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CHAPTER I
THE PROBLEM AND ITS BACKGROUND
This chapter aim to present the introduction, statement of the problem,
hypothesis, significance and importance of the study, scope and delimitations,
conceptual framework and research paradigm, and definition of terms.
Introduction
There is a growing consensus among leaders in higher education for the
need to change the general education curriculum to meet the changes in society
and technology.
For instance, in May of 2005, the board of nursing created a committee on
core competency standard development in collaboration with the commission on
higher education technical committee on nursing education with the primary goal
to develop the competency standards for nursing practice in the country. The new
competency standards will reuse as a unifying framework for nursing education.
Lifted from the article, in March of 2006 the Massachusetts board of
higher education and the Massachusetts organization of nurse Executives
(MONE) convened a facilitated working session entitled creativity and
compulsions building framework for the future of nursing education and
practices.
Indeed, they all focused to enhance nursing competencies that include
transitioning nurses into their practice.
Background of the Study
Lifted from the thesis book of group 1-10 batch 2007, since development
is every bit as important as theoretical knowledge in any professional education.
In the nursing education, this practicum is refused to as clinical learning
experience.
The clinical experience of a student nurse is considered the core of his/her
overall nursing education. The clinical area is where the student nurse put into
application all the theories they learned in the classroom. A clinical instructor
plays a crucial role in the student nurses’ development and learning in the clinical
area.
The clinical instructor’s performance of his/her role will determine the
student nurse’s clinical performance. Thus, it is essential that a clinical instructor
is efficient, competent and well-experienced to carry out his/her responsibilities
The proponents of this research wanted to determine the extent of
integration of the four core competencies by the clinical instructor among nursing
student in selected nursing institution, in addition, the study will relate to the
clinical performance of nursing student, in order to prove the extent of integration
of the four core competencies which set by the higher commission on education
as standard competency guide. The clinical performance of the student will
determined by the result of the end of semester’s WGA.
The researcher’s believes that nursing students experiences of their
clinical practice provide greater insight to develop on effective teaching strategy
in nursing education.
Conceptual Framework
The direction of this study is anchored to the standard core competency set
by the commission on higher education technical committee on nursing education
(CHED-TCNED) collaborated with the bound of nursing under the committee on
core competency standards development (CCCSD) promulgated under resolution
no. 112 S2005.
Another model that will be employed to achieve the proponent goals is the
competency outcome and performance assessment (COPA) model by Redman,
R.W, and Lenburg. (1999), her model will provide design as guide in doing self-
made questionnaires cited in her article.
Competent performance by health care professionals is expected
throughout society. However, defining what it is and teaching students how to
perform competency forces many challenges.
Moreover, increased accountability has become a common theme in
contemporary society. In the public market places, the theme of “let the buyer
beware” has been replaced with the philosophy of “excellence is defined by the
costumer”.
Therefore, whether the focus is on public officials, health care
professionals, on educators, the expectation is that standards of acceptable
performance will be adhered to and the public trait will be safeguard.
Table 1.1 Research Paradigm
The above framework has two boxes that represent the variables that will
undergone analysis, at the box at the left side presented the four key core
competencies which are the enhancing, enabling, empowering, patient care
competencies. The proponents will determine the extent of integration of these
competencies by the clinical instructor as perceive by the nursing students. On the
right side, the box presented the clinical performance of nursing students gather
after the end of semester WGA. The arrow with double head pointing in both
boxes is a sign to determine if there is relationship between the extents in which
the four core competencies was integrated by clinical instructor and the clinical
performance of nursing students.
Selected InstitutionClinical Performance of Nursing Students
Four key core competencies:
1. Enhancing2. Enabling3. Empowering4. Patient care
competencies
Lastly, the arrow pointing to the box at far right the selected nursing
institutions which are the following: Manila Doctors College, Arellano University
College of Nursing, Olivarez College of Nursing.
Statement of the Problem
The study aims to determine the extent of integration of Four Key Cppore
Competencies by clinical instructor and relate it to the clinical performance of the
Nursing student in selected institution.
Specifically, the following research queries will be answered:
1. What is the level performance of nursing students from selected institution?
2. To what extent of the following Four key core competencies integrated
by clinical instructor to the nursing standards for selected institution?
2.1. Enabling
2.2. Enhancing
2.3. Empowering
2.4. Patient care competencies
3. Is there a significant relationship between the perceive Extent of
integration of Four key core competencies by clinical instructor and the
clinical performance of nursing standards in selected nursing institution.
4. Is there a significant difference among selected nursing institution in
terms of clinical performance of nursing student in selected nursing
institution?
Hypothesis
The following hypothesis will be tested in.05 level of significance.
Ho. There is no significant relationship between the perceive extent of
integration of four key core competencies by clinical instructor and the clinical
performance of nursing student in selected institution.
Ho. There is no significant difference among selected institution in terms
of nursing student clinical performance.
Significance of the Study
The study is significant to the following.
To the nursing Administration- This study will provide valid measurement of
clinical Instructors and nursing students’ competency to develop a design to
enhance their K.S.A competing to produce excellent graduate to compete
globally.
To the Clinical Instructor- The study will provide unbiased insight of nursing
student that affect their clinical performance. The result is expected to make
changes, enhancement or even new strategy in teaching and learning.
To the Nursing Students- The study will show result of their perceived evaluation
to their clinical instructor. May this study inspire them to continue to strive to
attain excellence in their S.K.A competency to be prepared to become a
professional nurse.
To the Future Researcher- This study will serve as their reference. May they find
study interesting to develop, enhance betterment.
Scope and Delimitation
The researchers aims to determine the Extent of Integration of Four key
Core Competencies by clinical instructors among nursing students and relate it to
the Clinical performance of nursing students in selected nursing institution,
determining the difference between related Institute in their student clinical focus
is limited to the result of end of semester W.G.A of nursing. The respondent will
be 3rd yr nursing students of Manila Doctors College, Arellano University, San
Juan de Dios College of batch 2012, male and female no inclusion criteria, a
random sampling technique will be applied.
The respondent will answers the self made questionnaires, pertaining and
limited to the four key core competencies which are the following; Enabling,
Enhancing, Empowering, Patient care Competency. A Four point likest scale will
determine each key core competencies. Extent of integration by the clinical
instructor to the respondent.
The questionnaire will be validated by three nursing professors, expert on
this field after which, a pilot testing will be done.
Definition of Terms
The following terms are operationally defines to help the readers to
understand the content of the study.
Clinical Instructor- refers to the role, competency of a professional nurse
educator that the student will evaluate their Extent of Integration of Four
key Core competencies among nursing students.
Clinical Performance- refers to the evaluated end of semester W.G.A –
skills, knowledge and attitude competency of nursing student in selected
Institution.
Four Key Core Competencies- refers to the following Standard Sore
Competency in nursing practice.
Enabling- Refers to the doctor - patient relationship and the dynamic
exchanges that occurs before, during, and after the medical encounter.
Enhancing - refers to the accurate and updated documentation of client
care.
Empowering- refers to the practices in accordance with the nursing law
and other relevant legislation including contracts, informed consent.
Patient care competencies- refer to the knowledge base on the health
/illness status of individual / groups.
CHAPTER II
REVIEW OF RELATED LITERATURES AND STUDIES
This chapter is composed of the present study into the context of preceding,
related research. Materials were scanned from various libraries and were collated to
provide understanding of the subject under discussion. The purpose of this review of
literature is to analyze methods of assessing competence to practice in nursing and draw
conclusions on their validity.
Local Literature
In order to be a competent nurses, a good performance must be done.
Performance is what is done and how well it is done to provide health care. It is a
degree to which an organization does the right things and does them well. But this
is influenced strongly by its design or operation. The value in health care is
appropriate good balance between good outcome and excellent care and services.
There is a law (RA 7164) which is generally unheard of by registerend nurses that
recognizes the nurse to function independently and encourages clinical
specialization competence in nursing practice which is focused more on
demonstrating and implementing rather than assessment and evaluation (Yap,
2000). This is why there is a need for reorientation on the scope of nursing
practices which revolved around nursing process, including training in such areas
like assessment and evaluation.
According to RA 9173 Article III Section IX, also known as the Philippine
Act of 2002, “An act providing for a more responsive nursing profession,
repealing for the purpose Republic Act No. 7164, otherwise known as "The
Philippine Nursing Act of 1991" and for other purposes”
To help in the clinical competence of student nurses who will become
future registered nurses in the Philippines, assessment and evaluation should be
done. Assessment of clinical competence is generally based on observed
performance of skills. Evaluation of competence of students is needed and it
involves several raters (clinical instructors and staff nurses, etc) who will assess
different areas of competencies encompassing the three domains of learning -
knowledge, skills and attitudes (Caparas, 2001). Assessment results should be
used to provide feedback to both students and faculty to improve clinical
evaluation of students’ performance during clinical area work.
The Commission on Higher Education is the governing body covering
both public and private higher education institutions as well as degree-granting
programs in all tertiary educational institutions in the Philippines. In accordance
with pertinent provisions of Republic Act (RA) No. 7722, otherwise known as the
Higher Education Act of 1994 and pursuant to Commission en Banc Resolution
No. 170 dated April 19, 2009, and for the purpose of rationalizing Nursing
Education in the country to provide relevant and quality health services locally
and internationally, policies and standards for Bachelor of Science in Nursing
(BSN) program are adopted and promulgated by the Commission.
According to Article IV Section 5 of CHED Memorandum Order (CMO)
Series of 2009, “Graduates of Bachelor of Science in nursing program must be
able to apply analytical and critical thinking in the nursing practice. The nurse
must be competent in the following Key Areas of Responsibility and its respective
core competency standards and indicators” (www.ched.gov.ph).
In 2005, the Board of Nursing created the Committee on Core
Competency Standards Development in collaboration with the Commission on
Higher Education Technical Committee on Nursing Education with the primary
goal to develop the competency standards for nursing practice in the country.
New expectations for contemporary nursing practice competencies are emerging
which is heightened by the escalating complexity of globalization, the dynamincs
of health science and information technology demographic changes, healthcare
policy reforms, and the increasing and more exacting demands from the
consumers of health care. The new competency standards will serve as a unifying
framework for nursing education regulation and practice. Specifically, it will
serve as a guide in developong curriculum in nursing, framework in developing
test syllabus for entrants into the nursing profession, tool for performance
evaluation among nurses, basis for advanced nursing practice and specialization,
framework for developing a training curriculum for nurses, protect the public
from incompetent nurses and a yardstick for unethical and unprofessional practice
of nursing. There are Eleven Core Competency Standards for nursing practice
were identified: a) safe and quality nursing care, b) management of resources and
environment, c) health education, d) legal responsibility, e) ethico-moral
responsibility, f) personal and professional development, g) quality improvement,
h) research, i) record management, j) communications, and k) collaboration and
teamwork.
There are seven (7) Core Competencies under Safe and Quality Nursing
Care and each of the seven (7) core competencies have indicators that would
deem a nursing student a competent. First, there is demonstrating knowledge
based on the health /illness status of individual / groups. This can be indicated by
a nursing student who identifies the health needs of the clients (individuals,
families, population groups and/or communities) and who explains the health
status of the clients / groups. Second, the nursing student shoud provide sound
decision making in the care of individuals / families/groups considering their
beliefs and values, wherein he or she identifies wellness potential and/or health
problem of clients, gathers data related to the health condition, analyzes the data
gathered, selects appropriate action to support/enhance wellness response;
manage the health problem and monitors the progress of the action taken. Third,
there is promoting safety and comfort and privacy of clients. This can be done by
a nursing student who performs age-specific safety measures in all aspects of
client care, performs age-specific comfort measures in all aspects of client care
and performs age-specific measures to ensure privacy in all aspects of client care.
Fourth, there is setting priorities in nursing care based on clients’ needs. In this
core competency, the nursing student identifies the priority needs of clients,
analyzes the needs of clients and determines appropriate nursing care to address
priority needs/problems. Fifth, there is the ensurance of continuity of care. This
can be achieved by a nursing student who refers identified problem to appropriate
individuals / agencies and establishes means of providing continuous client care.
Sixth, is by administering medications and other health therapeutics, wherein a
nursing student must conform to the 10 golden rules in medication administration
and health therapeutics. Lastly, the seventh core competency is by utilizing the
nursing process as framework for nursing. This can be done by a nursing student
by obtaining informed consent and by completing appropriate assessment forms.
There are some interesting sex-specific pattern in the choice of academic
programs among college and graduate students. Male students tend to pursue
degrees in engineering, physical and natural science and business. Women, in
contrast, are heavily concentrated in nursing, home economics, education, social
sciences and humanities (Detablan, 2000).
Fundamental responsibility of the nurse is fourfold: to promote health, to
prevent illness, to restore health and to alleviate suffering. In carrying out
responsibilities, nurses assist individuals and families and communicate in the
prevention of illness. They minister to the needs of the patient, help them to
regain full health, provide comfort and support in the events of chronic or
incurable diseases. In doing so, a nurse should work competently to provide
proper and sufficient health services for the people (Buenaventura-Tungpalan, et
al., (2000).
Nurses should have a good foundation of learning for them to give quality
care to their patients. It is because, according to Mansibang (2006), “nursing is an
advocacy to secure people’s health through competence and high standard of
education.” He added that school must embody its dedication to nurses as
vanguards of healthcare and societal transformation. He also explained that
students must be taught how to develop critical thinking skills and conceptual
retention. In addition, when they become registered nurses, they should know how
to use their own judgments in dealing with difficult situations.
In fact, according to Cuevas (2001), “nurses should go back to the noble
reason of compassion and caring.” The emergence of nursing as a very lucrative
profession has taken its toll on the quality of service of the country’s nurses. She
further explained that bringing back the passion for money could overshadow the
passion for nursing is very important, because the passion for money could
overshadow the passion for nursing. The passion for work affects the nurse’s
approach toward the patients, thereby affecting the patients’ recovery time.
Second, we have to have the caring attitude towards our patients and finally, we
should have the passion in our profession. We are known worldwide for our
caring nurses, our so-called “new heroes” who contribute substantially to our
country by ensuring at all times there is high quality and integrity of our nursing
profession (Osit, 2006).
The following local literatures provided the researchers foundation on the
responsibility of nurses and what competence is, why competence should be
assessed and how it can be measured. It is important to improve the quality of
nursing in the Philippines so that the country could produce globally competitive
nurses (Vitriolo, 2006). But it wasn’t only about competitiveness why Filipino
nurses are sought after in other countries, also because of the caring attitude they
possess. Nursing remains as a perceived female role and requires certain basic
qualities that are innate in females and males need to work on them such as
empathy, caring, relationships, communication and that general ability to manage
thru all adversity.
Foreign Literature
Nursing student's experiences of their clinical practice provide greater
insight to develop an effective clinical teaching strategy in nursing education. The
main objective of this study was to investigate student nurses' experience about
their clinical practice.
Focus groups were used to obtain students' opinion and experiences about
their clinical practice. 90 baccalaureate nursing students at Shiraz University of
Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly
from two hundred students and were arranged in 9 groups of ten students. To
analyze the data the method used to code and categories focus group data were
adapted from approaches to qualitative data analysis.
Four themes emerged from the focus group data. From the students' point
of view," initial clinical anxiety", "theory-practice gap"," clinical supervision",
professional role", were considered as important factors in clinical experience.
The result of this study showed that nursing students were not satisfied
with the clinical component of their education. They experienced anxiety as a
result of feeling incompetent and lack of professional nursing skills and
knowledge to take care of various patients in the clinical setting.
Clinical experience has been always an integral part of nursing education.
It prepares student nurses to be able of "doing" as well as "knowing" the clinical
principles in practice. The clinical practice stimulates students to use their critical
thinking skills for problem solving.
Awareness of the existence of stress in nursing students by nurse
educators and responding to it will help to diminish student nurses experience of
stress.
Clinical experience is one of the most anxiety producing components of
the nursing program which has been identified by nursing students. In a
descriptive correlational study by Beck and Srivastava 94 second, third and fourth
year nursing students reported that clinical experience was the most stressful part
of the nursing program. Lack of clinical experience, unfamiliar areas, difficult
patients, fear of making mistakes and being evaluated by faculty members were
expressed by the students as anxiety-producing situations in their initial clinical
experience. In study done by Hart and Rotem stressful events for nursing students
during clinical practice have been studied. They found that the initial clinical
experience was the most anxiety producing part of their clinical experience. The
sources of stress during clinical practice have been studied by many researchers.
The researcher came to realize that nursing students have a great deal of
anxiety when they begin their clinical practice in the second year. It is hoped that
an investigation of the student's view on their clinical experience can help to
develop an effective clinical teaching strategy in nursing education.
A focus group design was used to investigate the nursing student's view
about the clinical practice. Focus group involves organized discussion with a
selected group of individuals to gain information about their views and
experiences of a topic and is particularly suited for obtaining several perspectives
about the same topic. Focus groups are widely used as a data collection technique.
The purpose of using focus group is to obtain information of a qualitative nature
from a predetermined and limited number of people.
Using focus group in qualitative research concentrates on words and
observations to express reality and attempts to describe people in natural
situations.
The group interview is essentially a qualitative data gathering technique. It
can be used at any point in a research program and one of the common uses of it
is to obtain general background information about a topic of interest.
Focus groups interviews are essential in the evaluation process as part of a
need assessment, during a program, at the end of the program or months after the
completion of a program to gather perceptions on the outcome of that program.
Kruegger (1988) stated focus group data can be used before, during and after
programs in order to provide valuable data for decision making.
The participants from which the sample was drawn consisted of 90
baccalaureate nursing students from two hundred nursing students (30 students
from the second year and 30 from the third and 30 from the fourth year) at Shiraz
University of Medical Sciences (Faculty of Nursing and Midwifery). The second
year nursing students already started their clinical experience. They were arranged
in nine groups of ten students. Initially, the topics developed included 9 open-
ended questions that were related to their nursing clinical experience. The topics
were used to stimulate discussion.
The following topics were used to stimulate discussion regarding clinical
experience in the focus groups.
1. How do you feel about being a student in nursing education?
2. How do you feel about nursing in general?
3. Is there anything about the clinical field that might cause you to feel
anxious about it?
4. Would you like to talk about those clinical experiences which you
found most anxiety producing?
5. Which clinical experiences did you find enjoyable?
6. What are the best and worst things do you think can happen during the
clinical experience?
7. What do nursing students worry about regarding clinical experiences?
8. How do you think clinical experiences can be improved?
9. What is your expectation of clinical experiences?
The first two questions were general questions which were used as ice
breakers to stimulate discussion and put participants at ease encouraging
them to interact in a normal manner with the facilitator.
The following steps were undertaken in the focus group data analysis.
1. Immediate debriefing after each focus group with the observer and
debriefing notes were made. Debriefing notes included comments about
the focus group process and the significance of data
2. Listening to the tape and transcribing the content of the tape
3. Checking the content of the tape with the observer noting and
considering any non-verbal behavior. The benefit of transcription and
checking the contents with the observer was in picking up the following:
a. Parts of words
b. Non-verbal communication, gestures and behavior...
The researcher facilitated the groups. The observer was a public health
graduate who attended all focus groups and helped the researcher by taking notes
and observing students' on non-verbal behavior during the focus group sessions.
Observer was not known to students and researcher.
The methods used to code and categorize focus group data were adapted
from approaches to qualitative content analysis discussed by Graneheim and
Lundman and focus group data analysis by Stewart and Shamdasani For coding
the transcript it was necessary to go through the transcripts line by line and
paragraph by paragraph, looking for significant statements and codes according to
the topics addressed. The researcher compared the various codes based on
differences and similarities and sorted into categories and finally the categories
was formulated into a 4 themes.
The researcher was guided to use and three levels of coding. Three levels
of coding selected as appropriate for coding the data.
Level 1 coding examined the data line by line and making codes which
were taken from the language of the subjects who attended the focus groups.
Level 2 coding which is a comparing of coded data with other data and the
creation of categories. Categories are simply coded data that seem to cluster
together and may result from condensing of level 1 code.
Level 3 coding which describes the Basic Social Psychological Process
which is the title given to the central themes that emerge from the categories.
The documents were submitted to two assessors for validation. This action
provides an opportunity to determine the reliability of the coding. Following a
review of the codes and categories there was agreement on the classification.
The study was conducted after approval has been obtained from Shiraz
university vice-chancellor for research and in addition permission to conduct the
study was obtained from Dean of the Faculty of Nursing and Midwifery. All
participants were informed of the objective and design of the study and a written
consent received from the participants for interviews and they were free to leave
focus group if they wish.
Most of the students were females (%94) and single (% 86) with age
between 18–25.
The qualitative analysis led to the emergence of the four themes from the
focus group data. From the students' point of view," initial clinical anxiety",
"theory-practice gap", clinical supervision"," professional role", was considered
as important factors in clinical experience.
This theme emerged from all focus group discussion where students
described the difficulties experienced at the beginning of placement. Almost all of
the students had identified feeling anxious in their initial clinical placement.
Worrying about giving the wrong information to the patient was one of the issues
brought up by students.
One of the students said:
On the first day I was so anxious about giving the wrong information to
the patient. I remember one of the patients asked me what my diagnosis is. ‘I said
'I do not know', she said 'you do not know? How can you look after me if you do
not know what my diagnosis is?'
From all the focus group sessions, the students stated that the first month
of their training in clinical placement was anxiety producing for them.
One of the students expressed:
The most stressful situation is when we make the next step. I
mean...clinical placement and we don't have enough clinical experience to
accomplish the task, and do our nursing duties.
Almost all of the fourth year students in the focus group sessions felt that
their stress reduced as their training and experience progressed.
Another cause of student's anxiety in initial clinical experience was the
students' concern about the possibility of harming a patient through their lack of
knowledge in the second year.
One of the students reported:
In the first day of clinical placement two patients were assigned to me.
One of them had IV fluid. When I introduced myself to her, I noticed her IV was
running out. I was really scared and I did not know what to do and I called my
instructor.
Fear of failure and making mistakes concerning nursing procedures was
expressed by another student. She said:
I was so anxious when I had to change the colostomy dressing of my 24
years old patient. It took me 45 minutes to change the dressing. I went ten times to
the clinic to bring the stuff. My heart rate was increasing and my hand was
shaking. I was very embarrassed in front of my patient and instructor. I will never
forget that day.
Sellek researched anxiety-creating incidents for nursing students. He
suggested that the ward is the best place to learn but very few of the learner's
needs are met in this setting. Incidents such as evaluation by others on initial
clinical experience and total patient care, as well as interpersonal relations with
staff, quality of care and procedures are anxiety producing.
The category theory-practice gap emerged from all focus discussion where
almost every student in the focus group sessions described in some way the lack
of integration of theory into clinical practice.
I have learnt so many things in the class, but there is not much more
chance to do them in actual settings.
Another student mentioned:
When I just learned theory for example about a disease such as diabetic
mellitus and then I go on the ward and see the real patient with diabetic mellitus,
I relate it back to what I learned in class and that way it will remain in my mind.
It is not happen sometimes.
The literature suggests that there is a gap between theory and practice. It
has been identified by Allmark and Tolly. The development of practice theory,
theory which is developed from practice, for practice, is one way of reducing the
theory-practice gap. Rolfe suggests that by reconsidering the relationship between
theory and practice the gap can be closed. He suggests facilitating reflection on
the realities of clinical life by nursing theorists will reduce the theory-practice
gap. The theory- practice gap is felt most acutely by student nurses. They find
themselves torn between the demands of their tutor and practicing nurses in real
clinical situations. They were faced with different real clinical situations and are
unable to generalize from what they learnt in theory.
Clinical supervision is recognized as a developmental opportunity to
develop clinical leadership. Working with the practitioners through the milieu of
clinical supervision is a powerful way of enabling them to realize desirable
practice. Clinical nursing supervision is an ongoing systematic process that
encourages and supports improved professional practice. According to Berggren
and Severinsson the clinical nurse supervisors' ethical value system is involved in
her/his process of decision making.
Clinical Supervision by Head Nurse (Nursing Unit Manager) and Staff
Nurses was another issue discussed by the students in the focus group sessions.
One of the students said:
Sometimes we are taught mostly by the Head Nurse or other Nursing staff.
The ward staff are not concerned about what students learn, they are busy with
their duties and they are unable to have both an educational and a service role
Another student added:
Some of the nursing staff have good interaction with nursing students and
they are interested in helping students in the clinical placement but they are not
aware of the skills and strategies which are necessary in clinical education and are
not prepared for their role to act as an instructor in the clinical placement
The students mostly mentioned their instructor's role as an evaluative
person. The majority of students had the perception that their instructors have a
more evaluative role than a teaching role.
The literature suggests that the clinical nurse supervisors should expressed
their existence as a role model for the supervisees.
One view that was frequently expressed by student nurses in the focus
group sessions was that students often thought that their work was 'not really
professional nursing' they were confused by what they had learned in the faculty
and what in reality was expected of them in practice.
We just do basic nursing care, very basic. ...You know...giving bed baths,
keeping patients clean and making their beds. Anyone can do it. We spend four
years studying nursing but we do not feel we are doing a professional job.
The role of the professional nurse and nursing auxiliaries was another
issue discussed by one of the students:
The role of auxiliaries such as registered practical nurse and Nurses Aids
are the same as the role of the professional nurse. We spend four years and we
have learned that nursing is a professional job and it requires training and skills
and knowledge, but when we see that Nurses Aids are doing the same things, it
cannot be considered a professional job.
The result of student's views toward clinical experience showed that they
were not satisfied with the clinical component of their education. Four themes of
concern for students were 'initial clinical anxiety', 'theory-practice gap', 'clinical
supervision', and 'professional role'.
The nursing students clearly identified that the initial clinical experience is
very stressful for them. Students in the second year experienced more anxiety
compared with third and fourth year students. This was similar to the finding of
Bell and Ruth who found that nursing students have a higher level of anxiety in
second year. Neary identified three main categories of concern for students which
are the fear of doing harm to patients, the sense of not belonging to the nursing
team and of not being fully competent on registration which are similar to what
our students mentioned in the focus group discussions. Jinks and Patmon also
found that students felt they had an insufficiency in clinical skills upon
completion of pre-registration program.
Initial clinical experience was the most anxiety producing part of student
clinical experience. In this study fear of making mistake (fear of failure) and
being evaluated by faculty members were expressed by the students as anxiety-
producing situations in their initial clinical experience. This finding is supported
by Hart and Rotem and Stephens. Developing confidence is an important
component of clinical nursing practice. Development of confidence should be
facilitated by the process of nursing education; as a result students become
competent and confident. Differences between actual and expected behavior in
the clinical placement creates conflicts in nursing students. Nursing students
receive instructions which are different to what they have been taught in the
classroom. Students feel anxious and this anxiety has effect on their performance.
The existence of theory-practice gap in nursing has been an issue of
concern for many years as it has been shown to delay student learning. All the
students in this study clearly demonstrated that there is a gap between theory and
practice. This finding is supported by other studies such as Ferguson and Jinks
and Hewison and Wildman and Bjork. Discrepancy between theory and practice
has long been a source of concern to teachers, practitioners and learners. It deeply
rooted in the history of nurse education. Theory-practice gap has been recognized
for over 50 years in nursing. This issue is said to have caused the movement of
nurse education into higher education sector.
Clinical supervision was one of the main themes in this study. According
to participant, instructor role in assisting student nurses to reach professional
excellence is very important. In this study, the majority of students had the
perception that their instructors have a more evaluative role than a teaching role.
About half of the students mentioned that some of the head Nurse (Nursing Unit
Manager) and Staff Nurses are very good in supervising us in the clinical area.
The clinical instructor or mentors can play an important role in student nurses'
self-confidence, promote role socialization, and encourage independence which
leads to clinical competency. A supportive and socializing role was identified by
the students as the mentor's function. This finding is similar to the finding of
Earnshaw. According to Begat and Severinsson supporting nurses by clinical
nurse specialist reported that they may have a positive effect on their perceptions
of well-being and less anxiety and physical symptoms.
The students identified factors that influence their professional
socialization. Professional role and hierarchy of occupation were factors which
were frequently expressed by the students. Self-evaluation of professional
knowledge, values and skills contribute to the professional's self-concept. The
professional role encompasses skills, knowledge and behavior learned through
professional socialization. The acquisition of career attitudes, values and motives
which are held by society are important stages in the socialization process.
According to Corwin autonomy, independence, decision-making and
innovation are achieved through professional self-concept. Lengacher (1994)
discussed the importance of faculty staff in the socialization process of students
and in preparing them for reality in practice. Maintenance and/or nurturance of
the student's self-esteem play an important role for facilitation of socialization
process.
One view that was expressed by second and third year student nurses in
the focus group sessions was that students often thought that their work was 'not
really professional nursing' they were confused by what they had learned in the
faculty and what in reality was expected of them in practice.
The finding of this study and the literature support the need to rethink
about the clinical skills training in nursing education. It is clear that all themes
mentioned by the students play an important role in student learning and nursing
education in general. There were some similarities between the results of this
study with other reported studies and confirmed that some of the factors are
universal in nursing education. Nursing students expressed their views and
mentioned their worry about the initial clinical anxiety, theory-practice gap,
professional role and clinical supervision. They mentioned that integration of both
theory and practice with good clinical supervision enabling them to feel that they
are enough competent to take care of the patients.
The result of this study would help us as educators to design strategies for
more effective clinical teaching. The results of this study should be considered by
nursing education and nursing practice professionals. Faculties of nursing need to
be concerned about solving student problems in education and clinical practice.
The findings support the need for Faculty of Nursing to plan nursing curriculum
in a way that nursing students be involved actively in their education.
The nursing industry has established eleven key areas of responsibility that
provide a framework for unifying nursing education, practice and regulation. This
comprehensive list of key areas and core competencies within each key area
furnishes the industry with a standardized measure that is used in all aspects of the
nursing profession (Landford, 2010).
Safety and Quality - The first key area of nursing responsibility focuses on
providing nursing care that is safe and of high quality. Under this key area, core
competencies include demonstrating knowledge about the health status and illness
of a patient; making appropriate decisions when caring for patients and
their families; and ensuring patient safety, privacy and comfort. Competencies
also include setting appropriate priorities in patient care, working with the
medical team to ensure stability of care, effectively administering medications
and other treatment modalities and performing assessments and nursing services
against a background of established nursing guidelines. The nurse also works with
the medical team and patient's family to develop a plan of care. Identifying the
goals of care and evaluating progress toward those goals are also core
competencies within this key area.
Resources and Environment - the next key area is the management of
resources and environment. Core competencies in this area include identifying
tasks that need to be completed, developing financially effective programs,
ensuring that equipment performs adequately and maintaining safety in the
environment.
Health Education - educational core competencies include assessing the
educational needs of the patient and family, developing and implementing health
education plans and learning materials and evaluating the outcome of education
administered.
Legal Responsibilities - core competencies in the legal key area include
following legally mandated state and federal processes and procedures, such as
obtaining informed consent from patients and adequately documenting all
procedures performed for patients.
Ethical Responsibilities - in this key area that concerns morals and
ethics, core competencies include respecting the rights of all individuals and
groups, accepting responsibility for individual decisions and adhering to the
nurses' national and international code of ethics.
Professional Development - the professional development key area
includes core competencies of identifying personal needs for education and
pursuing those goals, participating in professional organizations and
community activities, presenting a professional image and positive attitude as
well as performing work duties in a professional manner.
Quality Improvement - in the quality improvement key area, core
competencies include identifying areas for improvement, participating in
nursing rounds and audits, staying aware of variances in treatment and
recommending solutions to improve quality.
Research - core competencies in the research key area include
gathering and analyzing research data, sharing results and applying findings
to work functions.
Records Management - the records management key area includes core
competencies of maintaining appropriate documentation using the
appropriate system and staying within legal boundaries in the area of patient
privacy.
Communication - in this key area, core competencies include
establishing communication with the patient and treatment team, learning to
read verbal and nonverbal cues, using visual aids and other resources when
necessary, responding to patient and group needs and effectively using
technology to facilitate communication.
Teamwork - the teamwork and collaboration key area includes core
competencies of establishing beneficial working relationships with peers and
colleagues and communicating care plans with health team members.
Bellosillo et al (2008) postulated that due to the foregoing, new
expectations for contemporary nursing practice, competencies are emerging,
which is heightened by the escalating complexity of globalization, the dynamics
of health science and information technology, demographic changes, health care
policy reforms and the increasing and more exacting demands from the
consumers of health care. Moreover, the surge of overseas employment
opportunities for Filipino nurses creates depletion in the reservoir of competent
professional to serve the health needs of the country. These changes are spawned
by the multitudes of forces converging in the national as well as international
levels, which impact on the quality of nursing practice in the country.
Accordingly, the Board of Nursing had created a committee which is
responsible for developing competency standards for nursing practice in the
country and this is called: Committee on Core Competency Standards
Development (CCCSD) together with collaboration in the Commission on Higher
Education Technical Committee on Nursing Education (CHED-TCNED).
Furthermore, Bellosillo et al (2008) elaborated that the Committee was composed
of leaders from nursing education, nursing practice and nursing regulation. The
whole gamut of developing the standards were made possible through the
participation of representatives of professional nursing organizations, consumers
of nursing practice such as doctors, administrators and patients, senior nursing
students and in consultation with nurse executives from regulatory authorities in
three countries.
Most health care providers begin their health profession education
expecting to acquire the knowledge and skills needed to provide high-quality care.
However, as they advance through their education and begin their careers, they
discover that health care systems are exceedingly complex, with a myriad of
system issues that often make the provision of high-quality care difficult.
In addition, Bates et al (1995) discussed that nurses are uniquely
positioned to serve as change agents within health systems. By partnering with
other health care providers who share their vision for improving care and by
linking with institutional quality professionals, the impact of nursing
improvement efforts is heightened. As health care systems increasingly recognize
the value of this work, nurses find that their contributions to care improvement
lead not only to a sense of personal reward, but may lead to professional
advancement. Investment in the development of skills in quality improvement
provides a means for nurses to improve the lives of patients, build their own
careers, and improve the joy they derive from their work.
Since then, the Board of Nursing had released a Resolution No. 112 Series
of 2005 which centers on “A Resolution Adopting and Promulgating the
Competency Standards for Nursing Practice in the Philippines” which give
emphasis that the 11 core competency areas of nursing should be utilized as a
framework for the development of Instructional Standards in the Curriculum, the
formulation of course syllabi and questions in the Integrated Comprehensive
Nurse Licensure Examinations and the development of standards and
performance evaluation in the practice of nursing (Bellosillo, 2008).
After this resolution number had taken effect, different nursing schools in
the Philippines had adopted the application and incorporation of the eleven
nursing core competencies in their curriculum specifically in Nursing Care
Management and Related Learning Experience. The Mindanao Sanitarium and
Hospital College had already followed and applied these eleven nursing core
competencies as a model principle of nursing practice. The institution had
incorporated this in the related learning experience and part of their teaching
syllabi on the subject Nursing Care Management.
According to Scott (2008) developing meaningful competency
requirements for registered muses continues to confound the sing profession. The
challenge it presents for healthcare regulators is learning how to objectively
measure competencies across various settings, specialties, years of experience and
geographic regions. According to Oppewal et al. (2006), core competencies have
been developed in different specialty areas, but even nurses' awareness and
implementation of such standards vary. The National Council of State Boards of
Nursing (NCSBN) has worked, through their committees of Research and
Practice, Regulation, and Education, to develop a program to transition graduate
nurses into the profession; this program has been a culmination of research and
defines the needs of new nurses. Spector and Li (2007) discuss this ongoing
research that is being completed to assess the design of this program.
At the Center for American Noses LEAD Summit 2008, Dr. May Arm
Alexander, Chief Offices of Nursing Regulation for the NCSBN, will present
current research and findings about past, present and future issues related to
continued nursing competence.
According to J Allied Health (2006) this paper describes the amalgamation
of the core competencies identified for medicine, nursing, physical therapy, and
occupational therapy and the "harmonization" of these competencies into a
framework tor interprofessional education. The study was undertaken at a
Canadian university with a Faculty of Health Sciences comprised of three schools
(namely, medicine, nursing, and rehabilitation therapy). Leaders in
interprofessional education began to identify the common standards for the core
competencies expected of learners in all three schools at commensurate levels to
facilitate the integration of educational curricula aimed at interprofessional
education across the Faculty. The model that was created serves as a basis for
curriculum design and assessment of individuals and groups of learners from
different domains across and within the four professions. It particularly highlights
the relevance of cross-disciplinary competency teaching and 360-degree
evaluation in teams. Most importantly, it provides a launch pad for clarifying
performance standards and expectations in interdisciplinary learning.
While in the early stages of creating an academy of educators skilled at
teaching and evaluating interprofessional practice and education at a Canadian
university, two needs emerged as crucial to the success of a change in culture in
academic health sciences, namely: 1) to identify the common standards for the
core competencies expected of learners in all three schools at commensurate
levels and 2) to develop and evaluate a curriculum that can he delivered at the
appropriate levels and with appropriate standards for the four professions in the
faculty. These critical issues arose out of the expressed desire of teaching faculty
to have a shared vocabulary and better understanding of objectives, expectations,
and standards in their health care professions.
Consensus emerged that a logical place to begin would be with a
description of the vital competencies required tor the four professions. This paper
describes the amalgamation of the core competencies identified for medicine,
nursing, physical therapy, and occupational therapy and the 'harmonization' of
these competencies into a framework for interprofessional education.
A competency model that defines a set of expected skills both "vertically"
and "horizontally" between health care professions does not exist. A major barrier
to the success of interprofessional education has been the lack of understanding of
shared competencies for the members of the health care education team and a lack
of common vocabulary that can be used interchangeably for teaching and
evaluation.2
Consensus on core competencies in health care provides a common
framework and language for discussing how to teach and evaluate the
expectations for interdisciplinary performance in health care teams. Common core
competencies provide a shared understanding of the scope and requirements of a
specific role and mutual organization wide standards for performance.
A systematic review of the literature was conducted of MEDLINE,
CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED
(Allied and Complementary Medicine), and the Cochrane Database of Systematic
Reviews. The search terms included: education, competency-based; education,
interdisciplinary; interprofessional relations; professional competence; delivery of
health care, integrated; clinical competence; and patient care team. The yield from
this intensive search was extremely limited.
Although there were various articles about the importance of shared
learning,3 interprofessional education,4-6 working together as teams,7-9 and
integrated health delivery systems,10 there were few articles that outlined specific
competencies across disciplines. One paper11 outlined the need for allied health
professionals to shift educational paradigms to articulate common competencies
across several disciplines and recommended a proposal for achieving and
measuring competencies in an interdisciplinary manner.
Barr (2006) suggested that the case for competency-based
interprofessional education rests on the need to:
* Reposition interprofessional education in the mainstream of
contemporary professional education;
* Enable students to relate professional and interprofessional
studies coherently;
* Enable students on interprofessional courses to claim credits as
part of their professional education.
In nursing school, we are taught to respect the rights and dignity of all
clients. As the “world becomes smaller” and individuals and societies become
more mobile, we are increasingly able to interact with individuals as a competent
nurses. Competence becomes important for us as nurses and patient advocates.
Competence is the ability to provide effective care for clients who came from
different cultures. It requires sensitivity and effective communication, both
verbally and non-verbally (Anderson, 2009).
Competency, as discussed in the Competency standards approach to
professional education and practice, is defined as a combination of attributes
enabling performance of a range of professional tasks to the appropriate standards
(Gonczi, Hager & Oliver, 1990). Competency encompasses more than just a
psychomotor skill. It describes the attributes of knowledge, abilities, skills and
attitudes that underlie competent performance. Nurses know that psychomotor
skills are important but, performed without knowledge, they do not constitute
nursing. Nursing knowledge of health and disease processes is of little use
without appropriate nursing skills to implement. The abilities to plan and organize
our work are of little benefit to patients or clients if the attitude that nurses value
such as, caring and patience is not present. Therefore, integration of the
knowledge, abilities, skills and attitudes of nursing is the essential key to
understanding and performing competencies.
Competence does not mean expert. There exist various levels of
competence but each of these has a minimum acceptable level or standard.
Beginners are rarely expert, but they can be competent. They perform a wide
range of nursing activities methodically and well. They may be slow but develop
further skills and speed in time. They have to ask many questions but they know
which questions to ask. Beginning graduate nurses may be a little slow
completing total patient care, be somewhat limited in the range of skills they can
perform, not possess a great deal of specialized knowledge but they are easily
distinguished from someone who is not a nurse, or even a novice student nurse.
The experienced competent nurse works quickly and capably, able to care
for a highly complex and dependent patient in the critical care unit, or nurse
several high dependency patients in a busy surgical or medical ward. In the
community setting, nursing skills of assessment and decision-making are often
invisible, but are reflected in the delivery of patient care. Experienced and expert
nurses have amazing memories, seem to do twenty things at once, cope with
interruptions and can deal with emergencies, all calmly and expertly. Yet behind
the smooth performance we recognize the knowledge, abilities, skills and attitudes
that are integrated into the professional demonstration of excellent nursing. If you
have recognized an example of nursing such as this, then you can recognize
nursing competency.
In order for nurses to successfully design and build systems that support
the highest levels of nursing development, it must first understand it’s core
competencies. Competencies has been defined in the article, People Are Critical
to Success, as a set of behaviors that encompasses skills, knowledge, abilities, and
personal attributes that, taken together, are critical to successful work
accomplishment (Avilar, 2000). In addition, an ongoing process for change
management must be in place that addresses feedback, learning, and process
flexibility. A learning culture must be of prime importance to top leadership and
must flow throughout the organization. Responsiveness to cultural and climatic
change within the industry must be identified quickly, specifically, and accurately
to reduce the margin of error for profitability and growth.
Competency in nursing has a direct influence on the health and safety of
all patients. Unfortunately, the absence of competency may lead to serious
medical errors resulting in serious consequences for the patient. Medical error is
the failure to complete a planned action as intended or the use of a wrong plan to
achieve an aim (Institute of Medicine, 2002). It was determined in their report that
medical errors lead to the deaths of nearly 98,000 hospitalized patients each year.
The Agency for Healthcare Quality and Research annual report determined that
the quality of care and safety factors associated with care of patients in the United
States continue to cause concern in 2004.
Competence is a generic term referring to a person’s overall capacity,
while competency refers to specific capabilities, such as leadership (Eraut, 2001).
It is therefore important to be able to identify and measure the relevant
competencies that contribute to overall competence, and that each specific
competency is measured by a set of valid and reliable items representing the
appropriate knowledge, skills and abilities.
The safety of patients receiving medical care is clearly associated with the
competency of the healthcare providers, and quality care can only be
accomplished if the providers are deemed competent to provide the best possible
standard of care (Axley, 2008).
According to Joint Commission on Accreditation of Healthcare
Organizations (2006), competency is defined as a “determination of an
individual’s skills, knowledge, and capability to meet defined expectations”.
Furthermore, they require measuring the competency of the nurses.
Competency models have been implemented in both primary and
secondary education as a measure of success in a program of study. Specific
competencies are identified as role outcomes, or knowledge, skills, and attitudes,
or both, required for role performance, and then assessed by a criterion, usually a
behavioral standard (Rampey, et al., 2006). In accordance to that, core
competencies refer specifically to a group or compilation of skills or procedures
requiring the ability of an individual to successfully or competently perform the
requisite action and it differentiates quality and expertise in the identified
situation or individual (Hamel & Pahalad, 2006). However, competence is an
observable concept that is measurable, uniformed and validated through
examinations, assessment tools and rating scales (Coates & Chambers, 2004). In
contrast to that, competence is something more than the performance of skills and
accentuates the effects of skills on students and patients (Benner, 2002).
Assessment of nursing competence should be grounded in actual practice
and should include such dimensions as: ability to cope under pressure and over
time; delivery of compassionate, safe care of helpless patients; ability to solve
problems in crisis situations; ability to cope with the person in pain; and sensitive
care of the person who is dying. Other requirements for assessing competence are:
nursing competencies should be related to patient outcome; the criterion level for
competence should be established; and the assessment method should have
predictive validity in that it can predict competent performance in real-life
situations (Benner, 2002). It should be context-specific, therefore.
Although Abdellah spoke of the patient-centered approaches, she wrote of
nurses identifying and solving specific problems. This identification and
classification of problems was called the typology of 21 nursing problems.
Abdellah’s typology was divided into three areas: (1) the physical, sociological,
and emotional needs of the patient; (2) the types of interpersonal relationships
between the nurse and the patient; and (3) the common elements of patient care.
Adbellah and her colleagues thought the typology would provide a method to
evaluate a student’s experiences and also a method to evaluate a nurse’s
competency based on outcome measures (Tomey & Alligood, Nursing theorists
and their work 4th ed., p. 115).
A gender role is a set of behavioural norms associated particularly with
males or females in a given social group or system, often including the division of
labour between men and women. Gender-based roles coincident with sex-based
roles have been the norm in many traditional societies, with the specific
components and workings of the gender system of role division varying markedly
from society to society. Gender role is a focus of analysis in the social sciences
and humanities.
Alice Eagly’s “Social Role Theory” offers an explanation of gender
development that is based on socialization. She suggests that the sexual division
of labour and societal expectations based on stereotypes produced gender roles.
She distinguishes between the communal and agentic dimensions of gender-
stereotyped characteristics. The communal role is characterized by attributes, such
as nurturance and emotional expressiveness, commonly associated with domestic
activities, and thus, with women. The agentic role is characterized by attributes
such as assertiveness and independence, commonly associated with public
activities, and thus, with men. Behaviour is strongly influenced by gender roles
when cultures endorse gender stereotypes and form firm expectations based on
those stereotypes.
Florence Nightingale believed that most women would be required to
nurse, as part of their role as wife, mother or family caregiver (Torres, 2001).
Nursing remains a female dominated occupation and it has been regarded by
many societies as an innate feminine skill, which by being a natural part of the
woman's role required little in the way of development or reward.
On the other hand, male nurses are treated a bit better than the female
nurses on the floor. Female nurses tolerate a lot of abuse from administration and
from some doctors, whereas when men speak, complaints, concerns, findings,
assessments are heard sometimes louder than a female. In addition, he noted that
male nurses get paid more than female nurses. Male nurses do tend to move more
than females. Females get settled in and are afraid of change (Joey, 2006).
From the article entitled Dilemmas Facing Males in Nursing, it is stated
there that there will always be a gender issue in any treatment as long as patients
are allowed to have a preference. No one has the desire to remove that privilege.
There are advances in males taking on roles normally considered for female only
– e.g.: male midwives. The general perceptions of those mothers-to-be who meet
one have been generally receptive to the idea but it’s a big change in philosophy
for staff and patient alike. Change takes time and this one will not happen over
one generation. If a student or any nurse cannot accept that patients have a choice
in who treats them, then they are in the wrong profession, male or female. Where
logistics do not allow for a choice (e.g.: only female nurses and patient prefers a
male) then the service has a responsibility to improve that – not overcome the
issue by changing patient’s belief systems. The most frequent ’sexism’ of this
nature I have seen in healthcare is between staff and not patients- e.g.: using only
male staff to deal with an aggressive patient. Overall, the shortage on males in
nursing is because guys generally don’t choose nursing, not because the
profession is making it difficult for them. It remains a perceived female role and
requires certain basic qualities that are innate in females and males need to work
on them such as empathy, caring, relationships, communication and that general
ability to manage thru all adversity.
A person's gender role comprises several elements that can be expressed
through several factors, like clothing, behaviour, personal relationships, and
occupation. These elements are not fixed and have changed through time. Gender
roles traditionally were often divided into distinct feminine and masculine gender
roles, until especially the twentieth century when these roles diversified into many
different acceptable male or female roles in modernized countries throughout the
world. Thus, in many modern societies one's biological gender no longer
determines the functions that an individual can perform, allowing greater freedom
and opportunity for all people to achieve their individual potential and offer their
talents and abilities to society for the benefit of all.
Continuity of care is the comprehensive, coordinated and integrated
provision of health services. The focus of continuity of care is on the needs of the
client family, acknowledges clients and informal caregivers as partners in care,
and requires an interdisciplinary approach by formal caregivers (Bull & Roberts,
2001). Registered nurses are leaders in implementing collaborative practice. The
registered nurse, as a direct caregiver, has the most consistent presence in
providing care to a client and has knowledge of a client’s continuing care needs.
Therefore, a registered nurse can contribute significantly to the coordination and
planning for continuity of care for a client. (Wells, LeClerc, Craig, Martin &
Marshall, 2002).
Local Studies
According to Armento (2008) a lack of qualified nursing educators and an
increasing workload in colleges may exacerbate problems between students and
instructors, greatly undermining the learning environment. The most common
problems arising between nursing students and their instructors are lack of
communication, misunderstandings and social/cultural problems.
1.) Lack of Communication
In nursing school, it can be easy for students to have poor
communication with their instructors. Often, the instructor-to-student ratio shows
a large disparity, so students may not always get their questions or concerns
addressed. Student unions and organizations work to address this issue, but there
may still be problems.
At the beginning of the school year, get your instructors' contact numbers,
email addresses and office hours. Make sure to ask questions whenever
applicable. Nursing instructors encourage their students to be proactive, so if a
question is not urgent, seek out the answer yourself during self-guided study time,
or even create an informal study group, as a classmate may be able to assist.
Do not be intimidated, however. When you need clarification of a nursing
procedure or disease process, ask for it.
2.) Misunderstandings
Long hours and the general pressures of a clinical environment can lead to
misunderstandings between students and nursing instructors. Sometimes nursing
instructors give too little feedback and may inadvertently contribute to student
mistakes. Other times, nursing instructors seem impossible to please, which may
leave students discouraged. Both teaching styles have negative effects on students'
enthusiasm. In fact, they can promote hostility.
Whenever possible, ask nursing instructors exactly what they are looking
for during clinical rotations. Instructors, regardless of how harried they may be,
will prefer that a nursing student fully understand concepts and techniques rather
than risk patient safety by guessing the appropriate course of action.
3.) Social/Cultural Problems
Sociocultural problems are less common in nursing school than in other
educational environments because the material is so health-focused. The most
prominent concern may be cultural bias in textbooks and on certain exams.
Certain textbooks and exam questions may be uncomfortable for some students
because most nursing baselines are derived from European norms, rather than
encompassing a broad sociocultural perspective. Many nursing schools have
sought to remedy this by using textbooks that address differences among a variety
of cultures.
Cultural and religious awareness is important in providing sensitive
nursing care, so if nursing instructors are not adequately addressing diversity
issues, students should ask that such topics be considered. Nursing students
should also try to find and read books that address diversity and its place in the
clinical environment.
According Basa (2009) the responsibility for which a nurse should
demonstrate competence in:
1. Safe and quality nursing care
2. Management of resources and environment
3. Health education
4. Legal responsibility
5. Ethico-moral responsibility
6. Personal and professional development
7. Quality improvement
8. Research
9. Record Management
10. Communication
11. Collaboration and teamwork
I. Patient Care Competencies
1. Safe and Quality Nursing Care
Core Competency 1: Demonstrates knowledge base on the health /illness status of
individual / groups
Identifies the health needs of the clients (individuals, families, population groups
and/or communities)
Explains the health status of the clients/ groups
Core Competency 2: Provides sound decision making in the care of individuals /
families/groups considering their beliefs and values
Identifies clients’ wellness potential and/or health problem
Gathers data related to the health condition
Analyzes the data gathered
Selects appropriate action to support/ enhance wellness response; manage the
health problem
Monitors the progress of the action taken
Core Competency 3: Promotes safety and comfort and privacy of clients
Performs age-specific safety measures in all aspects of client care
Performs age-specific comfort measures in all aspects of client care
Performs age-specific measures to ensure privacy in all aspects of client care
Core Competency 4: Sets priorities in nursing care based on clients’ needs
Identifies the priority needs of clients
Analyzes the needs of clients
Determines appropriate nursing care to address priority needs/problems
Core Competency 5: Ensures continuity of care
Refers identified problem to appropriate individuals / agencies
Establishes means of providing continuous client care
Core Competency 6: Administers medications and other health therapeutics
Conforms to the 10 golden rules in medication administration and health
therapeutics
Core Competency 7: Utilizes the nursing process as framework for nursing
7.1 Performs comprehensive and systematic nursing assessment
Obtains informed consent
Completes appropriate assessment forms
Performs appropriate assessment techniques
Obtains comprehensive client information
Maintains privacy and confidentiality
Identifies health needs
7.2 Formulates a plan of care in collaboration with clients and other
members of the health team
Includes client and his family in care planning
Collaborates with other members of the health team
States expected outcomes of nursing intervention maximizing clients’ competence
Develops comprehensive client care plan maximizing opportunities for prevention
of problems and/or enhancing wellness response
Accomplishes client-centered discharge plan
Implements planned nursing care to achieve identified outcomes
Explains interventions to clients and family before carrying them out to achieve
identified outcomes
Implements nursing intervention that is safe and comfortable
Acts to improve clients’ health condition or human response
Performs nursing activities effectively and in a timely manner
Uses the participatory approach to enhance client-partners empowering potential
for healthy life style/wellness
7.3 Evaluates progress toward expected outcomes
Monitors effectiveness of nursing interventions
Revises care plan based on expected outcomes
2. Communication
Core Competency 1: Establishes rapport with client, significant others and
members of the health team
Creates trust and confidence
Spends time with the client/significant others and members of the health team to
facilitate interaction
Listens actively to client’s concerns/significant others and members of the health
team
Core Competency 2: Identifies verbal and non-verbal cues
Interprets and validates client’s body language and facial expressions
Core Competency 3: Utilizes formal and informal channels
Makes use of available visual aids
Utilizes effective channels of communication relevant to client care management
Core Competency 4: Responds to needs of individuals, family, group and
community
Provides reassurance through therapeutic touch, warmth and comforting words of
encouragement
Provides therapeutic bio-behavioral interventions to meet the needs of clients
Core Competency 5: Uses appropriate information technology to facilitate
communication
Utilizes telephone, mobile phone, electronic media
Utilizes informatics to support the delivery of healthca
3. Collaboration and Teamwork
Core Competency 1: Establishes collaborative relationship with colleagues and
other members of the health team
Contributes to decision making regarding clients’ needs and concerns
Participates actively in client care management including audit
Recommends appropriate intervention to improve client care
Respect the role of other members of the health team
Maintains good interpersonal relationship with clients , colleagues and other
members of the health team
Core Competency 2: Collaborates plan of care with other members of the health
Team
Refers clients to allied health team partners
Acts as liaison / advocate of the client
Prepares accurate documentation for efficient communication of services
4. Health Education
Core Competency 1: Assesses the learning needs of the client-partner/s
Obtains learning information through interview, observation and validation
Analyzes relevant information
Completes assessment records appropriately
Identifies priority needs
Core Competency 2: Develops health education plan based on assessed and
anticipated needs
Considers nature of learner in relation to: social, cultural, political, economic,
educational and religious factors.
Involves the client, family, significant others and other resources in identifying
learning needs on behavior change for wellness, healthy lifestyle or management
of health problems
Formulates a comprehensive health education plan with the following
components: objectives, content, time allotment, teaching-learning resources and
evaluation parameters
Provides for feedback to finalize the plan
Core Competency 3: Develops learning materials for health education
Develops information education materials appropriate to the level of the client
Applies health education principles in the development of information education
materials
Core Competency 4: Implements the health education plan
Provides for a conducive learning situation in terms of time and place
Considers client and family’s preparedness
Utilizes appropriate strategies that maximize opportunities for behavior change
for wellness/healthy life style
Provides reassuring presence through active listening, touch, facial expression and
gestures
Monitors client and family’s responses to health education
Core Competency 5: Evaluates the outcome of health education
Utilizes evaluation parameters
Documents outcome of care
Revises health education plan based on client response/outcome/s
II. Empowering Competencies
5. Legal Responsibility
Core Competency 1: Adheres to practices in accordance with the nursing law and
other relevant legislation including contracts, informed consent.
Fulfills legal requirements in nursing practice
Holds current professional license
Acts in accordance with the terms of contract of employment and other rules and
regulations
Complies with required continuing professional education
Confirms information given by the doctor for informed consent
Secures waiver of responsibility for refusal to undergo treatment or procedure
Checks the completeness of informed consent and other legal forms
Core Competency 2: Adheres to organizational policies and procedures, local and
national
Articulates the vision, mission of the institution where one belongs
Acts in accordance with the established norms of conduct of the institution/
organization/legal and regulatory requirements
Core Competency 3: Documents care rendered to clients
Utilizes appropriate client care records and reports.
Accomplishes accurate documentation in all matters concerning client care in
accordance to the standards of nursing practice.
6. Ethico-moral Responsibility
Core Competency 1: Respects the rights of individual / groups
Renders nursing care consistent with the client’s bill of rights: (i.e. confidentiality
of information, privacy, etc.)
Core Competency 2: Accepts responsibility and accountability for own decision
and actions
Meets nursing accountability requirements as embodied in the job description
Justifies basis for nursing actions and judgment
Projects a positive image of the profession
Core Competency 3: Adheres to the national and international code of ethics for
nurses
Adheres to the Code of Ethics for Nurses and abides by its provision
Reports unethical and immoral incidents to proper authorities
7. Personal and Professional Development
Core Competency 1: Identifies own learning needs
Identifies one’s strengths, weaknesses/ limitations
Determines personal and professional goals and aspirations
Core Competency 2: Pursues continuing education
Participates in formal and non-formal education
Applies learned information for the improvement of care
Core Competency 3: Gets involved in professional organizations and civic
activities
Participates actively in professional, social, civic, and religious activities
Maintains membership to professional organizations
Support activities related to nursing and health issues
Core Competency 4: Projects a professional image of the nurse
Demonstrates good manners and right conduct at all times
Dresses appropriately
Demonstrates congruence of words and action
Behaves appropriately at all times
Core Competency 5: Possesses positive attitude towards change and criticism
Listens to suggestions and recommendations
Tries new strategies or approaches
Adapts to changes willingly
Core Competency 6: Performs function according to professional standards
Assesses own performance against standards of practice
Sets attainable objectives to enhance nursing knowledge and skills
Explains current nursing practices, when situations call for it
III. Enhancing Competencies
8. Records Management
Core Competency 1: Maintains accurate and updated documentation of client care
Completes updated documentation of client care
Applies principles of record management
Monitors and improves accuracy, completeness and reliability of relevant data
Makes record readily accessible to facilitate client care
Core Competency 2: Records outcome of client care
Utilizes a records system ex. Carded or Hospital Information System (HIS)
Uses data in their decision and policy making activities
Core Competency 3: Observes legal imperatives in record keeping
Maintains integrity, safety, access and security of records
Documents/monitors proper record storage, retention and disposal
Observes confidentially and privacy of the clients’ records
Maintains an organized system of filing and keeping clients’ records in a
designated area
Follows protocol in releasing records and other information
9. Management of Resources and Environment
Core Competency 1: Organizes work load to facilitate client care
Identifies tasks or activities that need to be accomplished
Plans the performance of tasks or activities based on priorities
Verifies the competency of the staff prior to delegating tasks
Determines tasks and procedures that can be safely assigned to other members of
the team
Finishes work assignment on time
Core Competency 2: Utilizes financial resources to support client care
Identifies the cost-effectiveness in the utilization of resources
Develops budget considering existing resources for nursing care
Core Competency 3: Establishes mechanism to ensure proper functioning of
equipment
Plans for preventive maintenance program
Checks proper functioning of equipment considering the:
- intended use - safety
- cost benefits - waste creation and disposal storage
- infection control
- Refers malfunctioning equipment to appropriate unit
Core Competency 4: Maintains a safe environment
Complies with standards and safety codes prescribed by laws
Adheres to policies, procedures and protocols on prevention and control of
infection
Observes protocols on pollution-control (water, air and noise)
Observes proper disposal of wastes
Defines steps to follow in case of fire, earthquake and other emergency situations.
IV. Enabling Competencies
10. Quality Improvement
Core Competency 1: Gathers data for quality improvement
Identifies appropriate quality improvement methodologies for the clinical
problems
Detects variation in specific parameters i.e. vital signs of the client from day to
day
Reports significant changes in clients’ condition/environment to improve stay in
the hospital
Solicits feedback from client and significant others regarding care rendered
Core Competency 2: Participates in nursing audits and rounds
Shares with the team relevant information regarding clients’ condition and
significant changes in clients’ environment
Encourages the client to verbalize relevant changes in his/her condition
Performs daily check of clients’ records / condition
Documents and records all nursing care and actions implemented
Core Competency 3: Identifies and reports variances
Reports to appropriate person/s significant variances/changes/occurrences
immediately
Documents and reports observed variances regarding client care
Core Competency 4: Recommends solutions to identified problems
Gives an objective and accurate report on what was observed rather than an
interpretation of the event
Provides appropriate suggestions on corrective and preventive measures
Communicates solutions with appropriate groups
11. Research
Core Competency 1: Gather data using different methodologies
Specifies researchable problems regarding client care and community health
Identifies appropriate methods of research for a particular client /community
problem
Combines quantitative and qualitative nursing design through simple explanation
on the phenomena observed
Core Competency 2: Analyzes and interprets data gathered
Analyzes data gathered using appropriate statistical tool
Interprets data gathered based on significant findings
Core Competency 3: Recommends actions for implementation
Recommends practical solutions appropriate to the problem based on the
interpretation of significant findings
Core Competency 4: Disseminates results of research findings
Shares/presents results of findings to colleagues / clients/ family and to others
Endeavors to publish research
Submits research findings to own agencies and others as appropriate
Core Competency 5: Applies research findings in nursing practice
Utilizes findings in research in the provision of nursing care to individuals
groups / communities
Makes use of evidence-based nursing to enhance nursing practice
According to Bartolome et. al (2009) this study will give insight about
teaching competency among instructor as perceived by BSN level in students in
MDC. The group conducted this study with the objective and finding the
significant differences in the perceived level of competence of the instructors
when grouped according to the people. This study tested the null hypothesis that
there is no difference in all perceived level of competence of the instructor when
group according of their profile. The study sough to answer the following
questions. What is the profile of the respondents in terms of gender and socio
economic status? Is there a significant difference in the perceived level of the
instruction when grouped according to the profile of the respondents?
The method employed in this study is descriptive comparative quantitative
research method. The respondents were chosen by the purposive sampling
technique. Respondents are all BSN level III regardless of their gender. Professor
in NCM 102 who has at least 5 years of experience and a master degree holder.
The primary instrument used for data collection was questionnaire which focuses
on its teaching competency of the instructor in terms of personal and professional
aspects as perceived by BSN Level III students in MDC. The questionnaire was
sent to an experienced lecturer for validation and approval and then handed out to
the dean of college. The data gathered from the survey questionnaire were
tabulated analyzed and interpreted with the use of the following statistical
technician frequency and percentage distribution T-Test and ANOVA.
After through interpretation of analysis and data gathering, we were able
to come up with the following conclusion. The profile of the respondents revealed
that there are more female respondents and a socio economic status of P50000
and up monthly income predominate the respondents. There is no significant
relationship between the perception and competency of instructor in terms of
professional and personal aspect when grouped according to the respondent’s
gender and socio economic status. This study revealed an adjectival rating of
“Agree” in all question pertaining to the perception of instructors professional and
personal aspects. Therefore from the study made by the respondents, the null
hypothesis is accepted.
Based from the finding and conclusion drawn from this study, the
following recommendations are made to the nursing administration, thus would
enable them to analyze what aspects of as profession and the appropriate
methodologies in teaching would ensure efficacy and high competence in
teaching that would lead to the students learning and apply then after. To the
faculty instructor, it ----- to promote learning by having a good interpersonal
relationship between the students and instruction understanding what it takes to
keep the students interested and motivated to excel in their academic studies. To
the nursing students, it aims to assess the coordination and cooperation between
instructors and students in Manila Doctors College to upgrade knowledge and
skills if nursing through involvement and assistance in discrimination of the new
trends in nursing lectures and discussion to facilitate learning. To the Further
Researcher, this study gives guidance, inspiration, and better understanding for
their research about nursing education. This will give opportunity to the future
researcher to share information and concepts leading to good interpersonal
relationship between the learner and the educator.
The care competence of the fourth year students was determined in a study
conducted at Tiangha in 2007. The research made use of observation that
emphasized the importance of student nurses developing knowledge and skill
competence in applying theory learned in the classroom.
To support the study mentioned above, the study of Mangaoang in 2000
aimed to find out the level of performance of staff nurses along competency in
caring, decision making, moral responsibility/accountability, assertiveness and
interpersonal relations as perceived by staff nurses, immediate supervisors and
patients. Regularly, Colleges of Nursing should assess the clinical exposure and
implementation of the curriculum to identify the strengths and weaknesses.
Nursing service administration should develop or improve their tool to assess
performances of nurses. While nurse educators should imbibe to their students the
essence of developing their competency in caring, becoming morally responsible,
good decision maker, and establish a therapeutic interpersonal relationship for a
better quality care and to be carried on in their work.
According to Adversario (2003), “Quality care begins from one’s training
in school but even here the quality of training is slipping”. Medication errors in
the hospital are common though it can be prevented. The role of nurses in caring
for patients has also expanded to include her clinical skills in caring for clients
receiving somatic therapies like medication administration. The nurse has to be
knowledgeable not just in the interactive interventions but also in the use of the
medications to treat the illness. They must know the mechanism of action and side
effects of each medication (Basa, 2007).
On the survey done by Fonteyn and Flaig (2003) on bachelor of science in
nursing students with the usefullness of the written nursing process as means of
fostering nursing and individualizing client care, revealed that the respondents
gave negatives feedbacks regarding the value of nursing process bacause it would
be time consuming to write a good process instead of really understanding the
patient’s health problems.
Foreign Studies
According to Park (2007), in nursing, the clinical education experienced
by a student greatly affects future performance as a nurse. The clinical experience
provides opportunity for the student to integrate classroom theory and laboratory
skill. It is also often the time when a clinical instructor makes a decision about
whether the student will make a satisfactory nurse or not. The integration of
knowledge and skill and student evaluation is powerful factors in the preparation
of a nurse. These factors are influenced by the clinical instructor's ability to
facilitate a smooth transition from learner to practitioner. It would be of value to
know what clinical instructors do to assist students in making this transition.
These courses include both clinical educations, in the form of in-class
application of integrated care, as well as "real-world" clinical experiences
where students engage in supervised clinical practice and gain experience. In
order to be well prepared as Athletic Trainers, students must work diligently in
the classroom to understand the material presented AND they must also work
diligently in the clinical setting to apply their knowledge to real-world clinical
situations and to develop a high level of clinical skill. Clinical experiences are
NOT "work" experiences. Instead, they are educational experiences where
classroom knowledge is applied in real-world settings.
A search of the literature pertaining to clinical instruction leads to the
conclusion that little research has ken directed toward the basic analysis of
clinical teaching behavior. What ace the behaviors associated with the clinical
instructor role? Which behaviors are effective? Which are ineffective?
For example, "Instead of judging the student's practice, the teacher assists
the student in investigating his own practice and leaves the valuing process and
the decisions to change to the student" (Infante, 1975: 27). None have reported
actual descriptions d clinical instruction and those with suggestions on teaching in
the clinical area are not specific.
According to an article in the American Journal of Nursing, a standard
part of a nursing school curriculum is the clinical rotation, where a small group of
nursing students, supervised by a nursing clinical instructor, receives hands-on
training in a clinical or laboratory setting. A key component in this rotation is
evaluation: instructors evaluate students' ability in each lesson, and students
evaluate the instructor's effectiveness. Building an assessment strategy to evaluate
a nursing clinical instructor relies on a few key considerations.
1.) Evaluation format is an important consideration when thinking about
strategies to evaluate a nursing clinical instructor. Although nursing
schools have historically relied on paper forms for student and instructor
evaluation, the advent of technology in various health-care settings has led
some nursing instructors to use handheld computers for evaluation,
according to a Journal of Nursing Education article by Lehman and
colleagues. Other kinds of formatting can determine how much detail you
provide as you evaluate a nursing clinical instructor. For example, an
evaluation that offers pre-set multiple choices will provide less detail than
one that features open-ended questions. Brief evaluations will allow less
opportunity for constructive feedback than evaluations with dozens of
questions.
2.) Developing a strategy to evaluate a nursing clinical instructor will
invariably involve defining the categories of skills and abilities for which
students will evaluate the instructor. The Journal of Nursing Education has
published two helpful articles that review evaluation strategies: Kirschling
and colleagues suggest using a tool that evaluates both teacher
effectiveness and the course itself. The article recommends evaluating an
instructor on knowledge and expertise, teaching methods, communication
style, use of own experiences and opportunity for feedback. Tang and
colleagues, on the other hand, suggest evaluating instructors based on four
categories: professional competence, interpersonal relationships,
personality characteristics and teaching ability.
A study entitled “Assessing Competence to Practice in Nursing” was
conducted to assess the competence to nursing practice. Researchers made use of
questionnaire rating scales, ratings by observation, criterion-referenced rating
scales, simulations including the objective structured clinical examination
(OSCE), Benner’s model of skill acquisition, reflection in and on practice, self-
assessment and multi-method approaches as the study’s method.
Competence is an objective concept that can be measured, standardized
and validated with examinations, assessment tools and rating scales (Coates &
Chambers, 2002). There is a strong view that student-based evaluation is
essential (Rolfe, 2001).
Benner identifed competencies within a framework of seven domains of
nursing practice: the helping role; the teaching–coaching function; the diagnostic
and patient-monitoring function; effective management of rapidly changing
situations; administering and monitoring therapeutic interventions and regimes;
monitoring and ensuring quality of health care practices; and organizational and
work-role competencies.
The study “Assessing competency in nursing: a comparison of nurses
prepared through degree and diploma programs” conducted in the year 2004,
aimed to investigate the competencies of qualifiers from three-year degree and
three-year diploma courses in England at one, two, and three years after
qualification. It made use of a cross-sectional design. The instrument used was a
revised version of the Nursing Competencies Questionnaire, and a shortened
version of the said scale. Competence and competencies have been assessed using
observation, supervisory assessments, ability and knowledge tests, portfolios and
selfassessment.
A quantitative study performed by Towns, Couch and Sigler (2001),
determined if there exist perceptions of masculinity or feminity in various
professional occupations. The researchers concluded that some occupations are
classified as masculine, those that can be associated with power and control, while
the feminine occupations, are those connected to care giving. The results of their
study indicate significance not only because professional occupations possess
qualities that are associated with one gender over another but because nursing was
identified as being feminine.
Nursing has traditionally been a woman’s domain and may have its origins
in the evolution of man. The female has been regarded as the nurturer, while the
male was regarded as a hunter (Kumar, 2007, October). The foremost symbol is
Florence Nightingale.
Nurses and all health care professionals constantly struggle to maintain
patient safety a priority (Byers, 2004). Since the patient’s safety is an essential
part of the delivery of quality care, attaining a satisfactory standard of patient
safety obliges that all health care setting widen inclusive patient safety systems,
together with both of culture of safety and organizational supports for safety
procedures (Aspden, 2004).
Individuals need comfort, rest and sleep for physical and emotional well-
being, health and wellness. Comfort is a condition of physical and emotional well
being. Supporting patients with their comfort desires is a chief nursing assistant
responsibility. And as a matter of fact, supporting patients with physical or
emotional comfort needs is at the heart of nursing care (Hegner, 2004). Nurses
and all of the health care organization have the liability to hold information in a
way that does not put in danger the person or institutional rights of privacy and
confidentiality. Privacy and confidentiality uphold the nurse-patient rapport for
the reason that it brings about open communication and trust among the patients
and health care community. The defense of privacy of patients and providers
involve that records be kept back confidential and protected (Taylor, 2000).
Competence is a complex concept, political and often misunderstood
(Watson, 2002). In accordance with the study, the nurse’s encouraging words of
support and nurse’s calm and decisive approach establish a presence that builds
trust and well-being (Potter & Perry, 2005). Patients have reported that the
presence of nurses and their care giving activities contributes to a sense of well-
being and provides hope for faster recovery (Hegner, 2004). According to Aspden
(2004), “respect for persons involves treating people with considerations, i.e.,
listening to others, understanding them and responding with appreciation of their
intention”. In addition, nursing care looks also in all perspectives in giving
wellness to the patient. It is not only on providing medication and procedures, but
also to consider the emotional support in health teachings, as well as
compassionate service and caring are motivated by love (Watson, 2002).
A consistent recommendation has been to avoid a reductionist approach to
the study of competence, in which only work tasks and roles are considered
(Manley & Garbett, 2000; Watkins, 2000). Instead, a more holistic approach is
used whereby the concepts of knowledge and understanding are considered.
Regarded in this way, holistic competence cannot always be directly observed,
but rather inferred through the competent performance of tasks (Redfern et al.,
2002). As such, measurement of the underlying competencies requires the
evaluation of the constructs that underpin the accessible and quantifiable
performed tasks.
Priority setting is the process of establishing a preferential sequence for
addressing nursing diagnoses and intervention. Nurse can group them as having
high, medium, or low priority instead of rank-ordering diagnoses. The nurse and
the client then begin planning by deciding which nursing diagnosis requires
attention first, which second, and so on. (Kozier & Erb, 2008)
Nurses frequently use Maslow’s hierarchy of needs when setting priorities.
It provides each nurse with a priority of client care needs organized to provide the
best care to your client directed toward preventing any type of harm. The highest
priority ranked is physiologic needs, then down to safety, love, esteem, and self-
actualization being the lowest priority. The nurse also need to rank your patient
care on specific needs of each client to provide care to which client is in need of
your attention first. This can be obtained by following your ABC’s of care:
Airway, Breathing, and Circulation (Maji, 2009). Priorities change as the client’s
responses, problems, and therapies change. A nurse must consider a variety of
factors when assessing priorities, two these are the client’s priorities and the
urgency of the health problem. Involving the client in prioritizing and care
planning enhances cooperation, and regardless of the framework used, life
threatening situations require that the nurse assign them high priority (Kozier &
Erb, 2008).
In a study conductee at Harvard College and the Massachusetts Institute of
Technology (2003), entitled “Performance in Competitive Environments: Gender
Differences” states that the behavior of men and women in a competitive
environment may differ because of differences in skill, talent, and beliefs. A
competitive environment may produce differences in behavior as subjects adjust
their best choices to different strategic environments. Competition has a positive
effect on performance. This effect is stronger on boys than it is on girls, and the
gender composition of the competing pair is important. The crucial element in
this argument is that male’s and female’s preferences are affected differently by
changes in the institution - competitiveness, gender composition, etc.
Core competencies are the source of competitive advantage and enable the
firm to introduce an array of new services (Prahalad & Hamel, 2001). Hence,
Competence in nursing practice is complex and that involves cognitive and
kinesthetic aspects. It involves action and demonstration of both the physical and
cognitive skills used by nurses in the practice environment. (American Board of
Internal Medicine Foundation, 2002). In relation to that, according to the Institute
of Medicine or IOM (2001), the main focus of competence in nursing has
primarily been in the area of the clinical practice setting. It is in this setting where
there exists the highest risk of harm and/or poor patient outcomes that can be
directly linked to nursing practice activities.
Relevance to the Present Study
The presented Related Literature and studies from different foreign and
local resources are relevant to the study conducted because they demonstrated the
researchers’ comprehensive grasp of the issues and contemporary knowledge
about the subject matter, provided a substantive framework of reference, justified
and supported the ideas being tested and determined the researchability and
feasibility of the problem under study. In the process of implementing the study
and analyzing the gathered data, the above resources served as a ground for
conclusions and recommendations that made the study more meaningful and
useful, not just to other researchers but also to other people who find interest in
the topic of this research.
CHAPTER III
METHOD AND PROCEDURE
This chapter discuss in detail the research design and methodology, also the
method of research, population of the study, sampling design and the sampling technique,
the data gathering procedure and the statistical treatment to be used.
Research Method
The research design to be utilized in this study is descriptive type design. As
defened by Connie Mcnabb, descriptive type means gathering data that describes events
and then organizes, tabulates depicts , and describes the data and maybe used to reveal
summary statistics by showing responses to all possible questionnaire items. The
researcher assess the extent of integration of four key core competencies by clinical
instructors among third year BSN students in Manila Doctors College.
This study is a quantitative type of research wherein the gathered data will be
tested, measured and analyzed using specific statistical tools.
Sample and Sampling Technique
Simple random sampling techniques will be employed in choosing the
respondent. The number of sample will be determine through the use of sloven’s
formula.
Research Instrument
The questionnaire is the primary instrument in gathering data that will be used
for this study. The self- made questionnaire based from the four key core of
competencies by clinical instructors, structured with questions and corresponding
questions regarding to four key core competency. The variables will be measured
using an ordinal scale.
Not categorical because this is INTERVAL of four key core can be
quantified with no adherence to zero, wherein each question will be answered using
score value of 1 to 4 , in which 1 is the highest possible score which correspond to the
adjectival description of always , 2 for often , 3 for sometimes, and the lowest possible
score is 4 for seldom. Holistic interpretation of the composite team is the following: for
the corresponding adjectival rating of 1.00 – 1.50 as less extent of integration, 1.52 – 2.50
as moderate extent of integration, 2.51 – 3.50 greet extent of integration, 3.51 – 4.00 as
very great extent of integration.
Validation of the instrument
The survey questionnaire will be validated by three clinical instructors
who are expert in the field of nursing. Researchers self-made questionnaire will
be utilized to gather the needed data. This self-made questionnaire will be
formulated as extracted from the related literature and studies will undergone
validation by three clinical instructors who are expert in the field of nursing.
To ensure validity and reliability after the self made questionnaire will be
validated by three clinical instructors who are expert in the field of nursing, the
proponents will conduct pilot testing.
Data Gathering Procedure
The researchers will seek permission from the respective presidents of Manila
Doctors College, Arellano University College of Nursing , Olivarez College of Nursing
through the respective deans , in order to conduct the study and administer questionnaire.
Statistical Treatment of Data
The date gathered will be analyzed quantitatively, specifically the following
statistical tool will be used to answer problem number 1, frequency count and weighted
mean will be applied to determine the level of performance of nursing students from
selected nursing institution; to answer problem number 2 with regards to what extent
are the four key core competencies integrated by clinical instructor to the nursing
students from selected nursing institutions, weighted mean will be employed; To test the
relationship between the perceive extent of integration of four key core competencies by
clinical instructor and the clinical performance of nursing students in related nursing
institution; pearson’s and will be applied; and to test the difference among selected
institution in terms of clinical performance of nursing student in selected nursing
institutions, Analysis of variance (ANOVA) will be applied.