Use Quantitative Research In Your Nursing Clinical Practice.

Use Quantitative Research In Your Nursing Clinical Practice.

Use Quantitative Research In Your Nursing Clinical Practice.

A discussion board anwer in 1-3 paragraphs.

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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 of moving-forward behavior.

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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 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 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

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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 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 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

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