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Model of
Nursing Research
By: Dr. Nursalam, M.Nurs (Hons)
School of Nursing, Airlangga University
CURRICULUM VITAE Name : Dr. Nursalam, M.Nurs (Hons) 081339650000
Address : Jl. Keputih Tegal Timur 62 Surabaya 60111
E-mail : [email protected]
HIGHER, EDUCATION: 1. Doctor, Model of Nursing Care for HIV-AIDS, Postgraduate Programme,
Airlangga University, 2005
2. Honours Master of Nursing, 1997, University of Wollongong, New South
Wales, Australia
3. Master of Nursing (Coursework), 1996 Univ. Wollongong, NSW, Australia
4. Med. Surgical Nursing, Lambton College, Sarnia Ontario Canada, 1991
5. Diploma III in Nursing, Sutoma Surabaya 1988
ORGANISATION AND WORKING EXPERIENCES : 1. Lecturer and nurse in Diploma III in Nursing, Anesthesia, Ministry of Health, RI Surabaya
(1988 – 1997)
2. Lecturer in School of Nursing, Faculty of Medicine / Faculty of Nursing, Airlangga University
(since 1998)
3. Organization
1. Vice, Head, School of Nursing, Faculty of Medicine, UA (1999– 2008)
2. Vice Head, PPNI Educatin & Training, East Java Nursing Association (2000 – 2010)
3. Dean, Faculty of Nursing Airlangga University (2008 – 2010)
4. Nursing Manager, Airlangga University Hospital (2011-now)
PUBLICATION : •Books = 15
•Acredited journal & presentation (national & international)= 21
•Unaccredited journal = 17
“The world is a dangerous place to live; not because of the people who are evil, but
because of the people who don't
do anything about it.“
(Albert Einstein)
nursalam -2006
John Maynard Keynes
said:
The greatest difficulty in the world
is not for people to accept new
ideas, but to make them forget
about old ideas”
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
A knowledge base is
necessary for the recognition
of nursing as a science by
health professionals,
consumers, and society
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
What is Nursing Research?
Research is diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge
Nursing research must address questions relevant to the profession of nursing
– Grow the body of literature / body of nursing knowledge related to our profession
– What is related to our profession?
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
One goal of nursing research
Development of evidence-based practice,
with nurses using the current, best research
findings in their delivery of care
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
Forming A Good Questions:
EVIDENCE BASED - PICO P = Patient population or disease of interest (age, gender,
ethnicity, with a certain disorder hepatitis)
I = Intervention or range of interventions of interest (exposure to disease, prognostic factor A, risk behavior)
C = Comparison, you want to compare the intervention against (no disease, placebo or no intervention, prognostic factor B, absence of risk factor)
O = Outcome of interest (accuracy of diagnosis, rate of occurrence of adverse outcome)
In (P) immobile acute care patients, what is the
effect of (I) turning every 2 hours on (O) prevention
of pressure ulcers compared with (C) not turning
patients every 2 hours?
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
5 Steps to EBP
1. Ask the burning clinical question
2. Collect the most relevant and best evidence
3. Critically appraise the evidence
4. Integrate all evidence with one’s clinical
expertise, patient preferences, and values in
making a practice decision or change
5. Evaluate the practice decision or change
nursalam-MASALAH
NURSING RESEARCH
MODEL
M M P / PMW 1. MASALAH (PROBLEM)
2. METODOLOGI (METHODS): (DESAIN;
POPULASI, SAMPEL, SAMPLING;
VARIABEL-D-O; INSTRUMENT; PULTA;
ANALISIS; ETHICAL CLEARANCE)
3. PENULISAN (WRITING): CONTENT &
STRUKTUR
A GOOD RESEARCH PROBLEM?
ORIGINALITY
NOVELTY
CONTRIBUTION ON THEORY AND PRACTICE
TRENDS / PREVALENCY
WHY.....
MALNUTRITION ?
WHY.....
SURVEILANCE
(DHF)?
WHY.....
TRADITIONAL MEDICINE
WHY.....
ENVIRONMENT
WHY.....
HEALTH BEHAVIOR
DISASTER MANAGEMENT
HOW?
19
STRESS
nursalam-MASALAH
SEARCHING NURSING RESEARCH PROBLEM (P-34)
NURSING SCIENCE: MATERNITY,
PEDIATRIC, etc.
2. CASE SELECTION: INC,
Hospitalisation stress,, etc.
3. NURSING PROBLEM:
NANDA / GORDON (F1-F2)
IDEA
Prolonged 1st Stage of labour
BRAINSTROMING
Factors that cause the prolonged?
LITERATURE REVIEW
Factors: 5P, the dominant one is psyche:
husband support - has not been studied
VARIABLES 5P (power, passage, passanger,
psychological, provider ...)
Anxiety, straining strength , age, parity, family support,
Admission time, stress etc.
5. AIM AND OBJECTIVES (BLOOM + Objective + (V-V) …….
To explain the effect of husband support on acceleration of cervix dilatation for inpartum mother
4. RESEARCH QUESTIONS (Q-S-S) What is the effect of husband support on acceleration of cervix dilatation 1st stage of Labour for inpartum mother?
1. TOPIC
F-I-N-E-R
FRAMEWORK
TITLE
6. EFFECT OF HUSBAND SUPPORT ON ACCELERATION OF CERVIX DILATATION FOR INPARTUM MOTHER
“Prolonged 1st stage of labour
EXAMPLE: PROBLEM IDENTIFICATION BASED ON COMPETENCIES
MATERNITY NURSING
ANC INC PNC BBLR HRP Reproductive problem
Ax pregnant women
Physical examination
Pregnant excercise
Health education
Leopold-I Leopold-I Leopold-I
Contraception
Cont ....... MATERNITY NURSING
Assessment Stage I
Assessment Stage -II
Assessment Stage -III
Assessment Stage -IV
cervix dilatation
Physical change
Labour sign
Phsychological change
Bleeding Placenta Bounding Attachment
Bleeding
Pain management
Delivering preparation
Delivering guide
APGAR score
INC ANC PNC BBLR HRP Reproductive problem
Contraception
Cont .......
MATERNITY NURSING
Assessment intervention Implementation Evaluation
Involution Lactation Vital sign Postpartum blues
Breast care Mobility Diet Lactation Management
Diagnosis
Vulva Higiene Puerperium excercise
PNC ANC INC BBLR HRP Reproductive problem
Contraseption
INPARTUM
Pow
er:
Nu
trisi
Nutrition
status
Pregnant
excercise
?
?
?
?
? ?
?
?
?
?
?
?
?
SPIDER
WEB INPARTUM (1ST STAGE OF LABOUR )
Central Theme
Blood glucose
DM
Dia
betic
wou
nd
Treatment
? ?
?
?
?
? ?
?
?
Activity : type (DM
excercise, walking, etc)
?
?
?
?
?
SPIDER
WEB DIABETES MELLITUS
ATIENT SATISFACTIONP
The P
rob
lems
Sco
pe o
f
Wards
Operating
theater
Over
All Patients
Hospital don’t know
what px-expect
Hospital Policy not
research based
Nurses don’t
believe Research
result
Nurse don’t do
research
Nobody takes any
interest
No case conference
No name tag Nurse
Poor Relationship with
health team
Never H.E-when
Pt.discharge
No response on
complain
No programme to
visit Community
Different trust
SPIDER
WEB TOPIC / PROBLEM: PATIENT SATISFACTION
SOURCES OF RESEARCH PROBLEMS
NANDA (9
Exchanging)
GORDON (11
Health function
pattern)
P. Problem
E:? (Factor/ V.
Independent)
S:Signs &
Symptoms
NURSING
PROCESS:
Nursing
diagnosis
Sources:
1. Clinical/Co
mmunity
2. Literatur
review
3. Book/
journal
4. Discussion/
seminar
KEY:
- F: Feasibility
- I: Interesting
- N: Novel
- E: Ethics
- R: Relevant
RESEARCH
PROBLEM
Framework development
(based on nursing theory:
ROY; OREM; KING;
etc.)
p.
nursalam-MASALAH
SEARCHING RESEARCH PROBLEM –
F1 & F2
(SOURCES TO WRITE CHAPT 1 & 2)
F- 1
1. Sekitar 15 – 20% anak usia 5 – 6 tahun mengalami enuresis dan kebanyakan dari mereka adalah laki-laki (Norby, 2005).
2. Prevalensi enuresis pada usia 5 tahun adalah 7% untuk laki-laki dan 3% untuk anak perempuan (Houts, 1991)
3. Dampak secara sosial dan kejiawaan yang ditimbulkan akibat enuresis sungguh mengganggu kehidupan seorang anak (Harjaningrum, 2005).
4. Teori Functional bladder capacity mengatatakan bahwa anak dengan enuresis memiliki kapasitas fungsional kandung kemih yang lebih kecil dibanding anak yang tidak mengalami enuresis(Whale & Wong,1999).
F-2
1. Bladder-retention training biasanya dilakukan pada anak dengan kapasitas fungsional kandung kemih yang kecil (Harjaningrum,2005).
2. Pada beberapa anak dengan kapasitas fungsional kandung kemih yang kecil, penggunaan pembelajaran Bladder-retention training selama beberapa hari dapat membantu meningkatkan kapasitas fungsional kandung kemih pada malam hari (Marc Cendron,1999).
3. ............
Masalah
Pengaruh pembelajaran Bladder-retention training terhadap kemampuan dan frekwensi enuresis pada anak pra sekolah (3 – 6 tahun) belum dapat dijelaskan.
nursalam-MASALAH
2. WRITE CHAPTER LITERATURE
REVIEW
•THEORITICAL REVIEW (USE OF
NURSING THEORIES & OTHER
RELEVANT THEORY)
•THEORITICAL MAPPING (RESEARCH
ORIGINALITY)
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
Review of the Literature
Research should be built on the work of others
The “Literature” is all the written sources relevant to your topic
Primary source
– Written by the person who originated , or is responsible for generating, the ideas published
Secondary source
– Summarizes or quotes content from primary sources
– Paraphrase the works of primary authors
Meta-analysis or systematic reviews
Your work should mostly contain primary sources. Citations should be of primary sources not secondary sources
Generally, try to keep cited references to within 5 years
N
O
ARTICLE / RESEARCH TITLE
AND AUTHOR
RESEARCH METHOD (D-S-V-I-A) RESULT
1 Relationship of elderly excercise on body fit (Palestin, 2006) -elderly exercises
- vital signs
quantitative hubungan signifikan antara senam lansia
dengan tingkat kebugaran lansia
2. Pengaruh Senam Aerobik terhadap Peningkatan Kebugaran
Wanita Menopause (Hartini, 2007)
-Latihan Senam Aerobik
- Peningkatan Kebugaran
Kuantitatif Pra eksperimental Senam Aerobik memiliki pengaruh yang
signifikan pada peningkatan kebugaran
(stabilisasi nadi, RR, tekanan darah &
menopause syndrome)
3 Pengaruh Senam Lansia terhadap Kebugaran Jasmani pada
Lansia (Rochman, 2009)
- Senam Lansia
- Kebugaran (stabilisasi nadi, RR,
tekanan darah)
Observational rancangan analitik Ada Hubungan Senam Lansia dengan
kebugaran jasmani
4 Manfaat Senam terhadap Kebugaran Lansia (Kartinah, 2008) - Senam Tera
- Kebugaran
Kuantitatif pra eksperimental Senam Tera berpengaruh dalam
menstabilkan kadar immunoglobulin
5 Perbedaan Pengaruh Senam Otak dan Senam Lansia terhadap
Keseimbangan pada Orang Lanjut Usia (Herawati, 2008)
Senam Otak
Senam Lansia
Keseimbangan
Quasi eksperimen Senam otak dan senam lansia memberikan
hasil yang positif terhadap keseimbangan
Lansia
6 Hubungan
antara Karakteristik Personal dengan Kemandirian dalam
Activiy of Daily
Living (ADL) pada Lansia (Fathur, 2007)
karakteristik personal
kemandirian dalam Activiy of Daily
Living
Inferestial analitik eksperimen karakteristik personal memiliki hubungan
yang signifikan dengan kemandirian dalam
Activiy of Daily
Living (ADL)
7 Hubungan
Antara Tingkat Depresi Dengan Kemampuan Aktivitas Dasar
Sehari-Hari
Pada Lansia (Firmannulah, 2010)
Tingkat Depresi
Dengan Kemampuan Aktivitas Dasar
Sehari-Hari
Deskriptif analitik kolerasi ada hubungan yang signifikan dengan
interpretasi
korelasi negatif antara tingkat depresi
dengan kemampuan aktivitas seharihari
pada lanjut usia
8 Pengaruh
Pemberian Penyuluhan Kesehatan Terhadap Perubahan
Pengetahuan dan
Sikap Tentang Activity of Daily Living (ADL) pada lansia
(Setyowati, 2009)
Pemberian Penyuluhan Kesehatan
Perubahan Pengetahuan Activity of
Daily Living
Sikap Activity of Daily Living
Deskriptif dengan pendekatan
eksperimen korelasional
penyuluhan kesehatan
dapat meningkatkan pengetahuan lansia
tentang ADL
9 Pengaruh Pembelajaran Terbimbing terhadap Tingkat
Kemandirian ADL LAnsia (Kusrumentahingtyas,2010)
- Pembelajaran Terbimbing
- Kemandirian ADL
Kuantitatif Pre Eksperimental Pembelajaran Terbimbing memiliki
pengaruh yang signifikan terhadap Tingkat
Kemandirian ADL LAnsia
10 Hubungan antara Tingkat Depresi dengan Ketergantungan
dalam ADL
(Activity of Daily Living) pada Lansia (Aprinia, 2006)
tingkat depresi
ketergantungan dalam ADL
(Activity of Daily Living)
Studi korelasi Ada hubungan antara tingkat depresi
dengan ketergantungan dalam ADL
(Activity of Daily Living) pada lansia
11 Hubungan antara Gaya Hidup dengan Tingkat
Ketergantungan dalam Aktivitas Kehidupan
Sehari – hari Lansia
gaya hidup
tingkat ketergantungan dalam aktivitas
kehidupan
sehari – hari
Quasi eksperiment Terdapat hubungan antara gaya hidup
dengan tingkat ketergantungan dalam
aktivitas kehidupan
sehari – hari lansia
12 Hubungan Karateristik Demografi dengan Kemandirian
dalam Activity Daily Living (ADL) pada Lansia
(Sawika, 2005)
Karateristik Demografi
kemandirian
dalam Activity Daily Living (ADL)
Studi korelasi, Ada hubungan antara Karateristik
Demografi dengan kemandirian
dalam Activity Daily Living (ADL) pada
Lansia
nursalam-MASALAH
nursalam-MASALAH
3. DEVELOP A
1. FRAMEWORK (QUANTITATIVE)
2. RESEARCH QUESTION
(QUALITATIVE)
nursalam-MASALAH
FRAMEWORK
DEVELOPMENT
1. ROY: ADAPTATION MODEL
2. OREM: SELF CARE
3. CARING: WATSON & SWANSON
4. KINGS: OPEN SYSTEM MODEL
5. LEININGER: SUNRISE MODEL
6. etc.
What is the link between nursing
theory and the research process?
Theory provides direction for nursing research
Relationships of components in a theory help
to drive the research questions for
understanding nursing
Chinn and Kramer (2004), indicate a spiral
relationship between the two
Nursing also utilizes non-nursing
theories
Adaptation Model
Person as adaptive system. (From Roy, C. [1984]. Introduction to nursing: An adaptation model
[2nd ed., p. 30]. Englewood Cliffs, NJ: Prentice Hall.)
Feedback
Input Effectors Output Control
processes
Stimuli
Adaptation
level
Coping
mechanisms
Regulator
Cognator
Physiological function
Self-concept
Role function
Interdependence
Adaptive
and
ineffective
response
Psychosocial
Functioning
Quality of Life
Physical
Health
Psycho Psycho Neuro Neuro Immunology Immunology HEALTH HEALTH
Lived Experience Lived Experience
Psychosocial
Moderators
Coping Patterns
Person Factors
Pre tx: Critical Factors
Potential Co-Factors
Neuro-
Endocrine
Mediators
Immunological Mediators
Perceived Stress
PNI PNI
(Thorton & Andersen, 2006)
PNI
nursalam-MASALAH
Counseling for patient
with Stress – pre op
Learning process
(cognator)
Cognition -
Emotion
Pituitary
(ACTH)
Stress
Hypotalamus
(CRF)
Adrenal Cortex
(Cortisol )
IMMUNE RESPONSE MODULATION
(CD4; cytokin; IgG)
Perception
(+)
Coping (+)
Adrenal medulla
(Catecolamines
FRAMEWORK (p.403– ADAPTATION & PNI)
H
P
A
AXIS
A
D
A
P
T
A
T
I
O
N
Vital signs
(T, P, R, PB)
Self-care
Self-care
capabilities
(self-care
agency)
Therapeutic
self-care
demand
Nursing
Agency
(supportive
Educative)
R
R R
R
R
<
FIG. OREM – SELF CARE DEFICIT
OREM
Deficit
Cond
itio
nin
g
fact
ors
Cond
itio
nin
g
fact
ors
C
ond
itionin
g
factors
The Structure of Caring
The structure of caring as linked to the nurse’s philosophical attitude, informed understandings, message
conveyed, therapeutic actions, and intended outcome. (from Swanson, K. M. [1993]. Nursing as
informed caring for well-being of others. Image: The Journal of Nursing Scholarship, 25 [4], 352-357.)
Philosoohical attitudes towards persons (in general) and the designated client (in specific)
Informed understanding of the clinical condition (in general) and the situation and client (in specific)
Message
conveyed
to client
Maintaining
belief
Being
with Knowing
Doing
for Enabling
Therapeutic
actions
Intended
outcome
Client
well-
being ( )
Human Interaction for Goal
Attainment (King)
NURSE
PATIENT
PERCEPTION
ACTION
JUDGMENT
REAC
TION
INTERAC
TION
TRANSACTION
PERCEPTION
JUDGMENT
ACTION
FEEDBACK
FEEDBACK
Health (well being)
Diverse health
systems
Professional
system
Of
Individuals, families, group and
institutions
Diverse health systems
Nursing care decisions and actions
cultural care preservation/ maintenance
cultural care accommodation/
negotiation
cultural care repatterning/ restructuring
Culture congruent care
Nursing
LEININGER
Becoming a mother: A revised model. (From R. T. Mercer, 2008)
Father
or intimate
partner
Mother
d c b
a Infant
d c
b a
Word of
mouth
Personal
needs
Past
experience
Expected
service
Perceived
service
Service Quality
Dimensions:
(RATER)
•Reliability
•Assurance
•Tangibles
•Empathy
•Responsiveness
Service Quality Assessment
1. Expectations exceeded
ES<PS (Quality surprise)
2. Expectations met
ES~PS (Satisfactory quality)
3. Expectations not met
ES>PS (Unacceptable quality)
PERCEIVED SERVICE QUALITY
FOR PATIENT WITH “JAMKESMAS” (Parasuraman)
nursalam-MASALAH
1.To explain .......... on reducing stress response
2. To explain ....... patient coping
3. To prove on ....... vital signs
4. To proveon ........ cortisol
5. To prove on .......... Immune response modulation (CD4; cytokin; Ig)
Research aim:
To examine the effect of pre op counseling in nursing care on
reducing stress response, vital signs stability and immune
response modulation for pre op patient with ......
Objectives
nursalam-MASALAH
5. TITLE / RESEARCH TOPIC
1. BRIEF AND CLEAR
2. NO MORE THAN 14 WORDS
3. STATE THE OBJECTIVE AND
RESEARCH VARIABLES (DESIGN,
SAMPLE, PLACE)
nursalam-MASALAH
TITLE TO EXPLAIN (TAKE OUT)
EFFECT OF PRE OP COUNSELING IN NURSING
CARE ON REDUCING STRESS RESPONSE, VITAL
SIGNS AND IMMUNE RESPONSE MODULATION
FOR PATIENT WITH PRE OP
OR
PRE OP COUNSELING IN NURSING CARE ON
REDUCING STRESS RESPONSE, VITAL SIGNS,
AND IMMUNE RESPONSE MODULATION FOR
PATIENT WITH PRE OP
Oleh: Nursalam
NIM . 090214910D
Oleh: Nursalam NIM . 090214910D
nursalam-MASALAH
HYPOTHESIS (quantitative!)
Hypo = low
Thesis = statement
(a prediction about the relationship between variables.).
H1: There are effect of counseling on reducing stress
response, vital signs and immune response modulation
pre op patient with .......
nursalam-MASALAH
6. WRITE CHAPTER 1
(INTRODUCTION)
1.1 BACKGROUND (MSKS / MKSS)
1.2 SEARCHING RESEARCH PROBLEM
1.3 RESEARCH QUESTIONS
1.4 AIM AND OBJECTIVE (BASED ON
FRAMEWORK)
1.5 BENEFIT
nursalam-MASALAH
CHAPTER 1,2,3: ALREADY BAB 1 S/D BAB 3 SUDAH TERJAWAB
CHAPTER 1: INTRODUCTION
1. Background (MSKS / MKSS)
Paragraph 1: problems (F1 & F2)
Paragraph 2: scale of the problems
Paragraph 3: chronological
Paragraph 4: Solution
2. Research questions
3. Aim and objectives
4. Benefit (theoretically & Practice)
CHAPTER 2: LITERATURE REVIEW
CHAPTER 3: FRAMEWORK AND HYPOTHESIS
CHAPTER 4: RESEACH METHODS
nursalam-MASALAH
7. WRITE CHAPTER 4
(RESEARCH METHODS)
D –DESIGN (non experiment & experiment)
S – SAMPLE (POPULATION, SAMPLING,
SAMPLE SIZE)
V – VARIABLE (independent, dependent, ........)
I – INSTRUMENT (Observation, questionnaire, scale,
in vivo – vitro, in depth interview)
A – ANALYSIS (T-S-S-V)
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
“My basic principle is that you don’t make
decisions because they are easy; you don’t
make them because they are cheap; you don’t
make them because they’re popular; you
make them because they’re right” Fr. Theodore Hesburgh
nursalam-MASALAH
CONCLUTION
1. Deciding the Area of reseach and brain storming – spider web
2. Searching research problems based on empirical and theoritical (write chapter literature review)
3. Write framework & hypothesis
4. Write chapter Introduction
5. Write reseach methods
56 mtrla/13072010
“You don’t have to be great to get started,
but you have to get started to be great”
--------- Les Brown ----------
57 mtrla/13072010
GOOD LUCK
