or related → PURE / BASIC RESEARCH A. Descriptive - wanted to describe the variable as it is Ex. The new BSN curriculum - describe mo lang to B. Descriptive Correlational - wanted to describe the relationship of the variables to each other Ex. the new BSN curriculum and the readiness of the student nurses C. Descriptive Comparative - wanted to compare the variables to each other Ex. The new BSN curriculum and the old BSN curriculum LEVEL III EXPERIMENTAL - wanted to find out the cause and effect of the variables to each other → APPLIED RESEARCH ACCORDING TO APPROACH / DESIGN NON-EXPERIMENTAL - without manipulation (walang binibigay) ○ HISTORICAL - study of past issues Descriptive ○ SURVEY - use of interviews and questionnaires to gather public opinion Exploratory (opinion) ○ CASE STUDY - in depth or in detail studies of person and entities Descriptive (describe case of patient in detail) ○ METHODOLOGICAL - study of methods, tests, and procedures Descriptive (Describe the methods that was used, procedure that was done) ○ ANALYTICAL - further analysis of issues and events (present) Descriptive “analysis” 8 EXPERIMENTAL ○ TRUE EXPERIMENT - strict control over the variables Random For it to be considered a true experiment the elements of experimental research should be present / complete: 1. Element of randomization - lahat ng subjects may chance na maging experimental or control group 2. Element of manipulation - 3. Element of control *In an experimental research we usually use two sets of subjects Experimental group - only give the experimental manipulation Control group - give placebo (without therapeutic effect), and others ○ placebo - contains plain nss, sterile water, starch, sugar ○ others - other therapy ○ compare the effect from the experimental group When is the best time to give the placebo and others? - Placebo: give if there is without comparison - Others: give if with comparison ○ QUASI - control overcomes the variables ano man ang binigay mo, na overcome nila → HINDI NAGING EFFECTIVE quasi - “just like” non randomization Board Exam Question: You wanted to prove that cotrim is more effective than other drugs to respiratory infection. What should be given to the suitable control group? a. another experimental drug for respi infection b. a standard drug for respi infec → drug may therapeutic effect c. placebo d. another drug for respiratory infection (others) → with comparison kasi You wanted to prove that cotrim is effective for respiratory infection. What should be given to the suitable control group? a. another experimental drug for respi infection b. a standard drug for respi infec → drug may therapeutic effect 9 c. placebo → kasi without comparison d. another drug for respiratory infection (others) → with comparison kasi Double blind experiment - di alam ng Researcher and Subjects san naka-assign na group ang subjects ACCORDING TO TIME FRAME CROSS SECTIONAL STUDY ○ once lang ginagawa LONGITUDINAL STUDY ○ repetitive RETROSPECTIVE - study of the past to explain the present ○ RETRO - “past” PROSPECTIVE - study of present to predict the future ○ ex: global warming KAPANGYARIHAN: EXPLORATORY ○ if research is looking for opinion; if you see the word quality / automatic opinion ang kinuha ○ if the research is trying to get census (basta nagbibilang) example: ➔ Study the quality of life in barangay mabuhay ➔ Study the quality of education in barangay manggahan ➔ Study the favorite color in barangay makulay → census DESCRIPTIVE - word: Describe, relationship, simi/diff, facts and issues, study, analysis ○ CORRELATIONAL- Relationship of two variables ○ COMPARATIVE - similarities / differences EXPERIMENTAL ○ word: Effect ○ pag ka may Manipulation - anything that is given sa subjects Pag wala yung mga keywords → Process of Elimination 1. Look for the opinion → “Quality” / census 2. Check your options → Tanggalin mo na agad if wala ang keywords ng exploratory eliminate kasi most of the time wala daw ang exploratory sa options 10 3. Next, Look for manipulation → if may binibigay sa subjects → Experimental 4. If there’s no quality census and no manipulation → 🅧 Exploratory - Survey - Random subjects no idea 🅧 Experimental - True experimental / experimental - random - Quasi - non random ☑Descriptive - eto na sagot pag wala na yung dalawa - Historical - Case Study - Methodological - Analysis !!!!Pag research design ang tanong, walang mag mamadali EXAMPLE: You wanted to Study the health care delivery system used by nurses during world war II 1. Opinion - No Frequency / Census - No 2. Manipulation → Walang binigay 3. Descriptive - Historical SAMPLING DESIGNS Population - entire (all) aggregated cases, that the researcher would like to study Eligibility Criteria - exact criteria Accessible Population - entire aggregated cases that is within the reach of the researcher (eto lang kayang puntahan) Target Population / “Universe” (another term) - entire aggregated cases that the researcher would like to make generalization → dito na magfofocus Once you have already narrowed down the population / target population → you do sampling Sampling - processed used to get a representative of the population - refers the process of selecting a portion of population to represent the entire population 11 Samples - the representative *if ask in the board exam what is the #1 characteristic of a sample → REPRESENTATIVENESS / REPRESENTATION Sampling Plans ○ Non-probability → Non-random → may idea → lahat ba may chance? NOPE Types of Non-Probability Convenience or accidental sampling - samples are readily available Quota sampling - get the proportion of the population (may limit) Purposive / Judgemental sampling - samples are handpicked by the researcher, you chose based on the purpose of the research Snowball sampling - networking / referral system ○ Probability → Random → May idea → Lahat ba may chance? Yes Types of Probability Simple random sampling - everybody has a chance to become a sample Draw Lots, Roleta, Eenie meenie No grouping → Everyone has the chance to be picked Stratified random sampling Create a strata of the population and then divide the population into homogeneous group (pare-pareho) There is grouping (may basis ang grouping: strata) According to a certain characteristics Strata = Characteristics Cluster sampling Cluster = big groups May grouping but does not have basis, no distinct characteristics → they are just a big group prone to successive random sampling → because there is no distinct characteristics → they are just a big group kaya pa hati hatiin Example - You decided to group your population into the two groups, male and female → Stratified - You decide to group 10 provinces and you group each province → Cluster Systematic sampling - get the kth of the list 12 Formula: k = N / n N - population size n - sample size If ask to solve for systematic sampling use the SLOVIN’S FORMULA Memorize, lagi lumalabas sa boards: SLOVIN’S FORMULA 𝑁 𝑛 = 2 1 + 𝑁𝑒 REMEMBER: denominator → “ Isa kasama ni Nene” - N = population size - n = sample size - e = margin of error Follow → PEMDAS 2 1. Solve for the 𝑒 → multiply with population size add to 1 then divide = sample size 2000 ex. =4 500 kth = every 4th will be the participant Lalabas sa board exam - palaging lumalabas: ★ 4 Basic Rights of Research Subjects ★ ❖ Right not to be harmed Beneficence - to do (ginawa lang yung action) Non- maleficence - to prevent, or to protect ❖ Right to full disclosure Veracity - truth telling, honesty ❖ Right to self-determination Autonomy - right of subject to make own decision If the subject declined the researcher must Accept 13 Once patient refuses medication → Priority: Document immediately, inform the doctor he will decide what to do next, the doctor who decides to ask the patient to sign the waiver of responsibility Legal basis - code of ethics ❖ Right to anonymity, confidentiality and privacy Anonymity - do not disclose the name of the subject to protect their identity Confidentiality - do not disclose any information or the case of the patient may be revealed if: professionally directly involved allowed by law Privacy - private moments, parts, and properties Levels of Measurements - assign numbers according to rules Categorical Nominal data - name the category ○ assign numbers according to the category Ordinal data - ranking of events ○ order / ranking ○ ex: good, better, best Numerical Interval data ○ show ranking of events with equal intervals ○ the 0 is not absolute ○ ex. temperature Ratio ○ show ranking of events with equal intervals ○ the 0 is absolute ○ hindi pwede mag negative ○ ex. height Descriptive Analysis - only summarizes data Frequency of distribution - use of tables and graphs ○ tables and graphs are the ones that communicate to the readers Measures of central tendency ○ mean, median and mode 14 ○ mean - average ○ median - middle if dalawa lang binigay get the highest and lowest and divide by 2 ○ mode - frequently appears Measures of variability ○ Simple rank, range (highest minus (-) lowest), variance, standard deviation ★ Inferential Statistics 1. ANOVA 2. Chi-square 3. T-tests 1. Student T-test 2. Paired T-test KAPANGYARIHAN Population = prioritize the SETS 1. Anova - if you have 3 or more sets compared to 1 variable 2. Chi-square - if you only have 1 set and is compared to 2 or more variables that is focused on frequency 3. Pearson Product Moment of Correlation (Pearson r) - 1 set, 2 or more variables, focused on interval or ratio data - focus on numbers 4. T-tests 1. Student T-test - 2 sets of population compared to 1 variable 2. Paired T-test - 1 set of population → studying dependent group / results dependent results - ex. you wanted to study the average blood pressure of women after menstruation → need mo yung result ng before and after para makuha kaya paired dependent group: ex. study of twins → dependent to each other Summarize: 3 or more set → anova 2 set → student t test 1 set → may hahanapin tayo 1. before and after → paired t-test if wala look for: 2. numbers → Pearson r if wala look for: 3. Chi square na ang sagot sis 15 LEADERSHIP MANAGEMENT Management - art of getting things done with and through people so that the goals of the organization can be achieved. - Always about goal achievement Leadership - The use of one’s skills to influence others to perform to the best of their ability toward goal achievement Different influence tactics “AIRCUBES” Assertiveness – sending direct messages, standing up for your own rights without stepping on the rights of others. (Can motivate the members) Ingratiation – making others feel good or look good before making a request Rationality – use of reasoning Coalition – backing up a request together with your co-members Upward appeal – using the name of a superior formally or informally Blocking – threatening somebody to damage his opportunity for advancement or not being friendly to another person until he grants the request ○ Blackmail Exchange – reminding somebody of a previous person or return of favor Sanction – 2 Types of Leaders FORMAL LEADERS– these are the people who holds a position in the organization ➔ Top Level Leaders – focuses on the organization ◆ Monitors the entire organization ➔ Middle Level Leaders – middleman ◆ Coordinates with the top and first level leaders ➔ First Level Leaders – focuses on the operations ◆ Monitors the happenings in the ward INFORMAL LEADERS– people who do not hold a position in the organization, but they can motivate members to perform ➔ Senior staff or charge nurses 3 Styles of Leader AUTOCRATIC – leader focused, leader decides, and members does not have a voice 16 ➔ Best used in emergencies ➔ Staff’s level of anxiety ranges from severe to panic ◆ Incapable of decision making DEMOCRATIC – members have a voice in decision making and the leader acts as a facilitator ➔ Best used when you need the compliance of the members ➔ Raises motivation LAISSE-FAIRE – member focused, members decide, leader is just a decoration ➔ Best used when members are MATURED ➔ But also happens when the manager is new in the unit ➔ Leader monitors ◆ Decides what is right and wrong ➔ Danger of abusing temporary authority if members are IMMATURE - *Bureaucratic – rules and regulations (not always used) Contingency Theory – a leadership style may or may not be effective depending on the situation Authority - legitimate right to give command and to act on the interest of an organization - an officially sanctioned responsibility Power - ability to obtain, retain, and motivate people and to organize informational and material resources to accomplish a task Functions of Management PLANNING - Knowing where you are and where you want to be Strategic – Long term plan ○ Type of plan implemented within 3 to 5 years ○ Organization benefits ○ Top level leaders Operational – short term plan 17 ○ Usually changed annually, depends on the operation ○ Operations benefits ○ First level leaders SWOT Analysis ○ Strengths ○ Weaknesses ○ Opportunities ○ Threats Hierarchy of Planning ○ Mission and Vision Mission = reason Vision = wants to achieve (futuristic) ○ Philosophy – statement of beliefs, values, and principles “Believe” = philosophy Values centered General ○ Goals – general statements of aims and purposes Objective ○ Objectives – specific statements of aims and purposes that are used to reach your goals ○ Policies – plans reduced to statements that helps the organization in decision making General application, for everyone ○ Procedures – step by step instructions ○ Rules – guidelines for action and non-action Directed to employees Subject to regulation Budget -> revenue and expenses ○ Systematic way of meeting with the expenses ○ Focus of budget revenues and expenses / income and cost ○ Revenues = income ○ Expenses = cost ○ Both dapat ang lumabas, pagka isa lang, mali yun Types of Budget Capital budget - usually expensive 18 - Regardless of the price, basta it is For long term-use - Ex: bumili ng aircon Operational budget - Day to day - Payment for electricity; consumable materials etc Examples - maintenance ng aircon - Pero kapag: Repair and maintenance of aircon —> dito padin - Salary of Part-time employee - Salary of both full-time and part-time employee —> the org does not have a personnel budget Personnel budget - Salary of the full-time employee (Working 8 hours / 5 days a week) - Prepared ahead of time, only available on the day of salary Cash budget - Available all the time for emergency purpose - Petty cash / Cash-on-hand / Emergency cash / fund Examples - pag nag cacash advance ang empleyado kasi personnel budget only available sa day ng salary - Repair ng aircon If asked in the board exam about type of budget: 1.) ask is this is for Long term use? a.) If yes —> Capital budget b.) If no —> look for the other three ORGANIZING - establish a formal structure of an organization & job qualification & job description ➔ For work distribution ➔ 3 Elements of Organizational Structure ◆ Levels of Authority – there should always be a boss Levels depends on the size of the organization ◆ Lines of Communication 19 Solid line – direct relationship ○ Represent superior-subordinate relationship ○ Unity of Command is present ◆ Only one person who can give orders, the immediate superior ○ Scalar Chain is present ◆ Or also known as Chain of Command ◆ Follow the hierarchical order ◆ Reporting relationship – immediate superior ◆ Complaint – immediate superior of the person you are complaining ○ Lines of communication ◆ Solid line – within the communication - Vertical communication (patayo) ○ Upward (from baba) – Reporting ○ Downward (from taas) – Delegation - Horizontal / Lateral ○ Occurs within the same position, same department - Diagonal ○ Different departments ○ OR → DR Broken or dotted line – indirect relationship ○ A coordinated relationship (doctors are not your boss) ○ If this is a doctor’s order pertaining to patient care, you need to follow. RA 9173 Span of control – number of workers that directly report to a superior ○ Number of workers who works for the superior ➔ Major Forms of Organizational Structure ◆ Centralized Models – Central (Center) One person who has responsibility for decision making ○ Advantages: ◆ Cost effective (Less cost) ○ Disadvantages: ◆ Increase size of the organization ◆ Cumbersome (masikip) ◆ Diluted attention to staff 20 ◆ Decentralized or Participating Approach (BIGGER) Bigger organization broken down into smaller unit and the responsibility for decision making is delegated to the ones nearest the majority of the workers. ○ Advantages: ◆ Better interpersonal relationship ◆ The staff has a voice in decision making ◆ Greater/better imagination/creativity ○ Disadvantages: ◆ Costly (Mas magastos) ◆ Danger of breakdown in communication ◆ Problems in communication (unity of command) ➔ Job Description – Also termed performance responsibility ◆ Most important thing you need to know in your work ◆ Spells out your precise job content ◆ Purpose: Can prevent malpractice Used for delegation Point of evaluation Used for staffing ◆ Staffing – signing of competent people to fill the roles of the organization 4 Methods of Staffing Process ○ Conventional – oldest method ◆ Centralized or decentralized ◆ Discretion of the manager ○ Cyclic – the schedule repeats itself ◆ Manager creates a base schedule ○ *Forty hours – work for 8 hours a day, 5 days a week, with 2 days of ◆ Mandated by law in the PH Supported by the PD 442: Labor Code 6th day may be allowed or requested by the hospital provided that it is overtime ◆ Pre-Pandemic ○ Seven days – work for 10 hours a day, 7 days a week, followed by 7 days off 21 ◆ Used during the pandemic ➔ Nursing Care System – system that is used to deliver nursing care - Or Modalities of Nursing Care or Patterns of Nursing Care ◆ Case Nursing or Case Method – total care nursing 1:1 Private Duty Nursing Ideal used in the ICU (but not common practice) ◆ Functional – tasks are delegated among the staff Per function ◆ Team Nursing – group of nurses assigned to a group of patients where in there is a team leader Team leaders assess the situation and delegates tasks ◆ *Primary Nursing – 24 hour continuous coordinated comprehensive nursing service of 5-6 patients from admission to discharge 1:5 or 6 (maximum) Primary nurse – kung kanino naendorse Associate primary nurse – kapalit ng primary nurse Reliever – pag off primary at associate primary Madami pa din sila pero 1 per shift Primary Nurse – responsible for creating the NCP ○ Cannot be altered by the associate except if there is changes in the patient’s condition provided that he will report it to the primary Ideal used in the ward ◆ Modular Nursing – combination of team and primary nursing Group of nurses assigned to a group of patients responsible for 24 hours nursing care Geographical assignment of patients Take care of patients or case finding Used in disasters or crisis ◆ Case Management – utilizing the healthcare delivery system wherein the goals are: to deliver quality care 22 to promote the quality of life ○ Focus is long term treatment ○ Rehabilitation Centers and Psychiatric Facilities to decrease fragmentation ○ Decrease feeling of isolation and to contain cost ○ cost effective Utilized in nursing homes DIRECTING - Delegation / Delegating 2 ASPECTS - memorize this TECHNICAL - use of tasks, procedures, materials and equipments ○ Problems with technical, hanapin mo sa board exam: ★ show ★ teach ★ demonstrate ★ supervise ★ do / perform the procedure with the nurse INTERPERSONAL - attitude, behaviors and styles of direction giving Problems with: ○ Attitude and Behavior ★ Verbalization of feelings ○ Styles of direction giving ★ ASSERTIVENESS - hindi mayabang mag utos & dapat therapeutic *if question falls under the WHAT and WHO of delegation: Remember the 4 pointers of delegation: 1. Consider the position of the staff → know if licensed or not a. if licensed, go back to the ward na pinanggalingan, kung anong ginagawa niya sa ward nia before, yung ang kaya niyang gawin b. unlicensed → simple tasks 2. Ward → alamin saan ward galing and saan ward pupunta 3. Capabilities of the staff → which will depend on the position in the ward 4. Condition of the patient 23 You are a telemetry nurse and ask to float in the pediatric ward, what type of patient can be assigned to the floating nurse? a. patient with acute gastroenteritis (AGE) b. patient with dermatitis c. patient with tetralogy of fallot Telemetry nurse → reads cardiac monitor → can also read ecg → so handles patient with cardiac problems / cardiac complications CONFLICT - misunderstanding and disagreement between 2 or more person, agencies and organizations ✓ Conflicts are normal ✓ Priority: To solve the problem immediately Conflict - Resolution Strategies Avoidance ○ Manager: “Let us not talk about it” Dominance and Suppression ○ Manager: “I am the manager here, you have no choice” Restriction / power ○ Manager:I am the manager here, I will do what is best for everybody” ○ sino may power → siya gumagawa ng paraan Majority Rule ○ Manager: “Let us divide the house” ○ Voting ○ Madalas na ginagamit Smoothing ○ the unacceptable appears to be acceptable ○ ang mali ay ginagawang tama Compromise ○ meeting halfway ○ both may sina-sacrifice Collaboration ○ working hand in hand in solving the problem ○ brainstorming - all ideas are welcome, accept all ideas 24 *if manager is waiting for reports, reporting bago gumawa ng action sa issue → Automatically a wrong answer kasi walang participation si manager, just waiting for the report na hindi siya gumawa, nag aantay lang ng report, di sigurado There will be times, di strategy ang itatanong, yung approaches ang iaask 4 approaches in problem-solving 1. win - lose: able to solve the problem at the expense of others → Dominance and suppression 2. lose - win: able to solve the problem at your own expense → Restriction / power, Smoothing 3. lose - lose: both parties sacrificed in the solution of the problem → Compromise 4. win - win: both parties benefit from the solution of the problem → Collaboration *manager / you - members or others first part second part In all these approaches the manager solved the problem, checheck lang kung sino ang. In every conflict resolution may pagbabagong mangyayari: CHANGE MANAGEMENT Any alteration in the status quo (present situation) Perform problem-solving Kapangyarihan: The Change Process - Problem solving 1. Perceive the need for change - identify the problem, determine the issue, accept that there is something that needs to be changed → always remember, most of time time sinusulat na ng BON sa situation, di na need perceive, proceed to the next step 2. ★ Initiate a group interaction - bring the group together, meeting / conference with the group / members → do planning, find the best solution ➔ This step is the key to problem solving ➔ Who is the key? The Group ◆ need their support, have open communication with them 25 3. Implement the plan one step at a time ➔ do it gradually to prevent resistance 4. Evaluate the overall results ➔ go back to the 2 aspects of directing (Technical and Interpersonal) Example There's new equipment that was brought in the unit, the staff does not know how to use the new equipment. Together with the staff, you taught them gradually how to use the new equipment. Everyone learned but one staff member still had difficulty in using the new equipment. What are you going to do? → Go back to the 2 aspects of directing: Technical ang problem ✓ show, teach, demonstrate, supervise, do / perform the procedure with the nurse Same scenario, but the staffs, learned but resist to use the old equipment → Problem with interpersonal ✓ verbalization CONTROLLING - Seeing to it that what is planned is done - Controlling = Evaluating / Reviewing / Checking / Determining / Comparing Kapangyarihan: 4 Basics Steps of Controlling 1. Develop standards and criteria - basis for evaluation Standard - predetermined level of care → naka set na Criteria - characteristics use to meet the level of care Ex. Scrubbing ★ Basta controlling, evaluation → ang sagot ay always STANDARD 3 Types of Standards “S.P.O” → memorize this Structure - facilities, equipments, materials and management system Process - includes plans and procedures Outcome - results Steps for answering: 26 1. Check If the question ask for the results → Outcome 2. Tingnan if may ginagawa and kung sino: a. if may ginagawa si nurse, → Process b. if manager ang gumawa → management system → Structure 2. Determine compliance to standard and criteria 2 Types of Evaluation Nursing Audit - patient-focused 2 Types: ○ Concurrent (current) - evaluate as the care is given, pagka gawa ng intervention, evaluate agad response / result ni patient ○ Retrospective (past) - reviewing patient’s chart Performance Appraisal - staff-focused 2 Types: ○ Informal - incidental performance appraisal ○ Formal - systematically done based on the procedure, usually ends up in review sessions 3. Identify strength and weaknesses ➔ both dapat, if isa lang lumabas sa boards, automatically wrong Tip: Also the same with delegation. Delegation and evaluation compliment each other. So, delegate both strengths and weaknesses. AlWAYS BOTH 4. Act to reinforce strengths and to take corrective actions on the weaknesses How are you going to correct the weaknesses of the staff? ➔ go back to the 2 aspects of directing Example: Evaluation of unit. The staff are experiencing staff burn out. How are you going to correct this? Interpersonal → Verbalization Once you’ve reached controlling, are you done with management? NO, always remember functions of management, all of them are an ongoing function of management 27 STYLES OF LEADERSHIP COMMON STYLE AUTOCRATIC - leader-focused, best time to use in emergency DEMOCRATIC - members have a voice, leader is a facilitator best time to use: compliance LAISSEZ-FAIRE - staff-focused leader monitors best time to use: when members are matured BUREAUCRATIC - rules and regulations, by the book Management process involves five functions Planning Organizing Staffing Directing Controlling PLANNING Budget Focus: Revenues and expeneses or income and costs 1. Capital budget - long - term use 2. Operational - day to day, consumable materials, salary of part time workers 3. Personnel - salary of full time workers 4. Cash - always available, emergency uses Organizational Structures 1. Levels of authority 2. Lines of communication > Solid line – within the communication - Vertical communication (patayo) Upward (from baba) – Reporting Downward (from taas) – Delegation - Horizontal / Lateral Occurs within the same position, same department - Diagonal Different departments OR → DR > Broken line – outside 3. Span of control 28 Scalar Chain Reporting relationship – immediate superior Complaint – address the complaint immediate superior of the person you are complaining Nursing Care System – system that is used to deliver nursing care Or Modalities of Nursing Care or Patterns of Nursing Care Case Nursing or Case Method – total care nursing ○ 1:1 ○ Private Duty Nursing ○ Ideal used in the ICU (but not common practice) Functional - tasks are delegated among the staff ○ Act according to function Team Nursing – group of nurses assigned to a group of patients where in there is a team leader ○ Team leaders assess the situation and delegates tasks Primary Nursing – 24 hour continuous coordinated comprehensive nursing service of 5-6 patients from admission to discharge ○ 1:5 or 6 (maximum) ○ Primary nurse – kung kanino naendorse ○ Associate primary nurse – kapalit ng primary nurse ○ Reliever – pag off primary at associate primary ○ Primary Nurse – responsible for creating the NCP ○ Cannot be altered by the associate except if there is changes in the patient’s condition provided that he will report it to the primary ○ Ideal used in the ward Modular Nursing – combination of team and primary nursing ○ Group of nurses assigned to a group of patients responsible for 24 hours nursing care ○ Geographical assignment of patients ○ Take care of patients or case finding ○ Used in disasters or crisis Case Management – utilizing the healthcare delivery system wherein the goals are: ○ deliver quality care ○ to promote the quality of life ○ Focus is long term treatment ○ Rehabilitation Centers and Psychiatric Facilities ○ to decrease fragmentation ○ Decrease feeling of isolation and to contain cost ○ cost effective ○ Utilized in nursing homes 29 2 aspects of Directing / Delegation / Delegating Technical - use of tasks, procedures, materials and equipments ○ Problems with technical, hanapin mo sa board exam: ★ show, teach, demonstrate, supervise, do / perform the procedure with the nurse Interpersonal - attitude, behaviors and styles of direction ★ Verbalization of feelings TIP: Palmer question, if you see the word ignore - automatically wrong 4 pointers of Delegation 1. Consider the position → if Licensed or not 2. Ward → know where she came from and san pupunta 3. Capabilities of the staff → which will depend on the staff 4. Condition of the patient Problem-Solving → Change Process: 1. Perceive the need for change 2. Initiate a group interaction – bring the group together ★ – Key to problem solving ➔ The key – the group: need their acceptance, support ➔ Meeting – planning : find the best solution 3. Implement the plan, one step at a time / gradually 4. Evaluate the overall results ➔ go back to the 2 aspects of directing Technical → show / demonstrate Interpersonal → verbalization TIP: if you see coercion, application of force, intimidation → automatically wrong answer Styles of direction giving ★ ASSERTIVENESS - hindi mayabang mag utos & dapat therapeutic Best skill – Listening Best style – assertiveness 30 Controlling - seeing to it that what i planned is done – Evaluating / Reviewing / Checking / Determining / Comparing 4 Basic Steps 1. Develop standards and criteria - basis of evaluation ★ Basta controlling, evaluation → ang sagot ay always STANDARD 3 Types of Standards (SPO) Structure - facilities, equipments, materials and management system (Manager) Process - includes plans and procedures (Nurse) Outcome - results 2. Determine compliance to standard and criteria 2 Types of Evaluation Nursing audit - patient focused concurrent – record immediately retrospective - patient’s chart Performance appraisal - staff focused informal - incidental formal - systematic 3. Identify Strengths and Weaknesses should be both 4. Act to reinforce strengths and to take corrective actions on the weaknesses go back to the 2 aspects of directing TIP: If there are two options in the board exam that appears to have the same meaning, both of them are wrong answers Importance of Research in Nursing Professionalism - enhance the profession Accountability - increase accountability Social Relevance - contribute to society Research and Decision Making Ultimate Goal of nursing research: To improve the practice of NURSING - Client care - Patient Care - Nursing Care - Healthcare 31 Samples - Representative #1 characteristic of a sample → REPRESENTATIVENESS / REPRESENTATION Criteria used to Known Effectivity Validity - measure what is supposed to be measured kung ano man ang gagamitin mo, or yung tool is masasagot or iaaddress yung research problem mo Reliability - consistency or the repeatability of the tool kahit ilang beses binigay yung tool, same results / same response paren dapat = Reliable Sensitivity - able to detect small variations or find differences INDEPENDENT AND DEPENDENT VARIABLE 1. Identify the population, including all of their characteristics 2. Identify Sets 2 or more sets - focus on characteristics that differentiates them, that is automatically the INDEPENDENT VARIABLE 1 set only ○ characteristic has no sense ○ GO back to the question ○ Ask WHAT IS BEING STUDIED - FIXED : independent variable - VARYING : dependent variable Tip: all manipulation is automatically the independent variable QUALITATIVE RESEARCH DESIGN: 1. Phenomenological - experiences 2. Grounded Theory - researcher develops a theory, there is no theory – the first to create is the researcher 3. Case study 4. Ethnographic - studying beliefs, practices, cultures and traditions Qualitative vs Quantitative QUANTITY (keyword) - QUANTITATIVE QUALITY - QUALITATIVE 32 RESEARCH DESIGN 1. Look for the opinion→“Quality”/census → EXPLORATORY / SURVEY 2. Check your options → Tanggalin mo na agad if wala ang keywords ng exploratory eliminate kasi most of the time wala ang exploratory sa options 3. Next, Look for manipulation → if may binibigay sa subjects → EXPERIMENTAL - random subjects QUASI-EXPERIMENTAL - non-random subjects 4. If there’s no quality census and no manipulation DESCRIPTIVE - eto na sagot pag wala na yung dalawa A. Descriptive - describe B. Descriptive Correlational - relationship C. Descriptive Comparative - comparison - Historical: past issues - Case Study: case, in depth study - Methodological: methods and procedure - Analysis: issues and events (present) Non-Probability - Non-random (may idea) - No everyone has a chance 1. Convenience – samples are readily available 2. Quota – there is limit 3. Purposive – Judgemental, samples are handpicked 4. Snowball - referrals Probability - random (walang idea) - everyone has a chance 1. Simple - no grouping, everyone is included 2. Stratified - there is a grouping, has basis, grouped according to certain characteristics 3. Cluster - big grouping but has no basis 4. Systematic - kth of the list 33 4 Levels of measurement 1. Nominal - categorical: Name the category Gender, Marital status 2. Ordinal - categorical: Ranking Student level grades 3. Interval - numerical: 0 is not absolute Temperature 4. Ratio - numerical: 0 is absolute Height, Weight, Weekly food spending INFERENTIAL STATISTICS KAPANGYARIHAN 1. Box the Population = prioritize the SETS 3 or more set → ANOVA 2 set → STUDENT T TEST 1 set → may hahanapin tayo: Before and after→ paired t-test if wala look for: numbers→ Pearson r if hindi number → Chi square 34
