Basic research terminology

Basic research terminology

• The study investigation or Research project

When researcher addresses a problem or states a question and answers it through a disciplined research called study investigation or project.

• Researcher/Investigator/Scientist

Person who does a project is called as researcher/investigator/scientist.

• Subjects / Study participants

The people who are being studied in a quantitative study called as subjects. When subjects answer questions by the researcher called as respondents. In qualitative study, the individuals cooperating in the study play an active role referred to as informants.

• Phenomena or Concepts

The abstractions of particular aspects of human behavior such as pain, coping and so on called as concepts. In qualitative research, these abstractions are phenomena.

• Constructs

These are abstractions that invented or constructed by researcher, for example, ‘self care’ in Orem’s model or ‘stress adaptation’ in Roy’s model.

• Theory

A theory is systematic, abstract explanation of reality. Here, concepts are arranged together and explains the reality. In quantitative study, the researcher starts with a theory or a conceptual model and makes predictions about how phenomena will behave if the theory were true using deductive reasoning. In qualitative research, information from the participants gathered in which the researcher begins to conceptualize, seeking to explain patterns from the researcher- participant interactions. The goal is to arrive at a theory that explains phenomena as they occur, not as they are preconceived.

• Variables

In a quantitative study, concepts are referred as variables. The researcher attempts to understand how or why things vary and to learn about relationship. For example, a research focuses on lung cancer as a variable and the researcher studies the factors linked to lung cancer and to reach a conclusion that smoking causes lung cancer.
A variable has values continuously (height or weight) called continuous variable. The variable that expressed under category called categorical variables (male/female).

• Dependent and Independent variable

Many researchers focus on determination of cause and effect of phenomena. The presumed cause is independent variable and presumed effect is dependent variable. Variation of dependent variable is presumed to depend on variation in the independent variable. In a study, the researcher experiments the effect of coconut oil (the independent variable) on weight gain in premature infants (the dependent variable). These two variables are used to designate the direction of influence among them.
Example: A study to assess the effect of timing of sponge bath on axillary temperature
Independent variable: Timing of sponge bath
Dependent variable: Axillary temperature

• Conceptual definition and Operational definition

The variable will be defined as concepts universally called conceptual definition. The same variable will be defined by researcher indicating how the variable will be observed and measured in the actual research situation called as operational definition. The operational definition of a concept specifies the operations that the researcher must perform to collect the required information. The variable ‘weight’ can be operationally defined as ‘the amount that an object weighs in terms of pounds’.

• Data

The research datum (data) is the pieces of information obtained in a study. In quantitative study, the researcher identifies variables, develops operational definition of variables and collects the relevant data from the subjects related to variables. The researcher collects information as numerical data. The results show that 36% of study subjects have adequate knowledge regarding mammography and 64% of them are unaware of it.
In qualitative studies, the researcher collects the data as narrative descriptions called qualitative data. It can be obtained through conversations in naturalistic setting or obtaining narrative records such as diaries.
 For example: Question 1- Have you felt depressed in the morning?
           Participant 1- I have had a few ups and downs in the morning.

• Relationships

Researchers study phenomena in relation to other phenomena as they explore or test relationships. A relationship is a bond or connection between phenomena. For example; relationship between smoking and lung cancer. Both quantitative and qualitative researches help to examine the relationships. In a quantitative study, the researcher is interested in relationship between independent and dependent variables. Variation in the dependent variable is presumed to be related to variation in the independent variable. For example:  When education level of study subjects increase, the knowledge regarding prevention of non communicable diseases increases. Most quantitative research is conducted to determine the existence of relationship between the variables and often to quantify the strength of relationship.
Among variables, a variable acts as a cause and it leads to an effect called cause and effect (causal) relationship. Foe example, there is a relationship between calorie intake and weight gain.  An increase of one variable leads to increase in another variable called functional (associative) relationship. When pulmonary artery temperature increases, the tympanic temperature increases, but not in vice versa.
Qualitative researchers seek patterns of association such as meaning and dimensionality of phenomena of interest. Patterns of interconnected themes and processes are identified as a means of understanding the whole.
Major steps in a quantitative study
In quantitative study, researchers find a significant problem with related questions and hypothesis and try to obtain the answers at the end. It has logical sequence of steps that is similar across studies.

• Phase 1:Identification Phase

This phase includes identify the problem, discuss with experts, understand the relevance of the problem based research in current scenario, review the related literature, identify and formulate a theoretical framework, research objectives, research questions and hypotheses.
Step 1: Formulate and delimit the problem
The first step is to identify a research problem and consider various aspects of conducting research.
For example; Is this research important in the present scenario?
              Is it possible to conduct with in limitations?
              Are adequate resources available to conduct this research?
              Does it harm the study subjects?
Step 2: Review the related literature
The research is to be conducted with in the context of previous knowledge. To build on existing theory or research, the researcher understands about known facts of the topic. A thorough literature review might guide the researcher to conduct the study without any errors.
Step 3: Defining the theoretical framework
The ultimate aim of science is theory; it transcends the specifics of a particular time, place and group of people and aims to identify irregularities in the relationship among the variables. Using a theoretical framework during the study helps to achieve findings with broad significance and utility.
Step 4: Formulating hypothesis
A hypothesis predicts the relationship among the variables by the researcher. For example, is pregnancy induced hypertension in pregnant women related to stress factors present during pregnancy? The hypothesis is; the pregnant women with pregnancy induced hypertension has higher incidence of stressful events during pregnancy then pregnant women who don’t have symptoms.

• Phase II: The design and planning phase

In the second phase of research, the investigator makes decisions regarding the methods to be used to address research question. It consists of selecting a design, population, samples and conducts pilot study. This phase mainly focuses on methodological decisions.
Step 5: Selecting a research design
The research designs are highly structured and reduce the contamination of results. The researcher will select an appropriate design for obtaining answers to the questions being studied. 
Step 6: Identifying the population to be studied
During this phase, the researcher has to identify the population to be studied which meets the inclusion criteria for example; staff nurses, pregnant women and so on.
Step 7: Designing the sampling plan
The sampling plan suggests that the number of samples to be selected and how they are selected. Using a sample is more practical than collecting data from the population.
Step 8: Specifying methods to measure the research variables
Quantitative researchers develop or borrow methods to measure the research variables as accurately as possible. The researcher can use a variety of quantitative data collection approaches such as bio physiological measurements, interviews, formal observations and so on. The task of maintain accuracy during this phase is complex and challenging.
Step 9: Finalizing and reviewing research plan
The research plan has to be reviewed before proceeding to the implementation of the plan. The researcher has to develop a formal research proposal and get the approval from Institution Board Committee to conduct the study. In case of an experimental study, researchers my need approval from Human Subjects Committee to ensure that the research plan does not violate ethical principles.
Step 10: Conducting a pilot study and making revisions
Pilot study is a small scale trial run of the study to obtain information for improving the project or assessing its feasibility. After pilot study, the researcher can asses the feasibility of design, availability of participants, resources and time.

• Phase III: Empirical phase

It involves collecting of data and preparation of data for analysis.
Step 11: Data collection
The phase includes recruiting the sample, explain the study to participants, obtain informed consent, giving training to data collectors and collecting the data.
Step 12: Preparing the data for analysis
This step involves the transferring the data from written documents to compute files for analysis. Coding is the process of translating data into numeric form, for example; male-1 and female-2.

• Phase IV: Analytic phase

The phase consists of analyzing the data and interpreting the results.
Step 13: Analyzing the data
The quantitative data can be analyzed through statistical procedures, covers a broad range of techniques, including some simple procedures as well as complex and sophisticated methods.
Step 14: Interpreting the results
Interpretation is the process of making sense of the results and examining the implications of the findings with in a broader context. Interpretation of the results means researcher’s attempt to explain the findings in the light of what is known about theory and previous findings in the area and in light of adequacy of the methods used in the investigation.

• Phase V: Dissemination phase

The main aim of the phase is communicating and utilizing the findings.
Step 15: Communicating the findings
This is the phase of preparing a manuscript with an abstract and research report and publishes it in indexed journals.
Step 16: Utilizing the findings
The main aim of a high quality study is to plan for its utilization in the real world.
Major steps in a qualitative study
The qualitative researcher has a flexible approach to collect and analyze the data, it is impossible to define the flow of activities precisely, the flow varies from one study to another and researches do not know ahead of time how the study will proceed.

• Phase I: Conceptualizing and planning a qualitative study

The qualitative researchers begin with a topic which is poorly understood and about which is little known, and they do not develop hypotheses before going into the field. During the planning phase, the qualitative researches must also identify a study site that is consistent with the research topic. The researcher has to identify the type of setting such ad homes, clinics or community. The researchers need to gain entrée into the setting to ensure cooperation and access to informants.

• Phase II: Conducting qualitative study

The qualitative researcher begins by talking with or observing people who have first hand experiences with the phenomena under study. The discussions and observations are loosely structured, allowing for the expression of a full range of beliefs, feelings and behaviors.
As analysis and interpretation progress, the researcher begins to identify themes and categories, which are used to build a descriptive theory of the phenomenon. The principles of saturation will be used by the researchers, when themes and categories in the data become repetitive and redundant such that no new information can be gathered by further data collection.
The main highlight of qualitative study is that findings accurately reflect the experiences and view points of the participants, rather than the perception of the researcher in the quantitative study.

• Phase III: Disseminating qualitative findings

Qualitative reports are raw data, filled with rich verbatim passages directly from the participants. Qualitative findings often are used as the basis for the formulation of hypothesis that is tested by quantitative researcher.

Nursing research

Nursing research

Nursing research is a systematic search of knowledge, testing assumptions and answering questions with evidence regarding facts and issues related to patient, health, environment and nursing profession.

The importance of research in nursing

To acquire and develop knowledge regarding nursing services

To achieve professional responsibility

To define unique roles that nursing plays in multi-sectoral approach

To incorporate research evidence into clinical decisions

To maintain professional identity and boundary of roles and responsibility in education and clinical side

To modify and abandon the services which do not contribute to quality of nursing care

Utilize cum contributor cycle in research model (UCCR)

      

Nurses and nursing students have many roles in research, forms a cycle that reflects their activities and degree of participation to conduct a research. Nursing research pool is the collection of published manuscripts related to nursing education and practice after conducting a disciplined research. The nurses undergo two phases during their professional period, that is, utilize and contributor. During their professional life, they encounter issues and problems in various setting such as education, clinical and community, which leads to problem identification. The nurse utilizes nursing research pool to search information on a topic and develop an understanding of evidences related to the topic. Then, the researcher set objectives, design, sample size and go for data collection. They proceed into data analysis and results. They use nursing research pool to compare the present study results and existed study to assess the validity of the study. In contributor phase, they prepare manuscript and send it for publication process to disseminate the results into nursing research pool.

These cyclic activities include the following:

• Participation of journal club activities to discuss and critique research article
• Attend professional conferences to present research findings
• Evaluation of research for its applicability
• Review of proposed methods for gathering research information

Sources of knowledge for nursing

Nursing research is designed to explore different ways to acquire knowledge to enhance the quality of care to individual, family and community. These are various sources of knowledge for nursing such as tradition, authority, experience, trail and error, logical reasoning and disciplined research.

• Tradition

Many questions are solved on the basis of tradition or customs. There is much information passed on to us by tradition. It has advantages and disadvantages. The information passed by tradition, may  not have any evidences or scientific rationale. On the other side, each individual does not require to spend time to begin to initiate anything related to nursing service. Nonetheless, since many years, the nursing students are taught bed making by following step by step by nurse educators. One can question about the need of the procedure in 21st century, as all the bed linens in hospitals are disposable.

• Authority

Authority consists of nursing expertise in their specialties and is authorized to take decisions. The person who has no experience will always depend on authority to seek knowledge. The person will get expert advice and guidance from the authority, however, the authority is not infallible and their knowledge often goes unchallenged.

• Experience

The important characteristic of human mind is the ability to generalize, to recognize regularities and to make predictions based on observations. Own experience is the familiar and functional source of knowledge of nursing research. Each individual experience may vary according to their perceptions, thus, conflicts may rise.

• Trial and error

This method is closely related to experience. Using this approach, investigators use alternatives till the solution finds out. Probably, we have used this method in our personal lives also. It is a practical and applicable one, but, it may be fallible and inefficient.

• Logical reasoning

It is a method of combining knowledge, experience and formal system of thought. Inductive reasoning is the process of developing generalizations from specific observations. For example, a nurse may observe the fear among hospitalized children with out parent’s presence. Deductive reasoning is the process of developing specific predications from general principles. For example, one can assume that fear does occur among hospitalized children; we might predict that they have to be with their parents. To be precise, an approach to highlight relationships as one proceeds from general to specific.

• Disciplined research

It is developed by humans and conducted with a disciplined format to achieve objectives. It is the most sophisticated method of acquiring knowledge. It has features of induction and deduction; tend to be more reliable than tradition, authority, experience and logical reasoning also.

• Borrowed from other disciplines

Knowledge can be borrowed from psychology, medicine, pathology and so on to nursing profession to achieve high quality evidence based nursing care. The disciplined research in nursing is diverse in regards to questions asked and methodology used.

Paradigms for nursing research

A paradigm is a general perspective on the complexities of the real world. It is based on the basic philosophical questions.

• Ontologic- What is the nature of reality?
• Epistemologic- What is the relationship between the inquirer and that being studied?
• Axiologic- What is the role of values in the inquiry?
• Merthodologic- How should the inquirer obtain knowledge?

The paradigms are two types; positivist paradigm and naturalistic paradigm. The traditional scientific approach to conduct research has its underpinnings in the philosophical paradigm known as positivism. It emphasizes on rational and scientific methods.

Positivists attempt to hold their personal beliefs and biases in check as possible during their research to avoid contaminating the phenomena under investigation. The positivists’ scientific approach involves using disciplined procedures to test the researcher’s ideas about the nature of phenomena being studied and relationship among them. The knowledge obtained through fixed designs, emphasis on quantitative information and generalizes the findings through deductive process.

Naturalistic paradigm is also known as pnenomological paradigm, represents an interaction between the inquirer and participants. It assumes that knowledge is maximized when the distance between the researcher and participants in the study are minimized. It focuses on subjective information from participants using flexible designs, emphasis on narrative information, derives themes from generalized perceptions such as inductive process and uses qualitative analysis.

Paradigms and methods of research

• The positivist research and quantitative research

It refers to a set of orderly, disciplined methods used to acquire information. Here, the researcher moves in from the definition of problem and selection of concepts on which to focus to the solution of the problem. It has started with pre planned plan of action. The researcher uses ‘control’ involves imposing conditions on the research situation so that biases are minimized, precision and validity is maximized.

The researcher gathers empirical evidence (from senses, not from personal beliefs and feelings) to address research questions. The researcher uses tools to gather information such as questionnaire, check list and Likert scale and asked the participants to respond to the questions. Usually, the gathered information is quantitative and findings can be generalized.

• Naturalistic methods and qualitative research

It is a method if inquiry exploring human complexity directly. These investigations emphasize understanding the human experience as it is lived by collecting and analyzing narrative and subjective materials. It is flexible in nature, occurs in naturalistic settings. Through an inductive process, the researcher integrates the evidence to develop a theory or framework that helps to explain the process under observation. These findings are grounded in real life experiences of people with first hand of knowledge of a phenomenon.

Common features of naturalistic and positivist paradigm

• Ultimate goals: The ultimate aim of both paradigms is knowledge. They seek the truth of reality.
• External evidences: The researchers do not rely on their own beliefs, but focus on external evidences through their senses.
• Reliance in human cooperation: To understand the people’s characteristics or experiences need for human cooperation is essential.
• Ethical constraints: Research with human beings is guided by ethical principles that help to protect the researcher and the study participants.
• Fallibility of disciplined research: All studies have limitations but, a small simple study also contributes to the body of accumulated knowledge.

Purposes of nursing research

The main purpose of research is to answer questions and solve problems of relevance to the nursing profession.

• Identification

Many qualitative studies focus on phenomena about which little is known. The main task is to answer such question is ‘what is this phenomenon’ and ‘what is its name’.

• Description

The main objective of the research is the description and elucidation of phenomena relating to the nursing profession. Here, the researcher observes, counts, describes and classifies. Quantitative description involves the prevalence, incidence and size. Qualitative researches describe the dimensions, variations, importance and meaning of phenomena.

• Exploration

Exploratory research investigates the full nature of phenomena and other factors with which it is related. For example, a descriptive quantitative study on post partum depression, focus on the factors contributing to post partum depression, its manifestations and coping ability of patient with post partum depression. This type of research is designed to explore the various ways in which phenomenon is manifested and on underlying process.

• Explanation

The goal of explanatory research includes understand the natural phenomena and explains systematic relationships among phenomena. It is related to a theory, which represents a method of deriving, organizing and integrating ideas about the manner in which phenomena are interrelated. It focuses on understanding the full nature of a phenomenon.

• Prediction and control

The research is able to control and predict the phenomena even without understanding what the real cause is, but, they can suggest some preventive measures. For example, the research predicts that as maternal age increases, chance for bearing a child with Down syndrome increases. The incidence of syndrome may be partially controlled by amniocentesis and encouraging women to be pregnant at the earliest. There are many examples of nursing and health related studies, typically, quantitative ones in which prediction and control are the key objectives.

Basic and applied research

Basic research is undertaken to accumulate information, to improve understanding of a phenomena or to formulate or to refine a theory.

Applied research focuses on immediate solution to an existing problem. For example, a study to assess the effectiveness of nursing intervention. Basic research is discovering general principles of nature and human behavior, but applied research is designed to indicate how these principles can be used to solve problems in nursing practice.

Rosemarie Parse Human Becoming School Thought 1998 (USA)

Rosemarie Parse Human Becoming School Thought 1998 (USA) 

Rosemarie Parse earned her B.S. degree in nursing from Duquesne University and Master’s degree in nursing and PhD from the University of Pittsburgh, Pennsylvania. Rosemarie Parse initiated and currently chairs the nursing theory, guided to practice expert panel of the American Academy of Nursing. Recent works include Community: A Human Becoming Perspective (2003), Qualitative Inquiry: The Path of Sciencing (2001), Man-living-health: A theory of nursing (1981) and The Human Becoming School Thought; A Perspective of Nurses and other Health Care Providers (1998). 

In 1981, Rosemarie Parse presented a unique theory of nursing titled ‘Man-Living-Health’, which stated the man as Homosapiens. Her purpose was to post an idea of nursing rooted in human science as an alternative to ideas of nursing grounded in the natural sciences. Based on the purpose, she posted assumptions such as
1. Man is coexisting while co constituting rhythmical patterns with the environment.
2. Man is an open being, freely choosing meaning in situation, bearing responsibility for decisions.
3. Man is a living unity continuously co constituting patterns of relating.
4. Man is transcending multi dimensionally with the possibilities.
5. Health is an open process of becoming, experienced by man.
6. Health is rhythmically co constituting process of the man-environment relationship.
7. Health is as inter subjective process of transcending with the possibilities.
8. Health is unitary man’s negentropic unfolding.

In 1998, Rosemarie Parse revised the assumptions about the human becoming school of thought are

• The human is co existing while co constituting rhythmical patterns with the universe
• The human is open, freely choosing meaning in situation, bearing responsibility for decisions
• The human is unitary, continuously co constituting pattern of relating
• The human is transcending multi dimensionally with the possibles
• Becoming is Unitary Human-Living-Health
• Becoming is a rhythmically co constituting process of the human universe process
• Becoming is the human’s pattern of relating value priorities
• Becoming is an inter subjective process of transcending with the possibles
• Becoming is unitary human’s emergency

The original nine assumptions are further synthesized into three assumptions such as
1. Human becoming is freely choosing personal meaning in situations in inter subjective process of relating value priorities.
2. Human becoming is co creating rhythmical patterns of relating in open interchange with the universe
3. Human becoming is co transcending multi dimensionally with the unfolding possibilities

Principles
The main three themes can be identified in Parse’s (1998) assumptions: meaning, rhythmicity and transcendence. Meaning refers to the linguistic and imagined content of something and the interpretation that one gives to something. Rhythmicity refers to the paced and paradoxical patterning of the human universe mutual process. Transcendence is described as reaching beyond with possible, the hopes and dreams as seen in multidimensional experience. Each of Parse’s theme leads to principles of human becoming.
Principle 1: Structuring meaning multi dimensionally is co creating reality through the languaging of valuing and imaging. It inter relates the concept of imaging, valuing and languaging. Co creating refers to human universe participation in the creating of pattern. Languaging reflects the image and values through speaking and movement, valuing is the process of living cherished beliefs and imaging is to know the explicit and tacit knowledge.
Principle 2: Co creating rhythmical patterns of relating is living the paradoxical unity of revealing-concealing and enabling-limiting while connecting-separating. She stated that these rhythmical patterns are not opposites; they are two aspects of the same rhythm and exist simultaneously, one in foreground and other in the background.
Principle 3: Co transcending with possible is the powering and originating of transforming. Powering is an energizing force, the rhythm of which is the pushing-resisting of inter human encounters. Originating is inventing new ways of conforming- not conforming in the certainty-uncertainty of living. Transforming is defined as the changing of change and is recognized by increasing university.  

Human becoming and the four major concepts
Human universe
She stated human being as ‘lives at multidimensional realms of the universe all at once, freely choosing ways of becoming as meaning is given to situations.
Health
She described unitary human’s health as a synthesis of values, way of living. It is not the opposite of disease or a state that a human has but rather a continuously changing process that the human co creates in mutual process through the human universe experience and is incarnated as patterns of relating value priorities. 

Nursing
She defined nursing as a basic science, the practice of which is a performing art like drama, dance, in each, the artist creates something unique. The knowledge base of the discipline is the science of art and performance is the art creatively lived.
Environment
She define contextual situations of nursing practice as being nurse-person or nurse-group or nurse-community. She does not define specific practice setting related to environment. She is a successful nursing theorist to create a new paradigm of nursing. The human becoming school thought has gained recognition internationally.

Madeleine Leininger Transcultural nursing theory 1995 (USA)

Madeleine Leininger Transcultural nursing theory 1995 (USA)

 
Madeleine Leininger was born in 1925, received her basic nursing education from St. Anthony’s School of Nursing, Colorado, Master of Science in mental health nursing from the Catholic University of America and PhD in Social Anthropology from the University of Washington. She is the founder of transcultural nursing society and the journal of transcultural nursing. She has conducted many projects published extensively about transcultural nursing and human care theory worldwide.

Madeleine Leininger first used the terms such as transcultural nursing, ethno nursing and cross cultural nursing. In 2006, Madeleine Leininger defined trans cultural nursing (rather than cross cultural) as “a discipline of study and practice focuses on comparative culture care differences and similarities among and between cultures in order to assist human beings to attain and maintain meaningful and therapeutic health care practices that are culturally based”. The ethno nursing is a rigorous, systematic and in-depth method for studying multiple cultures and care factors with in familiar environment of people and to focus on the interrelationship of care and culture to arrive at the goal of culturally congruent care services. 

In 1985, Madeleine Leininger published her work on a theory. She defined ‘culture’ is the learned, shared and transmitted value, beliefs, norms and life ways of a particular group that guides thinking, decisions and actions in patterned ways. A subculture is a group with in the culture that differs from main culture. Culture care is the synthesized and culturally constituted assistive, supportive, facilitative caring acts towards self and others focused on evident or anticipated needs for the client’s health or well being or to face disabilities, death or other human condition. She viewed the care into two types: emic (general) and etic (professional) care. Emic care is a folk care, culturally learned and transmitted based on folk knowledge and skills. Etic care is professional care, formally learned through institutions include nursing. 

Cultural and socio structural factors include religion, kinship, politics, legal issues, education, economics, technology, philosophy of life and cultural beliefs. Culturally congruent care is defined as culturally based care knowledge, acts and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, life ways of clients for their health and well being or to prevent illness, disabilities or death. Cultural care diversity indicates the difference among human beings with respect to cultural care meanings, patterns, values, life ways and symbols related to providing beneficial care to clients of a designated culture. Cultural care universality indicates commonly shared cultural care phenomena features of human beings or a group with recurrent meaning, pattern, life ways that serve as a guide for care givers to provide assistive, supportive, facilitative or enabling people care for healthy outcome. 

She defined nursing as a learned, humanistic and scientific profession and discipline focused on human care phenomena and caring activities in order to assist, support and facilitate or enable individuals or groups to maintain their health or well being is culturally meaningful and beneficial ways or to help individual face handicaps or death.
Professional nursing care is defined as the formal and cognitively learned professional care knowledge and practice skills, obtained through educational institutions that are expected to provide assistive, supportive, enabling or facilitative acts to or for another individual or groups in order to improve human health well being. 

Madeleine Leininger (2002) discusses the concepts related to cultural care.

• Culture specific care- very specific to client’s needs
• Generalized culture care- commonly shared professional nursing care techniques that are beneficial to all
• Culture care conflict- signs of distress that fail to meet a client’s cultural expectations
• Culture care clashes- situation that arises problem
• Culture exports- sending of ideas to another culture
• Cultural imports- receiving of ideas from another culture
• Cultural space- the variation of cultures in the use of interpersonal distance to others
• Culture time- the dominant orientation of an individual to different parts, present and future periods that guides one’s thinking actions
• Culture care therapy- qualified transcultural nurses who offer assistive, supportive and facilitative healing reflections and practices to individuals who have experienced cultural pain, offenses and other concerns.

Madeleine Leininger’s short culturalogical assessment guide

• Phase 1- Record observation of what you see, hear or experience with clients.
• Phase 2- Listen to and learn from the client about cultural values.
• Phase 3- Identify and document recurrent client patterns and narrative stories with client meaning of what has been seen, heard and experienced.
• Phase 4- Synthesize themes and patterns of care derived from the phase 1, 2 and 3.
• Phase 5- Develop a culturally based client nurse care plan for decisions and actions for culturally congruent care.

To conclude, the theory of cultural care diversity and universality is of significance in a society that is becoming more and more aware of the cultural diversity with in the boundaries. It provides guidelines for the gathering of knowledge and a framework for making decisions about what care is needed or would he of the greatest benefit to the client.

Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

 
Patricia Benner was born in Virginia, received her bachelor’s degree in nursing from Pasadena College, master’s degree in medical surgical nursing and PhD from University of California in 1970 and 1982 respectively. She has nursing practice experience as staff nurse and in management, in medical surgical, emergency care unit, coronary care unit, intensive care and home care nursing. Benner is currently director of the National Nursing Education study for the Carnegie foundation for the advancement of teaching. In addition, she is a professor in the department of social and behavioral sciences at university of California.
The Dreyfus model of skill acquisition serves as the theoretical basis of Benner’s work in identifying the professional development of nurses. This model identifies ‘five stages of qualitatively different perceptions of their task as skill improves. These stages have been labeled as novice, advanced beginner, competent, proficient and expert. Benner states that the five levels reflect changes occurring in three aspects of skilled performance. They are;

• A movement from reliance on rules and abstract principles to the use of concrete past experiences as the basis of decision making
• Increasing ability to see the situation as a whole or the big picture
• Increasing involvement within the situation

Novice

• A complete beginner with no experience in the specialty area
• Practices using theoretical knowledge acquire through formal learning
• Relies on use of context free rules for drawing conclusions based on objective features of the situation

Advanced beginner

• The newly graduated nurse who has transferred to another specialty
• Begins to notice situational elements and structure in the clinical setting
• Begins constructing more and more complex rules developed from actual practice to help guide actions
• Begins to recognize changes in clinical state but lacks the experience to identify how to manage those changes

Competent

• The nurse who has about one to two years of experience on a specific unit and improves in clinical understanding, routines, technical skills, organized ability and ability to anticipate the likely course of events.
• Exemplifies standard of care
• Establish new rules and facilitates the choice of plan

Proficient
It is a transition stage that leads to expertise and experience results in development of synaptic pathways in the brain that alter the rules and principles based responses to a more situationally associated response set of behaviors referred to as intuition. The actions of a proficient nurse demonstrate a smooth based approach and are situationally appropriate. The communication and negotiation skill of proficient nurse increases in order to meet the situational needs of the patient and family.
Expert
They are vigilant monitors. Expert nurses situate themselves with in an observational distance of the patient in order to stay attained to the changing needs and condition of the patient. She attunes to changes and awareness of salient aspects of the situation is accomplished without conscious deliberation. She uses the ‘deliberative rationality’ to reflect on goals and actions to achieve those goals rather than former rules. They can take high positions based on their experience and are confident.
Domains of nursing practice and related competencies;

• The helping role

The healing relationship;
Creates a climate and establishes a commitment to healing
Provides comfort measures
Being with the patient
Provide and communicates through therapeutic touch
Guides the patient through physical and psychological change

• The teaching and coaching role

Timing captures a patient’s readiness to learn to;
Elicit and understand the patient’s interpretation of illness
Provides an interpretation of the patient’s condition and giving a rationale for procedure

• The diagnostic and patient monitoring function

Detection and documentation of significant changes in patient’s condition
Providing an early warning signal through diagnostic signs
Anticipates patient care needs
Assess the patient’s potential for wellness and for responding to various treatment strategies

• Effective management of rapidly changing situations

Skilled performance in extreme life threatening situation
Rapid matching of demands and resources in emerging situations
Identify and mange the patient crisis until physician is available

• Administering and monitoring therapeutic interventions

Starts and maintains intravenous therapy
Administer medications accurately and safely

• Monitoring and ensuring the quality of health care practices

Provide a back up system to ensure safe medical and nursing care
Supervise the patient care

• Organizational and work role competencies

Coordinates, orders and meets multiple patient needs
Sets priorities
Builds and maintains a therapeutic team
Copes with staff shortage and high turn over

Benner’s work can be understood in a simple form such as skill levels of novice to expert or can be applied in more expanded forms in terms of understanding critical thinking and caring practices. Her work has been influential in nursing to practice, especially in caring.