Model of

Nursing Research

By: Dr. Nursalam, M.Nurs (Hons)

School of Nursing, Airlangga University
CURRICULUM VITAE
Name : Dr. Nursalam, M.Nurs (Hons) 081339650000
Address : Jl. Keputih Tegal Timur 62 Surabaya 60111
E-mail : nursalam@fkp.unair.ac.id

HIGHER, EDUCATION:
1. Doctor, Model of Nursing Care for HIV-AIDS, Postgraduate Programme,
Airlangga University, 2005
2. Honours Master of Nursing, 1997, University of Wollongong, New South
Wales, Australia
3. Master of Nursing (Coursework), 1996 Univ. Wollongong, NSW, Australia
4. Med. Surgical Nursing, Lambton College, Sarnia Ontario Canada, 1991
5. Diploma III in Nursing, Sutoma Surabaya 1988

ORGANISATION AND WORKING EXPERIENCES :

1. Lecturer and nurse in Diploma III in Nursing, Anesthesia, Ministry of Health, RI Surabaya
(1988 – 1997)
2. Lecturer in School of Nursing, Faculty of Medicine / Faculty of Nursing, Airlangga University
(since 1998)
3. Organization
1. Vice, Head, School of Nursing, Faculty of Medicine, UA (1999– 2008)
2. Vice Head, PPNI Educatin & Training, East Java Nursing Association (2000 – 2010)
3. Dean, Faculty of Nursing Airlangga University (2008 – 2010)
4. Nursing Manager, Airlangga University Hospital (2011-now)
PUBLICATION :
•Books = 15
•Acredited journal & presentation (national & international)= 21
•Unaccredited journal = 17
 “The world is a dangerous
place to live; not because of
the people who are evil, but
because of the people who don't
do anything about it.“
(Albert Einstein)
 John Maynard Keynes
said:
The greatest difficulty in the world
is not for people to accept new
ideas, but to make them forget
about old ideas”

nursalam -2006
 A knowledge base is
necessary for the recognition
of nursing as a science by
health professionals,
consumers, and society

(Burns & Grove, 2001; Melnyk &

Fineout-Overholt, 2005)
 What is Nursing Research?
 Research is diligent, systematic inquiry or
investigation to validate and refine existing
knowledge and generate new knowledge
 Nursing research must address questions
relevant to the profession of nursing
– Grow the body of literature / body of
nursing knowledge related to our
profession
– What is related to our profession?
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
One goal of nursing research
 Development of evidence-based practice,
with nurses using the current, best research
findings in their delivery of care

(Burns & Grove, 2001;

Melnyk & Fineout-
Overholt, 2005)
 Forming A Good Questions:
EVIDENCE BASED - PICO
 P = Patient population or disease of interest (age, gender,
ethnicity, with a certain disorder hepatitis)
 I = Intervention or range of interventions of interest
(exposure to disease, prognostic factor A, risk
behavior)
 C = Comparison, you want to compare the intervention
against (no disease, placebo or no intervention,
prognostic factor B, absence of risk factor)
 O = Outcome of interest (accuracy of diagnosis, rate
of occurrence of adverse outcome)
 In (P) immobile acute care patients, what is the
effect of (I) turning every 2 hours on (O) prevention
of pressure ulcers compared with (C) not turning (Burns & Grove, 2001;
patients every 2 hours? Melnyk & Fineout-
Overholt, 2005)
 5 Steps to EBP

1. Ask the burning clinical question

2. Collect the most relevant and best evidence
3. Critically appraise the evidence
4. Integrate all evidence with one’s clinical
expertise, patient preferences, and values in
making a practice decision or change
5. Evaluate the practice decision or change
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
 NURSING RESEARCH
MODEL
M M P / PMW
1. MASALAH (PROBLEM)
2. METODOLOGI (METHODS): (DESAIN;
POPULASI, SAMPEL, SAMPLING;
VARIABEL-D-O; INSTRUMENT; PULTA;
ANALISIS; ETHICAL CLEARANCE)
3. PENULISAN (WRITING): CONTENT &
STRUKTUR nursalam-MASALAH
1. SEARCHING OF RESEARCH
PROBLEM ---- Phenomena
 A GOOD RESEARCH PROBLEM?

ORIGINALITY
NOVELTY
CONTRIBUTION ON THEORY AND PRACTICE
TRENDS / PREVALENCY
WHY.....

MALNUTRITION ?
WHY.....

SURVEILANCE
(DHF)?
WHY.....

TRADITIONAL MEDICINE
WHY.....

ENVIRONMENT
WHY.....

HEALTH BEHAVIOR
DISASTER MANAGEMENT

HOW?
STRESS

19
SEARCHING NURSING RESEARCH PROBLEM (P-34)
1. TOPIC
IDEA
Prolonged 1st Stage of labour NURSING SCIENCE: MATERNITY,
PEDIATRIC, etc.
BRAINSTROMING
Factors that cause the prolonged? 2. CASE SELECTION: INC,
Hospitalisation stress,, etc.
LITERATURE REVIEW
Factors: 5P, the dominant one is psyche: 3. NURSING PROBLEM:
husband support - has not been studied NANDA / GORDON (F1-F2)
“Prolonged 1st stage of labour
VARIABLES 5P (power, passage, passanger,
psychological, provider ...) F-I-N-E-R
Anxiety, straining strength , age, parity, family support,
Admission time, stress etc.
FRAMEWORK
4. RESEARCH QUESTIONS (Q-S-S)
What is the effect of husband support on acceleration of cervix dilatation 1st stage of Labour for inpartum mother?

5. AIM AND OBJECTIVES (BLOOM + Objective + (V-V) …….

To explain the effect of husband support on acceleration of cervix dilatation for inpartum mother
TITLE
nursalam-MASALAH
6. EFFECT OF HUSBAND SUPPORT ON ACCELERATION OF CERVIX DILATATION FOR INPARTUM MOTHER
EXAMPLE: PROBLEM IDENTIFICATION
BASED ON COMPETENCIES
MATERNITY NURSING

ANC INC PNC BBLR HRP Reproductive Contraception

problem

Ax pregnant Physical Pregnant Health education

women examination excercise

Leopold-I Leopold-I Leopold-I

 Cont .......
MATERNITY NURSING

ANC INC PNC BBLR HRP Reproductive Contraception

problem

Assessment Assessment Assessment Assessment

Stage I Stage -II Stage -III Stage -IV

Labour cervix Physical Phsychologic Placenta Bleeding Bleeding Bounding

sign dilatation change al change Attachment

Pain Delivering Delivering APGAR score

management preparation guide
 Cont .......
MATERNITY NURSING

ANC INC PNC BBLR HRP Reproductive Contraseption

problem

Assessment Diagnosis intervention Implementation Evaluation

Vital sign Involution Lactation Postpartum

blues

Vulva Higiene Breast care Mobility Diet Lactation Puerperium

Management excercise
SPIDER INPARTUM (1ST STAGE OF LABOUR )
WEB
?
Pregnant ?
Nutrition excercise ?
status ?
?

Power:
Nutrisi
?

INPARTUM

?
?

?
? ?

?
SPIDER DIABETES MELLITUS
WEB
? ?
?
Treatment ?
?
? Activity : type (DM
excercise, walking, etc)
?

Diabetic
wound
?

Central Theme
Blood glucose

DM

?
?

?
? ?

?
SPIDER TOPIC / PROBLEM: PATIENT SATISFACTION
WEB
Hospital don’t know
what px-expect Operating Over
Wards theater All Patients
No case conference
Nobody takes any No name tag Nurse
interest
Poor Relationship with

The Problems

Scope of
health team

Never H.E-when
Pt.discharge

PATIENT SATISFACTION

Hospital Policy not Different trust

research based
No response on
Nurses don’t complain
Nurse don’t do
believe Research
research
result
No programme to
visit Community
 SOURCES OF RESEARCH PROBLEMS
Sources:
NANDA (9 P. Problem NURSING KEY:
1. Clinical/Co
Exchanging) PROCESS:
E:? (Factor/ V. mmunity - F: Feasibility
GORDON (11 Independent) Nursing 2. Literatur - I: Interesting
Health function diagnosis review - N: Novel
pattern) S:Signs & 3. Book/ - E: Ethics
Symptoms journal - R: Relevant
4. Discussion/
seminar

RESEARCH
PROBLEM

Framework development
(based on nursing theory:
ROY; OREM; KING;
etc.)

p.
 SEARCHING RESEARCH PROBLEM –
F1 & F2
(SOURCES TO WRITE CHAPT 1 & 2)
F- 1
1. Sekitar 15 – 20% anak usia 5 – 6 tahun mengalami enuresis dan kebanyakan dari mereka
adalah laki-laki (Norby, 2005).
2. Prevalensi enuresis pada usia 5 tahun adalah 7% untuk laki-laki dan 3% untuk anak
perempuan (Houts, 1991)
3. Dampak secara sosial dan kejiawaan yang ditimbulkan akibat enuresis sungguh mengganggu
kehidupan seorang anak (Harjaningrum, 2005).
4. Teori Functional bladder capacity mengatatakan bahwa anak dengan enuresis memiliki
kapasitas fungsional kandung kemih yang lebih kecil dibanding anak yang tidak mengalami
enuresis(Whale & Wong,1999).
F-2
1. Bladder-retention training biasanya dilakukan pada anak dengan kapasitas fungsional kandung
kemih yang kecil (Harjaningrum,2005).
2. Pada beberapa anak dengan kapasitas fungsional kandung kemih yang kecil, penggunaan
pembelajaran Bladder-retention training selama beberapa hari dapat membantu meningkatkan
kapasitas fungsional kandung kemih pada malam hari (Marc Cendron,1999).
3. ............
Masalah
Pengaruh pembelajaran Bladder-retention training terhadap kemampuan dan frekwensi
enuresis pada anak pra sekolah (3 – 6 tahun) belum dapat dijelaskan.
nursalam-MASALAH
2. WRITE CHAPTER LITERATURE
REVIEW

•THEORITICALREVIEW (USE OF
NURSING THEORIES & OTHER
RELEVANT THEORY)

•THEORITICAL MAPPING (RESEARCH

ORIGINALITY)

nursalam-MASALAH
 Review of the Literature
 Research should be built on the work of others
 The “Literature” is all the written sources relevant to your
topic
 Primary source
– Written by the person who originated , or is responsible for
generating, the ideas published
 Secondary source
– Summarizes or quotes content from primary sources
– Paraphrase the works of primary authors
 Meta-analysis or systematic reviews
 Your work should mostly contain primary sources. Citations should be
of primary sources not secondary sources
 Generally, try to keep cited references to within 5 years
(Burns & Grove, 2001;
Melnyk & Fineout-
Overholt, 2005)
N ARTICLE / RESEARCH TITLE RESEARCH METHOD (D-S-V-I-A) RESULT
O AND AUTHOR
1 Relationship of elderly excercise on body fit (Palestin, 2006) -elderly exercises quantitative hubungan signifikan antara senam lansia
- vital signs dengan tingkat kebugaran lansia
2. Pengaruh Senam Aerobik terhadap Peningkatan Kebugaran -Latihan Senam Aerobik Kuantitatif Pra eksperimental Senam Aerobik memiliki pengaruh yang
Wanita Menopause (Hartini, 2007) - Peningkatan Kebugaran signifikan pada peningkatan kebugaran
(stabilisasi nadi, RR, tekanan darah &
menopause syndrome)
3 Pengaruh Senam Lansia terhadap Kebugaran Jasmani pada - Senam Lansia Observational rancangan analitik Ada Hubungan Senam Lansia dengan
Lansia (Rochman, 2009) - Kebugaran (stabilisasi nadi, RR, kebugaran jasmani
tekanan darah)
4 Manfaat Senam terhadap Kebugaran Lansia (Kartinah, 2008) - Senam Tera Kuantitatif pra eksperimental Senam Tera berpengaruh dalam
- Kebugaran menstabilkan kadar immunoglobulin
5 Perbedaan Pengaruh Senam Otak dan Senam Lansia terhadap Senam Otak Quasi eksperimen Senam otak dan senam lansia memberikan
Keseimbangan pada Orang Lanjut Usia (Herawati, 2008) Senam Lansia hasil yang positif terhadap keseimbangan
Keseimbangan Lansia
6 Hubungan karakteristik personal Inferestial analitik eksperimen karakteristik personal memiliki hubungan
antara Karakteristik Personal dengan Kemandirian dalam kemandirian dalam Activiy of Daily yang signifikan dengan kemandirian dalam
Activiy of Daily Living Activiy of Daily
Living (ADL) pada Lansia (Fathur, 2007) Living (ADL)
7 Hubungan Tingkat Depresi Deskriptif analitik kolerasi ada hubungan yang signifikan dengan
Antara Tingkat Depresi Dengan Kemampuan Aktivitas Dasar Dengan Kemampuan Aktivitas Dasar interpretasi
Sehari-Hari Sehari-Hari korelasi negatif antara tingkat depresi
Pada Lansia (Firmannulah, 2010) dengan kemampuan aktivitas seharihari
pada lanjut usia
8 Pengaruh Pemberian Penyuluhan Kesehatan Deskriptif dengan pendekatan penyuluhan kesehatan
Pemberian Penyuluhan Kesehatan Terhadap Perubahan Perubahan Pengetahuan Activity of eksperimen korelasional dapat meningkatkan pengetahuan lansia
Pengetahuan dan Daily Living tentang ADL
Sikap Tentang Activity of Daily Living (ADL) pada lansia Sikap Activity of Daily Living
(Setyowati, 2009)
9 Pengaruh Pembelajaran Terbimbing terhadap Tingkat - Pembelajaran Terbimbing Kuantitatif Pre Eksperimental Pembelajaran Terbimbing memiliki
Kemandirian ADL LAnsia (Kusrumentahingtyas,2010) - Kemandirian ADL pengaruh yang signifikan terhadap Tingkat
Kemandirian ADL LAnsia
10 Hubungan antara Tingkat Depresi dengan Ketergantungan tingkat depresi Studi korelasi Ada hubungan antara tingkat depresi
dalam ADL ketergantungan dalam ADL dengan ketergantungan dalam ADL
(Activity of Daily Living) pada Lansia (Aprinia, 2006) (Activity of Daily Living) (Activity of Daily Living) pada lansia
11 Hubungan antara Gaya Hidup dengan Tingkat gaya hidup Quasi eksperiment Terdapat hubungan antara gaya hidup
Ketergantungan dalam Aktivitas Kehidupan tingkat ketergantungan dalam aktivitas dengan tingkat ketergantungan dalam
Sehari – hari Lansia kehidupan aktivitas kehidupan
sehari – nursalam-MASALAH
hari sehari – hari lansia
12 Hubungan Karateristik Demografi dengan Kemandirian Karateristik Demografi Studi korelasi, Ada hubungan antara Karateristik
dalam Activity Daily Living (ADL) pada Lansia kemandirian Demografi dengan kemandirian
 3. DEVELOP A
1. FRAMEWORK (QUANTITATIVE)
2. RESEARCH QUESTION
(QUALITATIVE)

nursalam-MASALAH
 FRAMEWORK
DEVELOPMENT

1. ROY: ADAPTATION MODEL

2. OREM: SELF CARE
3. CARING: WATSON & SWANSON
4. KINGS: OPEN SYSTEM MODEL
5. LEININGER: SUNRISE MODEL
6. etc.

nursalam-MASALAH
 What is the link between nursing
theory and the research process?

 Theory provides direction for nursing research

 Relationships of components in a theory help
to drive the research questions for
understanding nursing
 Chinn and Kramer (2004), indicate a spiral
relationship between the two
Nursing also utilizes non-nursing
theories
 Adaptation Model
Input Control Effectors Output
processes

Coping Physiological function

Stimuli mechanisms Adaptive
Adaptation Self-concept and
Regulator Role function
level Cognator ineffective
Interdependence response

Feedback

Person as adaptive system. (From Roy, C. [1984]. Introduction to nursing: An adaptation model
[2nd ed., p. 30]. Englewood Cliffs, NJ: Prentice Hall.)
 PNI
Psycho Neuro Immunology HEALTH

Lived Experience

Potential Psychosocial
Co-Factors Moderators Psychosocial
Functioning

Person Neuro-
Immunological Quality of Life
Factors Perceived Coping Endocrine
Mediators
Stress Pattern Mediators
s Physical
Pre tx: Health
Critical
Factors
 PNI

(Thorton & Andersen, 2006

FRAMEWORK (p.403– ADAPTATION & PNI)
Counseling for patient
with Stress – pre op

Learning process
(cognator)
Perception
Coping (+)
(+)
Cognition -
Emotion

Stress A
D
A
Hypotalamus
H (CRF)
P
Adrenal medulla T
P (Catecolamines A
Pituitary
(ACTH) T
A I
Adrenal Cortex Vital signs O
AXIS (Cortisol ) (T, P, R, PB) N

IMMUNE RESPONSE MODULATION

(CD4; cytokin; IgG)
nursalam-MASALAH
OREM
Self-care

R R
Conditioning

Conditioning
Self-care

factors
factors

capabilities R Therapeutic
(self-care self-care
agency) < demand

Deficit
R
Conditioning

R
factors

Nursing
Agency
(supportive
FIG. OREM – SELF CARE DEFICIT Educative)
 The Structure of Caring

Maintaining
belief
Knowing
Being
with
Doing
for
Enabling
( )
Client
well-
being

Philosoohical Informed understanding Message

attitudes towards of the clinical condition conveyed Therapeutic Intended
persons (in general) (in general) and the to client actions outcome
and the designated situation and client
client (in specific) (in specific)

The structure of caring as linked to the nurse’s philosophical attitude, informed understandings, message
conveyed, therapeutic actions, and intended outcome. (from Swanson, K. M. [1993]. Nursing as
informed caring for well-being of others. Image: The Journal of Nursing Scholarship, 25 [4], 352-357.)
 Human Interaction for Goal
Attainment (King)
FEEDBACK
PERCEPTION
NURSE
JUDGMENT

ACTION
REAC INTERAC TRANSACTION
TION TION
PATIENT ACTION

JUDGMENT

PERCEPTION

FEEDBACK
LEININGER

Health (well being)

Of

Individuals, families, group and

institutions

Diverse health systems

Diverse health Nursing Professional

systems
system

Nursing care decisions and actions

cultural care preservation/ maintenance
cultural care accommodation/
negotiation
cultural care repatterning/ restructuring

Culture congruent care

 Father
or intimate
partner

a Mother Infant a
cb b
c
d d

Becoming a mother: A revised model. (From R. T. Mercer, 2008)

 PERCEIVED SERVICE QUALITY
FOR PATIENT WITH “JAMKESMAS”
(Parasuraman)

Word of Personal Past

mouth needs experience

Service Quality
Expected
Dimensions: Service Quality Assessment
service
(RATER) 1. Expectations exceeded
•Reliability ES<PS (Quality surprise)
•Assurance Perceived 2. Expectations met
•Tangibles service ES~PS (Satisfactory quality)
•Empathy 3. Expectations not met
•Responsiveness ES>PS (Unacceptable quality)
4. WRITE AIM AND OBJECTIVES

nursalam-MASALAH
Research aim:
To examine the effect of pre op counseling in nursing care on
reducing stress response, vital signs stability and immune
response modulation for pre op patient with ......
Objectives
1.To explain .......... on reducing stress response
2. To explain ....... patient coping
3. To prove on ....... vital signs
4. To proveon ........ cortisol
5. To prove on .......... Immune response modulation (CD4; cytokin; Ig)

nursalam-MASALAH
5. TITLE / RESEARCH TOPIC
1. BRIEF AND CLEAR
2. NO MORE THAN 14 WORDS
3. STATE THE OBJECTIVE AND
RESEARCH VARIABLES (DESIGN,
SAMPLE, PLACE)

nursalam-MASALAH
 TITLE TO EXPLAIN (TAKE OUT)
EFFECT OF PRE OP COUNSELING IN NURSING
CARE ON REDUCING STRESS RESPONSE, VITAL
SIGNS AND IMMUNE RESPONSE MODULATION
FOR PATIENT WITH PRE OP
OR
PRE OP COUNSELING IN NURSING CARE ON
REDUCING STRESS RESPONSE, VITAL SIGNS,
AND IMMUNE RESPONSE MODULATION FOR
PATIENT WITH PRE OP
Oleh: Nursalam
NIM . 090214910D

nursalam-MASALAH
 HYPOTHESIS (quantitative!)
 Hypo = low
 Thesis = statement
(a prediction about the relationship between variables.).

H1: There are effect of counseling on reducing stress

response, vital signs and immune response modulation
pre op patient with .......

nursalam-MASALAH
 6. WRITE CHAPTER 1
(INTRODUCTION)
1.1 BACKGROUND (MSKS / MKSS)
1.2 SEARCHING RESEARCH PROBLEM
1.3 RESEARCH QUESTIONS
1.4 AIM AND OBJECTIVE (BASED ON
FRAMEWORK)
1.5 BENEFIT

nursalam-MASALAH
 CHAPTER 1,2,3: ALREADY
BAB 1 S/D BAB 3 SUDAH TERJAWAB

CHAPTER 1: INTRODUCTION
1. Background (MSKS / MKSS)
Paragraph 1: problems (F1 & F2)
Paragraph 2: scale of the problems
Paragraph 3: chronological
Paragraph 4: Solution
2. Research questions
3. Aim and objectives
4. Benefit (theoretically & Practice)
CHAPTER 2: LITERATURE REVIEW
CHAPTER 3: FRAMEWORK AND HYPOTHESIS
CHAPTER 4: RESEACH METHODS nursalam-MASALAH
 7. WRITE CHAPTER 4
(RESEARCH METHODS)

D –DESIGN (non experiment & experiment)

S – SAMPLE (POPULATION, SAMPLING,
SAMPLE SIZE)
V – VARIABLE (independent, dependent, ........)
I – INSTRUMENT (Observation, questionnaire, scale,
in vivo – vitro, in depth interview)
A – ANALYSIS (T-S-S-V)
nursalam-MASALAH
 “My basic principle is that you don’t make
decisions because they are easy; you don’t
make them because they are cheap; you don’t
make them because they’re popular; you
make them because they’re right”
Fr. Theodore Hesburgh

(Burns & Grove, 2001; Melnyk &

Fineout-Overholt, 2005)
 CONCLUTION

1. Deciding the Area of reseach and brain

storming – spider web
2. Searching research problems based on
empirical and theoritical (write chapter
literature review)
3. Write framework & hypothesis
4. Write chapter Introduction
5. Write reseach methods
nursalam-MASALAH
“You don’t have to be great to get started,
but you have to get started to be great”
mtrla/13072010 56
--------- Les Brown ----------
GOOD LUCK

mtrla/13072010 57