ISHIK UNIVERSITY

FACULTY OF HEALTH SCIENCES

Department of NURSING,

Course book & Lecture Notes

Introduction to Nursing
For the first year students
2018 – 2019
Prepared by
Assist. Prof. Dr. Hoshyar Amin Ahmed

Introduction to Nursing Page 1

 ISHIK UNIVERSITY
FACULTY OF HEALTH SCIENCES
Department of NURSING,
2018-2019 Fall
Course Information for NSNG INTRODUCTION TO NURSING
Course Name: INTRODUCTION TO NURSING

Code Course type Regular Semester Theoretical Practical Credits ECTS

DENT 197 2 1 2 - 2 2
Name of Lecturer(s)-
Dr Hoshyar Amin Ahmed - PhD
Academic Title:
Teaching Assistant:
Course Language: English
Course Type: Basic
Office Hours 2
Contact Email: [email protected]
Tel:07504478527
Teacher's academic
Assistant Professor, PhD in Community Health Nursing, MSc in Community Health Nursing.
profile:
Course Objectives: At the end of the course the students will be able to discuss the historical development of
nursing, explain the professional growth within nursing, identify the critical attribution of
professionalism in nursing, discuss the difference between occupation and profession,
describe the nursing development, describe health and illness continuum, and recognize the
nursing research methodology.

Course Description This course provides a broad overview of Introduction to Nursing Profession and how it
(Course overview):
applies to everyday life. Major professional concepts are presented, including history,
professional development, socialization, nursing organizations, and nursing theories. Students
also explore the health illness and health care system and the nursing research methodology.

COURSE CONTENT
Week Hour Date Topic
1 2 25-29/11/2018 Definition of nursing
2 2 02-06/12/2018 History and development of nursing
3 2 09-13/12/2018 Profession and professionalism
4 2 16-20/12/2018 Nursing education
5 2 23-27/12/2018 Socialization in nursing
6 2 30/12/2018-3/1/2019 Levels of proficiency
7 2 6-10/1/2019 Models of professional socialization
8 2 13-17/1/2019 Organization socialization
9 2 20-24/1/2019 International and national nursing associations
10 2 27-31/1/2019 Philosophy of nursing theory
11 2 3-7/2/2019 Overview of nursing theory
12 2 10-14/2/2019 Health illness and health care system

Introduction to Nursing Page 2

 13 2 17-21/2/2019 Factors affecting health and illness
14 2 24-28/2/2019 Nursing research Methodology
15 2 3-7/3/2019 Nursing research methodology
16 2 10-14/3/2019 Final Examination
COURSE/STUDENT LEARNING OUTCOMES
1 Professional nursing
2 Nursing Research Methods
3 Nursing in health and wellness

Student's obligation You will be asked to fill out course evaluations before each of the two tests and before the final
(Special Requirements): exam. We are always open to feedback.
Course Book/Textbook:
Other Course
Handout texts, reports, presentations, and notes in the classroom
Materials/References:
Teaching Methods
Lectures, Exercises, Presentation, Assignments, Case Studies
(Forms of Teaching):
COURSE EVALUATION CRITERIA
Method Quantity Percentage (%)
Participation 1 10
Quiz 1 10
Homework 1 10
Midterm Exam(s) 1 30
Final Exam 1 40
Total 100

Examinations: Essay Questions, Multiple Choices, Short Answers

Extra Notes:

ECTS (ALLOCATED BASED ON STUDENT) WORKLOAD

Duration Total Work
Activities Quantity
(Hour) Load
Course Duration (Including the exam week: 16x Total course hours) 2 32 64
Hours for off-the-classroom study (Pre-study, practice) 16 16 256
Assignments Mid-terms 1 2 2
Final examination 1 2 2
Other 0
Total Workload 324
ECTS Credit (Total workload/25) 12.96

Peer review

Signature: Signature: Signature:

Name: Name: Name:
Head of
Lecturer De
Department

Introduction to Nursing Page 3

PREFACE

Before one can fully grasp the nature of nursing or define its practice, it is helpful
to understand the roots and influencing factors shaped its growth over time.
Nursing today is far different from nursing as it was practiced 60 years ago, and it
takes a vivid imagination to envision how the nursing profession will change as we
move forward in to the 21st century. To comprehend present-day nursing and at
the same time prepare for future, one must understand not only past events but also
contemporary nursing practices.

1.1 DEFINITION OF NURSING

Different people have defined nursing differently. However, in this unit we will see
some of the common definitions of nursing:

 Nursing is provision of optimal conditions to enhance the person's reparative

processes and prevent the reparative process from being interrupted.
 The practice of nursing is defined as diagnosing and treating human response
to actual or potential health problems through such services as case finding,
health teaching, health counseling; and provision of support to or restoration of
life and well-being and executing medical regimes prescribed by licensed or
otherwise legally authorized physician or dentist.
 Nursing is directed toward meeting both the health and illness need and man
who is viewed holistically as having physical, emotional, psychological
intellectual, social and spiritual.
 Nursing is a humanistic science dedicated to compassionate concern with
maintaining and promoting health, preventing illness and caring for and
rehabilitating the sick and disabled.

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 Nursing is a deliberate action, a function of the practical intelligence of nurses
and action to bring about humanely desirable conditions in persons and their
environments.
 As a practice discipline nursing's scientific body of knowledge is used to
provide an essential service to people, that is to promote ability to affect health
positively.

1.2. HISTORY AND DEVELOPMENT OF NURSING

It is difficult to trace the exact origin of the nursing profession. However, moral
action is the historical basis for the creation, evolution and practice of nursing.

1.2.1 NURSING IN ANCIENT CIVILIZATION

The early record of ancient civilization offers little information about those who
care for the sick. During this time beliefs, about the cause of disease were
embedded in superstition and magic and thus treatment often involved magical
cures.

 Ancient Egyptians developed community planning and strict hygienic rules

to control communicable diseases. The first recorded Nurses were seen
 In the Babylonian civilization, there were references to tasks and practices
traditionally provided by nurses. Nurses are mentioned occasionally in old
Testament as women who provide care for infant, for the sick and dying and
as midwives who assisted during pregnancy and delivery
 In ancient Rome, care of the sick and injuries was advanced in Mythology
and reality. Although medicine as a science was developed there was little
evidence of establishing a foundation for nursing.
 The ancient Greeks gods were believed to have special healing power. In
460 BC Hippocrates born and credited with being the Father of medicine. He
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 proved that illness had natural cause and not to be of a religious or magical
cause. Hippocrates first proposed such concepts as physical assessment,
medical Ethics, patient – centered care and observation and reporting. He
emphasized the importance of patient care that contributed a lot for the
groundwork of nursing.
 In ancient India, male nurses staffed early Hospitals and women served as
midwives and nursed ill family members.

1.2.2. NURSING IN THE MIDDLE AGES

During this time, monasticism and other religious groups offered the only
opportunities for men and women to pursue careers in nursing. It was the Christian
value of "love thy neighbor as the self" that had a significant impact on the
development of western nursing. The principle of caring was established with
Christ’s parable of Good Samaritan providing care for a tired and injured stranger.

In the third and fourth centuries several wealthy matrons of Roman empire,
including Marcella, Fabiola and Paula, converted to Christianity and used their
wealth to provide house of care and healing (the fore runner of hospital) for the
poor, the sick and homeless.

Women were not the sole providers of nursing service in the third century in
Rome. There was an organization of men called the parabalani Brotherhood. This
group of men provided care to the sick and dying from the great plague in
Alexandria.

1.2.3 DARK AGE OF NURSING

In this period Monasteries were closed and the work of women in religious order
was nearly ended. The few women who cared for the sick during this time were

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prisoners or homeless who had little or no training in nursing. Because of this,
nursing was considered as the most minimal of all tasks, and had little acceptance
and prestige.

1.2.4. THE DEVELOPMENT OF MODERN NURSING

Three images influenced the development of modern nursing. Ursuline Sisters of

Quebec organized the first training for nurses. Theodore Flender revived the
deaconess movement and opened a School in Kaiserwerth, Germany, which was
training nurses. Elizabeth Fry established the institute of Nursing Sisters. But in the
latter half of eighteenth century Florence Nightingale the founder of modern
nursing changed the form and direction of nursing and succeeded in establishing it
as a respected profession. She was born to wealthy and intellectual family in 1820.
In spite of opposition from her family and restrictive societal code for affluent
young English woman to be a nurse Nightingale believed she was "called” by God
to help others and to improve the wellbeing of mankind. In 1847 she received
three month's training at Kaiserwerth. In 1853 she studied in Paris with sister of
charity, after which she returned to England to assume the position of super
intendment of a charity hospital.

Nightingale worked to free nursing from the bonds of the church. She saw nursing
as a separate profession from the church, yet she began her career as the result of
the mystic experience.

During the Crimean war, Florence nightingale was asked to recruit a contingent of
female nurses. The Jamaica nurse Mary Grant was the first nurse recruited to
provide care to the sick and injured in the Crimean war. The achievements of
Florence nightingale in the war were so outstanding that she was recognized by the
queen of England who awarded her the Order of Merit.

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When she returned to England she established the nightingale school of nursing,
which was opened in 1860. The school served as a model for other training
schools. Its graduates traveled to other counties to manage hospitals and nursing
training programs.

1.2.5. HISTORY OF NURSING IRAQ

In ancient Iraq illness was considered to be punishment from sins or magic. Most
tribes and people had a medicine man or women called "Hakims" or “Tabeebs"
who performed rituals, using various plants and herbs to heal the sick. The
religious people were also providing care for the sick or injured in the religious
centers. Nursing training courses of six months duration were performed before
1950s. Intermediate nursing schools had been established since 1950s. Secondary
nursing schools established in 1970s. The first college of nursing had been
established in Baghdad University in 1962. Later on, colleges of nursing in other
cities had been established. In Kurdistan Region, the first college had been
established in Erbil firstly then in Suleimaniyah and Duhok respectively. In 2018,
two private colleges had been enrolled students in.

1.3.1. PROFESSION AND PROFESSIONALISM

Nursing is a profession. A profession is a calling that requires special knowledge

and skilled preparation.

1.3.2. CRITERIA OF A PROFESSION

• Professional status is achieved when an occupation involves practice,

• A profession carries great individual responsibility and based up on
theoretical Knowledge.

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 • The privilege to practice is granted only after the individual was completed a
standardized program of highly specialized education and has demonstrated
an ability to meet the standards for practice.
• The body of specialized knowledge is continually developed and Evaluated
through research.
• The members are self-organized and collectively assume the responsibility
of establishing standards for education and practice.

1.3.4. COMPARISON BETWEEN PROFESSION AND OCCUPATION

BASIS FOR
OCCUPATION PROFESSION
COMPARISON

Meaning Occupation refers to the A profession is an occupation or

regular activity performed vocation which requires a high
by a person to earn his degree of knowledge and
bread and butter. expertise in the specific field.

Code of conduct No Yes

Training Not necessary Compulsory

Regulated by No Yes
statute

Basis of pay Produce Skill and Knowledge

Higher education No Yes

Degree of There is no independence. A professional is completely

independence independent.

Responsibilities No Yes

Respect and Low Very high

Status

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PROFESSIONAL DEVELOPMENT

Professional development in Nursing can be viewed in relation to specialized

education, Knowledge base, Ethics, and autonomy.

1.3.4. ROLE OF THE PROFESSIONAL NURSE

1. Care provider: caring /comforting involve knowledge and sensitivity to what

matter and what is important to the client.

2. Communicator / Helper: Effective communication is an essential element of

all helping profession, including nursing. It helps the client to explain the internal
feeling.

3. Teacher/educator: teacher refers to activities by which the teacher helps the

student to learn. The client also need education based on the case.

4. Counselor: counseling is a process of helping a client to recognized and cope

with stressful psychological or social problem, to develop improved interpersonal
relationships and promote personal growth.

5. Client advocate: An advocate pleads the cause of others or argues or pleads for
a cause or proposal

6. Change agent: a change agent is a person or group who initiates changes or

who assists others in making modification in them or in the system.

7. Leader: leader ship is defined as mutual process of inter personal influence

through which the nurse helps a client make decision in establishing and achieving
goals to improve the client wellbeing.

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8. Manager: management defines manager as who plans, gives direction,
developing staff, monitoring operations, giving rewards fairly and representing
both staff member and administration as needed.

9. Researcher: majority of researchers in nursing are prepared at doctoral and

post-doctoral level. Although an increasing number of clinicians and nurses with
master’s degree are beginning to practice it.

1.3.5. NURSING EDUCATION

NURSING EDUCATION IN IRAQ

1. Practical Nursing Education: Hospital based practical nursing has been in

existence for many years due to shortage of nurses after the World War II. In the
past the practical nurse was the family, friends or community members who was
called to the home during emergencies. These were lay people who gained the
experience through self-taught. It started by requirement of 6th grade and lasted 3
months of training for male and females. Male students were awarded the title of
Dresser derived from “wound dressing”, while females were awarded the title of
Assistant Nurses. Then the duration of the training course changed to 6 months.

2. Assistant (Auxiliary nurses): This program required 6th grade and lasted for 3
years as intermediate nursing schools for only females. They were belonged to the
hospitals. The duration of the program was three years after primary school.

3. Nursing and Midwifery Secondary Nursing Schools: This program graduates

skilled nurses. It is existed in few of governorates. It was under the umbrella of the
General Foundation of Health Education and Training-Baghdad. Lately, it
belonged to the Health Directorates in each governorate. The duration of study is 3
years after intermediate school (9th grade).

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4. Technical Diploma: Duration of study is two years after secondary (High)
school (12th grade). This program is run by the Technical Institutes of the
Polytechnic or Technical Universities. The graduates had been employed under the
title “Institute Nurses”. Nowadays, this program is run by the Health Directorate in
Baghdad as well.

5. University Nurses: They study 4 academic years after secondary school (12th
grade) at the Faculties (Colleges) of Nursing. The graduates of this program are
awarded the title of University Nurses. The first College of Nursing had been
established in Baghdad University in 1962. It started by enrolment of female
students, while the first group of male student nurses was graduated from this
college in 1981. Later on the program continued in the other governorates.

Internationally, the following programs had been provided:

6. Registered nursing: In the United States, most basic education for registered
nurses is provided in three types of programs, Diploma, Associate degree, and
baccalaureate programs in Canada, the 2-years, 3-years or more diploma and
baccalaureate programs prepare registered nurses after passing a specific
examination.

4. Diploma: today’s diploma nursing program has changed markedly from the
original nightingale model, becoming hospital-based education programs that
provide a rich clinical experience for nursing students. These programs may last
two or more years and are often associated with colleges or universities.

5. Associate degree: In 1980 as a solution to the acute shortage of nurses that

came about because of World War II. Associated degree programs are offered in
the United States in junior colleges as well as in college and universities. An
associate's degree in nursing is a two-year degree that is obtained from a
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community college or vocational school. An associate's degree is the minimum
requirement to become a registered nurse; however, be advised that many
employers are requiring a bachelor's degree for many RN nursing roles.

6. Baccalaureate degree: Although baccalaureate nursing education programs

were established in universities in both United States and Canada in the early
1900s. In 1960s the number of the students enrolled in these programs increased
markedly. A bachelor of science in nursing (BSN) is required for many, but not all,
nursing careers. A BSN, like most bachelor's degrees, is typically a four-year
degree from a university or college. Like most other nursing degrees, a bachelor of
science in nursing combines classroom learning with hands-on training called
clinicals which allow students to obtain first-hand experience working with
patients in a clinical setting. A BSN should be obtained from an accredited nursing
program.

7. Masters programs: Requires a bachelor's degree in nursing or related field in

order to obtain MSN unless the student opt for one of the combined
bachelor's/master's programs. A master's degree in nursing is required to become
an advanced practice nurse (APN or APRN). Advanced practice nurses have more
clinical authority and autonomy, and typically earn more than "regular" registered
nurses. Some master's nursing programs may have a special focus or "track" for
certain medical specialties or types of nursing, such as a focus on forensic nursing
or a clinical nurse specialist track. A specialized master's degree is also required to
become a mid-level provider, such as a nurse practitioner (NP) or certified
registered nurse anesthetist (CRNA). Master's degrees are typically one to two
years of additional coursework that you can obtain while employed as a nurse.
Sometimes the employer will help pay for the master's degree in nursing if the

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student commit to working for a number of years into the future. An MSN must
also be completed from an accredited nursing program.

8. Doctorate Degrees in Nursing: The highest degree one can earn in nursing is a
doctorate level degree. You must first have a bachelor's and then a master's degree
before completing the doctorate degree in nursing and becoming what some refers
to as Doctor Nurse. There are two types of doctorates in nursing: a Doctor of
Nursing Practice (DNP) which focuses on the clinical aspects of nursing and a
Doctor of Nursing Science (DNSc, also a DSN or DNS). The latter is the more
common choice for those who wish to be professors at nursing programs or
researchers.

9. Continuing education: To formalize experiences designed to enlarge the

knowledge or skills of practitioners.

10. In service education: Program is administered by an employer; it is designed

to update the knowledge or skills of employees.

1.3.6. SOCIALIZATION IN NURSING

The Nurse student internalize, or take in, the knowledge, skills, attitudes beliefs,
norms culture, values and ethical standards of nursing and make them a part of
their own self-image and behavior. The process of internalization and development
of an occupation identity is known as professional socialization. Socialization is a
process by which a person learns the way of a group or society in order to become
a functioning participant. Socialization is a reciprocal learning process that occurs
through interaction with other people. Professional socialization in nursing is
believed to occur largely, but not entirely, during the periods students are in basic
nursing programs. It continues after graduation when they enter nursing practice.

Introduction to Nursing Page 14

Learning any new role is derived from a mixture of formal and informal
socialization E.g. Little boys learn how to assume the father role by what their own
fathers purposely teach them (formal socialization) and how they observe their
own and other fathers behaving (informal socialization).

In Nursing, formal socialization includes lessons the faculty intends to teach such
as how to plan nursing care, how to perform a physical examination on healthy
child, or how to communicate with psychiatric patient.

Informal socialization includes lessons that occur incidentally such as over

hearing a nurse teach a young mother how to care for her premature infant,
participating in the students nurse association or sitting in on nursing ethics
committee meeting part of professional socialization in simply absorbing the
culture of nursing that is the rites, rituals, and valued behavior of the profession.

This requires that students spend enough time with nurses in working setting for
adequate exposure to the nursing culture to occur. Most nurses agree that informal
socialization is often more powerful and memorable than formal socialization.

Learning any new role creates some degree of anxiety. Disappointment and
frustration sometimes occurs when student's learning expectations come in to
conflict with educational realities. Students' ideas of what they need to learn, when
they need to learn may differ from what actually occurs. They sometimes become
disillusioned when they observe nurses behaving in ways that differ from their
ideas about how nurses should behave. Knowing in Advance that these things may
happen can help students accurately assess the sources of their anxiety and manage
it more effectively.

Socialization is much more than the transmission of knowledge and skills. It serves
to develop a common nursing consciousness and is the key to keeping the
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profession vital and dynamic. It is not surprising there for that a good deal of
attention has been paid to this important process.

CHARACTERISTICS OF THE SOCIALIZED NURSE:

 Value her/his own beliefs and practice while respecting the belief and
practice of others.
 Respect the culture and religious beliefs of individuals.
 Become aware of the client’s culture as described by the client and know
client’s cultural values, beliefs, and behavior.
 Know what is right or wrong

The socialization process therefore involves changes in perception, knowledge,

skill, attitudes, and values. There are five levels of proficiency the nurse passes as
the nurse progress and acquires the knowledge, skill, attitudes, and values of
nursing.

LEVELS OF PROFICIENCY:

Stage 1 Novice: A novice may be a nursing student/ any nurse entering a clinical
setting where that person has no experience and governed by structured rules and
protocols.

Stage 2 Advanced beginner: can demonstrate marginally accepted performance.

The beginner has experience with enough real situations to be aware of meaningful
aspect of situation.

Stage 3 Competent: the nurse who has been on the job in similar situation for 2
or 3 years manifests Competence. Competence develops when the nurse
consciously and deliberately plans nursing care and coordinates multiple complex
care demands. Nursing competence provide a broad specification of nursing to
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cover the physical, psychological and spiritual care fields and serves as a bias for
considering the objectives of training. The major components of competency
include observation, interpretation, planning, action and evaluation.

Stage 4 proficient: The proficient nurse perceives a situation as a whole rather

than just its individual aspects. The nurse focuses on long-term goals and is
oriented toward managing the nursing care of a client rather than performing
specific task.

Stage 5 Expert: The expert nurse not only relies on rules, guidelines, or maxims
but also uses her/his understanding of situation to an appropriate action.

MODELS OF PROFESSIONAL SOCIALIZATION

1. COHEN'S STAGES OF PROFESSIONAL SOCIALIZATION

Stage I Unilateral dependence: Reliant on external authority, limited questioning

or critical analysis. Students are unlikely to question or analyze critically the
concepts teachers present because they lack the necessary background to do so.

Stage II Negatively/independence: Cognitive rebellion, diminished reliance on

external authority. Student’s critical thinking abilities and knowledge bases
expand.

Stage III Dependence/mutuality: Reasoned appraisal, beings integration of facts

and opinions following objective testing. Students evaluate the ideas of others.
They develop an increasingly realistic appraisal process and learn to test concepts
facts, ideas and models objectively.

Stage IV Interdependence collaborative decision making: commitment to

professional role; self-concept now includes professional role identity. Student's

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needs for both independence and mutually (sharing jointly with others) come
together

2. HINSHAW'S STAGES OF PROFESSIONAL SOCIALIZATION:

Hinshaw's stages of professional socialization is a potentially useful model

describing the educational aspect of professional socialization

Stage Key behavior

i. Initial innocence Initial image of nursing unaffected by reality

ii. Incongruities Initial expectations and reality collide, Questions carrier

choice; may drop out

iii. Identification Observes behavior of experienced nurses

iv. Role simulation Practices observed behavior; way feed unnatural in role

v. Vacillation Old image and conflict with new professional image

vi. Internalization Acceptance and comfort with new role

ORGANIZATION SOCIALIZATION

Organization socialization is the process by which an individual comes to

appreciate the values, abilities, expected behaviors and social knowledge essential
for assuming an organizational role and for participating as an organization
member.

The organization seeks through socialization to achieve high levels of individual

performance with positive impact on group and organization output.

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Each organization is an ongoing social system that has evolved a unique set of
values, ideas, frictions, conflicts, friendships coalitions.

It is the goal of orientation to enable the new person to enter this new system
intelligently and to cope successfully.

Socialization includes an introduction to group norms, the values and modes of

behavior that are respected.

Group norms are established as nurse’s attempt at resaving a potentially explosive

conflict of interest" the two conflicting interests are

1. A desire for companionship and peer recognition

2. A human desire for autonomy and individuality group norm can be positive
(supportive), negative (obstructing) or neutral (ineffectual)

The student nurses need orientation of the organization. The function of the
organization is to integrate individual and organizational needs which maintain the
integrity and self-confidence of the individual as well as the effectiveness and
unity of the organization.

As each individual is unique so each organization is unique. The blending of these

match less entities without sacrificing either, and augmenting both of them, make
up the special goal of orientation.

1.3.7. INTERNATIONAL AND NATIONAL NURSING ASSOCIATIONS

Associations are organizations of persons with common interests. As the number

of nurses increased the activities and problem in connection with work also
increased.

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A professional association is an association of practitioners who judge one another
as professionally competent and who banded together to perform social function’s
which they cannot perform in their separate capacities as individual.

NURSING ASSOCIATION

The nursing association must perform the following five functions for the
preservation and development of its profession

1. Defining and regulating the profession through setting and enforcing standard of
education and of education and practice for generalist and specialist.
2. Developing the knowledge base for practice in its broadest and narrowest
components.
3. Transmitting values norms, knowledge, and skill to nursing students, new
graduates and members of the profession for application in practice.
4. Communicating and advocating the value and contribution of field to several
publics and constituencies.
5. Attending to social and general welfare of their member. Professional
associations give their member social and moral support to perform their roles as
professionals and cope with professional problems.
INTERNATIONAL COUNCIL OF NURSES (ICN)

The international council of Nurses (ICN) was established in 1899. Nurses from
Great Britain, the United States, and Canada were among the founding members.
The Council is a federation of national Nurses’ association, such as the American
Nursing Association (ANA) and Canadian Association for Nurses (CAN).

THE OBJECTIVES OF ICN

1. To improve the standers and states of Nursing

2. To promote the development of strong National Nurses’ Association

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3. To serve as the authoritative voice for Nurses and the nursing profession
worldwide.
PHILOSOPHY OF NURSING THEORY

LEARNING OBJECTIVES

• Define belief, value and philosophy.

• Discuss the impact of beliefs and values on nurses’ professional practice.
• Explain the importance of a philosophy of nursing.
• Explain the importance of theory to the nursing profession
• Recognize some of the commonly used theories in nursing

Principled behavior flows from personal values that guide and inform our
responses, behaviors and decisions in all areas of our life. Ethical decision making
requires self-awareness and knowledge of ethical theories and principles. Such
awareness of self includes knowing what we value or consider important. Personal
values and moral development influence perceptions and decisions. This unit
examines the relationship of beliefs, values, and philosophies to the practice of
nursing. Therefore, readers are encouraged to examine their own values,
perspectives and tendencies and of other people and the situation they are in on
various decision making process.

2.1. BELIEFS, VALUES AND PHILOSOPHY OF NURSING

2.1.1. BELIEFS

A belief represents the intellectual acceptance of something as true or correct.

Beliefs can also be described as convictions or creeds. Beliefs are opinions that
may be, in reality, true or false. They are based on attitudes that have been

Introduction to Nursing Page 21

acquired and verified by experience. Beliefs are generally transmitted from
generation to generation.

In nursing, it is important to know and understand one’s beliefs because the

practice of nursing frequently challenges nurses’ beliefs. Although this may create
temporary discomfort, it is ultimately good because it forces nurses to consider
their beliefs carefully. They have to answer the question: “Is this something I
really believe, or have I accepted it because some influential person (such as a
parent or teacher) said it?” Abortion, living wills, the right to die, the right to
refuse treatment, alternative lifestyles, and similar issues confront all members of
contemporary society. Professional nurses must develop and refine their beliefs
about these and many other issues.

Beliefs are exhibited through attitudes and behaviors. Simply observing how
nurses relate to patients, their families, and nursing peers reveals something about
those nurses’ beliefs. Every day nurses meet people whose beliefs are different
from, or even diametrically opposed to, their own. Effective nurses recognize the
need to adopt nonjudgmental attitudes toward patients’ beliefs. A nurse with a
nonjudgmental attitude makes every effort to convey neither approval nor
disapproval of patients’ beliefs and respects each person’s right to his or her
beliefs.

CATEGORIES OF BELIEFS

People often use the terms beliefs and values interchangeably. Even experts
disagree about whether they differ or are the same. Although they are related,
beliefs and values are different.

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CATEGORIES OF BELIEFS:

1. Descriptive or existential beliefs: are those that are shown to be true or false.
An example of a descriptive belief is: “The sun will come up each morning.”

2. Evaluative beliefs: are those in which there is a judgment about good or bad.
The belief “Dancing is immoral” is an example of an evaluative belief.

3. Prescriptive (encouraged) and proscriptive (prohibited) beliefs: are those in

which certain actions are judged to be desirable or undesirable. The belief “Every
citizen of voting age should vote in every election” is a prescriptive belief, whereas
the belief “People should not engage in sexual intercourse outside of marriage” is a
proscriptive belief. Prescriptive and proscriptive beliefs are closely related to
values.

2.1.2. VALUES

Values are the social principles, ideals, or standards held by an individual, class, or
group that give meaning and direction to life.

A value is an abstract representation of what is right, worthwhile, or desirable.

Values reflect what people consider desirable and consist of the subjective
assignment of worth to behavior.

Although many people are unaware of it, values help them make both small, day-
to-day choices and important life decisions. Just as beliefs influence nursing
practice, values also influence how nurses practice their profession, often without
their conscious awareness. Everything we do, every decision we make and course
of action we take is based on our consciously and unconsciously chosen beliefs,
attitudes and values. Nursing is a behavioral manifestation of the nurse’s value
system.

Introduction to Nursing Page 23

Values influence behavior and that people with unclear values lack direction,
persistence, and decision-making skill. Because much of nursing involves having a
clear sense of direction, the ability to persevere, and the ability to make sound
decisions quickly and frequently, effective nurses must have a strong set of
professional nursing values.

TYPES OF VALUES

1. Personal Values: Most people drive some values from the society in which they
live. Eg: self-worth, sense of humor, , honesty, fairness and love

2. Professional values: are reflections of personal values. They are acquired

during socialization into nursing. Some of the important values of nursing are:

 Strong commitment to service

 Belief in the dignity and worth of each person
 Commitment to education
 Autonomy

VALUES CLARIFICATION

Nurses as well as people in other helping professions need to understand their

values. This is the first step in self-awareness, which is important in maintaining a
nonjudgmental approach to patients.

Importance of value clarification for nurses in professional practice

Value clarification in nursing:

 Provides a basis for understanding how and why we react and respond in
decision-making situations.

Introduction to Nursing Page 24

  Enables us to acknowledge similarities and differences in values when
interacting with others which ultimately promotes more effective
communication and care
 Enables nurses to be more effective in facilitating the nursing process with
others

Impact of institutional values on nurses

Nurses need to be conscious of both the spoken and unspoken values in their work
settings. Nurses should identify congruencies between personal values and those
of the institution, because accepting employment implies committing to the value
system of the organization.

CASE PRESENTATION

Azad has been the nurse manager of a unit for the past five years and is highly
regarded by the hospital’s administration. For the past several months, however, he
has been feeling less satisfied with his work because of staffing cuts and other
institutional decisions. Providing quality nursing care has always been the most
rewarding part of his job. However, recently he feels he is forced to attend more to
the needs of the organization. He considers leaving, but he has good benefits in the
organization and two children to support.

1. Identify values evident in this situation. Which of these reflect your personal
values?

2. What conflicts might arise from these values?

3. If you were in Azad’s position, what beliefs, ideals, or goals would guide you in
making a decision to stay or leave? Identify potential consequences of each choice.

Introduction to Nursing Page 25

Values Govern Nursing’s Social Policy statement

Groups, such as nursing, have collective identities that are evidenced by their
actions. These actions stem from a set of values and choices and by examining the
actions of groups from which their basic values can be logically inferred.

Organized nurses, sets forth the values that govern the profession. This is done in
a document published from time to time that is designed to explain nursing’s
relationship with society and nursing’s obligation to those who receive nursing
care.

2.1.3. PHILOSOPHY

Philosophy is defined as the study of the truths and principles of being, knowledge,
or conduct. A more literal translation, based on the Greek root words, means the
“love of wisdom”. It is a set of beliefs and attitudes that direct the behavior of
individuals to the achievement of a goal.

Everyone has a personal philosophy of life, which is unique from all others. People
develop personal philosophies as they mature. These philosophies serve as
blueprints or guides and incorporate each individual’s value and belief systems.

PHILOSOPHIES OF NURSING

Philosophies of nursing are statements of beliefs about nursing and expressions of

values in nursing that are used as bases for thinking and acting. Most philosophies
of nursing are built on a foundation of beliefs about people, environment, health,
and nursing

Every nurse has a philosophy of a set of beliefs upon which to base nursing action.
Nurses’ personal philosophies interact directly with their philosophies of nursing

Introduction to Nursing Page 26

and influence professional behaviors. An important point about philosophies of
nursing is that they are dynamic and change over time. Developing a philosophy
of nursing is not merely an academic exercise required by accrediting bodies.
Having a written philosophy can help guide nurses in the daily discussions they
must make in nursing practice.

SAMPLE PHILOSOPHY NURSING

Introduction

This statement of philosophy and purpose is developed from the thinking of

different nursing theorists.

Purpose

The purpose of Black lion nursing services and programs is to ensure that each
patient receives professional nursing care that is patient centered and goal –
directed, and to support healthcare education and research in nursing and other
disciplines. Black Lion nurses and their associates in the division of nursing carry
out their activities with one focus in mind– assisting the patient to achieve optimal
health outcomes.

Nursing as a Profession Service

Professional nursing is complex service that assists people (sick or well) in the
performance of those activities contributing to health, or its recovery (or to a
peaceful death) that they would perform unaided if they had the necessary strength,
will be or knowledge. It is likewise the unique contribution of nursing to help
people to be independent of such assistance as soon as possible. The activities that
nurses help patients carry out (or those that nurses carry out for patient) include the
therapeutic plans prescribed by physicians, by other health care providers, and by

Introduction to Nursing Page 27

nurses themselves. In carrying out these activities, nurses practice an art through
which technical; observation skills as well as scientific knowledge and clinical
judgment are systematically applied to the health needs of others in a caring
manner. Caring means being connected and having things matter. Thus by caring,
the nurse creates possibilities for coping in the face of risk and vulnerability.

2.2. OVERVIEW OF NURSING THEORY

Nursing theory attempts to describe or explain the phenomenon of nursing.

Nursing theory differentiates nursing from other disciplines and activities.
Theories are general concepts used to explain, predict, control, and understand
commonly occurring events. Theories provide a method of classifying and
organizing data in a logical, meaningful manner. A theory is a set of systematically
interrelated concepts or hypothesis that seeks to explain and predict phenomena.

Reasons for the interest in theory:

1. Theory development contributes to knowledge building and is seen as a means

of establishing nursing as a profession

2. The growth and enrichment of theory in and of itself is an important goal of

nursing, as a scholarly discipline, to pursue

3. Theory helps practicing nurses categorize and understand what is going on in

nursing practice; it helps them to predict client's response to nursing services and is
helpful in clinical decision making.

Relationship of theory to practice and research

Professional nursing practice is grounded in a theoretical foundation. Theoretical

concepts are developed as nursing practice evolves and is examined with respect to

Introduction to Nursing Page 28

existing knowledge. When these concepts are scientifically validated in a multitude
of practice situations, they provide guidelines for practice by way of conceptual
models. Conceptual models attempt to explain the nursing paradigm, or overall
scheme, which relates the nursing client to the context of environment of care, to
the health or illness situation, and to the practice of nursing. Following are some of
the commonly used theories in nursing.

2.3. TYPES OF NURSING THEORIES

General systems theory

A system is a set of interacting elements, all serving the common purpose of

contributing to the overall goal of the system. The whole system is always greater
than the sum of its parts.

Systems are hierarchical in nature and are composed of interrelated subsystems

that work together in such a way that a change in one element could affect other
subsystems as well as the whole. Boundaries separate systems both from each
other and from their environment

A system communicates with and reacts to its environment through process that
enters the system (input) or is transferred to the environment (output). An open
system allows energy, matter and information to move freely between systems and
boundaries. Open systems maintain balance through feedback.

Understanding systems theory helps nurses assess interaction among the input,
throughput and output process. The system theory helps nurses to view the
individual client, the family as well as the community holistically.

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Neumann’s Health care systems

Neuman Health care systems theory is derived from the systems theory. It is an
open systems model of two key components: stress and reaction to it. Both noxious
and beneficial stressors operate on the system, which attempts to maintain balance
or homeostasis.

Nursing is an interdependent part of the health care system and its surrounding
social system. Nursing's reciprocal relationship with system subparts contributes to
optimal functioning and the evolutionary survival of the whole system. The nurse
assesses the two of entropy and negentrophy to guide her/his interventions, which
aim to counteract entropy with a form of evolutionary adaptation, restoring and
maintaining equilibrium between forces or stressors. The nurse assesses the
factors, which influence a person's perceptual field; the meaning a stressor has top
client and the factors in his/her own perceptual field, which influences assessment
and giving care.

Roy adaptation Theory

According to this theory nursing is the practice of facilitating the adaptation of an

individual’s four subsystems (physiologic, self-concept, role function,
interdependence). The nurse attempts to modify or maintain stimuli affecting
adaptation within the nursing process. Nursing assessment focuses on two units of
analysis: the person's system and environmental interaction, while intervention is
concerned with manipulation of parts of the system or environment.

Orem's self-care nursing Theory

The model revolves around the concept of self-care. Orem describes nursing as a
creative effort of one human being to help another human being. Nursing is a

Introduction to Nursing Page 30

helping system which can be wholly compensatory; that is, the client is unable to
achieve self-care, therefore has health deviation self-care requisites; partly
compensatory where both nurse and client work to achieve self -care; or
supportive, educative, where the client is able to perform, or can and should
perform self-care but does not do so without assistance.

Rogers Model of the science of Unitary Man

Martha Rogers developed a model based on systems theory. She developed her
model around four components, which she called

1. Universe of open systems

2. Energy fields
3. Pattern and organization
4. Four dimensionality.

Using this model one can focus on client environment interaction and see the client
as functioning interdependently with others and the environment. The nurse's goal
is to promote holistic health and environment interaction in order to maximize
client health potential.

Johnson Behavioral Systems Model

Johnson believes that nursing care is directed toward caring for the whole patient
to facilitate effective and efficient behaviors necessary to prevent illness. Johnson
views nursing as being separate from medicine. She sees nursing's role as being
complementary to the medical role. This model emphasizes that both the internal
and external environments of the system need to be orderly and predictable to
maintain homeostasis. If the subsystems are out of balance, tension and

Introduction to Nursing Page 31

disequilibrium result. Nursing, as part of the external environment can help the
patient return to a state of balance.

REVIEW QUESTIONS

1. Describe the differences and similarities of belief, value and philosophy.

2. Discuss how values influence nursing practice? List two of your values
supportive of nursing practice and explain the mechanisms by which you acquired
these values

3. Discuss why value clarification is important both personally and professionally

4. Discuss how a philosophy of nursing influences nursing practice

5. What is the importance of theory development in nursing?

6. Discuss some of the commonly used theories in nursing.

7. You are appointed to a position of a Matron in a new hospital, and are asked to
formulate a philosophy how do you do it?

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HEALTH ILLNESS AND HEALTH CARE SYSTEM

LEARNING OBJECTIVES

1. Define health and illness

2. Explain the importance of health models to the profession of nursing
3. Discuss the commonly used health models in nursing

3.1. HEALTH AND ILLNESS

The World Health Organization defines health as “a state of complete physical,

mental and social well-being, not merely the absence of disease and infirmity.
This definition considers the total persons state of health and wellness as essential
component.

Health and illness is a relative concept, which is perceived differently by different

individuals. Wellness is not only the absence of disease; therefore, any definition
of health should consider the different dimensions influencing health.

The concept of health and wellness must allow for an individual variability. Health
is a dynamic state in which the person is constantly adapting to changes in the
internal and external environment.

Various models on the concept of health and wellness exist. Some are based on the
presence and absence of disease and others on holism, health beliefs and wellness.

3.2. MODELS OF HEALTH AND ILLNESS

Health models have been developed to help describe the concepts and relationships
involved in health and illness.

Introduction to Nursing Page 33

a. Host–agent-environment model

According to this model health is an ever-changing state and health and illness
depends on interaction of host, agent and environmental factors. These factors are
constantly in interaction and a combination of factors increases the possibility of
illness. When the agent, host and environment variables are in equilibrium health is
maintained. On the other hand when the balance is disrupted disease occurs.

Host–agent-environment model

b. The Health illness continuum model

According to this model, health is a constantly changing state, with high level
wellness and death being in the opposite ends of a graduated scale, or continuum.
The nurse must be aware that a client may place himself/herself at different points
on the continuum at any given time depending on how well he/she believes himself
to be functioning for his illness

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 The health illness continuum model

c. High-level wellness model

This model describes high-level wellness as functioning to one's maximum

potential while maintaining balance and purposeful direction in the environment.
The concept of high level of wellness can be applied to the individual, family,
community, environment, and society.

In High-level wellness model human beings are viewed as having five aspects:

1. Each individual is functioning as a total personality

2. Each person possess dynamic energy
3. Each person is at peace with inner and outer worlds
4. Each person has a relationship between energy use and self-integration
5. Each person has an inner world and an outer world

These five processes help the person know who and what he/she is. This model is
holistic, allowing the nurse to care for the total person with regard for all
dimensional factors affecting the person's state of being as he/she strives to reach
maximum potential.

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d. Health Belief Model

The health belief model is based on what people perceive, or believe, to be true
about them in relation to health. This model is based on three components:
perceived susceptibility to a disease, perceived seriousness of a disease and
perceived value of action. This model states that whether or not a person practices
a particular health behavior can be understood by knowing two factors: the degree
to which the person perceives a personal health threat and the perception that a
particular health practice will be effective in reducing that threat.

The perception of a personal health threat is itself influenced by at least three

factors: general health values, which include interest, and concern about health;
specific beliefs about vulnerability to a particular health problem; and beliefs about
the consequence of the health problem.

Whether or not the perception of a threat leads to changing health behavior also
depends on whether a person thinks a particular health practice will be effective
against the health problem in question and whether or not the cost of undertaking
that measure exceeds the benefits of the measure. The health belief model enable
nurses to understand why people practice health behavior and also to predict some
of the circumstances under which people’s health behavior will change.

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3.3. FACTORS AFFECTING HEALTH AND ILLNESS

1. Physical dimension-genetic makeup, age, developmental level, race and sex

2. Emotional dimension-how the mind and body interact to affect to body
function and to respond to body conditions also influence s health. Eg. long
term stress affects the body systems, anxiety affects health habits and
conversely calm acceptance and relaxation can actually change body
responses to illness.
3. Intellectual dimension-encompasses cognitive abilities, educational
background and past experiences.
4. Environmental dimensions-the environment has many influences on health
and illness. Housing sanitation, climate, pollution of air, food and water are
aspects of the environmental dimension.

Introduction to Nursing Page 37

 5. Sociocultural dimensions- health practices are strongly influenced by a
person's economic level, life style, family and culture.
6. Spiritual dimensions-spiritual and religious beliefs and values are important
components of how a person behaves in health and illness.

Dimensions of health and illness

3.4. NURSING IN WELLNESS AND HOLISTIC HEALTH CARE

Nurses carry out wellness promotion activities on primary, secondary and tertiary
levels

PREVENTING ACTIVITIES

Primary prevention: is a care directed toward health promotion and specific

protection against illness. E.g. Immunization, family planning and health
education.

Secondary Prevention: focuses on health maintenance for clients experiencing

health problems on prevention of complication or disabilities. E.g. Nursing care for
hospitalized clients, early detection and treatment of health problems.

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Tertiary prevention: is aimed at helping rehabilitate clients and restore them to a
maximum level of functioning following an illness. E.g. teaching a diabetic client
how to recognize and prevent complications.

REVIEW QUESTIONS

1. Why do you think the definition of health and illness is relative?

2. Discuss the contribution of health models in explaining health and illness
relationships and interactions
3. What are the factors influencing health –illness status.
4. In Iraq, how do you think sociocultural and spiritual development affect
health?
4.1. NURSING RESEARCH METHODOLOGY

a. DEFINITION OF RESERCH
Research is defined as a systematic and scientific process to answer to questions
about facts and relationship between facts. It is an activity involved in seeking
answer to unanswered questions. Research seeks to generate an answer to the
problem as well as suggesting additional questions in flood of further inquiry.
b. NEED FOR RESEARCH AND PURPOSES
 Develop, refine, and extend the, scientific base of knowledge, which is
required for quality nursing care, education, and administration.
 Enhance the body of professional knowledge in nursing.
 Provide foundation for evidence-based nursing practices.
 Help in expansion of knowledge, which is essential for continued growth of
nursing profession.
 Enhance their professional identity as research is an essential component of
any profession.
 Define the parameters of nursing, which will help nurses to identify
boundaries of nursing profession.
 Refine and eliminate old knowledge so that it helps in elimination of nursing
actions that have no effect on the achievement of desired client outcomes.

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  Enhance accuracy of different nursing educational and administrative
techniques.
 Develop and refine nursing theories and principles.
4.3. RESEARCH PROCESS
Conceptual phase
 Formulating and delimiting the problem
 Reviewing the related literature
 Under taking clinical field work
 Defining the framework and development of conceptual definitions
 Formulating hypothesis
Designing and planning phase
 Selecting a research design.
 Developing protocol for intervention
 Identifying the population to be studied
 Designing the sample plan.
 Specifying the method to measure the research variable.
 Developing methods for safeguarding human / animal rights.
 Finalizing and reviewing the research plan. ( pilot study. )
Empirical phase
 Collecting the data
 Preparing the data for analysis.
Analytic phase
 Analyzing the data
 Interpreting the result
Dissemination phase
 Communicating the findings
 Utilizing the finding in practice.
4.4. TYPES OF NURSING RESEARCH
According to earnest desire
1. Basic research
2. Applied research
3. Exploratory research
4. Descriptive research
5. Diagnostic research
Introduction to Nursing Page 40
 6. Evaluative research
7. Action research.
1. BASIC RESEARCH
 It is also known as Pure, theoretical or fundamental research, which is
always aimed to enriching the theory, by unraveling the untold mysteries of
nature.
 Basic research is the formal and systematic process of deductive-inductive
analysis leading to the development of theories.
 It is a theoretical or pure research that generates, rests and expands theories
that describe, explain, or predict the phenomenon of interest to the discipline
without regard to its later use.
PROCESS OF BASIC RESEARCH:
 OBSERVATION
 INDUCTI ON
 DEDUCTI ON
PURPOSES OF BASIC RESEARCH
 Basic research offers solution to many practical problems, e.g. Maslow's
theory of motivation.
 Basic research helps to find the critical factors in a practical problems/ e.g.
commonsense approach to any problem.
 Basic research develops many alternative solutions and thus enables us to
choose the best solutions.
Example
Behavioral and cognitive behavioral group –based on parenting programmes for
early – onset conduct problems in children aged 3 -12 year
2. APPLIED RESEARCH
 Applied research or empirical research always aims at enriching the
application of the theory
 It refers to "answers questions related to the applicability of basic theories in
practical situation; tests the practical limits of descriptive theories that does
not examine the efficacy of actions taken by practitioners."
 Applied research has been referred to as "practical application of the
theoretical."

Introduction to Nursing Page 41

Example:
The results of the applied research study "the effect of a social support boosting
interventions on stress, coping and social support in care givers of children with
HIV/AIDS" provide an example of research that has the potential for application in
specific practice settings. The results of the study indicated the seronegative
caregivers participating in a social support boosting intervention showed
substantially increased coping abilities.

CONTRIBUIONS OF APPLIED RESEARCH

 Uncovers new facts, which can contribute new facts which enrich the
concerned body of knowledge
 Offers an opportunity to test the validity of existing theories
 May help in conceptual clarification
 May integrate previously existing theories

3. EXPLORATORY RESEARCH
 Exploratory or formulative study conducted which relatively little is known
about the phenomenon, sometimes called pilot study.
 As enough data relevant to the problem are gathered the researcher
knowledge about his subject improves and he becomes capable of formulate
a clear hypothesis for further testing and confirmation.

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  Since this type of research the emphasis on discovery of ideas and insights
its design is always kept flexible and non-structured to permit considerations
of different aspects of a phenomenon.
PURPOSES OF EXPLORATORY RESEARCH
 To generate new ideas
 To increase the researchers familiarity with the problem, or 
 To make precise formulation of the problem
 To determine whether it is feasible to attempt the study

4. DESCRIPTIVE RESEARCH
 Descriptive research is non-experimental research designed to discover new
meaning and to provide new knowledge where there is very little known
about the phenomena of interest.
 Data collection by using one or more appropriate methods; observation,
interviewing and mail questionnaire.

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  Descriptive research aims at answering the 'what' and 'why' of the current
state of some system.

CRITERIAS OF DESCRIPTIVE RESEARCH

 Problem must be describable and not agreeable.
 The data should be amenable to an accurate objective and if possible
quantitative assemblage for reliability and significance.
 It should be possible to develop valid standards of comparison.
 It should lend itself to verifiable procedure for collection and analysis of
data.

5. DIAGNOSTIC RESEARCH
 Diagnostic study is similar to descriptive study with a different focus. It is
directed discovering what is happening, why it is happening and what can be
done. It aims at identifying the causes of problem and the possible solutions
for it.

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  More directly concerned with causal relationships and with implications for
action than descriptive study.
 Directed towards discovering not only what is occurring but why it is
occurring and what can be done about it.
 More actively guided by hypothesis than descriptive study.
 Not possible in areas where knowledge is not advanced enough to make
possible adequate
6. EVALUATIVE RESEARCH
 Evaluation is the determination of the results attained by some activity
(whether a Programme, a drug or a therapy or an approach or nursing
approach) diagnosed to accomplish some valid goal or objective.
 Evaluation study is made for assessing the effectiveness of social, or
economical, or health programmes implemented or for assessing the impact-
of developmental projects on the development of the project area (e.g.,
evaluate the effectiveness of structured teaching programmes on different
topics).
PURPOSES OF EVALUATIVE RESEARCH
 To discover whether and how well the objectives are being fulfilled.
 To determine the research for specific success or failure.
 To direct the course of experiment with techniques for increasing
effectiveness.
 To uncover principles underlying a successful programme.
 To base further research on the reason for the relative success of alternative
techniques.
 To redefine the means to be used for attaining objectives and to redefine
sub-goals, in light of research findings.
7. ACTION RESEARCH
 Action research arose from social change theory and has become a valuable
strategy in a variety of practice settings including nursing. As its name
implies action researchers pursue action and research outcomes at the same
time.
 Action research is focused on immediate application, not on the
development of theory or on general application.

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  Action research has the advantage of allowing research to be done in
situations where other research method may be difficult or impractical use.
"To achieve action, action research, is responsive, it has to be able to
respond to the emerging need of the situation .It must be flexible in a way
then some other research methods cannot be.


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QUALITATIVE RESEARCH
 Qualitative research is particularly well suited to study the human
experience of health, a central concern of nursing science.
 Because qualitative methods focus on the whole of human experience and
the meaning ascribed by individuals living the experience.
 These methods permit broader understanding and deeper insight into
complex human behaviours that what might be obtained from surveys and
other linear measures of perceptions

PHENOMINOLOGICAL STUDY

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Phenomenology is a "science whose purposed is to describe particular phenomena
or the appearance of things as lived experience." Six core steps used in
phenomenological study
1. Descriptive Phenomenology: It involves direct exploration analysis and
description of particular phenomena as free as possible from unexamined pre
suppositions aiming at maximum intuitive presentation.
2. Phenomenology of essence: Phenomenology of essence involves probing
through the data to search for common themes or essence and establishing patterns
of relationship shared by particular phenomenon.
3. Phenomenology of Appearances: Phenomenology of appearances involves
giving attention to the ways in which phenomena appear. In watching the ways in
which phenomena appear the researcher pays particular attention to the different
ways in which an object presents itself.
4. Constitutive Phenomenology: Constitutive phenomenology is studying
phenomena as they become established or constituted in our consciousness.
5. Reductive Phenomenology: Reductive phenomenology although addressed as a
separate process occurs concurrently throughout a phenomenological investigation.
The researcher continually addresses personal biases assumptions and purest
description of the phenomenon under investigation.
6. Interpretive or Hermeneutic Phenomenology: Interpretive frameworks within
phenomenology are

GROUNDED THEORY
 Grounded theory is an inductive, qualitative research method that seeks to
understand and explain human behavior
 The aim of this theory approach is to discover underlying social forces that
shape human behaviour. This method is used to construct theory where no
theory exists or in situations where existing theory fails to explain a set of
circumstances. The goal of this method is the development of theory that
explains underlying social and psychological processes.
For example , Nathanial’s study their main concern was moral distress and the
core category which processed their concern was moral reckoning.

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ETHNOGRAPHY
 Ethnography is the systematic process of observing, detailing, describing,
documenting and analysing the lifeways or particular patterns of culture or
subculture in order to group the lifeways or patterns of the people in their
familiar environment.
 Ethnographic attempts to describe the culture of group from the perspective
of the members- that is, how they view their own culture-through in-depth
study that involves systematic observations of the group activities language
and customs.
Historical Research
 History is a meaningful record of human achievement. It is not merely a list
of chronological event but a truthful integrated account of the, relationships
between persons, events, times and places.
 The use of history is to understand the past and try to understand the present
in the light or past event and development .
 Historical study is a study of past records and other information source with
view to restructuring the origin and development of an institution or a
movement or a system and discovering the trends in the past.

QUANTITATIVE RESEARCH
1. EXPERIMENTAL RESEARCH

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TYPES OF EXPERIMENTAL RESEARCH
 Pretest/post-test control group design
 Solomon four-group design
 Two-group random sample design
 Matching samples design
 Factorial designs.

RESEARCH DESIGNS
A quasi-experimental design may be defined as a quantitative research design in
which there is always manipulation of the independent variable(s) and control
measures are employed, but the other element of a true experiment, random
assignment of subjects, is absent.
1. Nonrandomized control group design
2. Counterbalanced design
3. Time series design
4. Control group time series design.
The nonrandomized control group design, also termed the none equivalent control
group design is often used in nursing research studies. When circumstances
preclude.
•random assignment of subjects to an experimental and control group at the
beginning of an experiment.
•A nontreatment group may be established for the purpose of comparing outcomes.
• However, there is no way to guarantee that the groups are equivalent as to other
characteristics. The counterbalanced design is more
Some of the previously described problems. This design can be used when more
than one treatment method is attempted. Each group of subjects is given a different
treatment at the same point in time during the course of the experiment.
The time series design is useful when an experimenter wants to measure the
effects of a treatment over a long period of time. In this design, the experimenter
would continue to administer the treatment and measure the effects a number of
times during the course of experiment.

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PRE-EXPERIMENTAL DESIGNS
Pre-experiments are the simplest form of research design. In a pre-experiment
either a single group or multiple groups are observed subsequent to some agent or
treatment presumed to cause change.
Types of Pre-Experimental Design
 One-shot case study design
 One-group pretest-posttest design
 Static-group comparison
NONEXPERIMENTAL QUANTITATIVE RESEARCH DESIGNS
In nonexperimental research, the researcher collects data and describes phenomena
as they exist. Unlike experimental research variables are not manipulated because
no interventions take place, there are no control measures, and there is no random
assignment of subjects to groups'
The following nonexperimental designs will be discussed:
I. Correlational designs.
II. II. Descriptive designs
III. III. Time perspective designs
IV. IV. Retrospective designs
V. V. Prospective designs
VI. VI. Designs that use existing data
VII. VII.Focus group research
VIII. VIII.Content analysis.

A. CORRELATIONAL DESIGNS
Correlational designs are nonexperimental designs that allow the researcher to
infer relationships among two or more variables, rather than to draw conclusions
about cause and effect.
B. DESCRIPTIVE DESIGNS
Descriptive research is often a preliminary to correlational research or to
experimental studies. Descriptive research studies (nit to be confused with
qualitative research) can serve new meaning and to provide new knowledge when
there is very little known about a topic of interest, They also provide a knowledge
base when a research problem needs to be refined when hypotheses need to be
formulated or data collection and analysis procedures need to be designed.

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C. TIME PERSPECTIVE DESIGNS.
In time perspective designs (also called time dimensional designs), time is an
important factor. Time perspective designs are concerned with examining trends or
changes across time.
D. RETROSPECTIVE DESIGNS
In retrospective designs (retrospective means "looking backward"), changes in the
independent variable have already occurred before the research due to the natural
course of events. The dependent variable (Y) is identified in the present, and then
the researcher looks to the previous event that has already occurred to identify the
possible independent variable.
E. PROSPECTIVE DESIGNS
In contrast to retrospective studies' which identify the dependent variable in the
present and look to the past to identify the independent variable, prospective
designs identify the independent variable (x) in the present and look to the future
to identify potential effects (Y).
F. DESIGNS THAT USE EXISTING DATA
Meta-analysis is a technique in which the investigator examines research findings
across a number of research investigations relating the same general phenomenon.
The investigator then pools the synthesizes the findings that is brings together the
findings of the many separate investigations relating to the same general
phenomenon. “The original investigators have done the analyzing; the meta-
analyst synthesizes the results of these analyses”
G. FOCUS GROUP RESEARCH
Focus group research design is a method that allows the researcher to examine the
points of view of a number of individuals as they share their opinions/concerns
about a topic. Essentially, a focus group consists of a small number of individuals
who share a common bond. This bond might be any number of things such as age,
number of children, wealth or lack of it, a specific disease or any other
commonality defined by the researcher.
H. CONTENT ANALYSIS
Content analysis is a data-analysis method that is used not only in quantitative
research but also in qualitative research. In quantitative research, content analysis
can be used as “a method to make inferences based on systematic, objective, and
statistical analysis of written text or oral communication and documentation”.

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In qualitative research, content analysis is a process to analyze the content of
qualitative information gathered from the study participants by "categorizing
observations into themes and concepts emerging from the data".
EXPERIMENTAL RESEARCH
1. This type of research always begins with some hypothesis which the
researcher wants to test.
2. Control of extraneous variables is a very important phase in this type of
research. Extraneous variables are those which operate in the experimental
situation in addition to the independent variable, they must be controlled, so
that they will not mask the possible effect of the independent variable.
3. Data generated by the research are used to establish cause and effect
relationship between two variables. On the basis of this data, one can predict
changes in the dependent variable for given changes and the independent
variables.
4. This type of research is narrow in scope. There are number of social science
subjects where this type of research is not possible.
NON EXPERIMENTAL RESEARCH
1. In this type of research, it is not essential to always have a hypothesis. All
exploratory and many descriptive research do not have any hypothesis.
2. In this type of research, the researcher exercises very little control over
extraneous variables.
3. Data generated by this type of research are not helpful in establishing the
cause and effect relationship between variables.
4. They can be used only to describe certain relationship without showing that
functions interdependent.
5. The scope of the research is very wide and applicable for all social science
research

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 ORGANIZATION OF RESEARCH PAPER
AIMRaD FORMAT

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