EVIDENCE-BASED PRACTICE IN NURSING.docxHaraLakambini
-Evidence-based Practice in Nursing
-Steps of Evidence-Based Practice
-Hierarchy of Evidence | Quantitative Questions
-Elements of Evidence-Based Practice
-Nursing Research
-Types of Research
-Rights of Human Subject
-Comparison of Nursing Process with Research Process Table
-Performance Improvement in Nursing
-Examples of Performance Improvement Models
-Relationship between Evidence-Based Practice, Research, and Performance Improvement
-Similarities and Differences among Evidence-Based Practice, Research, and Performance Improvement
THE NEED FOR EVIDENCE-BASED PRACTICE
STEPS OF EVIDENCE-BASED PRACTICE
PICOT FORMAT IN EBP
RATING SYSTEM FOR THE HIERARCHY OF EVIDENCE: QUANTITATIVE QUESTIONS
ELEMENTS OF EVIDENCE-BASED ARTICLES
INTEGRATE THE EVIDENCE
EVALUATE THE OUTCOMES OF THE PRACTICE DECISION OR CHANGE
COMMUNICATE THE OUTCOMES OF THE EVIDENCE-BASED PRACTICE DECISION
SUSTAIN KNOWLEDGE USE
NURSING RESEARCH
TRANSLATION RESEARCH
5 PHASES OF TRANSLATION RESEARCH
OUTCOMES RESEARCH
SCIENTIFIC METHOD
CHARACTERISTICS OF SCIENTIFIC RESEARCH
NURSING AND THE SCIENTIFIC APPROACH
TYPES OF RESEARCH
TYPES OF RESEARCH APPROACH
RESEARCH PROCESS
RIGHTS OF HUMAN SUBJECT
COMPARISON OF STEPS OF THE NURSING PROCESS WITH THE RESEARCH PROCESS
Performance Improvement
Performance Improvement Programs
EXAMPLES OF PERFORMANCE IMPROVEMENT MODELS
THE RELATIONSHIP BETWEEN EBP, RESEARCH, AND PERFORMANCE IMPROVEMENT
SIMILARITIES AND DIFFERENCES AMONG EVIDENCE-BASED PRACTICE, RESEARCH, AND PERFORMANCE IMPROVEMENT
KEY ELEMENTS
EVIDENCE-BASED PRACTICE IN NURSING.docxHaraLakambini
-Evidence-based Practice in Nursing
-Steps of Evidence-Based Practice
-Hierarchy of Evidence | Quantitative Questions
-Elements of Evidence-Based Practice
-Nursing Research
-Types of Research
-Rights of Human Subject
-Comparison of Nursing Process with Research Process Table
-Performance Improvement in Nursing
-Examples of Performance Improvement Models
-Relationship between Evidence-Based Practice, Research, and Performance Improvement
-Similarities and Differences among Evidence-Based Practice, Research, and Performance Improvement
THE NEED FOR EVIDENCE-BASED PRACTICE
STEPS OF EVIDENCE-BASED PRACTICE
PICOT FORMAT IN EBP
RATING SYSTEM FOR THE HIERARCHY OF EVIDENCE: QUANTITATIVE QUESTIONS
ELEMENTS OF EVIDENCE-BASED ARTICLES
INTEGRATE THE EVIDENCE
EVALUATE THE OUTCOMES OF THE PRACTICE DECISION OR CHANGE
COMMUNICATE THE OUTCOMES OF THE EVIDENCE-BASED PRACTICE DECISION
SUSTAIN KNOWLEDGE USE
NURSING RESEARCH
TRANSLATION RESEARCH
5 PHASES OF TRANSLATION RESEARCH
OUTCOMES RESEARCH
SCIENTIFIC METHOD
CHARACTERISTICS OF SCIENTIFIC RESEARCH
NURSING AND THE SCIENTIFIC APPROACH
TYPES OF RESEARCH
TYPES OF RESEARCH APPROACH
RESEARCH PROCESS
RIGHTS OF HUMAN SUBJECT
COMPARISON OF STEPS OF THE NURSING PROCESS WITH THE RESEARCH PROCESS
Performance Improvement
Performance Improvement Programs
EXAMPLES OF PERFORMANCE IMPROVEMENT MODELS
THE RELATIONSHIP BETWEEN EBP, RESEARCH, AND PERFORMANCE IMPROVEMENT
SIMILARITIES AND DIFFERENCES AMONG EVIDENCE-BASED PRACTICE, RESEARCH, AND PERFORMANCE IMPROVEMENT
KEY ELEMENTS
Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
CRIS LUTHER's RESEARCH METHODOLOGIES COMPILATIONcrisluther
RESEARCH METHODOLOGIES
by Cris Luther, B.S.N.,R.N.
This material is a compilation of various information on generally acceptable knowledge, concepts, principles, theories and practices in RESEARCH. It adapts contents from various publicly acknowledged publications, authors, theorists, authorities and practitioners whose works are commonly utilized in the academe and practice, and are frequently-tested competencies locally and abroad.
The works of these authors, theorists, authorities and practitioners are indispensable in learning research methodologies as they are indispensable in the completeness of this compilation.
Care has been taken to confirm accuracy of the information presented and describes generally accepted practices. However the student who prepared this material is not responsible for errors or omissions or for any consequences from application of the information in this compilation.
The primary goal of the student is to familiarize concepts in the subject RESEARCH METHODOLOGIES based on the COURSE OUTLINE provided by his Graduate School Professor DR. HELEN B. AGGABAO. It is not intended for commercial publication and resources were acquired legally.
It is his great pleasure that this compilation be reproduced for reference of other students aiming to thoroughly understand RESEARCH METHODOLOGIES.
EVIDENCE –BASED PRACTICES 1
Evidence-Based Practices
Stephanie Petit-homme
Miami Regional University
Professor: Garcia Mercedes
07/05/2021
Evidence-Based Practices to Guide Clinical Practices
In other terms recognized as evidence-based medication, evidence-based scientific practice is elucidated as the careful, obvious, and judicious use of the best indication in creating results for the outstanding care of separate patients. It helps those who brand the choices to device best healthcare practices while drawing the roadmaps for the health system. In clinical trials, the integration of the EBCP entails clinical respiratory medicine considers two fundamental principles. For example, the principle is the hierarchy of the evidence and the art of clinical decision-making.
The interrelationship between the theory, research, and EBP
The relationship between the theory, research, and the EBP supports the three recognition programs. They still relate in terms of the magnet model component of modern knowledge, innovation, and advancement. They describe in a way in which they lead to the promotion of quality in a setting that makes supports professional practices. Second, there is the identification of excellence in giving nursing services to sick people or the people who stay around. For instance, the model, which is other terms the magnet theory, has got five components ( Reddy, 2018).
The first constituent includes transformational management; the additional is structural authorization. The third one is archetypal specialized practices, new information, invention, and upgrading. Lastly, in the model, there are the empirical quality outcomes. For the achievement of the aims of the goals that have been set, there is a need to make sure that the theory, current knowledge innovation, and the improvements and the components that are found in view all the nurses who are located in the levels of the healthcare company need to get involved.
The research has its primary purpose for the help of coming up with knowledge or the validation done for the knowledge that has always been there from before based on the theory. There is systematic, scientific questioning in the research to give the answers to some of the specific questions. It can use the test hypotheses and the rigorous method, the primary purpose of the study being for investigation knowing of the new things and the exploration. There is a need to understand the philosophy of science.
Second, on the EBP, there is no development of the new knowledge or even the learning being validated. The primary purpose of the EBP is to translate the evidence and then apply it to medical executive. It uses the indication available to brand patient-care choices. The EBP goes yonder the exploration as fine as the persevering penchants and ideals. The EBP retains into deliberation that the best indication is for the opinion leaders and the experts. Even though there is the existence of definitiv ...
Presenting a published paper:
"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review
approach"
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
Based on your course reading assignments and your pending research p.docxcherishwinsland
Based on your course reading assignments and your pending research problem, what type of study do you believe you are conducting, and please explain why?
Extra materials:
Descriptive
research
is a study designed to depict the participants in an accurate way. More simply put, descriptive analysis is all about describing people who take part in the survey.
There are three ways a researcher can go about doing a descriptive research project, and they are:
Observational, defined as a method of viewing and recording the participants
Case study, defined as an in-depth study of an individual or group of individuals
Survey, defined as a brief interview or discussion with an individual about a specific topic
Mixed
methods
research
(Extracted from the article below) is the use of quantitative and qualitative methods in a single study or series of studies. It is a new methodology that is increasingly used by health researchers, especially within health services research. There is a growing literature on the theory, design, and critical appraisal of mixed methods research. However, few papers summarize this methodological approach for health practitioners who wish to conduct or critically engage with mixed methods studies.
Article: Using Mixed Methods in Health Research
Meta-Analysis
Meta
-
analysis
is a statistical technique for combining data from multiple studies on a particular topic. A Meta-analysis is an analytical tool for estimating the mean and variance of underlying population effects from a collection of empirical studies addressing ostensibly the same research question. Meta‐analysis has become an increasingly popular and valuable tool in psychological research, and significant review articles typically employ these methods.
Article: Meta-Analysis in Medical Research
Epidemiology
According to the Centers for Disease Control,
Epidemiology
is the method used to find the causes of health outcomes and diseases in populations. In epidemiology, the patient is the community and individuals are viewed collectively. By definition, epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, school, city, state, country, global).
Article: Epidemiology is a Science of High Importance
Longitudinal Studies
Longitudinal Study, an epidemiologic study that follows a population forward over time, evaluating the effects of one or more variables on a process. If individuals are followed, it is termed a longitudinal cohort study. If classes—e.g., age classes—are studied, it is a longitudinal cross-sectional study. Longitudinal studies are the converse (opposite) of horizontal (parallel) studies.
Article Longitudinal Studies
.
Based on yesterday Assignment (Green Machine)1. Provide a Com.docxcherishwinsland
Based on yesterday Assignment (Green Machine)
1. Provide a Comprehensive Strategy Assessment -
2. Describe each key competitor’s current positioning/marketing strategy.
3. What are each key competitor’s major sources of competitive advantage?
Note: I'm attached a Sample Document. please check it any questions or you can ping me.
.
Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
CRIS LUTHER's RESEARCH METHODOLOGIES COMPILATIONcrisluther
RESEARCH METHODOLOGIES
by Cris Luther, B.S.N.,R.N.
This material is a compilation of various information on generally acceptable knowledge, concepts, principles, theories and practices in RESEARCH. It adapts contents from various publicly acknowledged publications, authors, theorists, authorities and practitioners whose works are commonly utilized in the academe and practice, and are frequently-tested competencies locally and abroad.
The works of these authors, theorists, authorities and practitioners are indispensable in learning research methodologies as they are indispensable in the completeness of this compilation.
Care has been taken to confirm accuracy of the information presented and describes generally accepted practices. However the student who prepared this material is not responsible for errors or omissions or for any consequences from application of the information in this compilation.
The primary goal of the student is to familiarize concepts in the subject RESEARCH METHODOLOGIES based on the COURSE OUTLINE provided by his Graduate School Professor DR. HELEN B. AGGABAO. It is not intended for commercial publication and resources were acquired legally.
It is his great pleasure that this compilation be reproduced for reference of other students aiming to thoroughly understand RESEARCH METHODOLOGIES.
EVIDENCE –BASED PRACTICES 1
Evidence-Based Practices
Stephanie Petit-homme
Miami Regional University
Professor: Garcia Mercedes
07/05/2021
Evidence-Based Practices to Guide Clinical Practices
In other terms recognized as evidence-based medication, evidence-based scientific practice is elucidated as the careful, obvious, and judicious use of the best indication in creating results for the outstanding care of separate patients. It helps those who brand the choices to device best healthcare practices while drawing the roadmaps for the health system. In clinical trials, the integration of the EBCP entails clinical respiratory medicine considers two fundamental principles. For example, the principle is the hierarchy of the evidence and the art of clinical decision-making.
The interrelationship between the theory, research, and EBP
The relationship between the theory, research, and the EBP supports the three recognition programs. They still relate in terms of the magnet model component of modern knowledge, innovation, and advancement. They describe in a way in which they lead to the promotion of quality in a setting that makes supports professional practices. Second, there is the identification of excellence in giving nursing services to sick people or the people who stay around. For instance, the model, which is other terms the magnet theory, has got five components ( Reddy, 2018).
The first constituent includes transformational management; the additional is structural authorization. The third one is archetypal specialized practices, new information, invention, and upgrading. Lastly, in the model, there are the empirical quality outcomes. For the achievement of the aims of the goals that have been set, there is a need to make sure that the theory, current knowledge innovation, and the improvements and the components that are found in view all the nurses who are located in the levels of the healthcare company need to get involved.
The research has its primary purpose for the help of coming up with knowledge or the validation done for the knowledge that has always been there from before based on the theory. There is systematic, scientific questioning in the research to give the answers to some of the specific questions. It can use the test hypotheses and the rigorous method, the primary purpose of the study being for investigation knowing of the new things and the exploration. There is a need to understand the philosophy of science.
Second, on the EBP, there is no development of the new knowledge or even the learning being validated. The primary purpose of the EBP is to translate the evidence and then apply it to medical executive. It uses the indication available to brand patient-care choices. The EBP goes yonder the exploration as fine as the persevering penchants and ideals. The EBP retains into deliberation that the best indication is for the opinion leaders and the experts. Even though there is the existence of definitiv ...
Presenting a published paper:
"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review
approach"
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
Based on your course reading assignments and your pending research p.docxcherishwinsland
Based on your course reading assignments and your pending research problem, what type of study do you believe you are conducting, and please explain why?
Extra materials:
Descriptive
research
is a study designed to depict the participants in an accurate way. More simply put, descriptive analysis is all about describing people who take part in the survey.
There are three ways a researcher can go about doing a descriptive research project, and they are:
Observational, defined as a method of viewing and recording the participants
Case study, defined as an in-depth study of an individual or group of individuals
Survey, defined as a brief interview or discussion with an individual about a specific topic
Mixed
methods
research
(Extracted from the article below) is the use of quantitative and qualitative methods in a single study or series of studies. It is a new methodology that is increasingly used by health researchers, especially within health services research. There is a growing literature on the theory, design, and critical appraisal of mixed methods research. However, few papers summarize this methodological approach for health practitioners who wish to conduct or critically engage with mixed methods studies.
Article: Using Mixed Methods in Health Research
Meta-Analysis
Meta
-
analysis
is a statistical technique for combining data from multiple studies on a particular topic. A Meta-analysis is an analytical tool for estimating the mean and variance of underlying population effects from a collection of empirical studies addressing ostensibly the same research question. Meta‐analysis has become an increasingly popular and valuable tool in psychological research, and significant review articles typically employ these methods.
Article: Meta-Analysis in Medical Research
Epidemiology
According to the Centers for Disease Control,
Epidemiology
is the method used to find the causes of health outcomes and diseases in populations. In epidemiology, the patient is the community and individuals are viewed collectively. By definition, epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, school, city, state, country, global).
Article: Epidemiology is a Science of High Importance
Longitudinal Studies
Longitudinal Study, an epidemiologic study that follows a population forward over time, evaluating the effects of one or more variables on a process. If individuals are followed, it is termed a longitudinal cohort study. If classes—e.g., age classes—are studied, it is a longitudinal cross-sectional study. Longitudinal studies are the converse (opposite) of horizontal (parallel) studies.
Article Longitudinal Studies
.
Based on yesterday Assignment (Green Machine)1. Provide a Com.docxcherishwinsland
Based on yesterday Assignment (Green Machine)
1. Provide a Comprehensive Strategy Assessment -
2. Describe each key competitor’s current positioning/marketing strategy.
3. What are each key competitor’s major sources of competitive advantage?
Note: I'm attached a Sample Document. please check it any questions or you can ping me.
.
Based on what youve learned from the material on incidental teachin.docxcherishwinsland
Based on what you've learned from the material on incidental teaching, in a two page (minimum) double spaced paper, describe in detail how you would implement an incidentaI teaching model in a preschool classroom with 10 children. Include: methods of target behavior identification, methods of reinforcement, and expected outcomes as a result of IT implementation.
.
Based on what you have learned related to cybercrime and technol.docxcherishwinsland
Based on what you have learned related to cybercrime and technology, write 2 pages outlining your opinion of what might happen in the future with the emergence of artificial intelligence and/or autonomous vehicles (any kind) and other emerging technologies.
What kind of crimes do you think might be possible?
How might our legal system have to change in order to keep up?
Do we need stricter laws or better technology? or both?
.
Based on what you have learned in this class, write a letter to a fu.docxcherishwinsland
Based on what you have learned in this class, write a letter to a future employer that explains how religion, language, philosophy, material culture, non-material culture, and/or interaction with the environment have shaped the origins and evolution of world civilizations. Please provide at least two concrete examples.
pick on and write about it. 3 pages
.
Based on what you have learned about using unified communication.docxcherishwinsland
Based on what you have learned about using unified communication platforms in a collaborative environment,
create
a 5-slide presentation to a department head or the CEO of a company to convince the audience that this would benefit their business.
Remember to use this format:
Introduction
State the business problem
The current set up
What is Unified Communication Platforms
State how Unified Communication Platforms will help the business
Cite at least two apps that are part of Unified Communication Platforms that is recommended by you
Cost of moving to Unified Communication Platform
Conclusion
Click
the Assignment Files tab to submit your assignment.
.
Based on what you have learned about using cloud-based office pr.docxcherishwinsland
Based on what you have learned about using cloud-based office productivity software,
create
a 5-slide presentation to the department head or CEO to convince him or her that using a cloud-based office productivity suite would benefit the company.
Include
the following in your presentation:
The stated business problem
The current set up
The benefits of moving to the cloud:
The benefits of collaboration
The difference moving to the cloud will be over current practice
Cost of moving to the cloud
Be sure that you also
include
an Introduction and Conclusion slide, along with graphics, Speaker Notes, and a properly formatted APA Reference slide.
Click
the Assignment Files tab to submit your assignment.
.
Based on week 13 reading assignment wh,describe an IT or simil.docxcherishwinsland
Based on week 13 reading assignment wh,
describe an IT or similar business project you have done or are currently doing. In your discussion, provide information on the following:
1. What is that project? Provide complete description.
2. What was the scope, deliverable, and results of the project?
3. What constraints did you experience and how did you handle them?
4. If you had to do the same project again, what changes will you recommend?
Week 13 reading assignment attached
.
Based on the video, how do we make ourselves vulnerable or not so vu.docxcherishwinsland
Based on the video, how do we make ourselves vulnerable or not so vulnerable with decision-making. Sometimes do we try to make the uncertain, certain, by making a decision without the facts and taking into consideration everyone's perspective of the decision at hand? Do we pretend that the other perspective doesn't even exist when we are making decisions?
https://www.ted.com/talks/brene_brown_the_power_of_vulnerability/up-next
.
Based on the video (specifically Section 1 Understanding the Comm.docxcherishwinsland
Based on the video (specifically Section 1:
Understanding the Communications Plan
) think of a presentation or proposal you have given or observed, or may be giving in the future, and complete a Stakeholder Register (
Stakeholder Register example
). Requirements include a brief synopsis of the presentation or proposal (1 page maximum) and a completed register. You may use whatever format for the register (word document, spreadsheet, etc.) that is convenient
.
Based on the texts by Kafka and Eliot, (writing on one or the other .docxcherishwinsland
Based on the texts by Kafka and Eliot, (writing on one or the other or both), discuss how the writers seem critical of modern culture, as they portray modern man as a self-conscious functionary who fears an acute loss of spirituality and identity, as well as the ability to achieve authenticity and happiness, overcome by the dehumanizing forces of industrialization and capitalism in post-WWI Europe.
- at least 700 words.
- MLA style
.
Based on the texts by Kafka and Eliot, (writing on one or the ot.docxcherishwinsland
Based on the texts by Kafka and Eliot, (writing on one or the other or both), discuss how the writers seem critical of modern culture, as they portray modern man as a self-conscious functionary who fears an acute loss of spirituality and identity, as well as the ability to achieve authenticity and happiness, overcome by the dehumanizing forces of industrialization and capitalism in post-WWI Europe.
.
Based on the techniques discussed for hiding data on a computer, w.docxcherishwinsland
Based on the techniques discussed for hiding data on a computer, which method would you use for the following:
Hiding information from a young family member who uses the same computer
Hiding information from a colleague who is a network administrator
Hiding information from an intelligence agency, such as the CIA
data hiding techniques
: -
1.hide in the properties
2.rename/change extension
3.steganography
4.hash
5.encryption
6.bit shifting
.
Based on the readings, there are specific components that encompass .docxcherishwinsland
Based on the readings, there are specific components that encompass SW-PBIS. Please describe any additional components that you think should also be included in the SW-PBIS plan. State why you think this(these) component(s) should be included.
An initial posting of roughly 150 words is due by January 12th.
.
Based on the readings titled ‘Lost Trust’, ‘Chinese Port Cities’ a.docxcherishwinsland
Based on the readings titled ‘Lost Trust’, ‘Chinese Port Cities’ and ‘Emerging Urban Form of Accra’, identify and describe emerging URBAN spatial patterns in the United States, Shanghai (China) and Accra (Ghana) under globalization.
Instructions. This is a 3-2-paragraph essay and should fit onto one page, 1.5 spacing and 1-inch margins (About 400 words).
Your second paragraph should identify and describe the emerging spatial patterns for the core (USA). This paragraph should be about 100 words.
Your second third paragraph should identify and describe the spatial patterns for the semi-periphery (China). This paragraph should be about 100 words.
Your fourth paragraph should make spatial patterns for the periphery (Ghana). This paragraph should be about 100 words.
Your first paragraph should be a very, very brief introduction (no more than 2 sentences or about 50 words) and the fifth should be a very brief conclusion (no more than two sentences or about 50 words). These make up the 2 in the 3-2- paragraph essay.
By putting these five paragraphs together, you would have written an essay about emerging geographies of urbanization under globalization in the core, semi-periphery and periphery focusing on spatial patterns ONLY.
Rubic_Print_FormatCourse CodeClass CodeAssignment TitleTotal PointsHCA-807HCA-807-O500Contrast of Health Care Structures200.0CriteriaPercentageUnsatisfactory (0.00%)Less Than Satisfactory (73.00%)Satisfactory (82.00%)Good (91.00%)Excellent (100.00%)CommentsPoints EarnedContent70.0%Contrast of Public and Private Structures20.0%A contrast of public and private structures is either missing or not evident to the reader.A contrast of public and private structures is present, but incomplete or inaccurate.A contrast of public and private structures is presented, but is cursory and lacking in depth. The research used for support is outdated.A contrast of public and private structures is thoroughly presented and includes a discussion of all necessary elements. The contrast is moderately well supported though some sources of support are outdated.A contrast of public and private structures is thoroughly presented with rich detail and includes a discussion of all necessary elements. The contrast is well supported with current and/or seminal research.Analysis of Current Viability and Future Sustainability of Each Structure20.0%An analysis of current viability and future sustainability of each structure is either missing or not evident to the reader.An analysis of current viability and future sustainability of each structure is present, but incomplete or inaccurate.An analysis of current viability and future sustainability of each structure is present, but cursory. The research used for support is outdated.An analysis of current viability and future sustainability of each structure is present and thorough. The analysis is moderately well supported though some sources of support are outdated.An analysis of current viability and .
Based on the readings this week, answer the two following questions .docxcherishwinsland
Based on the readings this week, answer the two following questions in 150 words per question:
1. In this weeks' readings the Puerto Rican and Jamaican voice (specifically DJ Kool Herc losing his accent) were omitted from hip hop/rap culture while the Chicano voice was avidly expressed. In your opinion, what factors contributed to this binary of resistance and conformity? In other words, why do you think Chicanos held on to their language and slang, where other ethnic groups did not?
2. In hip hop/rap culture, how important is a name in the quest for identity formation? Use examples from the texts.
.
Based on the readings for the week, discuss your opinion on the need.docxcherishwinsland
Based on the readings for the week, discuss your opinion on the need for variance analysis in either a service provider setting (retail or restaurant), or manufacturing setting.
VanZante, N. (2007, April). Helping students see the "big picture" of variance analysis. Management Accounting Quarterly, 8(3), 39-40, 42-47. Retrieved March 17, 2010, from ProQuest Database.
.
Based on the reading assignment, your experience, and personal r.docxcherishwinsland
Based on the reading assignment, your experience, and personal research, please answer the following questions:
Thoroughly explain what is recovering, data, and validation as it relates to cell phone forensics?
What is evidence contamination as it relates to digital forensics?
List and describe at least two forms of contamination and how they can be avoided
What is the Faraday method?
List and explain three of the strategies associated with Faraday Methods
.
Based on the reading assignment (and in your own words), why are MNE.docxcherishwinsland
Based on the reading assignment (and in your own words), why are MNEs better able to exploit global opportunities (versus purely domestic competitors)?
Your response should be at least
200 words
in length. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.
[removed] [removed] [removed] [removed]
Moffett, M. H., Stonehill, A. I., & Eiteman, D. K. (2012).
Fundamentals of multinational finance
. (IV ed., pp. 14-14). New York: Pearson.
In-text citation
(Moffett, Stonehill & Eiteman, 2012)
No Wiki, no dictionary.com, please cite all work.
.
Based on the primary documents from chapter 23 of AmericanYawp, plea.docxcherishwinsland
Based on the primary documents from chapter 23 of AmericanYawp, please answer the following questions in a thoughtful, well-written essay of approximately 750 words:
1: What is Herbert Hoover’s fear about the New Deal? What does he mean when he warns that a new deal “would destroy the very foundations of our American system”?2: What was Huey Long’s plan? Would Hoover have approved of it? Why or why not?3: What was FDR’s plan, as outlined in his re-nomination speech? Would Long and Hoover have approved or disapproved of this plan? Why or why not?
Papers should be double-spaced with normal fonts and margins and include an introduction and conclusion
.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
2. INTRODUCTION
The current emphasis on evidence-based practice and
the desire to achieve “magnet status” has renewed
interest in nursing research in many health-care
institutions. The Magnet Recognition Program, devel-
oped by the American Nurses Credentialing Center
(ANCC), recognizes health-care organizations that
provide exceptional nursing care through a rigorous
system of standards and written documentation, culmi-
nating in a site visit and the resultant award (ANCC,
2005). This benchmark allows consumers of nursing
care to judge an institution’s quality and provides evi-
dence of nursing excellence. Evidence-based practice
assumes that nurses are able to appraise whether or not
a research study is scientifically sound/rigorous. It is
but one step in the very challenging process of clinical
decision-making. Although most nurses complete a
research course during their educational programs,
many have little practical experience in this skill and
they are now looking for ways to help them efficiently
appraise the value of research. Furthermore, graduate
students frequently are asked to critique research and
faculty members continue to search for methods to
help students better learn this skill. Finally, it has been
this author’s experience that, as health-care institutions
journey towards magnet status, many are partnering
with research faculty members for guidance in revising
nursing research committees, completing research,
and/or learning about research.
The quest by clinicians, nursing administrators and
students for more knowledge and skill in the research
process leads to the need for readily available methods
to critically evaluate research studies. Traditional nurs-
ing research texts offer guidelines related to critiquing
3. research; for example, Burns and Grove (2003) and
Polit and Beck (2004) contain chapters addressing this
issue. Most of these guidelines are written in an open-
ended question format requiring a verbal or narrative
reply. Although this method is thought-provoking, it is
subjective and often requires some prior knowledge of
the research process. Furthermore, it is not an efficient
way for busy professionals who have limited time to
judge a study’s worth.
A recent textbook, Evidence-Based Practice in Nurs-
ing and Healthcare (Melnyk & Fineout-Overholt,
2005) offers two chapters on critical appraisal of
research with an emphasis on rating the strength of
available evidence to inform clinical decisions and the
resultant nursing actions. In fact, the evidence-based
practice movement has yielded numerous articles
describing the types of evidence and procedures for
grading the quality of studies (Cochrane, 1970; Guyatt
et al., 1994; Greenlaugh, 1997; Melnyk, 2003). A recent
systematic review of critical appraisal tools yielded 121
published instruments available for this purpose
(Katrak et al., 2004). Of these, there were considerable
variability and overlap, and few documented psycho-
metric properties. Most instruments related to quanti-
tative studies and 49 summarized results in a numerical
format.
The need for practical research-appraisal instru-
ments, coupled with the numerous existing tools, cre-
ates information overload and can be frustrating for
busy consumers of research (clinicians) and faculty
282 J. R. Duffy
5. fears about appropriate treatment for her cancer, a
nurse might formulate a question such as, “In breast
cancer patients, what is the effect of treatment A com-
pared to treatment B?” Such a succinct question pro-
vides key words to guide a search of the literature on
the topic. The resultant literature will yield a number of
studies that can then be categorized and subjected to
the critical appraisal process.
CRITICAL APPRAISAL PROCESS
A preliminary step in the appraisal process is to distin-
guish among several types of quantitative studies. Four
broad categories of studies are presented: case studies,
non-experimental cross-sectional or cohort studies,
randomized clinical trials, systematic reviews, including
meta-analyses. Case studies describe the trajectory of a
patient; they tend to be detailed descriptions that alert
health professionals to conditions that are not rou-
tinely seen in practice. As such, they are interesting,
but not the result of a systematic inquiry. Non-
experimental cross-sectional studies examine clinical
issues in similar patient populations at one point in
time. A non-experimental cohort study examines
clinical issues in a patient population over a desig-
nated amount of time. These studies might compare
interventions or treatments, but lack random
assignment to groups. Randomized clinical trials com-
pare the effectiveness of an intervention/treatment.
Participants in these studies are randomly assigned to
respective groups and their outcomes are compared
with each other and a control group that receive the
usual care. As a result of these features, randomized
clinical trials are experimental and continue to be the
“gold standard” study design for judging the effective-
6. ness of an intervention/treatment. Finally, systematic
reviews are a collection of studies that addresses a
specific clinical issue. They incur a detailed literature
review, critical appraisal, and a summary of results of
several studies. A meta-analysis is a special form of sys-
tematic review that employs statistical tests to deter-
mine an estimate of treatment effect. Systematic
reviews, including meta-analyses, are considered to be
the highest level of evidence (Melnyk, 2003) and are
used to generate clinical guidelines and influence
clinical decisions.
Distinguishing among these types of quantitative
studies will guide the appraiser in choosing the appro-
priate framework. A research course and general
understanding of research methods will help the clini-
cian in this step. Once the particular type of study is
known, the appraiser should read the entire study first
to understand the population, intervention/treatment,
and the results. A framework chosen by the appraiser
and unique to the type of quantitative study should be
employed to guide the evaluation process. Appendix I
provides links to various critical appraisal tools. As
many such tools exist, it is important to choose only
those that fit the type of quantitative study and have
established validity and reliability. Such information is
found by carefully examining original peer-reviewed
publications and other studies that have used the spe-
cific instrument. The format and practicality are also a
concern; many critical appraisal tools have open-ended
questions that require careful narrative responses
while others are scored numerically.
Using each item, the study is evaluated by answering
the relevant questions. These results will identify the
overall strengths and weaknesses of a study and sug-
8. American Nurses Credentialing Center. ANCC Magnet Rec-
ognition Program – Recognizing Excellence in Nursing Ser-
vices. 2005. [Cited 16 August 2005]. Available from URL:
http://www.nursingworld,org/ancc/magnet/index.html.
Burns N, Grove S. The Practice of Nursing Research. Phila-
delphia: WB Saunders, 2003.
Cochrane A (ed.). A Critical Review, with Particular Refer-
ence to the Medical Profession. London: Office of Health
Economics, 1970.
Greenlaugh T. How to Read a Paper: The Basis of Evidence
Based Medicine. London: BMJ Publishing, 1997.
Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the med-
ical literature II. How to use an article about therapy or
prevention. B. What were the results and will they help me
in caring for my patients? Evidence-Based Medicine
Working Group. J. Am. Med. Assoc. 1994; 217: 59–63.
Katrak P, Bralocerkowski A, Jassy-Westropp N, Jumar VSS,
Gimmer K. A systematic review of the content of critical
appraisal tools. BMC Med. Res. Methodol. 2004; 4: 22.
Melnyk BM. Critical appraisal of systematic reviews: a key
strategy for evidence-based practice. Pediatr. Nurs. 2003;
29: 125, 147–149.
Melnyk BM, Fineout-Overholt E. Evidence-based Practice in
Nursing and Healthcare. Philadelphia: Lippincott, 2005.
Polit D, Beck CT. Nursing Research: Principles and Methods.
Philadelphia: Lippincott, Williams & Wilkins, 2004.
9. Princeton University. Word Net 2.0. 2003a. [Cited 22 June
2005]. Available from URL: http://www.dictionary.
reference.com/search?q=appraisal.
Princeton University. Word Net 2.0. 2003b. [Cited 22 June
2005]. Available from URL: http://www.dictionary.
reference.com/search?q=critical.
APPENDIX I
Links to critical appraisal frameworks
http://www.library.kent.ac.uk/livrary/info/subjectg/
healthinfo/critapprais.shtml.
http://www.shef.ac.uk/scharr/ir/units/critapp/
appres.htm.
http://.jama.ama-assn.org/cogi/content/full/.
http://bmj.bmjjournals.com/cgi/content/full.
http://www.phru.nhs.uk/casp/casp.htm.
http://www.shef.ac.uk/scharr/triage/index/critic.htm.
http://hsc.uwe.ac.uk/dataanalysis/crithome.htm.
http://www.city.ac.uk/library/subject_guides/nursing/
critical_appraisal.html.
http://www.ephu.man.ac.uk/Teaching/Undergrad/
CritApp/what.htm.
http://www.surgical-tutor.org.uk/default-
home.htm?amazon/appraisal.htm∼right.
http://www.be-evidence-based.com/secure_pages/
skills.php?id=40.
http://www.lshtm.ac.uk/hsru/casp/.
10. APPENDIX II
Process for critical appraisal of
quantitative studies
1. Distinguish among the types of quantitative
research.
2. Read the entire study and summarize the
population characteristics, intervention/treatment, and
results.
3. Choose and use an appropriate critical appraisal
framework.
4. Evaluate the study.
5. Combine the results of the evaluation with
clinical experience/expertise, professional values, and
patients’ preferences.
6. Use results to inform clinical decisions.
http://www.nursingworld,org/ancc/magnet/index.html
http://www.dictionary
http://www.dictionary
http://www.library.kent.ac.uk/livrary/info/subjectg/
http://www.shef.ac.uk/scharr/ir/units/critapp/
http://bmj.bmjjournals.com/cgi/content/full
http://www.phru.nhs.uk/casp/casp.htm
http://www.shef.ac.uk/scharr/triage/index/critic.htm
http://hsc.uwe.ac.uk/dataanalysis/crithome.htm
http://www.city.ac.uk/library/subject_guides/nursing/
http://www.ephu.man.ac.uk/Teaching/Undergrad/
http://www.surgical-
11. tutor.org.uk/defaulthome.htm?amazon/appraisal.htm%E2%88%
BCright%00
http://www.be-evidence-based.com/secure_pages/
http://www.lshtm.ac.uk/hsru/casp/
Rehabilitation Nursing • Vol. 36, No. 3 • May/June 91
Rehabilitation NURSING
A Study of Factors Affecting
Moving-Forward Behavior
Among People with Spinal
Cord Injury
Hsiao-Yu Chen, PhD MSc BSc RN • Chia-Hsiang Lai, PhD •
Tzu-Jung Wu, MS RN
Enhancing self-efficacy, self-perception, and social support can
be an effective way for people with spinal cord injury (SCI)
to move forward. The purpose of this study was to explore
relationships between “moving-forward behavior” and demo-
graphic and disease characteristics, self-efficacy, self-
perception, and social support among people with SCI. The
study was
designed as a descriptive-correlation, cross-sectional study. The
participants were selected using cluster random sampling
(n = 210) through the Spinal Injury Association in Taiwan. A
statistically significant relationship was found between
moving-forward behavior and age (t = -2.30, p < .05), self-
efficacy (γ = -0.25, p < .01), and self-perception (γ = -0.39, p
< .01). Age (odds ratio [OR] = 0.964, p < .05) and self-
perception (OR = 0.824, p < .05) were both significant
predictors
12. of moving-forward behavior.
Spinal cord injury (SCI) is a catastrophic event in
any person’s life. SCI can cause complete or partial
impairment of physical mobility, leaving the injured
person with the challenge of coping with and reha-
bilitating his or her injury (Chen & Boore, 2007, 2008;
Chen & Li, 2002; Gill, 1999; Sharma, 2005; Yang &
Wang, 2001). During the past 20 years great strides
have been made in SCI treatment. However, current
treatment continues to focus on the provision of
care in the acute stage and the prevention and treat-
ment of complications (Yu et al., 2006). Although
many scientists are studying nerve regeneration
and conducting stem cell research, a cure for SCI is
still a long way off (Chang, Cheng, & Chang, 2006;
Huang, Cheng, Wu, & Liao, 2003; Jiang, 2003; Pan
et al., 2008). As such, SCI continues to affect the
physical, psychological, social, and spiritual lives of
those with the injury and their families. In addition,
the economic burden placed on the national health
insurance system is considerable (Chen, 2008; Chen
& Boore, 2009; DeSanto-Madeya, 2006, 2009).
According to Chen and Boore (2008), positive
results for people with SCI include the ability to
overcome tragedy and having the courage to move
forward (Bournes, 2002; Reeve, 2003). Negative re-
sults include the inability to return to work and with-
drawal from society. The focus of our study was to
determine methods for helping people with SCI suc-
cessfully move forward to prevent work and social
withdrawal (Chen & Boore, 2006, 2007; Chen, Boore,
& Mullan, 2005). For people with SCI, moving forward
does not necessarily involve living completely inde-
pendently, but rather, it involves the ability to make
13. their own life decisions (Chen & Boore, 2007; Chen,
Boore, & Mullan; Gatehouse, 1995). Chen (2010)
used Parse’s Research Methodology to investigate
the meaning of moving forward and understand the
lived experience of 15 Taiwanese people with SCI;
their lived experience of moving forward was defined
as “a unitary experience of confronting difficulties,
going on, and finding self-value and confidence in
order to affirm oneself while co-creating successes
amid opportunities and restrictions” (p. 1132). Mov-
ing forward after SCI is a complex experience that is
multidimensional and dynamic, allowing the poten-
tial for a wide variety and large number of factors to
influence the process.
On the other hand, self-efficacy refers to a person’s
belief or sense of confidence in his or her own ability
to perform a particular task or behavior successfully
in the future (Bandura, 1977). Self-efficacy is believed
to play an important role among people with SCI be-
cause it determines whether an individual will initiate
certain behavior changes. Self-efficacy is a potential
universal measure, sensitive to a range of psychologi-
cal state and trait characteristics in an individual fol-
lowing an SCI (Middleton, Tate, & Geraghty, 2003).
A rigorous exploration of self-efficacy, self-
perception, and social support was an essential first
step for this study. Certain variables among psychoso-
cial factors—for example, self-efficacy, self-perception,
and social support—are linked to moving-forward
behavior among people with SCI (Figure 1; Chen &
Boore, 2007, 2008; DeSanto-Madeya, 2006; Gatehouse,
1995; Middleton, Tate, & Geraghty, 2003). However,
researchers have not yet adequately explored the
14. relationships between moving-forward behavior
and demographic and disease characteristics, self-
efficacy, self-perception, and social support within a
population of those with SCI. Therefore, the purpose
KEY WORDS
quantitative research
rehabilitation
spinal cord injury
Rehabilitation NURSING Rehabilitation NURSING
RNJ_11_MAY JUNE.indd 91 4/8/11 8:31 AM
92 Rehabilitation Nursing • Vol. 36, No. 3 • May/June
of this study was to explore the relationships between
moving-forward behavior and demographic and dis-
ease characteristics, self-efficacy, self-perception, and
social support among people with SCI in Taiwan.
Methods
Design
A cross-sectional design with a descriptive correla-
tion approach was used to understand how the rela-
tionship between self-efficacy, self-perception, social
support, and moving-forward behavior is perceived
by people with SCI. Data were collected from June
2007 to September 2007.
Population and Sample
15. The study inclusion criteria were (1) physician diag-
nosis of SCI, (2) older than 16 years, and (3) willing-
ness to complete a questionnaire survey and sign
the consent form. Cluster random sampling was
used to select four associations (north, central, east,
and south) from the 23 spinal injury associations
(SIAs) in Taiwan, and then purposive and snowball
sampling were used to select 50–60 participants
(mostly association members) from each associa-
tion. Researchers accessed the initial participant
list through the SIAs and conducted interviews at
either the SIAs or participants’ homes. Although
most participants were members of the SIAs, they
identified other nonmembers who were willing to
participate in this study, yielding a total sample size
of 210 participants.
Instruments
Based on the theoretical framework (Figure 1), a
questionnaire was designed that consisted of four
areas: demographic and disease characteristics, self-
efficacy, self-perception, and social support.
Demographic and disease characteristics were col-
lected, including data regarding age, gender, educa-
tional level, marital status, religion, work or school
status, membership with an SIA, time passed since
injury, cause of injury, level of injury, extent of injury,
and undergoing or having undergone a rehabilitation
program were collected.
The Moorong Self-Efficacy Scale (MSES) was ini-
tially generated by two clinicians (Middleton and
Geraghty) highly experienced in SCI management.
Middleton, Tate, and Geraghty (2003) developed the
16. final version of the MSES, which included 16 items,
each item rated on a 7-point Likert scale ranging from
1 (very uncertain) to 7 (very certain). For this study, the
7-point Likert scale was considered too difficult to
divide and distinguish the grades of meaning in Chi-
nese; therefore, a 5-point Likert scale, ranging from
1 (very uncertain) to 5 (very certain), was used. The
questionnaire contained 16 questions with a positive
score totaling 80. The original version of this scale
was translated into Chinese after the researchers ob-
tained authorization from the scale’s original authors
(Middleton, Tate, & Geraghty). The Chinese version of
the MSES was translated through a multistep process
of forward and backward translation by two bilingual
English- and Chinese-speaking researchers. The two
bilingual researchers compared the backward transla-
tion with the English MSES to check for conceptual
discrepancies. The tool was then tested for reliability in
the study. The Cronbach’s alpha value for self-efficacy
was 0.90, indicating good reliability.
Chen (2010) identified three core concepts of self-
perception of moving forward; these included eight
items in the three core categories, which were confront-
ing difficulties (2 items), going on and finding self-value
and confidence (3 items), and cocreating successes
amid opportunities and restrictions (3 items). This
section included using a 5-point semantic scale with a
possible total score of 40 points. The questions were: (1)
Do you accept your present physical state? (1 [strongly
refuse] to 5 [strongly accept]); (2) Are you able to leave
your family and live in a group? (1 [strongly disagree] to
A Study of Factors Affecting Moving-Forward Behavior Among
People with Spinal Cord Injury
17. Figure 1. Moving-Forward Behavior and Its Related Factors
Demographic and disease characteristics: age,
gender, educational level, marital status, religion,
work or school status, membership with a spi-
nal injury association, time passed since injury,
cause of injury, level of injury, extent of injury,
rehabilitation
Moving-forward behavior
Self-efficacy
Self-perception
Social support
RNJ_11_MAY JUNE.indd 92 4/8/11 8:31 AM
Rehabilitation Nursing • Vol. 36, No. 3 • May/June 93
5 [strongly agree]); (3) Do you care about other people’s
judgments? (1 [strongly care] to 5 [strongly ignore]); (4)
Are you comfortable making friends with not disabled
people? (1 [strongly refuse] to 5 [strongly accept]); (5) Do
you feel that your existence has any value? (1 [strongly
disagree] to 5 [strongly agree]); (6) Between possession
and loss, how would you describe your current situa-
tion? (1 [complete loss] to 5 [complete possession]); (7) Do
you hold hope for the future? (1 [strongly disagree] to
5 [strongly agree]); and (8) Do you face the future with
confidence? (1 [strongly disagree] to 5 [strongly agree]).
The section on social support examined 10 domains,
18. including environment, transportation, membership
in an SIA, support from family, support from friends,
financial status, social resources, work, school, and
residential care. Responses were based on a 5-point
Likert scale, which ranged from 1 (strongly disagree) to
5 (strongly agree), with a total positive score of 70 points.
The social support items included (1) At home,
there is always a family member who can give me
physical assistance whenever I need it; (2) I believe
that becoming a member of an SIA helps me return to
the community; (3) At home, there is always a family
member who can give me mental support whenever
I need it; (4) I believe that when I need help or when
I am in a bad mood, I have friends who can help me
or listen to my problems; (5) When I need to go out,
I have suitable transportation (car or motorcycle);
(6) I believe that government welfare resources (e.g.,
school fee exemption for children, reduced public
transportation fees, home-care services for the dis-
abled) are helpful to my family; (7) I can freely leave
and enter the house, bathroom, and toilet and don’t
need others to help me; (8) If someone with SCI wants
to go back into education, he or she can get adequate
help; (9) I believe that the social benefits offered by
the government do not help my economical situation;
(10) I feel that the design of disability-friendly public
facilities and spaces should take the needs of disabled
people into consideration; (11) I am satisfied with the
guidance on employment offered by the government;
(12) I believe that disability-friendly facilities in the
work environment fulfill my needs; (13) I am satis-
fied with the job opportunities that society currently
offers; and (14) I believe that if I need to go to a care
institution, I will receive good care.
19. Questionnaire Validity and Reliability
To ensure content validity and confirm that there
were enough relevant questions covering all major
aspects of the research question, six experts (includ-
ing a supervisor of a rehabilitation ward, a head
nurse, a physician, an occupational therapist, a
social worker, and a statistician) evaluated the
questionnaire. In addition, prior to the main study,
the researchers developed a pilot study involving
33 people with SCI (not included in the main study)
who were recruited from one of the SIAs and agreed
to participate to establish the internal consistency
and clarity of the questionnaire. The Cronbach’s
alpha values for self-efficacy, self-perception, and
social support were 0.90, 0.82, and 0.70, respectively,
indicating high reliability. There were 210 par-
ticipants in the main study. The Cronbach’s alpha
values for self-efficacy, self-perception, and social
support were 0.93, 0.87, and 0.78, respectively.
Ethical Considerations
Researchers acquired ethical approval from each
association before the study began and sent letters to
individual participants to inform them of the study
and ask for their voluntary written consent. Research-
ers guaranteed participants that they would not be
harmed, would have the right to withdraw from
the study at any time without penalty or effect on
their future care provision, and that all information
collected would remain anonymous and kept strictly
confidential to the research team members only.
Data Collection
For the purpose of establishing interrater reliability,
a researcher explained the aim of the study to the
20. social workers of the four SIAs and provided train-
ing regarding how to administer the questionnaire.
Permission from each SIA to conduct the study and
collect data by questionnaire was requested and
obtained. Subsequently, a social worker collected
the questionnaire data by visiting the majority of
participants at their homes to conduct one-on-one,
face-to-face interviews. Twenty participants pre-
ferred to be interviewed on their SIA’s premises.
These interviews were conducted in a quiet, private
room at a prearranged time.
Statistical Analysis
Researchers performed statistical analyses of the
data using SPSS version 14.0 software. Before
these analyses, the data sets for self-efficacy, self-
perception, and social support scores were checked
to see whether they were normally distributed; the
results confirmed that they were. Descriptive, Pear-
son product moment correlation, and multivariate
logistic regression were completed, as appropriate.
The significance level was set at 0.05.
Results
A total of 210 questionnaires were collected. Of them,
164 participants (78.1%) perceived that they were
moving forward, while 46 (21.9%) said they were
not able to move forward.
RNJ_11_MAY JUNE.indd 93 4/8/11 8:31 AM
94 Rehabilitation Nursing • Vol. 36, No. 3 • May/June
A Study of Factors Affecting Moving-Forward Behavior Among
21. People with Spinal Cord Injury
Demographic Characteristics
The mean age of participants was 38.9 (SD = 12.7)
years; more men (n = 168, 80%) than women (n
= 42, 20%) participated. Most participants (109,
51.9%) reported an educational level of senior high
school; 70 reported junior high school (33.3%), 27
had attended college or university (12.9%), 3 were
illiterate (1.4%), and 1 participant had only attended
primary school (0.5%). Of the 210 participants, 105
(50%) were single, 81 (38.6%) were married, 16
(7.6%) were divorced, and 8 (3.8%) were widowed.
Overall, 124 participants (59%) were of the Taoist/
Buddhist faith, while 37 (17.6%) were Christian/
Catholic. The remaining participants reported no
religion (36, 17.2%) or “other” (13, 6.2%). One
hundred sixty-seven (79.5%) participants used to be
employed, and 66 (31.4%) still had a job at the time
of the interview. Twenty-nine participants (13.8%)
had been attending school at the time of their
injury; of these, 22 had continued their studies. In
total, 182 participants (86.7%) were members of an
association related to spinal injury (Table 1).
Disease Characteristics
The mean amount of time passed since injury was
9.6 years (SD = 8.1 years). The most common cause
of injury was a traffic accident (122, 58.1%), fol-
lowed by falls (39, 18.6%), and disease (14, 6.7%).
The remaining 35 (16.6%) participants reported
other or unknown causes of injury. The most com-
mon injury area was the cervical spine (89, 42.4%),
followed by the thoracic spine (82, 39%), lumbar
spine (34, 16.2%), and other areas or unknown (5,
2.4%). Nearly half the participants (91, 43.3%) had
22. complete paraplegia, followed by 41 (19.5%) with
incomplete tetraplegia, 39 (18.6%) with incomplete
paraplegia, and 35 (16.7%) with complete tetraple-
gia. Finally, 84.8% (n = 178) had taken part in a
rehabilitation program (Table 1).
Relationships Between Moving-Forward
Behavior, Demographic and Disease
Characteristics, Self-Efficacy, Self-
Perception, and Social Support
A statistically significant relationship was found to
exist between age and moving-forward behavior
(t = -2.3; p < .05). There was no statistically significant
difference between any other demographic charac-
teristic and moving-forward behavior. In addition,
the results did not show any statistically significant
difference between any disease characteristic and
moving-forward behavior.
Self-efficacy was reported using a 5-point Likert
scale and consisted of 16 items with a positive score
totaling 80 points. The mean score was 56.77 (SD =
16.05), which indicated that, overall, patients were
Table 1. Demographic and
Disease Characteristics of
Participants (N = 210)
Variables n (%)
Gender
Male 168 (80)
Female 42 (20)
Education level
Illiterate 3 (1.4)
23. Primary school 1 (0.5)
Junior high school 70 (33.3)
Senior high school 109 (51.9)
College or university 27 (12.9)
Marital status
Single 105 (50)
Married 81 (38.6)
Widowed 8 (3.8)
Divorced 16 (7.6)
Religion
Taoist/Buddhist 124 (59)
Christian/Catholic 37 (17.6)
None 36 (17.2)
Other 13 (6.2)
Employment (before injury)
Yes 167 (79.5)
No 43 (20.5)
Employment (present)
Yes 66 (31.4)
No 144 (68.6)
Member of an SIA
Yes 182 (86.7)
No 28 (13.3)
Cause of injury
Traffic accident 122 (58.1)
Falls 39 (18.6)
Disease 14 (6.7)
Others 35 (16.6)
Level of injury
24. Cervical 89 (42.4)
Thoracic 82 (39.0)
Lumbar 34 (16.2)
Other or unknown 5 (2.4)
Extent of injury
Complete paraplegia 91 (43.3)
Incomplete paraplegia 39 (18.6)
Complete tetraplegia 35 (16.7)
Incomplete tetraplegia 41 (19.5)
Unsure 4 (1.9)
Rehabilitation
Yes 178 (84.8)
No 32 (15.2)
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Rehabilitation Nursing • Vol. 36, No. 3 • May/June 95
certain of their self-efficacy. The self-perception area
consisted of eight items with a total score of 40 points;
the mean score was 28.11 (SD = 9.42), which indicated
that, overall, the patients had a positive self-percep-
tion of moving forward. The social support scale con-
sisted of 14 items, including the reverse-scored items,
with a total score of 70 and a mean score of 44.37 (SD
= 15.21), which indicated that, overall, the patients’
satisfaction level with social support was acceptable.
In addition, higher scores for self-efficacy (mean =
57.50, SD = 12.73), self-perception (mean = 29.60, SD
= 6.25), and social support (mean = 43.30, SD = 9.54)
25. were found in people with SCI who were moving for-
ward rather than those who were not (self-efficacy:
mean = 48.30, SD = 12.65; self-perception: mean =
21.24, SD = 8.46; social support: mean = 42.57, SD =
7.65; Table 2).
A significant correlation was found between
moving-forward behavior and age (γ = -0.14, p < .05),
self-efficacy (γ = -0.25, p < .01), and self-perception (γ
= -0.39, p < .01; Table 3). There was a high correlation
between self-efficacy and self-perception (γ = 0.66, p <
.01), a moderate correlation between self-efficacy and
social support (γ = 0.53, p < .01), and a moderate cor-
relation between self-perception and social support
(γ = 0.33, p < .01; Table 3).
Based on the statistical significance of the results,
the variables of age, self-efficacy, self-perception, and
social support were chosen as predictive factors in the
multivariate logistic regression analysis. Age (OR =
0.964, p < .05) and self-perception (OR = 0.824, p < .05)
were both significant predictors of moving-forward
behavior (Table 4).
Discussion
The findings of this study showed that the fac-
tors affecting moving-forward behavior among
people with SCI included age, self-efficacy, and
self-perception.
No studies of how demographic and disease
characteristics influence moving-forward behavior
for people with SCI exist. This study demonstrated a
statistically significant relationship between age and
moving-forward behavior. A long-term, follow-up
study by Livneh and Antonak (2005) found that the
26. longer a chronic disease or debilitating injury lasted,
the higher the level of acceptance was among patients.
Because no statistically significant relationships were
found between moving-forward behavior and the
cause, level, or extent of injury, all people with com-
plete or incomplete paraplegia or tetraplegia should
be expected to be able to move forward, provided
they receive the appropriate rehabilitative care.
Table 2. Differences in Moving-
Forward Behavior and Self-
Efficacy, Self-Perception, and
Social Support (N = 210)
Moving
Forward n Mean SD
Self-efficacy No 46 48.30 12.65
Yes 164 57.50 12.73
Self-perception No 46 21.24 8.46
Yes 164 29.60 6.25
Social support No 46 42.57 7.65
Yes 164 43.30 9.54
Table 3. Relationships Between Moving-
Forward Behavior and Age, Self-Efficacy,
Self-Perception, and Social Support (N = 210)
Variables Age
Moving
Forward
27. Self-
Efficacy
Self-
Perception
Social
Support
Age 1.0 -0.14* -0.08 0.049 -0.14*
Moving forward 1.0 -0.25** -0.39** -0.10
Self-efficacy 1.0 0.66** 0.53**
Self-perception . 1.0 0.33**
Social support 1.0
*p < .05; **p < .01.
Table 4. Multivariable Logistic Regression Analysis of Age,
Self-
Efficacy, Self-Perception, and Social Support on Moving-
Forward
Behavior (N = 210)
Moving-Forward Behavior B SE Wald OR CI p-value
Age -0.037 0.018 4.057 0.964 0.930–0.999 .044
Self-efficacy -0.031 0.027 1.279 0.970 0.919–1.023 .258
Self-perception -0.193 0.045 18.832 0.824 0.755–0.899 .001
28. Social support 0.064 0.035 3.340 1.066 0.995–1.142 .068
OR = odds ratio; CI = confidence interval.
RNJ_11_MAY JUNE.indd 95 4/8/11 8:31 AM
96 Rehabilitation Nursing • Vol. 36, No. 3 • May/June
Although the mean scores of self-efficacy indicated
that patients had acceptable self-efficacy, there were
two particularly noteworthy items that received the
lowest possible scores (mean score < 3) on the self-
efficacy scale: ability to have a satisfying sexual rela-
tionship and avoiding bowel accidents. With regard
to sexual relationships, Teng (2002) and Chen, Boore,
and Mullan (2005) emphasized that people with SCI
should increase their understanding of their own
sexual function and that rehabilitation nurses should
gain an understanding of this problem and enhance
their counseling skills. Kennedy, Lude, and Taylor
(2006) conducted a study assessing the community
needs of people with SCI; occupation, sexual activ-
ity, and pain relief were identified as the areas least
satisfactorily addressed. The study’s results indicated
that the subject of sexual relationships still requires
attention. People with SCI also lack confidence when
it comes to preventing the occurrence of fecal incon-
tinence. Nonetheless, this stressful situation can be
overcome after the spinal shock stage by carrying out
bowel training so that a regular stool routine is estab-
lished (Chen & Boore, 2006).
Self-perception is significantly correlated to mov-
ing-forward behavior and is useful for predicting
29. moving-forward behavior. This study highlights the
importance of self-perception as a possible compre-
hensive measure responsive to a range of moving-
forward behaviors among individuals following SCI.
The self-perception scale is a new tool that was devel-
oped from qualitative research (Chen, 2010) and re-
fined in this study. Although the self-perception scale
is valuable as a brief, clinically relevant and easily
administered tool that may be used for planning nurs-
ing process approaches and measuring patients’ out-
comes of moving-forward behavior, further evalua-
tion of its implications for clinical practice is required.
Although there was no significant correlation be-
tween moving-forward behavior and social support
in this study, there was a high correlation between
social support and self-perception and self-efficacy,
which indicates that social support is also important.
Beedie and Kennedy (2002) emphasized that qual-
ity of social support predicts hopelessness and de-
pression after SCI. Granger (1982) proposed a health
accounting functional assessment (ESCROW: envi-
ronment, social interaction, cluster of family/mem-
bers, resource, outlook, work/school/retirement)
of long-term patients. A specially designed tool to
measure SCI patients’ social support does not exist;
however, the new measure used in this study appears
to be capable of capturing information regarding SCI
patients’ social support. Its implications for clinical
practice require further examination.
In this study, participants indicated the most dis-
satisfaction with employment and home care. Em-
ployment dropped from 79.5% before SCI to 31.4%
postinjury. According to Chou, Chen, and Lai (2008),
30. the unemployment rate among people with SCI in
Taiwan is as high as 46%. Kennedy and colleagues
(2006) found that occupation is one of the most impor-
tant areas indicative of highest community needs in
four European countries. A study by Jang, Wang, and
Wang (2005) found the degree of independence is the
main influencing factor in whether people with SCI
return to work. After injury, it is important that activi-
ties of daily living function be restored, followed by
reemployment guidance. In the United Kingdom and
the United States, there are comprehensive service
systems that provide people with SCI a wide array of
services throughout the continuum of care—from the
acute stage to discharge from the hospital and home-
environment planning, including services related to
leisure, recreation, and employment (Cheng, 2006;
Gatehouse, 1995; Grundy & Swain, 2002). In Taiwan,
no such service system exists (Cheng). People are rela-
tively dissatisfied with the social support system, in
particular, employment guidance, job opportunities,
and disability-friendly work environments (Chuang,
2008). In the future, the government should pay more
attention to disability-friendly work environments
and provide better employment guidance to help
more people with SCI return to work successfully.
Presently, the quality of care in rehabilitation institu-
tions is inconsistent in Taiwan. It is, therefore, impera-
tive that the quality of care and the environment in
these care institutions be significantly enhanced.
A Study of Factors Affecting Moving-Forward Behavior Among
People with Spinal Cord Injury
Key Practice Points
1. Although many scientists are studying nerve regeneration and
31. conducting stem cell research, a cure for spinal cord injury
(SCI) remains a long way off.
2. SCI has a constant effect on the physical, psychological,
social, and spiritual lives of those with the injury and their
families. In addition, the economic burden placed on the
national health insurance system is considerable.
3. Age, self-efficacy, and self-perception are influencing factors
for whether people with SCI can successfully move forward;
self-perception, self-efficacy, and social support are closely
related.
4. Three nursing interventions that rehabilitation nurses can
use in practice to help people move forward are (1) enhance
self-efficacy, (2) reinforce people’s self-perception of moving
forward, and (3) provide adequate social support and promote
social participation.
RNJ_11_MAY JUNE.indd 96 4/8/11 8:31 AM
Rehabilitation Nursing • Vol. 36, No. 3 • May/June 97
Study Limitations
The participants of this study consisted of people
who were discharged from the hospital; most were
members of an SIA and had access to the support
services provided by the association. Therefore, par-
ticipants moving forward outnumbered those who
had not moved forward. The sample could have
been biased because those with SCI living at home or
in residential accommodations who do not belong to
an SIA withdrew from society and were less likely to
be included in the study. Further study with a larger
32. sample size is needed and should include people
with SCI who do not belong to an SIA.
Researchers used a cross-sectional survey method
to collect data for this study. Collected data could have
been influenced by participants’ current situational
bias. Future research should focus on a longitudinal
study of people with SCI to follow up on the dynamic
experiences and changes related to moving-forward
behavior after rehabilitation hospitalization.
Conclusions and Implications for
Practice
This study found that age, self-efficacy, and self-
perception are influencing factors for whether
people with SCI can successfully move forward,
and that self-perception, self-efficacy, and social
support are closely related. Therefore, reha-
bilitation nurses need to provide humanistic and
holistic care, which stems from being attentive to
the unique life experience of each individual. At
present, people with SCI mostly resort to self-help,
mutual help, and self-rescue. We suggest provid-
ing appropriate nursing assessment and interven-
tions as soon as possible to help these patients
achieve moving-forward behavior so that they
may successfully return to productive and gratify-
ing lives in the community. The following three
nursing interventions have specific implications
for rehabilitation nursing practice and should be
considered as methods for helping people with SCI
move forward.
1. Enhance self-efficacy. The MSES scale could
be used to predict which individuals will
have greater difficulty adjusting after SCI.
33. Moreover, rehabilitation nursing care should be
individually tailored and structured to build an
individual’s confidence through procedural goal
achievement, with initial successes experienced
in performing specific tasks. For example,
with regard to an individual’s self-efficacy,
rehabilitation nurses could pay closer attention
to the patient’s sexual dysfunction and help him
or her reestablish a regular stool routine.
2. Reinforce people’s self-perception of moving
forward. This includes using the self-perception
scale to measure people’s impressions of
moving forward to provide appropriate nursing
care and understand the significance and
meaning of their injuries, helping to confront
difficulties and to go on and find self-value and
confidence to affirm oneself while cocreating
successes amid opportunities and restrictions.
3. Provide adequate social support and promote
social participation. Rehabilitation nurses
should encourage patients to take part in
activities outside the hospital, join an SIA,
and extend their interpersonal relationships;
nurses should provide information about social
welfare, regular follow-up, and home care.
These activities would help more people to
move forward and smoothly transfer from the
hospital to the community.
Acknowledgment
The study was supported by the Taiwan National
Science Council, grant no. 95-2314-B-166-002. The
authors acknowledge that all respondents com-
pleted the questionnaire truthfully.
34. About the Authors
Hsiao-Yu Chen, PhD MSc BSc RN, is an associate professor
of nursing in the department of nursing at the National Taic-
hung Nursing College in Taiwan. Address correspondence to
her at [email protected]
Chia-Hsiang Lai, PhD, is an assistant professor of nursing
at Central Taiwan University of Science and Technology in
Taiwan.
Tzu-Jung Wu, MS RN, is a nurse supervisor at Chung Shan
Medical University Hospital in Taiwan.
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