1. Prepare for Final Paper
Topic: Ethical Conduct of Research (Outcomes 1,6): 20 hours
Select a healthcare related research study. Identify the sample population. Analyze and critique the study to identify if sampling method reflects ethical principles including consent, conditions of the participants, study approved by IRB,
Minimum 20 pages excluding title and reference page.
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Papers that reflect over 17% SIMILARITIES will be assigned a ZERO. There is NO opportunity for late or re-submitted work!
MINIMUN 6 REFERENCES, from 2014 to 2019
YOU WANT ADDED MORE CRITIQUE QUESTION IF YOU WANT TO COMPLET THE 20 PAGES
FOLLOW THE TERM TEMPLATE APA PAPER TEMPLATE 6th
Title in Upper and Lower Case
Miami Regional College
MSN 5300: Advanced Nursing Inquiry and Evidence Based Practice
Title of Paper in Upper and Lower Case (Centered, Not Bold)
Paragraph one is the introduction to the paper. It should begin with something that will grab the reader’s attention and provide a citation to support your opening sentence (Norwood, 2002). Next, support that opening sentence with discussion or explanation with one or multiple sentences which will make up the body of the introductory paragraph. The last sentence of the introduction should highlight areas to be covered in the paper. APA success requires knowledge of the format and skill in concise, clear written communication.
Research Study Overview
This section is where you provide a summary of the research study being critiqued? What were the goals of the research? What health care related issue was addressed? Is it a good/feasible study to apply in clinical practice? Was a practical study, from a financial aspect? Use as many paragraphs as needed to cover the content appropriately.
Ethical Issues in Research
Use this paragraph to provide feedback/history on ethical issues on research.
Protection of Human Rights
What are the five human rights that must be protected during research/investigation? What do they stand for? How do they relate to this research study? Were any/all of the human rights protected in the duration of the research study in question? Use as many paragraphs as needed to cover the content appropriately. Ladkjfasdojfadfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf
Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf ;lskdm;vokmae ;obvkmse;rokmgageo sivjnseariun v;osdr g;I s;bnofnb;o aiermf ;sokdfmb;osiermg oskmfbopvsidfm b;mseoribgmseoribg nbsodfjbvs;ervjnnbs;odrkmfbv;oaerkmv sodbmsnoe;rif nvpsoeonvrsep.
What was the sampling method used, how did the researchers choose the subjects for participation? What other sampling methods could have worked better, provided better results? Does the sampling method used reflect ethical principles, was it a fair process? Is the population in question a vulnerable population, and if so were there special considerations taken? Use as many paragraphs as needed to cover the content appropriately.
Ina;osif;oaiwe mfasodifmaow vmoadifmgo ;aodifgi ;aodfvmao vma;o nvaoejjngfpsoinfv bnaeornfgvpesunfvpasjnvpadjfnvpajnvpoadf vpoasjdfnv[oiadsno[cv afnvpainfvpaw9unfvpasdj avmaojf;oaskdjfoaskdmv;lkamdsfovmewpoigfnasdock apovmaporingrpaio
What is an informed consent? In regards to this research study, was it obtained, if appropriate? If a consent was part of the study, was it obtained properly? Did the participants assent? If participants unable to consent, were they not competent, did a caregiver consent? Were participants provided full/complete detailed information or was it a short version? What components did it include? Use as many paragraphs as needed to cover the content appropriately.
Mv;aoskdkjfngaogna;o aosngfva;osing; aodkfkngvo;sdjfnv ngvsoerphngea;oi aojgnjvspdofinv;sdjfvn;sdozjfvns; vnaoeriengpa9eru vnapesring[earoi vnaeroinmg[eaoirm vna[eroimgfaoskmf;szlkmf ngae[iorng[awekmf mvaoeor[imges’aripom d;mokgm ae
Ethical Scientific Integrity
What are the credentials of the researchers? Did the researchers fabricate data, publish errors/ publish correction? Is there evidence of plagiarism? Use as many paragraphs as needed to cover the content appropriately. Ifnagw;oeifnaw;eo vo;ianener;ai nvzodsianvaei;or nag;oekermf naipeieufn ;aoidfvim; ;aodkzkfnv;azdfskjvn.
This section is where you will discuss all the information available (or lack thereof) regarding the IRB. Was the research study approved by an institutional review board? If not, why not? Was a research proposal submitted for approval by an IRB? Use as many paragraphs as needed to cover the content appropriately Adkjfasdojfa dfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf.
Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf.
What is HIPPA and how does it apply to a research study? Was the research conducted using database information, and if so, was the health information protected? How was it protected? Was any data de-identified? Were participants provided pseudonyms or assigned numbers? Use as many paragraphs as needed to cover the content appropriately.
Benefit to Risk Ratio
Discuss if a benefit to risk ratio was calculated and how? Did it provide am honest estimation? What is your opinion about the outcome of the study and the potential benefits? Can it have a positive impact on the individual, how about in the community? Use as many paragraphs as needed to cover the content appropriately. Ladkjfasdojfadfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf
Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf.
Most papers should end with a conclusion or summary, which consists a short description of the key points of the paper. It should be concise and contain little or no detail. No matter how much space is left on the page, the References are always on the next page.
References (centered, not bold)
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
You next reference.
Appendix A(centered, not bold)
This is the article to analyze, and critique
Resilience of people living with HIV/AIDS in Indonesia: a phenomenological study Kumboyono Kumboyono, Cathrine T Sukotjo, Yulia C Lestari, Dini P Wijayanti Faculty of Medicine, Brawijaya University, Malang City, Indonesia
Abstract Background: HIV/AIDS is one of the most continuously developing communicable diseases in the world. The number of people diagnosed with HIV/AIDS is currently increasing worldwide, including in Indonesia. People living with HIV/AIDS (PLWHA) fall into a state of crisis, which signifies the difficulties of living with chronic pathological conditions. Resilience is one unique phenomenon observed among PLWHA in Indonesia, which further reveals the results of current health management and expectations of PLWHA for better health programmes. Objective: This study aims to explore the mechanism of resilience in Indonesian PLWHA and the factors affecting that particular mechanism. Method: This is a qualitative phenomenological study. Twenty-seven PLWHA were selected from a primary healthcare centre in Malang City, East Java, Indonesia. Participants were selected from various economic, social, and diverse sexual orientation backgrounds. Participants were informed about the conduct of the research and consented to take part in the interview. Results: Diagnosis of HIV/AIDS signifies the beginning of psychological and social distress, the spiritual reaction after being diagnosed is a state of crisis, and the coping mechanism and understanding of life by PLWHA is a definite sign of resilience. Conclusion: HIV/AIDS is a chronic progressive disease and induces the distinct mechanism of resilience in Indonesian society. Future healthcare and management of PLWHA will be required to support and motivate this mechanism to guide PLWHA into a more comfortable and healthy lifestyle.
Keywords: HIV/AIDS, healthcare, meaning of life, resilience, spiritual
Introduction HIV/AIDS is one of the most continuously developing communicable diseases in the world among other communicable diseases, such as tuberculosis, affecting people diagnosed with immunocompromised conditions. The number of people living with HIV/AIDS (PLWHA) worldwide is currently increasing with a significant incline among Asian countries, especially the Asia and Pacific region . In Indonesia, the number of PLWHA is in synergy with the increasing pattern of an Asian epidemic, with 300,000 estimated new infections in 2015 . Having been diagnosed HIV-positive, novel psychological and social disturbances are certainly experienced by PLWHA in general. As reported by Dahlui , PLWHA are a vulnerable community experiencing a psychosocial burden, together with physical discomforts. Another study from India also reported the effects of stress and the psychosocial burden suffered by people diagnosed with HIV/AIDS . Although there is a mechanism of resilience to chronic diseases, this group of people are still under enormous pressure to survive the harmful pathological progress of HIV/AIDS and the opportunistic infections that follow. A lack of psychosocial support from family, for example, loss of parents and caregivers at an early age, adds to this pressure . Biological mechanisms of survival under the duress of chronic diseases, such as HIV/AIDS or tuberculosis, can result in two outcomes. People living with the chronic disease will experience the entire physical
andpsychologicaldisturbancesafterperseveringunder similar clinical manifestations for a long period of time. One outcome results in depression and loss of spiritual motivation that may lead to mortality [6,7]. The other is the mechanism of resilience, the most distinct phenomenon will eventually lead to survival while experiencing deteriorations of physical and psychological well-being [8,9]. Qualitative phenomenological studies exploring the mechanism of resilience in PLWHA and its other factors have not been the focus of researches in Indonesia. The purpose of this study is to explore the nature of resilience amongpeoplediagnosedwithHIV/AIDS.Themeaning of experiencing an HIV/AIDS burden, physically and psychologically, and also the social responses of PLWHA were recorded and reported in this study. This research is important as it will allow health professionals to identify the support required by PLWHA.
Method Design of study This study is a classical phenomenological study with an analytic descriptive approach. This approach is used to understand the meaning of the patient’s life after being diagnosed with HIV/AIDS. This study obtained an ethical health licence from the Ethical, Health, and Research Commission of Medical Faculty, Brawijaya University, Malang City (Ref: 261/EC/KEPK/04/2014) and was upheld according to the Helsinki Declaration of 1975.
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Population and sample For this study 27 PLWHA were selected by snowball sampling from Malang City, Indonesia. Criteria for selection were that participants had been diagnosed with HIV/AIDS for at least 1 year and be aged 18–40 years. The benefit to participants in this research was anincreaseinawarenessoftheimportanceofaccepting a diagnosis of HIV/AIDS in order to remain productive. They were selected according to achieved saturation of data . Participants consisted of 13 men and 14 womendiagnosedwithHIV/AIDSacquiredfromvarious modes of transmission, such as, multiple sexual partners: 17 participants; men who have sex with men: four participants; and injectable drug users: six participants. Participants were aged 25–34 years and lived in the areas of Malang city, Batu city, and Blitar municipality. The educational background of participants ranged from primary school, junior high school, senior high school, and vocational school. The marriagestatusofparticipantsvariedfrombeingsingle, married, and widowed. The occupational backgrounds of participants were freelancers, private-organisation workers, and homemakers.
Data collection Instrumentsusedtoanalysethedataweretheinterview process and the participative observation of researchers. Data were collected at the participants’ homes through private interviews and there were no repeat interviews. Data were recorded in the form of audio files (MP3) and the duration of interviews was 28–42 minutes. A community health nursing specialist who is a registered practitioner and a lecturer at Brawijaya University conducted the interviews
Data analysis Analysis of qualitative data was accomplished by creating a transcript of interview recordings and notes during the interview. Manual analysis of the data was carried out according to the Colaizzi method . Analysing qualitative data manually provides more precise results because the data contain information on attitudes, values, and feelings that cannot be detected by software The procedure was as follows: 1. Read all transcribed verbatim to gain a whole sense of the resilience experience; 2. review each transcript and extract significant statements; 3. explain the meaning of each significant statement; 4. organise the formulated meanings into clusters of themes; 5. integrate results into an exhaustive description of the phenomenon under study; 6. formulate an exhaustive description of the phenomenon in uniquivocal statements of identification as far as possible; and 7. ask participants about the findings thus far as a final validating step. The results of the analysis were based on keywords, categories, and themes and subthemes of qualitative
variables of the study. There were two themes (phases) in this research and two subthemes from each.
Results According to the results of qualitative analysis of data, the mechanism of resilience of PLWHA in Malang city can be divided into two phases: crisis phase and survival phase. The crisis phase can be described by examining the psychological and social stresses of a lifestyle acquired by PLWHA. Meanwhile, the survival phase is explored by asking about the changes in the spiritual pattern and future arrangements of PLWHA. Each theme is discussed thoroughly and described qualitatively according to specific subthemes. Crisis phase of people living with HIV/AIDS The crisis phase of PLWHA is described through two subthemes: psychological and social stress. Psychological stress: the psychological response of PLWHA after being diagnosed with HIV/AIDS can be illustrated by anxiety and anger conditions. Anxiety aroseinparticipantsconsideringtheuncertaintyoftheir lives, which could end in morbidities and mortalities. Anger is also one of the psychological responses after participants pass the initial shock of being diagnosed with HIV/AIDS. Some of them accuse God for their sickness and acquire deep enmity against those who they perceive as responsible for transmitting the disease: Now I am afraid, anxious, worried that my sickness will result in me being sick all my whole life or I might die someday.IthinkGodnolongerlovesme,Ihadthisperiod of being angry with God, but now I realised and widely opened my heart … I’m open to taking the advantages of my situation …, God is the almighty, God will be the one who heals me. (Patient [P] 5, male, 25 years) Social stress: Feeling isolated from the social environment is perceived by participants to be due to social stigma. Social stigma arises as an impact of incorrect perceptions of society about PLWHA and HIV transmission, in the forms of societal embarrassment, labeling, prejudice, social isolation, fear of being isolated and being shunned by society. Whereas some participants suffered from discrimination, several others admitted that they also received acceptance from people living around them, depending on the openness and educational level of their communities: People gossip about me … both my own family and the society … many say that it’s the burden I have to bear alone as a consequence of what I did. If I want to work, Iwillmostsurelyberejectedbecauseofthedisease.But luckily, now there’s no pressure from society, in this area, it’s no longer a taboo subject. (P21, female, 28 years) Survival phase of life of people living with HIV/AIDS The survival phase of PLWHA can be divided into these following two subthemes: changes of spiritual pattern and future arrangements. Changes to spiritual pattern: changes of spiritual meaning experienced by participants occur in the form
Research HIV Nursing; 2018: 18(1): 4–7
of spiritual closeness to God through surrendering all to God, repentance, diligence of prayers, and worship: I don’t want to grief for too long … because everything that’shappeningrightnowisGod’swill,ifGodgivesme the disease, God will be the one giving me medicine. Now I’m diligently reciting prayers, before my illness, I rarely do it. I can now read the Quran which I was to unable before. (P16, female, 30 years). Futurearrangement: Planningforthefutureistheform ofPLWHA’sawarenessinlearninglifelessonsfromtheir personal experiences by maintaining health and future arrangements for their family. Maintaining health is a method used by participants to support their declining immune system through behaviour changes and beliefs leading to a more healthy lifestyle. I want to show that though I am diagnosed with HIV positive, I can live a healthy lifestyle without medical problems. I will change my lifestyle, change all of them. … All the bad behavior of my past I have left, such as drinking, doing drugs, multiple sex partners, I have left all of it. (P23, male, 32 years). Future hope for the family is a participants’ wishes for the security of their family, the future of their children, and happiness of their parents and relatives to redeem their previous deeds. This phenomenon can be observed through this following comment: What I fear is; it is acceptable if it is only me who suffer the disease … what about my kids, who will take care of them if I die … I have to stay healthy for my children. Besides, I want to get work again; I want to please my parents. … My parents need more attention now. (P25, female, 29 years).
Discussion The results of this study indicate that resilience is the participants’ ability to bounce back to psychological and social norms after facing adversity owing to a positive HIV/AIDS diagnosis. The nature of resilience among people diagnosed with chronic diseases can be categorised into the crisis and survival phase. The former is signified by the beginning of a psychological and physical struggle immediately after having been diagnosed with a certain critical disease, such as HIV/AIDS. Individuals acquiring one particular severe disease enter the crisis phase, which is also the beginning of their mental and physical experiences as people under the pathological burden of chronic and worsening physical manifestations . Under the duress of discomfort and pain over a long period,togetherwiththeheavyburdenofpsychological and social pressures, individuals will finally arrive at certain destinations. One likely destination is morbidities and irreversibly deteriorating psychological conditions, which eventually lead to mortality. The other destination is an interesting phenomena to behold in itself, in which PLWHA and others suffering from chronic progressive disorders can persevere and acquire the physical resistance needed to counter the destructive progression of the disease. This phenomenon is called resilience and is a distinctive topic that may be discussed based on the results of this study.
According to the interview results, all the participants agree with the notion of having suffered great negative psychological changes regarding their diagnosis of HIV/AIDS. Participants admitted that some of them were hardly able to control the anger and hatred they had after first being informed about their actual clinical conditions. They perceived people in their close acquaintance as ones who were responsible for their clinical conditions, and this understanding led to justifying their motivation to harm innocent individuals and the perceived bad deeds of others in transmitting the virus. Other participants reacted in a different way by expressing great sadness, anxiety, and depression regarding their bleak future and low rate of survival under the rapid progressive manifestation of the disease. Based on these results of psychological and social reactions of the participants, it can be inferred that one significant negative event relating to their well-being can deflate the positive perceptions that participants’ acquire about themselves. The psychological and physical stress they receive after being diagnosed with HIV/AIDS signify the beginning of their long struggle andjourneyinreachingthecriticalphasethatallpeople with chronic disease will eventually reach. Those participants proceed both physically and mentally through the discomforts and the state of being constantly uncomfortable with themselves, which is specifically induced by the harmful particular stressor that is HIV/AIDS. Having been diagnosed with HIV/AIDS, initially, participants revealed a great distrust and absolutely blamed God and other spiritual systems of belief in their society, according to their upbringing. As most Indonesians consider that spiritual devotedness to God is the absolute duty in their private and public lifestyle, itisgenerallyperceivedasawrongdoingtoblameGod for the disease and discomfort the participants have to pass through in life. PLWHA in this study had a difficult time reconciling their sufferings with the goodness and righteousness of religious beliefs. This alsoaddedtotheirpsychologicalandphysicalburdens, whichfurtherledtoanxietyanddepression.Thismental stateofPLWHAisadistinctivepointinthecriticalphase of suffering from a chronic disease, and also has the role as a determining factor of the final destinations of the participants’ well-being. The final destinations of people with a chronic disease, as mentioned above, can manifest in mortalities owing to an individuals’ inability to cope with a long and strenuous psychological and physical burden. However, an interesting phenomenon called resilience to chronic disease can also exist and be presented in the final stages of an individuals’ struggle. According to this study, all participants reacted in a positive way regarding their experiences and meanings of life acquired by contracting HIV/AIDS. Most participants agreed to repent and improve their spiritual lifestyle by being more vigilant in prayers to God. Participants also admitted that they behaved more carefully after being diagnosed with HIV/AIDS to preserve their HIV Nursing; 2018: 18(1): 4–7 Research 6
remaining years and also to prepare economically and psychologically for their families. These are positive signs in the final destinations of PLWHA and can be further categorised into the resilience expected to be found in people with chronic disease. The resilience phenomena of PLWHA found in this study are in conjunction with the results of other previous studies of PLWHA. According to one study held in a Haitian children’s community diagnosed with HIV/AIDS , the participants admitted that they suffered great stress/depressive symptoms of being diagnosed with HIV/AIDS owing to a lack of social support, stigma, and discrimination; which agrees with the initial process of HIV/AIDS for participants of this study. Similarly, PLWHA in Brazil, Iran, and USA also revealedthepsychologicalandsocialstruggleofhaving negative social stigma from the environment, which is worsened with the struggle of coping with all the negative perceptions without their caregivers or family to support them [14,15,16]. AnHIV/AIDSdiagnosismaymakeanindividualstressed and impart a sense of grief. Therefore, a nurse has a veryimportantroleinhelpingpatientsthroughdisbelief of their fate and to be able to adapt to the condition oftheillness.Nursescanactascounsellorsbyproviding individual and group counselling and educators by providing accurate information about HIV/AIDS to the patient, family and community. The role of nurses as educators and counsellors is corroborated by research findings that reveal nurses have a role in providing access to knowledge and counselling for newly diagnosed HIV patients to help them in dealing with stigma and disclosure. The National HIV/AIDS Strategy of United States reveals that advanced and innovative education strategies are necessary to provide care that is free from stigma and discrimination [17,18]. An HIV/AIDS nursing education strategy involving PLHWA and experts in the field could help nurses reduce HIV/AIDS stigma in society. Conclusion PLWHAhaveachronicprogressivediseasethatinduces the distinct mechanism of resilience in Indonesian society. Future health care and management of PLWHA should socially support and motivate this mechanism to guide PLWHA into more comfortable and healthy lifestyles. The role of nurses as counsellors and educators can assist the adaptation of PLWHA in facing adversity after being diagnosed with HIV/AIDS.
Acknowledgements Conflicts of interests The authors declare there are no conflicts of interests regarding the funding and publication of this article. Funding The author is grateful for the support of the Directorate General of Higher Education, Ministry of Culture and Education, Republic of Indonesia in funding
this community health nursing research (Ref: 023.04.2.414989/2014). References 1. UNAIDS DATA 2017. Available at: www.unaids.org/sites/ default/files/media_asset/20170720_Data_book_2017_ en.pdf (accessed January 2018). 2. UNAIDS. Global AIDS update, 2016. Available at: www.unaids.org/en/resources/publications/all/ (accessed January 2018). 3. Dahlui M, Azahar N, Bulgiba A et al. HIV/AIDS related stigma and discrimination against PLWHA in Nigerian population. Plos One 2015; 10: e0143749. 4. Kumar S, Mohanraj R, Rao D et al. Positive coping strategiesandHIV-relatedstigmainSouthIndia. AIDSPatient Care STDS 2015; 29: 157–163. 5. Dejman M, Ardakani HM, Malekafzali B et al. Psychological, social, and familial problems of people living withHIV/AIDSinIran:aqualitativestudy. IntJPrevMed 2015; 6: 126. 6. SakiM,KermansashiSMK,MohammadiEetal.Perception ofpatientswithHIV/AIDSfromstigmaanddiscrimination. Iran Red Crescent Med J 2015; 17: e23638. 7. AmiyaRM,PoudelKC,Poudel-TandukarK etal. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. Plos One 2014: 9: e90959. 8. Kanez S. Depression and coping mechanism among HIV/AIDS patients under anti-retroviral therapy. Indian J Soc Psychiatry. 2016. 32: 149–153. 9. Sun W, Wu M, Qu P et al. Quality of life of people living withHIV/AIDSunderthenewepidemiccharacteristicsinChina and the associated factors. Plos One 2014; 8: e64562. 10. GentlesSJ,CharlesC,PloegJ,McKibbonKA.Sampling in qualitative research: Insights from an overview of the methods literature. Qualitative Report 2015; 20: 1772–1789. 11. Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative, 2nd edn. Philadelphia: Lipincott Williams & Wilkins, 1999. 12. Arrey AE, Bilsen J, Lacor P Deschepper R. Spirituality/ Religiosity: A cultural and psychological resource among sub-SaharanAfricanmigrantwomenwithHIV/AIDSinBelgium. Plos One 2016; 11: e0159488. 13. SurkanaPJ,MukherjeebJS,WilliamsdDRetal.Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti. AIDS Care 2010; 22: 803–815. 14. daSilvaLMS,TavaresJSK.Thefamily’sroleasasupport network for people living with HIV/AIDS: a review of Brazilian research into the theme. Cien Saúde Colet 2015; 20: 1109– 1118. 15. Forouzan AS, Jorjoran Shustari Z et al. Social support networkamongpeoplelivingwithHIV/AIDSinIran. AIDSRes Treat 2013; 2013: 715381. 16. Peterson JL, Rintamaki LS, Brashers DE et al. The forms and functions of peer social support for people living with HIV. J Assoc Nurses AIDS Care 2012; 23: 294–305. 17. Wei-Ti C, Shiu CS, Simoni J et al. Optimizing HIV care by expanding the nursing role: patient and provider perspectives. J Adv Nurs 2009; 49: 1841–1850. 18. FrainJA.PreparingeverynursetobecomeanHIVnurse. Nurse Educ Today 2017; 48: 129–33.
Correspondence: Kumboyono Kumboyono Email: [email protected] / [email protected]
Research HIV Nursing; 2018: 18(1): 4–7
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