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 OUTLINE OF THE STUDY This research report has been divided into the following chapters:

• Chapter 1: Orientation of the study The background to the study has been discussed in the preceding body of this chapter. • Chapter 2: Literature review Literature is intended to provide the background to the available knowledge and guide the researcher with the possible areas that may need to be studied. • Chapter 3: Research methodology This chapter covers the methodology employed for this study.

Included here is the research methods and research design. • Chapter 4: Data analysis and discussion. In this chapter, the data analysis, interpretation and discussion of the findings of the study is provided. • Chapter 5: Summary, limitations, conclusions and recommendations This chapter concludes the study and it provides a summary of the data, the limitations for the study as well as the conclusion and recommendations as applied to this study. 1.9 CONCLUSION This chapter briefly highlighted the background to, rationale for, and aims and objectives of the study. The research design and methodology including the population, data collection, data analysis and ethical considerations as pertaining to this study was briefly discussed.

Topic:Nurses’ knowledge, attitudes and practices of fall prevention in a selected hospital in the Kingdom of Saudi Arabia INTRODUCTION The fall prevention is …….. (citation). From fall …. (citation ) A critical challenge faced by the global community…… (citation) . According to (citation ), fall is a concern in ….that lack awareness education programs. Fall … is an increasing problem in developing countries. According to the World Health Organization (WHO), fall is ….. Proper fall prevention …… is of great importance in the healthcare services. During the rendering of healthcare services. When fall is not handled in the correct way it may lead to serious health consequences for patients and may have a significant negative impact health care industry (citation .). Here I have included an example of how you can write the introduction.

I would start with the words: Fall prevention…..The introduction must have at least 3 references in it (use only references which are not older than 3 years). 2 BACKGROUND For the purpose of clarification and to orientate the reader, a short introduction is given of the country and the area in which this study was conducted. This study was conducted in the Eastern region of Saudi Arabia with a population of…..million.

Saudi Arabia is one of the world’s oil rich countries and produces …barrels of oil every year. The country falls within the Middle East and is made up of…regions. The hospital under study falls within the Eastern region where most of the oil of the country is extracted.

The hospital specifically caters for soldiers and their families and employs various categories of nurses from a large number of countries. Table 1.1: Summary of information of alhasa ,Saudi numbers and nationalities of nurses currently employed ) The background is important because it now narrows down your study. You are going to fist just give a brief discussion of the country and then the hospital without mentioning the name of the hospital Here you are going to mention that the JCI sets the standards for this hospital and that fall prevention should be 3.1 whereas the current falls rate is 3.3 (give a reference here such as Clark, 2015: personal communication). Or Hospital statistics 2015) 1.3 PROBLEM STATEMENT The hospital under study is accredited once a year by JCI, an American company that sets definite standards and criteria which must be reached to attain its accreditation status.

The criteria for falls should be lower than 3.1 according to JCI (include a reference here), but currently it is at 3.2 (include a reference here). Therefor it can be concluded that the hospital is currently not up to standard with the patient falls currently reported. Table…provides the statistical information about falls in the hospital retrospectively form 2014-2015. Here I would include a table or a figure to indicate the number of falls.

Therefore, based on the introduction and background given above, this study attempts to assess the knowledge, attitudes and practices of three different categories of nurses regarding patient falls in the hospital. 1.4 PURPOSE AND OBJECTIVES The purpose of this study will be to investigate the knowledge, awareness of practices among nurses regarding fall prevention that may contribute to patient safety and care. 1.4.1 Research questions A research question is an interrogative sentence that poses a problem or problems regarding the development of knowledge (Van Bogaert 2008:213).

In order to achieve this purpose, this study wishes to answer the following questions: • What is the current knowledge, attitudes and practices of nurses regarding patient falls in a selected healthcare facility in Saudi Arabia? • How does the current knowledge, attitudes and practices of different categories of nurses compare? Please be reminded that these are only suggestions. You might want to use diffent objectives which you will get form your Model of Orem which is a self-care deficit model. I have no idea how this can be applied in the study. Try to use other models on patient safety and quality . 1.4.2 Research objectives Norwood (2010:114) and Burns, Grove and Gray (2013:138) explain research objectives to be clear, concise and declarative statements written in present tense form and focus on one or two concepts that are either identified or described.

The research objectives of this study were to: • describe the knowledge, attitudes and practices of categories of nurses regarding patient falls in a selected healthcare facility in Saudi Arabia • compare the knowledge, attitudes and practices of various categories of nurses regarding fall prevention CONCEPTUAL MODEL OF THIS STUDY The conceptual model that was used in this study based on… This is where you discuss the model on which the study will be based. First given a description of the model, secondly the rationale for using it and thirdly the application to the study DEFINITIONS OF KEY TERMS All major terms in the title must be discussed here. Golden rule: 1. Define 2. Describe 3. 3.Apply For the purpose of this study, the following terms were used as defined below. Here your key terms must be described.

I suggest the following 1. fall Do as the examples given below. Perhaps JCI or the hospital have a definite definition of falls 2. Attitude The term “attitude” is defined as “the way of behaving towards something or someone which shows how you think and feel” (Oxford Advanced Learner’s Dictionary 2014:81). For individuals to adopt a particular habit or response depends on the adequacy of the information they have and their attitude towards using this information to fulfil a particular task (Ngozi 2011:31). Therefore individual attitudes are informed by their perception of the situation and or consequences thereof. In this study the term “attitude” will mean the behaviour of the nurses fall prevention in a selected hospital environment in Saudi Arabia. 1.5.2 Knowledge The Oxford Advanced Learner’s Dictionary (2014:820) defines “knowledge” as “the information, understanding and skill that you gain through education or experience”.

For the purposes of this research, the term knowledge refers to the nurses’ acquired ability to understand and recognise the importance of fall prevention in a particular hospital in Saudi Arabia. 1.5.3 Nurses The importance of defining in your proposal is to first give the definition, then discuss in a sentence or two and then apply to your study. 1.5.4 Hospital Bansal, Mishra, Gautam, Changulani, Srivastava and Gour (2011:11) define the term “hospital” as “an establishment that provides medical care facilities to persons suffering or suspected to be suffering from any disease or injury”. In this study, a hospital is regarded as a healthcare facility that provides services to patients either as in-patients or out-patients. • Chapter 2: Literature review • More Literature review will be better, mention about what WHO , CDC, and if possible. More Literature review RESEARCH METHODOLOGY Research methodology consists of 2 things namely the research design and methods. Here is an example of how you can do it. In this section a brief overview is given to the research design and method.

A much more detailed discussion will be given in chapter 3 of the study. The research methodology aims to obtain a valid and reliable answer to a research problem and is governed by the underlying aim and objectives of the study (Bowling 2003:75). Burns and Grove (2009:218) describe research methodology as the “entire strategy for the study from the identification of the problem to collection of data in a logical and systematic way”. Research methodology thus refers to the research plan (research design) and its implementation (process to execute the plan by different methods).

Design A research design is a prototype for the ‘collection, measurement and analysis of data”, for the reason of a study (Gray 2009:131). According to Creswell (2014:12), a research design or otherwise known as strategies of inquiry are the heartbeat of a research project in that designs provide specific direction. In essence a research design will facilitate a researcher in outlining what needs to be done objectively, validly, most accurately and economically, formulate questions for respondents, collect the questionnaires and analyse the responses (Du Plooy-Cilliers, Davis & Bezuidenhout 2014:93). Conjointly Kumar (2014:94) declares that a research design is a procedural plan that is followed through accurately and communicated to others regarding how one will select respondents, collect information from the respondents, analyse the information and communicate the findings, and justification of each step utilised in the ‘research journey’.

Thus a research design is a “strategic plan for a research project, setting out broad structures and features of the research (Gray 2009:581). In this study, the research design is non-experimental, quantitative, and descriptive and cross sectional in nature. This is what your study will look like. Non-experimental Non-experimental designs are useful in research as they provide extensive amounts of information that assists a researcher in linking the gaps of enquiry in a specific field of study LoBiondo-Wood and Haber (2014:52). Furthermore non-experimental designs are employed to observe an outcome by first looking at the effects of a phenomena and working out the links to the causes (Kumar 2011:391).

A non-experimental design of research is employed when manipulation of the independent variable is not possible for example if they are attribute variables. This type of design may also be applied if for ethical reasons such manipulation is unacceptable (Belli 2009:60).

Quantitative Quantitative research is based on numbers or quantity measurements; therefore, the processes and results are expressed as numbers (Rajasekar, Philominathan & Chinnathambi 2013:9). A quantitative research design is based on a positivist paradigm which is focused on non-deductive reasoning and objective reality in which natural phenomena is researched by utilising predictable, measurable quantifiable information (Polit & Beck 2008:763). According to Creswell (2014:4), quantitative research deals with numbers and statistics that are collected by a structured instrument, analysed and structured into an organised report to examine relationships between phenomena.

Descriptive This aspect of research design is essential in the identification of the respondents or subjects characteristics as they exist. This statement is consistent with those of Hulley, Cummings, Browner, Grady and Newman (2007:5) who state that descriptive designs aim at defining the state in which these characteristics exist in at the time of the study. In addition, Du Plooy-Cilliers et al (2014:75) state that descriptive studies are designed to describe characteristics of an inquiry in science and to draw on the relationship that links the variables of the phenomena in question. Kumar (2011:10) further iterates that descriptive studies systematically describes phenomena and provides information about the attitude of respondents towards the phenomena under investigation. Cross sectional In a cross-sectional research design, the observations of the phenomena under study is done once, which implies that the outcome presents is a “snap-shot view” (Hulley et al 2013:5).

Cross-sectional designs is unique in its nature has its aim is to synthesise causal problems occurring over a period of time but based on conclusions derived from observations made at only one time (Rubin & Babbie 2010:281).

This statement is affirmed by Burke and Christensen (2013:403) that state that cross-sectional designs occur when data is collected from respondents at a single point in time. It is worth noting that this type of design takes a closer look at subgroups of a population rather than only one specific group (Holland & Rees 2010:119). Research methods Your research methods will be those things you will use during data collection. Here is an example Research methods aim to structure the study, gather and analyse information relevant to provide answers to the research questions (Polit & Beck 2008:15). Bowling (2002:75) points out that various methods and tools are used for different tasks and change according to research paradigms and questions. Population These are all the nurses that you mentioned in the table under background.

It is the large number and excludes nobody. A population consists of all the individuals that possess certain characteristics of interest to the researcher (Hulley 2007:28). There are two categories to consider here namely “target population”, and “accessible population”. The International Epidemiological Association (2008:243) defines a target population as “the collection of individuals, items, measurements about which the outcome of the study can be generalised”. In addition, the accessible population is the fraction of the total population that the researcher can access for the study (Hulley 2007:28).

In addition, Norwood (2010:484) defines the term population as a “set of elements that possess certain criteria that engenders common ground amongst elements”. Nieswiadomy (2012:147) argues that a target population constitutes people, things, objects and data, thus these are utilised to confer generalisations about a phenomena of interest. The accessible population for this study was all the nurses employed and working at the one selected healthcare facility in Saudi Arabia.

Table The accessible population Category of nurses Total number (N) Total Sample A sample for any study may consider all the members of a population under consideration if it is a small number, however, for large a population or depending on the research design a representative sample is selected. A sample is largely expected to be a representative of the population. Therefore the sample should accurately and directly represent the characteristics as reflected by the population (Polit & Beck 2012:275).

According to Du Plooy-Cilliers et al (2014:135), a sample is a “subset of a population that is considered to be representative of the population”. Table Sample of population as stratified per unit This is just an example of how you could do it Ward/unit SN1 SN2 PCT etc Strata Totals 1 Gynaecology and maternity wards 16 96 57 0 169 2 Female medical 14 20 13 0 47 3 Female surgical 5 18 12 0 35 4 Male medical 11 20 11 0 42 5 Male surgical 6 19 10 0 35 9 Infection control 0 5 0 0 5 10 Accident and emergency 12 47 22 0 81 11 Out-patient clinics 0 39 26 0 65 12 Minor theatre 0 22 13 0 35 13 Main theatre 3 31 16 0 50 17 Intensive care unit 6 33 0 0 39 Sampling Sampling refers to the process of selecting the members of the population that would participate in the study, that is, the sample. A stratified random sampling method was used in this study.

According to Gerrish and Lacey (2006:176), this method provides an equal chance of each member on the sampling frame to be selected. In this study, the target population was divided into 18 strata representing the different units within the hospital and further four strata according to the different cadres including the different ranks of nurses in the hospital. In this study, a survey of the population of the different categories was conducted. The proportionate sample size was selected with the support of a statistician and applied by means of computer selection of individual healthcare workers from each of the selected wards/units until the desired number were obtained. Because of the small numbers of the three categories namely, SN1, SN2, PCTs etc personnel, all of them were approached to participate in the study.

However since their participation was voluntary the researcher could not guarantee which members of the population responded, therefore, the selection process was regarded as an impartial process.

The sample size was estimated separately, since these groups are the primary strata. Sample size calculations were done in G*Power based on the estimation of a 50% proportion, at a 5% significance level and 5% precision (Buchner, Erdfelder, Faul & Lang 2009:1149). The formula used to estimate the sample size for each group is n=(z2r(1-r)N) (Ne2+z2r(1-r) Where n = calculated sample size N = population size z = critical value at the chosen significance level r = proportion to be estimated e = precision Elibility criteria The researcher applied the eligibility criteria to the sample.

Eligibility criteria define who is included in the sample for which this study was designed (Burns & Grove 2009:345; Polit & Beck 2008:338). The authors further state that eligibility criteria include a “list of characteristics essential for eligibility for membership in the target population”. To be included in the study the respondents selected had to fulfil the following inclusive criteria. • be permanently employed by the hospital under study • show willingness to participate in the study after explaining the consent form • be literate in English The exclusion criteria of the sample were also considered. Exclusion criteria define the potential participants who may be excluded in the study.

The following exclusion criteria were applied for this study: • All professional healthcare workers not employed by the hospital under study. • Any person who is not regarded as a professional nurse Include as you wish. This is just an example • Pediatric unit are not included Any staff member in the four categories who were not willing to sign the consent to participate in the study Data collection instrument The data collection instrument used for this study was a self-designed, self-administered questionnaire which consisted of four sections This will depend on your model as illustrated below (see Annexure A) Insert your questionnaire as annexure A Section 1: Knowledge of falls Section 1 is concerned with establishing the level of knowledge of nurse regarding fall prevention. Section 2: Attitudes towards falls Section 2 aims to interrogate the respondents’ attitudes towards fall prevention strategies Section 3: Practices towards falls Section 3 deals with the practices of fall prevention Section 4: Biographical information Section 4 deals with the biographical information of the respondents such as age, gender, qualifications, education on fall prevention….., and years of experience of respondents. Data collection method According to Polit and Beck (2012:716), data collection is the “method used to collect information required to conduct the research study”.

The data was collected using a self-designed questionnaire. The following processes were followed in the process of data collection: • Each ward/unit/department was visited by the researcher and the research topic, objectives and process will be explained. • Those who are eligible to participate in the study were selected according to the inclusion criteria. • Cardboard boxes were place at an agreed upon location in the wards for those who have filled the questionnaires to return them. • The researcher placed each questionnaire in an envelope and personally hand them to the respondent. • The questionnaires were placed in a sealed box kept in a locked cabinet in the office of the researcher. Once all the questionnaires were collected, the box containing the questionnaires was collected by the person entering the data on the Excel programme. The data was then sent by e-mail to a statistician who conducted the statistical analysis. Data analysis Analysis of the data obtained was done with the help of the statistician.

This was done using the SPSS computer program. Demographic information of respondents were tabulated overall and by health care worker group. Validity and reliability In this section, an overview of the validity and reliability of the research instrument is discussed. A more comprehensive and application is provided in chapter 3. • Validity Validity of a research instrument is determined by its ability to accurately measure what it is supposed to measure (LoBiondo-Wood & Haber 2006:338). The research instrument is valid if it reflects the concept it is supposed to measure. The important aspects of validity are content, face and construct. Of concern in this kind of study is external validity, that is, the extent to which findings can be generalised to the population beyond the sample.

This was ensured by improving participation through a simplified data collection tool (a questionnaire) which requires little time and less effort to complete. Declining to participate was reported. – Content validity Content validity represents the universe of content which provides the framework and basis for formulating the items that will be adequate to represent the content (LoBiondo-Wood & Haber, 2006:338). – Face validity Face validity is concerned with how the research instrument appears to the respondents (Bless & Higson-Smith 2000:133). According to LoBiondo-Wood and Haber (2006:338), face validity in tool development determines the readability and clarity of the content. – Construct validity Construct validity relates to the ability of the research instrument to measure the theoretical constructs it purports to measure (Burns & Grove 2009:230).

Content validity was assured by conducting a literature review on the researcher’s area of study. In order to ensure that all the different aspects were covered in the questionnaire. Supervisors of this study with research experience as well as the professional statistician assisted the researcher in formulating the questionnaire, and it was given to independent experts and a statistician to evaluate the face, content and construct validity and to check for conceptual and possible investigative bias. • Reliability Reliability of the data collection instrument is determined by its ability to yield the same results each time it is repeatedly applied to the same objects (Babbie 2004:141). De Vos, Strydom, Fouché and Delport (2005:162) add that reliability is stability or consistency of the measurement.

If the same variable is measured under the same conditions, a reliable instrument produces identical measurement and the measuring instrument is able to yield consistent numerical results each time it is applied (Burns & Grove 2009:396). Reliability of the questionnaire was assured by accurate and careful phrasing of each question to avoid ambiguity. Pre-testing of the instrument ensured accuracy and dependability of the instrument.

ETHICAL CONSIDERATIONS The researcher used the principles of the Belmont Report and the Declaration of Helsinki as ethical guidance throughout the study.

It was ensured that letters of permission were obtained from the relevant authorities and in addition, an informed consent sought from all the eligible participants. Only individuals that had acquired the age of majority as stipulated in relevant laws of the land will participate in the study. Ethical considerations encompass four main domains; as purported in Leedy and Ormrod (2013:104). • Protection from harm • Voluntary and informed participation • Right to privacy • Honesty Ethical clearance was sought from the College of Human Sciences’ higher studies – Higher Degrees Committee of the University of South Africa and granted. Further permission was obtained the Botswana Ministry of Health and the hospital under study. Each participant was ascertained to be of age of majority in Botswana which is 18 years of age and signed an informed consent before filling in the questionnaire. A letter requesting permission from the respondents explained the purpose and objectives of the study (see annexure B). A letter of introduction was appended to a consent form that accompanied each self-administered questionnaire.

In addition, the researcher held various meetings at departmental levels with the potential respondents where he discussed the aspects of the study. Emphasis was placed on the voluntary participation and the right of the respondents to enrol or withdraw from the study. The researcher explained to all potential respondents that if they agreed to the participation in the study, they would have to sign the consent form in the presence of the researcher or his assistants before they could take the questionnaire to complete at their own convenience, within a set period of time. Three weeks was suggested as adequate, but most questionnaires were returned within a few days.

Respondents were also informed that the research instrument would be handed out during each eight-hour shift and consent would be signed then. Handing over questionnaires to those individuals who had signed the consent form ensured that all the returned and completed questionnaires would have been consented to. Also there was anonymity since there were no identifiers obtained from the research respondents. The collected and filled questionnaires were kept under lock and key. Respect for human dignity of respondents requires that participants in a research study do so voluntarily (Dhai 2005:596). Voluntariness is one of the four elements of informed consent. The other three being information, understanding and decision making capacity.

The moral importance of informed consent is rooted in the principle of autonomy. This principle emphasizes the respect of individuals’ fundamental rights to determine their destiny. It is concerned with treatment of individuals as moral agents and protection of those with diminished autonomy as well as those who because of the legal status cannot express themselves (Joubert & Ehrlich 2007:33). This is also in agreement with the spirit of respect of treatment of people as autonomous agents according to the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research 1979:online).

Similarly the Declaration of Helsinki under paragraph 8 acknowledges and emphasizes the requirement of informed consent as a fundamental and basic human right which emphasises that informed consent must be obtained from prospect study participants (World Medical Association 2012:46). Consent obtained after offering adequate and relevant information is a pre-requisite to any sound ethical research whereby all participants are protected against charges of negligence. Consent must be therefore be informed, voluntary and prospective and reinforced every time the investigator is in contact with a research participant (Dhai 2005:596-597).

According to McQouid-Mason (2008:6-8), the elements of an informed consent as outlined below are a pre-requisite to the ethics of research. This is an example, try to use this according to your topic • Information The amount of information given to potential research respondents should be adequate and relevant to enable them make decision whether to participate or not that is compatible with their interests and values. There are three different standards that have evolved in the bioethical and legal context regarding the disclosure of information to potential participants in a research study.

These standards are namely; a professional practice, a reasonable person, and a subjective standard. None of these standards articulates the notion of complete information; however potential respondents ought to be provided with information, such as the nature and purpose of the planned study, the procedures involved, the known and likely harms and burdens, and the likely benefits among others. • Understanding the information disclosed ought to be packaged in such a way that potential respondents apprehend and appreciate the information to meaningfully deliberate on their decision regarding participation or not.

Information sheet should be written in ‘lay’ language at a level of difficulty suited to the reading and comprehension skills of the expected participant population. • Voluntariness This aspect defines the autonomous authorization of informed consent. It represents substantial non-controlled decisions and actions rather than complete freedom from external control, for external influences cannot be completely excluded. For example although persuasion conforms with and is compatible with informed consent, it is a form of external influence but does not translate to controlling. Examples of external influence that are not acceptable in research considered as controlling are coercion and manipulation. • Decision-making capacity This section interrogates the potential respondents’ state of mind and their ability to make decisions about participating in a study. Individuals ought to be able to determine whether participation or non-participation is consistent with their interests, values and preferences.

Other conditions leading to limited choices and opportunities for example dependency which may erode decision-making must be considered and eliminated. Otherwise such individuals should only be included in such a study where it is absolutely imperative that the outcome is essential for the care of their kind and such information would not be possible if they did not participate. For consent to be considered as valid, the individual must be of acceptable age as per the legislation. Otherwise, in case of underage participants, their parents and or legal guardians can give proxy consent. If for example the parent of a potential participant is himself or herself a minor, they cannot give consent on their children’s behalf (McQouid-Mason 2008:7). Bibliography Babbie, E & Mouton J. 2001.

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