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Adjustment, Legal
Management, Ethics
& Research in
Nursing
Comprehensive Review Notes
sanglei915 2010
Professional Adjustment, Legal Management, Ethics & 201
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NURSING RESEARCH
Nursing Research
Kerlinger - the systematic, empirical, controlled and critical investigation of a
hypothetical proposition in relation to a natural phenomena/ problem
Conducted to affirm or deny a hypothesis
Phenomenon.
everyday phenomenon that affects the nurse (eg. bacteria, drugs, physician)
Florence Nightingale
Birthplace – Italy
2 Training Ground – Germany
Greatest Contribution – environmental Theory, training RNs in Crimean War
School – Saint Thomas School of Nursing
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Ethics of a Researcher
S – Scientific Objective – conductive research for a good purpose or object for
your pt
C – Cooperation and Consent. Do not conduct data/experiment w/o a consent
(legally the patient owns the chart. However the hospital owns the chart)
I – Integrity – worked hard on the research
E – Equitable – acknowledging works or contribution of others
N – Nobility – protect the rights of your subjects
o Right not to be harmed
(physical, mental, moral harm) usually done during experimental
research
Physical Harm/ Negligence - undeliberate physical harm
Commission – done outside the standard practice of
nursing (e.g. urinary catheter placed on the nose of the pt)
Omission – from the very start, you did not do something
about it.
Moral Harm
Assault – mental fear/threat without physical harm
Battery – physically you harm the pt
Restraint is never an independent nursing order
physical restraint – e.g. Jacket
chemical restraint – e.g. use of psychotropic drug
Moral harm
Slander – oral defamation
Libel – published or placed in the newspaper
o Right to self-determination
o Right to privacy
Anonymity – identity of subject may not be disclosed. Privacy of
the Informant (pt) e.g. conduct a study on HIV pt. but the pt wants
his name to be written in the newspaper as Mr. X, Mr. Y or Mr. W
Confidentiality – information acquired must not be disclosed.
Privacy of the information e.g. conduct a study on HIV pt. but the
pt wants the nurse should only know
T – Truthfulness – put only the data you have collected
I – Importance – importance to the nursing profession
F – Factual – facts or data
I – Ideal (follow the 11 steps of research)
C – Courage
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N – Nursing problems
T – theories
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Independent Variable: PGH and NYGH (place of work)
Target Population: Filipino nurses
Dependent Variable: income
Research:
1. Identify the Problem
2. Purpose – objective using SMART (Systematic, Measurable, Attainable,
Realistic, Time Bounded)
3. Define Terms
a. Conceptual Definition – dictionary definition
b. Operational Definition – defined in accordance on how the researcher
used the word
4. Revision of Terms
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This shows relationship between a single independent
variable from single dependent variable.
E.g. “Filipinos Nurses working in USA has more
professional opportunities than those working in the
Philippines.
Complex hypothesis
This shows a relationship between two or more
independent variable from two or more dependent
variable.
E.g. “Filipino nurses who worked for 5yrs and passed the
CGFNS, TORFL, TSE, NCLEX has greater opportunities in
NY as compared to those in Manila”
Directional hypothesis
Specifies the direction of the relationship between
variables
E.g. “Filipino Nurses working in the USA has more
professional opportunities than those working in the Phils.”
Non-directional
Only predicts the relationship, but has no specific direction
between variables.
E.g. “There is a big difference between a Filipino Nurses
working in USA than those working in the Phils.”
Selecting research design
o Systematic controlled plan for finding the answer to a problem
o Roadmap, blueprint of the study
o Should have a proper research design
o If improper research design, there will be improper collection of data
o Purpose : key or tool for proper collection of data
o Types
According to Application
Basic/ Pure
o For personal knowledge, curiosity
Applied
o Based on problem solving approach
According to Methods
Experimental
o Performing active manipulation, observe and record
the result.
o Types of Experimental Research
control
divide group into 2.
Group a – control/comparison group
– will use the same soap everyday
Group b – experimental group –
those who will use the sample soap
randomization
Using sample by chance.
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Choose randomly to avoid
redundancy of result
Manipulation
Performing intervention
Validation
comparison of the effects
Quasi-experimental
False experiment.
No control sample. No control group
Non-experimental
o No manipulation is done. Only observation,
describe and record down the result.
o Types of non-experimental research design
base on time element
Retrospective (Ex Post Facto)
Getting actual experience
Studies a group of people after its
occurrence, experience or facts.
Experience of people in the past
Descriptive
Observe, describe & record.
Study of current events.
Prospective
Study of research about future
occurrence or future events.
Historical
Past that is written, documented,
published and recorded
Primary Data
o Observe
o 1st hand information
o person himself
Secondary Data
o 2nd Hand Information
About the past using records,
journals, books.
Study of the dead people thru his
written materials, facts
o according to data
quantitative
Data base on numerical
interpretation, data that are
measurable, using your senses, data
that are observable.
qualitative
Subjective data, feelings,
perception, beliefs, culture, attitude
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o Survey Research Design
Group
Small
Face to face
Large – not good result
Methods
Mailed survey
Face to face
Telephone survey
o According to Time Orientation
Cross Sectional
Applicable to 2 or more identical
group
Short term
For comparison
Longitudinal
1 group only
with initial and follow up survey
long term study
for developmental study
Selecting your population and samples
o sample
Part of population, data is collected.
The recipient of the experimental treatment in experimental design
or the individuals to be observed in a non-experimental design
o Types of sampling
Probability - equal presentation/ chances in the population.
Simple random technique
o Used a single/identical group.
o Fish bowl technique
Stratified random sampling
o You will first going to create a sub population from
the whole population before doing randomization.
o One population, you divide it.
Cluster random sampling
o You will first create a sub area in a population
before doing the randomization. In one population,
you make it smaller
Systematic random sampling
o Choosing a sample every nth name in the
population.
o Multiple of 100 names
o Sampling frame – list of names appearing as your
population
Non-probability sampling – you are not choosing by chance.
Accidental/ convenience sampling
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o Base on the accessibility/availability of your
sample.
o Kung sino pinakamalapit syo, yun ang kukunin mo.
Purposive/judgmental sampling
o Base on the common knowledge or popular
knowledge.
Snow-ball sampling
o get sampling base on last referral
Quota Sampling
o Setting criteria and getting samples fitting the
criteria
Conducting pilot studies
Collecting data
o types :
Questionnaires – use of pen and paper method
Dichotomous – divided into two. E.g. True or false. Yes or
no
Rating scale – poor 1, good 2, better 3, best 4
multiple choice
Interview – use of oral method of collection of data. Use of active
listening
Structured – with checklist, formal talk, list of question
Unstructured – informal talk, no pattern, anything goes
Records – pre existing data
Observation – use of ocular method using your senses
participant observation
non-participant observation
Problems :
o Hawthorne’s effects
The data you get from your sample is not
accurate.
The sample has a problem
Solution : double blind research – they
should not be conscious that they are being
studied
o Halo effect
The researcher has a problem.
He is manipulating the data collection.
It is affected by special feelings/treatment
between the researcher and the sample.
Analysis of Data
o part of research when the researcher is forming a body of knowledge out
of data collected for the purpose of affirming or denying your hypothesis
o Methods
Nominal method
Get data by means of categories.
E.g. male, female, income
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Ordinal method – base on rank eg. mild, moderate, severe
Interval
base on the distance between 2 numerical values
e.g. BP – 150/100 – 120/80, wt, circumference, ht
ratio – 3:10 children are malnourish
Interpretation of Data
o 2 Methods
quantitative method – base on numerical or graphical standards
qualitative method – use of narrative words
Communicating your conclusion
o Explaining the results of your work to the public
o Conclusion – final answer to your research
o Recommendation – suggestion to others
o Dissemination of Information
Methods :
thesis/book – written form
symposia/symposium – oral presentation
publish – a lot will be able to read your research
LEADERSHIP
Nursing Leadership
Style or process whereby a person is called a nurse leader influences a group of
people called his followers for the purpose of attaining only one goal/objective.
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P – personality (adaptability, independence, creative/assertive,
advocate) ability to adjust to the need of the pt
I – intelligence (proper judgment, proper decision making, proper
communication)
A – ability – (influence others, respect others, participate and
cooperate) Proper way to influence is thru health teaching
Charismatic theory – becomes a leader because of the charm
Situational theory/case to case basis
o a person can be a leader in one situation but only a follower in another
situation. (e.g. becomes a leader in where he specializes)
Leadership styles
Autocratic/Authoritarian/dictatorial/”hard” leader
o unilateral style of leadership. Only the leader here performs the decision
making without getting the inputs from his members.
o One sided style of leadership Behavior :
A – Apathy – insensitive to others
B – Boisterous speech
C – Consistency
D – Dominating
E – Exploitative behavior
F – ferocious behavior, to coerce or compel the group to follow him
o not a good style of leadership but only best style during emergency or
intensive crisis
Permissive, ultra-liberal, laissez faire, free-rein
o Loose style of nursing leadership.
o Giving excess freedom or liberality towards your subordinates if to lenient
in your subordinates, there will be ↓ control and power = ↑ negligence
Democratic/participative
o Best style of leadership. Mutual style of nursing leadership
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A – Authority
o basis of the leader to delegate tasks, responsibilities, jobs to be
performed by his subordinates
o 2 types of authority
Centralized – top to bottom for proper management
Decentralized – Bottom, to manage directly
B – Behavioral
o S – specialized body of knowledge and skills to do safe care
o P – patient centered
o A – accountability – liable for the results of your actions
o C – confidentiality – nurse-patient relationship
Exceptions to confidentiality of the contract :
P – patient consent, if there is
I – inform/report to healthcare team for purpose of
precautionary measures
C – Communicable disease
o RA 3573 Law on Notifiable Disease
o 24 – Polio/ Measles
o 1 Week – SAD/ HIV/Tetanus Neonaturom
C – Crimes
o Child Abuse 48 hours, Barangay, NGO
E – ethics
C – Communication skill
o transfer of information with understanding
o Communication barriers/communication backlog – eg. Dialect differences,
noise, deaf, high level of anxiety, hallucinating
D – Decision making skills
o Steps
identify the problem
identify person affected
gather options/alternative
brainstorming
delphitechnique – gathering solutions outside the group
(eg. specialized nurse)
choose and implement
Evaluation
E – Ethics
o Principles
o Principle of Autonomy
independent judgment or decision making
in all situation the pt himself is the one who should decide for his
own care
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Consent
respect the decision of the pt
explain the risk to the patient/SO
Waiver- a legal doc when the pt refuses for treatment.
o Principle of Veracity
telling the truth to the patient
#1 the patient has the right to know from the PHYSICIAN (not the
nurse)
o Principle of Double Effects
if the pt is made to choose between 2 equal danger and he only
needs to choose one, choose the one that will produce one good
effect and less evil effect.
o Principle of Beneficence
doing good to the patient (eg. providing therapeutic
communication, providing privacy)
o Principle of Non-maleficence
do no harm
3 types of Harm
Physical – negligence by commission
Mental – assault and battery
Moral – slander and libel
o Principle of Justice
Prioritize the needs of the patient.
To be able to provide nursing care to the patient, provide the
nursing process.
Nursing Process characteristics :
A – acceptable universally
B - based patients assessed needs
C – client focused
D – dynamics – base on the ever changing needs of the pt
E – equitable care
F – familiarity/rapport to the patient
G – goal directed towards solving the assessed needs of
the patient (SMART)
o Principle of Respect/Inviolability of life
Suicide and abortion is violation of this principle
F – Face/solve Conflicts
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NURSING MANAGEMENT
NURSING MANAGEMENT
choosing the right person and giving them the appropriate task for the purpose of
achieving their goal/objective in achieving total care
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5 steps in Management Process
Planning stage
o looking ahead of time.
o Formulating future goals/objective
o Types of plan
Standard/Operational Plan (NCP)
plans for everyday or ordinary activities
Strategic/Contingency Plan
plan used during sudden or acute crisis
Long-range/future Plan
Plans which you can’t evaluate immediately.
Usually lasts months or yrs.
Used for chronic patients, which requires longer period of
care.
o Stages of Planning Process
Mission – present reason of establishing organization
Vision - statement of your future purpose of the organization
Philosophy – set of values and beliefs of the organization
Goal – general statement of your purpose
Objectives – more specific statement of your purpose
Policies – set of rules and regulations in your organization
Procedures
Budgeting – proper allocation of your resources
o 3 types
Personnel
Compensation for salaries of
workers
Operational
everyday use of equipment and
facilities (gloves, water, electricity)
Capital
long term use equipment (MRI, CT
Scan, hospital beds, hospital
buildings)
Organizing
o 4 stages
Organize your team RN Subordinates
Duties of the RN
Only assessment can the nurse perform
Only the nurse can perform HT
Only the nurse should explain the procedure to the patient
Preparation, administration, treatment and drugs to the
patient
The nurse can only perform evaluation
The nurse can only do judgment
Delegate Task
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They can only delegate to subordinates the Routinary task
(standard, unchanging procedure) eg. monitoring of I&O,
bathing, ambulating, toileting, shampooing, transporting,
feeding, clothing, wiping
Stable patient - predictable outcome (eg. postmortem care
with direct supervision of the nurse only)
Supervision – need guidance
Staff Schedule/ Staffing
Schedules (How many hours)
o Traditional – 8hrs a day/40hrs/wk
o Ten hour shift/4 days a week
o Baylor plan – it consist of two shifting nurses
traditional – mon-fri 8hrs
2nd shift – 12hr shift during weekends
o Part-time work – fewer working hours per day and
may choose the day or work. Less than 8hrs job
o On – call – during shortage of nurses/staff but
increase in the number of patients.
Methods of Nursing care Delivery
Different Methods
o Primary – 24hrs a day
Primary nurse is the only nurse who is
responsible to make a care plan of the
patient from the moment of admission till the
moment of discharge. (eg. private duty
nurse or special nurse)
o Functional Method
DOH format/government hospitals
Assign nurse :
Duty/task
One nurse, one task
Highly recommended during a
period of shortage of nurses and
budget
poorest method of delivery because
communication is hindered
o Case Method/Case Nursing
Provide total care within your shift. Used in
ICU department
C – Case Method
T – total care to the patient
O – one is to one ratio
Directing/Delegation stage
o a job or a task is done or performed by another perform for you
o What you cannot delegate:
you cannot delegate total control of the procedure
you cannot delegate discipline of subordinates or staff members.
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Confidential task
Technical task
Medical task performing surgical procedure is done by the doc not
the nurse
Coordination/Collaboration
o the nurse needs to collaborate to other members of the health care team.
o Multi-interdisciplinary approach – to be able to provide holistic approach
to the patient.
o Types of Collaboration
Interpersonal/Intradepartmental
One patient, one unit.
Collaboration between one nurse to another healthcare
team in one unit/department
Eg. MI patient - nurse, dietary, specialized in cardio
Interdepartmental
4 units in one hospital.
Coordination of the patients care between 2-more
units/departments but still under one same hospital or
institution
Eg. patient due for appendectomy is transferred to the OR
Inter Agency/Institutional
Coordination of patient’s care between 2 or more
hospitals/health care institution for the benefit of the patient
Eg. lying – in due for C/S and was transferred to a hospital
Evaluation/Controlling
o stage wherein you determine whether or not your plans for your patient is
met or achieved
o Methods of evaluating staff performance
Checklist
You are being evaluated by higher in rank (eg. nurse
manager/supervisor or head nurse)
Nursing rounds
being evaluated by higher than you. (eg. Nurse
manager/supervisor or head nurse)
Psychiatric ward is not done by nursing rounds
Peer review
Being evaluated by same rank or level
poor method
Performance appraisal
the patient evaluates you
best method in evaluation
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Professional
A calling in which its members profess to have acquired special values,
knowledge, training or by experience so that they may guide others in that
special field.
Nursing is a profession
Calling – service oriented
Others – patients
Characteristics by profession
A – accountability/liability for the result
C – caring profession Central Focus
C – competent
E – ethics
S – service oriented
S – specialized scientific body of knowledge and skills
A doctor’s order is valid when giving medication is when it is put into writing and signed
by the physician. Whatever is not put into writing is considered not ordered by the
physician.
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Hospital Based Venue
D – Duties are routinary and supervised
A – Acquired different learning and technical skills
C- Coordination with HCT
S – Specialized areas
o Nurse Generalist – community nurse
o Nurse specialist – staff nurse
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Duties :
o Curative/rehabilitative
C – care for sick/injured laborers
R – Referral
V – Visit and ff. ups (home visits)
o Promotive/Preventive
N – nutritional
S – safety and sanitation
C – Counseling
4. Clinical Instructor
o Qualifications :
A – accredited nursing Org
M – MAN in nursing or other health courses
O – One yr clinical experience
R – R.N.
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U – understood by pt
M – matured both physically and mentally
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only registered medical, dental and veterinary practitioners are authorized to
prescribe drugs
3 information
o name of the MD, address of his clinic/hosp and PTRC license #
o name of the pt, age, sex
o drug name, frequency, duration of the drug
RA 6675 Generic Act
o all prescribed drug must be written in generic and brand name or generic
name but never the brand name alone
o Purpose : for the pt to choose what brand name they want
Remember the 10 R’s of medication
Right patient name by checking the pt wrist tag
Verbal or telephone – only done during emergency
doubts or error – in case there is doubt in medication, refer to the physician
IV drugs – in proper training
Professional Negligence
Negligence
Failure to do something which a reasonable and prudent nurse should have done
something under a particular situation. (eg. failure to raise side rails when the pt
is unconscious)
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3 elements of negligence
o duty on part of the nurse
o failure to do said duty
o injury, harm, death – most important negligence
Malpractice
injury, harm or death is not important in malpractice
The nurse is allowed to perform episiorrhapy
with proper training but not episiotomy
The nurse is allowed to perform IE but with 2 conditions :
o fetal aberration/ abnormal delivery
o prior to complete delivery
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That person who is in authority is asking for a sexual favor in an exchange of
another favor.
Types of Rape
Ordinary rape
o a forcible penetration of an organ for copulation to another organ for
copulation. (eg. women are only the victim)
sexual assault
o anything that is forcible inserted to a body orifice with sexual malice.
o Also form of rape (eg. hand or an object is being inserted in the anal.
Committed in both female or male)
o Intervention :
S – safety (emotional or physical safety)
R – report (↓ 18 – report to brgy.)
R – referral (if father is the rapist, refer to DSWD)
Abortion
is the expulsion or termination of a product of conception before the stage of
viability. (3-6month/12-24weeks)
Infanticide
infant is less than 3days or 72hrs of life.
Parricide
killing another person to whom you have a relationship (mother, father, husband)
Homicide
unintentionally killing another person without any relationship (eg. negligence in
giving meds)
Murder
intentionally killing another person without any relationship
Simulation of birth
Committed by any person who shall substitute one child to another child to alter
his identities for the purpose of losing his civil status. (eg. the midwife failed to
report the birth of the baby, giving wrong information of the gender of the baby)
PD 651 (Birth registration act)
law any person who assist in giving birth to report within 30 days to the Local
Civil Registration Office
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o St. Paul Iloilo 1907)
o San Juan de Dios (1907)
1st college of nursing (4years) – UP
RA 7164 (1991)
RA 9173 (Oct 21, 2002)
o Board of Nursing
Old
o M – MAN
o A – Accredited Nursing Org (PNA)
o F – five MAN team (1 chairman, 4 members)
o S – 65 y/o – 1 year interim period
o N – Not convicted of any crime
o P – Pecuniary interest (Absence)
o T – 10 years nursing practice
o C- Citizen of R.P.
New
o M – MAN
o A – Accredited Nursing Org (PNA)
o S – 7 MAN team (1 chairman, 6members)
o I – immediately resigned upon appt.
o N – Not convicted of any crime
o P – Pecuniary interest (Absence)
o T – 10 years nursing practice but 5 yrs must be in the
Phils.
o C- Citizen & resident of R.P.
Who formulates the question of the Board Exam?
– Board of Nursing
Having a license is a Privilege not a Right
Board of Nursing issues the license
PRC issues the certificate of registration
CHED are the ones who has the power to open and close a
nursing school
BON just inspects 5 consecutive years of below 80% passing rate,
the school will be closed
Powers and Functions of BON
o L – Licensure exam
o I – Issue COR
o M – Monitor standards of nursing practice
o E – Education
o C – Code of ethics
o H – Hear and decides cases of negligence and malpractice
o A – Accredits different organizations
o G – Guides Nursing Practice in the Phils
o Dean
R.N.,MAN
5 years nursing experience
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o Clinical Instructor
A – allied in nursing or any allied health courses
M – member of PNA
O – 1 yr experience
R – R.N.
o Nursing Administrator
B – BSN RN
A – Accredited Org
N – 9 units
T – 2 yrs
Chief/Director
RN + MAN + Add only MAN +
5 yrs supervisor master’s in GSC
experience PHN or (Gen.
(N.B. if primary CHN Staffing
hosp) Course)
o Examinees
CGM (Good Moral Character)
Proofs of Valid Holder of Filipino Citizenship
Proofs of valid holder of a BSN Degree only from schools whose
curriculum is approved by the CHED
3 docs sub to PRC
RLE certificate
TOR with Scanned picture
List of cases
Examination fee is P900
Last day Is :
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o Early bonding for mother is Early Rooming in and early baby breast
technique for early bonding Early bonding for father is thru cuddling
E.O. 51 – Milk Code (Breast Milk)
o Avoid manufactured or formula milk
How to be an R.N. under 9173
o Have all qualifications
o take the exam
o acquire the required ratings
o In order to pass the examination, an examinee must obtain a general
average of at least 75 % with a rating of not below sixty percent (60%) in
any subject
o An examinee who obtains an average rating of 75% or higher but gets a
rating below 60% in any subject must take the examination again but
only in the subject or subjects where he/she has rated below 60 % (60%).
In order to pass the succeeding examination, an examinee must obtain a
rating of at least 75% in the subject or subjects repeated
RA 8981 –Modernization Act.
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