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CHAPTER 1
THE PROBLEM AND ITS SCOPE
Introduction
Care is the language of nursing. It is traditionally defined as to have
concern for, to value, to have responsibility for, and to help. With regards
to this description, caring must be operationalized through intentional and
purposeful behavior. (Johnson & Webber, 2005)
Nurses have a caring intent. Their thoughts and behavior center in valuing
and helping others especially to their patient through the application of their
knowledge and skills acquired from formal education and values and meanings
gained through experience. (Gedder & Grosset, 2005)
Johnson and Weber mentioned in their book,An Introduction to Theory of
Reasoning in Nursing, that Quality health care has been defined as the provision
of high level professional service that are accessible to the population and that,
through the use of existing resources attain compliance and satisfaction of the
client. This definition of quality implies that the service delivered is the measure
rather than increase capacity of the individual to participate in the care process.
Out of the demand of nursing career nowadays in the world, the
Philippines produces an estimated 25,000 to 30,000 registered nurses a year but
the question is, are they all giving quality care aside from application of
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knowledge and skills? The connotation today of taking nursing profession is to
alleviate the economic status of the family but too often, the quality care to patient
is neglected. The researchers mutually agreed on this topic to evaluate whether
patients of different economic status receive quality care in the hospital.
Basically, a comparison of nursing care offered in the Private Rooms and Wards
is the focus of this study.
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Figure 1 Schematic Diagram of the Study Showing Quality Routine Nursing Care
in Private Rooms and Wards
3
QUALITY ROUTINE NURSING
CARE IN PRIVATE ROOMS AND
WARDS
Taking Rounds
IV Fluid monitoring
Taking Vital Signs
Administering Medications
Changing bed Linens
Promoting Cleanliness
Promoting proper hygiene
Health Teachings
Attending Needs
Ensuring Safety
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Statement of the Problem
The main purpose of the study is to determine the difference of quality
care provided by the nurse to the patients in private rooms and wards.
Specifically, this aims to answer the following questions:
1. What is the quality care perceived by the patients in private rooms?
2. What is the quality care perceived by the patients in wards?
3. Is there a significant difference in the quality of care as perceived by the
patients in private rooms and in the wards?
Hypothesis
1. Patients in private rooms received good quality care.
2. Patients in wards received fair quality care.
3. There is a significant difference in the quality of care in private rooms and
in the wards as perceived by the patients.
Significance of the Study
The result of this study will benefit the following:
1. Hospital administration, this study will aid the hospital in upholding their
reputation as a standard health institution. The result will motivate them to
conduct in-service training or CPE (Continuing Professional Education) for
nurses to improve the quality care.
2. Nurses, the result of the study will help the nurses to assess themselves if they
have rendered quality care to their patients. According to Venzon, Standard
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of care is used as a basis of comparison to determine whether nurses have
been provided or not in the execution of their studies. In addition to that, this
study will encourage them to act willfully on their responsibility as a nurse.
3. Patient, the result of the study will benefit them by receiving the quality care
they need. They will be educated of their rights as a health care consumer,
thus, optimum level of recovery will most likely be attained.
4. Future Researchers, this study may serve as a reference and would motivate
them to pursue similar research in a larger scale using more variables.
Definition of Terms
In order to facilitate understanding of the problem, the following key terms are
defined operationally:
Quality Care the provision of high level professional service that are accessible
to the population and that, through the use of existing resources attain
satisfaction of the client.
Nurse a person trained to care for a sick, injured and aged; a person who looks
for another person to tend to or care.
Patient a person confined in a private room or ward receiving quality care
rendered by a nurse.
Private Room a hospital accommodation with only one patient confined in a
room.
Ward a hospital accommodation with many beds for five to six patients.
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Taking Rounds visiting the patient to check on his/her condition done at the
beginning, during and at the end of the shift.
Intravenous Fluid Monitoring the checking of the intravenous (IV) fluid of the
patient, the type of solution, flow rate, the insertion site, the patency and
the time it was hooked.
Administering of Medication giving of medicine by a nurse to a patient through
intravenous tube, intramuscular route, intradermal route, subcutaneous,
oral route, and suppository or via nasogastric tube. It also means the nurse
ask the patients name, state the drugs name and indication before
administering.
Personal Hygiene self care by which people attend to such functions as bathing,
toileting, general body hygiene, and grooming. The nurse only promotes
this variable or encourage the patient when he/she is able to do his
activities of daily living.
Health Teachings the statement from a nurse that motivates the patient and/or
his/her family to gradually assume responsibility for his/her health care
and become independent from such assistance as soon as possible. It
includes exact information about the patients health condition, food
restriction and lifestyle modification.
Attending Needs the nurses responsibility to take immediate action to meet the
needs of a particular patient.
Ensuring Safety It is the proper precaution and assistance which is observed or
provided to prevent any accident or injury to the patient in the hospital vicinity.
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Vital Signs Monitoring refers to the taking of the clients blood pressure, body
temperature, pulse rate and respiratory rate. This is done after asking
permission and explaining the procedure to the patient. Privacy and
respect must be observe.
Cleanliness refers to a room that is neat and free from dirt or mess, trashes are
thrown in the garbage bin (biodegradable & non-biodegradable), bed side
table is properly placed and things are fixed.
Changing Bed linen changing of pillow case, blanket and bed sheet every other
day. The nurse may encourage the patient or significant others or could
delegate this task to a nurse aide.
Scope and Limitation of the Study
The study focuses on the quality of care offered by the nurses both in
patients staying in private rooms and wards. It involves 60 respondents, 30 from
private rooms and 30 from the wards who have met the criteria being imposed by
the researchers.
The study is concerned specifically on nine identified variables which are
taking rounds, IVF monitoring, administering medications, morning cares, health
teachings, attending needs, interaction, ensuring safety and vital signs monitoring.
The study was conducted between the period of June to August 2009 in
Valencia Sanitarium and Hospital Foundation Incorporation.
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CHAPTER 2
REVIEW OF RELATED LITERATURE AND CONCEPTUAL FRAMEWORK
This study evolves on the giving and providing of care to the patients in
different walks of life. It is important that the quality of care be evaluated so that
not only the patient and the Health Care Industry will be benefited but to the
Nurses to be as well. This study would be an inspiration for the nurses on the
importance of their care to the patient.
First, we should consider the meaning of care basing on the theory of Jean
Watson which is Human caring that focuses on the art and science of human
care. Caring is the essence of Nursing and the most central and unifying focus of
nursing practice. This theory offers a new way of conceptualizing and
maximizing human-human transactions that occurs daily in nursing practice. Her
major assumption about caring is the following: human caring in nursing is not
just an emotion, concern, attitude or benevolent desire. (De Laure & Ladner,
2006).
Caring connotes a personal response. It is an intersubjective human
process and is the moral ideal of nursing. It can be effectively demonstrated only
interpersonally and if its effective it promotes health and individual or family
growth. It promotes health more than does curing. Caring responses accept a
person not only as they are now, but also for what the person may become and a
caring environment offers the development of potential while allowing the person
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to choose the best action for the self at a given point in time (De Laure & Ladner,
2006).
The second thing that should be considered is the question What does a
quality care really means? The quality of health care services is the type of care
expected and maximizes the well being of patients once the balance between gain
and costs has been considered in all parts of the process (Johnson & Weber,
2007). In addition to that, quality in health care has been defined as the provision
of high level service that are accessible to the population and that, through the
use of existing resources attain compliance and satisfaction of the client (Venzon
& Nagtalon, 2006). Base on the different articles above, nursing profession is not
that easy as we thought.
The patient is the best, sometimes the only, judge of the interpersonal
aspect of care including the surroundings of patient care such as rooms and foods
often called the hotel service. The patients satisfaction is an essential goal of
health care and therefore a part of quality care. It is assumed that if the patient is
satisfied with his care, then it must be favorable good. Patients attitude influences
the degree of compliance to the medical regimen we received in the future.
(Venzon & Nagtalon, 2006).
Now, let us face the reality about the nursing care. It is a fact that quality
of patient care is the number one issue in nursing (Bueno & Fralic, 2008). This is
supported in the article about the issue of quality which has been focus of
industries and business enterprises from immemorial in attempt to capture the
market for their producers. The concept of quality and demand for quality care
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has been moved into all levels of the health care industry. Quality nursing care is
no longer a pursuit for professional excellence, but a consumer right. It is
imperative that the nursing profession evaluates its practice, modify, and/or
abandon those shown to have little or no effects on clients health, repackages its
service such that they meet the needs of its consumers. (Bergborn, 2008).
In this regard Nursing Research is one way of evaluating practices and
services provided and changing practice for better (Venzon & Nagtalon, 2006).
This issue is also observable here in the Philippines as well as in the other
countries. The researchers observed this while having their duties in the hospitals
where they were affiliated but they came to the idea that there must be a factor
involve in the change of quality care, the cost. Why is consideration of cost so
important? The very existence of the healthcare system depends on fiscal issues.
Cost has been a driving force for the change in the health care system as evidence
by the strength and numbers of manage care plans, increased use outpatient
hospitals stays. (Etches, 2007).
Though there are factors identified for the reduction of quality care, the
rights of the patient should not be over rule. In an attempt to provide universal
access to services in a cost-effective manner, quality does not have to be scarified.
For example, hospitals that are reducing the number of registered nurses
(downsizing) risk endangering quality. Safety and quality are frequently
compromised by inappropriate substitution of unqualified personnel for registered
nurses in direct care of clients. Remember that the first principle of the code of
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ethics for nurses is that treat everybody the same. We respect their dignity
regardless of their socio-economic status, says Taylor. (Hilton, 2004).
Let us consider the usual cares offered by the nurses to patients regardless
of their accommodation. As observed and practiced by the researchers in their
affiliated hospital here in Bukidnon.
Taking Rounds
The nurses start their duty by taking initial rounds wherein patients
condition where checked. Taking rounds is routinely done at the beginning of the
shift for the purpose of endorsement by the nurse on duty to the next shift. This
nursing responsibility is important for the next nurse on duty to know so that she
could plan her care for her shift. To know whom she will prioritize and to give or
attend to their immediate needs.
Monitoring of Intravenous Fluid
Monitoring of intravenous fluid of the patient is also practiced. An
important nursing function is to regulate the flow rate of an intravenous infusion.
The physician may describe in the order how long an infusion should last. It is
then a nursing responsibility to calculate the correct flow rate and regulate the
infusion. Problems that can result from incorrectly regulated infusion include
hypervolemia and hypovolemia. Unless a regulating device is being used, the
nurse administering the intravenous solution must regulate the drops per minute
manually by using the roller clamp to ensure that the prescribed amount of
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solution will be infused in the correct time span. (Kozier et al., 2004). Aside from
the flow rate, nurse should also check the type of intravenous fluid to be infused
according to the doctors order, the patency of the IV line and the site of insertion
for any unusuality.
Taking Vital Signs
Vital signs are a persons temperature, pulse, respiration, and blood
pressure. Health status is reflected in the indicators of vital body functioning. A
change in vital signs might indicate a change in health. Assessing vital signs is
part of nursing care in any setting. Institutional and agency policies govern when
and how frequently vital signs are to be assessed routinely. Vital signs are
assessed at least every four hours in hospitalized patient. (Taylor, et al, 2005). The
nurse should first identify the patient and explain the procedure before taking the
vital sign. Part of the procedure is doing it gently and accurately to promote
nurse-patient relationship.
Administering of Medications
Administering medication is done according to the Doctors order. Drug
administration is one of the highest risk areas of nursing practice and a matter of
considerable concern for both managers and practitioners. (Gladstone, 1995). In
Sumatras thesis, she quoted that when medication is being administered, The
Ten Rights safety rules should be followed: right medication, right amount, right
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time, right route, right patient, right assessment, right education, right evaluation,
right documentation and right to refuse the medication. (Lilley, et al, 2001).
Changing Bed Linens
Because people are usually confined to bed when ill, often for long
periods, the bed becomes an important element in the clients life.(Kozier, et al,
2004). Nurses need to be able to prepare hospital beds in different ways for
specific purposes. This task may also be delegated to the nurse aide. In Valencia
Sanitarium and Hospital, changing of bed linens is done every other day or
according to the patients preference.
Promoting Cleanliness
A place that is clean, safe, and comfortable contributes to the clients
ability to rest and sleep and to a sense of well-being. (Kozier, et al, 2004).
Promoting cleanliness refers to a room that is neat and free from dirt or mess,
trashes are thrown in the garbage bin (biodegradable & non-biodegradable), bed
side table is properly placed and things are fixed.
Personal Hygiene
Personal hygiene is the self care by which people attend to such functions
as bathing, toileting, general body hygiene, and grooming. It is important for
nurses to know exactly how much assistance a client needs for hygienic care.
(Kozier, et al, 2004). Morning care is often provided after clients have breakfast,
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although it may be provided before breakfast. It usually includes the provision of
urinal or bed pan, a bath or shower, perineal care, back massages, and oral, nail,
and hair care. Making the clients bed is part of morning care.(Kozier, et al, 2004).
This responsibility is usually done to a dependent patient or immobile thus nurse
assistance is needed in performing activities of daily living (ADLs). But when the
patient is able to do ADLs, the nurse may only do the promotion or
encouragement.
Health teachings
The decision to establish a health promotion program must be base on the
health needs of the people; also, specific health promotion, goals must be set.
Nurses may offer an abundance of information less formally. To do so, however,
nurses need up to date knowledge, the ability to assess learning needs, and
effective teaching skills. (Kozier, et al, 1997). As experienced by the researchers,
giving health teachings may include, the precipitating factors of the patients
sickness, educating for the signs and symptoms, and lifestyle modification base
on the patients condition.
Attending needs
Patients were confined for the reason of seeking care and it is the nurses
responsibility to attend to their needs while they are still in the hospital. Needs is a
general term which may consist of any information asked by the patients or
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interventions that must be perform to them. It could be physical, emotional or
spiritual needs.
Ensuring Safety
Providing safe, error-free care is the number one priority of all health care
professionals. On the other hand, the first objective of the professional practice
environment for nurses is to put the patient first and focus on patients safety and
quality care. (Rosenstein, 2005). According to Sumatras thesis, Watson suggests
that the nurse must provide comfort, privacy, and safety as part of this carative
factor. (George, 1995).
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CHAPTER 3
METHODOLOGY
This chapter presents the details of research design, research locale,
selection of study subjects and method of data collection.
Research Design
This research was a survey approach to determine the quality of care
perceived by the patients from different accommodations. The researchers
compared and documented the quality of care rendered by the nurses in private
room and ward accommodations of Valencia Sanitarium and Hospital.
Research Locale
This study was conducted in private rooms and wards of Valencia
Sanitarium and Hospital Foundation Incorporation which is now a tertiary level
hospital as approved by the Department of Health (DOH) on November 14, 2008.
This hospital is located in Valencia City, Bukidnon
It is a three story building with 70 rooms of which 12 from wards and 35
from private rooms. It has a bed capacity of 100 and a daily average patient count
of 50.
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Selection of the Study Subjects
The researchers selected 30 study subjects from private rooms and another
30 subjects from the wards using random sampling. They were qualified in the
following criteria:
1. Must be a patient of Valencia Sanitarium and Hospital
2. Willing to participate in the study.
3. Accommodated either in wards or private rooms.
4. Have stayed in the hospital for at least 2 days.
5. Either male or female.
6. Literate- able to read and write.
7. No barriers in reading and understanding.
8. Has not been taken cared by the student nurse
The study subjects in private room and wards were given a questionnaire
respectively evaluating the Quality Care they received. The researchers conducted
seven sessions of evaluation within 2 months, once every week until the desired
numbers of respondents are completed.
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Distribution of the StudySESSION PRIVATE ROOM
RESPONDENTS
WARD RESPONDENTS TOTAL
Grand Total 30 30 60
Research Instrument
The instrument that was used was a questionnaire formulated by the
researchers approved by the Research Adviser and three other Clinical Instructors
of Mountain View College. The questionnaire was based on the routine services
offered by the staff nurses in VSH and on the experience of the researchers in
Valencia Sanitarium and Hospital during their exposure in clinical area.
Each respondent was instructed to check the box with its corresponding
quality description. The questionnaire was arranged according to the variables
being identified, which is the routine nursing services in the hospital, and each
question has a corresponding scale: (5) always, and the equivalent of this routine
nursing care is excellence, (4) often, which means that the quality of routine
nursing care is good, (3) sometimes, this quality of routine nursing care rated as
First 3 9 12
Second 4 1 5
Third 2 6 8
Fourth 9 5 14Fifth 7 4 11
Sixth 5 2 7
Seventh 3 3
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fair,(2) rarely, that signifies poor quality routine nursing care,(1) never, this
means that the quality of routine nursing care is very poor performed.
Data Gathering Procedure
Before the actual collection of the data, the researchers formulated first a
questionnaire which was approved by the Research Adviser and three other
Clinical Instructors of Mountain View College. The researchers then asked
permission from the Director of the hospital to conduct a non-experimental study
in their hospital. They presented a letter approved by the Dean of Nursing
allowing the researchers to conduct a survey on the patients of VHS. The
researchers went to the Nurses station to have the list of patient qualified for the
study according to the formulated criteria and randomly noted down 10 names of
patients in private rooms and wards respectively.
Each researcher distributed questionnaires to the study subjects in the
wards and in the private rooms respectively completing 60 respondents from both
ward and private rooms in two-month time. The study subjects were instructed
properly and answered the questionnaire in the presence of the researchers. They
were informed about the purpose of the research and assured of their four rights as
a study subject which are (1) right not to be harmed,(2) right to full disclosure, (3)
right of self determination, and (4) right of privacy and confidentiality (Venzon &
Nagtalon, 2006).
The data collection was completed in two month time and was submitted
to the statistician of the school, MVC.
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CHAPTER 4
PRESENTATION, ANALYSIS & INTERPRETATIONOF THE FINDINGS
This chapter presents the analysis and interpretation of the result of the
study in comparing the quality care offered in private rooms and in wards.
Problem 1 : What is the quality care perceived by the patients in
private rooms?
Table 1 shows that monitoring of intravenous fluid (4.8), taking rounds
(4.6), taking Vital signs (4.56), and attending needs (4.16) rated as excellent
quality of care. On the other hand, administering of medications (3.9) ensuring
safety (3.6), and health teachings (3.5) were has a good quality nursing care,
while promoting proper hygiene (3.16), encouraging in changing bed linen (2.96),
and promoting cleanliness (2.93) has a fair quality carein the private rooms.
An important nursing function is to regulate the flow rate of an
intravenous infusion. The physician may describe in the order how long an
infusion should last. It is then a nursing responsibility to calculate the correct flow
rate and regulate the infusion. Problems that can result from incorrectly regulated
infusion include hypervolemia and hypovolemia. Unless a regulating device is
being used, the nurse administering the intravenous solution must regulate the
drops per minute manually by using the roller clamp to ensure that the prescribed
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amount of solution will be infused in the correct time span. (Kozier et al., 2004).
Since it is a routine nursing responsibility and a hospital protocol, it will also have
a high weighted mean which is 4.8.
Taking rounds is routinely done at the beginning of the shift for the
purpose of endorsement by the nurse on duty to the next shift. This nursing
responsibility is important for the next nurse on duty to know so that she could
plan her care for her shift, thus, taking rounds is always done.
Health status is reflected in the indicators of vital body functioning. A
change in vital signs might indicate a change in health. Assessing vital signs is
part of nursing care in any setting. Institutional and agency policies govern when
and how frequently vital signs are to be assessed routinely. Vital signs are
assessed at least every four hours in hospitalized patient.(Taylor, et al, 2005).
Thus, this variable is always done.
Patients were confined for the reason of seeking care and it is the nurses
responsibility to attend to their needs while they are still in the hospital, thus, the
variable attending needs has a weighted mean of 4.16 with a verbal description of
always done.
Drug administration is one of the highest risk areas of nursing practice and
a matter of considerable concern for both managers and practitioners. (Gladstone,
1995). In Sumatras thesis, she quoted that when medication is being
administered, The Ten Rights safety rules should be followed: right medication,
right amount, right time, right route, right patient, right assessment, right
education, right evaluation, right documentation and right to refuse the
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medication. (Lilley, et al, 2001). These rights are usually forgotten to apply in the
hospital setting per experienced. The researchers formulated reasons such as that
the medicine nurse relies on the patients name tag so they will no longer ask for
the patients name. Sometimes, the name, the indication, general action and
adverse reaction of the drugs are already explained to the patient on the first
administration therefore, medicine nurse will not repeat its explanation on the
next administration. So this variable is often done.
Providing safe, error-free care is the number one priority of all health care
professionals. On the other hand, the first objective of the professional practice
environment for nurses is to put the patient first and focus on patients safety and
quality care. (Rosenstein, 2005). According to Sumatras thesis, Watson suggests
that the nurse must provide comfort, privacy, and safety as part of this carative
factor. (George, 1995). Its the hospitals prerogative to set safety precautions and
control any hazardous materials to ensure the safety of their patients therefore this
variable has a weighted mean of 3.6.
The decision to establish a health promotion program must be base on the
health needs of the people; also, specific health promotion, goals must be set.
Nurses may offer an abundance of information less formally. To do so, however,
nurses need up to date knowledge, the ability to assess learning needs, and
effective teaching skills. (Kozier, et al, 1997). Therefore, health teachings is often
done by the nurses to the patient with a weighted mean of 3.5. As observed, the
doctors would give information to the patients about their condition, food
restrictions and practices that would affect their health as well as the treatment
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needed for their sickness during the Doctors visit, so nurses will serve as health
educators to reinforce the doctors order.
Personal hygiene is the self care by which people attend to such functions
as bathing, toileting, general body hygiene and grooming. It is important for
nurses to know exactly how much assistance a client needs for hygienic care.
(Kozier, et al, 2004). Nurses sometimes encourage the patients to perform their
personal hygiene because it is already part of their activities of daily living.
Because people are usually confined to bed when ill, often for long
periods, the bed becomes an important element in the clients life.(Kozier, et al,
2004). Since, most of the respondents were confined for at least two days,
changing of bed linens are sometimes done because the hospitals protocol for
changing linens is every other day.
A place that is clean, safe, and comfortable contributes to the clients
ability to rest and sleep and to a sense of well-being. (Kozier, et al, 2004).
Promotion of cleanliness are often neglected and sometimes done by the nurses
because they usually rely on the hospitals own institutional workers to maintain
the cleanliness of the surroundings.
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Table 1
The Quality of Care Perceived by Patients in Private Rooms
Indicators Weighted Mean Verbal Description
Rounds 4.6 Always
IVF Monitoring 4.8 Always
Vital Signs 4.56 Always
Drug Administration 3.9 Often
Bed Linen 2.96 Sometimes
Cleanliness 2.93 Sometimes
Proper Hygiene 3.16 Sometimes
Health Teachings 3.5 Often
Attending Needs 4.16 Always
Ensuring Safety 3.6 Often
Problem 2: What is the quality care perceived by the patients in
wards?
Table 2 presents that taking rounds (4.8), taking vital signs (4.66),
monitoring IV fluids (4.56), ensuring safety (4.26), and attending needs (4.23) has
excellent quality nursing care. Administering of medication (4.13) has a good
quality routine nursingcare, while health teachings (3.33), promoting of proper
hygiene (3.1), changing of bed linen (2.66), and encouraging cleanliness (2.53)
has a fairly quality nursing care in wards.
Taking rounds is routinely done at the beginning of the shift for the
purpose of endorsement by the nurse on duty to the next shift. This nursing
responsibility is important for the next nurse on duty to know so that she could
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plan her care for her shift, thus, taking rounds is always done, regardless of
accommodation.
Health status is reflected in the indicators of vital body functioning. A
change in vital signs might indicate a change in health. Assessing vital signs is
part of nursing care in any setting. Institutional and agency policies govern when
and how frequently vital signs are to be assessed routinely. Vital signs are
assessed at least every four hours in hospitalized patient. Thus, this variable is
always done too in wards.
As discussed previously, monitoring of Intravenous fluid and attending
needs are important nursing responsibility and part of the nurses daily routine
regardless of type of Hospital room accommodation; therefore, it is always done.
Unlike in private rooms, ensuring safety in wards is always done since
many patients are being accommodated in one room where the space is limited
thus increasing the risk for accidents and harms. For instance, a patient having
oxygen therapy while other patients are using nebulizer and other equipments that
need electricity are at higher risk for fire related accidents.
As discussed above, drug administration is one of the highest risk areas of
nursing practice and a matter of considerable concern for both managers and
practitioners. (Gladstone, 1995). In Sumatras thesis, she quoted that when
medication is being administered, The Ten Rights safety rules should be
followed: right medication, right amount, right time, right route, right patient,
right assessment, right education, right evaluation, right documentation and right
to refuse the medication. (Lilley, et al, 2001. These rights are usually forgotten to
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apply in the hospital setting per experienced. The researchers formulated reasons
such as that the medicine nurse relies on the patients name tag so they will no
longer ask for the patients name. Sometimes, the name, the indication, general
action and adverse reaction of the drugs are already explained to the patient on the
first administration therefore, medicine nurse will not repeat its explanation on the
next administration to maximize the time since there are a large number of
patients that needs to be attended. So, this variable is often done.
In wards, giving of health teachings, promoting of proper hygiene,
changing of bed linens, and encouraging cleanliness are sometimes done due to
the same reasons discussed in the result in private rooms.
Table 2
The Quality Care Perceived by Patients in Wards
Indicators Weighted Mean Verbal Description
Rounds 4.8 Always
IVF Monitoring 4.56 Always
Vital Signs 4.66 Always
Drug Administration 4.13 Often
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Bed Linen 2.66 Sometimes
Cleanliness 2.53 Sometimes
Proper Hygiene 3.1 Sometimes
Health Teachings 3.33 Sometimes
Attending Needs 4.23 Always
Ensuring Safety 4.26 Always
Problem 3: Is there a significant difference in the quality of care as
perceived by the patients in private rooms and in the wards?
The table shows that the average score of the quality care in wards is 3.83
with a qualitative description as often which is equivalent to good while the
average score of the quality care in private rooms is 3.82 with a qualitative
description as often which also equivalent to good. This presents that there is no
significant difference of quality care between private rooms and wards.
The researchers identified factors that would probably interfere in the
result of the study. The first one was the nurse-patient ratio which is a maximum
of one charged nurse, one medicine nurse; one nurse aide is to 18 patients
(1:1:1:18). When there are enough nurses to take care of the patients, quality care
is most likely to be achieved.
The second factor is quality control. It is a fact that quality of patient care
is the number one issue in nursing (Bueno & Fralic, 2008). This is supported in
the article about the issue of quality which has been focus of industries and
business enterprises from immemorial in attempt to capture the market for their
producers. The concept of quality and demand for quality care has been moved
into all levels of the health care industry. (Bergborn, 2008). The patient is the
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best, sometimes the only, judge of the interpersonal aspect of care including the
surroundings of patient care such as rooms and foods often called the hotel
service. The patients satisfaction is an essential goal of health care and therefore
a part of quality care. It is assumed that if the patient is satisfied with his care,
then it must be favorable good. (Venzon & Nagtalon, 2006)
Since Valencia Sanitarium & Hospital passed the requirement of
Department of Health for tertiary level, it is assumed that the hospital maintains
quality care.
Third, we have identified that the length of confinement could be one of
the factors. Most of the patients who participated in the study were confined for at
least two days; quality care is most likely to be achieved because the nurses are
still apt to do their responsibility. On the other hand, patients who have longer
period of confinement may have a lesser quality care basing on the variables used
by the researchers due to the following reasons: Nurses would no longer ask for
their name because they were already known; routine procedures, health teachings
and information about medication are less emphasized unlike on the first few days
of patients admission, since it has been habitually done by the nurse.
Table 3
Difference of Quality Care in Private Rooms and Wards as Perceived by the
Patients
WARDS PRIVATE ROOMS
Weighted Mean Qualitative Weighted Qualitative
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Description Mean Description
3.83 Often 3.82 Often
CHAPTER 5
SUMMARY, CONCLUSION AND RECOMMENDATIONS
This chapter presents the summary of the study, the conclusions and
recommendations base on the results.
Summary
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This study was about the quality of care in private rooms and wards as
perceived by the patients, and the significant difference in the quality of care as
perceived by patients in the private rooms and in the wards.
The study utilized the descriptive research design with 30 respondents
from private rooms and wards of Valencia Sanitarium & Hospital respectively
chosen through the criteria imposed by the researchers. The instrument used for
the study was a survey questionnaire formulated by the researcher and subjected
to a reliability test done by the research adviser and two clinical instructors. The
questionnaire was composed of ten identified routine nursing care which are the
following, taking rounds, intravenous fluid monitoring, taking vital signs,
administration of medication, changing of bed linens, promoting cleanliness and
proper hygiene, giving of health teachings, attending needs and providing safety.
The study subjects were instructed properly and answered the
questionnaires in the presence of the researchers.
The data was presented to the schools statistician for interpretation. The
result of the study shows that both patients in private rooms and wards perceived
that the quality care was often practiced but there is no significant difference in
the quality of care in terms of the variables identified above which are the routine
nursing care.
Conclusion
Based on the result of the study and the interpretation of the data gathered,
there is no significant difference in the quality of care in terms of the kind of
accommodation except for the variable ensuring safety that shows in the
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Asymp.Sig. (2-tailed) in test statistics with a result of .048. Therefore the
hypothesis which is There is a significant difference in the quality of care in
private rooms and in the wards as perceived by the patients is partially rejected.
Recommendation
The following are the recommendations based on the findings and
conclusions drawn from the study:
1. Valencia Sanitarium & Hospital should continue in upholding their
standard delivery of care. We also recommend that they should give more
emphasis on the variables in which the rating is low such as promoting
cleanliness, proper hygiene, changing bed linens and health teachings.
2. Nurses play a vital role in the delivery of care, so to further improve the
quality of their service, we recommend that they should always be
reminded of their responsibilities towards their patients. They should not
overlook small tasks such as promoting cleanliness in the environment,
changing bed linens and proper hygiene especially giving of health
teachings since these variables are sometimes done.
3. The upcoming researchers are recommended to add more variables to the
research questionnaire, to increase the number of respondents and expand
the research locale to other private and government hospitals to attain
more reliable results.
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REFERENCES
Bergborn, I. (2008). Factors Influencing Health Care. Scandinavian Journal ofCaring Sciences, 152.
Bueno, M.C. & Fralic, M.F. (2008). Current Issues in Nursing,401.
De Laure, S.C. & Ladner, P.K.Fundamentals of Nursing: Standards and
Practice. London: Lippincott Williams & Wilkins.
Etches, W.K. (2007, January 27-30). Improving Ward Management.Nursing
Standard,21(20), 35-40.
Gedder, S.C. & Grosset R.B. (2005). Webster Universal Dictionary & Thesaurus.
Scottland: David dale House.
Hilton, L. (2004).The Nurses Role.Nursing Spectrum and Nurses Week, 42-43.
Johnson, B.M. & Webber, P.B. (2005).An Introduction to Theory and Reasoning
in Nursing(2nd ed.). Philadelphia: Lippincott Williams & Wilkins Inc.
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Kozier, B., Erb, G. & Blais, K. (1997).Professional Nursing Practice Concepts
& Perspectives. (3rd ed.). California: Addiso-Wesley Longman, Inc.
Kozier, B., Erb, G., Berman, A. & Snyder, S. (2004).Kozier & Erbs Techniques
in Clinical Nursing Basic to Intermediate Skills. (5th ed.). New Jersey: PearsonEducation, Inc.
Taylor, C., Lillis, C. & LeMone, P. (2005).Fundamentals of Nursing .New York:
Lippincott Williams & Wilkins.
Venzon, N.L. & Nagtalon, J.M.V. (2006).Nursing Management Towards Quality
Care (3rd ed.). Quezon: C & E Publishing Inc.
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APPENDICES
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APPENDIX A
Research Questionnaire
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RESEARCH QUESTIONNAIRE
Nagahangyo mi sa inyong gamay nga oras sa pagtubag niining mga pangutana kabahin sapag atiman sa mga nurse kaninyo. Ug para sa inyo ng tubag, palihog i-check ang kahon sa matag
pangutana. Salamat sa inyong partisipasyon.
1. Gina-anhaan ba ka sa imong nurse sa
pagsugod, sa tunga-tunga ug sa kataposansa iyang duty?
2. Gina-monitor ba sa imong nurse angimo IV fluid o dextrose sama sa kung pila
ang nahabilin, sakto ang tulo ug kung
walay bara ang linya ug ang kamot na
ginatauran sa dextrose?
3. Ang imong nurse ba gapananghid, ga
obserbar sa imong privacy, gaatag ugsaktong pag-atiman, ug gahatag ug respeto
isip usa ka pasyente sa dili pa siyamagkuha ug vital signs.
4. Ang imong nurse ba gapangutana saimong pangalan? Ginaingon ba niya kungunsa ugpara asa ang tambal na iyang
ginahatag?
5. Ginadasig ba ka sa imong nurse sa
pag-ilis sa ug hapin sa imong katre.
6. Ginaplastar ba niya ang imong gamit
apil ang imong katre ug nagapahinumdum
na imentinar ang kahinluon sa imong
palibot?7. Ginadasig ba ka sa imong nurse sa
pagbuhat sa saktong pag-atiman ug pag-hinlo sa imong lawas?
8. Ang nurse ba nagahatag ug saktong
impormasyon ug eksplinasyon bahin sa
imong sakit ug pagkaon ug praktis angay sa
imong lawas?
9. Ang nurse ba nagagahin sa iyang
panahon ug gina aksyonan ang tanan
nimong panginahanglanon?
10. Ang nurse ba naay panglantaw saimong seguridad pinaagi sa paglikay sa
mga aksidente sulod sa hospital?
Please check:
Gender: ( ) lalaki
( ) babae
Age:
Date of Admission:
Accommodation: ( ) private rooms
( ) wards
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APPENDIX BRequest Letter
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APPENDIX CSummary Data
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Summary Data from Private RoomsPatients rounds IVF Vital
signs
Medicine Bed
linen
cleanliness hygiene teachings needs safety
1 5 5 5 5 5 5 5 5 5 52 5 5 4 4 5 4 1 4 4 33 4 4 4 4 4 4 1 4 4 44 4 5 5 4 5 5 4 4 4 35 5 5 5 5 5 3 3 3 4 56 5 5 5 5 5 5 4 5 5 57 5 5 5 4 5 5 4 4 5 58 5 5 5 5 5 5 5 5 5 59 5 5 5 3 1 1 1 1 3 110 3 5 3 3 1 3 3 3 3 311 5 5 5 5 2 3 3 4 5 112 4 4 3 1 1 1 1 1 1 213 5 5 4 4 4 4 1 4 5 4
14 4 4 3 1 1 3 3 3 3 315 3 3 3 2 1 1 1 1 1 116 5 5 5 3 1 1 1 1 3 117 5 5 5 5 5 5 5 5 5 518 5 5 5 3 3 4 4 4 5 519 5 5 5 2 1 1 1 1 5 120 5 5 5 5 5 5 5 5 5 521 3 5 5 4 1 2 5 5 4 5
22 5 4 5 3 3 1 3 1 4 5
23 5 5 5 4 1 1 4 4 4 3
24 5 5 4 5 5 4 5 4 5 4
25 4 5 4 4 3 5 5 5 5 4
26 5 5 5 5 5 3 5 5 5 4
27 5 5 5 5 3 1 4 4 4 4
28 5 5 5 5 1 1 3 5 5 4
29 5 5 5 5 1 1 1 1 5 5
30 4 5 5 4 1 1 4 4 4 3
Summary Data from WardsPatients rounds IVF Vital
signs
Medicine Bed
linen
cleanlines
s
hygiene teachings needs Safety
1 5 5 5 5 5 4 5 5 5 5
2 3 4 3 3 1 1 2 2 3 5
3 5 5 5 1 3 3 5 3 3 5
4 3 4 4 3 2 1 4 5 3 3
5 5 5 4 5 5 4 5 1 3 3
6 4 4 4 3 4 1 1 1 5 4
7 5 5 5 5 5 5 5 5 5 5
8 4 3 4 4 3 4 5 4 5 5
9 5 4 4 3 2 3 1 3 4 4
10 5 5 5 5 2 1 1 5 5 3
11 5 4 4 4 3 3 4 4 4 4
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12 5 3 5 5 1 3 4 1 5 5
13 5 5 5 3 1 2 3 5 5 5
14 5 5 5 4 4 3 5 5 5 5
15 5 4 5 5 1 1 1 1 5 5
16 5 5 5 4 4 1 1 3 3 4
17 5 4 5 4 1 1 1 1 3 4
18 5 5 5 5 1 1 1 5 5 5
19 5 5 5 5 1 1 1 1 4 5
20 5 4 4 5 1 1 1 1 5 1
21 5 5 5 5 2 1 5 5 3 5
22 5 5 5 5 1 1 1 1 3 3
23 5 5 5 5 5 5 2 5 5 5
24 5 5 4 4 2 4 5 4 3 4
25 5 5 5 5 5 5 5 5 5 5
26 5 5 5 5 4 4 5 5 5 5
27 5 5 5 1 1 3 5 5 5 5
28 5 5 5 4 2 1 1 1 3 1
29 5 5 5 4 3 3 3 3 5 5
30 5 5 5 5 5 5 5 5 5 5
APPENDIX DStatistical Studies
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Descriptives(a)
Statistic Std. Error
rounds Mean 4.60 .123
95% ConfidenceInterval for Mean
Lower Bound 4.35
Upper Bound 4.85
5% Trimmed Mean 4.67
Median 5.00
Variance .455
Std. Deviation .675
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.473 .427
Kurtosis.957 .833IVF Mean 4.80 .088
95% ConfidenceInterval for Mean
Lower Bound 4.62
Upper Bound4.98
5% Trimmed Mean 4.87
Median 5.00
Variance .234
Std. Deviation .484
Minimum 3
Maximum 5
Range 2
Interquartile Range 0
Skewness -2.499 .427
Kurtosis 6.057 .833
vital signs Mean 4.57 .133
95% ConfidenceInterval for Mean
Lower Bound 4.29
Upper Bound4.84
5% Trimmed Mean 4.63
Median 5.00
Variance .530
Std. Deviation .728
Minimum 3Maximum 5
Range 2
Interquartile Range 1
Skewness -1.397 .427
Kurtosis .493 .833
medicine Mean 3.90 .222
95% Confidence Lower Bound 3.45
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Interval for Mean Upper Bound4.35
5% Trimmed Mean 4.00
Median 4.00
Variance 1.472Std. Deviation 1.213
Minimum 1
Maximum 5
Range 4
Interquartile Range 2
Skewness -1.037 .427
Kurtosis .348 .833
bed linen Mean 2.97 .330
95% ConfidenceInterval for Mean
Lower Bound 2.29
Upper Bound3.64
5% Trimmed Mean 2.96
Median 3.00
Variance 3.275
Std. Deviation 1.810
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness .016 .427
Kurtosis -1.871 .833
cleanliness Mean 2.93 .307
95% ConfidenceInterval for Mean
Lower Bound 2.31
Upper Bound3.56
5% Trimmed Mean 2.93
Median 3.00
Variance 2.823
Std. Deviation 1.680
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.028 .427
Kurtosis -1.704 .833
hygiene Mean 3.17 .292
95% ConfidenceInterval for Mean
Lower Bound 2.57
Upper Bound3.76
5% Trimmed Mean 3.19
Median 3.50
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Variance 2.557
Std. Deviation 1.599
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.345 .427
Kurtosis -1.443 .833
teachings Mean 3.50 .279
95% ConfidenceInterval for Mean
Lower Bound 2.93
Upper Bound4.07
5% Trimmed Mean 3.56
Median 4.00
Variance 2.328
Std. Deviation 1.526Minimum 1
Maximum 5
Range 4
Interquartile Range 3
Skewness -.812 .427
Kurtosis -.833 .833
needs Mean 4.17 .204
95% ConfidenceInterval for Mean
Lower Bound 3.75
Upper Bound4.58
5% Trimmed Mean 4.30
Median 4.50
Variance 1.247
Std. Deviation 1.117
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.624 .427
Kurtosis 2.547 .833
safety Mean 3.60 .265
95% Confidence
Interval for Mean
Lower Bound 3.06
Upper Bound4.14
5% Trimmed Mean 3.67
Median 4.00
Variance 2.110
Std. Deviation 1.453
Minimum 1
Maximum 5
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Range 4
Interquartile Range 2
Skewness -.755 .427
Kurtosis -.687 .833
a room_priv.ward = 1
Tests of Normality(b)
Kolmogorov-Smirnov(a) Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
rounds .423 30 .000 .626 30 .000
IVF .494 30 .000 .471 30 .000
vital signs .424 30 .000 .622 30 .000
medicine .233 30 .000 .823 30 .000
bed linen .261 30 .000 .760 30 .000
cleanliness .242 30 .000 .810 30 .000hygiene .212 30 .001 .821 30 .000
teachings .295 30 .000 .781 30 .000
needs .272 30 .000 .736 30 .000
safety .208 30 .002 .822 30 .000
a Lilliefors Significance Correctionb room_priv.ward = 1
Descriptives(a)
Statistic Std. Error
rounds Mean 4.80 .101
95% ConfidenceInterval for Mean
Lower Bound 4.59
Upper Bound5.01
5% Trimmed Mean 4.89
Median 5.00
Variance .303
Std. Deviation .551
Minimum 3
Maximum 5
Range 2
Interquartile Range 0
Skewness -2.758 .427Kurtosis 6.731 .833
IVF Mean 4.60 .113
95% ConfidenceInterval for Mean
Lower Bound 4.37
Upper Bound4.83
5% Trimmed Mean 4.67
Median 5.00
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Variance .386
Std. Deviation .621
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.330 .427
Kurtosis .831 .833
vital signs Mean 4.67 .100
95% ConfidenceInterval for Mean
Lower Bound 4.46
Upper Bound4.87
5% Trimmed Mean 4.72
Median 5.00
Variance .299
Std. Deviation .547Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.407 .427
Kurtosis 1.201 .833
medicine Mean 4.13 .208
95% ConfidenceInterval for Mean
Lower Bound 3.71
Upper Bound4.56
5% Trimmed Mean 4.26
Median 4.50
Variance 1.292
Std. Deviation 1.137
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.486 .427
Kurtosis 1.987 .833
bed linen Mean 2.67 .285
95% Confidence
Interval for Mean
Lower Bound 2.08
Upper Bound3.25
5% Trimmed Mean 2.63
Median 2.00
Variance 2.437
Std. Deviation 1.561
Minimum 1
Maximum 5
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Range 4
Interquartile Range 3
Skewness .367 .427
Kurtosis -1.416 .833
cleanliness Mean 2.53 .278
95% ConfidenceInterval for Mean
Lower Bound 1.96
Upper Bound3.10
5% Trimmed Mean 2.48
Median 3.00
Variance 2.326
Std. Deviation 1.525
Minimum 1
Maximum 5
Range 4
Interquartile Range 3Skewness .307 .427
Kurtosis -1.429 .833
hygiene Mean 3.10 .333
95% ConfidenceInterval for Mean
Lower Bound 2.42
Upper Bound3.78
5% Trimmed Mean 3.11
Median 3.50
Variance 3.334
Std. Deviation 1.826
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.122 .427
Kurtosis -1.906 .833
teachings Mean 3.33 .319
95% ConfidenceInterval for Mean
Lower Bound 2.68
Upper Bound3.99
5% Trimmed Mean 3.37
Median 4.00
Variance 3.057
Std. Deviation 1.749
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.385 .427
Kurtosis -1.654 .833
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needs Mean 4.23 .171
95% ConfidenceInterval for Mean
Lower Bound 3.88
Upper Bound4.58
5% Trimmed Mean 4.26Median 5.00
Variance .875
Std. Deviation .935
Minimum 3
Maximum 5
Range 2
Interquartile Range 2
Skewness -.503 .427
Kurtosis -1.728 .833
safety Mean 4.27 .209
95% ConfidenceInterval for Mean Lower Bound 3.84Upper Bound4.69
5% Trimmed Mean 4.41
Median 5.00
Variance 1.306
Std. Deviation 1.143
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.755 .427
Kurtosis 2.715 .833
a room_priv.ward = 2
Tests of Normality(b)
Kolmogorov-Smirnov(a) Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
rounds .508 30 .000 .411 30 .000
IVF .407 30 .000 .656 30 .000
vital signs .429 30 .000 .623 30 .000
medicine .277 30 .000 .750 30 .000
bed linen .199 30 .004 .840 30 .000
cleanliness .276 30 .000 .818 30 .000
hygiene .251 30 .000 .752 30 .000
teachings .263 30 .000 .766 30 .000
needs .360 30 .000 .679 30 .000
safety .339 30 .000 .684 30 .000
a Lilliefors Significance Correctionb room_priv.ward = 2
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Test Statistics(a)
rounds IVF vital signs medicine bed linen cleanliness hygiene teachings needs safety
Mann-Whitney U 378.000 375.000 436.500 397.500 414.000 386.000 441.000 449.500 446.000 325.000
Wilcoxon W 843.000 840.000 901.500 862.500 879.000 851.000 906.000 914.500 911.000 790.000Z -1.481 -1.468 -.248 -.827 -.554 -.989 -.139 -.008 -.065 -1.980
Asymp. Sig. (2-tailed) .139 .142 .804 .408 .580 .323 .890 .994 .948 .048
Exact Sig. (2-tailed) .191 .194 .841 .420 .577 .330 .901 .991 .951 .052
Exact Sig. (1-tailed) .096 .097 .421 .210 .289 .165 .450 .496 .476 .026
Point Probability .030 .040 .029 .005 .002 .010 .008 .001 .005 .004
a Grouping Variable: room_priv.ward
Test Statistics(a)
rounds IVFvitalsigns medicine
bedlinen cleanliness hygiene teachings needs safety
Most ExtremeDifferences
Absolute.167 .167 .100 .100 .167 .133 .133 .133 .133 .233
Positive .167 .000 .100 .100 .067 .000 .133 .133 .067 .233
Negative .000 -.167 .000 .000 -.167 -.133 -.133 -.133 -.133 .000
Kolmogorov-Smirnov Z .645 .645 .387 .387 .645 .516 .516 .516 .516 .904
Asymp. Sig. (2-tailed) .799 .799 .998 .998 .799 .952 .952 .952 .952 .388
Exact Sig. (2-tailed) .233 .233 .583 .770 .522 .737 .738 .708 .595 .151
Point Probability .176 .161 .164 .164 .228 .373 .363 .303 .324 .075
a Grouping Variable: room_priv.ward
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