JEANETTE DULMOG

NCB

COMPREHENSION CHECK Fill in the blanks:

1. A ___THEORY_______ is a broad and abstract characterization of phenomena.

2. ____DESCRIPTIVE___________ theory thoroughly describes a phenomena.

3. _____CONCEPTS_ __________ are also the basic elements of conceptual models, but are not
linked to one another in a logically ordered, deductive system.

4. _____SCHEMATIC_________ models, sometimes called conceptual maps are symbolic

representations of phenomena that depict a conceptual model through the use of symbols or
diagrams.

5. A ____FRAMEWORK___________ is the conceptual underpinnings of a study.

CRITICAL THINKING ACTIVITIES EXAMPLE 1

Quantitative research Aspects of a quantitative nursing study, featuring terms and concepts
discussed are presented below, followed by some questions to guide critical thinking. The full
research report is available in Nursing Research, 52,148-158 Study "Theory of planned
behavior-based models for breastfeeding duration among Hong Kong mothers” (Dodgson.
Henly, Duckett, & Tarrant, 2003). Statement of Purpose The purpose of the study was to
evaluate the cross-cultural application of models based on the Theory of Planned Behavior
(TPB) to explain the duration of breastfeeding among new mothers in Hong Kong. The TPB
had previously been used to explain breastfeeding behaviors in Western cultures.

Method

A sample of 209 first-time breastfeeding mothers completed questionnaires during

postpartum hospitalization and provided information about breastfeeding at 1, 3, 6, 9, and 12
months post delivery or until they weaned. Theoretical Framework The TPB, as described
earlier, predicts people's behaviors based on a constellation of factors that include their
intentions, attitudes, perceived control, and subjective norms. In the present study, the
researchers used the TPB to predict new mothers' duration of breastfeeding over a l year
period based on their intention to breastfeed, which was operationalized as the mothers
judgment about the number of weeks they would breastfeed immediately postpartum.
Intention to breast feed, according to the TPB model, is in turn shaped by three types of
factors: the mothers attitudes toward breastfeeding (which are influenced by their beliefs
about breastfeeding outcomes; perceived social pressure to breastfeed (which is influenced
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by the mothers beliefs about social expectations-subjective norms); and perceptions that they
can control breastfeeding duration (which are influenced by factors that can help or hinder
breastfeeding). All of these predictor variables were measured during postpartum
hospitalization, and then the dependent variable, duration of breastfeeding, was measured in
follow-up contact in the year that followed. Dodgson and her colleagues tested the utility of
three predictive models. The first was a strict interpretation of the TPB, with two added
predictors of breastfeeding duration (breastfeeding problems and daily proximity of mother
and baby to each other). The second was a TPB based model with modifications derived from
a previous study of one of the investigators. The third was another TPB-based model that
ordered the chain of influence among predictor variables somewhat differently than in the
original model. In this model (shown in Figure below), perceived control over breastfeeding is
viewed as mediating the relationship between attitudes and subjective norms on the one
hand and breastfeeding intention on the other. TPB Perceived Control Mediated Model.
(Adapted from Dodgson et al., 2003). - refer to your module for the illustration

Key Findings

 All of the models had fairly good ability to predict breastfeeding duration in this sample of
Chinese women.

 The model that worked least well in predicting breastfeeding behavior was the original TPB
model. The other two models were equally good.

 All hypothesized paths of influence in the third model- the TPB Perceived Control Mediated
Model shown in Figure above-were statistically significant (i.e., they had a high probability of
being reliable).

1. Consider the following targeted questions, which may assist you in further assessing
aspects of the study:

a. What was the value of testing three competing models in a single study?

 The value of the three competing model is that to test the most effective model,
comparing, analysing, and evaluating the different data to have possible factors or
outcomes of their predictor variables in order to get the best and accurate findings
in their study. And also the value of testing three competing models in a single
study is to guide and generate ideas for their research, this can assess the worth of
the models or theories being used in their research study, and to provide a
foundation for new ones.
 To determine their point of view regarding the specific study including its
perspective, relevance and their comparison. Their results will definitely define
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what are those points of the study trying to implicate to the audience whose
studying it, the negative and positive side of each side will plays a significant role
as a full mediator between major and minor things about the study

b. Is there another model or theory that was described previously that could have been used
to study breastfeeding duration? If yes, would this model have been a better choice for
framework than the TPB?

 Yes, there is another model or theory that was described previously that could have
been used to study breastfeeding duration, it is the Becker's Health Belief Model
(HBM ) which is a framework for explaining people's health related behavior. In
here, the duration of breastfeeding depends upon the health related behavior of a
certain person. Yet, the better choice for framework would still be the TPB since it
is already proven to have fairly good ability to predict breastfeeding duration.

c. Based on the description of the TPB, where would the "box" for perceived control be placed
in a schematic model of the original TPB-that is, how would Figure above need to be
changed?

 The percieved control box must be placed in between the attitude about
breastfeeding and subjective norm .This is because based on the description,
behavioral intentions are best predictors of a person's actual behavior and
behavioral intentions are a function of attitude towards performing the behavior,
perceived control over the behavior and subjective norms the person's belief in
whether other's think the behavior should be performed.

d. What do the findings suggest about the cross-cultural utility of the TPB?

 The findings were mostly positive and in connection to the cross- cultural utility of
TPB, it suggests high reliable rate and can be utilized to study various cultural
behaviors based on a constellation of factors that include their intentions,
attitudes, perceived control, and subjective norms.

2. If the results of this study are valid and reliable, what are some of the uses to which the
findings might be put in clinical practice?

ANSWER:

 Since breast- feeding is important in the development of a child, the findings can
help the health practitioners and the patients to understand the factors which
affects the duration of breastfeeding by mothers. If the nurse has a better
understanding about the perspectives of the mother about breastfeeding, it will
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help her provide necessary health education which can prolong the duration of
breastfeeding.

EXAMPLE 2 (The full research report is available in Nursing Research, 52, 234–241) Study "A
theory of taking care of oneself grounded in experiences of homeless youth" (Rew, 2003)
Statement of Purpose The purpose of the study was to explore self-care attitudes and
behaviors of homeless adolescents and to develop a descriptive substantive theory. Method
Grounded theory methods were used. Data were collected through individual interviews with
15 youths. The two main questions posed in the interviews were: What helps you to remain
healthy, living as you do? and What would you like to tell me about how you take care of
yourself? Theoretical Framework A grounded theory method was adopted "because of its
potential to address the patterns of behavior within and between members of a particular
social group" (p. 235). Although Rew's grounded theory approach ensured that the end
product of her study would be a descriptive theory of homeless youth's health-related
behaviors, she consciously focused on an aspect of their behaviors that is linked to a
conceptual model of nursing, Orem's Self-Care Model. The report pointed out features of
Orem's model and noted that the concept of self-care had not previously been explored with
high-risk youth.

Key Findings

 Based on in-depth interviews, Rew identified an underlying social process that she labeled
“Taking Care of Oneself in a High-Risk Environment”. This basic social process linked together
three categories to form a descriptive theory of self-care for homeless youth.

 The three categories linked together in Rew's theory were: Becoming Aware of Oneself;
Staying Alive with Limited Resources; and Handling One's Own Health. As shown in the
schematic model in Figure below, each category contains two processes.

 Taking care of oneself for homeless youth was found to be “ a process of deciding and
acting in ways that enhance basic self-respect (caring about yourself) and that promote
health" (p. 237)

Refer to your module for the illustration Taking care of oneself in a high-risk environment.
(Adapted from Rew, 2003).

1. Consider the following targeted questions, which may assist you in further assessing
aspects of the study:

a. Was Rew testing Orem's theory in this study?

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 YES BECAUSE REW FOCUSES IN EACH INDIVIUALS ABILITY TO PERFORM SELF

CARE AND CONSCIOUSLY FOCUSED ON AN ASPECT ON THEIR BEHAVIORS THAT
LINKED TO A CONCEPTUAL MODEL.
 Because the study focuses on behaviors and self-care attitudes of the homeless
adolescent. The framework that Rew made used of the Orem’s Theory which is the
Self-Care Model wherein it talks about self-care in high risk environments to relate
the concept of the study but then the study resulted that this is not yet been
explored in some studies in regards to high risk youth.

b. In what way was the use of theory different in Rew's study than in the previous study by
Dodgson et al.?

 When it comes to the framework, for Rew’s study she used a ground theory
method as she collected valid data to her respondent’s through interview, the
theory was used to support her data to be able to come up with the conclusion.
While, Dodgson et.al in their precious study they used the theory as a foundation
and modified to be able to collect certain information and serve as a guide for their
study

c. Comment on the utility of the schematic model shown above.

 About the schematic model of Orem’s Self Care Theory, this model shows how the
factors affect one person. The framework is provided limited information, not
explaining how theorem was used in the study. Furthermore, the schematic model
shows a basic social process of taking care of oneself in a high risk environment

2. If the results of this study are trustworthy, what are some of the uses to which the findings
might be put in clinical practice?

ANSWER:

 The findings of this study are trustworthy and reliable it can be used in clinical
practice. Through the findings knowing that self-care behaviors of the participants
of the study is not just a thing that can easily done, wherein self-care is a process
of deciding and acting on our own ways for us to enhance care for ourselves. It can
also use and can be presented to health care providers in making specific programs
for them to have a better understanding about self-care