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PALMER Reviewer by Luansing

May 02, 202454 min read10679 words

A summary of Professional Reviewer Dr./Atty. Glenn R. Luansing’s Nursing Review Guide on Professional Adjustment, Leadership and Management, Ethics, and Nursing Research

CITE

Luansing, G. (2024). Nursing Review Guide: Professional Adjustment, Leadership and Management, Ethics, and Nursing Research (1st ed.). CentralBooks. ISBN:978-621-02-2289-0.

I: Professional Adjustment and Nursing Practice

INFO

Most of the following information is based on R.A. 9173, the Philippine Nursing Act of 2002 as presented in Atty. Luansing’s book.

A Profession is a calling requiring specialized knowledge and intensive academic preparations. In nursing, it is the performance, for a fee or a salary, of professional services e.g. responsible nursing care, observation of symptoms, accurate reporting and documentation, supervision of others, execution of nursing procedures, and execution of valid doctor’s orders. There are seven specific characteristics of a professional nurse (mn. AAACCESS):

  1. Accountability: the nurse is accountable for their actions.
  2. Autonomy: the nurse is able to think independently and take actions related to patient care within their scope of practice.
  3. Altruism: the nurse is selfless and services others without regard for compensation or reward.
  4. Caring Attitude: the nurse puts in diligent efforts to care for any client, sick or well, and regardless of the patient’s economic or social status.
  5. Competency: the nurse is competent in all of their duties, and continues professional training to keep up with changes in patient care. The nurse should be able to recognize when they are not qualified for their duties and act accordingly.
    • R.A. 10912, The Continuing Professional Development (CPD) Act of 2017 for nursing mandates 15 credit units for professional license renewal, in this case every 3 years. These are obtained from formal learning, non-formal learning, informal learning, self-directed learning, online learning activities, and professional work experience.
  6. Ethical: the nurse follows the nursing code of ethics and is equipped with the morality of human conduct, values, and standards.
  7. Service-Oriented: the nurse is dedicated to service, in that they are able to anticipate, recognize, and meet the patients’ needs.
  8. Specialized: the nursing profession requires a specialized body of knowledge and well-defined skills.

Scope of Nursing Practice

The scope of nursing practice is defined under Section 28, Article VI of the Philippine Nursing Act of 2002. A person is said to practice nursing when they render nursing services to other individuals or groups from womb to tomb. Nursing services include but are not limited to:

  • (1) provision of care through the nursing process
  • (2) collaborate with communal resources and health teams
  • (3) provide health education
  • (4) take student nurses as apprentices, and
  • (5) undertake nursing and health human resource development, training, and research.

Roles of a Professional Nurse

(mn. CCC-MART)

  1. Caregiver: to provide care and comfort, show concern for client welfare and safety, and utilize scientific knowledge in activities to do so.
  2. Change Agent: to initiate or assist in changing the patient’s condition or lifestyle, or the systems of care via Kurt Lewis’ Unfreeze, Change, Refreeze theory
  3. Counselor: helping the client recognize and cope with psychologic or social problems, develop an improved interpersonal relationship, promote personal growth, develop new or alternate attitudes, feelings, and behaviors, recognizing health choices, and developing a sense of control.
  4. Teacher: provide information regarding health, help the client learn or acquire new knowledge and skills, and encourage adherence to treatment and healthy lifestyles.
  5. Researcher: participate in identifying significant researchable problems and using the research process for investigation.
  6. Advocate: promote for what is best for the client, ensuring that their needs are met and rights are not violated; support the client’s decisions.
  7. Manager: makes decisions and coordinates the activities of others, delegating and allocating resources appropriately. Managers plan, direct, develop, monitor, and evaluate the quality of care and personnel. They represent the staff and administration as needed.

Becoming a Professional Nurse

  1. Obtain a Bachelor of Science in Nursing (BSN) degree
  2. Take the Nurse Licensure Examination (NLE): a test held for those qualified (a citizen, of good moral character, a holder of BSN degree) encompassing the basic competencies in nursing:
    • The Nursing Process (ADPIE)
    • Therapeutic Communication and Caring Behaviors
    • Collaborative Care
    • Decision-making Skills
    • Delegation
    • Promotive, Preventive, Palliative, Curative, and Rehabilitative Care
    • Accountability
    • Documentation and Reporting
    • Execution of Doctor’s Orders
  3. Passing the NLE: a minimum average grade of 75% from all subjects, with no subjects less than 60% must be met to pass the licensure examination.
    • If any subjects fall below to 60% mark but the examinee manages to reach a 75% average, the examinee must re-take the examination for their failed subjects with a 75% or greater rating.
  4. Oath-taking: all successful candidates are required to take an oath of professionals before the Board or any government official authorized to administer oaths.
  5. Registration: after qualification through examination, one may become a registered nurse after acquiring a certificate of registration (Section 17, Article IV)
    • Registration by Reciprocity may be provided without examination for nurses registered foreign countries that require the same qualifications and provide the same scope of practice. (Section 20, Article IV)
    • Special or Temporary Permits: foreign licensed nurses who are (1) internationally known specialists or outstanding experts, (2) on a medical mission providing free service in a particular institution, and (3) employed by schools/colleges of nursing as exchange professors. These permits are only effective for the duration of the project, medical mission, or employment contract. (Section 21, Article IV)
    • Non-issuance is done for individuals convicted of a crime involving moral turpitude, immoral/dishonorable conduct, or being of unsound mind. (Section 22, Article IV)
  6. Revocation and suspension is imposed upon individuals convicted of a crime involving moral turpitude, immoral/dishonorable conduct, being of unsound mind, or those who have performed unprofessional/unethical conduct, gross incompetence, serious ignorance, malpractice, negligence, or fraud. This will not exceed a period of four years. (Section 23, Article IV)
    • Reissuance of Revoked Certificates: after the expiry of the period of suspension (again, not longer than 4 years) for reasons of equity and justice and when the cause for revocation has disappeared and corrected, upon proper application therefore and the payment of the required fees, another certificate of registration/professional license may be granted. This is also applicable to lost certificates or licenses. (Section 24, Article IV)
    • Returning from Inactivity: nurses who have not actively practiced the profession for five consecutive years are required to undergo one month of didactic training and three months of practicum. The Board shall accredit hospitals to conduct these training programs. (Section 26, Article V)
  7. Nursing Specialization (Comprehensive Nursing Specialty Program) is mandated by Section 31, Article VII of the Nursing Act of 2002 to be formulated to upgrade the level of skill and competence of any clinician for the development of specialty nurse clinicians in the country, including but not limited to areas of critical care, oncology, renal, and such other areas as maybe determined by the Board.
    • This is a program by the Board of Nursing and Department of Health, the beneficiaries of which will be mandated to serve in any Philippine hospital for a period of at least two years of continuous service, as this program is funded by the Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation.

The Board of Nursing

The Board of Nursing, as stated in Section 3, Article III of the Nursing Act of 2002, is composed of a Chairperson and six members (1) appointed by the President of the Republic of the Philippines, (2) from among two recommendees, per vacancy, of the Philippine Regulation Commission, (3) chosen and ranked from a list of three nominees, per vacancy, of the accredited professional organization of nurses in the Philippines (Philippine Nurses Association).

  1. Qualifications of the Chairperson and Board members are as follow: (a) be a natural born citizen and resident in the Philippines, (b) be a member in good standing of the accredited professional organization of nurses, (c) be a registered nurse, holder of a master’s degree in nursing, education, or other allied medical profession (mandatory for the Chairperson; while only a majority of Board members must have a master’s degree), (d) have at least ten years of continuous practice prior to appointment, the last five years of which must have been in the Philippines, and (e) not convicted of any offense involving moral turpitude.
  2. Disqualifications and Prohibitions (Section 5, Article II) of the Chairperson and the Board members must (a) immediately resign from any teaching position or review program in any institution, agency, or instrumentality in both government and private sectors, (b) not have any pecuniary (financial) interest in or administrative supervision over any institution offering Bachelor of Science in Nursing, including review classes.
  3. Term (Section 6, Article III): the Chairperson and Members of the Board of Nursing shall hold office for a term of three years and until their successors have been appointed and qualified (the hold over period), provided that the Chairperson and Members of the Board may be reappointed for another term. Any vacancy filled by an ad interim appointment for the unexpired portion of the term only. Oath-taking is performed prior to the performance of one’s duties.
  4. Removal (Section 11, Article I) of a Member of the Board of Nursing may be due to (a) continuous neglect of duty or incompetence, (b) commission or toleration of irregularities in the licensure examination, and (c) unprofessional, immoral, or dishonorable conduct.

Term vs Tenure

“Term of Office” is a period during which an appointee, e.g. the Board of Nursing, can validly hold their office/public position as a matter of right. “Tenure of Office”, however, is the period during which the appointee is physically/actually occupying their public office. One’s term is fixed, while their tenure may be shortened in cases of removal, disqualification, or incapacitation.

The Board of Nursing is given the following Powers and Duties as written in Section 9, Article II of the Nursing Act of 2002:

  1. Conduct the licensure examination for nurses.
  2. Issue, suspend, and revoke certificates of registration for the practice of nursing.
  3. Monitor and enforce quality standards of nursing practice.
  4. Ensure quality nursing education by inspection and recommendation to the CHED. The Board may open and close colleges of nursing and/or nursing education programs upon written recommendation to CHED.
  5. Conduct hearings and investigations to resolve complaints against nurse practitioners, with the power to issue subpoena ad testificandum (respondents and witnesses) and subpoena duces tecum (documents).
  6. Promulgate a Code of Ethics in coordination and consultation with the Philippine Nurses Association.
  7. Recognize nursing specialty organizations in coordination with the Philippines Nurses Association.
  8. Prescribe, adopt, issue, and promulgate guidelines, regulations, measures, and decisions as may be necessary for the improvement and advancement of the nursing profession.

Prohibited Practice of Nursing

Section 35, Article VII of the Nursing Act of 2002 enumerates the following prohibited acts which, if an individual is convicted of, will produce a fine of not less than ₱50,000.00 nor more than ₱100,000.00 or imprisonment of not less than one year nor more than six years, or both upon discretion of the court:

  • Practicing nursing without the meaning of the Nursing Act:
    1. Without a certificate or license except if exempted, including the use of another’s certificate or license, invalid certificate or license, or falsely obtained certificate or license.
    2. Appending BSN/RN titles or any similar appendage to their name without having been conferred said degree or registration.
    3. Who, as a registered and licensed nurse, abets or assists in the illegal practice of another who is not qualified to practice nursing.
  • Conducting in-serve educational programs or review classes without permit from the Board and the Commission.
  • Employers who violate the minimum base pay of nurses and the incentives and benefits that should be accorded to them.
  • Any person or chief executive officer violating the provision of this Act and its rules and regulations.

Nursing Positions and Occupations

  1. Nurse Supervisor/Manager: requirements are being an RN, having 2 years of experience in general nursing service administration, and having taken at least 9 units in management and administration at the graduate level. (Section 29, Article VI)
  2. Chief Nurse/Director of Nursing Service: requirements are being an RN, having 5 years of experience in a supervisory or managerial position in nursing, be a member of good standing of the Philippine Nurses Association, and having a Master’s Degree in Nursing. (Section 29, Article VI)
    • For primary hospitals, the maximum requirements are 2 years of experience general nursing service administration, BSN, RN, and having taken at least 9 units in a management and administration courses at the graduate level.
    • For public health agencies, those who have a master’s degree in public health/community health nursing is prioritized.
    • For military hospitals, those who have a master’s degree in nursing and who have completed the General Staff Course (GSC) is prioritized.
  3. Institutional Nursing: nursing in hospitals and similar institutions; the provision of comprehensive health services both for in-patient and out-patient status. The nurse is developed in many areas of specialization not available in other areas of nursing practice.
    • Perform decision-making, delegation, technical procedures (e.g., IV therapy, ABG monitoring, Correlation of lab results with patient status), coordination of care, health education, documentation, supervision of subordinates, and client advocacy
  4. Private Duty Nursing: also known as private nurse practitioners, special duty nurses, or private nurse specialists, these are nurses expected to provide care to a small group of clients, usually a one-patient-one nurse ratio. Service is usually hired directly by individual clients and not by an institution.
    • These individuals are independent practitioners and are expected to be a specialist, working on their own without any supervision from any superior or manager. They attend to all basic and advanced procedures related to the care of their patient.
  5. Industrial Nursing: occupational/company nursing; the nurse practices their nursing skills in factories, offices, industrial zones, etc. where employer-employee relationships exist.
    • The Occupational Health Nurses Association of the Philippines (OHNAP) is responsible for certifying occupational health nurses, requiring a BSN, a post-graduate course for Basic Occupational Health Safety for Nurses (a specialization course under OHNAP Inc.), and at least three conventions with OHNAP within five (5) years of active membership.
    • These individuals take care of the health of laborers whether casual, probationary, or regular employees. They provide preventive measures to ensure the health and safety of workers in virtually any type of work setting.
  6. Clinical Instructor/Nurse Educator: a nurse tasked with educating nursing students regarding the different skills, nursing procedures, and theoretical foundations needed to be a competent nurse in the future.
    • Requirements include: be an RN; be a member of any accredited nursing organization; have at least one year of clinical practice in a field specialization; and be a holder of a master’s degree in nursing, education, or other allied medical and health sciences.
    • After at least five years of being a clinical instructor, a nurse educator may become a Dean
  7. Public Health Nurse: the primary level of nursing practice mainly involving promotive and preventive health care approaches. The essence of being a public health nurse is to provide care not only to a specific client, but primarily to the community.
    • Basic functions include health teaching, community and environmental sanitation, immunizations, disease prevention, nutritional counseling, awareness campaigns, health programs, etc.
    • Appropriate communication techniques are necessary for a public health nurse. They must accept diversities in cultures, beliefs, practices, etc. among members of the community where they are involved.
    • Actual provision of care is limited compared to an institutional nurse.
  8. Military Nursing: giving care to sick and injured patients admitted in any military hospital and installation. Trained and enlisted military nurses may also be assigned to provide services outside of the military hospitals, such as on occasions of calamities, war, and other similar catastrophes.
    • Being commissioned in a nurse corps puts a rewarding rank of 2nd Lieutenant at the respected course of service. Promotion in rank requires a nurse to complete the milestones in this career and may include the basics of competition.
    • Requirements for single (unmarried) individuals: citizenship obtained through birth; pleasing personality; board passing rate of 80% or above, otherwise by passing a qualifying examination; must not have given birth; must not exceed the age of 32 years old; must be at least 5’4” (men) and 5’2” (women); must be physically and mentally fit for military service.
    • Requirements for married individuals: priority is given to those who have at least three years of active military service and have successfully completed the clinical nursing program for EP nurses being conducted by the Office of the Chief Nurse, AFP, followed by those applicants who have satisfied (a) three years of current and continuous professional experience in hospital/clinic settings or as a member of a faculty of a school of nursing. and (b) preferably with a master’s in nursing or at least 9 units of post graduate studies leading to a master’s degree in nursing.
  9. Clinic/Office Nursing: assisting physicians and other medical practitioners in their own respective clinics
  10. School Health Nursing: care for students enrolled in schools/educational institutions
  11. Independent Nursing Practice/Nurse Specialist: highly experienced nursing practitioners who are not employed to any institution and maintains their own practice or nursing clinic.

Accredited Nursing Organization

The Philippine Nursing Association (PNA) was founded on September 2, 1922 under the name of “Filipino Nurses Association” in a meeting of 150 nurses presided by Anastacia Giron Tupas (founder). This organization was formed to serve the common needs and interest of Filipino nurses in so far as the practice of their profession is concerned.

  • The FNA was established for the purposes of: (a) attaining an optimal level of professionals standards, (b) responding to the changing health needs of the Philippine society, and (c) establishing linkages with the government, national and international agencies in the attainment of national health goals and welfare of member nurses.
  • The FNA was accepted as a member of the International Council of Nurses during the Congress held in Montreal, Canada on July 8–13, 1929.
  • The FNA took on the current name, PNA, on January 8, 1966, the same year the head office at 1663 F.T. Benitez Street, Malate, Manila, was inaugurated.
  • The PNA was given its national status under Proclamation Order No. 539 on October 17, 1988, incidentally declaring every last week of October the official “Nurse’s week”.

The objectives of the Philippine Nurses Association include:

  1. To promote and maintain the highest standards of nursing practice.
  2. To address problems concerning nurses through participation in formulation of all policies, guidelines, programs, and laws affecting nurses and nursing practice in the Philippines.
  3. To continuously upgrade professional competence through research, training, scholarship grants both foreign and local and dissemination of information.
  4. To collaborate with government, non-government and other allied professional group for the promotion of health services.
  5. To foster national and international goodwill among nurses and harness all energies towards the attainment of common goals.
  6. To help advance the science and art of nursing in the Philippines to meet the needs of a changing society.
  7. To recognize the exemplary performance and accomplishments of members.

Other Professional Nursing Associations

  • Association of Deans of the Philippine Colleges of Nursing
  • Occupational Health Nurses Association of the Philippines
  • Private Duty Nurses Association of the Philippines
  • Maternal and Child Nurses Association of the Philippines
  • Association of Nursing Service Administrators of the - Philippines
  • National League of Government Nurses
  • Military Nurses Association of the Philippines
  • Operating Room Nurses Association of the Philippines
  • Catholic nurses Guild of the Philippines
  • Graduate Nurses Christian Fellowship
  • Philippines Orthopedic Nurses Society

II: Nursing Leadership

Leadership is the process of persuasion and example-setting of an individual to influence a group to take action in accordance with their common goals, and achieve desired objectives. This process may be formal or informal based on appointment or status of the leader or de-facto leader. This process may be achieved through:

  1. Rationalization
  2. Coercion
  3. Exchange
  4. Blocking
  5. Assertion
  6. Ingratiation

Elements of Nursing Leadership

  1. Leader: the influencer.
  2. Followers: the members who are duty-bound to follow and respect the leader.
  3. Group: the combination of the leader and their followers.
  4. Process: the means, style, formulas, and policies used by the group to reach their common goals.
  5. Goal: the purpose, objective, or reason of a group.

Theories in Leadership

  • Great Man Theory: the prospect that leaders are born; that experience is less significant in what makes an individual a good leader. The characteristics of a leader are inherent and is not something that can be developed easily.
  • Trait Theory: certain traits, such as personality, intelligence, and abilities, make a leader. Individuals should strive to attain and develop these traits to become an excellent leader.
  • Charismatic Theory: the driving force of leadership is charisma.
  • Situational Theory: the greatest leader depends on the contexts and attributes of the situation; leadership is a “case-by-case” basis.
  • Vroom-Yetton Expectancy Theory: a model of decision-making where the leader determines the amount of participation by followers depending on the situation.
  • Contingency Theory: the most appropriate leadership style is contingent on situational factors.
  • Transformational Leadership Theory: the utilization of group empowerment to allow for success.
  • Transactional Leadership Theory: the utilization of policies, rules, or other written documents for objectives. Performance is important and rewarded or sanctioned.
  • Fielder’s Theory: the style utilized by a leader must match the situation it is being used in. (to-do: differentiate from contingency theory)
  • Path-Goal Theory: the leader is the one to set a path and traverse it along with his followers in achieving a goal, e.g., setting clear directions for a certain objective.

Leadership Styles

  1. Authoritarian; Autocratic; Dictatorial; “Hard” Leadership: a leadership style that focuses all power towards those in authority or higher positions. Decision-making is done without the influence of the followers or members of the group.
    • Leaders that utilize this style are often task-oriented and insensitive, and subject to dissatisfaction. They often display characteristics like a commanding, boisterous voice; a unilateral approach; a demanding attitude; a hostile personality; exploitative means; and demands no inputs or intervention from others.
    • This style may only become effective in emergent situations.
  2. Permissive; Ultra-liberal; Laissez-Faire; “Free-rein” Leadership: a leadership style opposite to a hard leadership, where freedom is freely given to the group, and results are often poor. Decision-making is light on all members of the team and no single individual holds initiative for action.
    • Leaders that utilize this style receive criticism for not taking on major responsibilities, and members often exercise vast and even leadership functions to compensate.
    • This style is dangerous in health care settings because of the risk of malpractice. It may only be utilized if all members of the team are well-trained or skilled.
  3. Democratic; Participative Leadership: the “mutual” style, where the leader exercises his powers and control to all members but allows for the participation of subordinates in the decision-making process. In this style, both the goals of the group and the welfare of its members are valued.
    • This style of leadership is highly valuable as it allows for highly flexible and cohesive group functioning.

The Powers of a Leader

  1. Legitimate Power: all powers vested upon the leader along with his position or rank; power formalized and sanctioned by the institution itself.
  2. Expert Power: the power of control based on the exceptional expertise a leader that is not ordinarily found in other members of the staff.
  3. Referent Power: power obtained from the admiration and respect of members based on special characteristics (e.g. charisma) of the leader.
  4. Connection Power: the ability to influence others based on linkages to other influential or powerful individuals.
  5. Reward Power: the positive power of a leader to incentivise actions or achievements, such as with bonuses, awards, promotions, or transfers.
  6. Coercive Power: the negative power of a leader to use duress to gain control, such as with reprimands, termination, and penalties.

Skills and Qualities of a Leader

Authority

Authority is the legitimate right of a leader to exact obligations from his subordinates. The abilities of a leader to delegate tasks to his subordinates for its compliance and discipline for its non-compliance.

  • Accountability is the legal liability arising from any omission or improper performance of any task or responsibility.
  • Responsibility is the personal or professional obligation and dependability to perform a specific task.

There are two ways of delegating authority:

  1. Centralized Authority: only individuals occupying administrative or top-level positions obtain the right to authority.
    • Ex.: staffing patterns and schedules is solely given to the Office of the Nursing Director, and they issue notices to inform all subordinates and demands immediate compliance.
  2. Decentralized Authority: authority itself is delegated to the operational level or even to ordinary personnel. This encourages full participation, better communication, representation, and relationship in a group.
    • Ex.: before the approval of a staff pattern or schedule, the Nursing Director requests unit managers for the type of schedules and patterns applicable for their respective units, where the unit manager then consults their subordinates. The Director then simply approves the submitted plans for each unit manager.

Behavior

Behavior affects leadership. It is required that a leader must possess a behavior that is group-centered:

  1. Vision
  2. Integrity
  3. Patience
  4. Passion
  5. Direction and Purpose
  6. Ability to Motivate
  7. Ability to Listen
  8. Trustworthy
  9. Critical Thinker
  10. Intelligence
  11. Self-Confidence
  12. Flexibility

Communication

The transfer of information with understanding from one person to another. This is used for Therapeutic Relationships, and occurs with four phases:

  1. Pre-interaction: prior to any initial contact with a client, where all relevant and necessary information related to the client are collected and reviewed prior to any initial meeting. The data obtained could be either primary or secondary depending on its source.
  2. Orientation: the initial meeting between the client and caregiver, where rapport and trust are established.
  3. Interaction/Working: the caregiver and client communicate and work together in order to determine, plan for, and intervene with the client’s problems for the fulfillment of the client’s needs.
  4. Termination: the client’s needs are met and the relationship is terminated.

Communication undergoes a cyclic process. The sender produces a message, encodes it via a means to deliver the message (verbal, nonverbal, written), and transmits it to the receiver. The receiver then decodes the message, then produces a message in return (feedback) to the initial sender.

  1. Sender/Encoder: the initiator of the communication process in order to transmit information.
  2. Message: the actual meaning sent.
  3. Encoding: the form the meaning takes in order to be delivered. This may be verbal, non-verbal, written, etc.
  4. Transmission: the actual transference of data.
  5. Receiver: the recipient of the message, and the one to decode (interpretation, perception, understanding of the message).
    • Decoding a message may meet barriers (alterations in the intended message) by various environmental, social, or cultural obstacles (Noise) like language barriers, physical noise, perceptive biases, etc. Discussed later in this section.
  6. Feedback: the response or alteration in behavior of the receiver as a reaction to the received message.

There are various types of communication behaviors utilized for the delivery of various kinds of data:

  1. Aggressive-Type Communication: loud, inappropriate, and confronting behavior utilized by hostile, egotistic, and sarcastic individuals.
  2. Passive-Type Communication: shy, quiet, uninvolved, apologetic, repressive, and easily manipulated individuals use this form of communication.
  3. Assertive-Type Communication: a balance of aggression and passivity, altering the dominance of one or the other depending on the needs of the context wherein communication is necessary. They may display the following characteristics (mn. FEW RIGHTS):
    • Facial Expressions are appropriate to the scenario and people.
    • Eye Contact is proper.
    • Well-Modulated Voice, tone, and intonation.
    • Respectful in communication.
    • Ideal in all situations.
    • Gestures are used appropriately.
    • Honest
    • Truthful
    • Spontaneously responsive

Effective communication utilizes various techniques:

  1. Offering Oneself
  2. Focusing on the Client
  3. Clarifying
  4. Summarizing
  5. Open-ended Questions
  6. Conveying Acceptance
  7. Supporting
  8. Providing Information
  9. Reflecting

Communication may be “blocked” by various barriers:

  1. Psychological Barrier: psychological states like panic, phobias, extreme anxiety, grief, loss, intense fear, aggression, or other emotional disturbances can alter the perception or even reception of messages.
  2. Environmental Barriers: noise, distance, and space, etc.
  3. Disinterested Listeners: a lack of interest in the sender’s messages interrupts the meaningful transference of information, even if the message is physically heard by the receivers.
  4. Semantic Barriers: multiple interpretations may be obtained from a single message due to ambiguity, lack of tone indicators, or the decoder.
  5. Physical Barriers: defects in speaking, seeing, listening, or cognition of the message.
  6. Others include non-legible handwriting, differences in dialect, use of jargon, etc.

Channels of Communication:

  1. Downward Communication: top-level positions that transmit messages down to subordinates, e.g. imposition of a new staffing pattern for all nursing personnels.
  2. Upward Communication: operational-level messages transmitted to the top-level positions, e.g. an appeal for an increment in wages and compensation from staff nurses.
  3. Lateral Communication: communication between equally-positioned individuals in the hierarchy.
  4. Diagonal Communication: the flow between different hierarchal levels but without a direct supervisor-subordinate relationship.

Decision Making

Decision-making is the process of providing resolutions of conflicts or problems by careful analyses of all possible information, data, or alternative solutions. This occurs in stages, almost similar to the nursing process, but where diagnosis occurs first (identify the problem and individuals affected), followed by assessment (gather all pertinent data), then PIE:

  1. Identify the Problem with the group.
  2. Determine the People Affected
  3. Gather All Pertinent Data
  4. Brainstorm All Possible Solutions
  5. Choose the Best Solution
  6. Implement the Chosen Solution
  7. Develop a Criteria for Evaluation of the solution’s effect on the problem.
  8. Evaluate the Solution Using the Criteria

Ethical

A leader is ethical. They must have good manners and the right conduct. They display appropriate behaviors, morality, and conscience in guiding and motivating other members of the team to function conscientiously.

Conflict Resolution

Conflict is the clash of ideas resulting in a potential crisis. These must be resolved by leaders as conflict hinders the achievement of common objectives. Conflict occurs in three contexts: Intrapersonal, occuring within an individual; Interpersonal, occuring between individuals; and Organizational or Interdepartmental, where conflict arises between two units, departments, or groups.

Conflict resolution utilizes different methods:

  1. Avoidance: the problem is avoided by the leader.
  2. Bargaining/Compromising: something is given up to gain something else; both parties gain something and lose something. They attempt to meet half-way their respective demands, and do their best to equally benefit all parties i.e. “We both win some and lose some”.
  3. Competing/Unilateral Action: the side with an advantage takes the opportunity to exploit the other party, i.e. “I win, you lose”.
  4. Smoothing/Accommodating: a party appeases the other party by using conscientious efforts or kindness. This may not resolve the conflict, producing a temporary result.
  5. Negotiation: the most advisable solution; both parties recognize the problem and mutually look for a solution acceptable to both.

III: Nursing Management

Management is a process for the accomplishment of organizational objects using both interpersonal and technical aspects, and using resources efficiently and effectively. A manager coordinates actions and resources available to achieve organizational goals and outcomes.

Theories in Management

  • Frederick Taylor’s Scientific Management Theory: management work can be scientifically done to be able to increase work production or output. It may be summarized as follows:
    • Selection of workers
    • Training of selected workers
    • Provision of adequate tools for workers
    • Proper treatment or evaluation
  • Human Relations Theory: effective management arises from good working relationships between the manager and laborers, and among the laborers themselves.
  • Douglas McGregor’s Motivational Theory: a manager may have two classes of workers:
    • Theory X: a “negative” type of worker that dislikes work and avoids responsibilities. They require duress to perform obligations. A high level of motivation is required for them to work.
    • Theory Y: a “positive” type of worker that are reliable and gives importance to their job for the best results. These workers are responsible, diligent, and trustworthy. They productively utilize time, energy, and efforts.
  • Henry Fayol’s Principles of Management: fourteen principles of management are outlined.
    • Division of Work:
    • Proper Authority, Responsibility, and Accountability:
    • Unity of Command:
    • Unity of Direction:
    • Remuneration of Personnel:
    • Balance between Centralization and Decentralization:
    • Subordination of Personal Interest with General Interest:
    • Scalar Chain/Chain of Command:
    • Security of Tenure:
    • Esprit de Corps; Team Spirit:
    • Span of Control:
    • Channels of Communication:
    • Respondeat Superior; Command Responsibility:
  • William Ouchi’s Theory Z: management is a shared relationships between the manager and their members. A participative form of management is utilized.
  • Total Quality Management: TQM; effective management involves a collective approach of the whole organization with the aim of providing quality and continuous client satisfaction based on resulting data.

Management Process

Planning

Planning involves no actual or physical tasks, and is merely a management tool used to conceptualized what is to be done in a future time. It is a future projection of the group’s goal and allows for the team to decide (form a blueprint) in advance. There are different types of plans:

  • Standing/Operational Plan: a plan used for regular or daily activities.
  • Strategic/Contingency Plan: a plan used during emergencies or crises.
  • Long-Term Plan: a plan utilized and revised or amended as necessary over weeks, months, or even years to accomplish and evaluate.

Planning involves multiple elements that outline the organization’s concept:

  • Mission: the present reason for establishing the organization, and the actual function and purpose of its existence.
  • Vision: what the organization wishes to achieve in the future; the prospective reason for its establishment.
  • Philosophy: the set of values and beliefs in an organization to promote unity in the fulfillment of their respective goal.
  • Goal: the general statement of the purpose of the organization.
  • Objective: the specific and measurable statement of the purpose of the organization.
  • Policies: a general statement on the course of action to be undertaken in fulfilling the organizational goals.
  • Procedure: the specific statement of a step-by-step process in undertaking the goal of the organization.
  • Rules: punitive steps in the event of any misdemeanor or omissions in the organization.

Budgeting is a tool used by a nurse manager during planning when allocating future resources in their respective health care units.

  • Personnel Budget: allocated expenses for compensation and remuneration of staff or workers, and is the most important budget.
  • Operational Budget: allotted expenses for day-to-day activities undertaken by an institution to operate, e.g. electricity, medical-surgical supplies, and other equipment for short-term use.
  • Capital Budget: capital expenditures; major equipment and facilities that can be utilized for long periods of time. It is the most expensive form of budget.
  • Other forms include a zero-based budget (all expenses equal all income), fixed-ceiling budget (a budget is set and does not move despite any changes in activity), and flexible budget (budget depends on organizational activity).

Organizing

Organizing is a management tool that determines the right people and their tasks to perform to achieve common objectives. It normally utilizes an Organizational Chart that structurally outlines the various parts and areas of an organization, and how they are interrelated with one another. It determines organizational control, the policy and decision-making process, and evaluates the strong and weak areas in an organization.

Staffing is a tool to determine the appropriate and adequate ratio of health care personnel to perform their respective organizational tasks for the benefit of the clients. These are schedules which the staff follows, and take various forms/types:

  1. Traditional: an 8-hours/day schedule (40 hour week)
  2. Non-Traditional: >8 hours/day schedule
  3. Baylor Plan: the division of a schedule to both traditional and non-traditional schedules (8 hour shifts during weekdays, 12 hour shifts during weekends)
  4. Part-Time: flexible (elective) and shorter schedules
  5. On-Call: the worker may be called to work when necessary, but is otherwise off-work.

Staffing can take on different patterns, depending on how schedules are decided/change:

  1. Centralized Staffing Pattern: schedules are decided and approved by top-level administrators.
  2. Decentralized Staffing Pattern: schedules are discussed and submitted by unit managers to administrators, who then approve the schedules.
  3. Permanent Schedule: an unchanging schedule.
  4. Self-scheduling: the operational-level workers decide on their shifts.
  5. Cyclical: definition needed

Nursing Care Delivery Methodologies enumerate the methods that a nursing staff team can respond to patient needs:

  1. Case Method: total patient care is given by an individual nurse to a specific case or diagnosis of a client. The nurse informs the nurse-manager regarding the patient’s concerns (private duty nurse).
  2. Functional Method: also commonly known as “task-based nursing”, wherein nurses are assigned specific tasks for patients. It is the poorest method of nursing care delivery, but is highly utilized when nurses are scarce or patients are abundant.
  3. Team Nursing: teams are formed from the group, and appoint a team leader or “charge nurse”. They assume responsibilities from the nurse manager for their members, and coordinates and supervises all the care provided by members of the team.
  4. Primary Nursing: direct patient care formulated by a primary nurse (and their team, if also utilizing team nursing) from the moment of admission until discharge. This is practically 24-hour continuous care, and demands an increase in accountability, responsibility, planning, communication, and coordination.

Directing/Delegation

Delegation is a management function wherein a task, procedure, or obligation is done by another person who accepts it. Effective delegation is done by:

  1. Determine the task to be delegated.
  2. Choose a delegee to perform the task.
  3. Match staff competency with the task. There must be capacity and acceptance to perform the delegated task.
  4. Provide open and continuous communication with the delegee.
  5. Obtain constant feedback and evaluation from your subordinate during and after performing the task. As such, only tasks that the delegator can best perform, assess and evaluate may be delegated.

There are many principles and characteristics to follow for delegation to be effective:

  • Provide a complete and continuous instruction for the delegated task.

  • Assume a face-to-face position and utilize proper eye contact when delegating.

  • Provide a calm environment when providing instructions.

  • Do not delegate during an emergency situation, as this should normally take time. Rushing delegation may result in errors and miscommunication.

  • Responsibilities may be delegated, but not accountability. Any errors by the delegee will be shared by the delegator.

  • Delegation should not breach confidentiality.

  • There must be a periodic and constant evaluation of tasks completed.

  • Give appropriate assistance and supervision.

Coordinating/Collaboration

Quality care is provided by multiple members of the health care team. Continuous communication, relationship, and interaction with other professionals is required for holistic care. There are three kinds of coordination/collaboration:

  • Intradepartmental/Interpersonal Coordination occurs within the same unit.
  • Interdepartmental Coordination occurs between departments under the same institution.
  • Interinstitutional/Agency Coordination occurs between institutions.

Evaluation/Controlling

The final step of the management process wherein the nurse manager determines whether the desired goal was met or achieved in accordance with organizational standards. It also involves management of possible outcome risk. Evaluation can be on-going, intermittent, terminal, or routine. Evaluation can be done through:

  1. Self-appraisal
  2. Checklist System
  3. Peer Review
  4. Nursing Audit
  5. Performance Appraisal
  6. Customs/Client Evaluation
  7. Benchmarking
  8. GANTT Charting
  9. Program Evaluation and Review Technique (PERT)
  10. Nursing Rounds
  11. Sentinel Event Review

IV: Ethics in Nursing Practice

Ethics is a word derived from the Greek word “Ethos”, which depicts a “characteristic way of acting”. It is a field of moral science in which deals with the morality of human acts. Nurses must be ethical, displaying that they are able to distinguish between right or wrong, that they feel an obligation to do what is good and avoid what is wrong, and that they have a sense of accountability for all actions taken.

Ethical Rights of Patients

(with the inclusion of the patients’ bill of rights)

  1. Right to Appropriate Medical Care and Humane Treatment: the provision of considerate and respectful care.
  2. Right to Information: Obtaining complete, current information concerning his diagnosis, treatment and prognosis in an understandable manner.
  3. Right to Informed Consent: receiving information necessary to give informed consent prior to the start of any procedure and/or treatment.
  4. Right to Refuse Treatment: patients are granted the ability to refuse treatment to the extent permitted by the law and to be informed of the medical consequences of their decision.
  5. Right to Privacy: every consideration of their privacy concerning their own medical care program must be provided.
  6. Right to Confidentiality: expect that all communications and records pertaining to their care should be treated as confidential.
  7. Expect that, within their capacity, the hospital must provide a reasonable response to their request for services.
  8. Obtain information regarding any relationship of their hospital to other health care and educational institutions insofar as their care is concerned.
  9. Right to Refuse Participation in Medical Research: the patient must be advised if the hospital proposes to engage in human experimentation affecting their care or treatment. The patient has the right to refuse and participate in such research projects.
  10. Expect reasonable continuity of care.
  11. Examine and receive explanation of the hospital bill regardless of the source of payment.
  12. Right to be Informed of Their Rights and Obligations as a Patient: the patient must know hospital rules and regulations apply to their conduct as a patient.
  13. Right to Express Grievances: the patient has the right to express complaints and grievances without fear of discrimination, reprisal, and to know about the disposition of such complaints.
  14. Right to Choose Health Care Provider and Facility
  15. Right to Self-determination: the patient has the right to avail any recommended diagnostic and treatment procedures.
  16. Right to Religious Belief: refusal of any medical treatment or procedures which may be contrary to their religious beliefs is respected.
  17. Right to Leave: the patient has the right to leave the hospital or any other health care institution regardless of their physical condition, provided that they are informed of the medical consequences of their decision and a waiver releasing those involved in their care of any obligation related to the consequences is signed, and that public health and safety is not compromised.

Bioethical Principles

  1. Autonomy: respecting the personal liberty or freedom of an individual to choose and implement one’s own decision. Patients are free to select appropriate treatment without external pressures. While nurses must correct faulty health beliefs and practices and reinforce healthy teachings, they must continue to respect culture, religion, or belief.
    • The only exception to a withdrawal of autonomy is during cases of emergency, where obtaining consent would place the life in probable danger, and when there is an implied waiver or consent— subjecting oneself to treatment without express consent, but with no objection or refusal.
  2. Beneficence: “do good”. The acts to promote positive changes or experiences for the patient.
  3. Non-maleficence: “do no harm”. The acts to prevent negative changes or experiences for the patient.
  4. Justice: the distribution of resources between parties based on necessity (equity) and not of external characteristics of race, age, etc. that are not related to care. This principle is used especially in periods of scarcity.
  5. Double Effect: the principle that actions may be morally good or at least neutral, yet produce bad effects. In such a case, the minimization of the bad effect is done, but is otherwise allowed to allow for the good effects to take place.
    • This principle is displayed in a therapeutic abortion: the “good” of saving the mother from death offsets the “bad” of performing an abortion.
  6. Veracity: “truth telling”. It is the obligation of the nurse to provide full disclosure of all information related to the care of the patient. This is backed by the Patient’s Bill of Rights (Right to Information). This principle extends to prohibition of the provision of fraudulent information and false hope/reassurances.
  7. Fidelity: “keeping promises”, in conjunction with veracity, is the completion of all obligations inherent and promised in the care of a patient. It is the loyalty to the care of the patient and the profession.
  8. Inviolability of Life: the life of every person is respected. Nurses must avoid all acts that will curtail, end, or endanger one’s life.
  9. Totality: the value of the “whole” is prioritized over its individual parts, such as when an amputation is performed— the totality of the individual is preserved with the sacrifice of one of its parts.
  10. Stewardship: the principle of taking care of those placed in one’s care.
  11. Confidentiality: privacy and anonymity of the patient, information provided by the patient, and all relevant records is upheld.
  12. Paternalism: the interjection of another person as the decision-maker in place of another when they are unable to decide for themselves. This may become a negative principle in cases where patient autonomy is interrupted, but is good for patients who are unfit for providing healthcare decisions.
    • If necessary, proxy consent may be given (in order of priority) by (a) the parents of the patient, then (b) their next of kin (closest relative in genealogy). In cases of emergent necessity, the physician will sign the consent in the best interest for the life of the patient.

A consent is an agreement between parties that creates an obligation for participating bodies. In healthcare, an example is a contract outlining services being provided by the institution to the patient in exchange for the patient’s financial compensation. In a standard contract, three basic elements are required: (a) the object, the subject of the contract— treatment, admission, etc., (b) the considerations, the reason for producing a contract, and (c) the consent of the patient itself.

An informed consent, therefore, is a consent only provided once the patient has full knowledge of the possible benefits, risks, alternatives, costs, and other pertinent information as provided by the physician or individual performing treatment in a way that the individual understands. The provision of an informed consent must be voluntary (of the individual’s own will) and must be personal (of the individual’s own act i.e. handwriting/signature/thumb mark).

The validity of consent can be summarized with the following criteria (mn. VOTUM):

  • Voluntary
  • Opportunity to ask questions: the patient must not have any uncertainties.
  • Treatment or surgery must be explained: full disclosure of the procedures must be given.
  • Understood by patients: patients must be given an explanation in line with their level of understanding and their language.
  • Matured both Physically (18+) and Mentally (Unaltered LOC)

Documentation and Charting

Documentation, charting, or recording, is the act of placing patient and care information into writing for posterity. Any care not documented is not given, despite all testimonies. Patient charts are legal documents and can be used to vindicate or convict members of the healthcare team for inadequate, negligent, or otherwise non-standard care. Good documentation follows the following characteristics (mn. FLIP):

  1. Full, Factual, and Accurate: complete, empirical, and non-speculatory/circumstantial.
  2. Legible in handwriting, syntax, and grammar.
  3. Written Immediately after procedure. If late, the entry should be specified as an addendum.
  4. Personal/Confidential; documentation cannot be delegated to those who did not perform care. The act is personal to the nurse performing the care being documented.

Conversely, negative characteristics in documentation may be summarized by the following (mn. LISA):

  1. Language, Jargons, or Words that are unacceptable in medical records. Use formal, recognizable, objective language.
  2. Improper Corrections: crossing out, liquid taper, etc. are not allowed. Strikethrough: draw one or two straight lines across the mistake and write it as an error or mistake, then date the correction and sign.
  3. Spaces and skips: do not leave spaces to avoid tampering or addition of information. Obstruct empty spaces with lines.
  4. Abbreviations are only used when recognized by the medical community and medical terminologists.

Such documents are kept for five years after the discharge or death of the patient. The records are kept for the following reasons (mn. CLEARS):

  1. Communication for patient’s care between the members of the healthcare team.
  2. Legal document if necessary (if a case is medicolegal in nature, it is kept for life.)
  3. Evidence for insurance claims, decision-making of the nurse, investigations, professional liabilities, etc.
  4. Assurance of Continuous Care
  5. Research
  6. Statistics

Medical records are owned by the hospital and as such must be kept confidential against any unauthorized person, with its contents only being divulged with the consent of the patient’s consent or upon court order. Medical records are the best written evidence for medicolegal cases. A court order demanding the release of a document may be presented to the institution holding the record. This is known as a subpoena duces tecum.

Last Wills and Testaments

V: Nursing Research

Research is a systematic, controlled, empirical, critical investigation and collection of data based on a certain hypothetical proposition about its relation to a phenomena (Kerlinger); it is a formal, systematic, and intensive process of analyzing problems through scientific means for purposes of discovery and development of an organized body of knowledge (Abdeilah).

  • Research is systematic, controlled, empirical/evidence-based, critical, and may be applied.

Research is used to obtain accurate and complete information and richer familiarity about phenomena; to provide explanations to any hypothesis based on observation of human behavior or through experimentation; to develop a new method or system of care to clients; to provide new knowledge and technology to improve the delivery of health services; to provide scientific knowledge; to provide clarifications about a certain concept, inquiry, or theory; and to provide predictions, testing, and control.

Ethical Considerations in Nursing Research

  1. Study is based on scientific objectives or purposes, conducted to develop not to destroy others.
  2. Gain proper cooperation and informed consent. Observe the principles of autonomy and self-determination.
  3. Maintain the integrity of the researcher and his work.
  4. Proper acknowledgment of the contributions of others.
  5. Protection of the basic human rights of subjects:
    • Right to be free from harm
    • Right to self-determination; the subject must be free from coercion, restraint, force, or other undue influences. Consent must be a voluntary act, and may be withdrawn at any time.
    • Right to privacy, which involves anonymity and confidentiality.
  6. Truthfulness with regards to the presentation of findings.
  7. Importance and significance to the nursing profession.
  8. Evidence-based practice; a factual basis and empiricism.
  9. Must proceed utilizing the basic steps in the research process.
  10. Maintain courage, patience, and determination to collect, analyze, and interpret data or information.
  11. As much as possible, experimental research must be free from any human testing.

Basic Steps in the Nursing Research Process

  1. Chapter I: The Problem and Its Setting
    • 1.0 Introduction
    • 1.1 Statement of the Problem; including historical background
    • 1.2 Problem Rationale
    • 1.3 Scope and Limitation
    • 1.4 Formulation of hypotheses
    • 1.5 Definition of Terms
  2. Chapter II: Review of Related Literature
    • 2.0 The Review of Related Literature
    • 2.1 Theoretical Framework
    • 2.2 Conceptual Framework
    • 2.3 Other Relevant Theories
  3. Chapter III: Research Methodology
    • 3.0 Nature of the Methodology Deployed
    • 3.1 Methodological Objectives
    • 3.2 Advantages and Limitations
    • 3.3 Rationale
    • 3.4 Sources of Data: selecting your population and samples, determining the appropriate tool for data collection, conducting pilot studies, and collection of data
  4. Chapter IV: Presentation, Analysis, and Discussion
    • 4.0 Presentation of Findings
    • 4.1 Analysis and Discussion
    • 4.2 Summary
  5. Chapter V: Conclusion and Recommendations
    • 5.0 Conclusion
    • 5.1 Recommendations and Suggestions

Research Problems

A problem is any condition, situation, or inquiry requiring solution through scientific investigation. They may be sourced from various concepts, literature, journals, books, essays, clippings, articles, issues affecting the health care system, experience (of the researcher), nursing assessment, areas of practice, theories and principles of nursing, and from curiosity. Good research problems feature:

  • Significance: the problem must be of adequate relevance and produces an important contribution to the nursing profession.
  • Feasibility/Measurability in terms of time, availability of subjects, cooperating and consent of participants, facilities, tools, equipment, financing, experience, and ethics.
  • General Applicability and Use
  • Researchable and Empirically Testable
  • Novel/Original
  • Clearly defined objectives/purposes

Purpose of the Study

The rationale of the researcher for conducting a study. It shows the significance and importance of conducting a certain research study and its probably contribution in the profession. It shows the reason for focusing on a certain study. Research, based on purpose, may be divided between:

  1. Basic Research: research used to generate new knowledge or ideas.
  2. Applied Research: research used to solve immediate assessed problems.

Research Variables

Variables are any characteristic or attribute of a person or an object which may be affected by an experience, events, or phenomenon being studied. It changes or “varies”, but basically can be measured either quantitatively or qualitatively. They may be classified as:

  1. Independent Variables: the “cause of the study”; the variable that is manipulated in an experimental research and greatly influences the dependent variable.
  2. Dependent Variables: the “effect or response of the study”; the variable that is being influenced by the independent variable.
  3. Extraneous/Confounding/Intervening Variables: variables that may affect the study, but the researcher does not choose to control.

Variables may be expressed or related in various forms:

  1. Proposition: an assertion of the relationship between concepts.
  2. Construct: a set of concepts which can be subjected to empirical testing.
  3. Model: a symbolic representation of phenomena. It symbolizes some aspects of reality, concrete or abstract, by means of likeness which may be structural, diagrammatic, pictorial, or mathematical (Bush, 1979).
  4. Assumption: assertions which are held to be true but has not been scientifically tested or proven. It is often merely based on common sense or basic reasoning.

Scope and Limitations

The scope of the study determines the specific area/s covered by the study. It should state the following:

  • A brief statement of the general purpose of the study.
  • The subject matter and topics studied and discussed.
  • The locale of the study, where the data were gathered or the entity to which the data belong.

The limitations of the study are constraints or restrictions on generalizability and utility of findings that are the result of the ways in which you chose to design the study and/or the method used to establish internal and external validity. This may include a lack of samples, unavailable data and literature, and other physical impossibilities during research itself.

Definition of Terms

Terms used within the study which may require specification or are otherwise significant may be defined by the researchers in the definition of terms. Terms may be defined conceptually or operationally, where the former utilizes the usual or common definitions usually taken from the dictionary or other common sources, and the latter is based on how the researcher used and applied the terms in his problem or study.

This provides the researcher an overview of the problem under study using prior, previous, or past research findings; studies; and data. It also:

  • Provides ideas and techniques in conducting a research study.
  • Determines the strengths and weaknesses of a study.
  • Provides a simple background, orientation, and current status regarding the problem.

Various literatures may be available for research, but they are generally classified as:

  1. Conceptual/Non-research Literature: mere narrations of experience, expert’s opinions, thoughts, and theories related to the problem.
  2. Research Literature: the result of scientific investigations, studies, and actual research done and published along the problem area. It may be found using library/index or computer search.

Research Concepts and Frameworks

A concept is a single abstract thought representing two or more interrelated ideas. It serves as the building blocks of a theory. A conceptual framework is a structural and diagrammatically presented set of relationships between concepts, and is referred to as a paradigm.

A theory is a tentative relationship between concepts and phenomena. These describe or explain the relationships of two or more concepts, and are mere abstractions of processes, interactions, and observations (Fawcett); a set of interrelated concepts, definitions, and propositions that presents a systematic view of phenomena by specifying the relationship among variables, with the purpose of explaining and predicting a phenomena (Kertinger, 1973). A theoretical framework is a general explanation of a problem under study utilizing an existing, established, or well-defined theories.

Research Hypotheses

A hypothesis is a tentative statement, prediction, or explanation of a supposed answer based on a presumption about the relationship between two or more variables.

  1. Null/Statistical Hypothesis: a type of hypothesis that shows or predicts no relationship or difference that occurs between a variable to another variable.
  2. Research/Alternate Hypothesis: states an expected relationship between variables.
  3. Simple/Univariate/Operational Hypothesis: a type of hypothesis that shows an anticipated relationship or difference between a single independent variable to a single dependent variable.
  4. Complex/Multivariate Hypothesis: a type of hypothesis that states the anticipated or predicted relationship between two or more independent variables to two or more dependent variables.
  5. Directional Hypothesis: a type of hypothesis that specifies a precise direction of the relationship between variables.
  6. Non-Directional Hypothesis: a type of hypothesis that shows no specific direction of the relationship between variables.

Research Design

A study’s design is the systematic and controlled plan on how the study will be conducted. It servers as the roadmap, skeletal framework or the blueprint in research.

Based on existing knowledge, research design may be

  1. Exploratory Studies: done to gain richer familiarity for phenomenon which has less or few existing information or data available.
  2. Descriptive Studies: done to study the relationship between variables in a known phenomenon; it studies the relationship and characteristics of a particular subject in a certain phenomena as it naturally happens (Brink and Wood, 2001)
  3. Explanatory Studies: helps provide basic explanations about the relationships between phenomenon.

Based on the setting or environment, research design may be

  1. Clinical Setting: often more controlled.
  2. Field Study: ordinary setting where subjects naturally exist.

Based on the type of data collected, research design may be

  1. Quantitative Research: a type of research whose result can be determined by objectivity, senses, and other empirical methods. This study is usually measurable, single reality, and can be subjected to statistical analysis based on numerical data.
    • Experimental and non-experimental designs
  2. Qualitative Research: a type of research that focuses on a subject’s subjective insights and values about given facts, i.e., perceptions, understanding, emotions, feelings, behavior, etc. These focus more on words than numbers. Data is represented in thematic or narrative forms.
    • Historical studies, case studies, phenomenological studies, ethnographic studies, ethnography, and grounded theory
  3. Mixed/Triangulation Research: a combination of quantitative and qualitative research.

Experimental Research

In this design, researchers try to manipulate or control the independent variable to reproduce a certain effect (on the dependent variable). It is mainly concerned with the “cause and effect” relationship. Some “True Experimental Designs” are Pretest-Posttest Control Group Design, Posttest Only Control Group, and the Solomon Four-Group Design. Experimental research has the following features:

  1. Manipulation: the researcher intervenes with the subject under study.
  2. Control: the researcher uses a certain system or condition to control the investigation or study
  3. Randomization of Samples: samples are acquired and segregated as control or experimental groups.
  4. Measurement/Validation of results

Quasi-experimental Studies

These are experimental research designs which may be missing some of the features listed above. Usually, there is no control or comparison group because participants are not randomized.

Various phenomenon may affect the validity of the research:

  1. Hawthorne’s Effect: changes in behavior attributed to the knowledge of being under study.
  2. Halo Effect: specific attributes, whether positive or negative, produce an assumption for other, non-related attributes that the researcher may falsely observe, e.g. good appearance does not constitute good decorum, but the latter may be implied by the former, even if not specifically observed.
  3. Experimenter’s Effect: the researcher’s own beliefs, principles, and values seep into the outcome of the research.
  4. Reactive Effect of the Pretest: the pretest effects the participants’ actions for the posttest, which produces an imbalance in behavior between tests.
  5. Selection Effect: a lack of randomization in assigning participants introduces bias.
  6. History Effect: events that occur outside of the study affect the behavior of the participants under study, such as economic changes.
  7. Maturation: the participants of the study mature and change during the study, and the findings become altered as a result.
  8. Attrition Effect: the result is altered by participants that drop-out of the study; the final sample may no longer be representative of the population.
  9. Instrumentation: the result is affected by changes in calibration of the instruments and equipment used between periods of measurement.

Non-experimental Research

Samples are not subjected to any burdensome control or manipulation. They can easily cooperate for these types of research, and the researcher is not concerned with the cause-and-effect phenomenon.

  1. Historical Approach: a type of research based on past events, primarily utilizing pre-existing data such as journals, records, and similar sources or the subjects themselves, merely recalling some past occurrences. Sources may be sources or secondary.
  2. Survey Studies: the utilization of mass/large/smaller groups; whether mailed, face-to-face, or through telephone; and simultaneously between groups (cross-sectional) or longitudinal (successive surveys for a single group).
  3. Comparative Studies: contrasting studies in relation to particular variables or phenomenon being studied. There are two types:
    • Retrospective Design: a study done “ex post facto”; after-the-fact. The researcher usually selects subjects who have undergone some related experience in the past and attempts to let them describe its relationship with a present study or investigation.
    • Prospective Design: a study done at the present, but where the study is consummated in any future time or upon the happening of a future event or occurrence which is certain to happen. The subjects are followed and observed for a period of time.
  4. Correlational Studies: a study to determine the strength of relationships among variables in a particular subject. This often utilizes statistical analysis.

Qualitative Research Studies

  1. Case Study/Case Analysis: research data is taken and analyzed on a certain focus group, institution, or single subject only. This is a type of subject that focuses on a smaller number of subjects, making the design costly and time-consuming.
  2. Ethnographic Studies: data are collected and analyzed coming from a certain cultural group or minority.
  3. Grounded Theory Studies: studies leading to the discovery or development of useful theories.
  4. Phenomenological Studies: data based on described human experiences, provided by the very same people involved.
  5. Field Studies: studies naturally conducted in an ordinary setting, such as in a community.

Population and Sample

  • A population is a general group to be studied.
  • A sample refers to a selected portion of the population from whom the data will be collected.
  • An element is an individual member of the sample population.
  • The sampling frame is the listing of all elements.

Samples may be chosen in various ways to improve its representation of the population:

  1. Simple Random Sampling: every element of the population is given an equal chance or opportunity to be chosen as a sample. No bias.
  2. Stratified Random Sampling: done by first dividing the population into sub-strata or sub-populations according to some subject character (e.g. age), then applying random sampling from each sub-strata or sub-population.
  3. Systematic Random Sampling: involves utilizing some method to choose from the population randomly, most commonly selecting every nth element from the population.
  4. Cluster Random Sampling: sampling by sub-areas of the population, applicable if a population is spread geographically.
  5. Accidental/Convenience Sampling: a non-probability sampling technique that involves choosing samples from readily available groups accessible to the researcher.
  6. Purposive/Judgmental Sampling: a non-probability sampling technique that involves choosing elements based on common knowledge or as a typical choice.
  7. Snowball Sampling: a non-probability sampling technique where the researchers use networking or referrals from previous elements to acquire more data, e.g. referrals of one cancer patient to a fellow cancer patient who underwent the same treatment.
  8. Quota Sampling: a non-probability sampling technique where the population is divided into subpopulations, and chosen based on “other” personal criteria instead of random sampling.

Data Collection

Data collection is the stage in the research process wherein the data is actually collected or received from subjects to ascertain the veracity of the researcher’s hypothesis and shall form the basis of the researcher’s conclusion. Among all of the stages of the research process, it is often the most budget and time-consuming. Good data collection is based on three characteristics:

  1. Reliability: if tested once or twice, the data will likely yield the same result.
  2. Validity: the test measures what it is meant to measure. This includes face validity, content validity, and construct validity.
  3. Accuracy: measurements are accurate and truthful.

Methods of data collection vary depending on requirements and resources:

  1. Questionnaires: among the most accessible forms of data collection. These may be:
    • Dichotomous: Yes-No or True-False questions
    • Rating Scale: choices are categorized and subjects answer according to the criteria, most often utilizing a Likert scale. One example is a scale of 1 to 5, with 1 as “Never” and 5 as “Very Frequently”.
  2. Observation: data collection using one’s senses. It is an ocular method of collecting descriptive behavioral data as it occurs.
    • Participant Observation: the observer actively joins the subject while performing observation.
    • Non-Participant Observation: the researcher is a mere passive observer during data collection.
    • Structured Observation: the researcher prepares a pre-determined list of phenomenon to observe for.
    • Non-Structured Observation: free-style observation.
  3. Interview: the utilization of oral communication skills between the researcher and his source to obtain data. It may be:
    • Structured: a list of specific questions are asked in the same manner to all respondents.
    • Unstructured: informal and open-ended questions are being asked. A simple, normal conversation.
    • Combined Method (Semi-structured)
  4. Pre-existing data or Record: data is collected from previous recordings, published, archives, or documented. It may be:
    • Primary: recorded by a source who actually experienced and observed a phenomena.
    • Secondary: second-hand information.
  5. Others: Q-Sort, Projective Techniques, Delphi Technique, Physiologic Measures, Visual Analogue Scale (VAS Technique)

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