Challenges of Nursing Students in Building and Maintaining Trusting Relationship on Older Adults

Joevhelle Rose O. Jornales1,2,3, Carla Nicole C. Dairo1,2,3, Pamela M. Mangula-

bnan1,2,3, Diana Rose A. Parenia1,2,3, and Melody M. Gatdula 1,2,3,5

1
College of Nursing
2
Research Development and Innovation Center
3
Our Lady of Fatima University-Cabanatuan Campus
4
Undergraduate Thesis

5
Research Adviser

February 2024
 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… ii
Table of Contents

Table of Cotents
List of Figures 2
List of Appendices 3
Abstract 4
1.0 Introduction
2.0 Background of the Study
2.1 Theoretical Framework
2.2 Literature Review
2.2.1
2.2.2
2.2.3
2.3 Research Simulacrum
2.3.1
2.3.2
3.0 Research Method 5
3.1 Research Design
3.2 Research Locale
3.3 Population and Sampling
3.4 Research Ethics
3.5 Research Instruments
3.6 Data Collection
3.7 Data Analysis
References 6

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CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… iii

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF NURSING

 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… iv

Abstract

The study will aim to explore the challenges that nursing students encounter in building and maintaining trust-
ing relationship in older adults. This research will use a descriptive method under the quantitative approach
and will disseminate survey questionnaires. The respondents of this study will consist of 221 students cur-
rently taking the Bachelor of Science in Nursing ranging from the second-year level to the fourth-year level
enrolled in the semester of 2023–2024, and a certain private university in Cabanatuan City will serve as the
primary location for the research. The study will use an evaluative research design. For future computations,
multiple regression analysis will be the statistical treatment to be used for evaluation. Multiple regression in-
volves the influence of two or more independent variables on the dependent variable. Students pursuing nurs-
ing degrees will benefit from this research by gaining an understanding of the obstacles and developing strate-
gies to overcome them in order to develop the self-assurance necessary to establish and maintain relationships
with the expanding population of elderly individuals in a variety of healthcare settings. While empirical re-
search surrounding the challenges with nursing students face in building trusting relationships with older
adults has grown over the past five years, there remains a lack of comprehensive studies regarding the mainte-
nance of trusting relationships with older adults.

Keywords: Challenges of nursing students, trusting relationship, older adults, Descriptive, Quantitative, Mul-
tiple Regression Analysis, Survey, Cabanatuan City, Nueva Ecija

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 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 5

1.0 Introduction

Providing healthcare services that respect and meet patients’ and caregivers’ needs are essential in promoting pos -
itive care outcomes and perceptions of quality of care, thereby fulfilling a significant aspect of patient-centered care re -
quirement. Achieving patient-centered care and communication in nurse-patient clinical interactions is complex as there
are always institutional, communication, environmental, and personal or behavioral related barriers. (Kwame and Petrucka
2021). In addition to involving patients in their own care and enhancing health outcomes, a strong foundation of trust be-
tween a patient and a nurse can help reduce patients' mistrust in the healthcare system. Active listening and improving ver -
bal and nonverbal communication abilities are two ways to promote trust. (Shanahan).

Although there are some studies pertaining to the barriers nursing students face in building trusting relationships with
older adults in some countries, there have been gaps that remain due to limited studies being present in certain geographi-
cal locations, specifically in developing countries such as the Philippines. There is no current research available within the
2018–2023 period that addresses the difficulties nursing students face in establishing and upholding trusting relationships
with older adults.

This study aims to understand the challenges faced by nursing students in building and maintaining trusting relation-
ships with older adults. In order to improve the standard of care given to the elderly and promote a healthcare system
based on compassion, trust, and patient-centered practices, it is critical to recognize and address these issues as these stu -
dents train to become the next generation of healthcare professionals. The researchers aim to understand the difficulties
students face in clinical settings, as nursing programs involve more than just lectures; they also need to develop proper re -
lationships with patients to effectively perform their clinical tasks.

The value and relevance of this research benefit both the patient and the student nurse themselves. Thorough research
would help gain in-depth knowledge that would support proper health care services and, at the same time, avoid medical
negligence. It will also open new windows of opportunity for the student nurses to learn how to critically analyze delicate
medical situations.

2.0 Background
2.1 Theoretical framework
This study is founded on the theory of interpersonal relations by Hildegard Peplau (1952).

According to Hildegard Peplau (1952), the nurse-patient relationship is a crucial therapeutic process, involving four
phases: orientation, identification, exploitation, and resolution. During the orientation phase, the nurse and patient get to
know each other, and collect medical data. Active listening and open communication during the identification phase help
alleviate patient concerns. The exploration phase sees active patient involvement in treatment, with the nurse providing
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 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 6

education and guidance. The resolution phase, as the patient's health progresses, leads to closure, fostering an enhanced
sense of autonomy and self-assurance, while the nurse introspectively evaluates progress and knowledge.

Given the foregoing, Hildegard Peplau's theory of interpersonal interactions provides therapeutic communication, which is
based on the nurse and patient, establishing trust and mutual respect while addressing the needs, concerns, and preferences
of patients and caregivers. The theory can be utilized to develop effective nurse-patient communication, which is an essen -
tial component of nursing care since it improves clinical outcomes and increases patient satisfaction. This theory is perti -
nent to the researcher's work since it focuses on developing and sustaining nurse-patient relationships. It will help the re -
searchers because it will serve as a cornerstone in the study they are conducting.

2.2 Literature Review

2.2.1 Challenges of nursing students

According to Andonova, Nikolova, Kyuchukova, and Ivanova (2021), nurse students undergo training to work with vari-
ous patient groups, including elderly patients. However, working with elderly patients presents specific challenges, includ-
ing communication difficulties, difficulty understanding new information, and memory impairment. Organizational diffi-
culties include insufficient experience, limited time for communication, and a lack of comfort in the patient's home. More-
over, the study of Kim and Kim 2023 reveals that nursing students face several barriers to delivering person-centered care
in clinical settings, including busyness, educational challenges, lack of awareness, relationship building, and policy ap-
proaches. To overcome these, increasing nurses, reducing workload, providing specific education, developing educational
models, strengthening supervision, improving communication skills, and improving policies are suggested strategies.

2.2.2 Building trusting relationship with older adults

As stated by Nielsen and Henriksen (2022), Building trust with older patients is important for nursing students. One
way to build trust is through therapeutic communication, which involves purposeful and understandable communication
between patients and caregivers. Engaging in narrative interviews with older patients can also enhance the patient-nurse
relationship and facilitate involvement in clinical decision making, leading to person-centered care (Shanahan and Cun -
ningham 2021). Additionally, increasing exposure to older adults through simulation activities can help nursing students
develop positive attitudes towards older adult care, increasing their confidence and comfort level in working with this pop-
ulation (Crownover and Heinrich 2021). Daily life activities simulation has been found to be an effective method in im -
proving nursing students' positive attitudes towards older adults, increasing empathy and awareness of geriatric (Demirtas
and Basak 2021).

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 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 7

2.2.3 Maintaining trusting relationship with older adults

Maintaining an appropriate doctor-patient relationship fosters trust, which influences patients' health attitudes and com-
pliance with medical recommendations. (Pawlikowska – Łagód and Suchodolska 2021). Trust plays a key role in building
this relationship, and it is influenced by factors such as the doctor-patient relationship itself, patients' hope, and stereotypes
about medical professionals (Hullur, Dandekar, and Raje 2020). Different models of the doctor-patient relationship can
impact the level of trust between them (Jeffrey 2020). Trust significantly impacts patient-physician satisfaction, with a
strong relationship between trust and physician performance. Physicians' interpersonal abilities, empathy, communication
ease, friendship, trust, and commitment are also highly valued by patients. (Berger, Bulmash, Drori, Ben-Assuli, Herstein
2020).

2.3 Research Simulacrum

Fig. 1. Research Simulacrum

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 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 8

2.3.1 Research Questions

Research Question 1: What challenges do nursing students encounter with older adults?
Research Question 2: What are the ways to build a trusted relationship with older adults?
Research Question 3: What are the ways to maintain a trusted relationship with older adults?
Research Question 4: Do the challenges of nursing students affect the building of trusting relationship with older
adults?
Research Question 5: Do the challenges of nursing students affect the maintaining of trusting relationship with older
adults?

2.3.2 Hypotheses
H1: The challenges of nursing students do not have a significant effect on building a trusting relationship with older
adults.
H2: The challenges of nursing students do not have a significant effect on maintaining a trusting relationship with older
adults.

3.0 Research Method

3.1 Research Design

This research will use a descriptive method under the quantitative approach and will use simple random sampling to
answer the survey questionnaires. The study will employ an evaluative research design to assess the challenges faced by
nursing students in building and maintaining trusting relationships with older adults; consequently, the study will rely on
numerical analysis and interpretation of the results.

3.2 Research Locale

A certain private university in Cabanatuan City will serve as the primary location for the research.

3.3 Population and Sampling

To ensure equal opportunity for every member of the target group, the researcher will select the participants using a
simple random sampling technique. The sample will consist of nursing students at the second- to fourth-year levels. The
researchers set the selection criteria for the respondents as follows: (1) male or female; (2) enrolled in the Bachelor of Sci -
ence in Nursing for the semester of 2023-2024; (3) second- to fourth-year level; (4) nursing students having their clinical
duty; (5) 18 years old and older; and (6) willing to participate in the study. The researchers excluded students who are (1)

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF NURSING

 CHALLENGES
less than 18 years OFhave
old, (2) do not NURSING STUDENTS
a clinical IN BUILDING
duty; and (3) ANDwho
nursing students MAINTAINING… 9
are not willing to participate in the
study.

2
z pq
n 0=
ⅇ2

Fig. 2. Cochran’s Formula

2
z pq
n 0=
ⅇ2
( 1.65 )2 ( 0.25 )
n 0= 2
( 0.05 )
2.7225 ( 0.25 )
n 0=
0.0025
0.680625
n 0=
0.0025
n 0=273
Fig. 3. Cochran’s Computation

n
1+ ( n−1 )
N

Fig.4. Modified Cochran’s Formula

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 CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 10

273
n 0=
( 273−1 )
1+
1160
273
n=
( 272 )
1+
1160

273
n=
1+0.234482759

273
n= n=221
1.234482759

Fig. 5. Modified Cochran’s Computation

3.4 Research Ethics

The Nuremberg code will be integrated into the research. Participants will get informed consent from the researchers
that includes a complete disclosure of the study. In addition to upholding the rights to fair treatment, confidentiality, pri -
vacy, and anonymity, as well as respect for human dignity, the researchers will ensure that no respondent will be harmed
or exploited. In particular, if answering the surveys could put them in emotional discomfort, the researchers will make
sure that all respondents are informed that their participation in the study is optional and that they are free to decline.
The participants will be given stickers and ticklers as a token of appreciation for their involvement in the research.

3.5 Research Instruments

The study's primary data-collection tool will be a printed survey questionnaire. This study will use research made ques-
tionnaires to aligned with the statement of the problem, consisting of 12 questions with a 4-point Likert scale: 4: strongly
OUR LADY OF FATIMA UNIVERSITY COLLEGE OF NURSING
agree, 3: agree,CHALLENGES
2: disagree, andOF
1: NURSING STUDENTS
strongly disagree. IN BUILDING
This will AND MAINTAINING…
assess the challenges 11 building and
of nursing students in
maintaining trusting relationship on older adults.

3.6 Data Collection

Before the dissemination of data, the researchers will wait for the approval of the IERC. Upon the approval of the
ethics review committee, the researchers will submit a letter of consent from the campus administrator to have permission
to conduct the study at the chosen university, then seek approval from the program head of the College of Nursing to carry
out the study at the chosen department, and then submit a request letter to the faculty members before the dissemination of
survey questionnaires. Once all of the aforementioned steps are done, the researchers will provide informed consent to the
students who meet the criteria for selection. The researchers will include information on the nature, purpose, and proce-
dure of the study and an invitation to participate in it. The selected nursing students will be informed that participating in
the study is entirely voluntary, and they may decline or withdraw at any point in the study. Researchers will treat all the
information in the questionnaires as confidential, and that information will be used only for the purpose of research. All of
the data will be tallied and stored on a password-protected computer, and only the research team members can access the
files. Afterwards, all files that contain information from the respondents shall be permanently deleted, and all printed
copies shall be shredded and properly disposed of.

3.7 Data Analysis

The researchers will use multiple regression analysis. Multiple regression analysis is a statistical tool used for evalua-
tion. Multiple regression involves the influence of two or more independent variables on the dependent variable.

Fig .6. Multiple Regression Formula

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CHALLENGES OF NURSING STUDENTS IN BUILDING AND MAINTAINING… 12

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