Download - 1. Final Research Sample
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CHAPTER 1
THE PROBLEM AND ITS SCOPE
INTRODUCTION
Rationale
University of Cebu College of Nursing is the seat of quality
education in nursing. The University upholds the standards as center of
excellence in nursing The school assured that the quality of nursing
practice is evidenced not only through academic performance but
more so in the related learning experience (RLE) both clinical and
community. Clinical experience has been the vital part of nursing
education. Clinical practice is the avenue for the students to utilize the
theories that they’ve learned in their discussion. 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. It is where the student
nurses enhance their knowledge in nursing concepts and principles as
well as to develop and improve their skills and attitude towards
rendering quality of nursing services.
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The main objective of this study are the following: to investigate
the level of competence of the level IV student nurses of Cebu –
Banilad in their related learning experience at the different affiliating
hospitals, to determine if the affiliating hospitals are able to provide
positive learning environment, to identify factors that hinders the level
of competence of the student nurses in their related learning
experience and lastly to serve as an aid developing an effective clinical
learning strategy in learning education.
There are so many hospitals here in Cebu that the nursing
students of University of Cebu can affiliate, from district hospitals like
Mingalanilla District Hospital, Bogo, District Hospital, Danao, District
Hospital, Sogod District Hospital, Daanbantayan Distict Hospital,
Bantayan Island District Hospita and Carcar District Hospital to tertiary
hospitals like Chong Hua Hospital and Visayas Community Medical
Center. Every hospital has their own policy regarding the affiliation of
the students in their institution. There is a big difference on how the
student nurses perform their competencies in different hospitals. Like
for example, in some hospitals student nurses are not allowed to plot
the vital signs of their patients in the chart, but in other hospital it is
allowed. In other words, student nurses have limitations in terms of
performing their duty depending on which institution they will be
assigned. The researchers view this aspect as a problem because it is
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some kind of a hindrance to the learning of the student nurses in the
area. They won’t be able to practice the procedures effectively.
Theoretical Background
The study is anchored on Patricia Benner’s Dreyfus model of Skill
acquisition. This model posits that in the acquisition and development
of a skill, a student passes through five levels of proficiency: novice,
advanced beginner, competent, proficient, and expert. These different
levels reflect changes in three general aspects of skilled performance:
One is a movement from reliance on abstract principles to the use of
past concrete experience as paradigms; The second is a change in the
learner's perception of the demand situation, in which the situation is
seen less and less as a compilation of equally relevant bits, and more
and more as a complete whole in which only certain parts are relevant;
The third is a passage from detached observation to involved
performer. The performer no longer stands outside the situation but is
now engaged in the situation (Dreyfus, 2009).
The process of competence development is a lifelong series of
doing and reflecting. As competencies apply to careers as well as jobs,
lifelong competency development is linked with personal development
as a management concept. And it requires a special environment,
where the rules are necessary in order to introduce novices, but people
at a more advanced level of competence will systematically break the
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rules if the situations require it. This environment is synonymously
described using terms such as learning organization, knowledge
creation, self organizing and empowerment (Dreyfus, 2009).
Beginners have had no experience of the situations in which they
are expected to perform. Novices are taught rules to help them
perform. The rules are context-free and independent of specific cases;
hence the rules tend to be applied universally. The rule-governed
behavior typical of the novice is extremely limited and inflexible. As
such, novices have no "life experience" in the application of rules.
"Just tell me what I need to do and I'll do it."
Advanced beginners are those who can demonstrate marginally
acceptable performance, those who have coped with enough real
situations to note, or to have pointed out to them by a mentor, the
recurring meaningful situational components. These components
require prior experience in actual situations for recognition. Principles
to guide actions begin to be formulated. The principles are based on
experience.
Competence, typified by the nurse who has been on the job in
the same or similar situations two or three years, develops when the
nurse begins to see his or her actions in terms of long-range goals or
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plans of which he or she is consciously aware. For the competent
nurse, a plan establishes a perspective, and the plan is based on
considerable conscious, abstract, analytic contemplation of the
problem.
The conscious, deliberate planning that is characteristic of this
skill level helps achieve efficiency and organization. The competent
nurse lacks the speed and flexibility of the proficient nurse but does
have a feeling of mastery and the ability to cope with and manage the
many contingencies of clinical nursing. The competent person does not
yet have enough experience to recognize a situation in terms of an
overall picture or in terms of which aspects are most salient, most
important.
The proficient performer perceives situations as wholes
rather than in terms of chopped up parts or aspects, and
performance is guided by maxims. Proficient nurses understand
a situation as a whole because they perceive its meaning in
terms of long-term goals. The proficient nurse learns from
experience what typical events to expect in a given situation and
how plans need to be modified in response to these events. The
proficient nurse can now recognize when the expected normal
picture does not materialize. This holistic understanding
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improves the proficient nurse's decision making; it becomes less
labored because the nurse now has a perspective on which of
the many existing attributes and aspects in the present situation
are the important ones.
The proficient nurse uses maxims as guides which reflect
what would appear to the competent or novice performer as
unintelligible nuances of the situation; they can mean one thing
at one time and quite another thing later. Once one has a deep
understanding of the situation overall, however, the maxim
provides direction as to what must be taken into account.
Maxims reflect nuances of the situation.
The expert performer no longer relies on an analytic
principle (rule, guideline, and maxim) to connect her or his
understanding of the situation to an appropriate action. The
expert nurse, with an enormous background of experience, now
has an intuitive grasp of each situation and zeroes in on the
accurate region of the problem without wasteful consideration of
a large range of unfruitful, alternative diagnoses and solutions.
The expert operates from a deep understanding of the total
situation. The chess master, for instance, when asked why he or
she made a particularly masterful move, will just say: "Because it
felt right; it looked good." The performer is no longer aware of
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features and rules;' his/her performance becomes fluid and
flexible and highly proficient. This is not to say that the expert
never uses analytic tools.
Highly skilled analytic ability is necessary for those situations
with which the nurse has had no previous experience. Analytic tools
are also necessary for those times when the expert gets a wrong grasp
of the situation and then finds that events and behaviors are not
occurring as expected. When alternative perspectives are not available
to the clinician, the only way out of a wrong grasp of the problem is by
using analytic problem solving.
Patient information centers were strategically placed throughout
the hospital, and nurses were give access to computerized patient
records, policies and procedures, medication information, patient
education tools and reference materials. Supply areas were also
strategically placed so that the patient care items would be readily
available (Donahue, 2008).
Access to information in the clinical setting can be found mainly
in the clients chart, kardex, and care plan. The chart is a document
that provides evidence of care and the patient’s response. The chart
itself contains several forms which are important to the preparation
and administration of nursing care. Documentation should indicate
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that the nurse did the following, assessed the patient for risk factors
for injury, plan strategies to protect the patient from harm,
implemented strategies to protect the patient from complication, such
as falls or skin breakdown, notified the physician of critical changes in
the patients status, and clearly documented the circumstances of an
incident or unusual event. (Kozier, 2002).
The kardex card represents the “hub” for all patient activities.
Physician orders are transcribed on the card. Lab tests medication and
activity levels are just few items documented in designated areas of
the kardex. Care plan identifies the patient’s usual or potential
problems, expected outcomes, and nursing actions. A discharge
criterion is also an integral part of the care plan. Patients chart
includes nurse’s notes. Clinical observations and nursing interventions
are documented in nurse’s notes. Medication records, it is where all
patient’s medication are documented. Temperature, pulse, and
respiration are graphed on the graphic sheet. Blood pressure readings,
intake and output records are also recorded on this form. Physicians
order are the orders indicated for the patient. Physician’s progress
notes contain daily observations and thoughts regarding treatments,
signs and symptoms experienced by the patient, operative risk
explained to the patient, and the patient’s response to therapy. History
and physical is the physician’s report of his assessment, and the
laboratory forms, are laboratory results sent from the laboratory to the
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unit. This sheet provides a valuable review of all laboratory results
(Smith, 2000).
According to Bordalba(2006) in his study on common problems in
Relating Learning Experience as encountered by level IV Nursing
students in X University, “There are hospitals everywhere; manned by
our qualified nurses and staff. These hospitals served as the training
ground for these nursing students. These training areas are expected
to enhance the capabilities and learning for these aspiring nurses. A
strong foundation for theoretical and practical experience is the
strongest weapon the society can give to nursing aspirants to prepare
themselves in the battle field both inside and out of the country.
Preceptorship may be used o help recruit, retain, orient, and
develop staff. They maybe used before students graduate to orient
them to the agency and to recruit them for hire. If students have
worked at an agency before graduation and are familiar with it, they
can make sounder decisions about where to work, are not as likely to
be unprepared for the work situation, and, consequently, are likely to
be retained longer. The preceptorship also gives agency personnel an
opportunity to evaluate students and determine if they are suitable
candidates for employment. During preceptorship faculty facilitate,
monitor, and evaluate student learning. Faculty direct students to
resources, offer suggestion regarding patient care problems, and lead
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discussions at conferences. The faculty member is responsible for
student learning and encourages students to apply class content. The
preceptor is responsible for the quality of patient care and facilitates
the student’s learning.
Preceptors are liaisons between the students and the agency.
They help students learn skills and learn how to organize their work.
They provide real-life experiences for students before graduation to
help reduce the difficulties of transition from school to work. There are
also disadvantages to preceptorships. They add to staff nurse
responsibilities and require time. Sometimes busy nurses have little
time to spend with students. It becomes difficult for faculty to evaluate
students because they have little direct observation of students’ work.
The use of preceptors requires considerable planning and
coordination. Role descriptions should clarify who chooses learning
experiences for the students, who supervises the student, and who
evaluates the student. Practical evaluation tools of the student,
preceptor, and faculty should be developed and used Educational and
service administrative support is needed.
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Providing hands-on care gives the students access to the patient.
Such care constitutes a legitimate reason for the students to be there
and satisfies the goal of helping the patients in a concrete, visible way.
At the same time, providing hands-on care opens the students to
committing an error that may harm the patient in some way, and so
technical skill development carries with it a high degree of anxiety that
may interfere with learning. By joining with students in their focus on
technical skills at the beginning of the clinical experience, and helping
them to broaden their vision of nursing care from technical skill
performance to the more salient skills of assessing and responding to a
variety of patient needs, the instructor capitalized on student’s
readiness to learn and makes clinical learning meaningful (Reilly,
2006).
Nursing students need sufficient practical experience to develop
full range of skills they need for effective practice has become a focus
in nursing education. Clinical education is a vital component in the
curricula of pre-registration nursing courses and provides student
nurses with the opportunity to combine cognitive, psychomotor and
affective domains (Henderson, 2009)
In the clinical setting, planning and selection of clinical learning
activities tends to be instructor- made. Depending upon the amount of
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experience and sense of self-efficacy held by the instructor, the nature
of clinical learning may become more student-centered. In either case,
the teacher guides the students in applying theory to patient care
clinical learning is aimed at knowledge application, skill acquisition and
professional role development (n Bradshaw & Lowenstein, 2007). The
clinical setting is identified as any setting where students provide
nursing care to real patients. Care of the patients in real life situations
reinforces that critical thinking is contextual. Instructors need to
empower students to think critically. Students who feel a sense of
empowerment take responsibility for the process of problem solving
(Bradshaw & Lowenstein, 2007).
As stipulated in Related Learning Experience Packet Guide, all
students’ encounters with the patient are expected to be supervised
by the clinical instructor. Before a student is allowed to perform a
nursing procedure, he/she is to review and recall the steps of the
procedure in detail with his clinical instructor. This is to assure both the
student and the clinical instructor that the former is prepare3d for the
responsibility. The dry run will also help relieve the anxiety and
promote self-confidence on the student.
Students are required a minimum number of performances for
each and having complied such does not mean he/she may not
perform same procedure any longer. Students learned best by
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observing and assisting at procedures, and when appropriate, by
guided performance of the procedure (RLE Packet guide, 2008).
Rolfe (1995) suggests that 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.
Students in professional education programs do respond
positively to opportunities to choose or structure some of their learning
experiences. These approach should be used frequently by the
teacher, to not only promote active learning but to instill in the
students a sense of empowerment, which is an important attribute for
the clinical setting. Technology- based learning activities direct the
students to engage in independent learning, research, and use visual
cues, such as video, to enhance comprehension (Bradshaw &
Lowenstein, 2007).
According to Tagapan (2006), in her study on Performances in
Theory and in Related learning Experience of Level II, UC-College of
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Nursing Student, “Performance in the clinical area is determined by the
level of preparation and achievement of the student in the skills
laboratory and that evaluation helps determine from day to day what
the students know and what they do not know, which skills have and
which need more work.”
Factors affecting perception in the nurse-client relationship are
the capacity for attention (reception of sensation) by both the nurse
and the client, the perspective each brings to the relationship, and the
physical condition of the receptors. Anxiety (the actual or anticipated
negative appraisal by the other) in the nurse or the client limits the
ability to be attentive in the communication process, interferes with
the validation of individual perspectives, and decreases physical
capacities. Validated perceptions between nurse and client essential
to goal setting and achievement the nurse must constantly of
communication regardless its form (Hood, 2006).
Age is another factor that influences our perceptions. The older
a person get, the richer their perspective foe perceiving life and
people. Thus, compared with a person of 20 a 60 years-old has more
complex fund of experiences to draw on in perceiving situations to
people. As a person grow older and have more experiences, their
perspective or many things changes (Wood 2002).
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Women and men, as social groups have different stand points,
although not every individual man and woman shares the standpoint
typical for his or her sex, instance, the care giving we generally
associate with women results less from any maternal instinct than from
the social role of mother, which teaches women to care for others,
notice who needs what, and defer their own needs (Wood, 2000).
Factors affecting perception in the nurse-client relationship are
the capacity for attention (reception of sensation) by both the nurse
and the client, the perspective each brings to the relationship, and the
physical condition of the receptors. Anxiety (the actual or anticipated
negative appraisal by the other) in the nurse or the client limits the
ability to be attentive in the communication process, interferes with
the validation of individual perspectives, and decreases physical
capacities. Validated perceptions between nurse and client essential
to goal setting and achievement the nurse must constantly of
communication regardless its form (Hood, 2006).
Self-efficacy is a belief in one’s abilities to engage in courses of
action that will lead to desired outcome. These individuals with high
self-efficacy tend to be confident and self-assured and feel they are
likely to be successful in whatever endeavors they undertake (Mc
Shane of Von Glinow, 2002). Self-efficacy results from undertaking
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challenging realistic task and succeeding. According to Felson(1984),
“students who experience academic success develop higher appraisals
more. To do one’s best and achieve is to feel more confident and
empowered. (Myers, 2000).
According to Bandura (1986), “Self-efficacy mechanism plays a
central role in human agency.” Self-judgement of operative capabilities
function as one set proximal determinants of how people behave, their
thoughts patterns, and the emotional reactions they experience in
taxing situations. In their daily lives, people continuously have to make
decisions about what courses of action to pursue and how long to
continue those they have undertaken. People’s judgement of their
capabilities additionally influences whether their thought patterns are
self-hindering or self-enhancing, and how much stress they experience
during anticipatory and actual transaction with the environment.
(Bandura, 2009).
The theory of self-efficacy proposes behavior change occurs
because expectations or expected results of the new behavior and
one’s belief about his or her ability to perform a specific behavior in a
specific situation. There are four sources form which a person’s degree
of self-efficacy arises: performance accomplishment, vicarious
experience, verbal persuasion and physiological state. Performance
accomplishment refers to learning that occurs through personal
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mastery of a particular skill or task. Accomplishments attained through
personal mastery are the most powerful source of efficacy
expectations. The most important determinant of behavior change is
when people learn (master) a new behavior by doing it (De Young,
2003).
People also increase their belief in their own ability to perform a
specific behavior when they watch someone else perform the behavior.
This is vicarious experience or learning through observation. It enables
people to learn by watching, through demonstration. Verbal persuasion
involves acting as the coach and providing encouragement. Patients
may need to be prompted to continue trying to master the targeted
behavior (De Young, 2003). Physiological states, on the other hand
include how a person judge their capableness, strength and
vulnerability (Bandura, 2009).
Acting on one’s self-efficacy judgements brings success or
missteps requiring further self- reappraisals of operative competencies.
Thus, in their daily transactions, people act on their thoughts and later
analyze how well their thoughts have served them in managing events.
It is the one and the same person who is doing and thinking and later
evaluating the adequacy of one’s knowledge, thinking skills, and action
strategies (Bandura, 2009).
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A firm sense of self –efficacy is an important contributor to the
attainment of further competencies and success. According to Sanna
(1990) “high self-efficacy heightens the person’s motivation and
persistence and thereby increases performance. In contrast low self
efficacy lowers motivation and persistence, thereby impairing
performance (Baron and Kerr, 2003).
Perceived competence is concerned with judgment of personal
capabilities. Self-beliefs of efficacy affect action through several
interviewing processes. People’s self-beliefs of efficacy determine how
much effort they will exert in an endeavor and how long they will
persevere in the face of obstacles. The stronger the belief in their
capabilities the greater and more persistent are their efforts. When
faced with difficulties people who have self-doubts about their
capabilities about their attempts prematurely and settle for mediocre
solutions, whereas those who have a strong belief in their capabilities
exert greater effort to master the perception of one's own competence
is critical to individual functioning throughout life challenge. (Sternberg
and Kolligian, 2000).
With self-efficacy and perceived competence person's behavior
also plays a role in empowerment. According to social cognitive theory,
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human behavior is the result of an interaction among the person
(characteristics and personality), the environment (physical and social)
and behavior itself. In this theory, the interaction between the person
and behavior involves the influences of a person's thoughts and
actions. The interaction between the person and the environment
involves human beliefs and cognitive competences that are developed
and modified by social influences and structures within the
environment. And another interaction, between the environment and
behavior, involves a person's behavior in determining the aspects of
their environment and in turn their behavior is modified by that
environment. (Jones, 2003).
A change in one of those factors changes all of them, a
phenomenon called reciprocal determinism. Behavior, Personal factors
and Environmental influences all operate as interacting determinants
that influences each other (De Young, 2003). The Personal Behavior
segment reflects the interaction between thought, affect and action.
Expectations, beliefs, self-perceptions, goals and intentions give shape
and direction to behavior. What people think, believe and feel affects
how they behave. The natural and extrinsic effects of their actions, in
turn, determine their thought patterns and emotional reactions. The
personal factor also encompasses the biological properties of the
individual. Physical structure and sensory and neural systems affect
behavior and impose constraints on capabilities. Sensory and neutral
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systems and brain structure are in turn, modifiable by behavioral
experiences (Bandura, 2009).
The environmental – Personal segment is concerned with the
interactive relation between personal characteristics and
environmental influences. Human expectations, beliefs, emotional
bents and cognitive competencies are developed and modified by
social influences that may convey information and activate emotional
reactions through modeling instruction and social persuasion According
to Lerner (1982), “ People evoke different reactions from their social
environment by their physical characteristics, such as their age, size,
race, sex and physical attractiveness. “ People similarly activate
different social reactions depending on their socially conferred roles
and status (Bandura, 2009).
The behavior - environmental segment represents the two-way
influences between behavior and the environment. In the transactions
of everyday life, behavior alters environmental condition and is, in
turn, altered by the very conditions it creates (Bandura, 2009).
Environment defers to the factors that can affect a person’s
behavior. There are social and physical environments; social
environment includes family members, friends and colleagues. Physical
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environment is the size of the room, the availability of imperative, or
the availability of certain foods. Environment as well as situation
provides a framework for understanding behavior (Jones, 2003).
Most aspects of environment do not operate as an influence
students until they are activated by appropriate behavior. Lectures do
not influence students until they attend their classes. Hot stove tops do
not burn unless they are touched and parents usually do not praise
their children unless they do something praiseworthy. The aspect of
potential environment that becomes actual environment for given
individuals thus depends on how they behave. Because of bi-
directionality of influence between behavior and environmental
circumstances, people are both products and producers of their
environment. They affect the nature of their experienced environment
through selection and creation of situations. People tend to select
activities and associates from the vast range of possibilities in terms of
their acquired preferences and competencies. Behavior determines
which of the many potential environmental influences will come into
play and what forms they will take (Bandura, 2009).
Environment influences, in turn, partly determine which form of
behavior are developed and activated. Student learning environment
consists of all the conditions and forces within educational settings that
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impact learning. Shuell (1989) visualized the student-learning
environment as rich psychological soup comprised of cognitive, social,
cultural, affective, emotional, motivational and curricular factors in
which teachers and students work together toward learning. Student-
learning at the primary and secondary educational levels generally
takes place in the traditional classroom environment. In contrast, at
the secondary level, students experience an increasing number of
applied learning environments, of which clinical nursing education
experience is a prime example. Clinical components of nursing
education are critical to the over-all curriculum, as they allow learners
to apply knowledge to practice, to develop problem-solving and
decision making skills and to practice responsibilities for their own
action (Kari, 2000).
Students are so focused on the immediate requirements of the
skills they are to perform that they loss sight of the reason the
procedure is needed and what should be the result at its completion.
Visualizing the end-product of the procedure, it should enable the
student to see the skill as a whole rather than as a sequence of steps
to be performed. This awareness of the whole task moves the students
forward the visualized end and results in a smoothes performance
(Reilly, 2006).
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There are certain factors that influence what and how a person
perceives. One reason perception vary among people is that they
differ in their sensory abilities. The five senses are not the same for all
of us. Person’s physiological states also influence perception. If a
person is tired or stressed, then likely perceive things more negatively
than they normally would (Wood 2002).
In the clinical environment, nursing students were given the
opportunity to apply the theories they learned from the classroom
environment. The related learning experience competencies they have
to comply are based on different nursing theories (Delaune& Ladner,
2006). Virginia Henderson, together with Bertha Harmer attempted to
identify those basic human needs viewed as the basis of nursing care.
These needs included the need to maintain the physiologic balance to
adjust to the environment, to communicate and participate in social
interaction and worship according to one’s faith (Henderson, 2009).
Capinpuyan (2007), in her study on Anxiety Level and Related
Learning Experience Performance of the Student Affiliates of University
of Cebu, stated that, “it is highly recommended that staff nurses will
provide support and assistance to young student nurses. That nursing
affiliates should be given proper orientation prior to every clinical
exposure and given enough opportunity to learn the concepts in the
classroom and skills laboratory.
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THE PROBLEM
Statement of the Problem
This study is conducted to determine the empowerment of student
nurses in the performance of Related Learning Experience.
Specifically, this study aims to answer the following questions:
1. What is the profile of the respondent’s:
1.1. Age; and
1.2. Gender.
2. What are the factors that can affect the level o empowerment of
student nurses in the Related Learning Exposure in Affiliated
Hospitals in terms of:
2.1. access to information;
2.2. resources;
2.3. support; and
2.4. opportunity to learn and develop.
3. Is there a significant relationship between the level of
empowerment and the affiliated hospital?
4. What action plan may be proposed for the study to empower
Level IV nursing students in Related Learning Exposure in
affiliated hospitals.
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Statement of Null Hypothesis
There is no significant relationship between the level of
empowerment and the affiliated hospitals.
Significance of the Study
This study will benefit the following entities:
Administration. The result of the study will provide the
baseline data that will serve as the basis for organizing plans and
activities and promote a better working learning environment
that can enrich empowerment of Level IV nursing students in the
RLE in Affiliated Hospitals. In addition, the proposed action plans
of this study may help the administration to create an
environment that will favor good performance among student
nurses. This in turn, will contribute to the provision of a higher
quality education.
Clinical Instructors. This study will identify personal
strengths and weaknesses therefore it can effectively propose an
action plan that will promote an environment that gives them
wider opportunities. Furthermore, they can perceive their roles
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as instrumental in giving quality education to students and
become good role models to the student nurse.
Staff Nurse. As one of the mentors, staff nurse should be
able to establish a good rapport among nursing students so that
they will feel comfortable working their experiences and
problems to the students so that they can work it out how such
problems can be resolved.
Students. Students are recipients of services provided by
clinical instructors. Being role models to students, they must set
good examples from which students will be basing their future
actions and practices.
Patients. This study will benefit the patients because
healthcare can be improved by better performance shown by
nurses due by hospital administrators based on identified
problems. In this way, the patient’s right receives better service
because the healthcare team has already understood each
others limitations experiencing with regards to the students.
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Future Researchers. This study will serve as guide for
future researchers in their quest for in depth information and
valuable data in studies that focus on the different variables that
result in Empowerment of Level IV nursing student in
performance of the RLE competencies in affiliated hospitals.
Through this work, future researchers can implement techniques
that can implement techniques that can empower level IV
nursing students.
Research Methodology
This chapter presents the research design, the research
environment, the research instrument, the data gathering procedure
and the statistical treatment. The researcher utilizes the descriptive
method of research in which questionnaires will be used to collect data
to determine variables that affect empowerment of level IV nursing
students in the RLE.
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INPUT PROCESS OUTPUT
Figure 1. Research Flow
Research Respondents
The respondents of our study are the Level IV student nurses who
are officially enrolled at the University of Cebu Banilad which are
randomly selected.
In getting the total number of respondents of our study, we utilize
the Sloven’s Formula which is N/N +N (e)² and the result is 399: where:
N = total population of level IV nursing students
Profiles of the respondents. The following factors affect theEmpowerment of BSN Level IV in terms of access to information; resources; support; and opportunity to learn and develop.
A non experimental design is used in the study. University of Cebu-Banilad is the research environment.Questionnaires are used to collect data on level IV nursing students in UC-Banilad.Data GatheringData ProcessingAnalysis and Interpretation
Proposed Action Plan
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= 1,170
e = the margin of error
= 5%
Solution:
Nn = 1+Ne2
= 1170
1+1170 (.05)²
= 399
Research Environment
The research study will conducted at University of Cebu-Banilad
campus, located at North Rosd, Barangay Banilad, Cebu City, across
Gaisano Country Mall, beside North Gate on its right side.
It is well-facilitated nine storey building, which have different
courses. The ground composes of the accounting office, cashier, clinic,
chapel, guidance office and canteen. The mezzanine composes of
CESDEV office, Bob Lim's Photoshop, faculty of the allied teachers, ESL
office and the function room. Second floor compose of the rooms 201-
226. Third floor compose of the library and the rooms 313-326. Fourth
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floor compose of the NSBO's office, and the faculty of general
education teachers. The fifth floor is where you can find the Dean's
office, faculty of second year, third year, and fourth year clinical
instructor. You can also see the HRM department in there. Sixth floor is
where you can find the rooms 601-626. In seventh floor, you can find
the two skills laboratory, the canteen and the rooms 701-726. In eight
floor, you can see the AVR 1 and 2 and rooms 801-803. In ninth floor,
you can see the Laboratories.
Research Instrument
The researcher will be using a researcher made questionnaire.
The questionnaire consists 5 pages with three parts. The first page is
the letter to respondents; second page contains the part I which is the
profile of the respondents as well as the part II which is the area where
the respondents were mostly exposed in his/her related learning
experience. The third and last pages contain the part III which are the
instructions on how the students will answer and the questions to be
answered by the level IV nursing students. Respondents are also
encouraged to give any suggestion on what they think is important to
empower their Related Learning Experience in affiliated hospitals.
31
The researchers used Likert scale of 1-4 as their choices, 4
means always, 3 most often, 2 seldom, and 1 never. In this manner,
the researcher will be able to obtain sufficient answer-basing on the
parameters given.
The researcher also conducted series of interviews to know the
side of each student about their outwork on the problem and as well as
to support the answer of the respondents.
Research Procedure
Data Gathering. The researcher started the study by making
proposed problems that the researchers saw with great importance to
determine the empowerment of the student’s nurses in the
performance of RLE competencies in affiliated hospitals. The proposed
problem was then submitted to one of our research instructor and was
then given to our research adviser for the selection of (5) possible
problems that is to be submitted to the Level IV Chairman, Ms. Ma
Estella P. Cabatana for the preliminary approval and was then
submitted to our Dean Dr. Helen C. Estrella for the final approval. After
which, a letter of request or transmittal letter was addressed to the
Level IV chairman of the College of Nursing in the University of Cebu,
asking for permission to allow the researchers to conduct a study
32
pertaining to their different perceptions about empowerment of the
student nurses in the performance of RLE competencies in affiliated
hospitals.
After approval and obtaining the complete list of level IV student
population, a Simple Random Sampling was utilized by the researchers
for getting the sample wherein a researcher made a questionnaire,
was formulated and subjected for corrections from the experts. The
researchers located the respondents through the set of activity
schedules in the school for their lecture given by the Level IV chairman
of each level for the RLE rotation. The members of the research team
then distributed questionnaires at the school for the collection of data.
After which, the research team were gathered to collate and tally the
gathered data. It was then interpreted with the use of statistical tools,
tabulated, analyzed and conclusion was drawn based from the result
taken.
33
DEFINITION OF TERMS
For better and clearer understanding of the study, some of the
terms are operationally defined:
Empowerment – is the opportunity of Level IV students to apply
theory into practice through Related Learning Experience in the
affiliated hospitals.
Related Learning Experience – is the experience of the Level
IV student nurses who are officially enrolled at the university of
Cebu Banilad; as they are expose to the affiliated hospital.
Level IV nursing students – are the fourth year nursing
students of University of Cebu Banilad who are officially enrolled
and who performs Related Learning Experience competencies in
the affiliated hospital and were chooses as the respondents of the
study.
34
Affiliated Hospitals – either tertiary or secondary hospital
where level IV nursing students who are officially enrolled at the
University of Cebu Banilad are given the chance to apply theory or
skills that they have learned in the classroom and laboratory
settings.
CHAPTER 2
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
In this chapter, data are analyzed and presented to answer the
specific factors that can affect the empowerment of student nurses in
the related learning experience. In line with these factors, the following
topics are looked into:
AGE RANGE:
AGE RANGE NO. OF RESPONDENTS28 - 32 223 – 27 1018 – 22 388
TABLE I. Number of respondents according to their age range.
Table I shows that 388 out of 400 level IV student nurses of X –
university who answered the questionnaire fall under the age range of
35
18 – 22, 10 fall under the age range of 23 – 27 and only 2 respondents
fall under the age range of 28 – 32.
GENDER:
GENDER NO. OF RESPONDENTS
MALE 122
FEMALE 278
Table II. Number of respondents according to their gender
Table II shows that 278 out of 400 respondents are female, and
only 122 are male.
36
AFFILIATED HOSPITALS: Chong Hua Hospitals
ACCESS TO INFORMATION:
4 3 2 1 INTERPRETATION
1. I am given the chance to have access on my patient records so that I can provide better nursing care.
195 Most of the respondents were often given the chance to have access on patient’s records.
2. I am permitted to get information from my patient through interview.
224 Most of the respondents were always permitted to get information from their patient through interview.
3. I am allowed to perform physical
assessment to my patient.
188 Most of the respondents were always allowed to perform physical assessment to their patient.
4. I am free to scan the physician’s report of his assessment, and the laboratory forms of my patient.
192 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.
5. Facilities and equipments are readily available for
156 Most of the respondents answer that the facilities and
37
students use. equipments were often available for students use.
6. Supply areas were strategically placed so that the patient care items would be readily available.
212 Most of the respondents answer that the supply areas were always strategically placed so that the patient care items would be readily available.
7. Facilities and equipments are adequate in number for students use
160 Most of the respondents answer that the facilities and equipments were always adequate in number for them to use.
8. Facilities and equipments are properly maintained to guarantee service outcomes.
212 Most of the respondents answer that the facilities and equipments were always properly maintained to guarantee service outcomes.
9. Facilities and equipments are functional for better patient care.
208 Most of the respondents answer that the facilities and equipments were always functional for better patient care.
10.Facilities and equipments are labeled accordingly to increase students productivity.
156 Most of the respondents answer that the facilities and equipments were always labeled accordingly to increase student’s productivity.
11.My clinical instructor guides me in applying theory to patient care.
183 Most of the respondents were often guided by their clinical instructor in applying theory to patient care.
38
12.My clinical instructor empower me to
think critically in doing tasks.
192 Most of the respondents were always empowered by their clinical instructor in thinking critically in doing tasks.
13.My clinical instructor allows me to perform dry run prior to performing special procedures so as to relieve anxiety.
179 Most of the respondents were often allowed by their clinical instructor in performing dry run prior to perform special procedures so as to relieve anxiety.
14.The staff orients me not only to the physical set-up but as well as the routine activities of the agency.
153 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency.
15.The staff ensures quality of my patient care and facilitates my learning.
165 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.
16.The staff provides me real-life experiences to help reduce the
difficulties of transition from school to work.
136 Most of the respondents were provided always a real-life experience to help reduce the difficulties of transaction from school to work by the staff.
17.I am permitted to make decisions about what courses of action to pursue with regards to patient care.
135 Most of the respondents were often permitted to make decisions about what courses of action to pursue with regards to patient
39
case.18.I am allowed to observe nursing procedures in the area.
208 Most of the respondents were always allowed to observe nursing procedures in the area.
19.I am allowed to perform nursing procedures that I’ve learned in the school to the area.
186 Most of the respondents were always allowed to perform nursing procedures that they’ve learned in the school to the area.
20.I am competent in doing the nursing procedures in the clinical areas.
210 Most of the respondents were often competent in doing nursing procedures in the clinical areas.
40
AFFILIATED HOSPITALS: VCMC
ACCESS TO INFORMATION:
4 3 2 1 INTERPRETATION
1. I am given the chance to have access on my patient records so that I can provide better nursing care.
276 183 4 0 Most of the respondents were always given the chance to have access on patient’s records.
2. I am permitted to get information from my patient through interview.
332 141 4 0 Most of the respondents were always permitted to get information from their patient through interview.
3. I am allowed to perform physical assessment to my patient.
268 165 20 0 Most of the respondents were always allowed to perform physical assessment to their patient.
4. I am free to scan the physician’s report of his assessment, and the laboratory forms of my patient.
284 150 22 0 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.
5. Facilities and equipments are readily available for students use.
125 216 54 1 Most of the respondents answer that the facilities and equipments were often available for students use.
6. Supply areas were strategically placed so that the patient care
108 252 40 1 Most of the respondents answer that the supply areas
41
items would be readily available.
were often strategically placed so that the patient care items would be readily available.
7. Facilities and equipments are
adequate in number for students use
72 249 56 3 Most of the respondents answered that the facilities and equipments were often adequate in number for students use.
8. Facilities and equipments are
properly maintainedto guaranteeservice outcomes.
140 213 50 1 Most of the respondents answer that the facilities and equipments were often properly maintained to guarantee service outcomes.
9. Facilities and equipments are
functional for betterpatient care.
136 234 36 2 Most of the respondents answer that the facilities and equipments were often functional for better patient care.
10.Facilities and equipments are labeled accordingly to increase students productivity.
136 210 54 1 Most of the respondents answer that the facilities and equipments were often labeled accordingly to increase student’s productivity.
11.My clinical instructor guides me in applying theory to patient care.
216 195 24 1 Most of the respondents were always guided by their clinical instructor in applying theory to patient care.
12.My clinical instructor empowers me to think critically in doing tasks.
188 207 30 1 Most of the respondents were often empowered by their clinical
42
instructor in thinking critically in doing tasks.
13.My clinical instructor allows me to perform dry run prior to performing
special procedures so as to relieve anxiety.
156 195 46 5 Most of the respondents were often allowed by their clinical instructors in performing dry run prior to perform special procedures so as to relieve anxiety.
14. The staff orients me not only to the
physical set-up but as well as the routine activities of the agency.
128 156 82 7 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency..
15.The staff ensures quality of my
patient care and facilitates my learning.
104 195 76 3 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.
16.The staff provides me real-life experiences to help reduce the
difficulties of transition from school to work.
108 192 70 6 Most of the respondents were provided often a real-life experience to help reduce the difficulties of transaction from school to work by the staff.
17.I am permitted to make decisions
about what courses of action to pursue with regards to patient care.
104 216 54 7 Most of the respondents were often permitted to make decisions about what courses of action to pursue with regards to patient case.
18.I am allowed to observe nursing procedures in the
264 174 14 1 Most of the respondents were always allowed to
43
area. observe nursing procedures in the area.
19.I am allowed to perform nursing procedures that I’ve learned in the school to the area.
248 165 30 0 Most of the respondents were always allowed to perform nursing procedures that they’ve learned in the school to the area.
20.I am competent in doing the nursing procedures in the clinical areas.
200 219 18 0 Most of the respondents were often competent in doing nursing procedures in the clinical areas.
AFFILIATED HOSPITALS: District Hospitals
44
ACCESS TO INFORMATION:
4 3 2 1 INTERPRETATION
1. I am given the chance to have access on my patient records so that I can provide better nursing care.
430 147 6 0 Most of the respondents were always given the chance to have access on patients records.
2. I am permitted to get information from my patient through interview.
492 93 6 1 Most of the respondents were always permitted to get information from their patient through interview.
3. I am allowed to perform physical assessment to my patient.
416 123 24 1 Most of the respondents were always allowed to perform physical assessment to their patient.
4. I am free to scan the physician’s report of his assessment, and the laboratory forms of my patient.
400 144 20 0 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.
5. Facilities and equipments are readily available for students use.
136 183 120 3 Most of the respondents answer that the facilities and equipments were often available for students use.
6. Supply areas were strategically placed so that the patient care items would be readily available.
120 231 102 0 Most of the respondents answer that the supply areas were often strategically placed so that the patient care items would be readily available.
7. Facilities and equipments are
adequate in number
68$$ 180 154 4 Most of the respondents answered that the
45
for students use facilities and equipments were often adequate in number for students use.
8. Facilities and equipments are properly maintained to guarantee
service outcomes.
112 189 130 2 Most of the respondents answer that the facilities and equipments were often properly maintained to guarantee service outcomes.
9. Facilities and equipments are
functional for better patient care.
112 225 108 1 Most of the respondents answer that the facilities and equipments were oftenly functional for better patient care.
10.Facilities and equipments are labeled accordingly to increase students
productivity.
92 222 114 4 Most of the respondents answer that the facilities and equipments were often labeled accordingly to increase student’s productivity.
11.My clinical instructor guides me in
applying theory to patient care.
264 228 30 1 Most of the respondents were always guided by their clinical instructor in applying theory to patient care.
12. My clinical instructor empower me to
think critically in doing tasks.
268 26 26 1 Most of the respondents were always empowered by their clinical instructor in thinking critically in doing tasks.
13. My clinical instructor allows me to perform dry run prior to performing special procedures so as to
216 171 90 2 Most of the respondents were always allowed by their clinical instructor in
46
relieve anxiety. performing dry run prior to perform special procedures so as to relieve anxiety.
14.The staff orients me not only to the
physical set-up but as well as the routine activities of the agency.
136 195 108 5 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency..
15.The staff ensures quality of my
patient care and facilitates my learning.
148 189 100 5 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.
16.The staff provides me real-life experiences to help reduce the difficulties of transition from school to work.
156 195 94 7 Most of the respondents were provided often a real-life experience to help reduce the difficulties of transaction from school to work by the staff.
17.I am permitted to make decisions
about what courses of action to pursue with regards to patient care.
132 222 100 1 Most of the respondents were always permitted to make decisions about what courses of action to pursue with regards to patient case.
18.I am allowed to observe nursing procedures in the area.
384 159 18 0 Most of the respondents were always allowed to observe nursing procedures in the area.
19.I am allowed to perform nursing procedures that I’ve learned in the
360 171 20 1 Most of the respondents were always allowed to perform nursing
47
school to the area. procedures that they’ve learned in the school to the area.
20. I am competent in doing the nursing procedures in the clinical areas.
252 252 22 0 Most of the respondents were always competent in doing nursing procedures in the clinical areas.
FACTORS AFFECTING EMPOWERMENT IN THE AFFLIATED
HOSPITALS
AFFILIATED HOSPITALS
ACCESS TO INFORMATION
RESOURCES
SUPPORT OPPORTUNITY TO LEARN
CHONG HUA HOSPITALS
3.28 3.15 3.01 3.09
48
VCMC 3.5 3.01 3.02 3.26
DISTRICT HOPITALS
3.7 2.65 3.02 3.31
Table IV. Weighted mean of factors affecting empowerment in Affiliated Hospitals
Respondents who are mostly exposed to District Hospitals has a
weighted mean of 3.7 which means that students were more
empowered in terms of access to information compared to VCMC which
has 3.5 weighted mean and Chong Hua Hospitals which has 3.28
weighted mean.
Respondents who are mostly exposed to Chong Hua Hospitals
has weighted mean of 3.15 which means that the students were more
empowered in terms of resources compared to VCMC which has3.01
and District Hospitals which has 2.65 weighted mean.
Respondents who are mostly exposed to VCMC and District
Hospitals has a weighted mean of 3.02 which means that the students
were more empowered in terms of support compared to Chong Hua
Hospitals which has only 3.01 weighted mean.
Respondents who are mostly exposed to District Hospitals have a
weighted mean of 3.31 which means that the students were more
empowered in terms of opportunity to learn and develop compared to
VCMC with a weighted mean of 3.26 and Chong Hua Hospital has
weighted mean of 3.09.
49
CHAPTER 3
SUMMARY
This study is conducted to determine the empowerment of
student nurses in the performance of Related Learning Experience.
Specifically, this study aims to answer the following questions:
50
3. What is the profile of the respondent’s:
1.3. Age; and
1.4. Gender.
4. What are the factors that can affect the level o empowerment of
student nurses in the Related Learning Exposure in Affiliated
Hospitals in terms of:
2.1. access to information;
2.2. resources;
2.3. support; and
2.4. opportunity to learn and develop.
3. Is there a significant relationship between the level of
empowerment and the affiliated hospital?
4. What action plan may be proposed for the study to empower
Level IV nursing students in Related Learning Exposure in
affiliated hospitals.
The respondents of our study are the Level IV student nurses who
are officially enrolled at the University of Cebu Banilad which are
randomly selected and n getting the total number of respondents of
our study, we utilize the Sloven’s Formula.
51
FINDINGS
Table I shows that 388 out of 400 level IV student nurses of X –
university who answered the questionnaire fall under the age range of
18 – 22, 10 fall under the age range of 23 – 27 and only 2 respondents
fall under the age range of 28 – 32
52
Table II shows that 278 out of 400 respondents are female, and
only 122 are male.
Table IV shows the Weighted mean of factors affecting
empowerment in Affiliated Hospitals where Respondents who are
mostly exposed to District Hospitals has a weighted mean of 3.7 which
means that students were more empowered in terms of access to
information compared to VCMC which has 3.5 weighted mean and
Chong Hua Hospitals which has 3.28 weighted mean.
Respondents who are mostly exposed to Chong Hua Hospitals
has weighted mean of 3.15 which means that the students were more
empowered in terms of resources compared to VCMC which has3.01
and District Hospitals which has 2.65 weighted mean.
Respondents who are mostly exposed to VCMC and District
Hospitals has a weighted mean of 3.02 which means that the students
were more empowered in terms of support compared to Chong Hua
Hospitals which has only 3.01 weighted mean.
Respondents who are mostly exposed to District Hospitals have a
weighted mean of 3.31 which means that the students were more
empowered in terms of opportunity to learn and develop compared to
VCMC with a weighted mean of 3.26 and Chong Hua Hospital has
weighted mean of 3.09.
53
CONCLUSION
Based on the finding of the study the researchers came up with
the following conclusions:
Out of 400 respondents 388 of respondents fall under the age
range of 18 – 22 and 277 of the respondents are females.
And showed that of the affiliated hospital where the respondents
are most exposed to, they are empowered in terms of access to
information at District Hospital, in terms of resources at Chong Hua
54
Hospital, in terms of support at Visayas Community Medical Center as
well as District Hospital, and in terms of opportunity to learn and
develop at District Hospital.
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