REVIEW ADVANCED SUBJECTS

Vital Points
Nursing Research and Biostatistics
 Research
• Systematic inquiry that uses disciplined methods
to answer questions and to solve problems
• Ultimate aim of scientific research : To develop ,
refine and expand the body of knowledge
• The most objective method through which the
nursing knowledge is getting is Scientific research
• Scientific research always uses empirical data
 Nursing Research
• Systematic inquiry designed to develop body
of knowledge about issues of importance to
nursing profession, including nursing practice,
education, administration and informatics
• The ultimate aim of nursing research : To
develop trustworthy evidence
• Research in Nursing and Health: First journal
related to Nursing Research
 INDUCTIVE AND DEDUCTIVE
REASONING

DEDUCTIVE REASONING
•Deductive reasoning works from the
more general to the more specific
• Sometimes this is informally called a
“top-down” approach
INDUCTIVE REASONING
•Moving from specific observations to
broader generalizations and theories. 
• “bottom up” approach
 Basic and Applied Research

• Basic research is also known as fundamental

or pure research since it is mainly concerned
with the improvement of scientific
knowledge. 
• Applied Research is the research that is
designed to solve specific practical problems
or answer certain questions.
Qualitative and quantitative research
Steps in Nursing Research
 Evidence Based Practice
•  “the conscientious, explicit and judicious use of current best evidence in
making decisions about the care of the individual patient. It means
integrating individual clinical expertise with the best available external
clinical evidence from systematic research”.
 Ethics in research
• Confidentiality refers to a condition in which
the researcher knows the identity of a
research subject, but takes steps to protect
that identity from being discovered by others.
• Anonymity is a condition in which the identity
of individual subjects is not known to
researchers.
 Informed consent
Informed consent" is the voluntary agreement of an individual, or his or her
authorized representative, who has the legal capacity to give consent, and who
exercises free power of choice, without undue inducement or any other form of
constraint or coercion to participate in research.
•The purpose of the study
•Expected duration
•Procedures of the study
•Information on their right to decline or withdraw
•Foreseeable consequences of withdrawing or declining
•Potential risk, discomfort or adverse effects
•Prospective research benefits
•Incentives, such as payment or rewards
•Whom to contact for questions
 Debriefing involves a structured or semi-structured verbal conversation between
the researcher and the subjects whereby an array of topics are addressed and
discussed, and the subjects are given an opportunity to ask questions.
Review of literature
 Primary and secondary sources of
Review of literature
• Primary Sources: Literature review mostly relies on primary source
• Research reports, which are description of studies studies written
by researchers who conducted them.
• Primary source is written by a person who developed the theory or
conducted the research or is the description of an investigation
written by the person who conducted it.
• Secondary Sources: Secondary source research documents or
description of studies prepared by someone other than the original
research.
• CINAHL (Cumulative Index to Nursing and Allied Health Literature)
• MEDLINE (Medical Literature Analysis and Retrieved System Online)
 Hypothesis and Assumptions
• An assumption is any statement that is
believed to be true
• A hypothesis is a statement of the
researcher's expectation or prediction about
relationship among study variables.
 Variables

A variable is
defined as anything
that has a quantity
or quality that varies
 Null hypothesis and Research
Hypothesis
• A null hypothesis or statistical hypothesis is a
hypothesis that says there is no statistical
significance between the two variables.
• Alternate hypothesis or research hypothesis
states that existence of relationship between
variables
Type 1 & Type 2 Errors
RESEARCH DESIGNS
Probability and nonprobability
sampling
 Validity and reliability
• Validity is a way to assess the quality of a
research study.
• Validity describes the degree to which the
results actually measure what they are
intended to measure.
• Reliability relates to the consistency of a
measure
Biostatistics : Normal distribution
curve
• Properties of a normal
distribution
• The mean, mode and
median are all equal.
• The curve is symmetric at
the center (i.e. around
the mean, μ).
• Exactly half of the values
are to the left of center
and exactly half the
values are to the right.
• The total area under the
curve is 1.
Types of Measurement
 Measures of central tendency
• Mean
• Median
• Mode
 Measures of central tendency
• Quartile deviation
• Mean deviation
• Standard deviation : Standard
deviation is the square root of the
arithmetic mean of the squares of the
deviations measured from the
arithmetic mean of the data Standard
deviation is considered to be the best
measure of dispersion. 
• Range : Subtracting the lowest value
from highest value
R = H-L
• Higher Value of Range implies Higher
Dispersion & Vice-versa.
• Z Score ( Normal deviate)
Chi square
Chi Square
NURSING EDUCATION
 Definitons
• Education is the creation of sound mind in the sound
body ( Aristotle)
• Education is the all-round drawing of the best in child
and man-body-mind and spirit. (M.K. Gandhi)
• Education is the manifestation of divine perfection
already existing in man. (Vivekananda)
• Education is the natural harmonious and progressive
development of man’s innate powers ( Pestalozzi)
• Education is not a preparation for life education is life
itself ( John Dewey)
• Education is the process through which child makes his
internal and external make up ( Froebel)
 Education as a process

• Bipolar process- Adams & Ross

Education as a tripolar process
Agencies of education

1 2
Philosophies of Education
Philosophy = Philos + Sophia
Philos - ‘love’
Sophia – ‘wisdom’
 Branches of philosophy
• Epistemology- origin and sources of
knowledge
• Logic- systematic study of knowledge and its
interrelationships
• Metaphysics- ultimate true nature of things
• Aesthetics- beauty and harmony in life
• Axiology- nature of morality and value
 Idealism Naturalism Realism Pragmatism

Exponents Froebel Tagore Aristotle, Iramus, Rebellias, Milton, Charles Saunders Pierce, William
Kant Aristotle, Comte, Darwin, Bernard Lord Montaigne, Locke, Bacon, James, John Dewey
Plato Shaw, Herbert Commenius, White-head, Bertrand Kilpatrick – Project method
Swami Vivekananda Russell Mulcaster, Rattle.
Sri Arabindo
Mahatma Gandhi

Key principle  Ultimate reality is spiritual. Ultimate reality is physical. Fully scientific attitude Ultimate reality is utility.
Spiritual values are supreme and Universe is the natural creation. Physical world is real. It is anthropo-centric. Human
universal Nature alone is entire reality. Cause-effect relation­ship is experience at the centre of reality.
universal and universally accepted.

Aims of education The aim of education is self- The aim of education is self-  
realization expression.
Self expression, self preservation,
education according to nature
Preparing the child for a real life.
Harmonious development,
Continuous experience , Social
efficacy
Aims of education are not pre-
determined

Curriculum Based on moral, spiritual and It is based on need, ability, Subjects concerning day-to-day life  Emphasis on practical and
intellectual values aptitude and the nature of the are included. utilitarian subjects.
child, Child is the centre of
education

Methods of teaching Idealists prescribe the following
methods of teaching- Question-
answer, Conversation, Dialogue,
Discussion, Lecture,
Argumentation, Intersection, Book
study etc
Learning by doing, learning through
experience, play-way method,
observation, Dalton Plan, Direct
method
Opposes bookish knowledge, Learning by activity.
justifies the use of appropriate AV Learning through experience.
aids in teaching I Project method.
Inductive method, objective Experimental method
methods, learning by walking and
by experience, correlation
teaching, experimental method
and heuristic method

Teacher Supreme and important place of Teacher is behind the scene. He is a He should provide opportunities He is a friend, philosopher and
teacher . The teacher as a gardener stage-setter, setting the stage, for observation and guide. He helps the child to solve
knows best as to how to care and facilitator experimentation. his problems himself.
develop a child like a plant

Discipline Idealism advocates discipline at all Total freedom and oppose Believes in self discipline Social discipline
cost punishment
Believes in self discipline
 Educational objectives
• Statements of those desired changes in
behavior as a result of specific
teaching- learning activity.
• Educational objectives describe the
goals toward which the education
process is directed–the learning that is
to result from instruction.
 Bloom’s taxonomy
• 1956 Benjamin Bloom divide educational
objectives into 3 domains
According to the level of behavior , progressing
from most simple to the highly complex
1. Cognitive: knowledge
2. Affective: attitudes, values
3. Psychomotor: Conation - motor skills
Bloom- cognitive domain
Karath- affective
Harrow- psychomotor
 Maxims of teaching
• Proceed from known to
unknown
• Proceed from concrete to
abstract
• Proceed from simple to complex
• Proceed from easy to more
difficult
• Proceed inductively
• Proceed from particular to
general
• Proceed from indefinite to
definite
• Proceed from empirical to
rational
• Proceed from whole to
parts
• Proceed from part to
whole
• Proceed from analysis
to synthesis
• Proceed from overview
to details
• From observation to
reasoning
• Proceed from
psychological to logical
 Curriculum
– The subject matter, clinical experiences and
practices that the faculty plans to implements for
a particular group of students is called curriculum
( DSSB Nursing officer Aug 2019)
– A well planned curriculum helps to realize the
educational objectives
 4 C’s of curriculum
• Cooperative
Programme or curriculum should be prepared by
group of persons, to reduce chance of error.
• Continuous
Continuous revision of the curriculum should be
essential
• Comprehensive
Interaction of the entire programme component must
be defined percisely
• Concrete
Concrete professional task must be constituting the
essential structure of a relevant programme
 Models of curriculum
1. Behavioral objective(product model): by Ralph Tyler. Output model.
Classic curriculum model which remains the foundation for a
performance based nursing curriculum
OBJECTIVES, CONTENTS , METHODS AND EVALUTION
2. Stenhouse’s process model: Input model, learning experiences/process
Model of curriculum which is more open ended and focuses on how
learning develops over a period of time
3. Lawton’s cultural analysis model:
4. Beattie’s four fold model:
 Curriculum as a map of key subjects
 Curriculum as schedule of basic skills
 Portfolio of meaningful personal experience
 Agenda of important cultural issues
 Types of curriculum
Olivia bevis
1. Legitimate curriculum: Written down curriculum, approved by accreditation
bodies
curriculum is one that is agreed on by the faculty either implicitly or explicitly. 
2. Illegitimate curriculum:
The illegitimate curriculum, according to Bevis (2000), is one known and actively
taught by faculty yet not evaluated because descriptors of the behaviors are
lacking. Such behaviors include “caring, compassion, power, and its use”
Eg: insight, creativity.
3. Hidden curriculum: The hidden curriculum consists of values and beliefs taught
through verbal and nonverbal communication by the faculty
Here unaware of the messages given by the way we teach..values, perceptions etc
( Learning that takes place in the school /college of nursing which is not the
designated part of official curriculum )
4. Null curriculum: Exists only in the heart and minds of educators but seldom in
reality.
 Core curriculum
• A set of course that is considered basic and
essential for future course or a study and which
utilize to solve the problem of common client
called core curriculum
• The approach of nursing process of giving
nursing care can be regarded as core
curriculum
• Standard curriculum was produced by the
league of Nursing education in 1917
 Steps in curriculum development
• Ralph Tyler
1.Formulation of educational objectives
2.Selection of learning experiences
3.Effective organization of learning experiences-
continuity, sequence, integration
4.Evaluation of the curriculum- Men, money,
materials, methods, minutes
 LESSON PLAN
• Lesson plan is a plan prepared by the teacher
to teach lesson in an organized manner
• Lesson plan is a core and heart of effective
teaching
• Time , Specific objectives, content, Teaching
learning activity, AV aid, Evaluation
• Steps: Planning, preparation/ introduction,
presentation, recapitulation or closing stage
 Microteaching
• Miniature teaching to practice teaching skill in the trainee teacher
• Teacher training and faculty development technique , where teacher
teaches 5-10 pupil for 5-10 minutes
• Student teacher practices only one selected skill
• Knowledge acquisition phase, skill acquisition phase , transfer phase
• Preparation of micro lesson plan – Skill acquisition phase
• Number of pupils: 5-10
• Types of pupils: real pupils/peers
Time duration: 36 minutes
• Teach-6 mts
• Feed back-6 mts
• Replan-12 mts
• Re teach-6 mts
• Re feedback-6 mts
Teaching methods
• Bed side clinic: organized clinical instruction in the presence of the
patient.
• Nursing care conference: like bed side clinic except presence of the
patient
• Nursing round : An extension of bedside clinic
• Nursing care study:
Most effective clinical teaching method
Blue print of nursing care rendered by a nursing student to a selected
patient , for a particular period by following nursing process approach
Study of breadth and depth of an individual patient
Detailed study of single individual as bases for diagnostic/ remedial
purpose
It gives total perspective of the patient and the care he requires and
receive
Principles of A-V Aids
 Epidiascope
• Projector for showing both transparent slides
and opaque objects

Diorama
 Is a model , representing a scene with natural
setting
 Effective in biological and social sciences
 3D Non-projected av aid
Evaluation
‘Valoir’- to be worth
Evaluation is the process of determining to what
extent the educational objectives are being
realized
–Ralph Tyler
Evaluation: Pupil’s qualitative progress and
behavioral changes are tested.
E.g. Very good, good, bad, etc.
Measurement: Refers to quantitative
description pupil’s attainment in a subject.
E.g. Exam score in a specific subject.
Assessment:
“Assessment in education is the process of
gathering , interpreting, recording and
using information about pupil’s
responses to an educational task.”
Criterion referenced assessment
It determines whether each student has
achieved specific skills or concepts.
E.g.: Driving test
Norm referenced assessment
Compare students to what is normal for
the age, class and course.
Percentile rank is preferred.
Methods of Evaluation
Formative
assessment
E.g: Teacher’s
assessment of
seminar presentation
Summative
assessment
E.g: Final University
exam.
 Checklists
• Check lists are list of item or performance
indicators requiring dichotomous response
like pass or fail, yes or no, present or absent
• Suited to assess performance
• Also called behavior inventory
• Used for process and procedure evaluation
• Examiner only can classify the judgment not
respondent
 Anecdotal records

A brief description of an
observed behavior or incident is
known as anecdotal records
Document observed incident of
a student’s clinical behavior
related to attainment of clinical
learning objectives
 Advantages
 Answering direct questions allows students to
demonstrate their achievement of learning outcomes.
 Enables students to read and revise a substantial
amount of content, as ‘anything can be asked’ is the
usual case with viva.
 Often cited as an oral communication skill considered
valuable for employment.
 For a well-constructed viva examination, a series of
candidates can be asked the same questions and their
answers can be compared and evaluated.
 Delphi technique
• Delphi technique is a group communication
method where panels of experts active at a
consensus over a series of questions and
discussions
• It is uses for estimating or forecasting
 OSCE
 The objective structured clinical
examination (OSCE), first used in the 1970s,
is an assessment of competence carried
out in a well-planned, structured and
objective way (Harden and Gleeson, 1979).
 It is well established within medicine and is
used increasingly in nurse education (Nulty
et al, 2011).
 Performance station, response station,
rest station
NURSING MANAGEMENT
⮚ Administration- derived from the Latin word
⮚ “ad + ministraire” means to care for or to look after
people to manage affairs.

⮚ Administration is the organization and direction of human

and material resources to achieve desired ends
- Pfiffner and
Presthus
Management
Management is the art of getting things done through and
with people in formally organized groups
- Harrold Koontz
Philosophies of administration

Cost effectiveness
Effective communication
Delegation of responsibilities
⮚ Father of modern management: Henry Fayol
⮚ Father of scientific management: Frederick Taylor
⮚ POSDCORB - Functions of management,
postulated by Luther Gullick & Urwick

⮚ Father of Total Quality Management [TQM]-

Edward Deming
⮚ Father of Quality Assurance- Donabedian
⮚ Management By Objectives [MBO]- Peter Drucker
⮚ Hawthorne effect- Elton Mayo
⮚ Douglas McGregor proposed Theory X and Y of
leadership
⮚ Hierarchy of needs- Abraham Maslow
⮚ 14 principles of management were given by Henri
Fayol and these are:
o Division of labor
o Authority
o Discipline
o Unity of command
o Unity of direction
o Subordination of individuals to common good
o Remuneration
o Centralization
o Scalar chain
oOrder
oEquity
oStability
oInitiative
oEspirit de corps
Functions of management by Luther Gullick

POSDCORB
Nursing Care Models
⮚Total patient care/case method
⮚Functional nursing
⮚Team nursing
⮚Primary nursing
⮚Case management
Total Patient Care (Case method)
Delivery
Functional Nursing Care Delivery
Model
Team Nursing
Model
Primary Nursing
Model
⮚ The Program Evaluation and Review
Technique [PERT]
⮚ GANTT
Inventory Control Methods
⮚A-B-C classification
⮚H-M-L classification
⮚X-Y-Z classification
⮚V-E-D classification
⮚F-S-N classification
⮚S-D-E classification
⮚G-O-L-F classification
⮚S-O-S classification
A-B-C classification
ABC– stands for Always Better Control
Based on monetary values of items
⮚A items – 5 to 10 % of total items which consumes
70 % of cost.
⮚B items – 15 to 20% of total items which consumes
20 % of cost.
⮚C items – 70 % of total items which consumes 10 %
of cost.
⮚ A – Items represent the high cost center
⮚ B – Items represent the moderate cost center
⮚ C- Items represent low cost center
VED Classification
Based on critically of the items in relation to the
functioning of the hospital.
⮚V- Vital items without hospital cannot perform its
functions.
⮚E – Essential items without which hospital can work
for short period.
⮚D- Desirable items non availability for considerable
period will not affect hospital function.
H-M-L Classification
Based on unit value
⮚H- High
⮚M- Medium
⮚L- Low
X-Y-Z Classification
Based on availability on a particular date in the
store
⮚X- items are whose stock value is high
⮚Y- items whose stock value lies between X and Z
items
⮚Z - items are whose stock value is low
F-S-N classification
Based on their consumption pattern
⮚F - Fast moving
⮚S - Slow moving
⮚N – Non moving
S-D-E classification
Based on availability of items
⮚S – Scarce items
⮚D- Difficult to obtain
⮚E – Easy to obtain
G-O-L-F classification
Based on the availability and nature of suppliers
⮚G –Governmental suppliers
⮚O- Ordinary suppliers
⮚L- Local suppliers
⮚F- Foreign suppliers
S-O-S classification
Base on seasonal availability of items
⮚S – Seasonal items
⮚O –Off season items
⮚ In material management, the period in days that
elapses between placing an order and receiving
the stores is termed as lead time.
⮚ Delegation: Delegation is the process of assigning
responsibility and authority to co-worker and
ensuring his accountability.
Quality Assurance
⮚TQM
⮚CQI
⮚QC
⮚General approach
oCredentialing
oLicensure
oCertification
oAccreditation
Specific Approaches
⮚Peer review
⮚Audit
⮚Utilization review
⮚Client’s satisfaction
⮚Incident review
Models of Quality Assurance
PDCA- Plan Do Check Act-Edward Deming
Donabedian Model ( Dr Donabedian)
⮚ Identity strength and limit
Six Sigma
⮚It refers to six standard deviations from the mean
and is generally used in quality improvement to
define the number of acceptable defects or errors
produced by a process.
⮚By achieving six sigma, failure rate is minimized
to 3.4 defects per million opportunities (99.9996%
success rate).
⮚Five steps (DMAIC)
oDefine
oMeasure
oAnalyze
oImprove
oControl
Nursing Audit
⮚The word ‘audit’ comes from the Latin word
‘auditus’ means hearing.

⮚Nursing audit refers to assessment of the quality

of clinical nursing.
Elison
Methods of Nursing Audit

Retrospective view
⮚In-depth assessment of quality after the patient
has been discharged
Concurrent review
⮚Includes assessing the patient at the bedside in
relation to predetermined criteria; interviewing
staff responsible for care and reviewing patients
record and care plan.
Leadership
⮚Leadership is the art of motivating a group of
people to act towards achieving a common goal.
⮚Leadership is the ability to influence other people.
Leadership Styles
Lewin’s leadership styles
⮚Autocratic/authoritarian style
⮚Democratic/ participative leadership style
⮚Laissez-Faire leadership style
Motivation
⮚The word motivation is coined from the Latin
word ‘movere’ means ‘to move’.
⮚Motivation is defined as a driving force within
individuals by which they attempt to achieve some
goals to fulfill some needs or expectation.
Herzberg Two Factor Theory
⮚Hygiene factors → which can demotivate when
not present.
oExample: Security, status, relationship with
subordinates, personal life, salary, work
conditions, relationship with supervisor and
administration.
⮚Motivational factors → which will motivate
when present.
oExample: Growth prospects, job advancement,
responsibility, challenges, recognition and
achievements.
 Types of staff development
• Induction
• Job orientation
• In service education
• Continuing education
• Training for special function