Thesis Kath- With Feedback

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Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

The Philippine government is working hard to offer a solution to the

burning issue of oversupply and unemployment of Filipino nursing graduates.

The large number of nursing graduates can be blamed by the mushrooming of

nursing schools that tried to accommodate students who want to enroll in the

nursing program.

In an attempt to solve this problem, the Philippine government first offered

the Nurses Assigned in Rural Service (NARS) program which deployed

registered nurses to provinces and barrios where their services are very much

needed. This year, the Department of Health (DOH) and the Department of

Labor and Employment (DOLE) introduced a new program that is similar to

NARS. The new program is called Registered Nurses for Health Enhancement

and Local Service (RN-Heals).

The new government program said to offer hope to almost 200,000

unemployed nurses in the country. This fact is said to be ironic because many

Filipinos die of preventable diseases just because they were not given an

opportunity to be treated by medical workers. This means that there is a great

demand for nurses in the country. What are lacking are the employment

opportunities for them.



The healthcare needs of Filipino people especially those living in far flung

areas and the need of nursing graduates for hospital experience and exposure

will both be dealt with through the RN-Heals program.

RN Heals hires licensed qualified nurses for one year —as ―contractuals.‖

The nurses are made to perform regular nursing tasks and augment the nursing

manpower in many understaffed hospitals; yet, they are considered ―trainees‖

with an allowance of not more than P8,000 a month. Meager as it is, the release

of the allowance in many cases is even delayed for 2-3 months. Meantime,

trainees spend for their daily needs (meals and transportation) and other

incidental expenses like scrub suits, gloves or even medicines for job-related

health problems like allergy, etc.

A more serious concern: RN Heals nurses have little or no protection at all

from possible work-related liabilities or accountabilities that may arise from the

performance of their duties.

The country has a huge pool of nurses. But severe unemployment

remains the core problem in the nursing front. Ironically, nursing service is

gravely needed in underserved and poor communities, and in public hospitals

that are generally ill-equipped and seriously understaffed. Indeed, there is

scarcity amidst plenty.



The government has neither observed nor implemented the standards that

itself has set especially the nurse-patient ratio of 1:12 for bedside nursing care,

and 1:20,000 for public health. In many government hospitals, a nurse usually

handles more than 20 patients—often even more, like in the National Mental

Health Center where a ward nurse is made to take charge of an average of 80-

100 psychiatric patients. Moreover, public health nurses should have been

receiving a starting monthly salary of P24,887, as per the Philippine Nursing Law

of 2002, but the government has not allotted any budget for the enforcement of

this law.

RN Heals neither ―heals‖ nor dignifies nurses because it is a form of

exploitation. The public health system can be made stronger by creating plantilla

positions for more nurses to meet the growing needs of the population. Health is

a major responsibility of the state, so the government should allot adequate

budget for health services and human resource. (Provide sources for your

discussions)

NARS sees nursing as a service profession and not merely a job; it is a

moral duty and commitment to care for the well and the sick. We can truly live up

to our commitment only with the government’s full support.

Provide a paragraph discussing on the purpose of the RN Heal program;

maybe you can find it from the program of activities.



Realizing how significant nurses in helping people in the community, this

study will be conducted to assess the competencies acquired on the Registered

Nurses for Health Enhancement and Local Service (RN-HEALS) program in

PJGMMRC hospital.

Conceptual Framework

The conceptual framework of the study which is presented in Figure 1

utilized the systems approach which consists of the input, the process, the

output, (and the outcome.)

The input consists of the demographic profile of the respondents, extent of

competencies acquired in the registered nurse heals program in PJGMRMC

hospital, and degree of the problems met in the registered nurse heals program

in PJGMRMC hospital

The process includes normative survey with the use of questionnaire

checklists, statistical treatment and analysis of data, personal interviews from

among the target respondents, actual observations in the research locale of the

study, and textual and tabular presentation of results.

The output deals with the improve the competencies acquired of the

registered nurse heals program in PJGMRMC hospital.

The outcome deals with the program may be formulated towards

registered nurse heals program in PJGMRMC hospital.



Figure 1.

Demographic profile of the respondents

Extent of competenciesacquired in theregistered nurse healsprogram in PJGMRMChospital

Degree of theproblems met in theregistered nurse healsprogram in PJGMRMC

hospital

Normative surveywith the use of

questionnairechecklists, statisticaltreatment andanalysis of data,personal interviewsfrom among thetarget respondents,actual observationsin the researchlocale of the study,and textual and

tabular presentation

Improve thecompetencies acquired of the registered nurseheals program inPJGMRMC hospital

Program may beformulated towardsregistered nurse healsprogram in PJGMRMC

hospital

INPUT

PROCESS

OUTPUT

OUTCOME



Statement of the Problem

This study will try to evaluate the extent of competencies acquired by the

Registered Nurses involved on the Registered Nurses for Health Enhancement

and Local Service (RN-HEALS) program in PJGMRMC hospital, as basis for

program enhancement. Specifically, it will seek to answer the following problems:

1. What is the demographic profile of the respondents in terms of:

1.1. Age;

1.2. Gender;

1.3. Educational Attainment; and

1.4. Years of Experience?

2. What is the extent of competencies acquired in the registered nurse

heals program in PJGMMRC hospital as described in terms of:

1.1. Cognitive;

1.2. Psychomotor; and

1.3. Affective?



3. Is there a significant difference in the assessment of respondents on the

extent of competencies acquired as a registered nurse in the heals program in

PJGMRMC hospital? As to what variables?

4. What is the degree of the problems met in the registered nurse heals

program in PJGMRMC hospital be described in terms of the above mentioned

variables?

5. Is there a significant different in the assessment of respondents on the

degree of the problems met in the registered nurse heals program in PJGMRMC

hospital? As to what variables?

6. What program may be formulated towards registered nurse heals

program in PJGMRMC hospital?

Hypotheses

The researcher will test the following hypothesis:

1. There is no significant difference in the assessment of respondents on the

extent of competencies acquired in the Registered Nurses for Health

Enhancement and Local Service (RN-HEALS) program in PJGMRMC hospital.

2. There is no significant different in the assessment of respondents on the

degree of the problems met in the Registered Nurses for Health Enhancement

and Local Service (RN-HEALS) program in PJGMRMC hospital.

Significance of the Study

This research study will be significant to the following:



Hospital administrators. Being the ones who receive applicants to work

in the operating room, they have to be consistent with policies set by their

institution with regard to the qualifications of their employees because this will be

the major basis for the assessment of their competencies. Also, always have

activities or have them attend seminars that will update their knowledge and skills

for better administration of care given to clients. The directors of the hospitals

can have better plans that will improve the services they are rendering to the

patients. The chief nurses, assistant chief nurses and supervisors can monitor

and guide the practice of nursing by their staff nurses and trainees in order to

ensure the competency and efficiency of care they are delivering to every patient

in the hospital.

RN HEALS. The study will greatly benefit them since they are the main

focus of the study. They will be able to reflect on their practices as nurses. They

will realize their strengths and weaknesses in dealing with clients in the hospitals,

and so, maintaining the good practice and improving the weak ones. By realizing

and doing such, they will be able to lift the names of nurses by being competitive

and leaders in promoting health for people.

Patients/clients. Strengthening the skills and competencies of operating

room nurses will make them feel they are always in good hand whenever they

will be entering the operating room for surgery. They can be assured of the

quality of nursing care given by the nurses and as well as by the doctors. The



thought of being with competent health workers will ease and lessen their fears

and worries/ or their anxieties.

Researcher. The findings of the study will give him important information

on how to become competent in the field of nursing he had chosen. Being an

nurse means that the life of the client depends on how he performs during the

hospitals procedure; therefore, he must think and act as a professional nurse

ready to follow all the orders of the doctors, and he must develop competence

and anticipating skills.

Significant others of the clients. Improved nursing competency may

make them trustful with nurses and doctors with whom they entrust their loved

one’s health condition.

(Just discuss what could be the possible benefits that can be

obtained from the findings of the study by the different stake holders)

Scope and Delimitation

The study will is conducted only in the Cabanatuan City. It will focused on

the competencies acquired by the Registered Nurses involved on the Registered

Nurses for Health Enhancement and Local Service (RN-HEALS) program in

PJGMRMC hospital.



The respondents of the study will be the nurse (Is it the nurses involve in

the RN Heals Program or the regular nurses in PJG they worked with?), doctor,

and patient in PJGMRMC hospital.

The study will cover a period of one (1) semester, and that is from

November 20012 to March 2013, and is delimited only to the items and specific

problem statements in the questionnaire, giving emphasis on the following: 1)

extent of competencies acquired in the Registered Nurses for Health

Enhancement and Local Service (RN-HEALS) program in PJGMRMC hospital; 2)

degree of the problems met in the Registered Nurses for Health Enhancement

and Local Service (RN-HEALS) program in PJGMRMC hospital.

Definition of TermsThe following terms are defined operationally for better understanding of

the readers.

NURSERN-HEALS PROGRAMSExtent of CompetenciesDegree of Problems



Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the related literature and studies that helped the

researcher identify the knowledge gap and strengthen his conviction on the area

under investigation.

Foreign LiteratureThe Nevada State Board of Nursing-NSBN (2008) stressed that registered

nurses should always maintain accountability for the overall provision of nursing

practice following the accepted standard of care. The NSBN recognized that

these nurses need to work effectively with assistive personnel, underscoring the

Formatted: Left



critical competencies or their abilities to assign and supervise. The RNs are

assigned tasks based on the needs and condition of the patients, potential for

harm, stability of the patients’ condition, complexity of the task, predictability of

the outcomes, abilities of the staff to whom the task is assigned, and the context

of other patient needs.

They perform intubation, postmortem enucleation, remove, clean and

reinsert a "donut" type pessary upon successful completion of formal education

and training which includes demonstration of competence in the use of this

device. Documentation of annual updates of education and demonstration of

competency are required, remove mediastinal drainage tubes, remove a

respirator when a patient has been determined to be brain dead and pronounced

dead by a physician. The nurse may refuse to remove the respirator for medical,

ethical, or moral reasons and perform epicardial pacing wire removal, provided

the following guidelines are followed:

1. The nurse is competent to perform the procedure and has the

documented and demonstrated knowledge, skill, and ability to perform the

procedure. Continued competency shall be documented annually and include

clinical review with successful return demonstration.

2. There are facility policies and procedures and any required

protocols in place for the nurse to perform the procedure. Protocols shall include

specific guidelines for patient monitoring after epicardial pacing wire removal.



3. The nurse maintains accountability and responsibility for nursing

care related to the procedure and follows the accepted standard of care.

4. The procedure is performed interdependently. It must be based on

an order by a physician, be performed under indirect supervision of a physician

and per protocol. It is performed only in a licensed medical facility where a

physician who has documented and demonstrated knowledge in the area of

cardiovascular surgery is present within the facility and available for one hour

following the procedure should complications arise. Replace a gastrostomy tube

or suprapubic catheter that is not sutured in a patient, has been in place for an

extended time, and there is a clearly established passageway, advance or

withdraw endoscope and colonoscope. The procedure is performed when the RN

is visualizing the lumen. The RN is permitted to advance or withdraw a flexible

sigmoidscope without direct visualization. The procedure is carried out under the

direct supervision of a licensed physician. Written policy and procedure are in

place, administer intrahepatic arterial chemotherapy (provided procedure is

approved by chief nurses and included in facility policies and procedures), and

administer medications for the purpose of induction of sedation for short-term

therapeutic, diagnostic, or surgical procedures (procedural sedation). There are

multiple sedation and anesthetic agents that cause profound changes in

respiratory status even at low doses. Some of these medications do not have

reversal agents and require the support of competent clinicians in advanced

airway management. Licensed professional nurses (RNs) who administer these



agents should be qualified to rescue patients whose level of sedation is deeper

than intended or those who enter the state of general anesthesia.

RNs may administer medications for the purpose of induction of sedation

for short-term therapeutic, diagnostic or surgical procedures (procedural

sedation). Authority for RNs to administer medications is derived from NRS

632.220. This places no limits on the type of medication or route of medication;

there is only the requirement that the drug be ordered by one lawfully authorized

to prescribe.

The registered nurse must be competent to perform the function, and the

function must be performed in a manner consistent with the standard of practice.

In administering medications to induce procedural sedation, the RN is required to

have the same knowledge and skills as for any other medication the nurse

administers. This knowledge base includes but is not limited to potential side

effects of the medication, contra-indications for the administration of the

medication, and amount of the medication to be administered.

The requisite skills include the ability to competently and safely administer the

medication by the specified route, anticipate and recognize the potential

complications of the medication, recognize emergency situations, and institute

emergency procedures.

Thus the RN shall be held accountable for knowledge of the medication

and for ensuring that the proper safety measures are followed. The institution

shall have in place a process for evaluating and documenting the RN’s



demonstration of the knowledge, skills and abilities for the management of

patients receiving agents to render procedural sedation. Evaluation and

documentation of competency shall occur on an annual basis.

The safety considerations for procedural sedation include: continuous

monitoring of oxygen saturation, cardiac rate and rhythm, blood pressure,

respiratory rate and level of consciousness. The RN shall ensure the immediate,

on-site availability of back-up personnel for airway management, resuscitative

and emergency intubation and of emergency equipment which contains

resuscitative and antagonistic medications, airway and ventilatory adjunct

equipment, defibrillator, suction and a source for administration of 100% oxygen.

The RN administering agents to render procedural sedation shall conduct a

nursing assessment to determine that administration of the drug is in the patient’s

best interest. The RN shall ensure that all safety measures are in force.

The RN is held accountable for any act of nursing provided to a patient.

The RN managing the care of the patient receiving procedural sedation shall not

leave the patient unattended or engage in tasks that would compromise

continuous monitoring of the patient by the registered nurse. The RN has the

right and obligation to act as the patient’s advocate by refusing to administer or

continue to administer any medication not in the patient’s best interest.

If the RN is a Registered Nurse First Assist (RNFA), preparation of

saphenous vein for coronary artery bypass grafting is within his/her scope of



nursing and of the Certified Nurse First Assistant (CRNFA) provided the following

guidelines are followed.

1. The nurse must have successfully completed an RN First Assistant

program that meets the Association of Operating Room Nurse (AORN) Education

Standards for RN First Assistant Programs and a clinical preceptorship devoted

to the application of knowledge and clinical skills associated with the process of

harvesting a coronary conduit/saphenous vein. The nurse must maintain

documentation of competency and maintain current CNOR certification.

2. The nurse will use surgical instruments to perform dissection or

manipulate tissue as directed by the surgeon to accomplish preparation/harvest

of a saphenous vein.

3. As part of informed consent, the patient or responsible party is

informed that a nurse will be performing the procedure.



procedure pursuant to NAC 632.071, 632.224, and 632.225.

5. There are agency policies and procedures, a provision for

privileging, and any required protocols in place for the nurse to perform the

procedure.

6. The nurse maintains accountability and responsibility for nursing

care related to post-operative follow-up for the procedure and follows the



accepted standard of care which would be provided by a reasonable and prudent

nurse.

7. The procedure is performed interdependently by the surgeon and

the nurse. The surgeon must be in attendance while the nurse performs this

procedure.

Hospital admissions are creating vast challenges for nurses because of

increased patient longevity, multiple organ system problems, greater survival

from critical states, and obesity. Due to these conditions, nursing success rate

for peripheral intravenous placement (PIVs) is becoming increasingly more

difficult. Using ultrasound for PIV placement, similar to nurses using ultrasound

for Peripherally Inserted Central Catheters (PICCs) can increase nursing success

rates. By increasing success rate at PIVs through ultrasound guidance, nurses

should see the following results:

1. Increased patient satisfaction from fewer access failed attempts,

2. Less damage to peripheral vasculature from fewer access attempts,

3. Intravenous treatment delay is prevented, and

4. Preventing delay of intravenous treatment fosters decreasing the length

of hospital stays and cost containment.

These procedures are within the scope of practice for a registered nurse

provided the following guidelines are followed:





procedure pursuant to NAC 632.071, 632.224, and 632.225.

2. There are agency policies and procedures and any required

protocols in place for the nurse to perform the procedure.

3. The nurse maintains accountability and responsibility for nursing care

related to the procedure and follows the accepted standard of care, be

authorized to perform the task of removing an epidural catheter. The Nevada

State Board of Nursing has determined that a registered nurse, who has

completed the appropriate training and follows all applicable competency

regulations under NAC 632, may be authorized to perform the task of removing

an epidural catheter, as defined, post-surgery/procedure, with a physician or

CRNA order.

The following epidural catheters may not be removed by a registered nurse:

1. Metal or spring epidural catheters,

2. Any tunneled epidural catheter, and

3. Spinal cord stimulators placed in the epidural space.

Safety is assured by undergoing a specific training program a registered

nurse removes an epidural catheter that has been placed by an Anesthesiologist

or a Certified Registered Nurse Anesthetist (CRNA). This practice would be

comparable to removal of femoral sheath catheters, removal of arterial line



catheters and removal of PICC lines which is currently within the scope of

practice of a registered Nurse.

Removal of an epidural catheter will be the responsibility of the qualified

registered nurse only after appropriate training and documentation of catheter

integrity and site integrity. Consumer safety may be documented through Quality

Assurance/Infection Control monitors.

For consumer safety, the qualified Registered Nurse may remove

percutaneously inserted epidural catheters.

Intervention and documentation with a patient should include site care and

cleanliness, removal of protective barriers, hygiene, indications of infection and

fluid leakage.

The removal of an epidural catheter by a Registered Nurse allows the

patient to have a broader option for elective epidural pain management while

maintaining a safe environment for the patient. Continued or additional epidural

pain management is not always a choice when a physician is responsible for

removing the catheter at the completion of a case or procedure.

Only registered nurses with the appropriate didactic and clinical return

demonstration skills training, in collaboration with the facility policies and

procedural support, may participate in the removal of epidural catheters. The

didactic portion of the education program should include but is not limited to,

anatomy, physiology, related pharmacology, assessment, contraindications,

exceptions, emergency preparedness and intervention.



A specified number of return demonstrations must be completed at the

end of the initial training. Annual skills validation must be demonstrated and

documented as part of each facilities education program. Each nurse must meet

all the competency requirements as set forth in NAC 632.

Removal of an epidural catheter may be considered within the scope of

practice of the registered nurse and only performed following the completion of

didactic and clinical training. A policy and procedure should be developed

specifically for the practice, and implemented in each facility following the nursing

process.

This procedure can be performed in any relevant department of each

facility by a qualified registered nurse. The areas impacted by this practice

change would include obstetrical and surgical services, post anesthesia recovery

units, out-patient services, ambulatory surgical centers, critical care and medical-

surgical units.

Annual documentation of competency and skills will be monitored by the

chief nurse in accordance with NAC 632.224 and 632.225. Infection control

monitors may be employed to measure infection rates.

Included in the literature search is a position statement from the American

Nurses’ Association. This position statement was written in collaboration with

Delaware Board of Nursing (6/90), Louisiana Board of Nursing (1/90); Ohio board

of Nursing (3/92); Oklahoma Board of Nursing (Fall/92); Wyoming Board of

Nursing (Spring/1993); and, South Carolina Board of Nursing.



Removal of epidural catheters by qualified registered nurses will decrease

cost to the patient by eliminating the additional visit by the physician or CRNA.

The impact on manpower will increase the continuity of patient nursing

care. The registered nurse will have the ability to assess the patient’s pain levels

prior to the removal of the epidural catheter, and with specific physician orders,

administer additional pain management medications through the epidural

catheter in a more timely manner, if necessary.

The qualified registered nurse will work as a team member with the

attending physician, consulting Anesthesiologist, or CRNA.

Currently, qualified nurses in the state of Nevada may:

remove mediastinal drainage tubes, insert and remove PICC lines, remove

arterial lines, remove femoral sheaths, and instill reversible opioid agonists via an

epidural catheter.

These procedures are within the scope of practice for a registered nurse

provided the following guidelines are followed:



procedure pursuant to NAC 632.

2. Prior to incorporating the practice of inserting EJ PIVs, the nurse

must have a minimum of two years of experience in infusion therapy. To

incorporate the insertion of EJ PICCs, the nurse must have a minimum of two

years of experience in infusion therapy and certification in PICC insertion. The



nurse must have successfully completed an external jugular educational program

that included theoretical content and clinical instruction to add insertion of either

EJ PIVs and/or EJ PICCs to his practice.

3. There are agency policies and procedures and any required

protocols in place for the nurse to perform the procedure.

The nurse maintains accountability and responsibility for nursing care related

to the procedure and follows the accepted standard of care.

The Board has determined that registered nurses and licensed practical

nurses may not perform intrauterine insemination, administer epidural

anesthetics. This procedure is reserved for CRNAs and physicians. Licensed

nurses must not be solely responsible for management of the patient under the

effects of epidural anesthesia, but may assist the physician in the patient's care,

accept employment as a nursing assistant, unless they hold a CNA certificate;

activity must be limited to the scope of practice for which the nurse is employed,

remove medications in the event of death of a home care client. A nurse

removing drugs is acting unprofessionally and may be subject to disciplinary

action for violating NAC 632.890, ss 15, 16, and/or 18.

A person who practices nursing or delivers patient care in relation to patients

who are located within the State of Nevada must be licensed by the Nevada

State Board of Nursing. The following activities include, but are not limited to,

conduct that is considered to be delivering patient care:

1. Any intent to enter into a therapeutic relationship with the patient.



2. Any notation or documentation in an individual patient’s medical

records.

3. Designation or acting as chief nurse.

4. Accepting an assignment for patient care.

5. Patient education.

6. Any nursing education that involves direct patient contact.

7. Designation as or acting as an RN who supervises care provided by

another RN, LPN or CNA.

Along the same perspective, the Australian Nursing Council Incorporate

(ANCI) clearly defines the principles to achieve culturally competent nursing care,

and require nurses to respect the values, customs, spiritual beliefs and practices

of all individuals and groups; however, they are not sufficiently explained or

developed to guide nursing practice. What the standards need to make clear is

that the constituents of competence are found not in the nurse alone but in the

relationship that exists between the nurse, their colleagues, patients, and

families, and with the situation itself.

The RN specializing in Perioperative Nursing practice performs nursing

activities in the preoperative, intraoperative and post-operative phases of their

patients’ surgical experience. Registered nurses enter perioperative nursing

practice at a beginning level depending on their expertise and competency to

practice. As they gain knowledge and skill, they progress on a continuum to an

advanced level of practice.



Based on the Standards and Recommended Practice for Perioperative

Nursing, the operating room nurse provides a continuity of care throughout the

perioperative period, using scientific and behavioral practices with the eventual

goal of meeting the individual needs of the patient undergoing surgical

intervention. This process is dynamic and continuous, and requires constant

reevaluation of individual nursing practice in the operating room.

The perioperative nurse is responsible and accountable for the major

nursing activities occurring in the surgical suite. These include, but are not

limited to the following:

Assessing the patient’s physiological and psychological status before,

during and after surgery;

Identifying priorities and implementing care based on sound judgment and

individual patient need;

Functioning as a role model of a professional perioperative nurse for

students and colleagues;

Functioning as a patient advocate by protecting the patient from

incompetent, unethical or illegal practices during the perioperative period;

Coordinating all activities associated with the implementation of nursing

care by other members of the health care team;

Demonstrating a thorough knowledge of aseptic principles and techniques

to maintain a safe and therapeutic surgical environment;



Directing or assisting with the care and handling of all supplies, equipment

and instruments to ensure their economic and efficient function for the

patient and personnel under both normal and hazardous conditions;

Performing as a scrub or circulating nurse as needed, based on

knowledge and expertise for a specific procedure;

Participating in continuing education programs directed toward personal

and professional growth and development; and

Participating in professional organization and research activities that

support and enhance perioperative nursing practice (Mc Murray, 2004).

Foreign Studies

According to Leeper (2005), competency standards for operating theater

practice were used in some countries to guide clinical and professional

behaviors. The need for competence assessment has been enshrined, but the

conceptualization and agreement about what signifies competence in Operating

Theatre has been lacking.

Three focus groups were conducted with 27 operating theatre nurses in

three major metropolitan hospitals in Queensland, Australia. Interviews were

audio taped and field notes were taken. Data were collected during 2008.

Thematic analysis was performed.

From the analysis of the textual data, three themes were identified:

coalescence of theoretical, practical, situational and aesthetic knowledge within a



technocratic environment; the importance of highly developed communication

skills among teams of divergent personalities and situations; and managing and

coordinating the flow of the list.

These findings identified that competence in respect to components of

knowledge, teamwork and communication, and the ability to coordinate and

manage were important and should be incorporated in operating theatre

Competency Standards. Additionally, findings may assist in the development of

an instrument to measure operating nurses' perceived competence.

According to Pateraki (2003), medical students must be competent in

basic aseptic technique (BAT) to function effectively in the operating room.

However, a comprehensive literature review revealed a deficit of research in

standardized BAT training for the operating room in medical school curricula.

A modified reactive Delphi technique was used to survey an expert panel

of 100 surgical educators. A focus group provided initial responses to key

questions, and the panel completed two surveys. In the first survey, the panel

identified elements for a BAT curriculum for the operating room. In the second

survey, the panel received feedback from the first survey and was asked to

respond in light of those results.

An 81% response rate was obtained from the first survey. A 74%

response rate was obtained from the second survey. Seven of the 18 essential

entry-level competencies (EELCs) identified were ranked as the most important.

The top five instructional strategies and the top three methods for evaluation



were also selected. The panel identified the third-year curriculum as the preferred

time of training and a nurse preceptor/educator as the preferred instructor.

These results provided a minimum set of educational objectives that could

be used to develop a standardized curriculum in BAT for the operating room for

medical students.

According to Howery DI (2000), there are indications of lack of

cooperation, lack of special O.R. training, as well as incompetence in hospital

management. Given that most subordinates considered their superior as hard-

working and responsible, the reasons why hospital management was unable to

appoint head nurses capable of managing the operating room in a conscientious

manner should be studied since good-will alone is not enough to create

competent leaders. Ways must be found to improve surgical team cohesion and

increase the team’s efficiency so that all of its members could enjoy job

satisfaction, which they deserved anyway.

On the other hand, the Australian Nursing Council-ANC (2002) provided a

guidance as to how assessment of competence might occur and identified six

principles for the assessment of competency: accountability, performance-based

assessment, contextual relevance, evidenced-based assessment, participation

and collaboration.

A study of 831 Australian health professionals including nurses revealed

that all health professionals involved in the study rated the ANCI competencies



as important and that the nurses identified 19 out of 65 competencies as unique

to the nursing profession.

From the regulatory perspective, although the ANMC competency

standards were already endorsed by all state and territory regulatory authorities,

the National Review of Nursing Education (2002) initiated by the Department of

Education, Science and Training took a more formalized and national approach

and recommended that nationally agreed principles be developed to underpin

State and Territory nursing legislation that should include requirements for

assessment against ANCI competencies for initial regulation of registered and

enrolled nurses.

From an academic perspective, the competencies were used as the basis

for all undergraduate programs and all nursing undergraduate curricula were

designed to meet the desired competency standards. However, the

competencies were not sufficiently culturally sensitive for contemporary

Australian society.

Brazen’ study (2003) revealed that most competencies in the human and

leadership categories were rated higher than the competencies in the financial

management, conceptual, and technical categories. These scores were

consistent on both subscale one (ie, knowledge and understanding) and

subscale two (ability to implement and/or use). Seven of the 10 lowest-rated

competencies were from the conceptual and technical categories; however, two

technical competencies (ie, nursing practice standards and infection control



practices) were rated among the top five competencies on subscales one and

two.

Local Literature

In response to the call of the World Health Assembly, the Philippines

reinforced and institutionalized the implementation of quality assurance where

patient safety was regarded as one of the key dimensions of quality care. It was

critical in the development of systems to improve health outcomes in the

Fourmula One for Health. The country however needed to consolidate the gains

of these efforts, strengthen a nationwide reporting system of adverse events, and

institute a mechanism that would encourage disclosures about said events.

Likewise, there was a dire need to encourage research in patient safety,

epidemiological studies of risk factors, effective and protective interventions,

assessment of associated cost of damage and protection. To secure more,

better and sustained financing for health; assure the quality and affordability of

health, goods and services; ensure access to and availability of essential and

basic health packages and improve performance of the health system, the

Department of Health and the Philippine Health Insurance Corporation (PHIC)

affirmed their commitment to patient safety policies and objectives thru the DOH

mandate, the Fourmula One(F1) for Health, and thru the Philippine Health

Insurance Corporation (PHIC) Benchbook to adopt the Fifty-fifth World Health



Assembly’s resolution in the formulating guidelines for the implementation of

Patient Safety Program.

According to maintaining technical competency includes providing clinical

expertise and implementing intra-operative care planning and general nursing

guidelines. Operating room nurse-managers maintain technical competence and

apply humanistic competency when teaching novice operating room staff

members. The potential operating room nurse managers of the future gain the

trust and respect of both staff members and physicians. Conceptual competency

refers to the ability to visualize the entire scope of a specific procedure.

Competent operating room nurse- managers understand that the operating room

is one unit within the total health care facility. They process competing demands

and address multiple tasks simultaneously, including financial management (eg,

budgeting, productivity, cost/benefit analysis). Maintaining financial goals must

be accomplished within a humanistic frame of reference. Furthermore, as leaders

of their units, operating room nurse managers guide, mentor, and delegate to

empower coworkers and direct problem-solving efforts.

Local Studies

In 1999, the qualitative study conducted by revealed that operating room

nurse-managers needed technical skills in clinical and managerial areas, in

addition to the human and conceptual skills.



In 2003, a researcher named explored on the professional preparation

required of operating room administrators. Although he did not identify specific

competencies, he did identify the need for in-service education because most

operating nurse managers were promoted from clinical positions and lacked

administrative backgrounds. He also examined hospital-based nurse-managers’

competencies and determined which competencies were most necessary for

them to be effective.

Synthesis of the Reviewed Literature and Studies

The related literature and studies—both foreign and local reviewed in the

conduct of the present study were similarly related with each other, this is owing

to the fact that they all deal with the present status of competencies of nurse,

here in the local setting and in abroad.

The related literature and studies cited in this study gave the researchers

an idea on the concept, mechanics and designs on how to conduct the present

study. The related literature and studies consulted in the conduct of the present

study only differs in terms of respondents, setting, period covered, and most

obviously the way how the present study will be conducted, including the

research design and statistical treatment of data.

Despite of the some few indifference encountered, the related literature

and studies earlier presented, all of them gave impetus and direction to the

researcher to effectively interpret relevant data, purposely to have clear

discussion on competencies of nurse, and other considerations relatively with the



conduct of the present study. Hence, in this particular instance the reviewed

literature and studies, both foreign and local are considered relevance in the

conduct of the present study.

Just get the main idea in every literature that you have reviewed, there is no

need for you to actually copy paragraphs from each literature. If you can get

literature that will follow this logical sequence: RN competencies, practice after

passing the board like residency or internship program that further enhance their

competencies, government aided programs for RN to improve their training,

government program on employment of professionals.

Formatted: Normal, Justified, Line sDouble



CHAPTER 3

RESEARCH METHODS AND PROCEDURES

This chapter presents the following: research methods, population of the

study, sampling designs, instrument used, reliability and validity of instrument,

procedures in data gathering, and statistical treatment of data.

Research Methods

This research study will used the descriptive method of research. Soriano

(2010) defines descriptive type of research as a study that finds answer to the

questions who, what, when, where and how. This type of research describes a

situation or given state of affairs in terms of special aspects or factors. This study

will be conducted through the normative survey with the use of questionnaire

checklist and interview schedule, actual observations within the research locale

of the study, and focal group discussion with the different sectors of the society in

the locality.

Population of the Study

The respondents involved in the conduct of this research study will be the

nurse, doctors, and selected patients within the PJGMRMC hospital. Table 1

presents the population and samples of the study.



Table 1 Population of the Study

Respondents F %

Nurse 20 33.33%

Doctors 10 16.66%

Selected Patients 30 50.00%Total 60 100%

How did you get the numbers and the percentages of respondents?

Sampling Design

The samples were selected through purposive sampling of the actual number

of the nurse, doctors, and selected patients within the jurisdiction of the research

locale of the study. This sampling design was adopted based on the rationale

that a true picture on the extent of competencies acquired in the registered nurse

heals program in PJGMRMC hospital, using as subjects the above stated

respondents. If it is purposive you have to provide criteria to follow in the

selection of your respondents.

Procedures in Data Gathering

The researchers will first seek permission from the Director of the

PJGMRMC hospital for allowing him to float the questionnaire checklist, conduct

personal interviews from among the target respondents, and undergo actual

observations in the research locale of the study. The researcher will personally

administer ed and explained the mechanics and concepts in answering the



questionnaire checklist for a period of one month to the target respondents to

facilitate the early retrieval of the instrument.

The data that will come from the conduct of personal interviews and actual

observations were used to supplement and contribute in assessing the 1) extent

of competencies acquired in the Registered Nurses for Health Enhancement and

Local Service (RN-HEALS) program in PJGMRMC hospital; 2) degree of the

problems met in the Registered Nurses for Health Enhancement and Local

Service (RN-HEALS) program in PJGMMRC hospital.

Research Instrument

This study will use a questionnaire that will be devised with the help and

guidance of adviser. It will be divided in four parts, as follows:

Part I of the instrument will be composed of 5-item checklist under six (or

three) headings, and that is: cognitive, affective, and psychomotor, which are all

designed to draw information on the extent of competencies acquired in the

Registered Nurses for Health Enhancement and Local Service (RN-HEALS)

program in PJGMRMC hospital.

The responses to each item will be evaluated according to the five-point

bipolar scale below:

Ranges Scale Verbal Description

4.21 - 5.00 5 Very Competent (VC)



3.41 - 4.20 4 Competent (C)

2.61 - 3.40 3 Moderately Competent (MC)

1.81 - 2.60 2 Slightly Competent (SC)

1.00 - 1.80 1 Not Competent (NC)

Part II of the instrument will be composed of 5-item checklist under six

headings, and that is: cognitive, affective, psychomotor, which are all designed to

draw information on degree of the problems met in the Registered Nurses for

Health Enhancement and Local Service (RN-HEALS) program in PJGMRMC

hospital..

The responses to each item will be evaluated according to the five-point

bipolar scale below:

Ranges Scale Verbal Description

4.21 - 5.00 5 Very Serious (VS)

3.41 - 4.20 4 Serious (S)

2.61 - 3.40 3 Moderately Serious (MS)

1.81 - 2.60 2 Slightly Serious (SR)

1.00 - 1.80 1 Not Serious (NS)

The researcher thru the help of adviser will also formulate an interview

guide schedule with blank spaces provided in each of the item relatively with the

statement of the problem, purposely to gather qualitative information from among

the different groups of respondents, purposely to complement the quantitative

data collected thru the questionnaire checklist.



The reliability and validity of the instrument will be established through the

following, i.e., the reliability which refers to the consistency of measuring

instrument, often used to describe a test was determined through the conduct of

test-retest.; and the validity, which refers to the degree to which a study supports

the intended conclusions drawn from the results will be establish examining each

item to know whether the instrument in question does in fact measure what it has

been designated to measure.

Statistical Treatment of Data

For Sub-Problem 1. The demographic profile of respondents will be

studied from the responses derived in Part I of the instrument. The frequency and

percentage distribution will be computed to evaluate the responses (Concepcion,

et. al., 2007).

Formula:

% = n x 100N

Where:% = Percentagen = ResponsesN = Population

For Sub-Problems 2,& 4. The extent of competencies acquired, and degree

of the problems met in the registered nurse heals program in PJGMRMC hospital

will be both studied from the responses derived in Part II, and Part III of the

instrument. The total weighted frequency and grand weighted mean will be

computed to evaluate the responses (Ybanez, 1997).

Formula: _



x = WMN

Where: _ x = Group Mean

= SummationWM = Weighted MeanN = Number of Cases

For Sub-Problems 3 and 5. The significant different in the assessment of

respondents on the extent of competencies acquired in the registered nurse

heals program , and the significant different in the assessment of respondents on

the degree of the problems met in the registered nurse heals program and, will

be both tested by using the f-ratio test. The level of significance will be

established at 0.05 level (Downie and Heath, 1997).

Formula:

f = Between-Groups Variance

Within-Group Variance

F = Mean Square Between (MSB)Mean Square Within (MSW)

F = MSBMSW

Where:

MSB = Sum of Squares Between = SSBDegrees of Freedom Between dfb

MSW = Sum of Squares Within = SSWDegrees of Freedom Between dfb

To find SSB and SSW:Formula:

SSB = (XC)2 - (X)2 = SST – SSB



N N

SST = X2 – X)2N

F = MSBMSW

Where:

MSB = Sum of Squares Between = SSBDegrees of Freedom Between dfb

SST = Total Sum of Squares

X = Item Values Per Column

N = Total Sample Size

SSB = Sum of Square Between

XC = Sum of the Value per Column

n = Sample Size

SSW = Sum of Squares Within

Note:

Find the SSB and SSW to solve the MSB and MSW, and then finally the f-

ratio.

Rule:

If after the computation, the result of the computed f-ratio is larger than

critical value of F05, reject Ho., or otherwise accept it.

This study will also use the qualitative and quantitative researches. In

quantitative research concepts are assigned numerical value, whereas in



qualitative research concepts are viewed as sensitizing ideas or terms that

enhances understanding of a given phenomenon (Hagan, 2003). The above

research methodology will be used based on the rationale that the true picture on

the extent of competencies acquired and degree of the problems met in the

Registered Nurses for Health Enhancement and Local Service (RN-HEALS)

program in PJGMRMC hospital will be determined.

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