Definitions of a Theory -...

Joannes Paulus T. Hernandez,

B.S.H.B., B.S.N., R.N. 1

Nursing Theory, Practice, and Research

Joannes Paulus T. Hernandez, B.S.H.B., B.S.N., R.N.

(Ongoing M.A.N.-A.H.N.)

University of the Philippines Open University-ManilaEmilio Aguinaldo College-ManilaDe La Salle University-Dasmariñas


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Definitions of a Theory

Pinnel and Menesis (1986): Systematic set of

interrelated concepts, definitions and deductions

that describe, explain or predict

interrelationships

Walker and Avant (1983): Internally consistent

group of relational statements (concepts,

definitions and propositions) that presents a

systematic view about a phenomenon and which

is useful for description, explanation, prediction,

and control


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Chin and Krammer (1991): Creative and

vigorous structuring of ideas that project a

tentative, purposeful and systematic view of a

phenomena

Dickoff and James (1986): Conceptual system of

framework invented for some purpose

Ellis (1986): Coherent set of hypothetical,

conceptual, and pragmatic principles forming a

general frame of reference for a field of inquiry


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How is theory different from a philosophy?

A theory is a set of concepts, definitions and propositions that

project a systematic view of phenomena by designing specific inter-

relationships among concepts for purposes of describing, explaining

and predicting. (Chinn and Jacobs 1987)

A philosophy is an inquiry into the nature of things based on logical

reasoning rather than empirical methods.

Marriner-Tomey considers the ‘products’ of the following theorists as

philosophies – Nightingale, Widenbach, Henderson, Abdellah, Hall,

Watson and Benner.


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Florence Nightingale never actually formulated a

theory of nursing but was accredited by others

who categorized her personal journaling (“Notes

on Nursing”) and communications into a

theoretical framework.


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What is a model?

A model is an idea that explains by using symbolic and physical visualization

What is a concept?

A mental idea of a phenomenon

What is a construct?

A phenomena that cannot be observed and must be inferred

What is a proposition?

A statement of relationship between concepts

What is a conceptual model?

A conceptual model is made up of abstract and general ideas (concepts) and propositions that specify their relationships

What is a paradigm?

A paradigm is a conceptual diagram


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Nursing Models:

Psychiatric Nursing

1. Roy's model of nursing

2. Tidal model

Pediatric Nursing

1. Casey's Nursing Model

Adult Nursing

1. Nightingale's model of nursing

2. Roper, Logan and Tierney

3. Orem's Model of Nursing

Community and Rehabilitation Nursing

1. Orem's Model of Nursing


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Components or Elements of a Theory

1. Purpose: “Why is the theory formulated?” —specifies the context

2. Concepts: building blocks of theory but alone cannot create a theory; varies per experiences and perceptions of the theorist, the nursing metaparadigm—(1) Person, (2) Nursing, (3) Health, and (4) Environment; Key Conceptsgive the theory uniqueness e.g. Orem’s Self Care, Roy’s Adaptation Model, Leininger’sTranscultural Nursing and Levine’s Conservation Principle


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Concepts in the Nursing Metaparadigm

1. Person – Recipient of care, including physical, spiritual,

psychological, and sociocultural components

– Individual, family, or community

2. Nursing– Actions, characteristics and attributes of person giving care

3. Health– Degree of wellness or illness experienced by the person

4. Environment– All internal and external conditions, circumstances, and

influences affecting the person


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3. Definitions: give meaning to concepts—(1)

Descriptive/Conceptual refers to the accepted

meaning of the term already used; (2)

Operational/Stipulative refers to the specific

use or definition of the term within the theory

4. Propositions/Theoretical Assertions:

expressions of relational statements between

and among concepts/links concepts


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5. Assumptions: accepted “truths” that are basic

and fundamental to the theory—(1) Factual

Assumptions are those knowable or potentially

knowable by empirical experience supported

by research; (2) Value Assumptions asserts or

implies what is right, good or ought to be


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Characteristics of a Theory

1. Systematic, logical and coherent: no

contradictions between and among the

concepts

2. Creative structuring of ideas: concepts

are mental images resulting from one’s

experiences and perceptions

3. Tentative in nature: can change over

time



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Theory Development


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Theory Development

1. Theory-Practice-Theory: based on theories developed by other disciplines and used in nursing situations, e.g. Peplau’s Theory of Interpersonal Relations in Nursing based on Sullivan’s Interpersonal theory

2. Practice-Theory: based on clinical practice through actual observations or experiences, e.g. Orlando’s Nursing Process Theory

3. Research-Theory/Inductive Method: based on research findings, e.g. Johnson’s Behavioral Systems Model

4. Theory-Research-Theory: based on other disciplines but given a unique nursing perspective, e.g. conceptual or theoretical frameworks in nursing research studies


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Significant Events in the

Development of Nursing TheoryPrior to 1960

- Nightingale’s works and writings

- Formal education of nurses

- Publication of Nursing Research

60s and 70s

- Scientific era: nurses questioned purpose of nursing

- Publications dealing with philosophy of nursing,

conceptual models and frameworks

- Process of theory development discussed among

professional nurses

- Symposia held on theory development in nursing

- Borrowed theories from other disciplines


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Significant Events in the

Development of Nursing Theory80s

- Acceptance of the significance of theory in nursing

- Revision and further development of theories

- More substantive debate on issues related to theory

development

80s to present

- Publication of books and articles on analysis,

application, evaluation, and further development of

nursing theories

- Courses on theories offered at the graduate school

level


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Uses of Theory

Theory guides and improves nursing practice—helps to identify the focus, the goals, and the means of practice

Theory guides research—research validates and modifies theory; theory forms the basis for hypothesis testing

Theory contributes to the development of the discipline’s body of knowledge—theory in nursing describes, explains, predicts and controls phenomena or events in order to achieve desired outcomes

Theory enhances communication—provides common language for understanding a phenomenon; creates a better link between practitioners, educators, administrators and researchers


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Types of Theories

1. According to range

a. Grand Theories: broadest in scope, e.g. Henderson’s The Nature of Nursing, Levine’s The Four Conservation Principles of Nursing, Roy’s Adaptation Model, and Orem’s Self Care

b. Middle Range Theories: fill the gap between the grand theory and micro theory; testable, e.g. Peplau’sPsychodynamic Nursing and Orlando’s Nursing Process Theory

c. Micro Theories: narrowest in scope; deal with specific and narrowly defined phenomena, e.g. Synergy Model—pairing the needs of the patient and their family with the strengths of the nurse providing care


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Types of Theories

2. According to orientation or focus of the theory

a. Client-Centered: focuses on the needs and problems of clients which are met, resolved or alleviated by nursing interventions, e.g. Nightingale, Abdellah, Henderson, Orem, Pender, Roy, Levine, and Hall


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Types of Theories

b. Nurse-Client Dynamics: focuses on the interaction between the nurse and client, e.g. Peplau, Watson, King, and Orlando

c. Nurse-Client-Environment Dynamics: focuses on the interaction between the nurse and client in an environment, e.g. Neuman and Leininger



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Types of Theories


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Client-Centered Theories

Nightingale

Abdellah

Henderson

Orem

Pender

Roy

Levine

Hall


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Florence Nightingale—

Environmental Theory

First nursing theorist– Unsanitary conditions

posed health hazard (Notes on Nursing, 1859)

5 components of environment– ventilation, light, warmth,

effluvia, noise

External influences can prevent, suppress or contribute to disease or death


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Environmental Model: Florence Nightingale

Theory Overview

Florence Nightingale is recognized as founder of modern-day nursing.

Her environmental model is based on the idea that the impetus for healing lies within the individual human being and the focus of care is to place the individual in an environment that is supportive to that healing process.

Her 13 canons speak to areas that require the attention of the nurse, such as cleanliness, ventilation, warming, light, noise, variety, nutrition, “chattering hopes and advices,” and observation of the sick.


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Nightingale’s Concepts

Theory Overview

Person

– Patient who is acted on by nurse

– Affected by environment

– Has reparative powers

Nursing

– Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process

– Practice of nursing was based on the belief that germs cause disease

Health

– Maintaining well-being by using a person’s powers

– Maintained by control of environment

Environment

– Foundation of theory. Included everything: physical, psychological, and social


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*****

Religious inspiration

called her to focus on

the health of the

masses


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Florence Nightingale

Began her nursing training in 1851 in

Germany

Pioneered the concept of formal nursing

education

Her experience in treating sick/injured

soldiers in the Crimean War strongly

influenced her philosophy of nursing

First to use statistics to guide care delivery


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“All sciences of observation depend upon statistical

methods—without these, are blind empiricism. Make

your facts comparable before deducing causes.

Incomplete, pell-mell observations arranged so as to

support theory; insufficient number of observations; this

is what one sees.”

Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 230.


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Based her ideas on individual, societal, and professional values

Her strongest influence was education, observation, and hands-on experience

She formulated her values through years of working with charities, hospitals, and the military


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In 1860 Nightingale published Notes on Nursing

Considered the first “nursing theorist”

Information on her theory has been obtained through interpretation of her writings

Her theory significantly influenced 3 other groups of theories - Adaptation Theory, Need Theory, & Stress Theory


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Nightingale’s Notes on Nursing:

Was not written as a nursing text

Was a guide to help organize and manipulate the

environment for persons requiring nursing care

Nightingale originally wanted women to teach

themselves to nurse and viewed Notes on

Nursing as “hints” to enable them to do so


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Nightingale on Notes on Nursing…

“I thank you sincerely & kindly for what you have to say

about my Notes on Nursing—you do not know how, in the

midst of much disappointment, such words cheer &

strengthen us. The only possible merit of my little book is

that there is not a word in it written for the sake of writing,

but only forced out of me by much experience in human

suffering.”

Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 231.

Nightingale’s Nursing Theory

The first published nursing theory (1860)

Persons are in relation with the environment

Stresses the healing properties of the physical

environment (fresh air, light, warmth, and

cleanliness)

Nursing puts patients in the “best conditions” for

nature to act upon them

Health is “the positive of which the pathology is the

negative”

“Nature alone cures”


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When aspects of the environment are out of

balance, the client must use energy to counter

these environmental stresses

Stresses drain the client of the energy needed for

healing

Viewed disease as a reparative process

The health of the home/community are critical

components in an individual’s health


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Theory basis: the inter-relationship of a

healthful environment with nursing

– External influences and conditions can

prevent, suppress, or contribute to disease or

death

Theory goal: Nurses help patients retain their

own vitality by meeting their basic needs

through control of the environment

Nursing’s Focus: control of the environment for

individuals, families and the community


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Three Types of Environments

1. Physical

2. Psychological

3. Social


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Physical Environment

Consists of physical elements where the

patient is being treated

Affects all other aspects of the environment

Cleanliness of environment relates directly

to disease prevention and patient mortality

Aspects of the physical environment

influence the social and psychological

environments of the person


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Psychological Environment

Can be affected by a negative physical

environment which then causes STRESS

Requires various activities to keep the mind

active (i.e, manual work, appealing food, a

pleasing environment)

Involves communication with the person, about

the person, and about other people

– communication should be therapeutic,

soothing, and unhurried


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Social Environment

Involves collecting data about illness and

disease prevention

Includes components of the physical

environment - clean air, clean water, proper

drainage

Consists of a person’s home or hospital room, as

well as the total community that affects the

patient’s specific environment


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5 Major Components of a Healthful Environment

1. Proper ventilation

2. Adequate light

3. Sufficient warmth

4. Control of noise

5. Control of effluvia (noxious odors)


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Nightingale’s Philosophy in Nursing Practice

13 Canons

Nightingale identified 13 canons to form the boundaries of nursing

practice and expected nurses to be ‘clear thinkers’ and

‘independent’ in their judgments.

1. Ventilation and warmth: The circulating air should be as pure as the outside air and at an adequate temperature to keep the patient warmed.

2. Light: Direct light contains healing properties for the patient and purifies the air of the room.

3. Cleanliness of rooms and walls: Rooms should be kept clean and free

of dust/debris associated with the ventilation necessary for health.

4. Health of houses: Maintaining a healing environment goes beyond just cleanliness, this also includes the air, water, sanitation and light.


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5. Noise: Any loud noise that jars a patient awake and subjects them to a state of excitement is more harmful than continuous noises, however loud.

6. Bed and bedding: The sick should be provided with clean bedding every 12 hours, beds should be narrow and safe in height, positioned in lightest area of the room or near windows, and have adequate pillow support to the head and back to promote breathing.

7. Personal cleanliness: Allowing patients to be soiled and unclean hinders the natural process of health and contributes to the condition in which disease flourishes.

8. Variety: Monotony and redundancy of surroundings are harmful to patients mental state of being, variety in surroundings are mostbeneficial to health.

9. Chattering hopes and advices: Visitors, families and caregivers should not attempt to cheer patients by giving false hopes.


13 Canons


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10. Taking food: The amount of food taken and the amount of food needed should always be considered.

11. What food: Analyze the patient’s tolerance and system reactions to foods not the types of food.

12. Petty Management: Knowing what to do when you are there, and what shall be done when you are not there (providing continuity of care through your documentation).

13. Observation of the sick: Observing the patient for indications of condition change, and to know how to judge the importance of such changes.

While Nightingale’s canons do not specifically address spirituality, she viewed

the patient in a holistic manner having a spiritual dimension as well.

(Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis,

Missouri: Mosby. pp. 86-87.)

13 Canons



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Nightingale’s Theory & Nursing’s

Metaparadigm - PERSON

Referred to by Nightingale as “the patient”

A human being acted upon by a nurse, or

affected by the environment

Has reparative powers to deal with disease

Recovery is in the patient’s power as long as a

safe environment exists


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Metaparadigm - NURSING

“I use the word nursing for want of a better word. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.” Florence Nightingale ("Florence Nightingale", n.d.)

Provides fresh air, light, warmth, cleanliness, quiet, and a proper diet

Facilitates a patient’s reparative process by ensuring the best possible environment

Influences the environment to affect health

Supports the nursing process even before its development

Florence Nightingale. (n.d.). Retrieved February 04, 2006, from

http://en.wikiquote.org/wiki/Florence_Nightingale


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Metaparadigm - NURSINGShe believed that: (1) nursing was a spiritual calling requiring ethics and a societal commitment to help those suffering, and (2) nurses should be formally educated to provide quality care (in contrast to the ‘lay-person nurse’ of that time era).

She also defined three different types of nursing:

1. Nursing proper- nursing the sick

2. General nursing- health promotion

3. Midwifery nursing

Nightingale viewed nursing as the ‘science of environmental management’ (with nurses altering the patient’s environment to promote health and healing). (Alligood, pp. 84-85)

Nursing education belongs in the hands of nurses

Nursing is a discipline distinct from medicine focusing on the patient’s reparative process rather than on their disease

Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis, Missouri:

Mosby.


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Metaparadigm - HEALTH

“Health is not only to be well, but to be able to use well every power we

have.” Florence Nightingale ("Florence Nightingale", n.d.)

Maintained by using a person’s healing powers to their fullest extent

Maintained by controlling the environmental factors so as to prevent disease

Disease is viewed as a reparative process instituted by nature

Health & disease are the focus of the nurse

Nurses help patients through their healing process

Florence Nightingale. (n.d.). Retrieved February 04, 2006, from http://en.wikiquote.org/wiki/Florence_Nightingale


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Metaparadigm - ENVIRONMENT

The foundational component of Nightingale’s

theory

The external conditions and forces that affect

one’s life and development

Includes everything from a person’s food to a

nurse’s verbal and non-verbal interactions with

the patient


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Theory Strengths

Although Nightingale developed her theory more than a century ago, her

concept of nursing is still relevant and consistent with our current nursing

process in the 21st century, standing the test of time.

Nightingale’s concept of the physical and psychological environment serves

as the foundation for providing holistic nursing care, while manipulation of

the environment (guided by the canons) works to remove obstacles thereby

creating an opportunity for healing.

Nightingale advocated nursing specialties (public health nursing, and

midwifery), showing consideration for unique patient needs.

Values: ethically based

Vision: personalized and holistic care

Voice: patient advocacy


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Theory Weaknesses

While Nightingale believed in health promotion, patient education

is not specifically addressed.

“Nightingale assumed that the patient would want to be healthy and

therefore would cooperate and assist the nurse to allow nature to help the

patient” (Alligood, p. 85). Yet there is no mention of patient

compliance/care issues. Nor does Nightingale mention enlisting patient

input when planning their care (aside from food preferences). The focus is

on the nurse doing for the patient, rather than fostering patient interaction

and promoting patient responsibility in caring for themselves to their best

ability.

Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis, Missouri:

Mosby.

Although Nightingale considered nursing a spiritual calling, and

envisioned the patient as having a spiritual component, she did not

address this dimension specifically.


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“…it does no good to pray to God to save us from disease as we

continue to drain our sewage into the lakes from which one drinks.”

"Diseases are not individuals arranged in classes like cats and dogs,

but conditions growing out of one another. The specific disease is the

grand refuge of the weak, uncultured, unstable minds, such as now rule

in the medical profession. There are no specific diseases; there are

specific disease conditions.” Florence Nightingale ("Florence

Nightingale", n.d.)

Florence Nightingale. (n.d.). Retrieved February 04, 2006, from http://en.wikiquote.org/wiki/Florence_Nightingale


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Faye Abdellah—Typology of 21 Nursing

Problems

A list of 21 nursing problems

– Condition presented or

faced by the patient or

family.

Problems are in 3 categories

– physical, social and

emotional

The nurse must be a good

problem solver


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Abdellah’s Typology of 21 Nursing Problems

Abdellah’s typology was divided into three areas: (1) the physical, sociological, and emotional needs of the patient; (2) the types of interpersonal relationships between the nurse and the patient; and (3) the common elements of patient care. The typology would provide a method to evaluate a student’s experiences and nurse’s competency based on outcome measures. (Tomey & Alligood, Nursing theorists and their work 4th ed., p. 115).


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Abdellah’s Typology of 21 Nursing Problems:

1. To promote good hygiene and physical comfort

2. To promote optimal activity, exercise, rest, and sleep

3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection

4. To maintain good body mechanics and prevent and correct deformities

5. To facilitate the maintenance of a supply of oxygen to all body cells

6. To facilitate the maintenance of nutrition of all body cells

7. To facilitate the maintenance of elimination

8. To facilitate the maintenance of fluid and electrolyte balance

9. To recognize the physiologic responses of the body to disease conditions

10. To facilitate the maintenance of regulatory mechanisms and functions


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Abdellah’s Typology of 21 Nursing Problems:

11. To facilitate the maintenance of sensory function

12. To identify and accept positive and negative expressions, feelings, and reactions

13. To identify and accept the interrelatedness of emotions and organic illness

14. To facilitate the maintenance of effective verbal and nonverbal communication

15. To promote the development of productive interpersonal relationships

16. To facilitate progress toward achievement of personal spiritual goals

17. To create and maintain a therapeutic environment

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs

19. To accept the optimum possible goals in light of physical and emotional limitations

20. To use community resources as an aid in resolving problems arising from illness

21. To understand the role of social problems as influencing factors in the cause of illness


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Patient-Centered Approaches: Faye Glenn Abdellah

Theory Overview

Faye Glenn Abdellah conducted research to identify ways to promote patient-centered comprehensive nursing care.

Nursing focused rather than patient focused.

21 basic nursing problems evolved through research focused on aneffort to move the focus of care from the disease to the patient.

The problems may be overt or covert, and problem solving is to used by the nurse.

The nursing process as a problem-solving process is compatible

with this approach.

Solving covert problems may resolve overt problems.

PLANNING is done primarily by the NURSE.


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Abdellah’s Concepts

Theory Overview

Person

– One who has physical, emotional, or social needs

– The recipient of nursing care.

Nursing

– A helping profession

– A comprehensive service to meet patient’s needs

– Increases or restores self-help ability

– Uses 21 problems to guide nursing care

Health

– Excludes illness

– No unmet needs and no actual or anticipated impairments

Environment

– Did not discuss much

– Includes room, home, and community


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Henderson’s Theory—Definition of Nursing

“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs.”

“She is temporarily the consciousness of

the unconscious, the love of life for the

suicidal, the leg of the amputee, the eyes

of the newly blind, a means of locomotion

for the infant, knowledge and confidence

for the young mother, the mouthpiece for

those too weak or withdrawn to speak,

and so on.”


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Definition and Components of Nursing: Virginia Henderson

Theory Overview

Virginia Henderson presented her definition of nursing as part of her effort to regulate nursing practice through licensure to protect nursing practice and the public.

14 components of basic nursing care augment the definition to provide an overall guide to the practice of nursing.

The source of difficulty resides with the client and not with the nurse.

Consequences of nursing actions include increased independence in the satisfaction of the client’s 14 fundamental or basic needs or peaceful death.

First nurse to speak to the importance of a peaceful death.

In NURSING DIAGNOSIS the focus will be on what the patient lacks the strength, will, or knowledge to accomplish.

The use of critical thinking in nursing practice is supported by the quote:“The nurse who operates under a definition that specifies an area of independent practice…must assume responsibility for identifying problems…”

No nursing model was developed.


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Henderson’s Concepts

Theory OverviewPerson

– An individual person or client is a whole, complete and independent being with biological, sociological, and spiritual components which are operationalized in the 14 fundamental or basic human needs

– The person must maintain physiological and emotional balance: the mind and body are inseparable

– The patient is an individual who requires assistance to achieve health and independence or peaceful death

– The patient and his family are viewed as a unit

Nursing

– Nursing is assisting the individual

– Nurses’ function is to alter the environment in such a way as to support the patient


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Henderson’s Concepts

Theory Overview

Health

– Health is equated with independence

– Individuals will achieve or maintain health if they have the necessary strength, will or knowledge.

– Health is viewed in terms of the patient’s ability to independently perform the 14 basic needs

Environment

– “The aggregate of all external conditions and influences affecting the life and development of an organism…”

– Can act either positively or negatively upon the patient

– Required of 7 essentials


B.S.H.B., B.S.N., R.N. 64

7 Essentials in the Environment

1. Light

2. Temperature

3. Air movement

4. Atmospheric pressure

5. Appropriate disposal of waste

6. Minimal quantities of injurious chemicals

7. Cleanliness of surfaces and furnishings coming in contact with the individual


B.S.H.B., B.S.N., R.N. 65

14 Basic Human Needs

1. Breathe normally

2. Eat and drink adequately

3. Eliminate body wastes

4. Move and maintain desirable position

5. Sleep and rest

6. Select suitable clothes—dress and undress

7. Maintain body temperature within normal range by adjusting clothing and modifying the environment

8. Keep the body clean and well-groomed and protect the integument

9. Avoid dangers in the environment and avoid injuring others;

10. Communicate with others expressing emotions, needs, fears, or opinions

11. Worship according to one’s faith

12. Work in such a way that there is a sense of accomplishment

13. Play or participate in various forms of recreation

14. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use available health facilities


B.S.H.B., B.S.N., R.N. 66

Dorothea Orem—

Self-Care Model

Self-care comprises those

activities performed independently

by an individual to promote and

maintain person well-being

Self care agency is the individual’s

ability to perform self care activities

Self-care deficit occurs when the

person cannot carry out self-care

The nurse then meets the self-care

needs by acting or doing for:

guiding, teaching, supporting or

providing the environment to

promote patient’s ability


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67


B.S.H.B., B.S.N., R.N. 68

Self Care Deficit Nursing Theory: Dorothea E. Orem

Theory Overview

Dorothea E. Orem’s general theory of nursing is made up of the three interrelated theories of self-care, self-care deficit, and nursing systems.

A peripheral concept, basic conditioning factors, applies to all of the theories.

The major concepts of self-care are self-care, self-care agency, self-care requisites (universal, developmental, and health deviation), and therapeutic self-care demand. The basic premise of the model is that individuals can take responsibility for their health and the health of others. In a general sense, individuals have the capacity to care for themselves or their dependents.

A self-care deficit exists when the therapeutic self-care demand exceeds self-care agency.

Nursing systems involve nursing agency and the design of nursing systems for care (wholly compensatory, partly compensatory, and supportive-educative).

Orem’s nursing process is a three-step process (diagnosis and prescription, nursing system design, production and management of nursing systems).

Desired outcomes, using Orem’s theory, would reflect adequate self-care agency.


B.S.H.B., B.S.N., R.N. 69

Orem’s Basic Conditioning Factors

1. Familial

2. Personal

3. Social


B.S.H.B., B.S.N., R.N. 70

Orem’s Concepts

Theory OverviewPerson

– Man as an integrated whole—a unity functioning biologically, symbolically and socially, logical and reflective of his or her experiences, self-reliant, responsible for self-care and well-being of his or her dependents

– Patient as an individual who is in need of assistance in meeting specific health-care demands because of lack of knowledge, skills, motivation, or orientation

Nursing

– As a (1) Community service—as an interpersonal process since it requires the social interaction of a nurse with a patient and involves transaction between them, an (2) Art—as the ability to assist others in the design, provision, and management of systems of self-care to improve or maintain human functioning at some level of effectiveness, and a (3) Technology—techniques of nursing must be learned, and skill and expertness in their use must be developed by person who pursue nursing as a career


B.S.H.B., B.S.N., R.N. 71

Orem’s Concepts

Theory Overview

Health

– As a state of wholeness or integrity of the individual human being, his parts, and his modes of functioning

– A healthy person is likely to have sufficient self-care abilities to meet his/her universal self-care needs

Environment

– Elements external to man

– Man and environment as an integrated system related to self-care


B.S.H.B., B.S.N., R.N. 72

Assumptions involving the concept of self-care:

1. Self-care is a requirement of every person.

2. Universal self-care involves meeting basic human needs.

3. Health-deviation self-care is related to disease or injury.

4. Each adult has both the right and the responsibility to care forhim/herself in order to maintain rational life and health; he/she may also have responsibilities for dependents.

5. Self-care is learned behavior processed by the ego and influenced by both self-concept and level of maturity.

6. Self-care is deliberative action.

7. Awareness of relevant factors and their meaning is a prerequisite condition for self-care action.


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B.S.H.B., B.S.N., R.N. 73

Assumptions underlying the general

theory of nursing:

1. Human beings require continuous deliberate inputs to themselves and their environment to remain alive and function in accordancewith natural human endowments.

2. Human agency, the power to act deliberately, is exercised in theform of care of self and others—identifying needs and making needed inputs.

3. Mature human beings experience privations in the form of limitations for action in care of self and others involving the making of life-sustaining and function-regulating inputs.

4. Human agency is exercised in discovering, developing, and transmitting to others, the ability to identify needs and make inputs to self and others.

5. Groups of human beings with structured relationships tend to cluster tasks and allocate responsibilities for providing care to group members who experience privation. The group can require deliberate input to self and others.


B.S.H.B., B.S.N., R.N. 74

Key Concepts

Agent: person taking action

Self-care agent: provider of self-care

Dependent self-care agent: provider of infant care or dependent adult care

Self-Care: the practice of activities that individuals personally initiate and perform on their own behalf in maintaining life, health, and well-being divided into three categories: (1) Demands; (2) Capabilities; and (3) Deficits.

Self-Care Requisites: expressions of purposes to be attained, and results desired from deliberate engagement in self-care divided into three categories: (1) Universal self-care requisites; (2) Developmental self-care requisites; and (3) Health-deviation self-care requisites.


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Key Concepts

Universal self-care requisites:

1. Sufficient intake of air.

2. Sufficient intake of water.

3. Sufficient intake of food.

4. Provision of care associated with elimination

processes.

5. Balance between activity & rest.

6. Balance between solitude & social interaction.

7. Prevention of hazards.

8. Promotion of human functioning & development within

social groups in accord with human potential,

limitations, and human desire to be normal.


B.S.H.B., B.S.N., R.N. 76

Key Concepts

Developmental self-care requisites ─ either specialized expressions of universal self-care requisites that have been particularized for developmental processes, or they are new requisites derived from:

1. conditions that support life processes and promote

specific developmental stages.

2. conditions affecting human development either

concerns the provision of care to prevent occurrence

of adverse conditions or concerns the provision of

care to prevent occurrence of or to overcome effects

of losses.


B.S.H.B., B.S.N., R.N. 77

Key Concepts

Health deviation self-care requisites ─ an individual with an illness, disease or injury is likely to have additional demands for self-care divided into six categories:

1. Seeking and securing appropriate medical assistance when

exposed to specific physical, biological agents, or environmental

conditions associated with human pathological states or when

there is evidence of genetic, physiological or psychological

conditions known to produce human pathology.

2. Being aware and attending to the effects and results of

pathological conditions and states including effects on

development.

3. Effectively carrying out medically prescribed diagnostic, therapeutic and

rehabilitative measures directed towards preventing specific types of

pathology, regulation of human integrated functioning, correction of

deformities, or compensating for disabilities.


B.S.H.B., B.S.N., R.N. 78

Key Concepts

4. Being aware of, attending to, or regulating the discomforts or deleterious effects of medical care measures performed or prescribed by physicians, including their effects on development.

5. Modifying self-concept to be able to accept one’s state of health or the need for specific forms of health care.

6. Learning to live with the effects of pathological conditions and states and the effects of medical diagnosis and treatment measures, in a lifestyle that promotes continued personal development.


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B.S.H.B., B.S.N., R.N. 79

Key Concepts

Therapeutic self-care demand ─ the sum

total of actions needed to perform in order

to meet known self-care requisites

Self-care agency ─ the ability of a person

to initiate and perform activities of self-

care



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83


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Nursing Systems Model

Wholly compensatory nursing system

– Patient dependent

Partially compensatory

– Patient can meet some needs but needs

nursing assistance

Supportive educative

– Patient can meet self care requisites, but

needs assistance with decision making or

knowledge


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85


B.S.H.B., B.S.N., R.N. 86

Sister Calista Roy—Adaptation Model

Five Interrelated Essential Elements

1. Patient: The person receiving care

2. Goal of nursing: Adapting to

change

3. Health-Being and becoming a

whole person

4. Environment

5. Direction of nursing activities-

Facilitating adaptation

The person is an open adaptive system

with input (stimuli), who adapts by

processes or control mechanisms

(throughput)

The output can be either adaptive

responses or ineffective responses


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Nola J. Pender—Health Promotion Model

Influenced by: (1) Bandura’s Social Learning

Theory, which emphasized the importance of

cognitive processes in behavior change and (2)

Fishbein’s Theory of Reasoned Action, which is

focused on behavior as a function of personal

attitudes and social norms.

Two main domains: (1) Cognitive-perceptual factors;

and (2) Modifying factors

Health Promotion is directed towards increasing the

(1) level of well-being and (2) self-actualization of a

given individual or group.

Health-promoting behaviors increase self-awareness,

self-satisfaction, enjoyment and pleasure.

Health-promoting behaviors are continuing self-care

activities that must be an integral part of an

individual’s lifestyle, e.g. physical exercise, proper

nutrition, and stress management.

Disease Prevention or Health Protection refers to

activities directed towards decreasing the probability

of experiencing illness by active protection of the

body against pathological stressors, e.g. detection of

illness in the asymptomatic stage.


B.S.H.B., B.S.N., R.N. 88

Assumptions

1. Persons seek to create conditions of living through which they can express their unique human health potential.

2. Persons have the capacity for reflective self-awareness, including assessment of their own competencies.

3. Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability.

4. Individuals seek to actively regulate their own behavior.

5. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time.

6. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan.

7. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.


B.S.H.B., B.S.N., R.N. 89

Propositions

1. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior.

2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits.

3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior.

4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior.

5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.

6. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect.

7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.


B.S.H.B., B.S.N., R.N. 90

Propositions

8. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior.

9. Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior.

10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.

11. The greater the commitment to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time.

12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention.

13. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior.

14. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

Source: Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2002).

Health Promotion in Nursing Practice (4th Edition). Upper Saddle River, NJ: PrenticeHall.


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93

•Provide training, guidance, and positive reinforcement.Confidence in one's ability to take action6. Self-Efficacy

•Provide how-to information.•Promote awareness.•Provide reminders.

Strategies to activate "readiness"5. Cues to Action

•Identify and reduce barriers through reassurance, incentives, and assistance.

One's belief in the tangible and psychological costs of the advised behavior

4. Perceived Barriers

•Define action to take — how, where, and when.•Clarify the positive effects to expected.•Describe evidence of effectiveness.

One's belief in the efficacy of the advised action to reduce risk or seriousness of impact

3. Perceived Benefits

•Specify and describe consequences of the risk and the condition.One's belief of how serious a condition and its consequences are

2. Perceived Severity

•Define population(s) at risk and their risk levels.•Personalize risk based on a person's traits or behaviors.•Heighten perceived susceptibility if too low.

One's belief of the chances of getting a condition

1. Perceived Susceptibility

ApplicationDefinitionConcept



94


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Nurse-Client Dynamics

Peplau

Watson

King

Orlando

Parse



96


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97


B.S.H.B., B.S.N., R.N. 98

Hildegard Peplau—Interpersonal Relations Model

Based on

psychodynamic nursing

– using an understanding of

one’s own behavior to

help others identify their

difficulties

Applies principles of

human relations

Patient has a felt need


B.S.H.B., B.S.N., R.N. 99

Peplau’s Concepts

Person

– An individual; a developing organism who tries to reduce anxiety caused by needs

– Lives in unstable equilibrium

Nursing

– A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible

– Involves problem-solving

Health

– Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living

Environment - Not defined


B.S.H.B., B.S.N., R.N. 100

Jean Watson—

Philosophy and Science of Caring

Caring can be demonstrated and

practiced

Caring consists of 10 Carative

Factors

Caring promotes growth

A caring environment accepts a

person as he is and looks to what

the person may become

A caring environment offers

development of potential

Caring promotes health better than

curing

Caring is central to nursing


B.S.H.B., B.S.N., R.N. 101

Watson’s 10 Carative Factors

1. Forming humanistic-altruistic value system

2. Instilling faith-hope

3. Cultivating sensitivity to self and others

4. Developing helping-trust relationship

5. Promoting expression of feelings

6. Using problem-solving for decision making

7. Promoting teaching-learning

8. Promoting supportive environment

9. Assisting with gratification of human needs

10. Allowing for existential-phenomenological forces


B.S.H.B., B.S.N., R.N. 102

Watson’s Concepts

Person– Human being to be valued, cared for, respected, nurtured, understood and assisted

Environment– Society

Health– Complete physical, mental and social well-being and functioning

Nursing– Concerned with promoting and restoring health, preventing illness


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B.S.H.B., B.S.N., R.N. 104

Imogene King—

Goal Attainment Theory

The nurse and patient mutually communicate,

establish goals and take action to attain goals

Each individual brings a different set of

values, ideas, attitudes, perceptions to

exchange

Open systems framework

– Human beings are open systems in

constant interaction with the environment

Personal System

– individual; perception, self,

growth, development, time

space, body image

Interpersonal

Society


B.S.H.B., B.S.N., R.N. 105

Imogene King—

Goal Attainment Theory

Personal System

– Individual; perception, self, growth, development,

time space, body image

Interpersonal

– Socialization; interaction, communication and

transaction

Society

– Family, religious groups, schools, work, peers



106


B.S.H.B., B.S.N., R.N. 107

Ida Jean Orlando—

Deliberative Nursing Process

The deliberative nursing process is set

in motion by the patient’s behavior

– All behavior may represent a cry for

help. Patient’s behavior can be

verbal or non-verbal.

The nurse reacts to patient’s behavior

and forms basis for determining nurse’s

acts.

– Perception, thought, feeling

Nurses’ actions should be deliberative,

rather than automatic

– Deliberative actions explore the

meaning and relevance of an

action.



108


B.S.H.B., B.S.N., R.N. 19


B.S.H.B., B.S.N., R.N. 109

Rosemary Parse—

Human Becoming Theory


includes Totality Paradigm

– Man is a combination of

biological, psychological,

sociological and spiritual

factors

Simultaneity Paradigm

– Man is a unitary being in

continuous, mutual

interaction with environment

Originally Man-Living-Health

Theory


B.S.H.B., B.S.N., R.N. 110

Parse’s Three Principles

1. Meaning

– Man’s reality is given meaning through lived experiences

– Man and environment co-create

2. Rhythmicity

– Man and environment co-create ( imaging, valuing, languaging) in rhythmical patterns

3. Co-transcendence

– Refers to reaching out and beyond the limits that a person sets

– One constantly transforms


B.S.H.B., B.S.N., R.N. 111

Rosemary Parse—


Person– Open being who is more than and different from the sum of

the parts

Environment– Everything in the person and his experiences

– Inseparable, complimentary to and evolving with

Health– Open process of being and becoming. Involves synthesis of

values

Nursing– A human science and art that uses an abstract body of

knowledge to serve people



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113



114


B.S.H.B., B.S.N., R.N. 20


B.S.H.B., B.S.N., R.N. 115

Nurse-Client-Environment

Dynamics

Neuman

Leininger

Johnson

Roger


B.S.H.B., B.S.N., R.N. 116

Betty Neuman—Systems Model

The person is a complete system,

with interrelated parts

– maintains balance and harmony

between internal and external

environment by adjusting to

stress and defending against

tension-producing stimuli

Focuses on stress and stress

reduction

Primarily concerned with effects of

stress on health

Stressors are any forces that alter

the system’s stability


B.S.H.B., B.S.N., R.N. 117

Betty Neuman—Systems Model

Flexible lines of resistanceSurround basic core

Internal factors that help defend against stressors

Normal line of resistanceNormal adaptation state

Flexible line of defenseProtective barrier, changing, affected by variables

Wellness is equilibrium

Nursing interventions are activites to: strengthen flexible lines of defense

strengthen resistence to stressors

maintain adaptation



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119


B.S.H.B., B.S.N., R.N. 120

Madeleine Leininger—

Culture Care Diversity and Universality

Based on transculturalnursing, whose goal is to provide care congruent with cultural values, beliefs, and practices

Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care


B.S.H.B., B.S.N., R.N. 21


B.S.H.B., B.S.N., R.N. 121

Madeleine Leininger—

Culture Care Diversity and Universality

Modes of nursing action

– Cultural care preservationhelp maintain or preserve health, recover from illness, or

face death

– Cultural care accommodation

help adapt to or negotiate for a beneficial health status,

or face death

– Cultural care re-patterning

help restructure or change lifestyles that are culturally

meaningful



122


B.S.H.B., B.S.N., R.N. 123

Dorothy Johnson—

Behavioral Systems Model

The person is a behavioral system

comprised of a set of organized,

interactive, interdependent, and

integrated subsystems

– Constancy is maintained

through biological,

psychological, and sociological

factors.

A steady state is maintained

through adjusting and adapting to

internal and external forces.


B.S.H.B., B.S.N., R.N. 124

Johnson’s 7 Subsystems

1. Affiliative subsystem: social bonds

2. Dependency: helping or nurturing

3. Ingestive: food intake

4. Eliminative: excretion

5. Sexual: procreation and gratification

6. Aggressive: self-protection and preservation

7. Achievement: efforts to gain mastery and

control


B.S.H.B., B.S.N., R.N. 125

Johnson’s Concepts

Person– A behavioral system comprised of subsystems constantly trying to maintain a steady state

Nursing– External regulatory force that is indicated only when there is instability

Health– Balance and stability

Environment– Not specifically defined but does say there is an internal and external environment


B.S.H.B., B.S.N., R.N. 126

Martha Rogers—

Science of Unitary Human Beings

Energy fields

– Fundamental unity of things

that are unique, dynamic,

open, and infinite

– Unitary man and

environmental field

Universe of open systems

– Energy fields are open, infinite,

and interactive


B.S.H.B., B.S.N., R.N. 22


B.S.H.B., B.S.N., R.N. 127

Roger’s Definitions

Pattern

– Characteristic of energy field

– A wave that changes, becomes complex and diverse

Four dimensionality

– A non-linear domain with out time or space

Integrality

– Continuous and mutual interaction between man and environment

Resonancy

– Continuous change longer to shorter wave patterns in human and environmental fields

Helicy

– Continuous, probabilistic, increasing diversity of the human andenvironmental fields.

– Characterized by non-repeating rhythmicities

– Change


B.S.H.B., B.S.N., R.N. 128

Patricia Benner –

From Novice to Expert

Described 5 levels of nursing

experience and developed

exemplars and paradigm cases to

illustrate each level

Levels reflect:

– movement from reliance on

past abstract principles to the

use of past concrete

experience as paradigms

– change in perception of

situation as a complete whole

in which certain parts are

relevant


B.S.H.B., B.S.N., R.N. 129

Patricia Benner –

From Novice to Expert

Novice

Advanced beginner

Competent

Proficient

Expert


B.S.H.B., B.S.N., R.N. 130

Nursing Research


B.S.H.B., B.S.N., R.N. 131

Nursing research

Includes study of:

1. Aspects

2. Components

3. Activities

4. Phenomena relating to health and of interest to nurses

To:

1. Describe

2. Explain

3. Predict

4. Control


B.S.H.B., B.S.N., R.N. 132

Purposes of Research to Nursing

Nursing is a profession

Major means to generate knowledge

To evaluate and document nurses

contributions to client’s health, well-being,

and health care delivery system

Duties of a nurse: RA 9173 Section 28e


B.S.H.B., B.S.N., R.N. 23


B.S.H.B., B.S.N., R.N. 133

ICN Definition (Position Statement on

Nursing Research, 1999)

“Nursing research is needed to generate new knowledge, evaluateexisting practice and services, and provide evidence that will inform nursing education, practice, research and management.”

“Research is directed toward understanding the fundamental mechanisms that affect the ability of individuals, families and communities to maintain or enhance optimum function and minimize the negative effects of illness. Nursing research should also be directed toward the outcomes of nursing interventions, so as to assure the quality and cost-effectiveness of nursing care.”

“Nursing research also encourages knowledge of policies and systems that effectively and efficiently deliver nursing care; awareness of the profession and its historical development; understanding of ethical guidelines for the delivery of the nursing services; and knowledge of systems that effectively prepare nurses to fulfill the profession’s current and future social mandate.”


B.S.H.B., B.S.N., R.N. 134

Quantitative vs. Qualitative

Objective

One reality

Reduction, control, prediction

Mechanistic

Parts equal the whole

Report statistical analysis

Researcher separate

Subjects

Context free

Subjective

Multiple realities

Discovery, description, understanding

Imperative

Organismic

Whole is greater than the parts

Report is rich in narrative

Researcher part of the research process

Participants

Context dependent


B.S.H.B., B.S.N., R.N. 135

Steps in the Research Process

1. Identify the problem

2. Conduct literature review

3. Identify theoretical/conceptual framework

4. Formulate hypothesis

5. Operationalize variables

6. Select research design

7. Ascertain and select sample

8. Conduct a pilot study

9. Collect data

10. Analyze data

11. Interpret results

12. Disseminate information


B.S.H.B., B.S.N., R.N. 136

Research Problem

A situation in need of a description or quantification, solution, improvement or alteration

Criteria: (1) Significance of the problem; (2) Researchability of the problem; (3) Feasibility; (4) Interest to the researcher

The focus of nursing research during the 1980s is clinical problems

→→→→ Both quantitative and qualitative research involve identifying a research problem/ question, collecting and analyzing data. Quantitative studies are reported using descriptive and analytic statistics while qualitative studies are reported in narrative format.


B.S.H.B., B.S.N., R.N. 137

Contents of a Research Proposal

1. The problem (background of the study, objectives of the study, statement of the problem, significance of the study, scope and limitation of the study, and definition of terms)

2. Theoretical background (review of literature, conceptual framework, and hypotheses)

3. Methodology (research design, research setting, sampling design, sample size, statistical analysis, data gathering process, research tools, and ethical considerations)

4. Plan for data analysis and interpretation


B.S.H.B., B.S.N., R.N. 138

Purposes of Literature Review

To search for research ideas/topics

To be oriented to what is known

To establish the conceptual context of our

study

To assess the feasibility of the study

To be informed on research purposes


B.S.H.B., B.S.N., R.N. 24


B.S.H.B., B.S.N., R.N. 139

Framework

An abstract logical structure of meaning that guides the development of the study and enables the researcher to link the findings to nursing body of knowledge

1. A conceptual framework deals with

abstractions that are put together because of

their relevance to a common theme

2. A theoretical framework does not have a

deductive system or propositions that asserts

a relationship between concepts


B.S.H.B., B.S.N., R.N. 140

Hypothesis

A statement of the anticipated or expected

relationship between variables (research

concepts): the independent and the dependent

An independent variable is the presumed

“cause”

A dependent variable is the presumed “effect”

The variability in the dependent variable is

presumed to be due to the variability in the

independent variable


B.S.H.B., B.S.N., R.N. 141

Operational Definition

A specification of the operations that a researcher must perform to collect the required information

Operational reasoning is the process of identification and discrimination between alternatives and viewpoints

Inductive reasoning is the process of forming general conclusions from articular instances

Statements that are taken for granted or are considered true, even though they have not been scientifically tested are called assumptions


B.S.H.B., B.S.N., R.N. 142

Data Collection Methods

Physiological/biophysical measures

Observational methods—use of checklists and rating scales

Interviews

Use of questionnaires

Psychological measures

Content analysis

Delphi technique

Projective techniques

Diaries


B.S.H.B., B.S.N., R.N. 143

Validity vs. Reliability

Validity of a research tool is the extent to which the instrument actually reflects the construct or variable being examined

1. Internal validity is the extent to which the results of the

study can actually be attributed to the action of the

independent variable and not something else

2. External validity is the degree to which the findings of

the study can be generalized to the target population

Reliability is concerned with how consistently the measurement technique measures the concept of interest


B.S.H.B., B.S.N., R.N. 144

Research Designs

A non-experimental design does no manipulation of the independent variable.

─ A descriptive design describes a situation as it naturally happens.

─ A correlational design examines the relationships between or

among two or more variables.

An experimental design manipulates the independent (experimental) variable using both experimental and control groups to establishes a cause and effect relationship.

─ A true experiment has three features: (1) subjects are randomly

assigned; (2) experimental variable is manipulated; and (3) with at

least 2 groups—experimental and control

─ A quasi-experimental design is one where the investigator

manipulates the independent variable but does not include

randomization or controls.


B.S.H.B., B.S.N., R.N. 25


B.S.H.B., B.S.N., R.N. 145

Probability vs. Non-probability Sampling

In probability sampling every member of the

population has a probability of being included in

the sample, e.g. simple random sampling,

stratified random sampling, cluster sampling,

and systematic sampling

In non-probability sampling not every element of

the population has an opportunity to be included,

e.g. accidental/convenience, quota, purposive,

network/snowballing


B.S.H.B., B.S.N., R.N. 146

Levels of Measurement in Research

1. Nominal is used when data can be organized into categories of a defined property but the categories cannot be compared.

2. Ordinal is used when data can be assigned to categories of an attribute that can be ranked.

3. Interval is used when data have equal distances between intervals in the scale but there is no absolute zero point.

4. Ratio is used when data has an absolute zero point (as opposed to interval) and is the highest form of measure.


B.S.H.B., B.S.N., R.N. 147

Data Analysis

Frequency tabulations

Measures of central tendency (mean,

median, mode)

Correlations (scatterplot, chi-square,

Spearman rank-order correlation, and

Pearson r)


B.S.H.B., B.S.N., R.N. 148

Elements of an Ethical Research

Protecting subjects’ rights

Balancing the benefits and risks in a study

Obtaining informed consent

Obtaining institutional approval for

research


B.S.H.B., B.S.N., R.N. 149

Ethical Issues and Considerations in Research

Autonomy: The researcher should get the research participants/respondents’ informed consent. Informed consent implies that: (1) the participant received adequate information about the research project; (2) the participant understood what he/she is expected to do and the implications of his/her participation; and (3) he/she participated voluntarily.

Right to privacy: The researcher should ensure the anonymity of the research participants and the confidentiality of the data/information collected from them.

Anonymity: Refers to the protection of participants in a study that even the researcher cannot link them the information they provided.

Confidentiality: Refers to the protection of the participants that their identities will not be linked to the information they provided and will never publicly divulged.


B.S.H.B., B.S.N., R.N. 150

Ethical Issues and Considerations in Research

Beneficence: This implies the benefits of the research to the research subjects/participants. This should be adequately explained to the participants.

Nonmaleficence: Refers to the avoidance of harm or reduction of risks to the research subject. The researcher should weigh the risks and the benefits of the study. The benefits should be far greater than the risks.

Social justice: This includes three issues: (1) right to be represented in the sample; (2) right of equal access to knowledge; and (3) right not to be discriminated against. This ethical value is prominent in experimental studies particularly those studies that have great promise to do good (e.g. drug that may cure a disease) to the participants.

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