Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

A criterion that makes nursing as a profession is that it has a theoretical body

of knowledge and expertise leading to defined skills, abilities and norms (Balita,

2008). Knowing such, individual aspirants to provide care and assistance to the

infirmed are ought to undergo formal nursing education in order to follow their

pursuit. Through centuries, nursing started as simply intuitive and apprentice--- as

answer to the virtual call of altruism and service--- until it was finally established by

Florence Nightingale as educated nursing through her Environmental Theory. From

then, the evolution of nursing as a profession began; it started to adapt with social and

environmental changes as well as scientific, technological and medical developments

over time. Schools, colleges and universities--- even hospitals--- that offered nursing

as a degree flourished, accompanied by an increase of demand for nurses all over the

world. This is particular to the Philippine setting. Filipino nurses remain to be the best

manpower for the nursing profession, and this reputation extends globally. That is

why, amidst the global financial crisis, the demand for Filipino nurses never actually

ceased, contrary to the rumors of its decline. Students and licensed nurses alike, desire

that this legacy regarding Filipino nurses abroad continue; with this, government and

private educational agencies keep developing the nursing curriculum in the

Philippines, one that is suitable for both local and international needs and trends of

nursing practice.
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Central Luzon Doctors’ Hospital- Educational Institution in Tarlac has been

recognized to provide quality nursing education and training that led at producing

effective professional nurses that are able to meet the global standards. Student nurses

that the institution caters are exposed to different areas of several health care facilities;

mainly Central Luzon Doctors’ Hospital and Tarlac Provincial Hospital. Although

clinical exposures to the two main hospitals are considered greatly important

altogether in molding student nurses from CLDH- EI, the researchers would want to

determine the nursing procedures commonly performed by NCM 104 students in

CLDH and TPH as well as the difference of such between the two leading medical

institution in relation to the identified factors affecting them. The idea of conducting

this study came about through the researchers’ brainstorming about several concerns

that BSN students from CLDH- EI are currently faced with. The researchers ended

with a discussion on comparisons among previous exposures from the areas of NCM

104; hence, the problem sprung. With a few revisions and after identifying research

variables, the actual research problem finally emerged.

Statement of the Problem

The study was conducted in order to establish the difference between the

performed nursing procedures by NCM 104 students on designated/ assigned areas in

relation to the identified factors affecting them, and to draw out its implication to

nursing. Specifically, the study aimed to answer these problems:

1. What is the demographic profile of the respondents as to:

a. gender;
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b. area of exposure; and

c. time of duty?

2. What are the nursing procedures commonly performed by the respondents

during their clinical exposure on designated area of CLDH and TPH?

3. What are the main factors affecting the performance of nursing procedures by

the respondents during their clinical exposure as to:

a. environmental factors; and

a.1. equipments

a.1.1. availability of equipments

a.1.2. adequacy of equipments

a.1.3. functionability of equipments

a.1.4. usability by students

a.2. facilities

a.2.1. availability of facilities

a.2.2. adequacy of facilities

a.2.3. functionability of facilities

b. motivational factors?

b.1. clinical instructors

b.2. hospital staff and personnel

b.3. patients

4. Is there a significant difference in the nursing procedures performed by the

respondents between CLDH and TPH?

5. What is the implication of the study to nursing education?

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Hypothesis

There is no significant difference in the nursing procedures performed by the

respondents on designated areas between CLDH and TPH.

Significance of the Study

This study is significant to the following target population:

In a general perspective, the researchers would want to contribute to nursing

education particular to CLDH- EI.

Nursing Students:

It will help them to be aware on which areas, to what circumstances and which

factors will affect their performance of nursing procedures. Through increased

awareness, they will be able to determine when, where and how will they be able to

maximize their learning of performing nursing procedures effectively.

Clinical Instructors:

It would help them in creating their plan of activities and effective teaching

strategies in the clinical areas that will be beneficial to their students despite the

existing factors that may affect actual delivery of nursing procedures.

Administrators of the Institution:

The researchers would relay to administrators regarding the existing factors

that generate an effect on the actual delivery of nursing procedures by their students as

of present time. In this manner, administrators of the institution will able to coordinate

collaboratively with health care facilities and clinical instructors about existing

policies and protocols to be observed, or if there are some adjustments needed to be

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made in terms of the nursing curriculum or methods of instruction that will enable

students to learn amidst the existence of factors that may affect the performance of

nursing procedures in clinical areas.

Through the results of this research study, the researchers intend that the BSN

department of CLDH- EI will be guided in terms of devising means to improve

teaching strategies to students in clinical areas of the concerned hospitals. Given the

advantages and disadvantages of conducting clinical exposures in TPH and in CLDH,

this study may serve as motivation for generating alternatives or supplemental learning

activities that will maximize and intensify the learning of BSN students, specifically in

NCM 104.

Scope and Delimitation of the Study

The main focus of this study is determining the difference between the nursing

procedures performed by NCM 104 students on designated/ assigned areas of CLDH

and TPH in relation to the identified factors affecting them. This would be made

known by establishing a difference between nursing procedures commonly performed

between the abovementioned hospitals.

The assigned areas in CLDH and TPH by which the respondents would have

had any exposure considered for the study were Emergency Room, Intensive Care

Unit, and Surgery Ward.

The BSN Level 4 of CLDH- EI in the academic year 2009- 2010 was

comprised of 7 sections but only four sections were selected for the reason that these

respondents were both exposed to CLDH and TPH. These sections, particularly
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sections (B, D, E, F), have a total of 160 students, by which respondents were chosen

from. These students were believed to have been taking NCM 104 and would have

been exposed to any of the areas mentioned in TPH and CLDH by the time the

researchers conducted the study.

The factors included in the study were: first, the environmental factors in terms

of specified equipments and facilities in the hospitals, and secondly the motivational

factors involving clinical instructors, staff nurses and patients confined within the

areas of concern. Procedures taken into consideration as expected to be performed by

the respondents were the following: taking vital signs, performing assessment,

charting, bed making, respiratory modalities such as oxygenation and nebulization,

catheterization, nasogastric or orogastric feeding (NGT/OGT), intravenous

preparation, administration of medicine (oral and parenteral) and specimen collection.

The study was conducted for one to two months. The researchers included data

gathering through approved and reliable questionnaires which were filled up by

respondents. Thereafter, the data obtained and gathered by the researchers were

subjected to tabulation, statistical testing and interpretation.

Definition of Terms

These are the terms that are of direct concern in the study. These were defined

operationally by the researchers.

Adequacy. This refers to enough number of equipments and facilities available in

the hospital for use.

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Assessment. The process of collecting, organizing, validating, and recording data

or information about a client’s health status.

Area of Exposure. It pertains to the area were the researchers will be focusing in

the study. These are the ER, ICU, and Surgery.

Auscultation. The action of listening to sounds from the heart, lungs, or other

organs, typically with a stethoscope, as a part of medical diagnosis.

Availability. This refers to presence of equipments and facilities in the hospital.

Blood pressure. The blood pressure is the pressure of the blood within the arteries.

It is produced primarily by the contraction of the heart muscle. It's measurement is

recorded by two numbers. The first (systolic pressure) is measured after the heart

contracts and is highest. The second (diastolic pressure) is measured before the heart

contracts and lowest. A blood pressure cuff is used to measure the pressure. Elevation

of blood pressure is called "hypertension".

BSN- Bachelor of Science in Nursing. It is the course to which the respondents are

currently enrolled.

Catheterization. A process by which a catheter is aseptically inserted into urethra.

Clinical instructors. This refers to mentors of nursing students.

CLDH- Central Luzon Doctors’ Hospital. This refers to a private health care facility

and the official training hospital of the respondents. It is the school where the

respondents are enrolled.

Demographic profile. This is the description of the respondents as to gender, area

of exposure and time of duty.

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Dorsal recumbent. The supine position with the person lying on the back, head,

and shoulders.

Environmental factors. These may be in terms of availability, adequacy,

functionability and usability of equipments and facilities that may or may not affect

performance of nursing procedures.

Equipments. These are instruments or materials involved in performing nursing

procedures (eg. BP apparatus, mechanical ventilator).

Facilities. These are amenities readily available in the hospital for patient use and

comfort (eg. hospital bed, IV stand).

Fowler's position. A position in which the patient is semi-sitting with the head and

trunk elevated 45-90 degrees.

Functionability. This refers to the hospital equipments and facilities that are

working and with no defects.

Gender. This is the description of respondents as to male or female.

Heart rate. The number of heart beats per unit time, usually per minute. The heart

rate is based on the number of contractions of the ventricles (the lower chambers of

the heart). The heart rate may be too fast (tachycardia) or too slow (bradycardia). The

pulse is bulge of an artery from the wave of blood coursing through the blood vessel

as a result of the heart beat. The pulse is often taken at the wrist to estimate the heart

rate.

Hospital staff and personnel. This refers to people who are employed in the

hospital.
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Inspection. The visual examination of the body using the eyes and a lighted

instrument if needed. The sense of smell may also be used.

Inspection. A visual examination for detection of features or qualities perceptible

to the eye.

Lateral position. A position in which the patient lies on one side of the body.

Lithotomy. Position in which the patient is on their back with the hips and knees

flexed and the thighs apart. The position is often used for vaginal examinations and

childbirth.

Medical hand washing. Pertains to the hygiene practices related to the

administration of medicine and medical care that prevents or minimizes disease and

the spreading of disease. The main medical purpose of washing hands is to cleanse the

hands of pathogens (including bacteria or viruses) and chemicals which can cause

personal harm or disease.

Motivational factors. This refers to factors that may or not affect performance of

nursing procedures from other people present in the hospital during duty.

Nasogastric Tube Feeding. Feeding of patient with milk and medications through a

tube inserted in the nares to the stomach.

NCM 104- or Nursing Care and Management 104. This is a nursing subject and

second in the NCM series; it deals with Medical and Surgical Nursing.

Nebulization. Process of delivering a fine spray of medication or moisture to a

client.

Nursing procedures. It refers to nursing interventions performed by the respondents

as part of their related learning experience in the nursing education curriculum.

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Occupied bed making. The process and art of changing linens, pillowcases and

blankets to a bed which is being occupied by a patient who is either comatose or

immobilized. There is an involved technique in moving the patient while maintained

in bed and while changing sheets of the bed.

Oral Administration. It is a means of administering drugs through oral route.

Oxygenation. The act, process or result of oxygenating.

Parenteral Administration. Pertaining to medication administered by a route that

bypasses the GI tract such as drug given by injection.

Patients. This refers to those confined in the hospital to which nursing care are

rendered.

Percussion. The striking together of two bodies, especially when noise is produced.

The sound, vibration, or shock caused by the striking together of two bodies.

Performance. It refers to the execution of a nursing procedure in the clinical area.

Prone position. A position in which the patient lies on the abdomen with the head

turned to one side.

Respiratory rate. The number of breaths per minute or, more formally, the number

of movements indicative of inspiration and expiration per unit time. In practice, the

respiratory rate is usually determined by counting the number of times the chest rises

or falls per minute. By whatever means, the aim is to determine if the respirations are

normal, abnormally fast (tachypnea), abnormally slow (bradypnea), or nonexistent

(apnea).

Sims' position. A position in which the patient lies on one side with the under arm

behind the back and the upper thigh flexed, used to facilitate vaginal examination.
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Specimen Collection. Obtaining and preserving a specimen for laboratory test.

Surgical hand washing. A fundamental part of sterilization procedures and disease

control for dental workers; helps reduce or prevent infection and transmittal of

microbes among people and objects; for regular dental procedures, liquid soap and

water is sufficient but for surgical procedures, antimicrobial cleansers should be used.

Temperature. An expression of heat or coldness in terms of a specific scale; a

measure of the average kinetic energy due to thermal agitation of the particles in a

system.

Time of duty. This refers to the duration in the day or night to which respondents

were exposed in CLDH and TPH.

TPH- Tarlac Provincial Hospital. It is referred as a tertiary health care facility, one

among the hospitals that the respondents have their clinical exposure.

Trendelenburg position. The patient is supine on a surface inclined 45 degrees,

head at the lower end and legs flexed over the upper end.

Unoccupied bed making. The process and art of changing linens, pillowcases and

blankets to a bed which is unoccupied. This is usually accomplished prior to a

patient’s admission.

Usability. This refers to the permission granted to nursing students to make use of

hospital equipments.

Vital Signs. This is also called as cardinal signs, consisting of Blood Pressure,

Heart/Pulse Rate, Respiratory Rate, Temperature.

Wound Dressing. The use of aseptic technique in cleaning wound to prevent

infection.