hypothesis example nursing

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4.2 Basic Concepts

Open Resources for Nursing (Open RN)

Before learning how to use the nursing process, it is important to understand some basic concepts related to critical thinking and nursing practice. Let’s take a deeper look at how nurses think.

Critical Thinking and Clinical Reasoning

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [1] Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.” It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research.

“Critical thinkers” possess certain attitudes that foster rational thinking. These attitudes are as follows:

Independence of thought: Thinking on your own
Fair-mindedness: Treating every viewpoint in an unbiased, unprejudiced way
Insight into egocentricity and sociocentricity: Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
Intellectual humility: Recognizing your intellectual limitations and abilities
Nonjudgmental: Using professional ethical standards and not basing your judgments on your own personal or moral standards
Integrity: Being honest and demonstrating strong moral principles
Perseverance: Persisting in doing something despite it being difficult
Confidence: Believing in yourself to complete a task or activity
Interest in exploring thoughts and feelings: Wanting to explore different ways of knowing
Curiosity: Asking “why” and wanting to know more

Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [2] To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. [3]

Inductive and Deductive Reasoning and Clinical Judgment

Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process.

Inductive reasoning involves noticing cues, making generalizations, and creating hypotheses. Cues are data that fall outside of expected findings that give the nurse a hint or indication of a patient’s potential problem or condition. The nurse organizes these cues into patterns and creates a generalization. A generalization is a judgment formed from a set of facts, cues, and observations and is similar to gathering pieces of a jigsaw puzzle into patterns until the whole picture becomes more clear. Based on generalizations created from patterns of data, the nurse creates a hypothesis regarding a patient problem. A hypothesis is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored.

No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. A nurse is similar to the detective looking for cues in Figure 4.1. [4] Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to take action quickly, especially in emergency situations. They can see how certain objects or events form a pattern (i.e., generalization) that indicates a common problem (i.e., hypothesis).

Example: A nurse assesses a patient and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice.

Photo showing person looking at camera through a magnifying glass

Deductive reasoning is another type of critical thinking that is referred to as “top-down thinking.” Deductive reasoning relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, federal regulations, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems.

Example: Based on research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. (See Figure 4.2). [5] The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking because the intervention is applied to all patients regardless if they have difficulty sleeping or not.

Clinical judgment is the result of critical thinking and clinical reasoning using inductive and deductive reasoning. Clinical judgment is defined by the National Council of State Boards of Nursing (NCSBN) as, “The observed outcome of critical thinking and decision-making. It uses nursing knowledge to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care.” [6] The NCSBN administers the national licensure exam (NCLEX) that measures nursing clinical judgment and decision-making ability of prospective entry-level nurses to assure safe and competent nursing care by licensed nurses.

Evidence-based practice (EBP) is defined by the American Nurses Association (ANA) as, “A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the health care consumer’s history and condition, as well as health care resources; and patient, family, group, community, and population preferences and values.” [7]

Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [8] The mnemonic ADOPIE is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: A ssessment, D iagnosis, O utcomes Identification, P lanning, I mplementation, and E valuation.

The nursing process is a continuous, cyclic process that is constantly adapting to the patient’s current health status. See Figure 4.3 [9] for an illustration of the nursing process.

Image showing workflow of nursing process, with labels

Review Scenario A in the following box for an example of a nurse using the nursing process while providing patient care.

Patient Scenario A : Using the Nursing Process [10]

Photo of simulated patient facing camera

A hospitalized patient has a prescription to receive Lasix 80mg IV every morning for a medical diagnosis of heart failure. During the morning assessment, the nurse notes that the patient has a blood pressure of 98/60, heart rate of 100, respirations of 18, and a temperature of 98.7F. The nurse reviews the medical record for the patient’s vital signs baseline and observes the blood pressure trend is around 110/70 and the heart rate in the 80s. The nurse recognizes these cues form a pattern related to fluid imbalance and hypothesizes that the patient may be dehydrated. The nurse gathers additional information and notes the patient’s weight has decreased 4 pounds since yesterday. The nurse talks with the patient and validates the hypothesis when the patient reports that their mouth feels like cotton and they feel light-headed. By using critical thinking and clinical judgment, the nurse diagnoses the patient with the nursing diagnosis Fluid Volume Deficit and establishes outcomes for reestablishing fluid balance. The nurse withholds the administration of IV Lasix and contacts the health care provider to discuss the patient’s current fluid status. After contacting the provider, the nurse initiates additional nursing interventions to promote oral intake and closely monitor hydration status. By the end of the shift, the nurse evaluates the patient status and determines that fluid balance has been restored.

In Scenario A, the nurse is using clinical judgment and not just “following orders” to administer the Lasix as scheduled. The nurse assesses the patient, recognizes cues, creates a generalization and hypothesis regarding the fluid status, plans and implements nursing interventions, and evaluates the outcome. Additionally, the nurse promotes patient safety by contacting the provider before administering a medication that could cause harm to the patient at this time.

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

The “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” [11] A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff. [12]

The “Assessment” component of the nursing process is further described in the “ Assessment ” section of this chapter.

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [13] A nursing diagnosis is the nurse’s clinical judgment about the client's response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses. [14]

The “Diagnosis” component of the nursing process is further described in the “ Diagnosis ” section of this chapter.

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” [15] The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

The “Outcomes Identification” component of the nursing process is further described in the “ Outcomes Identification ” section of this chapter.

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” [16] Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [17]

The “Planning” component of the nursing process is further described in the “ Planning ” section of this chapter.

Nursing Care Plans

Creating nursing care plans is a part of the “Planning” step of the nursing process. A nursing care plan is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process. Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision. Developing nursing care plans and implementing appropriate delegation are further discussed under the “ Planning ” and “ Implementing ” sections of this chapter.

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.” [18] Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed. [19]

The “Implementation” Standard of Professional Practice also includes the subcategories “Coordination of Care” and “Health Teaching and Health Promotion” to promote health and a safe environment. [20]

The “Implementation” component of the nursing process is further described in the “ Implementation ” section of this chapter.

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [21] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. [22]

The “Evaluation” component of the nursing process is further described in the “ Evaluation ” section of this chapter.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

Promotes quality patient care
Decreases omissions and duplications
Provides a guide for all staff involved to provide consistent and responsive care
Encourages collaborative management of a patient’s health care problems
Improves patient safety
Improves patient satisfaction
Identifies a patient’s goals and strategies to attain them
Increases the likelihood of achieving positive patient outcomes
Saves time, energy, and frustration by creating a care plan or path to follow

By using these components of the nursing process as a critical thinking model, nurses plan interventions customized to the patient’s needs, plan outcomes and interventions, and determine whether those actions are effective in meeting the patient’s needs. In the remaining sections of this chapter, we will take an in-depth look at each of these components of the nursing process. Using the nursing process and implementing evidence-based practices are referred to as the “science of nursing.” Let’s review concepts related to the “art of nursing” while providing holistic care in a caring manner using the nursing process.

Holistic Nursing Care

The American Nurses Association (ANA) recently updated the definition of nursing as, “Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in the recognition of the connection of all humanity.” [23]

The ANA further describes nursing is a learned profession built on a core body of knowledge that integrates both the art and science of nursing. The art of nursing is defined as, “Unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care.” [24]

Nurses care for individuals holistically, including their emotional, spiritual, psychosocial, cultural, and physical needs. They consider problems, issues, and needs that the person experiences as a part of a family and a community as they use the nursing process. Review a scenario illustrating holistic nursing care provided to a patient and their family in the following box.

Holistic Nursing Care Scenario

A single mother brings her child to the emergency room for ear pain and a fever. The physician diagnoses the child with an ear infection and prescribes an antibiotic. The mother is advised to make a follow-up appointment with their primary provider in two weeks. While providing discharge teaching, the nurse discovers that the family is unable to afford the expensive antibiotic prescribed and cannot find a primary care provider in their community they can reach by a bus route. The nurse asks a social worker to speak with the mother about affordable health insurance options and available providers in her community and follows up with the prescribing physician to obtain a prescription for a less expensive generic antibiotic. In this manner, the nurse provides holistic care and advocates for improved health for the child and their family.

Caring and the Nursing Process

The American Nurses Association (ANA) states, “The act of caring is foundational to the practice of nursing.” [25] Successful use of the nursing process requires the development of a care relationship with the patient. A care relationship is a mutual relationship that requires the development of trust between both parties. This trust is often referred to as the development of rapport and underlies the art of nursing. While establishing a caring relationship, the whole person is assessed, including the individual’s beliefs, values, and attitudes, while also acknowledging the vulnerability and dignity of the patient and family. Assessing and caring for the whole person takes into account the physical, mental, emotional, and spiritual aspects of being a human being. [26] Caring interventions can be demonstrated in simple gestures such as active listening, making eye contact, touching, and verbal reassurances while also respecting and being sensitive to the care recipient’s cultural beliefs and meanings associated with caring behaviors. [27] See Figure 4.4 [28] for an image of a nurse using touch as a therapeutic communication technique to communicate caring.

Dr. Jean Watson is a nurse theorist who has published many works on the art and science of caring in the nursing profession. Her theory of human caring sought to balance the cure orientation of medicine, giving nursing its unique disciplinary, scientific, and professional standing with itself and the public. Dr. Watson’s caring philosophy encourages nurses to be authentically present with their patients while creating a healing environment. [29]

Photo showing closeup of a younger hand holding an elderly one

Now that we have discussed basic concepts related to the nursing process, let’s look more deeply at each component of the nursing process in the following sections.

Klenke-Borgmann, L., Cantrell, M. A., & Mariani, B. (2020). Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives, 41 (4), 215-221. ↵
Powers, L., Pagel, J., & Herron, E. (2020). Nurse preceptors and new graduate success. American Nurse Journal, 15 (7), 37-39. ↵
“ The Detective ” by paurian is licensed under CC BY 2.0 ↵
“ In the Quiet Zone… ” by C.O.D. Library is licensed under CC BY-NC-SA 2.0 ↵
NCSBN. (n.d.). NCSBN clinical judgment model . https://www.ncsbn.org/14798.htm ↵
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
“ The Nursing Process ” by Kim Ernstmeyer at Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
“Patient Image in LTC.JPG” by ARISE project is licensed under CC BY 4.0 ↵
American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
American Nurses Association. (n.d.). The nursing process . https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
American Nurses Association. (2021). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association. ↵
American Nurses Association. (n.d.) The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
Walivaara, B., Savenstedt, S., & Axelsson, K. (2013). Caring relationships in home-based nursing care - registered nurses’ experiences. The Open Journal of Nursing, 7 , 89-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722540/pdf/TONURSJ-7-89.pdf ↵
“ hospice-1793998_1280.jpg ” by truthseeker08 is licensed under CC0 ↵
Watson Caring Science Institute. (n.d.). Watson Caring Science Institute. Jean Watson, PHD, RN, AHN-BC, FAAN, (LL-AAN) . https://www.watsoncaringscience.org/jean-bio/ ↵

Reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.

A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.

A type of reasoning that involves forming generalizations based on specific incidents.

Subjective or objective data that gives the nurse a hint or indication of a potential problem, process, or disorder.

A judgment formed from a set of facts, cues, and observations.

A proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring.

“Top-down thinking” or moving from the general to the specific. Deductive reasoning relies on a general statement or hypothesis—sometimes called a premise or standard—that is held to be true. The premise is used to reach a specific, logical conclusion.

The observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care.

A lifelong problem-solving approach that integrates the best evidence from well-designed research studies, theories, clinical expertise, health care resources, and patient preferences and values.

An easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

Individual, family, or group which includes significant others and populations.

Specific documentation of the planning and delivery of nursing care that is required by the Joint Commission.

Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.

A relationship described as one in which the whole person is assessed while balancing the vulnerability and dignity of the patient and family.

Developing a relationship of mutual trust and understanding.

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The First Step: Ask; Fundamentals of Evidence-Based Nursing Practice

In this module, we will learn about identifying the problem, start the “Ask” process with developing an answerable clinical question, and learn about purpose statements and hypotheses.

Content includes:

Identifying the problem
Determining the Population, Intervention, Comparison, and Outcome (PICO)
Asking a Research/Clinical Question (Based on PICO)

Statements of Purpose

Objectives:

Describe the process of developing a research/practice problem.
Describe the components of a PICO.
Identify different types of PICOs.
Distinguish function and form of statements of purpose.
Describe the function and characteristics of hypotheses.

Development of a Research/Practice Problem

Practice questions frequently arise from day-to-day problems that are encountered by providers (Dearholt & Dang, 2012). Often, these problems are very obvious. However, sometimes we need to back up and take a close look at the status quo to see underlying issues. The basis for any research project is indeed the underlying problem or issue. A good problem statement or paragraph is a declaration of what it is that is problematic or what it is that we do not know much about (a gap in knowledge) (Polit & Beck, 2018).

The process of defining the practice/clinical problem begins by seeking answers to clinical concerns. This is the first step in the EBP process: To ask . We start by asking some broad questions to help guide the process of developing our practice problem.

Is there evidence that the current treatment works?
Does the current practice help the patient?
Why are we doing the current practice?
Should we be doing the current practice this way?
Is there a way to do this current practice more efficiently?
Is there a more cost-effective method to do this practice?

Problem Statements:

For our EBP Project, we will need to ask these broad questions and then develop our problem that exists. This establishes the “background” of the issue we want to know more about.

For example, if we are choosing a clinical question based on wanting to know if adjunct music therapy helps decrease postoperative pain levels than just pharmaceuticals alone, we might consider the underlying problems of:

Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery (Gan, 2017).
Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs (Gan, 2017).
Multimodal analgesic techniques are widely used but new evidence is disappointing (Rawal, 2016).

In the above examples, we are establishing that poorly managed postoperative pain is a problem. Thus, looking at evidence about adjunctive music therapy may help to address how we might manage pain more effectively. These are our problem statements. This would be our introduction section on the EBP poster. For the sake of our EBP poster, you do not need to list these on the poster references. A heads up: The sources used to help develop our research/clinical program should not be the same resources that we use to answer our upcoming clinical question. In essence, we will be conducting two literature reviews: One, to establish the underlying problem; and, two: To find published research that helps to answer our developed clinical question.

Here is the introduction to the article titled, “The relationships among pain, depression, and physical activity in patients with heart failure” (Haedtke et al, 2017). You can read that the underlying problem is multifocal: 67% of patient with heart failure (HF) experience pain, depression is a comorbidity that affects 22% to 42% of HF patients, and that little attention has been paid to this relationship in patients with HF. The researchers have established the need for further research and why further research is needed.

Here is another example of how the clinical problem is addressed in an EBP poster that wants to appraise existing evidence related to dressing choice for decubitus ulcers.

When trying to communicate clinical problems, there are two main sources (Titler et al, 1994, 2001):

Problem-focused triggers : These are identified by staff during routine monitoring of quality, risk, adverse events, financial, or benchmarking data.
Knowledge-focused triggers : There are identified through reading published evidence or learning new information at conferences or other professional meetings.

Sources of Evidence-Based Clinical Problems:

Most problem statements have the following components:

Problem identification: What is wrong with the current situation or action?
Background: What is the nature of the problem or the context of the situation? (this helps to establish the why)
Scope of the problem: How many people are affected? Is this a small problem? Big problem? Potential to grow quickly to a large problem? Has been increasing/decreasing recently?
Consequences of the problem: If we do nothing or leave as the status quo, what is the cost of not fixing the issue?
Knowledge gaps: What information about the problem is lacking? We need to know what we do not know.
Proposed solution: How will the information or evidence contribute to the solution of the problem?

If you are stumped on a topic, ask faculty, RNs at local facilities, colleagues, and key stakeholders at local facilities for some ideas! There is usually “something” that the nursing field is concerned about or has questions about.

Components of a PICO Question

After we have asked ourselves some background questions, we need to develop a foreground (focused) question. A thoughtful development of a well-structured foreground clinical/practice question is important because the question drives the strategies that you will use to search for the published evidence. The question needs to be very specific, non-ambiguous , and measurable in order to find the relevant evidence needed and also increased the likelihood that you will find what you are looking for.

In developing your clinical/practice question, there is a helpful format to utilize to establish the key component. This format includes the Patient/Population, Intervention/Influence/Exposure, Comparison, and Outcome (PICO) (Richardson, Wilson, Nishikawa, & Hayward, 1995).

Let’s dive into each component to better understand.

P atient, population, or problem: We want to describe the patient, the population, or the problem. Get specific. We will want to know exactly who we are wanting to know about. Consider age, gender, setting of the patient (e.g. postoperative), and/or symptoms.

I ntervention: The intervention is the action or, in other words, the treatment, process of care, education given, or assessment approaches. We will come back to this in more depth, but for now remember that the intervention is also called the “Independent Variable”.

C omparison: Here we are comparing with other interventions. A comparison can be standard of care that already exists, current practice, an opposite intervention/action, or a different intervention/action.

O utcome: What is that that we are looking at for a result or consequence of the intervention? The outcome needs to have a metric for actually measuring results. The outcome can include quality of life, patient satisfaction, cost impacts, or treatment results. The outcome is also called the “Dependent Variable”.

The PICO question is a critical aspect of the EBP project to guide the problem identification and create components that can be used to shape the literature search.

An image with descriptions of PICO. " P Stands for patient or population. Who is your patient? (disease or health status, age, race, sex). "I" stands for intervention (or influence). what do you plan to do for the patient? (specific tests, therapies, medications). "C" stands for comparison. What is the alternative to your plan? (e.g. No treatment, standard care, different treatment, etc.). "O" stands for outcome. What outcome do you seek? (less symptoms, less frequency, decrease incidence, full health, etc.)

Let’s watch a nice YouTube video, “PICO: A Model for Evidence-Based Research”:

“PICO: A Model for Evidence Based Research” by Binghamton University Libraries. Licensed CCY BY .

Great! Okay, let’s move on and discuss the various types of PICOs.

Types of PICOs

Before we start developing our clinical question, let’s go over the various types of PICOs and the clinical question that can result from the components. There are various types of PICOs but we are concerned with the therapy/treatment/intervention format of PICO for our EBP posters.

Let’s take a look at the various types of PICOs:

The first step in developing a research or clinical practice question is developing your PICO. Well, we’ve done that above. You will select each component of your PICO and then turn that into your question. Making the EBP question as specific as possible really helps to identify specific terms and narrow the search, which will result in reducing the time it times searching for relevant evidence.

Once you have your pertinent clinical question, you will use the components to begin your search in published literature for articles that help to answer your question. In class, we will practice with various situations to develop PICOs and clinical questions.

Many articles have the researcher’s statement of purpose (sometimes referred to as “aim”, “goal”, or “objective”) for their research project. This helps to identify what the overarching direction of inquiry may be. You do not need a statement of purpose/aim/goal/objective for your EBP poster. However, knowing what a statement of purpose is will help you when appraising articles to help answer your clinical question.

The following statement of purpose was written as an aim. The population (P) was identified as patients with HF, the interventions (I) included physical activity/exercise, and the outcomes (O) included pain, depression, total activity time, and sitting time as correlated with the interventions.

In the articles above, the authors made it easy and included their statements of purpose within the abstract at the beginning of the article. Most articles do not feature this ease, and you will need to read the introduction or methodology section of the article to find the statement of purpose, much like within article 3.1.

In qualitative studies, the statement of purpose usually indicates the nature of the inquiry, the key concept, the key phenomenon, and the population.

Function and Characteristics of Hypotheses.

A hypothesis (plural: hypothes es ) is a statement of predicted outcome. Meaning, it is an educated and formulated guess as to how the intervention (independent variable – more on that soon!) impacts the outcome (dependent variable). It is not always a cause and effect. Sometimes there can be just a simple association or correlation. We will come back to that in a few modules.

In your PICO statement, you can think of the “I” as the independent variable and the “O” as the dependent variable . Variables will begin making more sense as we go. But for now, remember this:

Independent Variable (IV): This is a measure that can be manipulated by the researcher. Perhaps it is a medication, an educational program, or a survey. The independent variable enacts change (or not) onto the independent variable.

Dependent Variable (DV): This is the result of the independent variable. This is the variable that we utilize statistical analyses to measure. For instance, if we are intervening with a blood pressure medication (our IV), then our DV would be the measurement of the actual blood pressure.

Most of the time, a hypothesis results from a well-worded research question. Here is an example:

Research Question : “Does sexual abuse in childhood affect the development of irritable bowel syndrome in women?”

Research Hypothesis : Women (P) who were sexually abused in childhood (I) have a higher incidence of irritable bowel syndrome (O) than women who were not abused (C).

You may note in that hypothesis that there is a predicted direction of outcome. One thing leads to something.

But, why do we need a hypothesis? First, they help to promote critical thinking. Second, it gives the researcher a way to measure a relationship. Suppose we conducted a study guided only by a research question. Take the above question, for example. Without a hypothesis, the researcher is seemingly prepared to accept any result (Polit & Beck, 2021). The problem with that is that it is almost always possible to explain something superficially after the fact, even if the findings are inconclusive. A hypothesis reduces the possibility that spurious results will be misconstrued (Polit & Beck, 2021).

Not all research articles will list a hypothesis. This makes it more difficult to critically appraise the results. That is not to say that the results would be invalidated, but it should ignite a spirit of further inquiry as to if the results are valid.

Hypotheses (also called alternative hypothesis) can be stated as:

Directional or nondirectional
Simple or complex
Research or Null

Simple hypothesis : Statement of causal (cause and effect) relationship – one independent variable (intervention) and one dependent variable (outcome).

Example : If you stay up late, then you feel tired the next day.

Complex hypothesis : Statement of causal (cause and effect) or associative (not causal) between two or more independent variables (interventions) and/or two or more dependent variables (outcomes).

Example : Higher the poverty, higher the illiteracy in society, higher will be the rate of crime (three variables – two independent variables and one dependent variable).

Directional hypothesis : Specifies not only the existence but also the expected direction of the relationship between the dependent (outcome) and the independent (intervention) variables. You will also see this called “One-tailed hypothesis”.

Example : Depression scores will decrease following a 6-week intervention.

Nondirectional hypothesis : Does not specify the direction of relationship between the variables. You will also see this called “Two-tailed hypothesis”.

Example : College students will perform differently from elementary school students on a memory task (without predicting which group of students will perform better).

Null hypothesis : The null hypothesis assumes that any kind of difference between the chosen characteristics that you see in a set of data is due to chance. Now, the null hypothesis is why the plain old hypothesis is also called alternative hypothesis. We don’t just assume that the hypothesis is true. So, it is considered an alternative to something just happening by chance (null).

Example : Let’s say our research question is, “Do teens use cell phones to access the internet more than adults?” – our null hypothesis could state: Age has no effect on how cell phones are used for internet access.

And then, further develop the problem and background through finding existing literature to help answer the following questions:

Knowledge gaps: What information about the problem is lacking? We need to know what we do not know.

With the previous example of pain in the pediatric population, here is an example of an Introduction section from a past student poster:

What was the research problem? Was the problem statement easy to locate and was it clearly stated? Did the problem statement build a coherent and persuasive argument for the new study?
Does the problem have significance for nursing?
Was there a good fit between the research problem and the paradigm (and tradition) within which the research was conducted?
Did the report formally present a statement of purpose, research question, and/or hypotheses? Was this information communicated clearly and concisely, and was it placed in a logical and useful location?
Were purpose statements or research questions worded appropriately (e.g., were key concepts/variables identified and the population specified?
If there were no formal hypotheses, was their absence justified? Were statistical tests used in analyzing the data despite the absence of stated hypotheses?
Were hypotheses (if any) properly worded—did they state a predicted relationship between two or more variables? Were they presented as research or as null hypotheses?

References & Attribution

“ Green check mark ” by rawpixel licensed CC0 .

“ Light bulb doodle ” by rawpixel licensed CC0 .

“ Magnifying glass ” by rawpixel licensed CC0

“ Orange flame ” by rawpixel licensed CC0 .

Chen, P., Nunez-Smith, M., Bernheim, S… (2010). Professional experiences of international medical graduates practicing primary care in the United States. Journal of General Internal Medicine, 25 (9), 947-53.

Dearholt, S.L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd Ed.). Indianapolis, IN: Sigma Theta Tau International.

Gan, T. (2017). Poorly controlled postoperative pain: Prevalence, consequences, and prevention. Journal of Pain Research, 10, 2287-2298.

Genc, A., Can, G., Aydiner, A. (2012). The efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting. Support Care Cancer, 21 , 253-261.

Haedtke, C., Smith, M., VanBuren, J., Kein, D., Turvey, C. (2017). The relationships among pain, depression, and physical activity in patients with heart failure. Journal of Cardiovascular Nursing, 32 (5), E21-E25.

Pankong, O., Pothiban, L., Sucamvang, K., Khampolsiri, T. (2018). A randomized controlled trial of enhancing positive aspects of caregiving in Thai dementia caregivers for dementia. Pacific Rim Internal Journal of Nursing Res, 22 (2), 131-143.

Polit, D. & Beck, C. (2021). Lippincott CoursePoint Enhanced for Polit’s Essentials of Nursing Research (10th ed.). Wolters Kluwer Health.

Rawal, N. (2016). Current issues in postoperative pain management. European Journal of Anaesthesiology, 33 , 160-171.

Richardson, W.W., Wilson, M.C., Nishikawa, J., & Hayward, R.S. (1995). The well-built clinical question: A key to evidence-based decisions. American College of Physicians, 123 (3), A12-A13.

Titler, M. G., Kleiber, C., Steelman, V.J. Rakel, B. A. Budreau, G., Everett,…Goode, C.J. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13 (4), 497-509.

Evidence-Based Practice & Research Methodologies Copyright © by Tracy Fawns is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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HOW TO WRITE A HYPOTHESIS: EXAMPLES, FORMAT, AND SAMPLES

by ella | Apr 17, 2024 | Uncategorized

How To Write A Hypothesis: Examples, Format, And Samples

by ella | Apr 11, 2024 | Uncategorized

The end product of your labor will be documented as a research study., a research article, a term paper, or any other type of academic document. In this particular scenario, you have to begin your job by formulating the hypothesis on its own. Although it may appear to be easy at first glance, there are quite a few challenges for novices. This involves having problems coming up with an exact formulation of it.

Where is the hypothesis in a research paper

A research hypothesis is a specific statement or topic that is the focal point of any academic investigation. It covers certain variables that may affect your topic and a problem that has received little or no prior research. In this scenario, the researcher is tasked with considering them from a scientific standpoint.

Next, we will walk you through the process of writing a hypothesis in a precise and accurate way and with some written hypothesis examples.

What is the purpose of writing a hypothesis

A statement or assumption that provides an answer to a question you posed before but have not evaluated is an example of a research hypothesis. This will serve as the foundation of your study, which you will utilize to validate or invalidate your premise.

Most of the time, significant research efforts will deal with many theories. These are connected to various facets of the problem that is being investigated. As a result, you will analyze the assumptions in a segmented fashion after dividing them according to the research areas. When working on a project, one needs to base their decisions on previously learned information in addition to an established theory. In addition, one must keep in mind that it must be able to be tested. In other words, it is anything that may be shown false or proven correct using methods of scientific study.

One possible hypothesis example research is as follows:

Your assignment requires you to provide evidence to support or refute this theory using survey findings. Statistical analysis, review of reports, and presentation of other processed data are requested.

Keep in mind that you can hire a paper writer who, as part of your research paper hypothesis , will include the survey results and conduct statistical analysis.

Concerning hypotheses, variables

To make an educated prediction, you must consider the factors in your hypothesis. One can classify them as independent or dependent, depending on their level of autonomy. You are required to establish a causal link between at least two variables.

The independent (confounding) variable refers to everything the researcher can influence or modify, such as the starting condition. The researcher looks at the dependent (or superfluous) variable. It is witnessed in conditions that have been constructed. It would help if you first determined the overarching purpose of your work before beginning to educate yourself on how to compose an assignment that includes both independent and dependent variables.

For instance, you make the presumption that consuming hedgehog meat lowers one’s likelihood of developing cardiovascular disease. Consumption of hedgehog meat, the independent variable, is the root of the problem. The dependent variable here is an impact that is supposed to occur: improved cardiovascular health.

How to write a hypothesis statement

The most common question beginning researchers have is the format for a hypothesis statement. Compiling laconic forecasts is part of this involved process, which is challenging. These results are derived from actual tests that were carried out. We can lend you a hand with this project. We have devised five procedures that scholars might follow to compose an assignment of high quality and extensive scope.

The first thing you need to do is think of a question before you start writing your hypothesis.

When beginning to produce a hypothesis for a research paper, you first need to create a research question that your article will attempt to address. It has to have a laser-like concentration on a particular issue. Please make an effort to be as particular as possible while yet maintaining its suitability for research within the context of your topic

You need to employ six timeless assertions to compose an excellent assignment. Therefore, you need to include more details on who, what, where, when, why, and how. It would be best to make the query comprehendible by referring to the positioning difficulty.

The second step is to compile preliminary research in support of your hypothesis

Before you write a research hypothesis, you should conduct preliminary research to see whether or not your assumption is valid and can be demonstrated. Through either observation or experimentation, you will obtain essential insights. You might also use the findings obtained by your peers who have already researched this topic. as a result; you will construct an idea using formulated variables. You are going to do research on them and figure out the connections between them.

Formulate a credible working hypothesis

You may learn how to write a formal hypothesis by analyzing the outcomes of your initial preparation and the research questions you posed. In the beginning, emphasize the primary issue with the tests. You have to condense it down to its most essential elements. Avoid making extensive remarks to prevent the work from becoming too short.

Be as explicit as possible, and avoid hazy judgements. Take, for instance:

This is not a desirable choice. When testing a hypothesis, it is preferable to do it in the manner of: this is an uncomplicated statement that does not include any extraneous information. It makes it possible for you to witness an intended impact right away. If you want your research paper to be of higher quality, you should get some practical assistance in writing it.

Develop a more precise hypothesis based on your research

Check to see that the formulation of a hypothesis for a research proposal is accurate. You need to check to see if it possesses the following components:

Dependent and independent variables

A subject or phenomenon that will be examined.

The anticipated results of the study you want to carry out are as follows: there must be some experiment or observation.in this approach, you can specify the question being studied. You will also be able to validate it if that becomes necessary. Put it another way, and you will shift from general to specific.

The fifth step is to compose a null hypothesis

You may need to compose a null hypothesis. You could wonder, “why and when?” when using this approach to particular process statistics. You ought to make it clear whether or not you intend to illustrate your thesis using its premise. This stance is crystal obvious and does not build linkages between the variables.

For instance, the following assertion is an example of a null hypothesis:

It is the foundation upon which one may give their own opinion. It makes it possible to construct a proof base using the findings of researchers’ studies.

What differentiates a null hypothesis from an alternative hypothesis?

Examining testable assertions will help you better understand how to create null and alternative hypotheses, which will serve as the foundation of the study. A “null hypothesis” is constructed after the findings are analyzed. It is a statement that does not relate to any of the variables.

At the same time, scientists frequently consider contrasting theories in their research. In this particular instance, they have previously identified a relationship between occurrences. Have you ever considered using a specialized writing service for your research paper? Therefore, the above remark concerning the number of times people go to the doctor may be changed to refer to studies on:

Hypothesis examples research paper

Researchers frequently struggle while attempting to conceptualize the foundation for the composition of a research report. As a result, we are providing them with some instances of hypotheses that will be helpful. This will correlate to connections based on if-then statements. You will also provide a concise summary of the primary component of the ongoing research with their assistance. We will assist you in designing an assignment and provide a variety of working possibilities, including the following:

It might be challenging to figure out where to begin when hypothesis writing for a research proposal. In particular for those who aspire to careers in academia! Ultimately, instructions for a task must be crystal clear and highly detailed. In addition to this, its potential for continued development must be viable. The following suggestions can assist you in formulating your argument:

Investigate the fascinating aspects.

Consider the most recent research and issues about the chosen subject. Bring attention to what you wanted to investigate; perhaps it will be a notion related to some of your earlier works.

Could you give me some specifics about it?

Invest some effort in doing preliminary analyses. It would be best if you also had to emphasize contentious features and modern-day press concerns. Even thoroughly investigated phenomena might, on occasion, yield encouraging results.

Pay attention to the task you’re doing.

It is usually simpler to carry on than to begin something brand fresh. On the other hand, it’s possible that you didn’t consider all the theses from the earlier research enough.

Bring clarity to the many factors.

Avoid unclear statements. Does that sound like a challenge? Help with your college paper is available to you.

Conclusions regarding the method of writing a scientific hypothesis

If you have read up to this point, you should already be familiar with the step-by-step process of creating a hypothesis. Conduct research about the issue and the topic before beginning to write. You need to bring attention to the thesis that has room for additional development. It is highly recommended that you carry out the following steps:

Define the query to which you are hoping to obtain a response.
Carry out some preliminary investigation.
Put your best effort into it.
The variables, the subject, the phenomena, and the desired result should all be refined.

In a nutshell

A hypothesis is a statement in which your predictions concerning the findings of your investigation are stated. It is an unproven hypothesis that may or may not provide a solution to the issue posed by your study. Specific research projects may require you to compose many hypotheses, each targeting a distinct facet of the overarching study issue.

A hypothesis is not the same as a simple assumption; instead, it should be founded on previous research and established information. In addition, it has to be testable, which implies that it can be validated or debunked by applying scientific research techniques. You have the option at nursingpapersmarket.com to work with the writers there to get assistance with your research projects and papers.

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Chapter 4 Nursing Process

4.1. nursing process introduction, learning objectives.

Use the nursing process to provide patient care
Identify nursing diagnoses from evidence-based sources
Describe the development of a care plan
Prioritize patient care
Describe documentation for each step of the nursing process
Differentiate between the role of the PN and RN

Have you ever wondered how a nurse can receive a quick handoff report from another nurse and immediately begin providing care for a patient they previously knew nothing about? How do they know what to do? How do they prioritize and make a plan?

Nurses do this activity every shift. They know how to find pertinent information and use the nursing process as a critical thinking model to guide patient care. The nursing process becomes a road map for the actions and interventions that nurses implement to optimize their patients’ well-being and health. This chapter will explain how to use the nursing process as standards of professional nursing practice to provide safe, patient-centered care.

4.2. BASIC CONCEPTS

Before learning how to use the nursing process, it is important to understand some basic concepts related to critical thinking and nursing practice. Let’s take a deeper look at how nurses think.

Critical Thinking and Clinical Reasoning

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [ 1 ] Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.” It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research.

“Critical thinkers” possess certain attitudes that foster rational thinking. These attitudes are as follows:

Independence of thought: Thinking on your own
Fair-mindedness: Treating every viewpoint in an unbiased, unprejudiced way
Insight into egocentricity and sociocentricity: Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
Intellectual humility: Recognizing your intellectual limitations and abilities
Nonjudgmental: Using professional ethical standards and not basing your judgments on your own personal or moral standards
Integrity: Being honest and demonstrating strong moral principles
Perseverance: Persisting in doing something despite it being difficult
Confidence: Believing in yourself to complete a task or activity
Interest in exploring thoughts and feelings: Wanting to explore different ways of knowing
Curiosity: Asking “why” and wanting to know more

Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [ 2 ] To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. [ 3 ]

Inductive and Deductive Reasoning and Clinical Judgment

Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process.

No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. A nurse is similar to the detective looking for cues in Figure 4.1 . [ 4 ] Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to take action quickly, especially in emergency situations. They can see how certain objects or events form a pattern (i.e., generalization) that indicates a common problem (i.e., hypothesis).

Inductive Reasoning Includes Looking for Cues

Example: Based on research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. (See Figure 4.2 ). [ 5 ] The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking because the intervention is applied to all patients regardless if they have difficulty sleeping or not.

Deductive Reasoning Example: Implementing Interventions for a Quiet Zone Policy

Clinical judgment is the result of critical thinking and clinical reasoning using inductive and deductive reasoning. Clinical judgment is defined by the National Council of State Boards of Nursing (NCSBN) as, “The observed outcome of critical thinking and decision-making. It uses nursing knowledge to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care.” [ 6 ] The NCSBN administers the national licensure exam (NCLEX) that measures nursing clinical judgment and decision-making ability of prospective entry-level nurses to assure safe and competent nursing care by licensed nurses.

Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [ 8 ] The mnemonic ADOPIE is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: A ssessment, D iagnosis, O utcomes Identification, P lanning, I mplementation, and E valuation.

The nursing process is a continuous, cyclic process that is constantly adapting to the patient’s current health status. See Figure 4.3 [ 9 ] for an illustration of the nursing process.

The Nursing Process

Review Scenario A in the following box for an example of a nurse using the nursing process while providing patient care.

Patient Scenario A: Using the Nursing Process [ 10 ]

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

The “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” [ 11 ] A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff. [ 12 ]

The “Assessment” component of the nursing process is further described in the “ Assessment ” section of this chapter.

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [ 13 ] A nursing diagnosis is the nurse’s clinical judgment about the client's response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses. [ 14 ]

The “Diagnosis” component of the nursing process is further described in the “ Diagnosis ” section of this chapter.

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” [ 15 ] The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

The “Outcomes Identification” component of the nursing process is further described in the “ Outcomes Identification ” section of this chapter.

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” [ 16 ] Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [ 17 ]

The “Planning” component of the nursing process is further described in the “ Planning ” section of this chapter.

NURSING CARE PLANS

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.” [ 18 ] Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed. [ 19 ]

The “Implementation” component of the nursing process is further described in the “ Implementation ” section of this chapter.

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [ 21 ] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. [ 22 ]

The “Evaluation” component of the nursing process is further described in the “ Evaluation ” section of this chapter.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

Promotes quality patient care
Decreases omissions and duplications
Provides a guide for all staff involved to provide consistent and responsive care
Encourages collaborative management of a patient’s health care problems
Improves patient safety
Improves patient satisfaction
Identifies a patient’s goals and strategies to attain them
Increases the likelihood of achieving positive patient outcomes
Saves time, energy, and frustration by creating a care plan or path to follow

Holistic Nursing Care

Holistic Nursing Care Scenario

Review how to provide culturally responsive care and reduce health disparities in the “ Diverse Patients ” chapter.

Caring and the nursing process.

The American Nurses Association (ANA) states, “The act of caring is foundational to the practice of nursing.” [ 25 ] Successful use of the nursing process requires the development of a care relationship with the patient. A care relationship is a mutual relationship that requires the development of trust between both parties. This trust is often referred to as the development of rapport and underlies the art of nursing. While establishing a caring relationship, the whole person is assessed, including the individual’s beliefs, values, and attitudes, while also acknowledging the vulnerability and dignity of the patient and family. Assessing and caring for the whole person takes into account the physical, mental, emotional, and spiritual aspects of being a human being. [ 26 ] Caring interventions can be demonstrated in simple gestures such as active listening, making eye contact, touching, and verbal reassurances while also respecting and being sensitive to the care recipient’s cultural beliefs and meanings associated with caring behaviors. [ 27 ] See Figure 4.4 [ 28 ] for an image of a nurse using touch as a therapeutic communication technique to communicate caring.

Touch as a Therapeutic Communication Technique

Review how to communicate with patients using therapeutic communication techniques like active listening in the “ Communication ” chapter.

4.3. ASSESSMENT

Assessment is the first step of the nursing process (and the first Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” This includes collecting “pertinent data related to the health and quality of life in a systematic, ongoing manner, with compassion and respect for the wholeness, inherent dignity, worth, and unique attributes of every person, including but not limited to, demographics, environmental and occupational exposures, social determinants of health, health disparities, physical, functional, psychosocial, emotional, cognitive, spiritual/transpersonal, sexual, sociocultural, age-related, environmental, and lifestyle/economic assessments.” [ 1 ]

Nurses assess patients to gather clues, make generalizations, and diagnose human responses to health conditions and life processes. Patient data is considered either subjective or objective, and it can be collected from multiple sources.

Subjective Assessment Data

Subjective data is information obtained from the patient and/or family members and offers important cues from their perspectives. When documenting subjective data stated by a patient, it should be in quotation marks and start with verbiage such as, The patient reports. It is vital for the nurse to establish rapport with a patient to obtain accurate, valuable subjective data regarding the mental, emotional, and spiritual aspects of their condition.

There are two types of subjective information, primary and secondary. Primary data is information provided directly by the patient. Patients are the best source of information about their bodies and feelings, and the nurse who actively listens to a patient will often learn valuable information while also promoting a sense of well-being. Information collected from a family member, chart, or other sources is known as secondary data . Family members can provide important information, especially for individuals with memory impairments, infants, children, or when patients are unable to speak for themselves.

See Figure 4.5 [ 2 ] for an illustration of a nurse obtaining subjective data and establishing rapport after obtaining permission from the patient to sit on the bed.

Example. An example of documented subjective data obtained from a patient assessment is, “The patient reports, ‘My pain is a level 2 on a 1-10 scale.’”

Objective Assessment Data

Objective data is anything that you can observe through your sense of hearing, sight, smell, and touch while assessing the patient. Objective data is reproducible, meaning another person can easily obtain the same data. Examples of objective data are vital signs, physical examination findings, and laboratory results. See Figure 4.6 [ 3 ] for an image of a nurse performing a physical examination.

Physical Examination

Example. An example of documented objective data is, “The patient’s radial pulse is 58 and regular, and their skin feels warm and dry.”

Sources of Assessment Data

There are three sources of assessment data: interview, physical examination, and review of laboratory or diagnostic test results.

Interviewing

Interviewing includes asking the patient questions, listening, and observing verbal and nonverbal communication. Reviewing the chart prior to interviewing the patient may eliminate redundancy in the interview process and allows the nurse to hone in on the most significant areas of concern or need for clarification. However, if information in the chart does not make sense or is incomplete, the nurse should use the interview process to verify data with the patient.

After performing patient identification, the best way to initiate a caring relationship is to introduce yourself to the patient and explain your role. Share the purpose of your interview and the approximate time it will take. When beginning an interview, it may be helpful to start with questions related to the patient’s medical diagnoses to gather information about how they have affected the patient’s functioning, relationships, and lifestyle. Listen carefully and ask for clarification when something isn’t clear to you. Patients may not volunteer important information because they don’t realize it is important for their care. By using critical thinking and active listening, you may discover valuable cues that are important to provide safe, quality nursing care. Sometimes nursing students can feel uncomfortable having difficult conversations or asking personal questions due to generational or other cultural differences. Don’t shy away from asking about information that is important to know for safe patient care. Most patients will be grateful that you cared enough to ask and listen.

Be alert and attentive to how the patient answers questions, as well as when they do not answer a question. Nonverbal communication and body language can be cues to important information that requires further investigation. A keen sense of observation is important. To avoid making inappropriate inferences , the nurse should validate any cues. For example, a nurse may make an inference that a patient is depressed when the patient avoids making eye contact during an interview. However, upon further questioning, the nurse may discover that the patient’s cultural background believes direct eye contact to be disrespectful and this is why they are avoiding eye contact. To read more information about communicating with patients, review the “ Communication ” chapter of this book.

A physical examination is a systematic data collection method of the body that uses the techniques of inspection, auscultation, palpation, and percussion. Inspection is the observation of a patient’s anatomical structures. Auscultation is listening to sounds, such as heart, lung, and bowel sounds, created by organs using a stethoscope. Palpation is the use of touch to evaluate organs for size, location, or tenderness. Percussion is an advanced physical examination technique typically performed by providers where body parts are tapped with fingers to determine their size and if fluid is present. Detailed physical examination procedures of various body systems can be found in the Open RN Nursing Skills textbook with a head-to-toe checklist in Appendix C . Physical examination also includes the collection and analysis of vital signs.

Registered Nurses (RNs) complete the initial physical examination and analyze the findings as part of the nursing process. Collection of follow-up physical examination data can be delegated to Licensed Practical Nurses/Licensed Vocational Nurses (LPNs/LVNs) , or measurements such as vital signs and weight may be delegated to trained Unlicensed Assistive Personnel (UAP) when appropriate to do so. However, the RN remains responsible for supervising these tasks, analyzing the findings, and ensuring they are documented .

A physical examination can be performed as a comprehensive, head-to-toe assessment or as a focused assessment related to a particular condition or problem. Assessment data is documented in the patient’s Electronic Medical Record (EMR) , an electronic version of the patient’s medical chart.

Reviewing Laboratory and Diagnostic Test Results

Reviewing laboratory and diagnostic test results provides relevant and useful information related to the needs of the patient. Understanding how normal and abnormal results affect patient care is important when implementing the nursing care plan and administering provider prescriptions. If results cause concern, it is the nurse’s responsibility to notify the provider and verify the appropriateness of prescriptions based on the patient’s current status before implementing them.

Types of Assessments

Several types of nursing assessment are used in clinical practice:

Primary Survey: Used during every patient encounter to briefly evaluate level of consciousness, airway, breathing, and circulation and implement emergency care if needed.
Admission Assessment: A comprehensive assessment completed when a patient is admitted to a facility that involves assessing a large amount of information using an organized approach.
Ongoing Assessment: In acute care agencies such as hospitals, a head-to-toe assessment is completed and documented at least once every shift. Any changes in patient condition are reported to the health care provider.
Focused Assessment: Focused assessments are used to reevaluate the status of a previously diagnosed problem.
Time-lapsed Reassessment: Time-lapsed reassessments are used in long-term care facilities when three or more months have elapsed since the previous assessment to evaluate progress on previously identified outcomes. [ 4 ]

Putting It Together

Review Scenario C in the following box to apply concepts of assessment to a patient scenario.

Scenario C [5]

Ms. J. is a 74-year-old woman who is admitted directly to the medical unit after visiting her physician because of shortness of breath, increased swelling in her ankles and calves, and fatigue. Her medical history includes hypertension (30 years), coronary artery disease (18 years), heart failure (2 years), and type 2 diabetes (14 years). She takes 81 mg of aspirin every day, metoprolol 50 mg twice a day, furosemide 40 mg every day, and metformin 2,000 mg every day.

Ms. J.’s vital sign values on admission were as follows:

Blood Pressure: 162/96 mm Hg
Heart Rate: 88 beats/min
Oxygen Saturation: 91% on room air
Respiratory Rate: 28 breaths/minute
Temperature: 97.8 degrees F orally

Her weight is up 10 pounds since the last office visit three weeks prior. The patient states, “I am so short of breath” and “My ankles are so swollen I have to wear my house slippers.” Ms. J. also shares, “I am so tired and weak that I can’t get out of the house to shop for groceries,” and “Sometimes I’m afraid to get out of bed because I get so dizzy.” She confides, “I would like to learn more about my health so I can take better care of myself.”

The physical assessment findings of Ms. J. are bilateral basilar crackles in the lungs and bilateral 2+ pitting edema of the ankles and feet. Laboratory results indicate a decreased serum potassium level of 3.4 mEq/L.

As the nurse completes the physical assessment, the patient’s daughter enters the room. She confides, “We are so worried about mom living at home by herself when she is so tired all the time!”

Critical Thinking Questions

Identify subjective data.

Identify objective data.

Provide an example of secondary data.

Answers are located in the Answer Key at the end of the book.

4.4. DIAGNOSIS

Diagnosis is the second step of the nursing process (and the second Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse analyzes assessment data to determine actual or potential diagnoses, problems, and issues.” The RN “prioritizes diagnoses, problems, and issues based on mutually established goals to meet the needs of the health care consumer across the health–illness continuum and the care continuum.” Diagnoses, problems, strengths, and issues are documented in a manner that facilitates the development of expected outcomes and a collaborative plan. [ 1 ]

Analyzing Assessment Data

After collection of assessment data, the registered nurse analyzes the data to form generalizations and create hypotheses for nursing diagnoses. Steps for analyzing assessment data include performing data analysis, clustering of information, identifying hypotheses for potential nursing diagnosis, performing additional in-depth assessment as needed, and establishing nursing diagnosis statements. The nursing diagnoses are then prioritized and drive the nursing care plan. [ 2 ]

Performing Data Analysis

After nurses collect assessment data from a patient, they use their nursing knowledge to analyze that data to determine if it is “expected” or “unexpected” or “normal” or “abnormal” for that patient according to their age, development, and baseline status. From there, nurses determine what data are “clinically relevant” as they prioritize their nursing care. [ 3 ]

Example. In Scenario C in the “Assessment” section of this chapter, the nurse analyzes the vital signs data and determines the blood pressure, heart rate, and respiratory rate are elevated, and the oxygen saturation is decreased for this patient. These findings are considered “relevant cues.”

Clustering Information/Seeing Patterns/Making Hypotheses

After analyzing the data and determining relevant cues, the nurse clusters data into patterns. Assessment frameworks such as Gordon’s Functional Health Patterns assist nurses in clustering information according to evidence-based patterns of human responses. See the box below for an outline of Gordon’s Functional Health Patterns. [ 4 ] Concepts related to many of these patterns will be discussed in chapters later in this book.

Example. Refer to Scenario C of the “Assessment” section of this chapter. The nurse clusters the following relevant cues: elevated blood pressure, elevated respiratory rate, crackles in the lungs, weight gain, worsening edema, shortness of breath, a medical history of heart failure, and currently prescribed a diuretic medication. These cues are clustered into a generalization/pattern of fluid balance, which can be classified under Gordon’s Nutritional-Metabolic Functional Health Pattern. The nurse makes a hypothesis that the patient has excess fluid volume present.

Gordon’s Functional Health Patterns [ 5 ]

Health Perception-Health Management: A patient’s perception of their health and well-being and how it is managed

Nutritional-Metabolic: Food and fluid consumption relative to metabolic need

Elimination: Excretory function, including bowel, bladder, and skin

Activity-Exercise: Exercise and daily activities

Sleep-Rest: Sleep, rest, and daily activities

Cognitive-Perceptual: Perception and cognition

Self-perception and Self-concept: Self-concept and perception of self-worth, self-competency, body image, and mood state

Role-Relationship: Role engagements and relationships

Sexuality-Reproductive: Reproduction and satisfaction or dissatisfaction with sexuality

Coping-Stress Tolerance: Coping and effectiveness in terms of stress tolerance

Value-Belief: Values, beliefs (including spiritual beliefs), and goals that guide choices and decisions

Identifying Nursing Diagnoses

After the nurse has analyzed and clustered the data from the patient assessment, the next step is to begin to answer the question, “What are my patient’s human responses (i.e., nursing diagnoses)?” A nursing diagnosis is defined as, “A clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community.” [ 6 ] Nursing diagnoses are customized to each patient and drive the development of the nursing care plan. The nurse should refer to a care planning resource and review the definitions and defining characteristics of the hypothesized nursing diagnoses to determine if additional in-depth assessment is needed before selecting the most accurate nursing diagnosis.

Nursing diagnoses are developed by nurses, for use by nurses. For example, NANDA International (NANDA-I) is a global professional nursing organization that develops nursing terminology that names actual or potential human responses to health problems and life processes based on research findings. [ 7 ] Currently, there are over 220 NANDA-I nursing diagnoses developed by nurses around the world. This list is continuously updated, with new nursing diagnoses added and old nursing diagnoses retired that no longer have supporting evidence. A list of commonly used NANDA-I diagnoses are listed in Appendix A . For a full list of NANDA-I nursing diagnoses, refer to a current nursing care plan reference.

NANDA-I nursing diagnoses are grouped into 13 domains that assist the nurse in selecting diagnoses based on the patterns of clustered data. These domains are similar to Gordon’s Functional Health Patterns and include health promotion, nutrition, elimination and exchange, activity/rest, perception/cognition, self-perception, role relationship, sexuality, coping/stress tolerance, life principles, safety/protection, comfort, and growth/development.

Knowledge regarding specific NANDA-I nursing diagnoses is not assessed on the NCLEX. However, analyzing cues and creating hypotheses are part of the measurement model used to assess a candidate’s clinical judgment. Read more about the NCLEX and Next Generation NCLEX in the “ Scope of Practice ” chapter.

Nursing diagnoses vs. medical diagnoses.

You may be asking yourself, “How are nursing diagnoses different from medical diagnoses?” Medical diagnoses focus on diseases or other medical problems that have been identified by the physician, physician’s assistant, or advanced nurse practitioner. Nursing diagnoses focus on the human response to health conditions and life processes and are made independently by RNs. Patients with the same medical diagnosis will often respond differently to that diagnosis and thus have different nursing diagnoses. For example, two patients have the same medical diagnosis of heart failure. However, one patient may be interested in learning more information about the condition and the medications used to treat it, whereas another patient may be experiencing anxiety when thinking about the effects this medical diagnosis will have on their family. The nurse must consider these different responses when creating the nursing care plan. Nursing diagnoses consider the patient’s and family’s needs, attitudes, strengths, challenges, and resources as a customized nursing care plan is created to provide holistic and individualized care for each patient.

Example. A medical diagnosis identified for Ms. J. in Scenario C in the “Assessment” section is heart failure. This cannot be used as a nursing diagnosis, but it can be considered as an “associated condition” when creating hypotheses for nursing diagnoses. Associated conditions are medical diagnoses, injuries, procedures, medical devices, or pharmacological agents that are not independently modifiable by the nurse, but support accuracy in nursing diagnosis. The nursing diagnosis in Scenario C will be related to the patient’s response to heart failure.

Additional Definitions Used in NANDA-I Nursing Diagnoses

The following definitions of patient, age, and time are used in association with NANDA-I nursing diagnoses:

The NANDA-I definition of a “patient” includes:

Individual: a single human being distinct from others (i.e., a person).
Caregiver: a family member or helper who regularly looks after a child or a sick, elderly, or disabled person.
Family: two or more people having continuous or sustained relationships, perceiving reciprocal obligations, sensing common meaning, and sharing certain obligations toward others; related by blood and/or choice.
Group: a number of people with shared characteristics generally referred to as an ethnic group.
Community: a group of people living in the same locale under the same governance. Examples include neighborhoods and cities. [ 8 ]

The age of the person who is the subject of the diagnosis is defined by the following terms: [ 9 ]

Fetus: an unborn human more than eight weeks after conception, until birth.
Neonate: a person less than 28 days of age.
Infant: a person greater than 28 days and less than 1 year of age.
Child: a person aged 1 to 9 years
Adolescent: a person aged 10 to 19 years
Adult: a person older than 19 years of age unless national law defines a person as being an adult at an earlier age.
Older adult: a person greater than 65 years of age.

The duration of the diagnosis is defined by the following terms: [ 10 ]

Acute: lasting less than 3 months.
Chronic: lasting greater than 3 months.
Intermittent: stopping or starting again at intervals
Continuous: uninterrupted, going on without stop.

New Terms Used in 2018-2020 NANDA-I Diagnoses

The 2018-2020 edition of Nursing Diagnoses includes two new terms to assist in creating nursing diagnoses: at-risk populations and associated conditions. [ 11 ]

At-Risk Populations are groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as demographics, health/family history, stages of growth/development, or exposure to certain events/experiences.

Associated Conditions are medical diagnoses, injuries, procedures, medical devices, or pharmacological agents. These conditions are not independently modifiable by the nurse, but support accuracy in nursing diagnosis [ 12 ]

Types of Nursing Diagnoses

There are four types of NANDA-I nursing diagnoses: [ 13 ]

Problem-Focused
Health Promotion – Wellness

A problem-focused nursing diagnosis is a “clinical judgment concerning an undesirable human response to health condition/life processes that exist in an individual, family, group, or community.” [ 14 ] To make an accurate problem-focused diagnosis, related factors and defining characteristics must be present. Related factors (also called etiology) are causes that contribute to the diagnosis. Defining characteristics are cues, signs, and symptoms that cluster into patterns. [ 15 ]

A health promotion-wellness nursing diagnosis is “a clinical judgment concerning motivation and desire to increase well-being and to actualize human health potential.” These responses are expressed by the patient’s readiness to enhance specific health behaviors. [ 16 ] A health promotion-wellness diagnosis is used when the patient is willing to improve a lack of knowledge, coping, or other identified need.

A risk nursing diagnosis is “a clinical judgment concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes.” [ 17 ] A risk nursing diagnosis must be supported by risk factors that contribute to the increased vulnerability. A risk nursing diagnosis is different from the problem-focused diagnosis in that the problem has not yet actually occurred. Problem diagnoses should not be automatically viewed as more important than risk diagnoses because sometimes a risk diagnosis can have the highest priority for a patient. [ 18 ]

A syndrome diagnosis is a “clinical judgment concerning a specific cluster of nursing diagnoses that occur together, and are best addressed together and through similar interventions.” [ 19 ]

Establishing Nursing Diagnosis Statements

When using NANDA-I nursing diagnoses, NANDA-I recommends the structure of a nursing diagnosis should be a statement that includes the nursing diagnosis and related factors as exhibited by defining characteristics . The accuracy of the nursing diagnosis is validated when a nurse is able to clearly link the defining characteristics, related factors, and/or risk factors found during the patient’s assessment. [ 20 ]

To create a nursing diagnosis statement, the registered nurse completes the following steps. After analyzing the patient’s subjective and objective data and clustering the data into patterns, the nurse generates hypotheses for nursing diagnoses based on how the patterns meet defining characteristics of a nursing diagnosis. Defining characteristics is the terminology used for observable signs and symptoms related to a nursing diagnosis. [ 21 ] Defining characteristics are included in care planning resources for each nursing diagnosis, along with a definition of that diagnosis, so the nurse can select the most accurate diagnosis. For example, objective and subjective data such as weight, height, and dietary intake can be clustered together as defining characteristics for the nursing diagnosis of nutritional status.

When creating a nursing diagnosis statement, the nurse also identifies the cause of the problem for that specific patient. Related factors is the terminology used for the underlying causes (etiology) of a patient’s problem or situation. Related factors should not be a medical diagnosis, but instead should be attributed to the underlying pathophysiology that the nurse can treat. When possible, the nursing interventions planned for each nursing diagnosis should attempt to modify or remove these related factors that are the underlying cause of the nursing diagnosis. [ 22 ]

Creating nursing diagnosis statements has traditionally been referred to as “using PES format.” The PES mnemonic no longer applies to the current terminology used by NANDA-I, but the components of a nursing diagnosis statement remain the same. A nursing diagnosis statement should contain the problem, related factors, and defining characteristics. These terms fit under the former PES format in this manner:

Problem (P) – the patient p roblem (i.e., the nursing diagnosis)

Etiology (E) – related factors (i.e., the e tiology/cause) of the nursing diagnosis; phrased as “related to” or “R/T”

Signs and Symptoms (S) – defining characteristics manifested by the patient (i.e., the s igns and s ymptoms/subjective and objective data) that led to the identification of that nursing diagnosis for the patient; phrased with “as manifested by” or “as evidenced by.”

Examples of different types of nursing diagnoses are further explained below.

Problem-Focused Nursing Diagnosis

A problem-focused nursing diagnosis contains all three components of the PES format :

Problem (P) – statement of the patient response (nursing diagnosis)

Etiology (E) – related factors contributing to the nursing diagnosis

Signs and Symptoms (S) – defining characteristics manifested by that patient

SAMPLE PROBLEM-FOCUSED NURSING DIAGNOSIS STATEMENT

Refer to Scenario C of the “Assessment” section of this chapter. The cluster of data for Ms. J. (elevated blood pressure, elevated respiratory rate, crackles in the lungs, weight gain, worsening edema, and shortness of breath) are defining characteristics for the NANDA-I Nursing Diagnosis Excess Fluid Volume . The NANDA-I definition of Excess Fluid Volume is “surplus intake and/or retention of fluid.” The related factor (etiology) of the problem is that the patient has excessive fluid intake. [ 23 ]

The components of a problem-focused nursing diagnosis statement for Ms. J. would be:

Fluid Volume Excess

Related to excessive fluid intake

As manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, increased weight of 10 pounds, and the patient reports, “ My ankles are so swollen .”

A correctly written problem-focused nursing diagnosis statement for Ms. J. would look like this:

Fluid Volume Excess related to excessive fluid intake as manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, an increase weight of 10 pounds, and the patient reports, “My ankles are so swollen.”

Health-Promotion Nursing Diagnosis

A health-promotion nursing diagnosis statement contains the problem (P) and the defining characteristics (S). The defining characteristics component of a health-promotion nursing diagnosis statement should begin with the phrase “expresses desire to enhance”: [ 24 ]

Signs and Symptoms (S) – the patient’s expressed desire to enhance

SAMPLE HEALTH-PROMOTION NURSING DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. demonstrates a readiness to improve her health status when she told the nurse that she would like to “learn more about my health so I can take better care of myself.” This statement is a defining characteristic of the NANDA-I nursing diagnosis Readiness for Enhanced Health Management , which is defined as “a pattern of regulating and integrating into daily living a therapeutic regimen for the treatment of illness and its sequelae, which can be strengthened.” [ 25 ]

The components of a health-promotion nursing diagnosis for Ms. J. would be:

Problem (P): Readiness for Enhanced Health Management

Symptoms (S): Expressed desire to “learn more about my health so I can take better care of myself.”

A correctly written health-promotion nursing diagnosis statement for Ms. J. would look like this:

Enhanced Readiness for Health Promotion as manifested by expressed desire to “learn more about my health so I can take better care of myself.”

Risk Nursing Diagnosis

A risk nursing diagnosis should be supported by evidence of the patient’s risk factors for developing that problem. Different experts recommend different phrasing. NANDA-I 2018-2020 recommends using the phrase “as evidenced by” to refer to the risk factors for developing that problem. [ 26 ]

A risk diagnosis consists of the following:

As Evidenced By – Risk factors for developing the problem

SAMPLE RISK DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. has an increased risk of falling due to vulnerability from the dizziness and weakness she is experiencing. The NANDA-I definition of Risk for Falls is “increased susceptibility to falling, which may cause physical harm and compromise health.” [ 27 ]

The components of a risk diagnosis statement for Ms. J. would be:

Problem (P) – Risk for Falls

As Evidenced By – Dizziness and decreased lower extremity strength

A correctly written risk nursing diagnosis statement for Ms. J. would look like this:

Risk for Falls as evidenced by dizziness and decreased lower extremity strength.

Syndrome Diagnosis

A syndrome is a cluster of nursing diagnoses that occur together and are best addressed together and through similar interventions. To create a syndrome diagnosis, two or more nursing diagnoses must be used as defining characteristics (S) that create a syndrome. Related factors may be used if they add clarity to the definition, but are not required. [ 28 ]

A syndrome statement consists of these items:

Problem (P) – the syndrome

Signs and Symptoms (S) – the defining characteristics are two or more similar nursing diagnoses

SAMPLE SYNDROME DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Clustering the data for Ms. J. identifies several similar NANDA-I nursing diagnoses that can be categorized as a syndrome . For example, Activity Intolerance is defined as “insufficient physiological or psychological energy to endure or complete required or desired daily activities.” Social Isolation is defined as “aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state.” These diagnoses can be included under the the NANDA-I syndrome named Risk for Frail Elderly Syndrome. This syndrome is defined as a “dynamic state of unstable equilibrium that affects the older individual experiencing deterioration in one or more domains of health (physical, functional, psychological, or social) and leads to increased susceptibility to adverse health effects, in particular disability.” [ 29 ]

The components of a syndrome nursing diagnosis for Ms. J. would be:

– Risk for Frail Elderly Syndrome

– The nursing diagnoses of Activity Intolerance and Social Isolation

Additional related factor: Fear of falling

A correctly written syndrome diagnosis statement for Ms. J. would look like this:

Risk for Frail Elderly Syndrome related to activity intolerance, social isolation, and fear of falling

Prioritization

After identifying nursing diagnoses, the next step is prioritization according to the specific needs of the patient. Nurses prioritize their actions while providing patient care multiple times every day. Prioritization is the process that identifies the most significant nursing problems, as well as the most important interventions, in the nursing care plan.

It is essential that life-threatening concerns and crises are identified immediately and addressed quickly. Depending on the severity of a problem, the steps of the nursing process may be performed in a matter of seconds for life-threatening concerns. In critical situations, the steps of the nursing process are performed through rapid clinical judgment. Nurses must recognize cues signaling a change in patient condition, apply evidence-based practices in a crisis, and communicate effectively with interprofessional team members. Most patient situations fall somewhere between a crisis and routine care.

There are several concepts used to prioritize, including Maslow’s Hierarchy of Needs, the “ABCs” (Airway, Breathing and Circulation), and acute, uncompensated conditions. See the infographic in Figure 4.7 [30] on The How To of Prioritization .

The How To of Prioritization

Maslow’s Hierarchy of Needs is used to categorize the most urgent patient needs. The bottom levels of the pyramid represent the top priority needs of physiological needs intertwined with safety. See Figure 4.8 [31] for an image of Maslow’s Hierarchy of Needs. You may be asking yourself, “What about the ABCs – isn’t airway the most important?” The answer to that question is “it depends on the situation and the associated safety considerations.” Consider this scenario – you are driving home after a lovely picnic in the country and come across a fiery car crash. As you approach the car, you see that the passenger is not breathing. Using Maslow’s Hierarchy of Needs to prioritize your actions, you remove the passenger from the car first due to safety even though he is not breathing. After ensuring safety and calling for help, you follow the steps to perform cardiopulmonary resuscitation (CPR) to establish circulation, airway, and breathing until help arrives.

Maslow’s Hierarchy of Needs

In addition to using Maslow’s Hierarchy of Needs and the ABCs of airway, breathing, and circulation, the nurse also considers if the patient’s condition is an acute or chronic problem. Acute, uncompensated conditions generally require priority interventions over chronic conditions. Additionally, actual problems generally receive priority over potential problems, but risk problems sometimes receive priority depending on the patient vulnerability and risk factors.

Example. Refer to Scenario C in the “Assessment” section of this chapter. Four types of nursing diagnoses were identified for Ms. J.: Fluid Volume Excess, Enhanced Readiness for Health Promotion, Risk for Falls , and Risk for Frail Elderly Syndrome . The top priority diagnosis is Fluid Volume Excess because it affects the physiological needs of breathing, homeostasis, and excretion. However, the Risk for Falls diagnosis comes in a close second because of safety implications and potential injury that could occur if the patient fell.

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵

Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020 . Thieme Publishers New York. ↵

Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York. ↵

Gordon, M. (2008). Assess notes: Nursing assessment and diagnostic reasoning. F.A. Davis Company. ↵

NANDA International. (n.d.). Glossary of terms . https://nanda .org/nanda-i-resources /glossary-of-terms / ↵

NANDA International. (n.d.). Glossary of terms . https://nanda .org/nanda-i-resources /glossary-of-terms/ ↵

NANDA International. (n.d.). Glossary of terms. https://nanda .org/nanda-i-resources /glossary-of-terms/ ↵

“The How To of Prioritization” by Valerie Palarski for Chippewa Valley Technical College is licensed under CC BY 4.0 ↵

“ Maslow's hierarchy of needs.svg ” by J. Finkelstein is licensed under CC BY-SA 3.0 ↵

4.5. OUTCOME IDENTIFICATION

Outcome Identification is the third step of the nursing process (and the third Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” The RN collaborates with the health care consumer, interprofessional team, and others to identify expected outcomes integrating the health care consumer’s culture, values, and ethical considerations. Expected outcomes are documented as measurable goals with a time frame for attainment. [ 1 ]

An outcome is a “measurable behavior demonstrated by the patient responsive to nursing interventions.” [ 2 ] Outcomes should be identified before nursing interventions are planned. After nursing interventions are implemented, the nurse will evaluate if the outcomes were met in the time frame indicated for that patient.

Outcome identification includes setting short- and long-term goals and then creating specific expected outcome statements for each nursing diagnosis.

Short-Term and Long-Term Goals

Nursing care should always be individualized and patient-centered. No two people are the same, and neither should nursing care plans be the same for two people. Goals and outcomes should be tailored specifically to each patient’s needs, values, and cultural beliefs. Patients and family members should be included in the goal-setting process when feasible. Involving patients and family members promotes awareness of identified needs, ensures realistic goals, and motivates their participation in the treatment plan to achieve the mutually agreed upon goals and live life to the fullest with their current condition.

The nursing care plan is a road map used to guide patient care so that all health care providers are moving toward the same patient goals. Goals are broad statements of purpose that describe the overall aim of care. Goals can be short- or long-term. The time frame for short- and long-term goals is dependent on the setting in which the care is provided. For example, in a critical care area, a short-term goal might be set to be achieved within an 8-hour nursing shift, and a long-term goal might be in 24 hours. In contrast, in an outpatient setting, a short-term goal might be set to be achieved within one month and a long-term goal might be within six months.

A nursing goal is the overall direction in which the patient must progress to improve the problem/nursing diagnosis and is often the opposite of the problem.

Example. Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. had a priority nursing diagnosis of Fluid Volume Excess. A broad goal would be, “ Ms. J. will achieve a state of fluid balance. ”

Expected Outcomes

Goals are broad, general statements, but outcomes are specific and measurable. Expected outcomes are statements of measurable action for the patient within a specific time frame that are responsive to nursing interventions. Nurses may create expected outcomes independently or refer to classification systems for assistance. Just as NANDA-I creates and revises standardized nursing diagnoses, a similar classification and standardization process exists for expected nursing outcomes. The Nursing Outcomes Classification (NOC) is a list of over 330 nursing outcomes designed to coordinate with established NANDA-I diagnoses. [ 3 ]

Patient-Centered

Outcome statements are always patient-centered. They should be developed in collaboration with the patient and individualized to meet a patient’s unique needs, values, and cultural beliefs. They should start with the phrase “The patient will…” Outcome statements should be directed at resolving the defining characteristics for that nursing diagnosis. Additionally, the outcome must be something the patient is willing to cooperate in achieving.

Outcome statements should contain five components easily remembered using the “SMART” mnemonic: [ 4 ]

M easurable
A ttainable/Action oriented
R elevant/Realistic

See Figure 4.9 [ 5 ] for an image of the SMART components of outcome statements. Each of these components is further described in the following subsections.

SMART Components of Outcome Statements

Outcome statements should state precisely what is to be accomplished. See the following examples:

Not specific: “The patient will increase the amount of exercise.”
Specific: “The patient will participate in a bicycling exercise session daily for 30 minutes.”

Additionally, only one action should be included in each expected outcome. See the following examples:

“The patient will walk 50 feet three times a day with standby assistance of one and will shower in the morning until discharge” is actually two goals written as one. The outcome of ambulation should be separate from showering for precise evaluation. For instance, the patient could shower but not ambulate, which would make this outcome statement very difficult to effectively evaluate.
Suggested revision is to create two outcomes statements so each can be measured: The patient will walk 50 feet three times a day with standby assistance of one until discharge. The patient will shower every morning until discharge.

Measurable outcomes have numeric parameters or other concrete methods of judging whether the outcome was met. It is important to use objective data to measure outcomes. If terms like “acceptable” or “normal” are used in an outcome statement, it is difficult to determine whether the outcome is attained. Refer to Figure 4.10 [ 6 ] for examples of verbs that are measurable and not measurable in outcome statements.

Figure 4.10

Measurable Outcomes

See the following examples:

Not measurable: “The patient will drink adequate fluid amounts every shift.”
Measurable: “The patient will drink 24 ounces of fluids during every day shift (0600-1400).”

Action-Oriented and Attainable

Outcome statements should be written so that there is a clear action to be taken by the patient or significant others. This means that the outcome statement should include a verb. Refer to Figure 4.11 [ 7 ] for examples of action verbs.

Figure 4.11

Action Verbs

Not action-oriented: “The patient will get increased physical activity.”
Action-oriented: “The patient will list three types of aerobic activity that he would enjoy completing every week.”

Realistic and Relevant

Realistic outcomes consider the patient’s physical and mental condition; their cultural and spiritual values, beliefs, and preferences; and their socioeconomic status in terms of their ability to attain these outcomes. Consideration should be also given to disease processes and the effects of conditions such as pain and decreased mobility on the patient’s ability to reach expected outcomes. Other barriers to outcome attainment may be related to health literacy or lack of available resources. Outcomes should always be reevaluated and revised for attainability as needed. If an outcome is not attained, it is commonly because the original time frame was too ambitious or the outcome was not realistic for the patient.

Not realistic: “The patient will jog one mile every day when starting the exercise program.”
Realistic: “The patient will walk ½ mile three times a week for two weeks.”

Time Limited

Outcome statements should include a time frame for evaluation. The time frame depends on the intervention and the patient’s current condition. Some outcomes may need to be evaluated every shift, whereas other outcomes may be evaluated daily, weekly, or monthly. During the evaluation phase of the nursing process, the outcomes will be assessed according to the time frame specified for evaluation. If it has not been met, the nursing care plan should be revised.

Not time limited: “The patient will stop smoking cigarettes.”
Time limited: “The patient will complete the smoking cessation plan by December 12, 2021.”

In Scenario C in Box 4.3, Ms. J.’s priority nursing diagnosis statement was Fluid Volume Excess related to excess fluid intake as manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, an increase weight of 10 pounds, and the patient reports, “My ankles are so swollen.” An example of an expected outcome meeting SMART criteria for Ms. J. is, “The patient will have clear bilateral lung sounds within the next 24 hours.”

4.6. PLANNING

Planning is the fourth step of the nursing process (and the fourth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” The RN develops an individualized, holistic, evidence-based plan in partnership with the health care consumer, family, significant others, and interprofessional team. Elements of the plan are prioritized. The plan is modified according to the ongoing assessment of the health care consumer’s response and other indicators. The plan is documented using standardized language or terminology. [ 1 ]

After expected outcomes are identified, the nurse begins planning nursing interventions to implement. Nursing interventions are evidence-based actions that the nurse performs to achieve patient outcomes. Just as a provider makes medical diagnoses and writes prescriptions to improve the patient’s medical condition, a nurse formulates nursing diagnoses and plans nursing interventions to resolve patient problems. Nursing interventions should focus on eliminating or reducing the related factors (etiology) of the nursing diagnoses when possible. [ 2 ] Nursing interventions, goals, and expected outcomes are written in the nursing care plan for continuity of care across shifts, nurses, and health professionals.

Planning Nursing Interventions

You might be asking yourself, “How do I know what evidence-based nursing interventions to include in the nursing care plan?” There are several sources that nurses and nursing students can use to select nursing interventions. Many agencies have care planning tools and references included in the electronic health record that are easily documented in the patient chart. Nurses can also refer to other care planning books our sources such as the Nursing Interventions Classification (NIC) system. Based on research and input from the nursing profession, NIC categorizes and describes nursing interventions that are constantly evaluated and updated. Interventions included in NIC are considered evidence-based nursing practices. The nurse is responsible for using clinical judgment to make decisions about which interventions are best suited to meet an individualized patient’s needs. [ 3 ]

Direct and Indirect Care

Nursing interventions are considered direct care or indirect care. Direct care refers to interventions that are carried out by having personal contact with patients. Examples of direct care interventions are wound care, repositioning, and ambulation. Indirect care interventions are performed when the nurse provides assistance in a setting other than with the patient. Examples of indirect care interventions are attending care conferences, documenting, and communicating about patient care with other providers.

Classification of Nursing Interventions

There are three types of nursing interventions: independent, dependent, and collaborative. (See Figure 4.12 [ 4 ] for an image of a nurse collaborating with the health care team when planning interventions.)

Figure 4.12

Collaborative nursing interventions, independent nursing interventions.

Any intervention that the nurse can independently provide without obtaining a prescription is considered an independent nursing intervention . An example of an independent nursing intervention is when the nurses monitor the patient’s 24-hour intake/output record for trends because of a risk for imbalanced fluid volume. Another example of independent nursing interventions is the therapeutic communication that a nurse uses to assist patients to cope with a new medical diagnosis.

Example. Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with Fluid Volume Excess . An example of an evidence-based independent nursing intervention is, “The nurse will reposition the patient with dependent edema frequently, as appropriate.” [ 5 ] The nurse would individualize this evidence-based intervention to the patient and agency policy by stating, “The nurse will reposition the patient every 2 hours.”

Dependent Nursing Interventions

Dependent nursing interventions require a prescription before they can be performed. Prescriptions are orders, interventions, remedies, or treatments ordered or directed by an authorized primary health care provider. [ 6 ] A primary health care provider is a member of the health care team (usually a physician, advanced practice nurse, or physician’s assistant) who is licensed and authorized to formulate prescriptions on behalf of the client. For example, administering medication is a dependent nursing intervention. The nurse incorporates dependent interventions into the patient’s overall care plan by associating each intervention with the appropriate nursing diagnosis.

Example. Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with Fluid Volume Excess . An example of a dependent nursing intervention is, “The nurse will administer scheduled diuretics as prescribed.”

Collaborative nursing interventions are actions that the nurse carries out in collaboration with other health team members, such as physicians, social workers, respiratory therapists, physical therapists, and occupational therapists. These actions are developed in consultation with other health care professionals and incorporate their professional viewpoint. [ 7 ]

Example. Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with Fluid Volume Excess . An example of a collaborative nursing intervention is consulting with a respiratory therapist when the patient has deteriorating oxygen saturation levels. The respiratory therapist plans oxygen therapy and obtains a prescription from the provider. The nurse would document “ The nurse will manage oxygen therapy in collaboration with the respiratory therapist ” in the care plan.

Individualization of Interventions

It is vital for the planned interventions to be individualized to the patient to be successful. For example, adding prune juice to the breakfast meal of a patient with constipation will only work if the patient likes to drink the prune juice. If the patient does not like prune juice, then this intervention should not be included in the care plan. Collaboration with the patient, family members, significant others, and the interprofessional team is essential for selecting effective interventions. The number of interventions included in a nursing care plan is not a hard and fast rule, but enough quality, individualized interventions should be planned to meet the identified outcomes for that patient.

Creating Nursing Care Plans

Nursing care plans are created by registered nurses (RNs). Documentation of individualized nursing care plans are legally required in long-term care facilities by the Centers for Medicare and Medicaid Services (CMS) and in hospitals by The Joint Commission. CMS guidelines state, “Residents and their representative(s) must be afforded the opportunity to participate in their care planning process and to be included in decisions and changes in care, treatment, and/or interventions. This applies both to initial decisions about care and treatment, as well as the refusal of care or treatment. Facility staff must support and encourage participation in the care planning process. This may include ensuring that residents, families, or representatives understand the comprehensive care planning process, holding care planning meetings at the time of day when a resident is functioning best and patient representatives can be present, providing sufficient notice in advance of the meeting, scheduling these meetings to accommodate a resident’s representative (such as conducting the meeting in-person, via a conference call, or video conferencing), and planning enough time for information exchange and decision-making. A resident has the right to select or refuse specific treatment options before the care plan is instituted.” [ 8 ] The Joint Commission conceptualizes the care planning process as the structuring framework for coordinating communication that will result in safe and effective care. [ 9 ]

Many facilities have established standardized nursing care plans with lists of possible interventions that can be customized for each specific patient. Other facilities require the nurse to develop each care plan independently. Whatever the format, nursing care plans should be individualized to meet the specific and unique needs of each patient. See Figure 4.13 [ 10 ] for an image of a standardized care plan.

Figure 4.13

Standardized Care Plan

Nursing care plans created in nursing school can also be in various formats such as concept maps or tables. Some are fun and creative, while others are more formal. Appendix B contains a template that can be used for creating nursing care plans.

4.7. IMPLEMENTATION OF INTERVENTIONS

Implementation is the fifth step of the nursing process (and the fifth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse implements the identified plan.” The RN may delegate planned interventions after considering the circumstance, person, task, communication, supervision, and evaluation, as well as the state Nurse Practice Act, federal regulation, and agency policy. [ 1 ]

Implementation of interventions requires the RN to use critical thinking and clinical judgment. After the initial plan of care is developed, continual reassessment of the patient is necessary to detect any changes in the patient’s condition requiring modification of the plan. The need for continual patient reassessment underscores the dynamic nature of the nursing process and is crucial to providing safe care.

During the implementation phase of the nursing process, the nurse prioritizes planned interventions, assesses patient safety while implementing interventions, delegates interventions as appropriate, and documents interventions performed.

Prioritizing Implementation of Interventions

Prioritizing implementation of interventions follows a similar method as to prioritizing nursing diagnoses. Maslow’s Hierarchy of Needs and the ABCs of airway, breathing, and circulation are used to establish top priority interventions. When possible, least invasive actions are usually preferred due to the risk of injury from invasive options. Read more about methods for prioritization under the “ Diagnosis ” subsection of this chapter.

The potential impact on future events, especially if a task is not completed at a certain time, is also included when prioritizing nursing interventions. For example, if a patient is scheduled to undergo a surgical procedure later in the day, the nurse prioritizes initiating a NPO (nothing by mouth) prescription prior to completing pre-op patient education about the procedure. The rationale for this decision is that if the patient ate food or drank water, the surgery time would be delayed. Knowing and understanding the patient’s purpose for care, current situation, and expected outcomes are necessary to accurately prioritize interventions.

Patient Safety

It is essential to consider patient safety when implementing interventions. At times, patients may experience a change in condition that makes a planned nursing intervention or provider prescription no longer safe to implement. For example, an established nursing care plan for a patient states, “The nurse will ambulate the patient 100 feet three times daily.” However, during assessment this morning, the patient reports feeling dizzy today, and their blood pressure is 90/60. Using critical thinking and clinical judgment, the nurse decides to not implement the planned intervention of ambulating the patient. This decision and supporting assessment findings should be documented in the patient’s chart and also communicated during the shift handoff report, along with appropriate notification of the provider of the patient’s change in condition.

Implementing interventions goes far beyond implementing provider prescriptions and completing tasks identified on the nursing care plan and must focus on patient safety. As front-line providers, nurses are in the position to stop errors before they reach the patient. [ 2 ]

In 2000 the Institute of Medicine (IOM) issued a groundbreaking report titled To Err Is Human: Building a Safer Health System . The report stated that as many as 98,000 people die in U.S. hospitals each year as a result of preventable medical errors. To Err Is Human broke the silence that previously surrounded the consequences of medical errors and set a national agenda for reducing medical errors and improving patient safety through the design of a safer health system. [ 3 ] In 2007 the IOM published a follow-up report titled Preventing Medication Errors and reported that more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. This report emphasized actions that health care systems could take to improve medication safety. [ 4 ]

Read additional information about specific actions that nurses can take to prevent medication errors; go to the “Preventing Medication Errors” section of the “ Legal/Ethical” chapter of the Open RN Nursing Pharmacology textbook.

In an article released by the Robert Wood Johnson Foundation, errors involving nurses that endanger patient safety cover broad territory. This territory spans “wrong site, wrong patient, wrong procedure” errors, medication mistakes, failures to follow procedures that prevent central line bloodstream and other infections, errors that allow unsupervised patients to fall, and more. Some errors can be traced to shifts that are too long that leave nurses fatigued, some result from flawed systems that do not allow for adequate safety checks, and others are caused by interruptions to nurses while they are trying to administer medications or provide other care. [ 5 ]

The Quality and Safety Education for Nurses (QSEN) project began in 2005 to assist in preparing future nurses to continuously improve the quality and safety of the health care systems in which they work. The vision of the QSEN project is to “inspire health care professionals to put quality and safety as core values to guide their work.” [ 6 ] Nurses and nursing students are expected to participate in quality improvement (QI) initiatives by identifying gaps where change is needed and assisting in implementing initiatives to resolve these gaps. Quality improvement is defined as, “The combined and unceasing efforts of everyone – health care professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning).” [ 7 ]

Delegation of Interventions

While implementing interventions, RNs may elect to delegate nursing tasks. Delegation is defined by the American Nurses Association as, “The assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel or licensed practical nurses (LPNs) while retaining accountability for the outcome.” [ 8 ] RNs are accountable for determining the appropriateness of the delegated task according to condition of the patient and the circumstance; the communication provided to an appropriately trained LPN or UAP; the level of supervision provided; and the evaluation and documentation of the task completed. The RN must also be aware of the state Nurse Practice Act, federal regulations, and agency policy before delegating. The RN cannot delegate responsibilities requiring clinical judgment. [ 9 ] See the following box for information regarding legal requirements associated with delegation according to the Wisconsin Nurse Practice Act.

Delegation According to the Wisconsin Nurse Practice Act

During the supervision and direction of delegated acts a Registered Nurse shall do all of the following:

Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.

Provide direction and assistance to those supervised.

Observe and monitor the activities of those supervised.

Evaluate the effectiveness of acts performed under supervision. [ 10 ]

The standard of practice for Licensed Practical Nurses in Wisconsin states, “In the performance of acts in basic patient situations, the LPN. shall, under the general supervision of an RN or the direction of a provider:

Accept only patient care assignments which the LPN is competent to perform.

Provide basic nursing care. Basic nursing care is defined as care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.

Record nursing care given and report to the appropriate person changes in the condition of a patient.

Consult with a provider in cases where an LPN knows or should know a delegated act may harm a patient.

Perform the following other acts when applicable:

Assist with the collection of data.

Assist with the development and revision of a nursing care plan.

Reinforce the teaching provided by an RN provider and provide basic health care instruction.

Participate with other health team members in meeting basic patient needs.” [ 11 ]

Read additional details about the scope of practice of registered nurses (RNs) and licensed practical nurses (LPNs) in Wisconsin’s Nurse Practice Act in Chapter N 6 Standards of Practice .

Read more about the American Nurses Association’s Principles of Delegation.

Table 4.7 outlines general guidelines for delegating nursing tasks in the state of Wisconsin according to the role of the health care team member.

General Guidelines for Delegating Nursing Tasks

Documentation of Interventions

As interventions are performed, they must be documented in the patient’s record in a timely manner. As previously discussed in the “Ethical and Legal Issues” subsection of the “ Basic Concepts ” section, lack of documentation is considered a failure to communicate and a basis for legal action. A basic rule of thumb is if an intervention is not documented, it is considered not done in a court of law. It is also important to document administration of medication and other interventions in a timely manner to prevent errors that can occur due to delayed documentation time.

Coordination of Care and Health Teaching/Health Promotion

ANA’s Standard of Professional Practice for Implementation also includes the standards 5A Coordination of Care and 5B Health Teaching and Health Promotion . [ 12 ] Coordination of Care includes competencies such as organizing the components of the plan, engaging the patient in self-care to achieve goals, and advocating for the delivery of dignified and holistic care by the interprofessional team. Health Teaching and Health Promotion is defined as, “Employing strategies to teach and promote health and wellness.” [ 13 ] Patient education is an important component of nursing care and should be included during every patient encounter. For example, patient education may include teaching about side effects while administering medications or teaching patients how to self-manage their conditions at home.

Refer to Scenario C in the “Assessment” section of this chapter. The nurse implemented the nursing care plan documented in Appendix C. Interventions related to breathing were prioritized. Administration of the diuretic medication was completed first, and lung sounds were monitored frequently for the remainder of the shift. Weighing the patient before breakfast was delegated to the CNA. The patient was educated about her medications and methods to use to reduce peripheral edema at home. All interventions were documented in the electronic medical record (EMR).

4.8. EVALUATION

Evaluation is the sixth step of the nursing process (and the sixth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [ 1 ] Both the patient status and the effectiveness of the nursing care must be continuously evaluated and the care plan modified as needed. [ 2 ]

Evaluation focuses on the effectiveness of the nursing interventions by reviewing the expected outcomes to determine if they were met by the time frames indicated. During the evaluation phase, nurses use critical thinking to analyze reassessment data and determine if a patient’s expected outcomes have been met, partially met, or not met by the time frames established. If outcomes are not met or only partially met by the time frame indicated, the care plan should be revised. Reassessment should occur every time the nurse interacts with a patient, discusses the care plan with others on the interprofessional team, or reviews updated laboratory or diagnostic test results. Nursing care plans should be updated as higher priority goals emerge. The results of the evaluation must be documented in the patient’s medical record.

Ideally, when the planned interventions are implemented, the patient will respond positively and the expected outcomes are achieved. However, when interventions do not assist in progressing the patient toward the expected outcomes, the nursing care plan must be revised to more effectively address the needs of the patient. These questions can be used as a guide when revising the nursing care plan:

Did anything unanticipated occur?
Has the patient’s condition changed?
Were the expected outcomes and their time frames realistic?
Are the nursing diagnoses accurate for this patient at this time?
Are the planned interventions appropriately focused on supporting outcome attainment?
What barriers were experienced as interventions were implemented?
Does ongoing assessment data indicate the need to revise diagnoses, outcome criteria, planned interventions, or implementation strategies?
Are different interventions required?

Refer to Scenario C in the “Assessment” section of this chapter and Appendix C . The nurse evaluates the patient’s progress toward achieving the expected outcomes.

For the nursing diagnosis Fluid Volume Excess , the nurse evaluated the four expected outcomes to determine if they were met during the time frames indicated:

The patient will report decreased dyspnea within the next 8 hours.

The patient will have clear lung sounds within the next 24 hours.

The patient will have decreased edema within the next 24 hours.

The patient’s weight will return to baseline by discharge.

Evaluation of the patient condition on Day 1 included the following data: “ The patient reported decreased shortness of breath, and there were no longer crackles in the lower bases of the lungs. Weight decreased by 1 kg, but 2+ edema continued in ankles and calves .” Based on this data, the nurse evaluated the expected outcomes as “ Partially Met ” and revised the care plan with two new interventions:

Request prescription for TED hose from provider.

Elevate patient’s legs when sitting in chair.

For the second nursing diagnosis, Risk for Falls , the nurse evaluated the outcome criteria as “ Met ” based on the evaluation, “ The patient verbalizes understanding and is appropriately calling for assistance when getting out of bed. No falls have occurred. ”

The nurse will continue to reassess the patient’s progress according to the care plan during hospitalization and make revisions to the care plan as needed. Evaluation of the care plan is documented in the patient’s medical record.

4.9. SUMMARY OF THE NURSING PROCESS

You have now learned how to perform each step of the nursing process according to the ANA Standards of Professional Nursing Practice. Critical thinking, clinical reasoning, and clinical judgment are used when assessing the patient, creating a nursing care plan, and implementing interventions. Frequent reassessment, with revisions to the care plan as needed, is important to help the patient achieve expected outcomes. Throughout the entire nursing process, the patient always remains the cornerstone of nursing care. Providing individualized, patient-centered care and evaluating whether that care has been successful in achieving patient outcomes are essential for providing safe, professional nursing practice.

Video Review of Creating a Sample Care Plan [ 1 ]

4.10. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)

Instructions: Apply what you’ve learned in this chapter by creating a nursing care plan using the following scenario. Use the template in Appendix B as a guide.

The client, Mark S., is a 57-year-old male who was admitted to the hospital with “severe” abdominal pain that was unable to be managed in the Emergency Department. The physician has informed Mark that he will need to undergo some diagnostic tests. The tests are scheduled for the morning.

After receiving the news about his condition and the need for diagnostic tests, Mark begins to pace the floor. He continues to pace constantly. He keeps asking the nurse the same question (“How long will the tests take?”) about his tests over and over again. The patient also remarked, “I’m so uptight I will never be able to sleep tonight.” The nurse observes that the client avoids eye contact during their interactions and that he continually fidgets with the call light. His eyes keep darting around the room. He appears tense and has a strained expression on his face. He states, “My mouth is so dry.” The nurse observes his vital signs to be: T 98, P 104, R 30, BP 180/96. The nurse notes that his skin feels sweaty (diaphoretic) and cool to the touch.

Critical Thinking Activity:

Group (cluster) the subjective and objective data.

Create a problem-focused nursing diagnosis (hypothesis).

Develop a broad goal and then identify an expected outcome in “SMART” format.

Outline three interventions for the nursing diagnosis to meet the goal. Cite an evidence-based source.

Imagine that you implemented the interventions that you identified. Evaluate the degree to which the expected outcome was achieved: Met – Partially Met – Not Met.

IV GLOSSARY

The act or process of pleading for, supporting, or recommending a cause or course of action. [ 1 ]

Unconditionally acceptance of the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care. [ 2 ]

Groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as demographics, health/family history, stages of growth/development, or exposure to certain events/experiences. [ 3 ]

Medical diagnoses, injuries, procedures, medical devices, or pharmacological agents. These conditions are not independently modifiable by the nurse, but support accuracy in nursing diagnosis. [ 4 ]

Care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable. [ 5 ]

A relationship described as one in which the whole person is assessed while balancing the vulnerability and dignity of the patient and family. [ 6 ]

Individual, family, or group, which includes significant others and populations. [ 7 ]

A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions. [ 9 ]

Grouping data into similar domains or patterns.

Nursing interventions that require cooperation among health care professionals and unlicensed assistive personnel (UAP).

While implementing interventions during the nursing process, includes components such as organizing the components of the plan with input from the health care consumer, engaging the patient in self-care to achieve goals, and advocating for the delivery of dignified and person-centered care by the interprofessional team. [ 10 ]

Reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow. [ 11 ]

Subjective or objective data that gives the nurse a hint or indication of a potential problem, process, or disorder.

Observable cues/inferences that cluster as manifestations of a problem-focused, health-promotion diagnosis, or syndrome. This does not only imply those things that the nurse can see, but also things that are seen, heard (e.g., the patient/family tells us), touched, or smelled. [ 12 ]

The assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. [ 13 ]

Interventions that require a prescription from a physician, advanced practice nurse, or physician’s assistant.

Interventions that are carried out by having personal contact with a patient.

An electronic version of the patient’s medical record.

A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the health care consumer’s history and condition, as well as health care resources; and patient, family, group, community, and population preferences and values. [ 14 ]

Statements of measurable action for the patient within a specific time frame and in response to nursing interventions. “SMART” outcome statements are specific, measurable, action-oriented, realistic, and include a time frame.

An evidence-based assessment framework for identifying patient problems and risks during the assessment phase of the nursing process.

A judgment formed from a set of facts, cues, and observations.

Broad statements of purpose that describe the aim of nursing care.

Employing strategies to teach and promote health and wellness. [ 15 ]

Any intervention that the nurse can provide without obtaining a prescription or consulting anyone else.

Interventions performed by the nurse in a setting other than directly with the patient. An example of indirect care is creating a nursing care plan.

A type of reasoning that involves forming generalizations based on specific incidents.

Interpretations or conclusions based on cues, personal experiences, preferences, or generalizations.

Nurses who have had specific training and passed a licensing exam. The training is generally less than that of a Registered Nurse. The scope of practice of an LPN/LVN is determined by the facility and the state’s Nurse Practice Act.

A disease or illness diagnosed by a physician or advanced health care provider such as a nurse practitioner or physician’s assistant. Medical diagnoses are a result of clustering signs and symptoms to determine what is medically affecting an individual.

Specific documentation of the planning and delivery of nursing care that is required by The Joint Commission.

A systematic approach to patient-centered care with steps including assessment, diagnosis, outcome identification, planning, implementation, and evaluation; otherwise known by the mnemonic “ADOPIE.”

Data that the nurse can see, touch, smell, or hear or is reproducible such as vital signs. Laboratory and diagnostic results are also considered objective data.

A measurable behavior demonstrated by the patient that is responsive to nursing interventions. [ 17 ]

The format of a nursing diagnosis statement that includes:

Problem (P) – statement of the patient problem (i.e., the nursing diagnosis)

Etiology (E) – related factors (etiology) contributing to the cause of the nursing diagnosis

Signs and Symptoms (S) – defining characteristics manifested by the patient of that nursing diagnosis

Orders, interventions, remedies, or treatments ordered or directed by an authorized primary health care provider. [ 18 ]

Information collected from the patient.

Member of the health care team (usually a medical physician, nurse practitioner, etc.) licensed and authorized to formulate prescriptions on behalf of the client. [ 19 ]

The skillful process of deciding which actions to complete first, second, or third for optimal patient outcomes and to improve patient safety.

The “combined and unceasing efforts of everyone — health care professionals, patients and their families, researchers, payers, planners, and educators — to make the changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning).” [ 20 ]

Developing a relationship of mutual trust and understanding.

A nurse who has had a designated amount of education and training in nursing and is licensed by a state Board of Nursing.

The underlying cause (etiology) of a nursing diagnosis when creating a PES statement.

Patients have the right to determine what will be done with and to their own person.

Principles and procedures in the discovery of knowledge involving the recognition and formulation of a problem, the collection of data, and the formulation and testing of a hypothesis.

Information collected from sources other than the patient.

Data that the patient or family reports or data that the nurse makes as an inference, conclusion, or assumption, such as “The patient appears anxious.”

Any unlicensed personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. [ 21 ]

Obtaining Subjective Data in a Care Relationship

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 4 Nursing Process.
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NURSING PROCESS INTRODUCTION
BASIC CONCEPTS
OUTCOME IDENTIFICATION
IMPLEMENTATION OF INTERVENTIONS
SUMMARY OF THE NURSING PROCESS
LEARNING ACTIVITIES

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HOW TO WRITE A HYPOTHESIS: EXAMPLES, FORMAT, AND SAMPLES

by ella | Apr 13, 2024 | Uncategorized

How To Write A Hypothesis: Examples, Format, And Samples

by ella | Apr 11, 2024 | Uncategorized

Where is the hypothesis in a research paper

Next, we will walk you through the process of writing a hypothesis in a precise and accurate way and with some written hypothesis examples.

What is the purpose of writing a hypothesis

One possible hypothesis example research is as follows:

Keep in mind that you can hire a paper writer who, as part of your research paper hypothesis , will include the survey results and conduct statistical analysis.

Concerning hypotheses, variables

How to write a hypothesis statement

The first thing you need to do is think of a question before you start writing your hypothesis.

The second step is to compile preliminary research in support of your hypothesis

Formulate a credible working hypothesis

Be as explicit as possible, and avoid hazy judgements. Take, for instance:

Develop a more precise hypothesis based on your research

Check to see that the formulation of a hypothesis for a research proposal is accurate. You need to check to see if it possesses the following components:

Dependent and independent variables

A subject or phenomenon that will be examined.

The fifth step is to compose a null hypothesis

For instance, the following assertion is an example of a null hypothesis:

It is the foundation upon which one may give their own opinion. It makes it possible to construct a proof base using the findings of researchers’ studies.

What differentiates a null hypothesis from an alternative hypothesis?

Hypothesis examples research paper

Investigate the fascinating aspects.

Consider the most recent research and issues about the chosen subject. Bring attention to what you wanted to investigate; perhaps it will be a notion related to some of your earlier works.

Could you give me some specifics about it?

Pay attention to the task you’re doing.

It is usually simpler to carry on than to begin something brand fresh. On the other hand, it’s possible that you didn’t consider all the theses from the earlier research enough.

Bring clarity to the many factors.

Avoid unclear statements. Does that sound like a challenge? Help with your college paper is available to you.

Conclusions regarding the method of writing a scientific hypothesis

Define the query to which you are hoping to obtain a response.
Carry out some preliminary investigation.
Put your best effort into it.
The variables, the subject, the phenomena, and the desired result should all be refined.

In a nutshell

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Hypothesis testing: selection and use of statistical tests

20 Hypothesis testing selection and use of statistical tests Chapter Contents Introduction The logic of hypothesis testing Steps in hypothesis testing Illustrations of hypothesis testing The relationship between descriptive and inferential statistics Selection of the appropriate inferential test The χ 2 test χ 2 and contingency tables Statistical packages Summary Introduction Hypotheses are statements about the association between variables as pertaining to a specific person or population. For example, ‘penicillin is an effective treatment for pneumonia’ or ‘obesity is a risk factor for heart disease’. Hypotheses addressing the state of populations are tested using sample data. Inferences are conclusions based on data using samples and are therefore always open to the possibility of error. In this chapter we will examine the use of inferential statistics for establishing the probable truth of hypotheses, as tested through sample data. Inferential statistics are based on applied probability theory and entail the use of statistical tests. There are numerous statistical tests available that are used in a similar fashion to analyse clinical data. That is, all statistical tests involve setting up the relevant hypotheses, H 0 and H A , and then, on the basis of the appropriate inferential statistics, computing the probability of the sample statistics obtained occurring by chance alone. We are not going to attempt to examine all statistical tests in this introductory book. These are described in various statistics textbooks or in data analysis manuals. Rather, in this chapter we will examine the criteria used for selecting tests appropriate for the analysis of the data obtained in specific investigations. To illustrate the use of statistical tests we will examine the use of the chi-square test (χ 2 ). This is a statistical test commonly employed to analyse categorical data. Finally, we will briefly examine the uses of the Statistical Package for Social Sciences™ (SPSS) for data analysis in general. The aims of this chapter are to: 1. Discuss the criteria by which a statistical test is selected for analysing the data for a specific study. 2. Demonstrate the use of the χ 2 test for analysing nominal scale data. 3. Explain how statistical packages are used for quantitative data analysis. The logic of hypothesis testing Hypothesis testing is the process of deciding using statistics whether the findings of an investigation reflect chance or real effects at a given level of probability or certainty. If the results seem to not represent chance effects, then we say that the results are statistically significant. That is, when we say that our results are statistically significant we mean that the patterns or differences seen in the sample data are likely to be generalizable to the wider population from our study sample. The mathematical procedures for hypothesis testing are based on the application of probability theory and sampling, as discussed previously. Because of the probabilistic nature of the process, decision errors in hypothesis testing cannot be entirely eliminated. However, the procedures outlined in this chapter enable us to specify the probability level at which we can claim that the data obtained in an investigation support experimental hypotheses. This procedure is fundamental for determining the statistical significance of the data as well as being relevant to the logic of clinical decision making. Steps in hypothesis testing The following steps are conventionally followed in hypothesis testing: 1. State the alternative hypothesis (H A ), which is the based on the research hypothesis. The H A asserts that the results are ‘real’ or ‘significant’, i.e. that the independent variable influenced the dependent variable, or that there is a real difference among groups. The important point here is that H A is a statement concerning the population. A real or significant effect means that the results in the sample data can be generalized to the population. 2. State the null hypothesis (H 0 ), which is the logical opposite of the H A . The H 0 claims that any differences in the data were just due to chance: that the independent variable had no effect on the dependent variable, or that any difference among groups is due to random effects. In other words, if the H 0 is retained, differences or patterns seen in the sample data should not be generalized to the population. 3. Set the decision level, α (alpha). There are two mutually exclusive hypotheses (H A and H 0 ) competing to explain the results of an investigation. Hypothesis testing, or statistical decision making, involves establishing the probability of H 0 being true. If this probability is very small, we are in a position to reject the H 0 . You might ask ‘How small should the probability (α) be for rejecting H 0 ?’ By convention, we use the probability of α = 0.05. If the H 0 being true is less than 0.05, we can reject H 0 . We can choose an α of 0.05, but not more, That is, by convention among researchers, results are not characterized as significant if p > 0.05. 4. Calculate the probability of H 0 being true. That is, we assume that H 0 is true and calculate the probability of the outcome of the investigation being due to chance alone, i.e. due to random effects. We must use an appropriate sampling distribution for this calculation. 5. Make a decision concerning H 0 . The following decision rule is used. If the probability of H 0 being true is less than α, then we reject H 0 at the level of significance set by α. However, if the probability of H 0 is greater than α, then we must retain H 0 . In other words, if: a. p (H 0 is true) ≤ α, reject H 0 b. p (H 0 is true) > α, retain H 0 It follows that if we reject H 0 we are in a position to accept H A , its logical alternative. If p ≤ 0.05 then we reject H 0 , and decide that H A is probably true. Illustrations of hypothesis testing One of the simplest forms of gambling is betting on the fall of a coin. Let us play a little game. We, the authors, will toss a coin. If it comes out heads (H) you will give us ≤1; if it comes out tails (T) we will give you ≤1. To make things interesting, let us have 10 tosses. The results are: Oh dear, you seem to have lost. Never mind, we were just lucky, so send along your cheque for ≤10. Are you a little hesitant? Are you saying that we ‘fixed’ the game? There is a systematic procedure for demonstrating the probable truth of your allegations: 1. We can state two competing hypotheses concerning the outcome of the game: a. the authors fixed the game; that is, the outcome did not reflect the fair throwing of a coin. Let us call this statement the ‘alternative hypothesis’, H A . In effect, the H A claims that the sample of 10 heads came from a population other than P (probability of heads) = Q (probability of tails) = 0.5 b. the authors did not fix the game; that is, the outcome is due to the tossing of a fair coin. Let us call this statement the ‘null hypothesis’, or H 0 . H 0 suggests that the sample of 10 heads was a random sample from a population where P = Q = 0.5. 2. It can be shown that the probability of tossing 10 consecutive heads with a fair coin is actually p = 0.001, as discussed previously (see Ch. 19). That is, the probability of obtaining such a sample from a population where P = Q = 0.5 is extremely low. 3. Now we can decide between H 0 and H A . It was shown that the probability of H 0 being true was p = 0.001 (1 in a 1000). Therefore, in the balance of probabilities, we can reject it as being true and accept H A , which is the logical alternative. In other words, it is likely that the game was fixed and no ≤10 cheque needed to be posted. The probability of calculating the truth of H 0 depended on the number of tosses ( n = the sample size). For instance, the probability of obtaining heads every times with five coin tosses is shown in Table 19.4 . As the sample size ( n ) becomes larger, the probability for which it is possible to reject H 0 becomes smaller. With only a few tosses we really cannot be sure if the game is fixed or not: without sufficient information it becomes hard to reject H 0 at a reasonable level of probability. A question emerges: ‘What is a reasonable level of probability for rejecting H 0 ?’ As we shall see, there are conventions for specifying these probabilities. One way to proceed, however, is to set the appropriate probability for rejecting H 0 on the basis of the implications of erroneous decisions. Obviously, any decision made on a probabilistic basis might be in error. Two types of decision errors are identified in statistics as type I and type II errors . A type I error involves mistakenly rejecting H 0 , while a type II error involves mistakenly retaining the H 0 . Researchers can make mistakes about the truth or falsity of hypotheses using sample research data. Statistical method does not provide a guarantee against making a mistake, but it is the most rigorous way of making these decisions. In the above example, a type I error would involve deciding that the outcome was not due to chance when in fact it was. The practical outcome of this would be to falsely accuse the authors of fixing the game. A type II error would represent the decision that the outcome was due to chance, when in fact it was due to a ‘fix’. The practical outcome of this would be to send your hard-earned ≤10 to a couple of crooks. Clearly, in a situation like this, a type II error would be more odious than a type I error, and you would set a fairly high probability for rejecting H 0 . However, if you were gambling with a villain, who had a loaded revolver handy, you would tend to set a very low probability for rejecting H 0 . We will examine these ideas more formally in subsequent parts of this chapter. Let us look at another example. A rehabilitation therapist has devised an exercise program which is expected to reduce the time taken for people to leave hospital following orthopaedic surgery. Previous records show that the recovery time for patients had been µ = 30 days, with σ = 8 days. A sample of 64 patients were treated with the exercise program, and their mean recovery time was found to be = 24 days. Do these results show that patients who had the treatment recovered significantly faster than previous patients? We can apply the steps for hypothesis testing to make our decision. 1. State H A : ‘The exercise program reduces the time taken for patients to recover from orthopaedic surgery’. That is, the researcher claims that the independent variable (the treatment) has a ‘real’ or ‘generalizable’ effect on the dependent variable (time to recover). 2. State H 0 : ‘The exercise program does not reduce the time taken for patients to recover from orthopaedic surgery’. That is, the statement claims that the independent variable has no effect on the dependent variable. The statement implies that the treated sample with = 24, and n = 64 is in fact a random sample from the population µ = 30, σ = 8. Any difference between and µ can be attributed to sampling error. 3. The decision level, α, is set before the results are analysed. The probability of α depends on how certain the investigator wants to be that the results show real differences. If he set α = 0.01, then the probability of falsely rejecting a true H 0 is less than or equal to 0.01 (1/100). If he set α = 0.05, then the probability of falsely rejecting a true H 0 is less than or equal to 0.05 or (1/20). That is, the smaller the α, the more confident the researcher is that the results support the alternative hypothesis. We also call α the level of significance. The smaller the α, the more significant the findings for a study, if we can reject H 0 . In this case, say that the researcher sets α = 0.01. (Note: by convention, α should not be greater than 0.05.) 4. Calculate the probability of H 0 being true. As stated above, H 0 implies that the sample with = 24 is a random sample from the population with µ = 30, σ = 8. How probable is it that this statement is true? To calculate this probability, we must generate an appropriate sampling distribution. As we have seen in Chapter 17 , the sampling distribution of the mean will enable us to calculate the probability of obtaining a sample mean of = 24 or more extreme from a population with known parameters. As shown in Figure 20.1 , we can calculate the probability of drawing a sample mean of = 24 or less. Using the table of normal curves (Appendix A), as outlined previously, we find that the probability of randomly selecting a sample mean of = 24 (or less) is extremely small. In terms of our table, which only shows the exact probability of up to z = 4.00, we can see that the present probability is less than 0.00003. Therefore, the probability that H 0 is true is less than 0.00003. Figure 20.1 Sampling distribution of means. Sample size = 64, population mean = 30, standard deviation = 8. 5. Make a decision. We have set α = 0.01. The calculated probability was less than 0.0001. Clearly, the calculated probability is far less than α, indicating that the difference is unlikely to be due to chance. Therefore, the investigator can reject the statement that H 0 is true and accept H A , that patients in general treated with the exercise program recover earlier than the population of untreated patients. The relationship between descriptive and inferential statistics As we have seen in the previous chapters, statistics may be classified as descriptive or inferential. Descriptive statistics describe the characteristics of data and are concerned with issues such as ‘What is the average length of hospitalization of a group of patients?’ Inferential statistics are used to address issues such as whether the differences in average lengths of hospitalization of patients in two groups are significantly different statistically. Thus, descriptive statistics describe aspects of the data such as the frequencies of scores, and the average or the range of values for samples, whereas inferential statistics enables researchers to decide (infer) whether differences between groups or relationships between variables represent persistent and reproducible trends in the populations. In Section 5 we saw that the selection of appropriate descriptive statistics depends on the type of data being described. For example, in a variable such as incomes of patients, the best statistics to represent the typical income would be the mean and/or the median. If you had a millionaire in the group of patients, the mean statistic might give a distorted impression of the central tendency. In this situation the median statistic would be the most appropriate one to use. The mode is most commonly used when the data being described are categorical data. For example, if in a questionnaire respondents were asked to indicate their sex and 65% said they were male and 35% said they were female, then ‘male’ is the modal response. It is quite unusual to use the mode only with data that are not nominal. As a rule, the scale of measurement used to obtain the data and its distribution determine which descriptive statistics are selected. In the same way, the appropriate inferential statistics are determined by the characteristics of the data being analysed. For example, where the mean is the appropriate descriptive statistic, the inferential statistics will determine if the differences between the means are statistically significant. In the case of ordinal data, the appropriate inferential statistics will make it possible to decide if either the medians or the rank orders are significantly different. With nominal data, the appropriate inferential statistic will decide if proportions of cases falling into specific categories are significantly different. Thus, when the data have been adequately described, the appropriate inferential statistic will follow logically. However, when selecting an appropriate statistical test, the design of the investigation must also be taken into account.

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Research Hypothesis In Psychology: Types, & Examples

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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A research hypothesis, in its plural form “hypotheses,” is a specific, testable prediction about the anticipated results of a study, established at its outset. It is a key component of the scientific method .

Hypotheses connect theory to data and guide the research process towards expanding scientific understanding

Some key points about hypotheses:

A hypothesis expresses an expected pattern or relationship. It connects the variables under investigation.
It is stated in clear, precise terms before any data collection or analysis occurs. This makes the hypothesis testable.
A hypothesis must be falsifiable. It should be possible, even if unlikely in practice, to collect data that disconfirms rather than supports the hypothesis.
Hypotheses guide research. Scientists design studies to explicitly evaluate hypotheses about how nature works.
For a hypothesis to be valid, it must be testable against empirical evidence. The evidence can then confirm or disprove the testable predictions.
Hypotheses are informed by background knowledge and observation, but go beyond what is already known to propose an explanation of how or why something occurs.

Predictions typically arise from a thorough knowledge of the research literature, curiosity about real-world problems or implications, and integrating this to advance theory. They build on existing literature while providing new insight.

Types of Research Hypotheses

Alternative hypothesis.

The research hypothesis is often called the alternative or experimental hypothesis in experimental research.

It typically suggests a potential relationship between two key variables: the independent variable, which the researcher manipulates, and the dependent variable, which is measured based on those changes.

The alternative hypothesis states a relationship exists between the two variables being studied (one variable affects the other).

A hypothesis is a testable statement or prediction about the relationship between two or more variables. It is a key component of the scientific method. Some key points about hypotheses:

Important hypotheses lead to predictions that can be tested empirically. The evidence can then confirm or disprove the testable predictions.

In summary, a hypothesis is a precise, testable statement of what researchers expect to happen in a study and why. Hypotheses connect theory to data and guide the research process towards expanding scientific understanding.

An experimental hypothesis predicts what change(s) will occur in the dependent variable when the independent variable is manipulated.

It states that the results are not due to chance and are significant in supporting the theory being investigated.

The alternative hypothesis can be directional, indicating a specific direction of the effect, or non-directional, suggesting a difference without specifying its nature. It’s what researchers aim to support or demonstrate through their study.

Null Hypothesis

The null hypothesis states no relationship exists between the two variables being studied (one variable does not affect the other). There will be no changes in the dependent variable due to manipulating the independent variable.

It states results are due to chance and are not significant in supporting the idea being investigated.

The null hypothesis, positing no effect or relationship, is a foundational contrast to the research hypothesis in scientific inquiry. It establishes a baseline for statistical testing, promoting objectivity by initiating research from a neutral stance.

Many statistical methods are tailored to test the null hypothesis, determining the likelihood of observed results if no true effect exists.

This dual-hypothesis approach provides clarity, ensuring that research intentions are explicit, and fosters consistency across scientific studies, enhancing the standardization and interpretability of research outcomes.

Nondirectional Hypothesis

A non-directional hypothesis, also known as a two-tailed hypothesis, predicts that there is a difference or relationship between two variables but does not specify the direction of this relationship.

It merely indicates that a change or effect will occur without predicting which group will have higher or lower values.

For example, “There is a difference in performance between Group A and Group B” is a non-directional hypothesis.

Directional Hypothesis

A directional (one-tailed) hypothesis predicts the nature of the effect of the independent variable on the dependent variable. It predicts in which direction the change will take place. (i.e., greater, smaller, less, more)

It specifies whether one variable is greater, lesser, or different from another, rather than just indicating that there’s a difference without specifying its nature.

For example, “Exercise increases weight loss” is a directional hypothesis.

Falsifiability

The Falsification Principle, proposed by Karl Popper , is a way of demarcating science from non-science. It suggests that for a theory or hypothesis to be considered scientific, it must be testable and irrefutable.

Falsifiability emphasizes that scientific claims shouldn’t just be confirmable but should also have the potential to be proven wrong.

It means that there should exist some potential evidence or experiment that could prove the proposition false.

However many confirming instances exist for a theory, it only takes one counter observation to falsify it. For example, the hypothesis that “all swans are white,” can be falsified by observing a black swan.

For Popper, science should attempt to disprove a theory rather than attempt to continually provide evidence to support a research hypothesis.

Can a Hypothesis be Proven?

Hypotheses make probabilistic predictions. They state the expected outcome if a particular relationship exists. However, a study result supporting a hypothesis does not definitively prove it is true.

All studies have limitations. There may be unknown confounding factors or issues that limit the certainty of conclusions. Additional studies may yield different results.

In science, hypotheses can realistically only be supported with some degree of confidence, not proven. The process of science is to incrementally accumulate evidence for and against hypothesized relationships in an ongoing pursuit of better models and explanations that best fit the empirical data. But hypotheses remain open to revision and rejection if that is where the evidence leads.

Disproving a hypothesis is definitive. Solid disconfirmatory evidence will falsify a hypothesis and require altering or discarding it based on the evidence.
However, confirming evidence is always open to revision. Other explanations may account for the same results, and additional or contradictory evidence may emerge over time.

We can never 100% prove the alternative hypothesis. Instead, we see if we can disprove, or reject the null hypothesis.

If we reject the null hypothesis, this doesn’t mean that our alternative hypothesis is correct but does support the alternative/experimental hypothesis.

Upon analysis of the results, an alternative hypothesis can be rejected or supported, but it can never be proven to be correct. We must avoid any reference to results proving a theory as this implies 100% certainty, and there is always a chance that evidence may exist which could refute a theory.

How to Write a Hypothesis

Identify variables . The researcher manipulates the independent variable and the dependent variable is the measured outcome.
Operationalized the variables being investigated . Operationalization of a hypothesis refers to the process of making the variables physically measurable or testable, e.g. if you are about to study aggression, you might count the number of punches given by participants.
Decide on a direction for your prediction . If there is evidence in the literature to support a specific effect of the independent variable on the dependent variable, write a directional (one-tailed) hypothesis. If there are limited or ambiguous findings in the literature regarding the effect of the independent variable on the dependent variable, write a non-directional (two-tailed) hypothesis.
Make it Testable : Ensure your hypothesis can be tested through experimentation or observation. It should be possible to prove it false (principle of falsifiability).
Clear & concise language . A strong hypothesis is concise (typically one to two sentences long), and formulated using clear and straightforward language, ensuring it’s easily understood and testable.

Consider a hypothesis many teachers might subscribe to: students work better on Monday morning than on Friday afternoon (IV=Day, DV= Standard of work).

Now, if we decide to study this by giving the same group of students a lesson on a Monday morning and a Friday afternoon and then measuring their immediate recall of the material covered in each session, we would end up with the following:

The alternative hypothesis states that students will recall significantly more information on a Monday morning than on a Friday afternoon.
The null hypothesis states that there will be no significant difference in the amount recalled on a Monday morning compared to a Friday afternoon. Any difference will be due to chance or confounding factors.

More Examples

Memory : Participants exposed to classical music during study sessions will recall more items from a list than those who studied in silence.
Social Psychology : Individuals who frequently engage in social media use will report higher levels of perceived social isolation compared to those who use it infrequently.
Developmental Psychology : Children who engage in regular imaginative play have better problem-solving skills than those who don’t.
Clinical Psychology : Cognitive-behavioral therapy will be more effective in reducing symptoms of anxiety over a 6-month period compared to traditional talk therapy.
Cognitive Psychology : Individuals who multitask between various electronic devices will have shorter attention spans on focused tasks than those who single-task.
Health Psychology : Patients who practice mindfulness meditation will experience lower levels of chronic pain compared to those who don’t meditate.
Organizational Psychology : Employees in open-plan offices will report higher levels of stress than those in private offices.
Behavioral Psychology : Rats rewarded with food after pressing a lever will press it more frequently than rats who receive no reward.

Research Methodology

Qualitative Data Coding

What Is a Focus Group?

Cross-Cultural Research Methodology In Psychology

What Is Internal Validity In Research?

Research Methodology , Statistics

What Is Face Validity In Research? Importance & How To Measure

Criterion Validity: Definition & Examples

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10.1 - setting the hypotheses: examples.

A significance test examines whether the null hypothesis provides a plausible explanation of the data. The null hypothesis itself does not involve the data. It is a statement about a parameter (a numerical characteristic of the population). These population values might be proportions or means or differences between means or proportions or correlations or odds ratios or any other numerical summary of the population. The alternative hypothesis is typically the research hypothesis of interest. Here are some examples.

Example 10.2: Hypotheses with One Sample of One Categorical Variable Section

About 10% of the human population is left-handed. Suppose a researcher at Penn State speculates that students in the College of Arts and Architecture are more likely to be left-handed than people found in the general population. We only have one sample since we will be comparing a population proportion based on a sample value to a known population value.

Research Question : Are artists more likely to be left-handed than people found in the general population?
Response Variable : Classification of the student as either right-handed or left-handed

State Null and Alternative Hypotheses

Null Hypothesis : Students in the College of Arts and Architecture are no more likely to be left-handed than people in the general population (population percent of left-handed students in the College of Art and Architecture = 10% or p = .10).
Alternative Hypothesis : Students in the College of Arts and Architecture are more likely to be left-handed than people in the general population (population percent of left-handed students in the College of Arts and Architecture > 10% or p > .10). This is a one-sided alternative hypothesis.

Example 10.3: Hypotheses with One Sample of One Measurement Variable Section

A generic brand of the anti-histamine Diphenhydramine markets a capsule with a 50 milligram dose. The manufacturer is worried that the machine that fills the capsules has come out of calibration and is no longer creating capsules with the appropriate dosage.

Research Question : Does the data suggest that the population mean dosage of this brand is different than 50 mg?
Response Variable : dosage of the active ingredient found by a chemical assay.
Null Hypothesis : On the average, the dosage sold under this brand is 50 mg (population mean dosage = 50 mg).
Alternative Hypothesis : On the average, the dosage sold under this brand is not 50 mg (population mean dosage ≠ 50 mg). This is a two-sided alternative hypothesis.

Example 10.4: Hypotheses with Two Samples of One Categorical Variable Section

Many people are starting to prefer vegetarian meals on a regular basis. Specifically, a researcher believes that females are more likely than males to eat vegetarian meals on a regular basis.

Research Question : Does the data suggest that females are more likely than males to eat vegetarian meals on a regular basis?
Response Variable : Classification of whether or not a person eats vegetarian meals on a regular basis
Explanatory (Grouping) Variable: Sex
Null Hypothesis : There is no sex effect regarding those who eat vegetarian meals on a regular basis (population percent of females who eat vegetarian meals on a regular basis = population percent of males who eat vegetarian meals on a regular basis or p females = p males ).
Alternative Hypothesis : Females are more likely than males to eat vegetarian meals on a regular basis (population percent of females who eat vegetarian meals on a regular basis > population percent of males who eat vegetarian meals on a regular basis or p females > p males ). This is a one-sided alternative hypothesis.

Example 10.5: Hypotheses with Two Samples of One Measurement Variable Section

Obesity is a major health problem today. Research is starting to show that people may be able to lose more weight on a low carbohydrate diet than on a low fat diet.

Research Question : Does the data suggest that, on the average, people are able to lose more weight on a low carbohydrate diet than on a low fat diet?
Response Variable : Weight loss (pounds)
Explanatory (Grouping) Variable : Type of diet
Null Hypothesis : There is no difference in the mean amount of weight loss when comparing a low carbohydrate diet with a low fat diet (population mean weight loss on a low carbohydrate diet = population mean weight loss on a low fat diet).
Alternative Hypothesis : The mean weight loss should be greater for those on a low carbohydrate diet when compared with those on a low fat diet (population mean weight loss on a low carbohydrate diet > population mean weight loss on a low fat diet). This is a one-sided alternative hypothesis.

Example 10.6: Hypotheses about the relationship between Two Categorical Variables Section

Research Question : Do the odds of having a stroke increase if you inhale second hand smoke ? A case-control study of non-smoking stroke patients and controls of the same age and occupation are asked if someone in their household smokes.
Variables : There are two different categorical variables (Stroke patient vs control and whether the subject lives in the same household as a smoker). Living with a smoker (or not) is the natural explanatory variable and having a stroke (or not) is the natural response variable in this situation.
Null Hypothesis : There is no relationship between whether or not a person has a stroke and whether or not a person lives with a smoker (odds ratio between stroke and second-hand smoke situation is = 1).
Alternative Hypothesis : There is a relationship between whether or not a person has a stroke and whether or not a person lives with a smoker (odds ratio between stroke and second-hand smoke situation is > 1). This is a one-tailed alternative.

This research question might also be addressed like example 11.4 by making the hypotheses about comparing the proportion of stroke patients that live with smokers to the proportion of controls that live with smokers.

Example 10.7: Hypotheses about the relationship between Two Measurement Variables Section

Research Question : A financial analyst believes there might be a positive association between the change in a stock's price and the amount of the stock purchased by non-management employees the previous day (stock trading by management being under "insider-trading" regulatory restrictions).
Variables : Daily price change information (the response variable) and previous day stock purchases by non-management employees (explanatory variable). These are two different measurement variables.
Null Hypothesis : The correlation between the daily stock price change (\$) and the daily stock purchases by non-management employees (\$) = 0.
Alternative Hypothesis : The correlation between the daily stock price change (\$) and the daily stock purchases by non-management employees (\$) > 0. This is a one-sided alternative hypothesis.

Example 10.8: Hypotheses about comparing the relationship between Two Measurement Variables in Two Samples Section

Calculation of a person's approximate tip for their meal

Research Question : Is there a linear relationship between the amount of the bill (\$) at a restaurant and the tip (\$) that was left. Is the strength of this association different for family restaurants than for fine dining restaurants?
Variables : There are two different measurement variables. The size of the tip would depend on the size of the bill so the amount of the bill would be the explanatory variable and the size of the tip would be the response variable.
Null Hypothesis : The correlation between the amount of the bill (\$) at a restaurant and the tip (\$) that was left is the same at family restaurants as it is at fine dining restaurants.
Alternative Hypothesis : The correlation between the amount of the bill (\$) at a restaurant and the tip (\$) that was left is the difference at family restaurants then it is at fine dining restaurants. This is a two-sided alternative hypothesis.

Statistics Made Easy

4 Examples of Hypothesis Testing in Real Life

In statistics, hypothesis tests are used to test whether or not some hypothesis about a population parameter is true.

To perform a hypothesis test in the real world, researchers will obtain a random sample from the population and perform a hypothesis test on the sample data, using a null and alternative hypothesis:

Null Hypothesis (H 0 ): The sample data occurs purely from chance.
Alternative Hypothesis (H A ): The sample data is influenced by some non-random cause.

If the p-value of the hypothesis test is less than some significance level (e.g. α = .05), then we can reject the null hypothesis and conclude that we have sufficient evidence to say that the alternative hypothesis is true.

The following examples provide several situations where hypothesis tests are used in the real world.

Example 1: Biology

Hypothesis tests are often used in biology to determine whether some new treatment, fertilizer, pesticide, chemical, etc. causes increased growth, stamina, immunity, etc. in plants or animals.

For example, suppose a biologist believes that a certain fertilizer will cause plants to grow more during a one-month period than they normally do, which is currently 20 inches. To test this, she applies the fertilizer to each of the plants in her laboratory for one month.

She then performs a hypothesis test using the following hypotheses:

H 0 : μ = 20 inches (the fertilizer will have no effect on the mean plant growth)
H A : μ > 20 inches (the fertilizer will cause mean plant growth to increase)

If the p-value of the test is less than some significance level (e.g. α = .05), then she can reject the null hypothesis and conclude that the fertilizer leads to increased plant growth.

Example 2: Clinical Trials

Hypothesis tests are often used in clinical trials to determine whether some new treatment, drug, procedure, etc. causes improved outcomes in patients.

For example, suppose a doctor believes that a new drug is able to reduce blood pressure in obese patients. To test this, he may measure the blood pressure of 40 patients before and after using the new drug for one month.

He then performs a hypothesis test using the following hypotheses:

H 0 : μ after = μ before (the mean blood pressure is the same before and after using the drug)
H A : μ after < μ before (the mean blood pressure is less after using the drug)

If the p-value of the test is less than some significance level (e.g. α = .05), then he can reject the null hypothesis and conclude that the new drug leads to reduced blood pressure.

Example 3: Advertising Spend

Hypothesis tests are often used in business to determine whether or not some new advertising campaign, marketing technique, etc. causes increased sales.

For example, suppose a company believes that spending more money on digital advertising leads to increased sales. To test this, the company may increase money spent on digital advertising during a two-month period and collect data to see if overall sales have increased.

They may perform a hypothesis test using the following hypotheses:

H 0 : μ after = μ before (the mean sales is the same before and after spending more on advertising)
H A : μ after > μ before (the mean sales increased after spending more on advertising)

If the p-value of the test is less than some significance level (e.g. α = .05), then the company can reject the null hypothesis and conclude that increased digital advertising leads to increased sales.

Example 4: Manufacturing

Hypothesis tests are also used often in manufacturing plants to determine if some new process, technique, method, etc. causes a change in the number of defective products produced.

For example, suppose a certain manufacturing plant wants to test whether or not some new method changes the number of defective widgets produced per month, which is currently 250. To test this, they may measure the mean number of defective widgets produced before and after using the new method for one month.

They can then perform a hypothesis test using the following hypotheses:

H 0 : μ after = μ before (the mean number of defective widgets is the same before and after using the new method)
H A : μ after ≠ μ before (the mean number of defective widgets produced is different before and after using the new method)

If the p-value of the test is less than some significance level (e.g. α = .05), then the plant can reject the null hypothesis and conclude that the new method leads to a change in the number of defective widgets produced per month.

Additional Resources

Introduction to Hypothesis Testing Introduction to the One Sample t-test Introduction to the Two Sample t-test Introduction to the Paired Samples t-test

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Nurse-to-Patient Ratio: Hypothesis Test Study

A hypothesis test study allows determining if a hypothesis is true based on research findings. For example, concluding whether an increased nurse-to-patient ratio results in improved patient health outcomes would help make decisions about the desired staffing levels (Giuliano, Danesh, & Funk, 2016). The present paper will describe a study to test the proposed hypothesis.

Prior to beginning the study, it is essential to identify the research and null hypotheses. The research hypothesis is that an increased nurse-to-patient ratio results in a decreased rate of readmissions. The null hypothesis is that there is no correlation between the nurse-to-patient ratio and readmissions rate. The independent variable in the proposed study is the nurse-to-patient ratio, whereas the dependent variable is the rate of readmissions at 30 days after discharge.

To test the hypothesis, it would be necessary to study readmission rates at two separate acute care hospitals with different nurse staffing levels. The data should be recorded for at least three months to make viable conclusions. It is expected that the difference in 30-day readmission rates would be comparable to those in nurse-to-patient ratios. For instance, if Hospital 1 has a 20% higher nurse-to-patient ratio than Hospital 2, it can be guessed that the readmissions rate in Hospital 1 will be 15-20% lower than in Hospital 2.

The outcomes of this hypothesis test study could help in administrative decision-making and patient advocacy. If the null hypothesis were rejected, it would mean that a higher nurse-to-patient ratio contributes to patient health and improves patient safety. Nurses would be able to use these results to show hospital leaders that it is critical to increasing the number of nurses employed to enhance patient outcomes.

Giuliano, K. K., Danesh, V., & Funk, M. (2016). The relationship between nurse staffing and 30-day readmission for adults with heart failure. The Journal of Nursing Administration, 46(1), 25-29.

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Home » Northern Arizona University » How Do You Write A Nursing Hypothesis?

How Do You Write A Nursing Hypothesis?

Table of Contents

How do you write a hypothesis example?

Usually, you’ll want to form your hypothesis as a statement, not a question. For example: If I raise the temperature of a cup of water, then the amount of sugar that can be dissolved in it will be increased.

What is a hypothesis in nursing research?

A hypothesis is a statement of the researcher’s expectation or prediction about relationship among study variables . The research process begins and ends with the hypothesis. It is core to the entire procedure and, therefore, is of the utmost importance.

What is hypothesis example?

Examples of Hypotheses “ Students who eat breakfast will perform better on a math exam than students who do not eat breakfast .” “Students who experience test anxiety prior to an English exam will get higher scores than students who do not experience test anxiety.”

How do you formulate a hypotheses?

How to Formulate an Effective Research Hypothesis

State the problem that you are trying to solve. Make sure that the hypothesis clearly defines the topic and the focus of the experiment.
Try to write the hypothesis as an if-then statement.
Define the variables.

What are the 3 required parts of a hypothesis?

A hypothesis is a prediction you create prior to running an experiment. The common format is: If [CAUSE], then [EFFECT], because [RATIONALE]. In the world of experience optimization, strong hypotheses consist of three distinct parts: a definition of the problem, a proposed solution, and a result .

Which statement is the best example of a hypothesis?

The best example of a hypothesis is If a plant receives water, then it will grow faster . Explanation: In the scientific method of research, a hypothesis can be described as a tentative statement that can be proved right or wrong. A hypothesis can be tested through experiments and the results can be deduced from it.

What is an example of hypothesis testing in nursing?

What is a hypothesis in healthcare?

[hi-poth´ĕ-sis] a supposition that appears to explain a group of phenomena and is advanced as a bases for further investigation . alternative hypothesis the hypothesis that is formulated as an opposite to the null hypothesis in a statistical test.

What is a simple hypothesis?

Simple hypotheses are ones which give probabilities to potential observations . The contrast here is with complex hypotheses, also known as models, which are sets of simple hypotheses such that knowing that some member of the set is true (but not which) is insufficient to specify probabilities of data points.

What are 5 characteristics of a good hypothesis?

A good hypothesis possesses the following certain attributes.

Power of Prediction. One of the valuable attribute of a good hypothesis is to predict for future.
Closest to observable things.
Simplicity.
Testability.
Relevant to Problem.
Relevant to available Techniques.

What is an example of a hypothesis question?

For example, let’s say you have a bad breakout the morning after eating a lot of greasy food. You may wonder if there is a correlation between eating greasy food and getting pimples. You propose the hypothesis: Eating greasy food causes pimples.

What makes a good hypothesis?

Criteria for good hypotheses be as brief and clear as possible; state an expected relationship or difference between two or more variables; be testable; and. be grounded in past knowledge, gained from the literature review or from theory.

How do you state a hypothesis introduction?

The first few paragraphs of a journal article serve to introduce the topic, to provide the author’s hypothesis or thesis, and to indicate why the research was done . A thesis or hypothesis is not always clearly labled; you may need to read through the introductory paragraphs to determine what the authors are proposing.

Is a hypothesis always a question?

What is a hypothesis? A hypothesis is a statement that can be proved or disproved. A research question can be made into a hypothesis by changing it into a statement .

Do hypothesis have to be if then?

The hypothesis is often written using the words “IF” and “THEN.” For example, “If I do not study, then I will fail the test.” The “if’ and “then” statements reflect your independent and dependent variables. The hypothesis should relate back to your original question and must be testable.

Which of the following is the best example of a strong hypothesis?

Answer and Explanation: Answer: c. Plants that get less light will grow less . A strong hypothesis defines the variable that can be measured and the relationship between…

How do you write a hypothesis for a research proposal?

Variables in hypotheses. Hypotheses propose a relationship between two or more variables.
Ask a question. Writing a hypothesis begins with a research question that you want to answer.
Do some preliminary research.
Formulate your hypothesis.
Refine your hypothesis.
Phrase your hypothesis in three ways.
Write a null hypothesis.

Which of the following is the best example of a scientific question?

A good scientific question is: “ What effect does the pH of water have on radish seed germination? ” Good scientific questions are defined, measurable, and controllable.

What are the 7 steps in hypothesis testing?

1.2 – The 7 Step Process of Statistical Hypothesis Testing

Step 1: State the Null Hypothesis.
Step 2: State the Alternative Hypothesis.
Step 3: Set.
Step 4: Collect Data.
Step 5: Calculate a test statistic.
Step 6: Construct Acceptance / Rejection regions.
Step 7: Based on steps 5 and 6, draw a conclusion about.

Why is hypothesis important in nursing?

Implications for practice: Hypothesis testing strengthens the quality of the quantitative studies, increases the generality of findings and provides dependable knowledge . This is particularly true for quantitative studies that aim to explore, explain and predict/control phenomena and/or test theories.

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Null Hypothesis Examples

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In statistical analysis, the null hypothesis assumes there is no meaningful relationship between two variables. Testing the null hypothesis can tell you whether your results are due to the effect of manipulating a dependent variable or due to chance. It's often used in conjunction with an alternative hypothesis, which assumes there is, in fact, a relationship between two variables.

The null hypothesis is among the easiest hypothesis to test using statistical analysis, making it perhaps the most valuable hypothesis for the scientific method. By evaluating a null hypothesis in addition to another hypothesis, researchers can support their conclusions with a higher level of confidence. Below are examples of how you might formulate a null hypothesis to fit certain questions.

What Is the Null Hypothesis?

The null hypothesis states there is no relationship between the measured phenomenon (the dependent variable ) and the independent variable , which is the variable an experimenter typically controls or changes. You do not need to believe that the null hypothesis is true to test it. On the contrary, you will likely suspect there is a relationship between a set of variables. One way to prove that this is the case is to reject the null hypothesis. Rejecting a hypothesis does not mean an experiment was "bad" or that it didn't produce results. In fact, it is often one of the first steps toward further inquiry.

To distinguish it from other hypotheses , the null hypothesis is written as H 0 (which is read as “H-nought,” "H-null," or "H-zero"). A significance test is used to determine the likelihood that the results supporting the null hypothesis are not due to chance. A confidence level of 95% or 99% is common. Keep in mind, even if the confidence level is high, there is still a small chance the null hypothesis is not true, perhaps because the experimenter did not account for a critical factor or because of chance. This is one reason why it's important to repeat experiments.

Examples of the Null Hypothesis

To write a null hypothesis, first start by asking a question. Rephrase that question in a form that assumes no relationship between the variables. In other words, assume a treatment has no effect. Write your hypothesis in a way that reflects this.

Other Types of Hypotheses

In addition to the null hypothesis, the alternative hypothesis is also a staple in traditional significance tests . It's essentially the opposite of the null hypothesis because it assumes the claim in question is true. For the first item in the table above, for example, an alternative hypothesis might be "Age does have an effect on mathematical ability."

Key Takeaways

In hypothesis testing, the null hypothesis assumes no relationship between two variables, providing a baseline for statistical analysis.
Rejecting the null hypothesis suggests there is evidence of a relationship between variables.
By formulating a null hypothesis, researchers can systematically test assumptions and draw more reliable conclusions from their experiments.
Difference Between Independent and Dependent Variables
Examples of Independent and Dependent Variables
What Is a Hypothesis? (Science)
Definition of a Hypothesis
What 'Fail to Reject' Means in a Hypothesis Test
Null Hypothesis Definition and Examples
Scientific Method Vocabulary Terms
Null Hypothesis and Alternative Hypothesis
Hypothesis Test for the Difference of Two Population Proportions
How to Conduct a Hypothesis Test
What Is a P-Value?
What Are the Elements of a Good Hypothesis?
What Is the Difference Between Alpha and P-Values?
Hypothesis Test Example
Understanding Path Analysis
An Example of a Hypothesis Test

COMMENTS

Developing a research problem and hypothesis: Nursing
So, Nurse Jory's research purpose is "The purpose of this research study is to explore barriers to appointment attendance.". After the research problem and purpose statement comes the research hypothesis, by identifying the research variables. Research variables are the concepts that are measured, manipulated, or controlled in a study.
4.2 Basic Concepts
Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes "reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.". [1] Using critical thinking means that nurses take extra steps to maintain ...
Hypothesis Testing, P Values, Confidence Intervals, and Significance
An example of a hypothesis is below. Research Hypothesis: Drug 23 will significantly reduce symptoms associated with Disease A compared to Drug 22. ... Nursing, Allied Health, and Interprofessional Team Interventions. All physicians, nurses, pharmacists, and other healthcare professionals should strive to understand the concepts in this chapter ...
The First Step: Ask; Fundamentals of Evidence-Based Nursing Practice
Directional hypothesis: Specifies not only the existence but also the expected direction of the relationship between the dependent (outcome) and the independent (intervention) variables. You will also see this called "One-tailed hypothesis". Example: Depression scores will decrease following a 6-week intervention.
How to Write a Strong Hypothesis
Developing a hypothesis (with example) Step 1. Ask a question. Writing a hypothesis begins with a research question that you want to answer. The question should be focused, specific, and researchable within the constraints of your project. Example: Research question.
A Practical Guide to Writing Quantitative and Qualitative Research
INTRODUCTION. Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses.1,2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results.3,4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the ...
Research Problems, Purposes, and Hypotheses
Associative hypothesis, p. 149. Background for a problem, p. 131. Causal hypothesis, p. 149. ... . . . . Nursing historical research lends insight into the complex health issues that nurses face today and may guide policy and nursing practice [problem statement ... For example, Thompson and Keeling (2012) examined the role of the public health ...
HOW TO WRITE A HYPOTHESIS: EXAMPLES, FORMAT, AND SAMPLES
Formulate a credible working hypothesis. You may learn how to write a formal hypothesis by analyzing the outcomes of your initial preparation and the research questions you posed. In the beginning, emphasize the primary issue with the tests. You have to condense it down to its most essential elements.
PDF Nursing Research Series Essentials of Science: Methods, Appraisal and
©Kaiser Permanente Northern and Southern California Nursing Research Research Aims, Purpose, and Hypotheses 19 [email protected] ©2010 Kaiser Permanente Southern & Northern California Nursing Research Hypothesis •A hypothesis is a formal statement of the expected relationship between two or more variables in a specified population.
Chapter 4 Nursing Process
A hypothesis is a proposed explanation for a situation. It attempts to explain the "why" behind the problem that is occurring. If a "why" is identified, then a solution can begin to be explored. ... Another example of independent nursing interventions is the therapeutic communication that a nurse uses to assist patients to cope with a ...
What is a Research Hypothesis: How to Write it, Types, and Examples
Here are some good research hypothesis examples: "The use of a specific type of therapy will lead to a reduction in symptoms of depression in individuals with a history of major depressive disorder.". "Providing educational interventions on healthy eating habits will result in weight loss in overweight individuals.".
Research Hypothesis: Definition, Types, Examples and Quick Tips
3. Simple hypothesis. A simple hypothesis is a statement made to reflect the relation between exactly two variables. One independent and one dependent. Consider the example, "Smoking is a prominent cause of lung cancer." The dependent variable, lung cancer, is dependent on the independent variable, smoking. 4.
HOW TO WRITE A HYPOTHESIS: EXAMPLES, FORMAT, AND SAMPLES
Next, we will walk you through the process of writing a hypothesis in a precise and accurate way and with some written hypothesis examples. What is the purpose of writing a hypothesis. A statement or assumption that provides an answer to a question you posed before but have not evaluated is an example of a research hypothesis. This will serve ...
Hypothesis testing: selection and use of statistical tests
1. State the alternative hypothesis (H A), which is the based on the research hypothesis.The H A asserts that the results are 'real' or 'significant', i.e. that the independent variable influenced the dependent variable, or that there is a real difference among groups. The important point here is that H A is a statement concerning the population.
Formulating hypothesis in nursing research
Formulating Hypothesis in Nursing Research. Health & Medicine. 1 of 16. Download now. Download to read offline. Formulating hypothesis Maria. Hypothesis is. Hypothesis Translates a. Example Does history.
Teaching nursing students how to prioritize hypotheses using
Oct 16, 2023, 15:55 PM. <4-minute read> Teaching nursing students to prioritize hypotheses is an essential step for nurse educators as they develop clinical judgment skills in new nurses. Learn how interactive resources can help. Developing strong clinical judgment skills in nursing students is a primary focus for all nurse educators because it ...
Research Hypothesis In Psychology: Types, & Examples
Examples. A research hypothesis, in its plural form "hypotheses," is a specific, testable prediction about the anticipated results of a study, established at its outset. It is a key component of the scientific method. Hypotheses connect theory to data and guide the research process towards expanding scientific understanding.
PDF Hypothesis Testing
Example 3: Public Opinion About President Step 1. Determine the null and alternative hypotheses. Null hypothesis: There is no clear winning opinion on this issue; the proportions who would answer yes or no are each 0.50. Alternative hypothesis: Fewer than 0.50, or 50%, of the population would answer yes to this question.
10.1
10.1 - Setting the Hypotheses: Examples. A significance test examines whether the null hypothesis provides a plausible explanation of the data. The null hypothesis itself does not involve the data. It is a statement about a parameter (a numerical characteristic of the population). These population values might be proportions or means or ...
4 Examples of Hypothesis Testing in Real Life
Example 1: Biology. Hypothesis tests are often used in biology to determine whether some new treatment, fertilizer, pesticide, chemical, etc. causes increased growth, stamina, immunity, etc. in plants or animals. For example, suppose a biologist believes that a certain fertilizer will cause plants to grow more during a one-month period than ...
Nurse-to-Patient Ratio: Hypothesis Test Study
Words: 279 Pages: 1. A hypothesis test study allows determining if a hypothesis is true based on research findings. For example, concluding whether an increased nurse-to-patient ratio results in improved patient health outcomes would help make decisions about the desired staffing levels (Giuliano, Danesh, & Funk, 2016).
How Do You Write A Nursing Hypothesis?
The hypothesis is often written using the words "IF" and "THEN.". For example, "If I do not study, then I will fail the test.". The "if' and "then" statements reflect your independent and dependent variables. The hypothesis should relate back to your original question and must be testable. Recent post: What Kind Of Evidence ...
How to Formulate a Null Hypothesis (With Examples)
To distinguish it from other hypotheses, the null hypothesis is written as H 0 (which is read as "H-nought," "H-null," or "H-zero"). A significance test is used to determine the likelihood that the results supporting the null hypothesis are not due to chance. A confidence level of 95% or 99% is common. Keep in mind, even if the confidence level is high, there is still a small chance the ...

4.2 Basic Concepts

Critical Thinking and Clinical Reasoning

Inductive and Deductive Reasoning and Clinical Judgment

Nursing Process

Outcomes Identification

Nursing Care Plans

Implementation

Benefits of Using the Nursing Process

Holistic Nursing Care

Caring and the Nursing Process

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The First Step: Ask; Fundamentals of Evidence-Based Nursing Practice

Statements of Purpose

Development of a Research/Practice Problem

Components of a PICO Question

Types of PICOs

Function and Characteristics of Hypotheses.

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HOW TO WRITE A HYPOTHESIS: EXAMPLES, FORMAT, AND SAMPLES

How To Write A Hypothesis: Examples, Format, And Samples

Where is the hypothesis in a research paper

What is the purpose of writing a hypothesis

One possible hypothesis example research is as follows:

Concerning hypotheses, variables

How to write a hypothesis statement

The first thing you need to do is think of a question before you start writing your hypothesis.

The second step is to compile preliminary research in support of your hypothesis

Formulate a credible working hypothesis

Be as explicit as possible, and avoid hazy judgements. Take, for instance:

Develop a more precise hypothesis based on your research

Dependent and independent variables

The fifth step is to compose a null hypothesis

For instance, the following assertion is an example of a null hypothesis:

What differentiates a null hypothesis from an alternative hypothesis?

Hypothesis examples research paper

Conclusions regarding the method of writing a scientific hypothesis

In a nutshell

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Nursing Fundamentals [Internet].

Chapter 4 Nursing Process

4.2. BASIC CONCEPTS

Critical Thinking and Clinical Reasoning

Inductive and Deductive Reasoning and Clinical Judgment

Nursing Process

Patient Scenario A: Using the Nursing Process [ 10 ]

Outcomes Identification

NURSING CARE PLANS

Implementation

Benefits of Using the Nursing Process

Holistic Nursing Care

Holistic Nursing Care Scenario

Review how to provide culturally responsive care and reduce health disparities in the “ Diverse Patients ” chapter.

Review how to communicate with patients using therapeutic communication techniques like active listening in the “ Communication ” chapter.

Read more about Dr. Watson’s theory of caring at the Watson Caring Science Institute .

4.3. ASSESSMENT

Subjective Assessment Data

See Figure 4.5 [ 2 ] for an illustration of a nurse obtaining subjective data and establishing rapport after obtaining permission from the patient to sit on the bed.

Objective Assessment Data

Physical Examination

Sources of Assessment Data

Interviewing

Reviewing Laboratory and Diagnostic Test Results

Types of Assessments

Putting It Together

Scenario C [5]

4.4. DIAGNOSIS

Analyzing Assessment Data

Performing Data Analysis

Clustering Information/Seeing Patterns/Making Hypotheses

Gordon’s Functional Health Patterns [ 5 ]

Identifying Nursing Diagnoses

Additional Definitions Used in NANDA-I Nursing Diagnoses

New Terms Used in 2018-2020 NANDA-I Diagnoses

Types of Nursing Diagnoses

Establishing Nursing Diagnosis Statements

Problem-Focused Nursing Diagnosis

SAMPLE PROBLEM-FOCUSED NURSING DIAGNOSIS STATEMENT

Health-Promotion Nursing Diagnosis

SAMPLE HEALTH-PROMOTION NURSING DIAGNOSIS STATEMENT

Risk Nursing Diagnosis