2. ) قالوا سبحانك لا علم لنا إلا ما علمتنا انك أنت العليم الحكيم (
بسم الله الرحمن الرحيم
) قالوا سبحانك لا علم لنا إلا ما علمتنا انك أنت العليم الحكيم (
البقرة 32
صدق الله العظيم

3. Assistant professor in Medical-surgical Nursing
Research Methodology
Dr. Atef Ismail
Assistant professor in Medical-surgical Nursing

4. INTRODUCTION

5. Introduction The importance of research in Nursing:
Provides the basis for expanding the unique body of scientific knowledge that forms the foundation of nursing practice.

6. Introduction Cont…
Many nurses are engaging in research to help to develop, refine, and extend the scientific base of knowledge fundamental to the practice of nursing this expansion of knowledge is essential for the continued growth of nursing profession.

7. Introduction Cont…
Nurses who base as many of their clinical decisions as possible on scientifically documented information are being professionally accountable to their care and are helping nursing to achieve its own professional identity.
The spiraling costs of health care

8. Introduction Cont…
● Some research findings help to eliminate nursing actions that have no effect on the achievement of desired client outcomes.
● Consumers of nursing research: read reports of studies, typically to keep up to date on information that might be relevant to their practice or to develop new skills. Nurses are increasingly expected to maintain, at a minimum, this level of involvement with research.

9. Introduction Cont…
● The producers of Nsg Research: Nurses who actively participate in the design and implementation of scientific studies.

10. Definitions of Nursing Research:-
- "Systematic, formal, rigorous process used to gain solutions to problems or to discover and interpret new facts in clinical practice, Nsg education or nursing administration.
- The systematic, objective process of analyzing phenomena of importance to nursing.

11. Systematic inquiry that uses orderly scientific methods to answer question or solve problems.
Historical Evolution and future Directions of Nursing Research.
The research in nursing began with Florence
Nightingale in 1850, who Made detailed, recorded
observations about the effects of Nsg actions
during the Crimean war.

12. Historical Evolution Cont…
Focused mainly On studies
related to Nsg education.
1950s - An increase in the number of nurses with advanced academic preparation.
The establishment of the "Nursing Research journal“ and the availability of funding to support nursing research skills in faculty.

13. Historical Evolution Cont…
By the 1970s - the growing number of nurses conducting research studies and the increase in discussions of theoretical issues surrounding nursing research.
Three additional journals that focus on
nursing research, Advance In Nsg science,
Research in nursing and health, and the
western journal of Nursing Research –
were established in the 1970s.

14. Historical Evolution Cont…
There was also a change in emphasis in nursing research studies from areas such as teaching, administration, curriculum, recruitment and nurses themselves to the improvement of client or patient care.
The 1980s brought Nag research to anew level of development.
Increase in the number of qualified nurse researchers.

15. Historical Evolution Cont…
widespread availability of computers for the collection and analysis of information.
The National center of Nursing Research was established in 1986.
The center for Research for nursing was created in 1983 by (ANA).
An important new journal was also established in the late 1980s (Applied Nursing Research).

16. Historical Evolution Cont…
The 1990s- To continue to develop a scientific base of knowledge for Nursing practice.
Studies concerning the effectiveness of clinical Judgments on client outcomes are expected to continue.
In 2004 the Journal Worldviews on Evidence-Based Nursing begins publication.

17. Current Topics of Interest to Nurse Researcher.
Research concerning the promotion of positive health practices.
Research concerning the nursing process or clinical judgments.
Research concerning compliance with prescribed programs of treatment.
Research concerning groups at risk for specific health problems.

18. Current Topics of Interest to Nurse Researcher. … Cont
Research concerning the description of holistic nursing situation.
Research concerning Minority groups: include the identification of cultural beliefs that influence the health care practices of various ethnic groups.

20. RESULTS

21. Table (1) Socio-demographic characteristics and medical data of the sample (n=24).
gender
Frequency
Percent
Male 16
66.7
Female 8
33.3
Total 24
100.0
Age
From years 14
58.33
From years
33.33
From years 2
8.33
limb amputated
Lower limb 11
45.8
Upper limb
More than one limb
8.4
marital status
Married 13
54.2
Single

22. Table (1) Socio-demographic characteristics and medical data of the sample (n=24) Cont’d.
residency
Frequency
Percent
Northern Governorate 12
50.0
Gaza Governorate 11
45.8
Southern Governorate 1
4.2
Total 24
100.0
educational level
Primary education or less 10
41.67
Preparatory and Secondary Education
45.83
University or more 3
12.50
100
occupation status
Without work 19
79.17
Work
4.17
Student 4
16.67
causes of injury
Gun shot
Tank shell 8
33.33
shrapnel from a rocket plane 14
58.33
Other

23. RESULTS
Tables (2 & 3) related to the answer for the first stated research question:
What are the different types and levels of psychological stress exhibited by the amputees in Gaza governorates during Gaza war?

24. Table (2) The pre test stress level scores for the study group subjects (n=24).
Pre test scores 1
334 2
309 3
393 4
369 5
398 6
405 7
380 8
428 9
356 10
351 11
328 12
312
Subject
Pre test scores 13
361 14
387 15
340 16
380 17
319 18
348 19
375 20
317 21
306 22
376 23
311 24
432

25. Responsibility stress Total degree of the stress
Table (3) Types and ranks of psychological stress exhibited by the sample (n=24).
scope
No. of items
Sum
Mean
Std. Deviation
% weight
rank
Amputation stress 25
1548
64.500
6.372
86.00 3
Peer stress 23
1386
57.750
9.808
83.70 4
Family stress 20
1048
43.667
9.300
72.78 7
Responsibility stress
1266
52.750
5.929
87.92 2
Physiological stress
1203
50.125
7.537
83.54 5
Coping stress 18
1140
47.500
5.437
87.96 1
Emotional stress
1024
42.667
6.445
79.01 6
Total degree of the stress
144
8615
37.605
83.09

26. RESULTS
Tables from 4-7 & figure 1 are related to the first hypothesis states that:
Total & subtotal mean pre-test stress scores of the study group subjects will be higher than those of the post-test stress scores.

27. Table (4) The differences between pre and post application of program (n=24).
Scope
Ranks N
Mean Rank
Sum of Ranks Z
Asymp. Sig. 2-tailed
sig. level
Amputation stress
Negative Ranks 24
12.5
300
4.287
0.000
* *
Positive Ranks
Ties
Total
Peer stress
4.289
Family stress
* * P <0. 01

28. Responsibility stress
Table (4) The differences between pre and post application of program (n=24)ctd
Scope
Ranks N
Mean
Rank
Sum Of Z
Asymp. Sig. (2-tailed)
sig. level
Responsibility stress
Negative Ranks 24
12.5
300
4.295
0.000
* *
Positive Ranks
Ties
Total
Physiology stress
4.288
Coping stress
4.289
* * P <0. 01

29. Total degree of the stress
Table (4) The differences between pre and post application of program (n=24) ctd
Scope
Ranks N
Mean
Rank
Sum Of Z
Asymp. Sig. (2-tailed)
sig. level
Emotional stress
Negative Ranks 24
12.5
300
4.288
0.000
* *
Positive Ranks
Ties
Total
Total degree of the stress
4.287
* * P <0. 01

30. Responsibility stress Total degree of the stress
Table (5) Means & Std. deviation for pre and immediate post test stress scores (N=24)
application
No. of items
pre application
post application
scope
Mean
Std. Deviation
Amputation stress 25
64.500
6.372
29.917
4.353
Peer stress 23
57.750
9.808
26.917
2.205
Family stress 20
43.667
9.300
22.208
1.865
Responsibility stress
52.750
5.929
29.625
4.985
Physiology stress
50.125
7.537
26.708
4.349
Coping stress 18
47.500
5.437
27.542
4.978
Emotional stress
42.667
6.445
21.333
3.046
Total degree of the stress
144
37.605
14.423

31. The research hypothesis was supported.
Table (6) Pre & immediate post test stress level scores of the study group subjects (n=24)
subject
Pre test
Post test 1
334
157 2
309
196 3
393
194 4
369
187 5
398
190 6
405
170 7
380
198 8
428
188 9
356 10
351
174 11
328
185 12
312
183
subject
Pre test
Post test 13
361
198 14
387
193 15
340
169 16
380
199 17
319
188 18
348
165 19
375
180 20
317
174 21
306
147 22
376 23
311 24
432
The research hypothesis was supported.

32. Figure (1) illustrates the differences between pre-test and post-test of stress scores for total and subtotal stress scores.

33. Table (7) Z value and η 2 for every scope of psychological stress.
Effect size
Amputation stress
4.287
18.382
22.382
0.821
large
Peer stress
4.289
18.392
22.392
Family stress
18.377
22.377
Responsibility stress
4.295
18.446
22.446
0.822
Physiology stress
4.288
18.384
22.384
Coping stress
Emotional stress
18.390
22.390
Total degree of the stress
18.375
22.375

34. RESULTS
Tables from 8-12 & figure 2 are related to the second hypothesis states that:
Total & subtotal mean stress scores of the study group subjects after two months will be the same as those of the post-test.

35. Table (8) The differences between post and follow-up effect of program after 2 months of application (n=24).
Scope
Ranks N
Mean Rank
Sum of Ranks Z
Asymp. Sig. (2-tailed)
sig. level
Amputation stress
Negative Ranks 4
3.5 14
1.753
0.080
not sig.
Positive Ranks 1
Ties 19
Total 24
Peer stress
0.447
0.655 2 22
Family stress
1.382
0.167
4.25 17 18

36. Responsibility stress
Table (8) The differences between post and follow-up effect of program after 2 months of application (n=24). Cont’d.
Responsibility stress
Negative Ranks 1
1.5
0.816
0.414
not sig.
Positive Ranks 2
2.25
4.5
Ties 21
Total 24
Physiology stress
1.461
0.144 3 9 20
Coping stress
1.841
0.066 4
2.5 10

37. Total degree of the stress
Table (8) The differences between post and follow-up effect of program after 2 months of application (n=24). Cont’d.
Emotional stress
Negative Ranks
1.604
0.109
not sig.
Positive Ranks 3 2 6
Ties 21
Total 24
Total degree of the stress
7.833 47
1.681
0.093 12
10.333
124
*P <0.05

38. Table (9) Means & Std. Deviation for immediate post and follow-up tests stress scores (N=24).
application
No. of items
post application
follow- up application
scope
Mean
Std. Deviation
Amputation stress 25
29.917
4.353
29.083
3.752
Peer stress 23
26.917
2.205
27.083
2.653
Family stress 20
22.208
1.865
22.917
3.063
Responsibility stress
29.625
4.985
5.073
Physiology stress
26.708
4.349
27.292
4.563
Coping stress 18
27.542
4.978
27.875
5.059
Emotional stress
21.333
3.046
21.917
3.243
Total degree of the stress
144
14.423
15.410

39. Responsibility stress
Table (10) The differences between pre-test, immediate post-test and follow up test of total and subtotal stress scores among the study group (N=24).
Scope
Source of variance
Sum of Squares df
Mean Square F
Sig.
Sig. level
Amputation stress
Between Groups 2
0.000
* *
Within Groups 69
24.546
Total 71
Peer stress
36.031
Family stress
33.118
Responsibility stress
28.579
* * P <0.01

40. Total degree of the stress
Table (10) The differences between pre-test, immediate post-test and follow up test of total and subtotal stress scores among the study group (N=24). Cont’d.
Scope
Source of variance
Sum of Squares df
Mean Square F
Sig.
Sig. level
Physiology stress
Between Groups 2
0.000
* *
Within Groups 69
32.182
Total 71
Coping stress
26.646
Emotional stress
20.442
Total degree of the stress
* * P <0.01

41. follow- up application Responsibility stress
Table (11) Scheffe post test Matrix To identify the direction of differences between pre-test, immediate post-test and follow up test of total and subtotal stress scores (N=24).
Dependent Variable
application (I)
Application (J)
Mean Difference (I-J)
Sig.
sig. level
Amputation stress
pre application
post application
34.583
0.000
* *
follow- up application
35.417
0.833
0.844
not sig.
Peer stress
30.833
30.667
-0.167
0.995
Family stress
21.458
20.750
-0.708
0.913
Responsibility stress
23.125
22.833
-0.292
0.982
* * P <0.01

42. follow- up application Total degree of the stress
Table (11) Scheffe post test Matrix To identify the direction of differences between pre-test, immediate post-test and follow up test of total and subtotal stress scores (N=24). Cont’d.
Dependent Variable
application (I)
Application (J)
Mean Difference (I-J)
Sig.
sig. level
Physiology stress
pre application
post application
23.417
0.000
* *
follow- up application
22.833
-0.583
0.939
not sig.
Coping stress
19.958
19.625
-0.333
0.975
Emotional stress
21.333
20.750
0.905
Total degree of the stress
-1.833
0.968
* * P <0.01

43. Responsibility stress Total degree of the stress
Table (12) Compression between Means & Std. Deviation for pre, immediate post and follow-up tests of total & subtotal stress scores (N=24).
application
pre test
Immediate post test
follow- up test
scope
Mean
Std. Deviation
Amputation stress
64.500
6.372
29.917
4.353
29.083
3.752
Peer stress
57.750
9.808
26.917
2.205
27.083
2.653
Family stress
43.667
9.300
22.208
1.865
22.917
3.063
Responsibility stress
52.750
5.929
29.625
4.985
5.073
Physiology stress
50.125
7.537
26.708
4.349
27.292
4.563
Coping stress
47.500
5.437
27.542
4.978
27.875
5.059
Emotional stress
42.667
6.445
21.333
3.046
21.917
3.243
Total degree of the stress
37.605
14.423
15.410

44. Figure (2) illustrates the differences between pre-test, immediate post-test and follow up test (after 2 months) of stress levels for total and subtotal stress scores.

45. The second research hypothesis was supported.
The result revealed that there was no statistically significant difference among age, gender, limb amputation, marital status, residency, level of education, occupational status and levels of psychological stress of the amputees in Gaza governorates during Gaza war in pre-post and follow up tests.

46. CONCLUSION

47. Conclusion
Based on the result of present study, it can be concluded that:
The amputees exhibited high stress scores and they had challenges on many levels; the most frequent types of stresses exhibited by them were Coping stress, Responsibility stress, Physiology stress, Amputation stress Peer stress, Emotional stress and Family stress.
The training counseling program had a positive effect in reducing the level of physiological stress among the amputees. And group counseling based on Rational Emotive Behavior Therapy was found to be effective in changing the subject’s belief irrational to a rational belief system.

48. Conclusion … Cont
The result of sessions' evaluation form analysis revealed that; the session about the development of the scientific problem solving approach in different situations occupied the first rank and the amputees benefit from instruction in effective problem-solving skills.

49. RECOMMENDATIONS

50. Recommendations
According to the results of the current study, the following recommendations are suggested:
For amputees:
Teaching the amputee to examine and modify his or her irrational perceptions and beliefs to minimize the misconceptions and self-defeating outlook on life and to maximize coping skills and a more realistic philosophy of life.

51. Recommendations …Cont
Skills training include teaching amputees to control their emotions, and get rid of negative emotions and teaching them the problem-solving skills for the prevention of irrational ideas to reduce their level of stress.
Realism in dealing with stressful situations that the amputee understands his real capabilities and potential in order not to expose himself to the feeling of helplessness and failure and disappointment.

52. Recommendations …Cont
Encouraging amputees to participate in group teaching stress management activities.
To re-apply the training counseling program used in this study to the rest of the wounded amputees in Palestine.

53. Recommendations …Cont
For institutions that provide rehabilitation services for amputees:
Give more attention to Group counseling of amputees for its importance in early detection of mental and emotional problems.
Provide female counselor for amputated women who expressed their belief that they would feel more at ease working with a woman.

54. Recommendations …Cont
Need to prepare leaflets and brochures according to the Rational Emotive Behavior theory to guide and help amputees of rational thinking.
Conducting workshops in the field of psychological counseling in order to gain access to certain criteria to help alleviate the stress effects of amputees.

55. Recommendations …Cont
For research:-
further studies be undertaken in understanding the scope and impact of amputation within the Palestine context as no data on this could be found.
to expand this research in the other settings in Palestine.
More research is needed of psychological stress correlates the battle and non-battle amputees.

56. Recommendations …Cont
further study on the associations between problem solving and psychosocial outcomes and coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functions among wounded amputees.
Replicate the study in other settings with a larger and probability sample

57. } ولا تيْأَسوا مِن رَوْحِ الله إنّه لا ييْأَسُ مِن رَوْح الله إلا القومُ الكافرون {يوسف 87

58. THANK YOU