EVALUATION OF THE UNDERSTANDING AND UTILIZATION OF

NURSING THEORIES AMONG UNDERGRADUATE NURSING

STUDENTS OF THE UNIVERSITY OF BENIN IN ENHANCING

PATIENT CARE

BY

AJAYI Moses Osabhohlen

BMS1802580

DEPARTMENT OF NURSING SCIENCE

SCHOOL OF BASIC MEDICAL SCIENCES

UNIVERSITY OF BENIN

BENIN CITY

SEPTEMBER, 2023
 CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

In the field of clinical education, a persistent challenge lies in the gap between theoretical

knowledge imparted in the classroom and the practical experiences encountered by students

in clinical settings (Factor, et al., 2017). While clinical education serves as the core of the

medical curriculum, theoretical knowledge is the complementary element of practice. These

two facets, theory, and practice, are intrinsically linked, and their harmonious integration

empowers students to acquire the knowledge, skills, and attitudes required to deliver optimal

care. Therefore, effective performance in clinical settings necessitates a seamless blend of

theory and practice (Abdulai, et al., 2019).

The dichotomy between theoretical knowledge and clinical experience is a recognized

obstacle faced by medical students, as articulated by the referenced sources (Factor, et al.,

2017). Although clinical education is considered the foundation of medical training, it is in

clinical rotations and experiences where students confront real-life healthcare scenarios,

putting their theoretical learning into action. Theory, on the other hand, underpins their

understanding of the reasoning behind their decisions and actions, fostering critical thinking

and informed clinical judgment (Phillip, et al., 2017).

The synergistic relationship between theory and practice cannot be overstated. Theory

informs practice, guiding students in their patient care decisions, while clinical experiences

offer invaluable insights that contribute to the development and refinement of medical

knowledge and theories.

The incorporation of both theoretical and practical learning experiences is of paramount

importance in medical education. This dynamic integration enables students to appreciate the

relevance of their classroom learning in the context of authentic patient encounters. As a

result, they develop the necessary competence and confidence to provide exemplary

healthcare services (Phillip, et al., 2017).

Ultimately, achieving proficiency in clinical settings hinges upon bridging the gap between

theoretical knowledge and practical application. By addressing this challenge head-on,

educators can create a comprehensive and effective medical curriculum that equips students

with the aptitude and mindset required for successful clinical practice. Through this seamless

integration of theory and practice, the next generation of healthcare professionals will be

well-prepared to deliver high-quality, patient-centered care, ensuring positive outcomes for

their patients and advancing the field of medicine (Phillips, et al. 2017).

The evidence shows that students in clinical learning environments are often unable to match

the theoretical content learned in the classroom with what they are actually doing in practice

and consequently, they cannot provide the care competently for patients (Hamidzadeh, et al.,

2019). There are numerous obstacles and pitfalls in clinical setting and health care centers for

the delivery of effective health care services (Hussein & Osuji, 2017).

Although they may be capable in theory and able to discuss what they learned in the

classroom, they cannot use this capability in a variety of health-related situations during

internship (Hamidzadeh, et al., 2019). Hence, in real clinical situations, they are unable to

generalize from what they have learned in theory. The earlier studies have shown some of the

factors that contribute to theory-practice gaps such as system inadequacies, resource

restrictions, lack of experience, poor workplace condition and the lack of collaboration of

clinical settings and educational institutions with students’ (Abdulai, et al., 2019).

Although studies about theory-practice gap have been varied, most of these studies are

conducted on nursing staff; hence the main gap of these studies is neglecting other persons

such as trainers and trainees who have a central role in clinical teaching and learning.

Moreover, experiences and understandings of the gap between what is taught in the
classroom and what is practiced in clinical settings during internship have not been deeply

described; therefore, this study aims to explore the barriers of utilizing theoretical knowledge

as taught in the classroom and in the clinical settings, i.e. in situations where undergraduate

students are possibly unable to transfer theoretical knowledge into clinical practice

experience.

1.2 Statement of the Problem

Nursing theories form the essential foundation for evidence-based practice and guide nurses i

n their decision-making and patient care. However, concerns are arising about the knowledge

and application of these theories among undergraduate nurses at the University of Benin. One

major issue is the inadequate awareness of nursing theories, with some students lacking a co

mprehensive understanding of their relevance to patient care, potentially leading to a limited

appreciation of theoretical underpinnings. Additionally, challenges exist in integrating nursin

g theories into patient care, as students may struggle to apply their knowledge effectively in r

eal-world clinical settings, creating a disconnect between theory and practice.

This study will also highlight the significance of nursing theories in evidence-based practice,

as they enable informed decisions based on scientific knowledge and research. Failure to gras

p the importance of nursing theories among undergraduate nurses might hinder their ability to

implement evidence-based practices critically. Moreover, understanding nursing theories is cr

ucial for nurses' professional growth, and the lack of knowledge and utilization among underg

raduate students may impede their ability to provide high-quality patient care and stay update

d with advancements in the field.

To address these concerns, the research aims to assess the level of knowledge and utilization

of nursing theories among undergraduate nurses at the University of Benin. The study seeks t

o identify barriers and challenges hindering the integration of nursing theories into patient car

e, and its findings will inform targeted interventions and educational strategies. By enhancing
nursing students' understanding and application of nursing theories, the research endeavors to

improve patient care outcomes and promote evidence-based nursing practices, ultimately ben

efitting the nursing profession and the overall healthcare system.

1.3 Research Questions

The following research questions will be answered in this study:

1. What is the level of knowledge of nursing theories among undergraduate nurses at the

University of Benin?

2. What is the level of utilization of nursing theories in patient care among

undergraduate nurses at the University of Benin?

3. What are the barriers and challenges hindering the effective integration of nursing

theories into patient care among undergraduate nurses at the University of Benin?

1.4 Objectives of the Study

The aim of this study is to assess knowledge and utilization of nursing theories among

undergraduate nurses of the University of Benin towards patient care. Specifically , it is set:

1. To assess the level of knowledge of nursing theories among undergraduate nurses at th

e University of Benin.

2. To examine the utilization of nursing theories in patient care among undergraduate nu

rses at the University of Benin.

3. To identify barriers and challenges hindering the effective integration of nursing theor

ies into patient care among undergraduate nurses at the University of Benin.

1.5 Significance of the study

The finding from this study will be useful in improving Patient Care. By evaluating the knowl

edge and utilization of nursing theories among undergraduate nurses, the study seeks to identi

fy potential gaps and challenges. Addressing these issues can lead to enhanced patient care as
nursing theories play a crucial role in providing evidence-based, holistic, and patient-centered

care.

Also, the findings of the study can inform curriculum development and improvements in nurs

ing education at the University of Benin and other similar institutions. Incorporating nursing t

heories effectively into the curriculum can help nursing students understand the theoretical fo

undations of their practice and translate them into real-world patient care scenarios.

It will also assist in promoting Evidence-Based Practice. Understanding and utilizing nursing

theories are essential for evidence-based practice, which forms the basis of high-quality nursi

ng care. The study's results can contribute to strengthening evidence-based nursing practices

among undergraduate nurses, thereby positively impacting patient outcomes.

The research on the knowledge and utilization of nursing theories can add to the existing bod

y of knowledge in nursing theory and education. The study's insights may stimulate further re

search in this area and help generate evidence to support the integration of nursing theories in

to nursing practice.

Finally, the findings from this study will Informing Policy and Guidelines. Policymakers and

nursing regulatory bodies can benefit from the study's findings to develop guidelines and poli

cies that promote the incorporation of nursing theories into nursing practice. This can contrib

ute to standardizing nursing education and improving overall healthcare quality.

1.6 Research Hypotheses

1. There is no significant association between sociodemographic characteristics and

level of knowledge of nursing theories among undergraduate nurses in the

University of Benin

2. There is no significant association between sociodemographic characteristics and

level of utilisation of nursing theories among undergraduate nurses in the

University of Benin
1.7 Scope of the study

The scope of this study covers knowledge and utilization of nursing theories among

undergraduate nurses in the University of Benin, Benin City. These theories will be assessed

in relation to patients care.

1.8 Operational definition of Terms

Knowledge of Nursing Theories: "Knowledge of nursing theories" refers to how much

undergraduate nursing students at the University of Benin understand and remember different

nursing theories and their relevance to nursing practice. We will assess this by using a test

that asks questions about various nursing theories and their application in real-life patient

care scenarios. Correct answers attracts a score of 1, while wrong answers attracts a score of

0. The total score obtained will be expressed as a percentage

Understanding nursing theories: This refers to the means of comprehending the concepts

and principles that guide nursing practice and patient care. Understanding nursing theories

plays a vital role in the evolution of nursing as a discipline and they not only establish the

critical contributions made by the profession, but also provide nurses with frameworks that

guide their practice, grow professionally, and improve the care they deliver to patients.

Utilization of Nursing Theories in Patient Care: This refers to how well undergraduate

nurses put the concepts and principles of nursing theories into action when taking care of

patients.

Patient Care: This refers to the comprehensive and individualized attention that

undergraduate nursing students give to patients. This includes assessing their health, creating

care plans, administering treatments, and evaluating the outcomes.

Undergraduate Nurses: This refers to students currently enrolled in the Bachelor of Science

in Nursing (BSN) program at the University of Benin.

Evidence-Based Practice (EBP): "Evidence-based practice" refers to the integration of the

best available research evidence, clinical expertise, and patient preferences and values in

making healthcare decisions.

Holistic Care: "Holistic care" means providing comprehensive care that considers the

physical, emotional, social, and spiritual aspects of the patient. We will evaluate how well

undergraduate nursing students demonstrate a holistic approach to patient care, incorporating

nursing theories to address patients' needs comprehensively.

 CHAPTER TWO

LITERATURE REVIEW

2.1 Conceptual Framework

2.1.1 Overview of Nursing Theories

Nursing theories have over the years served many purposes. The development has been

influenced by society and by many different ontological and epistemological interests. For

decades, nurse scholars have been strong in developing theory and at the same time scholars

and practitioners have discussed the development of theories and concepts for practice (Hall,

2017), and not least the use and usefulness of nursing theories in practice. The historical

critique of nursing theory is also the present critique. The critique is based on many

differences: there still exists disagreement about the focus of nursing—is it the active, self-

providing patient, that society needs in order to keep healthcare costs down, or is it the not-

so-active patient who need society’s/nurses’ help to live with his or her illness. There is also

disagreement about the philosophical foundation of the discipline: should nurses focus on

self-care or caring, which is related to the focus of the discipline, and about the epistemology

of nursing: should knowledge be derived from rationality or relations, which altogether

constitute the problems we have with the development of theory and the use of theory. Add to

that a global pressure to de-professionalize nursing and other professions in order to serve the

New Public Management of health care. In that discourse, theory is of no use for nursing

(Thorne & Sawatzky, 2019).

As a consequence, nursing theories are being faded out of nursing education and thereby

nursing practice, which has now reverted back to being more task oriented and governed on

the one hand, by bureaucrats hired by the government to increase effectiveness, and on the

other, the marketization of society. Sadly, it seems that nurses have been “drawn into this

preoccupation with productivity (cost)-effectiveness and efficiency, and more specifically, to

accept and work hard for what has come to count as productivity in healthcare settings”

(Rudge, 2018). This development has left nurses’ practices as increasingly instrumental and

rationalized (Ceci, Pols, & Purkis, 2017).

The discipline of nursing is on a slippery slope with regard to the ever increasing lack of

nursing theory in its work. The misguided attempt to eliminate the use of nursing theory as

the underpinning of practice is ultimately affecting patient care. A clarion call to the

discipline regarding the need for theory in research and practice is required. Nursing will

soon become just another set of tasks rather than the profession needed by patients and their

families. The discipline has allowed others to set the rules, make the decisions, and change

nursing not for the benefit of the patient but for the convenience of healthcare organizations

(Karnick, 2019, p. 117).

2.1.2 EPISTEMOLOGICAL ISSUES IN NURSING

Nursing is situated in a field between a practice discipline and an academic discipline.

Several perspectives are therefore inherent in the discussion about the theoretical foundation

of nursing/nursing theories: generally, it is about what nurses should be able to do and what

that requires from nursing education. Basically, it is about what constitutes the core of

nursing—nursing ontology. This means that several positions/paradigms are at play. It is a

constant interplay between if nurses have too much theory or too little, why do we/do we

need philosophy, too few practical competencies, “too posh to wash” or too few theoretical

competencies (Rolfe, 2019). The essence of the dispute is nursing ontologies and

epistemologies—in the plural. Nursing has a social mandate and exists on the basis of this

mandate: … the discipline is defined by social relevance and value orientations rather than by

empirical truths. Thus the discipline must be continually re-evaluated in terms of societal

needs and scientific discoveries (Donaldson & Crowley, 2018, p. 118). Thus, the discipline
must continually be re-evaluated by society and by the profession, which means that nursing

ontology and epistemology is developed/changed parallel to the development of society.

Although contested and challenged (Schön, 2017), a profession is defined by a set of

common markers/characteristics: autonomy, monopoly, specializing, abstraction, education,

professional ethics and judgement (Staugaard, 2017). Most of these markers have distinctive

theories and practices as prerequisites. Thus, nursing needs its own core theories as part of

nursing’s own body of knowledge because of the social mandate (the patients we are

responsible for helping) and being an autonomous profession (the knowledge base we ground

our practice in). Both have scientific development as prerequisites. Jensen (2019) argues that

if a science “is to be more than an arbitrary chosen label, a time bound classification; the use

of it must be followed by theoretical considerations” (Jensen, 2019, p. 45). This is also true

for nursing. Any form of scientific practice is expressed in and regulated by concepts (Jensen

& Andersen, 2021). Concept development is therefore an important part of knowledge

development within a discipline (Eriksson, 2020). A scientific discipline constantly seeks to

clarify specific issues, concepts and theories utilized in the discipline and which subject

matter to be researched (Jensen, 2019). Concepts are developed through research, and

development of core concepts is the first phase of knowledge development. By clarifying and

specifying central concepts, the disciplines ontology and epistemology are clarified at the

same time.

2.1.3 What is theory

It is interesting to look at how knowledge has been understood in nursing and just as

important what has shaped and influenced how knowledge has been understood and

interpreted during times. The goal of scientific activity is to generate knowledge. Then, it is

obvious that you need to have an argument as to what constitutes valid knowledge (Delmar,

2017; Hoeck, 2021). When discussing knowledge, science and theory, it is important to
understand the Western culture’s deep roots in the classical Greek philosophers Plato,

Socrates and Aristotle (app. 400 BC). A description of the concept theory and derived

understandings of knowledge is therefore valuable (Delmar, 2017).

Socrates is the source of the characteristics of the concept of theory (Benner, Tanner, &

Chesla, 2019). His intention was to try and understand what characterize the at that time new

scientific disciplines like physics, astronomy, and geometry. Earlier on, disciplines did exist,

however not as scientific field, and they were based on experiences and activities in practice.

The understanding of the new sciences was that they had to be based on theory, which,

according to Socrates, had three essential characteristics: explicit, universal and abstract.

Since then, Descartes and Kant completed Socrates’ mission by adding one characteristic

each, discreet and systematic. The sixth characteristic has been added by modern science. The

so-called ideal theory, which characterizes a scientific discipline, is therefore characterized by

being (1) explicit: the theory is laid out so complete that it may be understood by any rational

human being. Intuition and interpretation does not belong here. (2) Universal: the theory is

true at all times and in all places. (3) Abstract: the theory does not contain specific examples.

(4) Discrete: the theory must contain context-free elements. (5) Systematic: decontextualized

elements are being related to each other by rules and laws. And (6) predictable and complete:

all variations in the elements must be specified in order to predict (Delmar, 2017). The

conventional meaning of science is the epistemic meaning, which means “well founded” and

“what must be regarded as correct” (Flyvbjerg, 2021). This refers to science that has achieved

“paradigmatic and normal-scientific level in the Kuhnian sense” (Flyvbjerg, 2021, p. 173),

which means it can explain and predict in terms of context-free knowledge both in the natural

and in human sciences. This understanding is the ideal in the natural sciences. The results are

founded on a relative, cumulative knowledge production, whose elements are explanation and

prediction. Ideal theories in the conventional meaning do not refer to common interpretations,
metaphors or exemplars as they are context-free. Flyvbjerg, who is a professor in Oxford and

known as having developed the criteria for the concrete science, raises the classic question of

whether the conventional model of science is a suitable ideal for the study of human activity.

In other words, is the science of human beings and society different from natural science?

Flyvbjerg (2021) points out that the study of human beings and social phenomena has never

been, and never can be, scientific in the conventional meaning of science, in an epistemic

sense, and therefore, it is not meaningful to talk about “theory” in the study of human activity

and social phenomena.

Hence, the social sciences should not model themselves on the natural sciences, or measure

their achievements accordingly (Flyvbjerg, 2021). This means that the result of other forms of

science can never be theory, understood as theory in the conventional meaning of science.

Thus, by definition, it cannot explain or predict incidents in the world of the human being,

using context-free characteristics.

2.1.4 THE EPISTEMOLOGY OF NURSING THEORY—THE SOCRATIC IDEAL

During the last three decades, the traditional, Western, Socratic understanding of theory

characterized by being abstract and context-free has influenced the development of nursing

knowledge by the adoption of empirical methods and research, which has facilitated nursing

science as an empirical science (Hall, 2017; Kim, 2020). This way of conceptualizing theory

influenced the development in American social science in the classification of theories in

grand theories and middle-range theories (Merton, 1968; Mills, 1959). The term “grand

theory” was coined by sociologist C.W. Mills as a form of highly abstract theorizing where

the formal organizing of concepts took priority of the social world. Grand theories were seen

as more or less separate from concrete concerns of everyday life and its variety in time and

space. A grand theory serves as an overall explanation of phenomena in a particular

discipline. It is an approach to theory construction where the theory can be verified by data or
empirical testing. A grand theory consists of a set of concepts and the relationships among

them (Ayres, 2022). They serve as an overall explanation of a discipline. The concepts

addressed in grand theories are highly abstract and therefore untestable. Grand theories are

very broad, tend to simplify complex issues, are static and unresponsive to changing

conditions (Ayres, 2022).

Middle-range theory was developed by sociologist R. K. Merton and is another approach to

theory construction. Middle-range theories start with an empirical phenomenon and from that

creating general statements that can be verified by data, in other words a kind of “truth

testing” based on the belief that “if a ‘theory’ is valid it ‘explains’.” Middle-range theories are

hypotheses that can be tested via empirical research. It consists of a limited set of

assumptions. They have a limited set of data to research and interpret. It serves as the filling

in of “blancs” in “is this working” and gives validity to the concepts. Middle-range theories

were supposed to look at measurable aspects of social reality. Ultimately, the body of middle-

range theories would become a system of universal laws. This way of looking at theorizing

stems from the Socratic way of understanding theory where the goal is to construct one

superior, universal theory. This development influenced immensely on nursing science and

the development of nursing knowledge (Kim, 2020).

Prior to the 1970s, the development of nursing theories was directed at both the practice and

the discipline of nursing reflecting opposite views on whether the discipline should govern

the practice or vice versa. This changed in the late 1970s where it became more viable to

conceptualize nursing knowledge into general theories referred to as grand theories (Risjord,

2010). These kinds of theories consist of a set of highly abstract concepts and the relationship

between them. The concepts cannot easily be operationalized into variables or used in the

hypothesis, and therefore, grand theories are not testable. Nursing theories classified as grand

theories consisted of, e.g., Nightingale, Orem, Henderson, Newman, Levine and Roy’s
theories or models. In the 1990s, middle-range theories became popular (Risjord, 2010).

Middle-range theories were developed to make grand theories more concrete in order to

support nursing interventions. Middle-range theories are still abstract but presumably testable

by observation or experiment because the concepts, logically derived from the grand theories,

have been made more concrete and specific. Thus, the theoretical focus/ attention shifted

from developing new grand theories to concept development, which again could be applied to

the development of middle-range theories. An abundance of middle-range theories were

published between 1988 and 2001, e.g., Mishel, Reed, Barker, Kolcaba and Swanson (Tomey

& Alligood, 2021).

The philosophical/epistemological view of nursing knowledge and the understanding and

assumptions embedded in the notion of grand theories and middle-range theories are that

nursing is a basic science; scientific theories are value-free, have a distinctive logical

structure and are deductively derived/conceived. This philosophical understanding of theory

development was modelled after the natural sciences. This position of nursing epistemology

theory had important consequences for the relation of theory to practice. The view that basic

science was not supposed to provide practical guidance made nursing theory and research

rather irrelevant to clinical practice (Ceci et al., 2017). The theory practice in nursing was

opened and is still open due to the dominant philosophical view of science. Therefore,

according to Risjord (2020) and others, it can also be closed by a different philosophical

understanding of nursing science.

2.1.5 Knowledge of Nursing Theories

Nursing theories are systematic and structured frameworks that describe, explain, and predict

phenomena related to nursing practice. They encompass a range of concepts, principles, and

models that help nurses understand the essence of nursing and its impact on patient care

(Alligood, 2018). Understanding nursing theories is fundamental for nursing students as it

provides them with a theoretical foundation for practice. It helps them make informed clinical

decisions, develop critical thinking skills, and enhance their ability to provide patient-

centered care (Parker & Smith, 2019). Knowledge of nursing theories can be categorized into

various levels. At the foundational level, students are introduced to key nursing theorists and

their core concepts. At a deeper level, students should be able to analyze, critique, and apply

nursing theories in clinical situations (Masters, 2020). Assessing the level of knowledge

among undergraduate nurses can involve both qualitative and quantitative methods. Surveys,

quizzes, and standardized tests can quantify theoretical knowledge, while open-ended

questions and interviews can provide insights into students' ability to apply theories in

practice (Henshaw et al., 2018). Nursing education plays a pivotal role in shaping students'

knowledge of nursing theories. The curriculum, teaching methods, and faculty expertise are

crucial factors influencing the acquisition of theoretical knowledge (Fawcett & DeSanto-

Madeya, 2018). It's essential to emphasize the practical relevance of nursing theories to

undergraduate nurses. The ability to link theory to practice is critical for providing evidence-

based care and ensuring positive patient outcomes (McEwen & Wills, 2019). Nursing is a

dynamic profession, and knowledge of nursing theories is not static. Undergraduate nurses

should be encouraged to engage in lifelong learning and continue exploring nursing theories

as they progress in their careers (Masters, 2020).

2.1.6 Utilization of Nursing Theories in Patient Care

Utilizing nursing theories in patient care is a fundamental aspect of evidence-based practice

in nursing. Nursing theories provide a structured framework that guides nurses in delivering

care that is patient-centered, holistic, and evidence-based. In this section, we will explore the

importance of nursing theories in patient care.

Theoretical Foundation of Nursing Practice:

Nursing theories serve as the foundation for nursing practice. As stated by Meleis (2018),

nursing theories help nurses understand the essence of nursing and provide a systematic

approach to delivering care. For instance, the Roy Adaptation Model, developed by Sister

Callista Roy, emphasizes the assessment and adaptation of patients to their environments,

helping nurses address patient needs more effectively (Roy, 2019).

Enhancing Patient Outcomes:

Utilizing nursing theories in patient care has been associated with improved patient

outcomes. A study by Tourangeau et al. (2018) found that nurses who applied nursing

theories in their practice were more likely to achieve positive patient outcomes, including

reduced complications and better patient satisfaction.

Holistic Patient Assessment:

Nursing theories emphasize holistic assessment, considering not only the physical aspects of

a patient but also their psychological, social, and spiritual needs. The Neuman Systems

Model, developed by Betty Neuman, highlights the importance of assessing patients

comprehensively within the context of their environments (Neuman & Fawcett, 2017).

Tailoring Care Plans:

Nursing theories assist in tailoring care plans to individual patient needs. For example,

Orem's Self-Care Deficit Nursing Theory emphasizes the importance of identifying patients'

self-care abilities and designing interventions to meet their self-care deficits (Taylor, 2017).

Evidence-Based Practice:

The utilization of nursing theories aligns with evidence-based practice. As noted by Melnyk

and Fineout-Overholt (2018), evidence-based practice integrates the best available evidence

with clinical expertise and patient preferences. Nursing theories provide a structured way to

incorporate evidence into nursing care.

Education and Practice:

Education plays a crucial role in promoting the utilization of nursing theories in patient care.

Nursing programs incorporate various nursing theories into their curricula to prepare future

nurses. Moreover, ongoing professional development encourages practicing nurses to apply

these theories in their daily care routines (Alligood & Tomey, 2018).

Challenges in Application:

While nursing theories offer many benefits, there are challenges in their application. Some

nurses may perceive nursing theories as too abstract or disconnected from their daily practice.

Bridging the gap between theory and practice remains an ongoing challenge in nursing

education and clinical settings (Walker & Avant, 2019).

2.1.7 Barriers and Challenges of Nursing Theories in Patient Care

1. Lack of Awareness and Knowledge:

Barrier: Many nurses may have limited exposure to nursing theories during their education,

leading to a lack of awareness and knowledge.

Challenge: Overcoming this barrier requires comprehensive education and training programs

that introduce nursing theories early in nursing curricula and reinforce their importance

throughout the education process.

2. Time Constraints:

Barrier: Nursing professionals often work in fast-paced and demanding healthcare settings,

leaving limited time for in-depth consideration and application of nursing theories.

Challenge: Balancing the application of nursing theories with efficient patient care delivery

requires time management skills and ongoing support from healthcare institutions.

3. Resistance to Change:

Barrier: Resistance to adopting new approaches, including nursing theories, can be common

among healthcare providers who are accustomed to traditional practices.

Challenge: Addressing this resistance necessitates organizational culture change, leadership

support, and continuous education and communication about the benefits of nursing theories

in improving patient outcomes.

4. Resource Constraints:

Barrier: Limited resources, including staffing, technology, and educational materials, can

hinder the implementation of nursing theories in patient care.

Challenge: Healthcare institutions must allocate resources strategically, invest in staff

development, and leverage technology to support the application of nursing theories.

5. Interdisciplinary Collaboration:

Barrier: Effective utilization of nursing theories may require collaboration with other

healthcare disciplines, which can be challenging due to differences in language, goals, and

priorities.

Challenge: Promoting interdisciplinary teamwork and communication is essential to

overcoming this barrier and ensuring a holistic approach to patient care.

6. Complexity of Nursing Theories:

Barrier: Some nursing theories can be complex and abstract, making it difficult for nurses to

apply them directly to patient care situations.

Challenge: Simplifying and adapting nursing theories for practical use, along with providing

guidance and training, can help nurses better understand and apply these theories in their

practice.

7. Lack of Evaluation and Feedback:

Barrier: Inadequate feedback and evaluation mechanisms can hinder nurses' ability to assess

the effectiveness of applying nursing theories in patient care.

Challenge: Establishing feedback loops and evaluation processes within healthcare

organizations can help nurses continually refine their application of nursing theories and

measure their impact on patient outcomes.

Ethical and Cultural Considerations:

Barrier: Nursing theories may not always account for the diverse cultural and ethical

considerations in patient care, posing challenges when applying them in different contexts.

Challenge: Nurses must be culturally competent and able to adapt nursing theories to respect

individual values and beliefs while providing patient-centered care.

Limited Research and Evidence Base:

Barrier: Some nursing theories may lack a robust evidence base, making it challenging for

nurses to justify their application in evidence-based practice.

Challenge: Encouraging and conducting research on the application and outcomes of nursing

theories can help build a stronger evidence base, providing a foundation for their integration

into patient care.

8. Educational Gaps:

Barrier: Nursing education programs may not adequately prepare students to understand and

apply nursing theories in real-world clinical settings.

Challenge: Nursing schools should revise curricula, emphasize theory-practice integration,

and offer ongoing professional development to address these gaps.

Effective Integration of Nursing Theories into Patient Care

Effective Integration of Nursing Theories into Patient Care is a fundamental aspect of nursing

practice. Nursing theories serve as conceptual frameworks that guide nurses in understanding

and implementing patient care (McEwen & Wills, 2019). They play a crucial role in decision-

making processes, helping nurses identify patient needs, plan interventions, and evaluate

outcomes, thereby enhancing the quality of care (Alligood, 2018). In this context, Evidence-
Based Practice (EBP) becomes vital, aligning nursing practice with research evidence and the

principles of nursing theories (Melnyk & Fineout-Overholt, 2018). Nursing theories often

emphasize holistic care, which considers physical, emotional, social, and spiritual dimensions

of patient well-being (Orem, 2021). This holistic approach aligns with the concept of patient-

centered care, wherein patient preferences, values, and goals are central (Institute of

Medicine, 2001). Moreover, the integration of nursing theories promotes better

communication and collaboration within healthcare teams, leading to improved care

coordination and patient safety (Joint Commission, 2018). Continuous assessment,

implementation, and evaluation, as advocated by many nursing theories, contribute to

adapting care plans and optimizing patient outcomes (Yoder-Wise, 2017). Additionally,

nursing theories stress the importance of cultural competence in care delivery, ensuring that

diverse cultural perspectives are considered and respected in nursing practice (Campinha-

Bacote, 2021). In essence, effective integration of nursing theories into patient care results in

comprehensive, patient-centered, and evidence-based care that continuously evolves to meet

the dynamic needs of patients, ultimately improving the quality of healthcare.

2.2 Theoretical Framework

The theoretical framework for this study is the Social Cognitive Theory. Social Cognitive

Theory, developed by Albert Bandura, is a psychological framework that emphasizes the

importance of social interactions, cognitive processes, and observational learning in

understanding human behavior. Bandura's theory challenges behaviorism, which primarily

focused on the role of reinforcement and punishment in shaping behavior. Social Cognitive

Theory posits that individuals learn from observing others (modeling), and their behaviors are

influenced by both personal and environmental factors.

Figure 2.1: Social Cognitive Theory

The key concepts and principles of Social Cognitive Theory include:

Observational Learning: Also known as imitation or modeling, this concept suggests that

people can learn new behaviors and acquire information simply by observing others.

Observational learning is a fundamental element of Social Cognitive Theory.

Reciprocal Determinism: Bandura argued that behavior, personal factors (such as thoughts,

beliefs, and emotions), and environmental factors (social and physical) all interact and

influence each other. This bidirectional relationship suggests that individuals can influence

their environment and, in turn, be influenced by it.

Self-Efficacy: Self-efficacy refers to an individual's belief in their own ability to successfully

perform a particular task or behavior. High self-efficacy is associated with increased

motivation and persistence, while low self-efficacy can lead to self-doubt and reduced effort.
Vicarious Reinforcement and Punishment: People can learn not only from direct personal
experiences of rewards and punishments but also by observing the consequences of others' actions.
If they see someone being rewarded for a behavior, they are more likely to imitate it, and if they see
someone being punished, they are less likely to repeat that behavior.

Triadic Reciprocal Causation: This concept refers to the interplay between personal factors,

behavior, and the environment. It suggests that these three factors constantly interact and

influence each other in a dynamic way.

Cognitive Processes: Social Cognitive Theory acknowledges the role of cognitive processes,

such as attention, memory, and thinking, in shaping behavior. Individuals process information

from their environment and use it to guide their actions.

Self-Regulation: People have the ability to set goals, monitor their progress, and regulate

their behavior to achieve those goals. Self-regulation is a cognitive process that plays a

significant role in personal development and behavior change.

Application of Social Cognitive Theory to Your Study

Observational Learning: In your study, you can investigate how undergraduate nursing

students learn about nursing theories through observation. This involves examining how they

acquire knowledge and skills by observing instructors, experienced nurses, and their peers.

Explore whether exposure to practical applications of nursing theories in clinical settings

influences their understanding and utilization.

Modeling: Within the framework of Bandura's theory, consider how the presence of role

models or mentors might impact students' adoption of nursing theories. Are there certain

faculty members or experienced nurses who serve as influential models for incorporating

nursing theories into practice? This can be explored through interviews and surveys.

Self-Efficacy: Self-efficacy, or individuals' beliefs in their capability to perform specific

tasks, is a central element of Social Cognitive Theory. Assess the self-efficacy beliefs of

undergraduate nursing students regarding their ability to apply nursing theories in patient
care. Identify factors that enhance or diminish their self-efficacy, such as positive feedback,

successful experiences, or challenges faced in clinical settings.

Behavioral Outcomes: Bandura's theory also emphasizes that self-efficacy beliefs influence

behavior. Investigate whether students with higher self-efficacy related to nursing theories are

more likely to actively integrate these theories into their patient care practices. Look for

correlations between self-efficacy levels and actual utilization of nursing theories.

Social Factors: Explore how social interactions within the university, including interactions

with instructors, peers, and clinical preceptors, shape students' perceptions of the importance

and applicability of nursing theories. Analyze how feedback and support from these social

sources impact the integration of nursing theories into practice.

Interventions: Consider designing interventions based on Social Cognitive Theory principles

to enhance the knowledge and utilization of nursing theories among undergraduate nursing

students. For instance, educational interventions that incorporate role models, provide

opportunities for observational learning, and boost self-efficacy beliefs can be developed and

tested.

2.3 Empirical Review

Ramalho, et al., (2021) analyzed the application of the theory evaluation model proposed by

Meleis in Brazilian studies. Through an integrative review of online articles published from

2012 to 2022, the study found that 16 selected studies confirmed the use of only three of the

five stages proposed for Meleis' theories analysis. These stages included Description of the

Theory, Criticism of the Theory, and Analysis of the Theory, with a predominant focus on a

single unit of analysis in each. The review concluded that the analysis of nursing theories

provides essential support to nurses in various dimensions of care, from practice to research,

education, and administration. Meleis' model was highlighted as vital for the development of
nursing knowledge, contributing to the discipline by enabling critical reflections on nursing

theories for their theoretical and practical applicability.

Scott & McSherry (2019) concuded a critical analysis aimed to clarify key concepts associated

with evidence-based nursing (EBN) to provide nurses with a practical definition for use in

their practice. The study conducted an in-depth review and synthesis of literature, finding that

evidence-based nursing could be defined as a distinct concept. Nurses needed to understand

what EBN means, what constitutes evidence, how EBN differs from evidence-based medicine

and evidence-based practice, and the process of engaging with and applying evidence. The

review emphasized the importance of educating nurses about these concepts to bridge the gap

between evidence and practice and consolidate nursing's position in the evidence-based field.

Brown et al., (2020) conducted a cross-sectional study aimed to explore the relationships

between perceived barriers to research use and the implementation of evidence-based practice

(EBP) among hospital nurses. Surprisingly, the study found that perceived barriers to research

use predicted only a small fraction (2.7% to 4.5%) of practice, attitude, and knowledge/skills

associated with EBP. The findings challenged the common assumption that barriers

significantly hinder the implementation of EBP among hospital nurses. The study suggested

that focusing on barriers might not be the most effective approach in promoting EBP. Instead,

it called for further research to identify predictors of EBP and determine which subset of

nurses is most amenable to adopting evidence-based practice.

Leach et al., (2019) conducted a national cross-sectional survey among registered Australian

osteopaths. A total of 332 osteopaths participated in the survey, and their demographic

characteristics closely resembled those of the Australian osteopathy workforce. The majority

of respondents held positive attitudes toward EBP, with a significant proportion agreeing that

EBP helps in decision-making about patient care and improves the quality of patient care.

Despite their positive attitudes, the survey found that most osteopaths reported only a
moderate level of perceived skill in EBP. Furthermore, they engaged infrequently in EBP

activities, with the majority indicating that only a very small or small proportion of their

clinical practice was based on clinical research evidence. The study identified several barriers

to the uptake of EBP among osteopaths, including a lack of time and a shortage of clinical

evidence specific to osteopathy. On the other hand, key enablers of EBP uptake included

access to the internet and online databases at work, as well as access to full-text articles and

EBP education materials. In conclusion, the survey revealed that while Australian osteopaths

expressed favorable attitudes toward EBP, there was a gap between their attitudes and actual

EBP practices. The study highlights the need to develop effective strategies to enhance EBP

uptake in osteopathy, potentially leading to improved patient outcomes. Identifying and

addressing the barriers while promoting the use of available enablers may be crucial steps in

advancing evidence-based practice within the osteopathic profession in Australia.

Stickler and Fields, (2021) assessed the knowledge, attitudes, and perceived barriers related

to teaching evidence-based practice (EBP) among nursing faculty in two schools of nursing

offering baccalaureate and master's level programs in the southwestern United States. The

researchers employed a survey-based approach, utilizing various instruments including a

demographic survey, the Evidence-Based Practice Questionnaire, and the BARRIERS to

Research Utilization Scale. They collected data from nursing faculty members and used

descriptive statistics, Pearson's correlations, and hierarchical multiple regression procedures

for data analysis. The study's findings revealed several important insights. Firstly, it was

noted that faculty members with master's level education had significantly higher mean

scores in the practice of EBP compared to those with doctoral preparation. While faculty

generally held positive views of EBP, their attitudes toward EBP were more favorable than

their actual knowledge, skills, and practice of EBP. This discrepancy indicated that possessing

traditional research knowledge and skills did not necessarily translate into a supportive
attitude or proficiency in the EBP process or the ability to acquire and appraise evidence

effectively. The study highlighted the importance of understanding faculty members'

knowledge, attitudes, and practices related to teaching EBP. This understanding is critical for

transforming the culture within nursing schools to one that embraces an evidence-based

framework for teaching nursing practice. It also emphasized the need for integrating EBP

content into curricula and ensuring that students gain mastery and appreciation of EBP. In

essence, the study shed light on the challenges faced by nursing faculty in effectively

teaching EBP and the areas where improvements and support may be required to facilitate the

integration of EBP into nursing education.

The study titled "Nurses’ perceptions of evidence-based nursing practice," conducted by

Koehn and Lehman (2018), aimed to explore Registered Nurses' perceptions, attitudes, and

knowledge/skills associated with evidence-based practice (EBP). Prior research in this area

has often used descriptive surveys to investigate nurses' perceptions, facilitators, and barriers

related to EBP. However, this study emphasized the importance of comprehending the

organizational context before implementing EBP. The research employed a descriptive, cross-

sectional survey design using a validated measure of EBP. All Registered Nurses (n = 1031)

working at a large medical center in the United States were invited to complete the

questionnaires, resulting in a final response rate of 40.9% (n = 422). The study's findings

revealed that participants had moderate scores regarding their practice and attitudes toward

EBP, while their knowledge/skills mean scores were somewhat lower. Notably, statistically

significant differences were identified in attitudes between nurses with baccalaureate and

higher education levels compared to those with associate and diploma education. The most

frequently cited barriers to implementing EBP were identified as time constraints and

knowledge gaps. In conclusion, the study highlighted the importance of conducting a

methodical assessment when developing a systematic plan for implementing a culture of

evidence-based practice within healthcare institutions. The findings underscored the need for

targeted interventions to address knowledge deficits and time constraints among nurses,

ultimately facilitating the successful integration of EBP into nursing practice.

Melnyk and colleagues (2019) conducted a study focussing on identifying key factors that are

correlated with the extent to which nurses engage in evidence-based practice (EBP). A

descriptive survey was conducted with a convenience sample of 160 nurses who attended

EBP conferences or workshops in four Eastern U.S. states. The primary aims of the study

were to describe nurses' knowledge, beliefs, skills, and needs related to EBP, investigate

relationships among these variables, and identify major barriers and facilitators to EBP. The

findings revealed that while participants had strong beliefs about the benefits of EBP, their

actual knowledge of EBP was relatively low. The study identified significant relationships

between the extent to which nurses' practice is evidence-based and factors such as nurses'

knowledge of EBP, their beliefs about its benefits, having an EBP mentor, and utilizing

resources like the Cochrane Database of Systematic Reviews and the National Guideline

Clearinghouse. The conclusion emphasized the need for healthcare systems to implement

interventions that not only enhance nurses' knowledge and skills in EBP but also strengthen

their beliefs in the benefits of evidence-based care. EBP mentors were identified as

potentially crucial in accelerating the shift towards evidence-based nursing practice. The

study called for theoretically driven randomized controlled trials to test the effectiveness of

interventions aimed at advancing evidence-based care, underlining the urgency of promoting

evidence-based practices in nursing.

The study conducted by Zhou, et al., (2019) aimed to assess the attitudes, knowledge, and pra

ctice of Registered Nurses (RNs) regarding evidence-based practice (EBP) in the traditional

Chinese nursing field. The research also sought to identify relevant sociodemographic and pr

ofessional factors that might influence these aspects. The study utilized a multiple institutiona
l cross-sectional survey design, employing self-reported questionnaires, including the Eviden

ce-Based Practice Questionnaire (EBPQ), as well as self-designed questionnaires. The findin

gs indicated that, on average, RNs held a positive view of EBP, with the highest scores observ

ed in the domain of attitude, followed by knowledge, and the lowest scores in the practice do

main. Additionally, RNs with more extensive professional experience tended to have stronger

EBP knowledge. Those facing higher work pressure tended to have less positive attitudes tow

ards EBP, and RNs with negative professional attitudes tended to score lower across EBP do

mains. The study also found statistically significant differences between RNs with research e

xperience and those without in terms of attitude and knowledge. In conclusion, the study reve

aled that the surveyed RNs generally held a positive view of EBP, with attitudes being more p

ositive than their knowledge and practice of EBP. The findings suggested that factors such as

longer professional experience, administrative positions, research experience, lighter workloa

ds, and a more positive professional attitude might facilitate the adoption and implementation

of EBP among RNs in the traditional Chinese nursing field. These insights can inform strategi

es to promote EBP in nursing practice in this context.

Kilicli, et al., (2019) conducted a study aimed to assess the attitudes, beliefs, and factors

influencing evidence-based nursing (EBN) practice among cardiovascular nurses in Turkey.

The study recognized the growth of cardiovascular nursing as a specialty but noted a lack of

research on EBN knowledge, attitudes, beliefs, and implementation specifically among

cardiovascular nurses. Therefore, the research sought to investigate cardiovascular nurses'

attitudes toward EBN, their sources of knowledge, and the factors that support EBN in the

Turkish context. A cross-sectional survey with a descriptive and comparative design was

conducted, involving 62 cardiovascular nurses working at two hospitals in Turkey. Data

collection included the use of the Evidence-Based Nursing Attitude Questionnaire and a

sociodemographic questionnaire that gathered information on nurses' sources of knowledge,

supporting factors for EBN implementation, research experience, use of clinical guidelines,

and barriers to applying EBN. The collected data were analyzed using descriptive and

inferential statistics. The findings revealed that cardiovascular nurses held positive attitudes,

feelings, beliefs, and intentions regarding EBN. Cardiac surgery nurses reported significantly

higher positive attitudes and intentions toward EBN compared to cardiology nurses. Nursing

experience and information acquired during nursing school were more frequently used

sources of knowledge in their clinical practice than research results. Approximately half of

the respondents were familiar with EBN. Nurses with graduate degrees, those who reviewed

nursing research, and those familiar with EBN exhibited significantly more positive attitudes

toward EBN. The study also identified that nurses required sufficient time, resources, a

clinical practice background, and support from hospital administration to implement EBN

effectively. In conclusion, the study suggested the need for educational interventions to

enhance EBN knowledge and skills among cardiovascular nurses. It also recommended the

training and assignment of mentor nurses in cardiovascular clinics to support the

implementation of EBN. These measures could contribute to the promotion and integration of

evidence-based nursing practices in cardiovascular care in Turkey.

The study conducted by Chan, et al., (2020) aimed to explore the impact of a mentorship

program on evidence-based practice (EBP) among nurses in an acute hospital in Singapore.

The research recognized that EBP is crucial for improving clinical outcomes in nursing and

aimed to assess whether mentorship could help early adopters of EBP create an EBP culture.

Nine nurses participated in the mentorship program throughout 2015. As part of the program,

mentees conducted ward-based EBP education sessions for their nursing colleagues. To

measure the program's effect, the Evidence-Based Practice Questionnaire (EBPQ) was used

to assess changes in the knowledge, attitude, and practice of EBP among both the mentees

and their ward colleagues. EBPQ surveys were administered before and three months after
the completion of the program, and Wilcoxon rank-sum tests were used to compare changes

in EBPQ scores. The results indicated that both the mentees and their ward colleagues

reported improved post-test median scores across all EBPQ subscales and the overall score.

However, the mentees showed a larger magnitude of improvement in their EBPQ scores

compared to their ward colleagues. In conclusion, the research demonstrated that a hospital-

based research and EBP mentorship program had a positive impact on nurses' knowledge,

attitude, and practice of EBP. This program contributed to the development of an EBP culture

change within the hospital, emphasizing the importance of mentorship in promoting and

integrating evidence-based practice among nursing professionals.

The study by Oh and Yang (2019) aimed to evaluate the effectiveness of an evidence-based

practice (EBP) education program using blended learning for undergraduate nursing students.

Given the increasing importance of EBP in nursing practice, the study sought to enhance the

critical thinking and decision-making skills of senior nursing undergraduates. The study

involved 45 senior nursing undergraduates from a university in Seoul, Korea, who were

divided into two groups: an intervention group (21 students) and a control group (24

students). The intervention group participated in an intensive 30-hour EBP education

program, while the control group did not receive this intervention. The researchers assessed

several outcome variables, including EBP knowledge, self-efficacy, and evidence utilization,

at baseline and two months after the intervention. The findings indicated that there were no

significant differences between the intervention and control groups concerning their

background characteristics and outcome variables. However, the intervention group showed

significant improvements in EBP knowledge, self-efficacy, resource utilization, and databases

utilization compared to the control group. These improvements were statistically significant

(p < 0.01). In conclusion, the study demonstrated the effectiveness of an EBP education

program with blended learning in enhancing EBP knowledge, self-efficacy, and evidence
utilization among senior nursing undergraduates. The findings suggested the potential

benefits of incorporating blended learning into EBP education, and further research was

recommended to develop train-the-trainer programs for nursing educators and maximize the

effectiveness of blended learning in EBP education.

Azami et al. (2020) conducted a study aimed to investigate information literacy, evidence-

based nursing (EBN), nurses' attitudes, nurses' knowledge, and medication errors among

nurses at Kerman University of Medical Sciences in Iran. This study employed a survey

methodology, with the study group consisting of 164 nurses working in four hospitals

affiliated with Kerman University of Medical Sciences. The participants were selected

through simple random sampling. The research instrument included four sections:

demographic information, information literacy, evidence-based practice, and medication

errors. Data were collected and analyzed using SPSS version 22. The study's results revealed

that the nurses had a good understanding of the terminology used in evidence-based medicine

(p < 0.0001). Additionally, the study observed a significant increase in nurses' attitude levels

and their ability to implement and utilize evidence-based nursing practices. The study

findings indicated that there was a significant positive relationship between information

literacy and evidence-based nursing. This suggests that as nurses' information literacy

increased, their engagement in evidence-based nursing practices also increased, and vice

versa. The strength of this relationship was moderate, with a correlation coefficient of 0.37.

Furthermore, the results demonstrated a significant relationship between information literacy

and evidence-based nursing with nurses' knowledge and attitudes towards medication errors.

The study conducted by Alqahtani, et al., (2019) aimed to examine the influence of individual

factors among staff nurses in Saudi Arabia on their knowledge, attitudes, and implementation

of evidence-based practice (EBP). The study also sought to identify facilitators and barriers to

EBP implementation in this context. The study employed a cross-sectional, correlational

design and used a convenience sample of 227 staff nurses from four hospitals in Riyadh,

Saudi Arabia. The survey questions included the Evidence-Based Practice Questionnaire and

individual factors. Data analysis involved the use of multiple linear regression models. The

findings indicated that among the individual factors, attitudes towards EBP had the highest

mean score, followed by EBP knowledge and EBP implementation. The study revealed that

EBP training and research involvement were associated with EBP knowledge in both

bivariate and multivariate analyses. None of the individual factors were associated with

attitudes towards EBP. However, there was a positive association between knowledge and

attitudes towards EBP. Furthermore, both knowledge and attitudes had a positive influence on

EBP implementation. Interestingly, the study found that receiving EBP training made it

somewhat more challenging for nurses to participate in the EBP implementation process.

Additionally, attitudes were found to partially mediate the relationship between knowledge

and EBP implementation. The study concluded that nurses in Saudi Arabia demonstrated

willingness to engage in the EBP process. However, they acknowledged the need to enhance

their knowledge and skills to become active participants in the EBP process. The findings

underscored the importance of addressing individual factors, particularly attitudes and

knowledge, to promote EBP implementation among nurses in Saudi Arabia.

 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This section describes the methods and procedures used in the study. This will be discussed u

nder the following sub-headings: Research design, Research setting, Population target, Sampl

e size and sampling techniques, Instrument for data collection, Validity/reliability of the instr

ument, Ethical consideration, Method of data collection, and Method of data analysis

3.1 Research Design

A research design refers to the overall strategy or framework of the study and it constitutes th

e blueprint for the collection, measurement, and analysis of data. The descriptive survey met

hod was considered the most appropriate design because it is cheap and most suitable for this

study considering the fact that surveys used to obtain information concerning the current statu

s of the phenomena and to describe “what exists” with respect to variables or conditions in a s

ituation.

3.2 Research Setting

The study was carried out in the Department of Nursing Science, School of Basic Medical

Sciences, College of Medical Sciences, University of Benin, Benin City, Edo state. Benin Cit

y is situated approximately 25 miles North of the Benin river and situated 200 miles by road e

ast of Lagos.

3.3 Population of Study

The target population for this study were Five hundred and twelve (512) male and female und

ergraduate nursing students from the Department of Nursing Science, School of Basic

Medical Sciences, University of Benin.

3.4 Sample Size and Sampling Technique

Sample size
Sample of a study is a subset of a population selected to participate in a research study. The sa

mple size comprised of Fwo hundred and twenty-five (225) students in the University of Beni

n. This was estimated using the formulae below;

(Taro Yamen, 1967)

Where;

n = sample size

N = population size

e = level of precision (confidence interval)

e = 0.05

N = 512

Thus;
2
n=512/(1+512 ∗0.05 )

n ~225

Applying a 10% attrition, we have 39.7

The minimum expected sample size = 225+23 = 248

Sampling technique

Convenient sampling technique will be used.

3.5 Instrument for Data Collection

Data collection tool is an instrument used to collect data needed to address research questions.

The instrument for this study was a self-structured questionnaire, which was chosen because

the survey research design was used in this study. The questionnaire enhanced the collection

of data from a large number of respondents within a limited period of time(Chinweuba, Ihean

acho, & Agbapuonwu, 2014). The research instrument was constructed in Four (4) sections su

ch that section A covered the demographic characteristics of the students, while the other
sections covers items that relates to study’s objetives. The questionnaire contained closed end

ed questions and was constructed using the multiple-choice questions and Likert scale.

3.6 Validity of the Instrument

Validity refers to the degree to which a research instrument measures what it intends to measu

re (Jessen, 2012). A face and content validity were done by the researcher’s supervisor, and a

n expert in Biostatistics and all corrections after their review were effected.

3.7 Reliability the Instrument

Reliability refers to the degree to which a research instrument produces stable and consistent

results (Davidson, 2011). A reliable instrument is one that can produce the same results if the

behaviour is measured again by the same scale (Davidson, 2011). According to Jessen (2012),

the reliability of a measuring tool can be assessed in various ways. The Cronbach Alpha relia

bility technique was employed in this study. Reliability was upheld by using the same instrum

ent to collect data from the respondents and clarifications was done so that they did not misun

derstand the items in the questionnaire. In this study, the reliability testing was carried out suc

h that 25 questionnaires were distributed to faculties not selected for this study and their resp

onses will be analyzed for reliability. The Cronbach Alpha values greater than 0.7 will be

considered adequate.

3.8 Ethical Consideration

The ethical principles of research include certain requirements for the researcher: the research

information given to the participants, voluntary and autonomous participation and the possibil

ity to withdraw at any time they wish (Davidson, 2011). The principle of voluntary participati

on, maintenance of anonymity and confidentiality was maintained throughout the study.

Ethical approval will be collected from the College of Medical Sciences ethical review

committee. The questionnaires will be clearly explained to the selected students before and d

uring the process of answering them.

3.9 Method of Data Collection

Data for this study will be collected through the administration of questionnaires to responde

nts. It will be administered to the students during their break period. The distribution and coll

ection of filled questionnaires from the respondents will take place from August to October, 2

023.

3.10 Method of Data Analysis

Data analysis is a mechanism for reducing and organising data to produce findings that requir

e interpretation by the researcher (Jessen, 2012). All data was coded, entered and analyzed usi

ng Statistical Package for Social Sciences (SPSS) version 28.0 spread sheet. Data will be pres

ented using frequency and percentages in tables. Hypotheses testing will be tested using Chi-

square test of association. The level of significance will be set at p< 0.05.
 References

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 DEPARTMENT OF NURSING SCIENCE
SCHOOL OF BASIC MEDICAL SCIENCES
UNIVERSITY OF BENIN
QUESTIONNAIRE

Dear Respondent
I am an undergraduate student of the above-named institution. I am conducting research on
Evaluation of the understanding and utilization of nursing theories among
undergraduate nursing students of the university of benin in enhancing patient care
This questionnaire is designed to collect information for the study.
This is purely a research exercise. Kindly respond to the following questions whatever
information you supply will be treated in confidence. Please ( ü) as required in one or more
places or write in the space provide. All questions and responses are very important to this
study, please do well to answer them appropriately.
Thanks.
Section A: DEMOGRAPHIC CHARACTERISTICS

1. Age: 18-20 [ ] 21-25 [ ] 26-30 [ ] 31-35 [ ] 36-40 [ ] 41-45 [ ] 46-50 [ ] Over 50

2. Gender: Male [ ] Female [ ] Non-binary [ ] Prefer not to say
3. Ethnicity: Benin [ ] Yoruba [ ] Igbo [ ] Hausa [ ] Others [ ]
4. Religion: Christian [ ] Muslim [ ]
5. Marital Status: Single [ ] Married [ ] Divorced [ ] Widowed [ ] In a relationship
6. Residential Status: On-campus housing [ ] Off-campus housing [ ] Commuting

SECTION B: KNOWLEDGE OF NURSING THEORIES

1. Which nursing theorist is known for the theory of "[B]Self-Care Deficit Theory[/B]"? A.
Florence Nightingale [ ] B. Dorothea Orem [ ] C. Virginia Henderson [ ] D. Jean Watson
2. According to the Health Promotion Model, who plays a key role in promoting a patient's
health? A. Family members [ ] B. Healthcare providers [ ] C. The patient's employer [ ] D.
Community organizations
3. Which nursing theory emphasizes the importance of meeting a patient's basic needs to
achieve health and independence? A. Roy's Adaptation Model [ ] B. Watson's Theory of
Human Caring [ ] C. Peplau's Interpersonal Relations Theory [ ] D. Maslow's Hierarchy of
Needs
4. According to the Theory of Human Caring developed by Jean Watson, what is the core of
nursing practice? A. Medication administration [ ] B. Compassionate and holistic care [ ] C.
Technology and equipment use [ ] D. Efficient time management
5. Betty Neuman's Systems Model focuses on: A. Promoting self-care in patients [ ] B. The
nurse-patient therapeutic relationship [ ] C. The impact of stress on patient health [ ] D. The
importance of cultural competence in nursing
6. According to Madeleine Leininger's Theory of Cultural Care Diversity and Universality,
what is essential in providing culturally congruent care? A. Uniform treatment for all
patients [ ] B. Ignoring cultural differences [ ] C. Tailoring care to individual cultural needs
[ ] D. Avoiding patients from diverse backgrounds
7. Which nursing theorist is associated with the Theory of Interpersonal Relations, which
emphasizes nurse-patient interactions? A. Dorothea Orem [ ] B. Virginia Henderson [ ] C.
Hildegard Peplau [ ] D. Imogene King
8. In the Theory of Goal Attainment developed by Imogene King, what is the central focus of
nursing? A. Promoting adaptation [ ] B. Achieving patient goals [ ] C. Maintaining
homeostasis [ ] D. Providing technical care
9. Which nursing theory is based on the idea that individuals are open systems that interact with
their environments? A. Betty Neuman's Systems Model [ ] B. Patricia Benner's Novice to
Expert Theory [ ] C. Martha Rogers' Science of Unitary Human Beings [ ] D. Callista Roy's
Adaptation Model
10. According to the Theory of Transcultural Nursing developed by Madeleine Leininger, what is
the term used to describe the learned, shared, and transmitted values, beliefs, norms, and
lifeways of a particular group? A. Cultural awareness [ ] B. Cultural imposition [ ] C.
Cultural competence [ ] D. Cultural diversity
Section C: Utilisation of Nursing Theory
Please indicate your level of agreement with the following statements on a scale of 1 to 4,
with 1 being "Strongly Disagree" and 4 being "Strongly Agree."
S D A S
D A
I am familiar with various nursing theories.
I believe that nursing theories are essential for guiding patient care.
I incorporate nursing theories into my daily patient care practices.
I can identify the nursing theories that are most relevant to my patient
population.
I regularly use nursing theories to plan patient-centered care.
I feel confident in my ability to apply nursing theories in patient
assessments.
My colleagues and I discuss and share insights about nursing theories in
our work.
I believe that using nursing theories enhances the quality of patient care.
I receive adequate training and education on nursing theories in my
workplace.
Nursing theories are integrated into our institution's policies and
procedures for patient care.

Section D: Barriers and challenges hindering the effective integration of nursing

theories into patient care
Strongly Disagree Agree Strongly
disagree agree
High patient acuity and workload prevent me
from considering nursing theories during care
delivery.
Inadequate training and education on nursing
theories affect my ability to apply them in
real patient scenarios.
Insufficient support or mentorship for nurses
attempting to integrate nursing theories
affects success.
Lack of access to up-to-date nursing theory
resources (books, articles, etc.) impedes
integration into patient care.
Limited time during patient care shifts
hinders my ability to apply nursing theories
effectively.
Nursing administration does not prioritize the
incorporation of nursing theories into patient
care protocols.
Resistance from colleagues who do not value
nursing theories creates obstacles in their
integration.
The absence of feedback mechanisms to
evaluate the effectiveness of nursing theory
integration discourages efforts.
The complexity of nursing theories makes it
challenging to translate them into practical
patient care strategies.
The focus on task-oriented care in my
workplace diminishes the emphasis on
nursing theories.