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NURSING
RESEARCH,
LEADERSHIP AND
MANAGEMENT

NURSING RESEARCH
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- Came from the French word “cerchier” meaning to seek or to search
- A systematic and objective process of analyzing phenomena related to nursing
- systematic inquiry designed to develop knowledge about issues of importance to the
nursing profession, including nursing practice, education, administration and informatics.

The researcher uses systematic, orderly and objective methods of seeking information. The scientific
method uses empirical data – data gathering through the sense of organs. (CBQ JUNE 07)

 Because nursing is a profession, should contribute to the generation of new knowledge.

 Through nursing research we nurses could evaluate and document their contribution to their clients
health and well being and to the health care delivery system.

What is the major reason for conducting nursing research?

a. improve nursing care of the clients
b. promote the growth of the nursing profession
c. document the cost effectiveness of nursing care
d. ensure accountability of nursing practice.

(CBQ.JUNE 2007, JUNE 08, JUNE 09,NOV. 09, LIFTED FROM Kozier Page 26)
 Test taking strategy: principle of umbrella effect: options b, c, and d will fall to option A.
 Test taking strategy: patient centered approach

STEPS IN NURSING RESEARCH PROCESS:

STEP I . PROBLEM
 a situation in need of solution

FOUR CRITERIA (June 2007): FRIS

1. Feasibility - analyzes how much time, money and materials you will need to complete the research
problem
2. Researchability – must be subjected into scientific investigation
3. Interest – researcher must be interested and curious about the research problem because the
researchers enthusiasm could be a factor for the completion of the research study.
4. Significance - has a potential to contribute to nursing science because it seeks to enhance client care.
JUNE 08.

STEP II . SOURCES OF RESEARCH PROBLEM (TILES)

Theory – a supposition or system of ideas that are seem to be interrelated (June07)
Interest
Literature
Experience
Suggestions (from nursing experts)

(CBQ. DECEMBER 2007)

In formulating the research hypotheses, researcher Myrna should state the research question as:
A. What is the response of the staff nurses to the health values?
B. How is variable “health value” perceived in a population?
C. Is there a significant relationship between health values and health promotion activities of the
staff nurses?
D. How do health values affect health promotion activities of the staff nurses?

STEP II. PURPOSE

- researchers intends to do on the research subject.
- Usually it contains an active verb plus the preposition “to”
- Example: to enhance client care, to assess the post surgical patients’ knowledge in caring for his
colostomy bag.

Study purposes includes:

1. what the researcher will do
2. who the subjects will be
3. where the data will be collected

STEP III. REVIEW OF RELATED LITERATURE

- To review means to view again on the literature works of others.

What is the purpose of conducting review of related literature?

 To know what is already known and unknown on the topic
(CBQ. DEC 2006, JUNE 2007 & DEC.07 & JUNE 08 - LIFTED FROM KOZIER PAGE 29)

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 2 KINDS OF REVIEW OF RELATED LITERATURE

1. RESEARCH – must be subjected into scientific investigation

2. NON- RESEARCH/CONCEPTUAL – non research materials based on the opinion and experience of
the researcher. It includes experiences, opinions, and theories of experts along the problem area. It
also includes articles from books, journals and magazines.

CBQ: A thorough review of related literature covers the last 5 years.

 lifted from Lydia Venson page 45 1st paragraph.

SOURCES OF DATA (JUNE 2007)

1. PRIMARY SOURCE – a description of research study written by the original researcher. Ex. Journal
article sand data collected from interview and questionnaire

2. SECONDARY SOURCE – a description of research study written by someone other than the
researcher. Ex: histories and biographies

CBQ.-JUNE 2007
A primary source of nursing research study is:
a. An author that summarized or cited the works of the original researcher
b. A description of the research study written by the researcher who conducted the study
c. A description of the research study written by the researcher who did not conduct the study.

STEPS IN REVIEW OF RELATED LITERATURE (December 2007): ROW

Read literature
Organize literature
Write/Written literature

CBQ.-DEC. 2007 LIFTED FROM NIESWIADOMY

Myrna needs to review relevant literature and studies. The following processes are undertaken in
reviewing literature EXCEPT:
A. locating and identifying resources
B. clarifying a research topic
C. reading and recording notes
D. using the library

2 TYPES OF RESEARCH DEFINITION

1. OPERATIONAL - these are terms that are defined according to the special way they are used in the
study ; a type of definition defined by the “researcher”
Ex: weight is something seen in kg/lbs
2. THEORETICAL/CONCEPTUAL – defined by “dictionary”
Ex: weight = body mass index/ gravity
3. LEXICAL – definitions taken from authorities on the terms being defined.
Ex: According to Aristotle, weight is…

 DEVELOP A THEORETICAL/CONCEPTUAL FRAMEWORK

A. THEORY - a supposition or system of ideas that are interrelated.
B. CONCEPT – concrete or abstract
C. CONSTRUCT – group of concepts that are directly or indirectly observable
D. PROPOSITION – assertion of relationship between variables
E. THEORETICAL FRAMEWORK – propositional statement from one theory
F. CONCEPTUAL FRAMEWORK – links concepts from several theories, previous research, own
experience.
G. EMPIRICAL GENERALIZATION – statement based on observation of similar patterns of event. Ex: All
people who are stressed will tend to have increase BP.

FRAMEWORK OF THE STUDY

 To organized the study and help develop a way to interpret study findings and explanation
CBQ-DEC. 2007 LIFTED FROM NIESWIADOMY
By developing a framework within ideas are organized and the researcher is able to show that
In both quantitative and qualitative research,
the proposed study the used
is a logical of a frame
extension of reference
of common is required. Which of the following
knowledge.
items serves as the purpose of a framework?
A. Incorporates theories into nursing’s body of knowledge
B. Organizes the development of study and links the findings to nursing’s body of knowledge
C. Provides logical structure of the research findings
D. Identifies concepts and relationships between concepts

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IDENTIFYING THE STUDY ASSUMPTIONS
- are beliefs that are held to be true but have not necessarily been proven.
- Ex. All human beings need love.
- Ex. All nurses like to give adequate nursing care but there are factors that prevent them from devoting their
full time to the care of patients.

SCOPE, LIMITATION AND DELIMITATION

SCOPE – extend to which the study will be made

LIMITATION – A.K.A. extraneous variable, factors beyond the control of the researcher
DELIMITATION - limitation placed by the researcher

STEP IV . FORMULATE HYPOTHESIS

GOOD HYPOTHESIS: TDIP

Theoretically based ; testable
Directly related to the problem; declarative sentence
Includes the population and variables
Present tense format

A good hypothesis is easily understood, is specific and conceptually clear and can be tangibly measured.

VARIABLES – is any quality of a person institution or situation that varies or takes on different values.
(JUNE07 - JULY 2010)

1. INDEPENDENT – presumed “CAUSE”

2. DEPENDENT – presumed “EFFECT”
3. EXTRANEOUS/ CONFOUNDING/ UNCONTROLLED- variables that are beyond the control of the
researcher. AKA as limitation of the study. Ex. Force majeur and fire
4. DICHOTOMOUS – variables with two categories ex. Male and Female
5. POLYCHOTOMOUS – variables with two or more variables ex. race
6. DISCRETE – can take only a finite number of values – ex. BP,RR, PR
7. CONTINOUS – can take a variety of range ex. Temperature

CBQ-DEC. 2007:
You are interested to study the effects of medication and relaxation on the pain experienced by
cancer patients. What type of variable is pain?
a. Dependent
b. Correlational
c. Independent
d. Descriptive
 Test taking strategy: principle of elimination: remove b and d because they are type of research design
and choose between a and c.

TYPES OF HYPOTHESIS

-According to number of variables: JUNE 09

1. SIMPLE – consists of 1 independent variable and 1 dependent variable
2. COMPLEX - consists of 2 independent variable and 1 dependent variable or vice versa.

- According to relationship of variables:

1. RESEARCH/ ALTERNATIVE/ OPERATIONAL/ SUBSTANTIVE/ SCIENTIFIC/ THEORETICAL –
relationship is present
a. DIRECTIONAL – predicts the exact relationship between variables
Ex. Older patient is more at risk of getting fall than younger ones.
b. NON- DIRECTIONAL- there is a relationship but it does not specify what it is.
Ex: There is a relationship between the age of the patient in getting fall.
2. NULL/STATISTICAL – no relationship
Ex. There is no relationship between the age of the patient in getting fall.
HYPOTHESES TYPES OF INDEPENDENT DEPENDENT VARIABLE
HYPOTHESES VARIABLE
Rock music increases heart Simple Rock music Heart rate
rate among elderly
Birth weight is lower among Simple Level of alcohol use of Birth weight
infants of alcoholic mothers mothers
than among infants on non
alcoholic mothers
Primary nursing promotes Simple Method of Nursing Patients satisfaction
patients satisfaction than the Care Delivery
case method of assignment

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The level of job mobility is Simple Type of nurse Job mobility
different for psychiatric nurse practitioner
than for medical- surgical
nurse practitioners.
Problem-oriented recording Simple Type of recording Patient care
leads to more effective process
patient care than narrative
recording.
More post partum
depression and feelings of a. post partum depression
inadequacy are reported by b. feelings of inadequacy
women who give birth by
cesarean delivery than those Complex Method of delivery
who deliver vaginally
Daily weight loss is greater
for adults who follow a
reduced calorie diet and Complex a. Type of diet Weight loss
exercise daily than for those b. Exercise
who do not follow a reduced
calorie diet and do not
exercise daily.
Heredity and environment Complex a. Heredity Student’s performance
influence the student’s b. Environment
performance in school
activities.

STEP V. RESEARCH DESIGN ( DEC 06 - JULY 2010)

- blueprint of nursing research
- over all plan in conducting nursing research(JUNE 2007)

TWO MAJOR APPROACHES:

I. QUANTITATIVE RESEARCH
 associated with quantity
 can perform mathematics ex. Percentage and ratio (JUNE 2008)
 associated with logical positivism – hard science or scientific method (JUNE2007)
 ETIC PERSPECTIVE – more concern on data collected than the respondents

EXPERIMENTAL RESEARCH DESIGN

- Can truly test hypothesis

- Consist of 2 groups
3 elements
1. Randomization
2. Manipulation of variables
3. Control/ experimental group
EX.
Lawrence plans to undertake a study of BGY. A and B to utilization of MCN services
after organizing and training BHW in BGY. A

1. TRUE EXPERIMENTAL:
a. MANIPULATION
b. EXPERIMENTAL/CONTROL GROUP
c. RANDOMIZATION

TYPES:
A. PRETEST- POSTTEST CONTROL GROUP DESIGN( JUNE 09, NOV.09&JULY 2010)
1. THE SUBJECTS ARE RANDOMLY ASSIGNED TO GROUPS
2. PRE- TEST IS GIVEN TO BOTH GROUPS
3. EXP. GROUP RECEIVES THE EXPERIMENTAL TXT AND COMPARISON GROUP RECEIVES THE
ROUTINE ONE
4. POST- TEST IS GIVEN TO BOTH GROUP

B. POSTTEST – ONLY CONTROL GROUP DESIGN9N0V. 09 &JULY 2010)

1. SUBJECTS ARE RANDOMLY ASSIGNED TO GROUPS
2. EXP. GROUP RECEIVES THE EXP TXT.
3. CONTROL GROUP RECEIVES THE ROUTINE ONE/ NO TXT.
4. POST- TEST IS GIVEN TO 2 GROUPS

C. SOLOMON FOUR- GROUP DESIGN

1. SUBJECTS ARE RANDOMLY ASSIGNED TO ONE OF THE 4 GROUPS
1. 2 GROUPS, EXP GROUP 1 AND COMPARISON GROUP 1 ARE PRE- TESTED
2. 2 OF THE GROUPS, EXP GROUP 1 AND 2 RECEIVES THE EXP TXT.
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 3. CONTROL GROUP NO TXT.
4. POST- TEST GIVEN TO ALL FOUR GROUPS

2. QUASI- EXPERIMENTAL:
“handpick your subject”
The researcher implemented a medication regimen using a new type of combination drugs to
a manic patient while another group of manic patient receives the routine drugs. The
researcher however handpicked the experimental group for they are the clients with multiple
episodes of bipolar disorder.
TYPES:
A. NONEQUIVALENT CONTROL GROUP DESIGN – similar to pretest- post test control group design
B. TIME SERIES DESIGN – experimental txt is administered between series of observation

3. PRE- EXPERIMENTAL:
TYPES:
A. ONE SHOT CASE STUDY – a single group is exposed to an experimental txt and observed after the
txt. (JULY 2010)
B. ONE GROUP PRETEST- POSTTEST DESIGN – comparison between a group before and after the
exp. txt.

 THREATS TO VALIDITY( JUNE 08)

A. INTERNAL VALIDITY – concerns the degree to which changes in the dependent variable can be
attributed to the independent variable.
Maturation – changes that occur within the subjects during an experimental study.
Attrition - dropout
Mortality- when the subject dropout rate is different between experimental and Comparison group
Bias – when the study results are attributed to the experimental treatment but, In fact, the results
occur because of subject differences before the treatment
Instrumentation change – concerns the difference between the pretest and post test
Measurements that is related to a change in the accuracy of the instrument
Testing – refers to the influence of the pretest or knowledge of baseline data on
Posttest scores
History – occurs when some event besides the experimental treatment occurs during The course of
a study and this event influences the dependent variable

B. EXTERNAL VALIDITY – concerns the degree to which study results can be generalized to other
people and other settings.
Hawthorne effect – occurs when study participants respond in a certain manner Because they are
aware that they are being observed.
Experimenter effect – occurs when the researcher characteristics or behaviors Influence subject
behavior.
Reactive effects of the pretest – measurement effect, occurs when subjects have Been sensitized
to the treatment through taking the pretest.

NNON- EXPERIMENTAL RESEARCH DESIGN

-No manipulation of variables! JUNE 07

A. Descriptive – the phenomenon of interest may have already been studied in the past, and there is
enough information to ask questions about the relationship between variables.
↓
COCOMESU
↓
1. CORRELATIONAL – examine the strength of the relationship; do x and y vary together
Positive relationship- one variable increases, and the other variable increases
Negative relationship - one variable increases, and the other variable decreases
Ex: The relationship of gender and salary.
(gender cannot be manipulated)
-Keyword : “relationship”

2. COMPARATIVE – examine the difference between intact groups on some dependent

variable of interest.
Ex: A comparative study between male and female to their lifestyle
a. Retrospective studies / ex post facto – “after the fact”
b. prospective studies - the independent variable is identified in the present and the
dependent variable is measured in the future.

3. METHODOLOGICAL – concerned with the development, testing and evaluation of research

Instruments and methods.
Ex. Wong and Baker pain scale used in pedia.

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 4. SURVEY – public opinion; your favorite
Ex. You conduct a study who is the favorite comedian of barangay 214, 50 % said
Dolphy, 27% said Michael V. and 23% said Vic Sotto.

TYPES OF SURVEY

a. NORMATIVE SURVEY – determine the normal or typical condition of situation and

people.
b. SOCIAL SURVEY – aim s to study and diagnose a current social problem
c. COMMUNITY SURVEY – conducted in communities, peasant village, interrelated with
social survey because both may be centered in major social problems such as poverty and
dependency and health.
d. SCHOOL SURVEY – investigations conducted in schools.

II. QUALITATIVE RESEARCH

- Associated with quality
- Associated with “naturalistic inquiry” – explores human feelings and experience
( June 2007) POLIT AND HUNGLER 1999 PAGE 13.
- Beliefs, experience and values(JUNE 2008)
- EMIC PERSPECTIVE - more concerned on the respondents than data collection
- focuses on insights and understanding of individual perceptions on the phenomenon under
study.
- it is considered as “soft science”, concerned with the “subjective” meaning of experience to an
individual.

TYPES:

PHENOME GROUNDED
CASE STUDY HISTORICAL ETHNOGRAPHIC -NOLOGICAL THEORY
In depth or Study of events Study of “culture” Study of human 2 sociologists
extensive study that occur in the Best method- interview feelings and namely Glasser
of person “past” of key informants and experience and Strauss
,individual and participant as observer Involves data
group Ex. Ex. collection,data
Rouss is to Ex. Chococestar is analysis and then
Ex. perform a study Maegan visited a tribe conducting a a theory is
Kimy research about how nurses located somewhere in research study on derived
on TB. Its perform surgical China, it is called the how Mark, an AIDS
transmission, asepsis during Shin Jea tribe. She client lives his life.
causative agent World War studied the way of life,
and factors, II. tradition and the
treatment sign societal structure of
and symptoms these people.
as well as
medication and
all other
extensive
information
about
tuberculosis.

CBQ-JUNE07

Which of the following studies is based on qualitative research?

A. A study measuring difference in blood pressure before, during and after the
procedure.
B. A study examining oxygen levels after endotracheal suctioning
C .A study examining clients reactions to stress after open heart surgery
D. A study measuring nutrition and weight loss/ gain in clients with cancer
 CBQ JUNE07 LIFTED FROM KOZIER REVIEW QUESTIONS PAGE 32
 OPTIONS A,B,&D ARE QUANTITATIVE RESEARCH.

When both qualitative and quantitative research methods are used simultaneously in the
same study, this procedure is called:
A. triangulation
B. saturation – repetition of salient points
C. methodology – method/strategy
D. bracketing – researcher should put aside their own feelings in order for the
Researcher to listen to the feelings of the person being examined.

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VI. SAMPLING (JUNE 07, NOV 09& JULY 2010)
- A process of getting a portion to represent the general population

POPULATION
 Complete set of individual or object that possess some common characteristics that is of
interest of the researcher.

TARGET POPULATION
 Aggregate of cases about which the researcher would like to make generalization

ACCESSIBLE POPULATION
 Actually available for the study; reasonably reach

SAMPLE
 Is the segment of the population from whom the data will be actually be collected.

ELEMENT
 Single entity

CBQs:
A process of selecting a portion to represent the general population is termed as:
A. Design C. Problem
B. Hypothesis D. Sample

What does a sample group represent?

A. Control group C. Universe
B. Study subjects D. General Population

What is the most important characteristics of a sample?

A. Randomization C. Appropriate number
B. Appropriate Location D. Representativeness

Random sampling ensures that each subject has:

A. been selected systematicall C. been selected based on set criteria
B. characteristics that match other samples D. an equal chance of selection

SAMPLING METHOD:

I. PROBABILITY SAMPLING – everyone has the chance to be selected

A. SIMPLE RANDOM SAMPLING – by chance; draw out of hat and bingo wheel
B. STRATIFIED RANDOM SAMPLING - according to strata or “level
C. SYSTEMATIC SAMPLING – every nth of the population
D. CLUSTER/ MULTI- STAGE – getting a sample according to geographic location

II. NON-PROBABILITY SAMPLING – not everyone has the chance to be selected

A. CONVENIENCE/ ACCIDENTAL/ INCIDENTAL – uses readily available on the street and hospital. The
weakest type of sampling because of BIAS.
B. PURPOSIVE/ JUDGMENTAL – there is a conscious selection of subjects; handpick your samples.
C. SNOWBALL/ NETWORKING – getting a sample by referra
D. QUOTAS – getting a sample according to their specific characteristics; CRITERIA

TIME FRAME FOR STUDYING THE SAMPLE:

1. Cross Sectional Study
-examines sample in ONE POINT IN TIME
2. Longitudinal Study
-examines sample OVER A PERIOD OF TIME IN THE FUTURE
*Special Type: COHORT STUDY (persons are studied who have been born during a particular
time period)

PILOT STUDY (NOV. 09)

- “dress rehearsal”
- A miniature trial version of the study conducted before the actual research to prevent any future disaster
that might result from in correct data analysis, data collection, process and design.- JUNE 2007

VII. COLLECTION OF DATA

- Involves collection of data

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FACTORS TO CONSIDER: SERV

Simplicity - clear and simple to avoid the risk of errors

Efficiency – capability of an instrument to measure items within a given period of time and budget
Reliability – degree of consistenc
Validity – ability to measure what is intended to be measured

*COVER LETTER
 Letter that accompany the questionnaire disclosing the following information; the writer’s
purpose, who is sanctioning the study, what will be done with the information, the reason why
the respondents should answer and the deadline for returning the questionnaire.

INSTRUMENTS:

1. QUESTIONNAIRE – most common research instrument; pen and paper

TYPES:
A. DEMOGRAPHIC – data or characteristics of the subject ex: age, gender, religion
B. OPEN- ENDED – essay; fill in the blank
C. CLOSE ENDED – two alternative questions ex. True or false question.
1.COLLECTIVE EXHAUSTIVE – all possible answer ex: highest educational attainment
2.MUTUALLY EXCLUSIVE - no overlap between categories ex: monthly incom
D. CONTINGENCY QUESTION - relevant for some and not for other respondents. Ex: nationality

2. INTERVIEW – second most common research instrument

TYPES (DECEMBER 07)

A. STRUCTURED – specific question will only be asked and no additional question
B. SEMI- STRUCTURED – free to probe to major questions
C. UNSTRUCTURED – ordinary conversation

3. OBSERVATION METHOD – most direct means if you are interested on the behavior of the
respondents.
A. NONPARTICIPANT OBSERVER (OVERT) – openly identifies that she or he is conducting
research and provides subjects with information about the types of data that will be collected.
B. NONPARTICIPANT OBSERVER (COVERT) - is one who does not, before the beginning of
data collection, identify herself or himself to the subjects who are being observed.
C. PARTICIPANT OBSERVER (OVERT) - involved with participants openly and with the full
awareness of those people who will be observed
D. PARTICIPANT OBSERVER (COVERT) – observer interacts with the participants and observes
their behavior without their knowledge.

4. BIOPHYSIOLOGIC DATA
A. IN VIVO – physical set up of the hospital
B. INVITTO – lab results such as CBC and biopsy

CBQ – JULY 2010

The Effect of Crossing the Legs to Blood Pressure. What instrument you will use to measure
dependent variable?
-biophysiological/
5. DELPHI TECHNIQUEPHYSIOLOGIC MEASURES
– consulting to experts

6. RECORDS/PRE- EXISTING DATA – data that has not been collected before ex. Patient’s chart.

VIII. ORGANIZATION OF DATA

 Involves tabulation and organization of data

1. NOMINAL
 Data can be organized into categories
 Marital status, gender

2. INTERVAL
 Have an equal numerical distance
 Temperature

3. RATIO
 Highest form of measure
 BP,RR,PR

4. ORDINAL
 Data can be arranged by rank
 Educational attainment

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IX. ANALYSIS OF DATA NOV 08 – JULY 2010

DESCRIPTIVE STATISTICS – describe and synthesize data obtained from empirical observation and
measurement.

A. MEASURE TO CONDENSE DATA

FREQUENCY DISTRIBUTION – simply counting the scores

GRAPHIC REPRESENTATION – graph, data are readily apparent
PERCENTAGE – fraction of (JUNE 08).

B. MEASURE OF CENTRAL TENDENCY( 3 M)

MODE (Mo) – frequently appeared

MEDIAN(Mdn) – absolute center
MEAN – average response

C. MEASURE OF VARIABILITY

RANGE – H- L
PERCENTILE – is a datum point below which lies a certain percentage of the values in a
frequencu distribution
STANDARD DEVIATION
VARIANCE – Square of standard deviation

D. MEASURE OF RELATIONSHIP
- measures the correlation between variables

CORRELATION COEFFICIENT (r) – pairing of one variable to another variable.

SCATTER PLOTS/SCATTER DIAGRAM/SCATTERGRAM – graphic representation between
variables
CONTINGENCY TABLES – cross- tabulation, displaying the relationship between sets of nominal
data
Ex. Relationship between gender and exercise behavior

Gender Exercise Do not exercise Total

regularly regularly
Male 35 15 50
Female 10 40 50
Total 45 55 100
*TYPES OF CORRELATION PROCEDURE

1. PEARSON PRODUCT – MOMENT CORRELATION (PEARSON r)

 most common correlation procedure used in nursing research when both sets of data are at
interval or ratio.
Ex. Correlation between blood pressure measurements taken on the upperarm and the fore arm of 246
pt in an emergency dept. of a 1,071- bed teaching hospital.
2. SPEARMAN rho
 correlation used in ordinal data
Ex. Correlation between pain and anxiety.

INFERENTIAL STATISTICS – use to make conclusion on data

CBQ-DEC.2007
A research study found out that 60% of patients complains were due to delayed responses of nurses in
the emergency department. Which of the following measurement of data was used in this study?
A. Measures of variability
B. Frequency distribution
C. Measures of central tendency
D. Inferential statistics

STATISTICAL TEST (JUNE 09 – JULY 2010)

A.T test /STUDENT t test – compares the difference of means of two groups of values
B. ANOVA – compares the difference of means of more than two groups of values
C. CHI SQUARE – compare nominal type of data; expected vs observed

X. COMMUNICATION
- final step in research process

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XI. UTILIZATION OF FINDINGS
- final step in research process for the researcher.

NURSING RESEARCH ETHICS

1. NUREMBERG CODE – birth of your informed consent
2. HELSINKI DECLARATION – research should not be done in violation of human rights.
3. BELMONT REPORT – articulated with 3 principles: beneficence, justice and respect for human dignity.

BASIC HUMAN RIGHTS OF THE RESEARCH SUBJECT

5 R’S
1. RIGHT TO INFORMED CONSENT
2. RIGHT NOT TO BE HARMED
3. RIGHT TO CONFIDENTIALITY AND ANONYMITY
4. RIGHT TO FULL DISCLOSURE
5. RIGHT TO REFUSE OR WITHDRAW FROM THE PARTICIPATION

NURSING LEADERSHIP AND MANAGEMENT

NURSING LEADERSHIP
- An interpersonal process to effect change on the behavior of others.
- Process by which a nurse influence one or more person to achieve specific goals in the provision of
nursing care in one or more patients.

THEORIES OF LEADERSHIP (JUNE 08)

1. GREAT MAN THEORY

– assumes that some are born to be lead whereas others are born to be led.
– They are born with the capacity to persuade, influence and motivate others.
2. CHARISMATIC THEORY – intangible characteristics; leader uses his charm/ charisma to lead the
group
3. TRAIT THEORY
– Leader has innate abilities that should be develop for him/her to become a successful leader.
– Intelligent, initiative, creative and communication skills
4. SITUATIONAL THEORY – emphasizes on the maturity level of the leader/ member
5. CONTINGENCY THEORY
- Leader can be effective if he/she can immediately resolve an emergency or crisis situation.
- 3 aspects: leader member relation, task structure, and position power.
6. PATH –GOAL THEORY – if you are the leader you should clear and pave the way.
7. EXPECTANCY THEORY- people acts as they do because they know that their behavior will produce
satisfactory results.
8. TRANSACTIONAL – giving reward for any good behavior
9. TRANSFORMATIONAL – leader promises change by stimulating people to change
*Hallmark: empowerment

LEADERSHIP STYLES (JUNE 08)

1. AUTOCRATIC/ DICTATORIAL/ DIRECTIVE

- leader is the center of the group
- useful during emergency situation
- foster dependence

2. DEMOCRATIC/ PARTICIPATIVE/ CONSULTATIVE

- everyone is included in decision- making
- concensus building
- foster independence

3. LAISSEZ- FAIRE/ ULTRALIBERAL/ PERMISSIVE/ FREE REIGN

- let alone style
- workers are left without supervision and direction
- fosters chaos
- not useful in health care delivery system where maintenance of standards is required

2 TYPES OF LEADERS
1. FORMAL LEADERS
 Appointed by organization and given office or legitimate authority to act

2. INFORMAL LEADERS
 Don’t have official power to direct activities of others
 Seniority

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POWER IN THE ORGANIZATION

1. REWARD POWER
The ability to reward others for complying

2. COERCIVE POWER
Fear of punishment if one fails to conform

3. LEGITIMATE POWER
The power vested upon a leader in relation with his position

4. REFERENT POWER
Traits admired by people

5. EXPERT POWER
Skillful, having knowledge and training

6. SELF
Emanates age, gender

7. CONNECTION
It’s not what you know its whom you know

LEADERSHIP AND CHANGE

TYPES:
1. UNPLANNED CHANGE – usually haphazard and the results can be unpredictable
Ex: change as a result of a war or a natural disaster.
2. PLANNED CHANGE – intended, purposive attempt by individual, group and organization
3. COVERT CHANGE – is hidden or occurs without the individual’s awareness
Ex. A person can become increasingly deaf without being aware
4. OVERT – change about which a person is aware
Ex. Development of abdominal pain

STAGES:
1. UNFREEZING STAGE – motivation to establish some sort of change occurs
2. MOVING – actual change is planned in detail and then started
3. REFREEZING – changes are integrated and stabilized, integrated the idea into their own value system.

STRATEGIES FOR EFFECTIVE CHANGE (December 07 FROM Marriner Tommey)

1. EMPIRICAL- RATIONAL CHANGE
 Explain the reason why you need to change
2. NORMATIVE- REEDUCATIVE STRATEGIES
 Train or teach people how to do a change
3. POWER- COERCIVE STRATEGIES
 Threat or fear from the authority will lead a change

NURSING MANAGEMENT
-is a process by which a cooperative group directs action toward common goal.
-series of systematic, sequential or steps directed toward the achievement of organizational goal

ROLES OF MANAGER ( Mintsberg)

1. INTERPERSONAL – connecting one person to another, as a leader who hires, trains, encourages, fires
remunerates.

2. INFORMATIONAL – disseminates about existing rules and regulation as the representative or

spokesperson of the organization.

3. DECISION ROLE – a trouble shooter who handles unexpected situations such as resignation of
subordinates, firing and losses clients and negotiator when conflict arises.

FUNDAMENTAL SKILLS OF MANAGER (Katz) - December 07& June 08 : CIT

CONCEPTUAL SKILLS
 Ability to see individual matters as they relate to the total picture and to develop
creative ways.

INTERPERSONAL SKILLS / HUMAN RELATION SKILLS

 Dealing with people and how to get along with them

TECHNICAL SKILLS
 Proficiency in performing an activity in the correct manner with the right technique

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MANAGEMENT THEORIES (JUNE 08)

A. CLASSICAL THEORIES

1. HENRI FAYOL
 Father of Management Process School
 4 tasks (PODC)

2. MAX WEBER
 Father of Organizational theory
 Line authority

B. SCIENTIFIC MANAGEMENT

1. FREDERICK TAYLOR
 Father of scientific management
Principles
 Choose the best method
 Choose the best people
 Educate your people
 Develop a friendly relationship

2. FRANK AND LILIAN GILBERTH

 Job simplification

3. HENRY GANTT
 Concerned with the problem of efficiency
Gantt Chart – a forerunner of the (PERT) Program Evaluation and Review Technique.

C. BEHAVIORAL THEORIES

1. ABRAHAM MASLOW – hierarchy of needs

2. WILLIAM OUCHI
 THEORY Z – involved workers are the key to increase productivity

3. DOUGLAS MC GREGOR
 THEORY X AND Y

4. ROBERT BLAKE AND JANE MOUTON

 Two critical dimensions of leadership
1. concern for production
2. concern for people
5 Basic Management Styles
1. Task manager (9,1) – high concern for production and low concern to people,stresses operating
efficiency thru control and view people as tools for production.
2. Impoverished manager (1,1) – low concern to both people and production, found in managers who
feel they have been repeatedly denied of promotion
3. Team manager (9,9)- optimal managerial skill; high concern to both people and production;
problems are confronted directly and mutual trust, respect and interdependence are fostered.
4. Organization manager (5,5) – there is a balance concern to people and production. With this, leader
and its member realizes they need more effort to increase their production
5. Country club manager (1,9) – low concern to production and low concern to people; thoughtful and
friendly managers.

MANAGEMENT PROCESS: PODC

PLANNING ORGANIZING DIRECTING CONTROLLING

Vision, Mission, Organizational chart, Delegation, Performance

Philosophy Organizational Supervision, Appraisal, Nursing
Goals, Objectives, structure, Staffing, Communication, Audit, Quality
Budgeting AND TIME Scheduling, Job Coordination, Assurance, Quality
MANAGEMENT Descriptions, and Conflict and Circle, Peer Review
Patient Care Decision- making Structure, Process
Classification, TYPES and Outcome
OF PT’S Standards and
ASSIGNMENT Discipline

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I. PLANNING
- determining objectives and identifying methods that lead to the achievement of those objectives. Making future
projection to achieve desired results.
 What activity we expect to do
 Why it will be done
 Where it will be done
 When we expect to do it
 How it will be done
 Who is going to do it

KINDS OF PLANNING
1. LONG RANGE/STRATEGIC PLANNING
- extended 3-5 years
- determine the direction of the organization, allocates resources and determine time frame. This is
done by the top managers.
- SWOT (STRENGTH, WEAKNESS,OPPURTUNITIES AND THREAT)
2. INTERMEDIATE PLANNING
- 6 months to 2 years
- done by the middle mngt.
3.OPERATIONAL PLANNING/ SHORT RANGE PLANNING
- short planning that deals with day to day maintenance activities
- done by the first level

PLANNING TOOLS

1. VISION – outlines the organization’s future role and function

Example: The medical Center envisions itself to become a center for excellence providing holistic
approach to health care services as a center of wellness.
2. MISSION - reason for existence
Example: Its mission is to promote and maintain health, prevent or cure illness, allay pain and
suffering.
3. PHILOSOPHY – beliefs that influence nursing practice
Example: Clients have the right to the best possible health are regardless of their race, creed,sex
social status and political belief.
4. GOALS – end to be accomplished
Example: develop and implement staff development programs to meet the need for increased
knowledge and skills
5. OBJECTIVES – something aimed at or strived for; things done to achieve goal
Example: to develop and implement at least 12 staff development program by the end of the fiscal
year.

BUDGETING
 A tool used by a nurse manager when allocating future resources
TYPES
1. REVENUE BUDGET – summarizes the income; cash going “in”
2. OPERATING BUDGET – cash “out” ; day to day operation that includes wages, salaries, supplies,
electric bill and waste and water disposal.CBQ. JUNE 0
3. CASH BUDGET – pety cash, cash on hand, balance between cash in and cash out for money available
for immediate use in order to know if an organization can afford bills that must be paid.
4. CAPITAL BUDGET – associated with operating some major asset ex. Building,automobile computers
and purchasing ambulance.JUNE 08
5. PERSONNEL BUDGET – determine recruitment, hiring and firing of personnel

TIME MANAGEMENT – how time is used

PRINCIPLES:
1. effective communication
2. ability to plan effectively
3. delegation
*efficiency – doing the task right
*effectivity – doing the right task correctly

II. ORGANIZING
– the process of establishing formal authority

ORGANIZATION
 The structure or people that allows an agency to enact it’s philosophy and achieve its goal
ORGANIZATIONAL CHART
 Drawing that shows how the part of organization are linked

CONCEPTS OF ORGANIZING (SARAP)

 STATUS - rank given to a person

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  ACCOUNTABILITY - taking full responsibility for the quality of work and behavior while engaged in the
practice of the profession CBQ JUNE 07
 RESPONSIBILITY – is the obligation to perform the assigned tasks CBQ DECEMBER 07
 AUTHORITY - the right to act or make decisions without the approval of higher administrators
2 TYPES
A. LINE AUTHORITY
 Is the authority that entitles a supervisor to direct an individual work
B. STAFF AUTHORITY
 Is the authority in position created to support, assist, recommend and generally reduces the
supervisors informational responsibilities
 POWER – ability to influence others

PRINCIPLES OF ORGANIZATION
1. UNITY OF COMMAND – there can only be one superior to avoid confusion and overlapping of duties
DEC 06 – JULY 2010
2. SCALAR PRINCIPLE/ CHAIN OF COMMAND/ HIERARCHY – flow from higher to lower authority
3. DEPARTMENTALIZATION - grouping of workers with similar assignment
4. SPAN OF CONTROL – number of people that can be directly supervised (4-6).
5. DECENTRALIZATION – proper delegation of authority

STAFFING
 Is a tool to determine the appropriate ratio of health care personnel to perform their respective
organizational tasks for the benefit of the client.
SCHEDULING
 Time table showing the planned work days and shifts for nursing personnel.
TYPES:
1. CENTRALIZED – done by the chief nurse
2. DECENTRALIZED – done by supervising or head nurse
3. CYCLICAL- covers a designated number of weeks and repeated there on

PATIENTS CARE CLASSIFICATION

 Method of grouping patient according to the amount and complexity of nursing requirement.

LEVEL I MINIMAL For discharge/ convalescing patient

LEVEL II MODERATE CARE/INTERMEDIATE Needs some assistance of activities

of daily living
LEVEL III TOTAL, COMPLETE/INTENSIVE Completely dependent; v/s every 30
mins.; patients who need close
attention throughout the shift.
LEVEL IV CRITICAL/HIGHLY SPECIALIZED Continous monitoring; v/s every 15-
30 mins.; hourly urinary output

METHODS OF NURSING CARE DELIVERY

1. CASE METHOD - same as PDN; 1 RN: 1 patient ; TOTAL PATIENT CARE
2. PRIMARY NURSING – nursing care directed by a nurse in a 24 hour basis

CBQ-Dec07
What is the purpose of a secondary nursing in primary nursing?
 They are responsible for the care of the patient if the primary nursing is off
duty.

3. FUNCTIONAL NURSING - task oriented and very useful in emergency situation

4. TEAM NURSING - one nurse will lead a group of nurses
*What is the heart /hallmark of team nursing? - TEAM CONFERENCE
5. MODULAR NURSING – a special type of nursing care delivery method, where Team and Primary
Nursing are combined. Used when there is not enough RN to practice primary nursing method (instead
of primary nurse only, there will be a primary team)

III. DIRECTING
-Issuance of orders, assignments and instructions that enables the nursing personnel to understand what are
expected from them.

A. DELEGATION –transferring a tasks to a competent individual. CBQ DEC 06 - JULY2010

WHAT CANNOT BE DELEGATED

1. overall responsibility, authority, accountability and completion of all activities in the unit
2. authority to sign one’s name
3. jobs that are too technical
4. sterile procedure
5. initial and terminal assessment
6. unstable patient
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 PRINCIPLES OF DELEGATION
1. right person
2. right task
3. right amount of time
4. delegate in advance
5. delegate gradually
6. consult first before delegating
7. avoid gaps and overlaps

B. DECISION MAKING/PROBLEM SOLVING

1. Problem identification
2. Analyzing of the problem
3. Development of alternative solution
4. Selection of solution
5. Implementation and follow- up

C. COMMUNICATION - Transmission of information, opinion between individual.

TYPES:
1. VERBAL - spoken words
2. NON- VERBAL - facial expressions, gestures, body language and touch- Dec.07
ELEMENTS
1. SENDER – a person or group who wishes to convey a message to another
2. RECEIVER – the listener,observer
3. FEEDBACK – response; message that the receiver returns to the sender

D. CONFLICT – clash between 2 opposing parties

TYPES:
1. INTRAPERSONAL – conflict within self
2. INTERPERSONAL - conflict between 2 or more persons
3. INTRAGROUP - conflict within a group
4. INTERGROUP – conflict between 2 groups
CONFLICT RESOLUTION DEC. 07
1. AVOIDANCE
 Avoid confrontation
2. ACCOMODATION
 Self- sacrifice
3. COMPETETION
 Win at all cost
4. COMPROMISE
 Split the difference
5. COLLABORATION
 Both workout

E. COORDINATION DEC 06 – JULY 2010

COORDINATION WITH SOCIAL SERVICE

 indigent patients needing material or financial assistance, medicines blood or prosthesis, abandoned
babies, victims of rape, child abuse and patients needing referral to other community agencies for
continuity of care.

COORDINATION WITH RADIOLOGY SERVICE

 for any visualization

COORDINATION WITH THE DIETARY SERVICES

 preparation of the patients diet and distributing them to the right patient

COORDINATION WITH THE NUTRITIONIST

 if patients needing special instructions of diet

COORDINATION WITH BIOMEDICAL TECHNICIAN/ENGINEER

 for maintenance and repair of hospital facilities

COORDINATION WITH THE MRS (MEDICAL RECORD SECTION)

 for patient’s record/chart

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IV. CONTROLLING

TYPES OF EVALUATION:

A. PERFORMANCE APPRAISAL
 Employee’s performance is evaluated against standard. CBQ JUNE 08
TOOLS
1. Check – list
2. Ranking
3. Rating Scales
4. Essay
5. Anectodal Recording – describes nurses experience with a group in validating technical skills.

B. QUALITY ASSURANCE
 Evaluation of services to make sure that it meets the standard.
TYPES OF STANDARD – JULY 2010
1. STRUCTURE – how well the equipment and setting
2. PROCESS - how well is the nursing care is given
3. OUTCOME - desired result

C. NURSING AUDIT – review of patients chart DEC 07 &JUNE 2008

TYPES:
1. CONCURRENT - patient is still in the hospital
2. TERMINAL/ RETROSPECTIVE - pt was already discharged

*CONTINOUS QUALITY IMPROVEMENT/TOTAL QUALITY IMPROVEMENT – is a process of continuously

improving a system by gathering data or performance and using multi- disciplinary team to analyze system,
collect measurement and propose changes. CBQ JULY 2010

*BENCHMARKING - comparing your services to other institution. (JULY 2010)

FINANCIAL MANAGEMENT (DEC07 & JUNE08)

• Fixed cost – cost incurred that is unrelated to volume of output
• Variable cost – cost that vary in proportion to volume

• Direct cost – cost that is directly related to patient care

• Variable cost – cost that is not directly related to patient care

• Incremental budgeting
• Zero-based budgeting

COST CONTAINMENT
-keeping cost within acceptable limits (due to inflation and other parameters)
-INVOLVES:
1. Cost Awareness: focuses the employees on costs.
2. Cost Monitoring: focuses on how much cost is spent and will be spent.
3. Cost Management: focuses on what can be done by whom to contain costs.
4. Cost Incentives: motivate cost containment as it reward desired behavior.
5. Cost Avoidance: means not buying supplies, technology, or services
6. Cost Reduction: means spending less for goods and services.
7. Cost Control: effective use of available resources; similar to COST EFFECTIVENESS.

If any of you lack wisdom, let him ask of God,

that giveth to all men liberally, and upbraideth not;
and it shall be given him.
James 1:5
PREPARED BY:
DONNIEDEX P. PARROCHA, RN
MAR ANGELO DF TAMAYO, RN

GOD BLESS!
AIM TO TOP MERGE BABIES!

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