Dr. Nursalam, M.Nurs

Model of
Nursing Research
By: Dr. Nursalam, M.Nurs (Hons)
School of Nursing, Airlangga University
CURRICULUM VITAE
Name
Address
E-mail
: Dr. Nursalam, M.Nurs (Hons) 081339650000
: Jl. Keputih Tegal Timur 62 Surabaya 60111
: nursalam@fkp.unair.ac.id
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)
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”
nursalam -2006
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
(Burns & Grove, 2001;
– What is related to our profession?
Melnyk & FineoutOverholt, 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 & FineoutOverholt, 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
(Burns & Grove, 2001;
Melnyk & Fineoutpatients every 2 hours?
Overholt, 2005)

5 Steps to EBP
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
1.
(Burns & Grove, 2001;
Melnyk & FineoutOverholt, 2005)
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 &
nursalam-MASALAH
STRUKTUR
1. SEARCHING OF RESEARCH
PROBLEM ---- Phenomena
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?
STRESS
19
SEARCHING NURSING RESEARCH PROBLEM (P-34)
IDEA
Prolonged 1st Stage of labour
1. TOPIC
NURSING SCIENCE: MATERNITY,
PEDIATRIC, etc.
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.
2. CASE SELECTION: INC,
Hospitalisation stress,, etc.
3. NURSING PROBLEM:
NANDA / GORDON (F1-F2)
“Prolonged 1st stage of labour
F-I-N-E-R
FRAMEWORK
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?
5. AIM AND OBJECTIVES (BLOOM + Objective + (V-V) …….
To explain the effect of husband support on acceleration of cervix dilatation for inpartum mother
TITLE
nursalam-MASALAH
6. EFFECT OF HUSBAND SUPPORT ON ACCELERATION OF CERVIX DILATATION FOR INPARTUM MOTHER
EXAMPLE: PROBLEM IDENTIFICATION
BASED ON COMPETENCIES
MATERNITY NURSING
ANC
INC
Ax pregnant
women
Leopold-I
PNC
Physical
examination
Leopold-I
BBLR
Pregnant
excercise
Leopold-I
HRP
Reproductive
problem
Health education
Contraception
Cont .......
MATERNITY NURSING
ANC
PNC
INC
Assessment
Stage I
Labour
sign
BBLR
Assessment
Stage -II
cervix
dilatation
Physical
change
Pain
management
Phsychologic
al change
Delivering
preparation
HRP
Reproductive
problem
Assessment
Stage -III
Placenta
Delivering
guide
Bleeding
APGAR score
Contraception
Assessment
Stage -IV
Bleeding
Bounding
Attachment
Cont .......
MATERNITY NURSING
ANC
PNC
INC
Assessment
Vital sign
Involution
Vulva Higiene
Diagnosis
Lactation
Breast care
BBLR
HRP
intervention
Reproductive
problem
Implementation
Contraseption
Evaluation
Postpartum
blues
Mobility
Diet
Lactation
Management
Puerperium
excercise
SPIDER
WEB
INPARTUM (1ST STAGE OF LABOUR )
?
Nutrition
status
Pregnant ?
excercise
?
?
?
Power:
Nutrisi
?
?
INPARTUM
?
?
?
?
?
?
SPIDER
WEB
DIABETES MELLITUS
?
?
?
Treatment
?
?
?
Diabetic
wound
Activity : type (DM
excercise, walking, etc)
?
?
Central Theme
Blood glucose
DM
?
?
?
?
?
?
SPIDER
WEB
TOPIC / PROBLEM: PATIENT SATISFACTION
Hospital don’t know
what px-expect
Wards
Operating Over
theater
All Patients
Nobody takes any
interest
No case conference
No name tag Nurse
Scope of
The Problems
Poor Relationship with
health team
Never H.E-when
Pt.discharge
PATIENT SATISFACTION
Hospital Policy not
research based
Nurses don’t
believe Research
result
Different trust
Nurse don’t do
research
No response on
complain
No programme to
visit Community
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
RESEARCH
PROBLEM
Framework development
(based on nursing theory:
ROY; OREM; KING;
etc.)
p.
KEY:
- F: Feasibility
- I: Interesting
- N: Novel
- E: Ethics
- R: Relevant
SEARCHING RESEARCH PROBLEM –
F1 & F2
(SOURCES TO WRITE CHAPT 1 & 2)
F- 1
1.
2.
3.
4.
Sekitar 15 – 20% anak usia 5 – 6 tahun mengalami enuresis dan kebanyakan dari mereka
adalah laki-laki (Norby, 2005).
Prevalensi enuresis pada usia 5 tahun adalah 7% untuk laki-laki dan 3% untuk anak
perempuan (Houts, 1991)
Dampak secara sosial dan kejiawaan yang ditimbulkan akibat enuresis sungguh mengganggu
kehidupan seorang anak (Harjaningrum, 2005).
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)
nursalam-MASALAH
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
(Burns & Grove, 2001;

Melnyk & FineoutOverholt, 2005)
N ARTICLE / RESEARCH TITLE
O 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)
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)
-Latihan Senam Aerobik
- Peningkatan Kebugaran
- Senam Lansia
- Kebugaran (stabilisasi nadi, RR,
tekanan darah)
Manfaat Senam terhadap Kebugaran Lansia (Kartinah, 2008) - Senam Tera
- Kebugaran
Observational rancangan analitik Ada Hubungan Senam Lansia dengan
kebugaran jasmani
Kuantitatif pra eksperimental
Senam Tera berpengaruh dalam
menstabilkan kadar immunoglobulin
5
Perbedaan Pengaruh Senam Otak dan Senam Lansia terhadap Senam Otak
Keseimbangan pada Orang Lanjut Usia (Herawati, 2008)
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)
Hubungan
Antara Tingkat Depresi Dengan Kemampuan Aktivitas Dasar
Sehari-Hari
Pada Lansia (Firmannulah, 2010)
karakteristik personal
kemandirian dalam Activiy of Daily
Living
Inferestial analitik eksperimen
Tingkat Depresi
Dengan Kemampuan Aktivitas Dasar
Sehari-Hari
Deskriptif analitik kolerasi
Pengaruh
Pemberian Penyuluhan Kesehatan Terhadap Perubahan
Pengetahuan dan
Sikap Tentang Activity of Daily Living (ADL) pada lansia
(Setyowati, 2009)
Pengaruh Pembelajaran Terbimbing terhadap Tingkat
Kemandirian ADL LAnsia (Kusrumentahingtyas,2010)
Pemberian Penyuluhan Kesehatan
Perubahan Pengetahuan Activity of
Daily Living
Sikap Activity of Daily Living
Deskriptif dengan pendekatan
eksperimen korelasional
karakteristik personal memiliki hubungan
yang signifikan dengan kemandirian dalam
Activiy of Daily
Living (ADL)
ada hubungan yang signifikan dengan
interpretasi
korelasi negatif antara tingkat depresi
dengan kemampuan aktivitas seharihari
pada lanjut usia
penyuluhan kesehatan
dapat meningkatkan pengetahuan lansia
tentang ADL
- Pembelajaran Terbimbing
- Kemandirian ADL
Kuantitatif Pre Eksperimental
Hubungan antara Tingkat Depresi dengan Ketergantungan
dalam ADL
(Activity of Daily Living) pada Lansia (Aprinia, 2006)
Hubungan antara Gaya Hidup dengan Tingkat
Ketergantungan dalam Aktivitas Kehidupan
Sehari – hari Lansia
tingkat depresi
Studi korelasi
ketergantungan dalam ADL
(Activity of Daily Living)
gaya hidup
Quasi eksperiment
tingkat ketergantungan dalam aktivitas
kehidupan
sehari – nursalam-MASALAH
hari
Karateristik Demografi
Studi korelasi,
kemandirian
4
7
8
9
10
11
12
Hubungan Karateristik Demografi dengan Kemandirian
dalam Activity Daily Living (ADL) pada Lansia
Pembelajaran Terbimbing memiliki
pengaruh yang signifikan terhadap Tingkat
Kemandirian ADL LAnsia
Ada hubungan antara tingkat depresi
dengan ketergantungan dalam ADL
(Activity of Daily Living) pada lansia
Terdapat hubungan antara gaya hidup
dengan tingkat ketergantungan dalam
aktivitas kehidupan
sehari – hari lansia
Ada hubungan antara Karateristik
Demografi dengan kemandirian
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.
nursalam-MASALAH
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
Input
Stimuli
Adaptation
level
Effectors
Control
processes
Coping
mechanisms
Regulator
Cognator
Physiological function
Self-concept
Role function
Interdependence
Output
Adaptive
and
ineffective
response
Feedback
Person as adaptive system. (From Roy, C. [1984]. Introduction to nursing: An adaptation model
[2nd ed., p. 30]. Englewood Cliffs, NJ: Prentice Hall.)
PNI
Psycho
Neuro
Immunology
HEALTH
Lived Experience
Potential
Co-Factors
Person
Factors
Pre tx:
Critical
Factors
Psychosocial
Moderators
Perceived
Stress
Coping
Pattern
s
Psychosocial
Functioning
NeuroEndocrine
Mediators
Immunological
Mediators
Quality of Life
Physical
Health
PNI
(Thorton & Andersen, 2006
FRAMEWORK (p.403– ADAPTATION & PNI)
Counseling for patient
with Stress – pre op
Learning process
(cognator)
Perception
(+)
Coping (+)
Cognition Emotion
Stress
Hypotalamus
(CRF)
H
P
Pituitary
(ACTH)
A
AXIS
Adrenal Cortex
(Cortisol )
IMMUNE RESPONSE MODULATION
(CD4; cytokin; IgG)
nursalam-MASALAH
Adrenal medulla
(Catecolamines
Vital signs
(T, P, R, PB)
A
D
A
P
T
A
T
I
O
N
OREM
Self-care
Self-care
capabilities
(self-care
agency)
R
Therapeutic
self-care
demand
R
<
Conditioning
factors
Deficit
R
FIG. OREM – SELF CARE DEFICIT
R
Nursing
Agency
(supportive
Educative)
Conditioning
factors
Conditioning
factors
R
The Structure of Caring
Maintaining
belief
Philosoohical
attitudes towards
persons (in general)
and the designated
client (in specific)
Knowing
Informed understanding
of the clinical condition
(in general) and the
situation and client
(in specific)
Being
with
Message
conveyed
to client
Doing
for
Enabling
Therapeutic
actions
( )
Client
wellbeing
Intended
outcome
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.)
Human Interaction for Goal
Attainment (King)
FEEDBACK
PERCEPTION
NURSE
JUDGMENT
ACTION
PATIENT
ACTION
REAC
TION
INTERAC
TION
JUDGMENT
PERCEPTION
FEEDBACK
TRANSACTION
LEININGER
Health (well being)
Of
Individuals, families, group and
institutions
Diverse health systems
Diverse health
systems
Nursing
Professional
system
Nursing care decisions and actions
cultural care preservation/ maintenance
cultural care accommodation/
negotiation
cultural care repatterning/ restructuring
Culture congruent care
Father
or intimate
partner
d
cb
a Mother
Infant
a
b
c
d
Becoming a mother: A revised model. (From R. T. Mercer, 2008)
PERCEIVED SERVICE QUALITY
FOR PATIENT WITH “JAMKESMAS”
(Parasuraman)
Word of
mouth
Service Quality
Dimensions:
(RATER)
•Reliability
•Assurance
•Tangibles
•Empathy
•Responsiveness
Personal
needs
Expected
service
Perceived
service
Past
experience
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)
4. WRITE AIM AND OBJECTIVES
nursalam-MASALAH
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
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)
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
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)
nursalam-MASALAH
“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
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
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
nursalam-MASALAH
“You don’t have to be great to get started,
but you have to get started to be great”
mtrla/13072010
--------- Les Brown ----------
56
GOOD LUCK
mtrla/13072010
57