1

CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction

Care is the language of nursing. It is traditionally defined as “to have

concern for”, “to value,” “to have responsibility for,” and to “help.” With regards

to this description, caring must be operationalized through intentional and

purposeful behavior. (Johnson & Webber, 2005)

Nurses have a caring intent. Their thoughts and behavior center in valuing

and helping others especially to their patient through the application of their

knowledge and skills acquired from formal education and values and meanings

gained through experience. (Gedder & Grosset, 2005)

Johnson and Weber mentioned in their book, An Introduction to Theory of

Reasoning in Nursing, that “Quality health care has been defined as the provision

of high level professional service that are accessible to the population and that,

through the use of existing resources attain compliance and satisfaction of the

client. This definition of quality implies that the service delivered is the measure

rather than increase capacity of the individual to participate in the care process.

Out of the demand of nursing career nowadays in the world, the

Philippines produces an estimated 25,000 to 30,000 registered nurses a year but

the question is, are they all giving quality care aside from application of

1
 2

knowledge and skills? The connotation today of taking nursing profession is to

alleviate the economic status of the family but too often, the quality care to patient

is neglected. The researchers mutually agreed on this topic to evaluate whether

patients of different economic status receive quality care in the hospital.

Basically, a comparison of nursing care offered in the Private Rooms and Wards

is the focus of this study.

 3

QUALITY ROUTINE NURSING

CARE IN PRIVATE ROOMS AND
WARDS

Taking Rounds

IV Fluid monitoring

Taking Vital Signs

Administering Medications

Changing bed Linens

Promoting Cleanliness

Promoting proper hygiene

Health Teachings

Attending Needs

Ensuring Safety

Figure 1 Schematic Diagram of the Study Showing Quality Routine Nursing Care
in Private Rooms and Wards
 4

Statement of the Problem

The main purpose of the study is to determine the difference of quality

care provided by the nurse to the patients in private rooms and wards.

Specifically, this aims to answer the following questions:

1. What is the quality care perceived by the patients in private rooms?

2. What is the quality care perceived by the patients in wards?

3. Is there a significant difference in the quality of care as perceived by the

patients in private rooms and in the wards?

Hypothesis

1. Patients in private rooms received good quality care.

2. Patients in wards received fair quality care.

3. There is a significant difference in the quality of care in private rooms and

in the wards as perceived by the patients.

Significance of the Study

The result of this study will benefit the following:

1. Hospital administration, this study will aid the hospital in upholding their

reputation as a standard health institution. The result will motivate them to

conduct in-service training or CPE (Continuing Professional Education) for

nurses to improve the quality care.

2. Nurses, the result of the study will help the nurses to assess themselves if they

have rendered quality care to their patients. According to Venzon, “Standard

 5

of care is used as a basis of comparison to determine whether nurses have

been provided or not in the execution of their studies.” In addition to that, this

study will encourage them to act willfully on their responsibility as a nurse.

3. Patient, the result of the study will benefit them by receiving the quality care

they need. They will be educated of their rights as a health care consumer,

thus, optimum level of recovery will most likely be attained.

4. Future Researchers, this study may serve as a reference and would motivate

them to pursue similar research in a larger scale using more variables.

Definition of Terms

In order to facilitate understanding of the problem, the following key terms are

defined operationally:

Quality Care – the provision of high level professional service that are accessible

to the population and that, through the use of existing resources attain

satisfaction of the client.

Nurse – a person trained to care for a sick, injured and aged; a person who looks

for another person to tend to or care.

Patient – a person confined in a private room or ward receiving quality care

rendered by a nurse.

Private Room – a hospital accommodation with only one patient confined in a

room.

Ward – a hospital accommodation with many beds for five to six patients.
 6

Taking Rounds – visiting the patient to check on his/her condition done at the

beginning, during and at the end of the shift.

Intravenous Fluid Monitoring – the checking of the intravenous (IV) fluid of the

patient, the type of solution, flow rate, the insertion site, the patency and

the time it was hooked.

Administering of Medication – giving of medicine by a nurse to a patient through

intravenous tube, intramuscular route, intradermal route, subcutaneous,

oral route, and suppository or via nasogastric tube. It also means the nurse

ask the patient’s name, state the drug‘s name and indication before

administering.

Personal Hygiene – self care by which people attend to such functions as bathing,

toileting, general body hygiene, and grooming. The nurse only promotes

this variable or encourage the patient when he/she is able to do his

activities of daily living.

Health Teachings – the statement from a nurse that motivates the patient and/or

his/her family to gradually assume responsibility for his/her health care

and become independent from such assistance as soon as possible. It

includes exact information about the patient’s health condition, food

restriction and lifestyle modification.

Attending Needs – the nurse’s responsibility to take immediate action to meet the

needs of a particular patient.

Ensuring Safety – It is the proper precaution and assistance which is observed or

provided to prevent any accident or injury to the patient in the hospital vicinity.
 7

Vital Signs Monitoring – refers to the taking of the client’s blood pressure, body

temperature, pulse rate and respiratory rate. This is done after asking

permission and explaining the procedure to the patient. Privacy and

respect must be observe.

Cleanliness – refers to a room that is neat and free from dirt or mess, trashes are

thrown in the garbage bin (biodegradable & non-biodegradable), bed side

table is properly placed and things are fixed.

Changing Bed linen – changing of pillow case, blanket and bed sheet every other

day. The nurse may encourage the patient or significant others or could

delegate this task to a nurse aide.

Scope and Limitation of the Study

The study focuses on the quality of care offered by the nurses both in

patients staying in private rooms and wards. It involves 60 respondents, 30 from

private rooms and 30 from the wards who have met the criteria being imposed by

the researchers.

The study is concerned specifically on nine identified variables which are

taking rounds, IVF monitoring, administering medications, morning cares, health

teachings, attending needs, interaction, ensuring safety and vital signs monitoring.

The study was conducted between the period of June to August 2009 in

Valencia Sanitarium and Hospital Foundation Incorporation.

 8

CHAPTER 2

REVIEW OF RELATED LITERATURE AND CONCEPTUAL FRAMEWORK

This study evolves on the giving and providing of care to the patients in

different walks of life. It is important that the quality of care be evaluated so that

not only the patient and the Health Care Industry will be benefited but to the

Nurses to be as well. This study would be an inspiration for the nurses on the

importance of their care to the patient.

First, we should consider the meaning of care basing on the theory of Jean

Watson which is “Human caring” that focuses on the art and science of human

care. “Caring is the essence of Nursing and the most central and unifying focus of

nursing practice.” This theory offers a new way of conceptualizing and

maximizing human-human transactions that occurs daily in nursing practice. Her

major assumption about caring is the following: human caring in nursing is not

just an emotion, concern, attitude or benevolent desire. (De Laure & Ladner,

2006).

Caring connotes a personal response. It is an intersubjective human

process and is the moral ideal of nursing. It can be effectively demonstrated only

interpersonally and if it’s effective it promotes health and individual or family

growth. It promotes health more than does curing. Caring responses accept a

person not only as they are now, but also for what the person may become and a

caring environment offers the development of potential while allowing the person

8
 9

to choose the best action for the self at a given point in time (De Laure & Ladner,

2006).

The second thing that should be considered is the question “What does a

quality care really means?” The quality of health care services is the type of care

expected and maximizes the well being of patients once the balance between gain

and costs has been considered in all parts of the process (Johnson & Weber,

2007). In addition to that, quality in health care has been defined as the provision

of high level service that are accessible to the population and that, through the

use of existing resources attain compliance and satisfaction of the client (Venzon

& Nagtalon, 2006). Base on the different articles above, nursing profession is not

that easy as we thought.

“The patient is the best, sometimes the only, judge of the interpersonal

aspect of care including the surroundings of patient care such as rooms and foods

often called the “hotel” service. The patient’s satisfaction is an essential goal of

health care and therefore a part of quality care. It is assumed that if the patient is

satisfied with his care, then it must be favorable good. Patient’s attitude influences

the degree of compliance to the medical regimen we received in the future.”

(Venzon & Nagtalon, 2006).

Now, let us face the reality about the nursing care. It is a fact that quality

of patient care is the number one issue in nursing (Bueno & Fralic, 2008). This is

supported in the article about the issue of quality which has been focus of

industries and business enterprises from immemorial in attempt to capture the

market for their producers. The concept of quality and demand for quality care
 10

has been moved into all levels of the health care industry. Quality nursing care is

no longer a pursuit for professional excellence, but a consumer right. It is

imperative that the nursing profession evaluates its practice, modify, and/or

abandon those shown to have little or no effects on client’s health, repackages its

service such that they meet the needs of its consumers. (Bergborn, 2008).

In this regard Nursing Research is one way of evaluating practices and

services provided and changing practice for better” (Venzon & Nagtalon, 2006).

This issue is also observable here in the Philippines as well as in the other

countries. The researchers observed this while having their duties in the hospitals

where they were affiliated but they came to the idea that there must be a factor

involve in the change of quality care, the cost. Why is consideration of cost so

important? The very existence of the healthcare system depends on fiscal issues.

Cost has been a driving force for the change in the health care system as evidence

by the strength and numbers of manage care plans, increased use outpatient

hospitals stays. (Etches, 2007).

Though there are factors identified for the reduction of quality care, the

rights of the patient should not be over rule. In an attempt to provide universal

access to services in a cost-effective manner, quality does not have to be scarified.

For example, hospitals that are reducing the number of registered nurses

(“downsizing”) risk endangering quality. Safety and quality are frequently

compromised by inappropriate substitution of unqualified personnel for registered

nurses in direct care of clients. Remember that the first principle of the code of
 11

ethics for nurses is that treat everybody the same. We respect their dignity

regardless of their socio-economic status, says Taylor. (Hilton, 2004).

Let us consider the usual cares offered by the nurses to patients regardless

of their accommodation. As observed and practiced by the researchers in their

affiliated hospital here in Bukidnon.

Taking Rounds

The nurses start their duty by taking initial rounds wherein patient’s

condition where checked. Taking rounds is routinely done at the beginning of the

shift for the purpose of endorsement by the nurse on duty to the next shift. This

nursing responsibility is important for the next nurse on duty to know so that she

could plan her care for her shift. To know whom she will prioritize and to give or

attend to their immediate needs.

Monitoring of Intravenous Fluid

Monitoring of intravenous fluid of the patient is also practiced. An

important nursing function is to regulate the flow rate of an intravenous infusion.

The physician may describe in the order how long an infusion should last. It is

then a nursing responsibility to calculate the correct flow rate and regulate the

infusion. Problems that can result from incorrectly regulated infusion include

hypervolemia and hypovolemia. Unless a regulating device is being used, the

nurse administering the intravenous solution must regulate the drops per minute

manually by using the roller clamp to ensure that the prescribed amount of
 12

solution will be infused in the correct time span. (Kozier et al., 2004). Aside from

the flow rate, nurse should also check the type of intravenous fluid to be infused

according to the doctor’s order, the patency of the IV line and the site of insertion

for any unusuality.

Taking Vital Signs

Vital signs are a person’s temperature, pulse, respiration, and blood

pressure. Health status is reflected in the indicators of vital body functioning. A

change in vital signs might indicate a change in health. Assessing vital signs is

part of nursing care in any setting. Institutional and agency policies govern when

and how frequently vital signs are to be assessed routinely. Vital signs are

assessed at least every four hours in hospitalized patient. (Taylor, et al, 2005). The

nurse should first identify the patient and explain the procedure before taking the

vital sign. Part of the procedure is doing it gently and accurately to promote

nurse-patient relationship.

Administering of Medications

Administering medication is done according to the Doctor’s order. Drug

administration is one of the highest risk areas of nursing practice and a matter of

considerable concern for both managers and practitioners. (Gladstone, 1995). In

Sumatra’s thesis, she quoted that when medication is being administered, “The

Ten Rights” safety rules should be followed: right medication, right amount, right
 13

time, right route, right patient, right assessment, right education, right evaluation,

right documentation and right to refuse the medication. (Lilley, et al, 2001).

Changing Bed Linens

Because people are usually confined to bed when ill, often for long

periods, the bed becomes an important element in the client’s life.(Kozier, et al,

2004). Nurses need to be able to prepare hospital beds in different ways for

specific purposes. This task may also be delegated to the nurse aide. In Valencia

Sanitarium and Hospital, changing of bed linens is done every other day or

according to the patient’s preference.

Promoting Cleanliness

A place that is clean, safe, and comfortable contributes to the client’s

ability to rest and sleep and to a sense of well-being. (Kozier, et al, 2004).

Promoting cleanliness refers to a room that is neat and free from dirt or mess,

trashes are thrown in the garbage bin (biodegradable & non-biodegradable), bed

side table is properly placed and things are fixed.

Personal Hygiene

Personal hygiene is the self care by which people attend to such functions

as bathing, toileting, general body hygiene, and grooming. It is important for

nurses to know exactly how much assistance a client needs for hygienic care.

(Kozier, et al, 2004). Morning care is often provided after clients have breakfast,
 14

although it may be provided before breakfast. It usually includes the provision of

urinal or bed pan, a bath or shower, perineal care, back massages, and oral, nail,

and hair care. Making the clients bed is part of morning care.(Kozier, et al, 2004).

This responsibility is usually done to a dependent patient or immobile thus nurse

assistance is needed in performing activities of daily living (ADLs). But when the

patient is able to do ADLs, the nurse may only do the promotion or

encouragement.

Health teachings

The decision to establish a health promotion program must be base on the

health needs of the people; also, specific health promotion, goals must be set.

Nurses may offer an abundance of information less formally. To do so, however,

nurses need up to date knowledge, the ability to assess learning needs, and

effective teaching skills. (Kozier, et al, 1997). As experienced by the researchers,

giving health teachings may include, the precipitating factors of the patient’s

sickness, educating for the signs and symptoms, and lifestyle modification base

on the patient’s condition.

Attending needs

Patients were confined for the reason of seeking care and it is the nurses’

responsibility to attend to their needs while they are still in the hospital. Needs is a

general term which may consist of any information asked by the patients or
 15

interventions that must be perform to them. It could be physical, emotional or

spiritual needs.

Ensuring Safety

Providing safe, error-free care is the number one priority of all health care

professionals. On the other hand, the first objective of the professional practice

environment for nurses is to put the patient first and focus on patient’s safety and

quality care. (Rosenstein, 2005). According to Sumatra’s thesis, Watson suggests

that the nurse must provide comfort, privacy, and safety as part of this carative

factor. (George, 1995).

 16

CHAPTER 3

METHODOLOGY

This chapter presents the details of research design, research locale,

selection of study subjects and method of data collection.

Research Design

This research was a survey approach to determine the quality of care

perceived by the patients from different accommodations. The researchers

compared and documented the quality of care rendered by the nurses in private

room and ward accommodations of Valencia Sanitarium and Hospital.

Research Locale

This study was conducted in private rooms and wards of Valencia

Sanitarium and Hospital Foundation Incorporation which is now a tertiary level

hospital as approved by the Department of Health (DOH) on November 14, 2008.

This hospital is located in Valencia City, Bukidnon

It is a three story building with 70 rooms of which 12 from wards and 35

from private rooms. It has a bed capacity of 100 and a daily average patient count

of 50.

16
 17

Selection of the Study Subjects

The researchers selected 30 study subjects from private rooms and another

30 subjects from the wards using random sampling. They were qualified in the

following criteria:

1. Must be a patient of Valencia Sanitarium and Hospital

2. Willing to participate in the study.

3. Accommodated either in wards or private rooms.

4. Have stayed in the hospital for at least 2 days.

5. Either male or female.

6. Literate- able to read and write.

7. No barriers in reading and understanding.

8. Has not been taken cared by the student nurse

The study subjects in private room and wards were given a questionnaire

respectively evaluating the Quality Care they received. The researchers conducted

seven sessions of evaluation within 2 months, once every week until the desired

numbers of respondents are completed.

 18

Distribution of the Study

SESSION PRIVATE ROOM WARD RESPONDENTS TOTAL
RESPONDENTS

First 3 9 12
Second 4 1 5
Third 2 6 8
Fourth 9 5 14
Fifth 7 4 11
Sixth 5 2 7
Seventh 3 3
Grand Total 30 30 60

Research Instrument

The instrument that was used was a questionnaire formulated by the

researchers approved by the Research Adviser and three other Clinical Instructors

of Mountain View College. The questionnaire was based on the routine services

offered by the staff nurses in VSH and on the experience of the researchers in

Valencia Sanitarium and Hospital during their exposure in clinical area.

Each respondent was instructed to check the box with its corresponding

quality description. The questionnaire was arranged according to the variables

being identified, which is the routine nursing services in the hospital, and each

question has a corresponding scale: (5) always, and the equivalent of this routine

nursing care is excellence, (4) often, which means that the quality of routine

nursing care is good, (3) sometimes, this quality of routine nursing care rated as
 19

fair,(2) rarely, that signifies poor quality routine nursing care,(1) never, this

means that the quality of routine nursing care is very poor performed.

Data Gathering Procedure

Before the actual collection of the data, the researchers formulated first a

questionnaire which was approved by the Research Adviser and three other

Clinical Instructors of Mountain View College. The researchers then asked

permission from the Director of the hospital to conduct a non-experimental study

in their hospital. They presented a letter approved by the Dean of Nursing

allowing the researchers to conduct a survey on the patients of VHS. The

researchers went to the Nurse’s station to have the list of patient qualified for the

study according to the formulated criteria and randomly noted down 10 names of

patients in private rooms and wards respectively.

Each researcher distributed questionnaires to the study subjects in the

wards and in the private rooms respectively completing 60 respondents from both

ward and private rooms in two-month time. The study subjects were instructed

properly and answered the questionnaire in the presence of the researchers. They

were informed about the purpose of the research and assured of their four rights as

a study subject which are (1) right not to be harmed,(2) right to full disclosure, (3)

right of self determination, and (4) right of privacy and confidentiality (Venzon &

Nagtalon, 2006).

The data collection was completed in two month time and was submitted

to the statistician of the school, MVC.

 20

CHAPTER 4

PRESENTATION, ANALYSIS & INTERPRETATION

OF THE FINDINGS

This chapter presents the analysis and interpretation of the result of the

study in comparing the quality care offered in private rooms and in wards.

Problem 1 : What is the quality care perceived by the patients in

private rooms?

Table 1 shows that monitoring of intravenous fluid (4.8), taking rounds

(4.6), taking Vital signs (4.56), and attending needs (4.16) rated as excellent

quality of care. On the other hand, administering of medications (3.9) ensuring

safety (3.6), and health teachings (3.5) were has a good quality nursing care,

while promoting proper hygiene (3.16), encouraging in changing bed linen (2.96),

and promoting cleanliness (2.93) has a fair quality carein the private rooms.

An important nursing function is to regulate the flow rate of an

intravenous infusion. The physician may describe in the order how long an

infusion should last. It is then a nursing responsibility to calculate the correct flow

rate and regulate the infusion. Problems that can result from incorrectly regulated

infusion include hypervolemia and hypovolemia. Unless a regulating device is

being used, the nurse administering the intravenous solution must regulate the

drops per minute manually by using the roller clamp to ensure that the prescribed

20
 21

amount of solution will be infused in the correct time span. (Kozier et al., 2004).

Since it is a routine nursing responsibility and a hospital protocol, it will also have

a high weighted mean which is 4.8.

Taking rounds is routinely done at the beginning of the shift for the

purpose of endorsement by the nurse on duty to the next shift. This nursing

responsibility is important for the next nurse on duty to know so that she could

plan her care for her shift, thus, taking rounds is always done.

Health status is reflected in the indicators of vital body functioning. A

change in vital signs might indicate a change in health. Assessing vital signs is

part of nursing care in any setting. Institutional and agency policies govern when

and how frequently vital signs are to be assessed routinely. Vital signs are

assessed at least every four hours in hospitalized patient.(Taylor, et al, 2005).

Thus, this variable is always done.

Patients were confined for the reason of seeking care and it is the nurses’

responsibility to attend to their needs while they are still in the hospital, thus, the

variable attending needs has a weighted mean of 4.16 with a verbal description of

always done.

Drug administration is one of the highest risk areas of nursing practice and

a matter of considerable concern for both managers and practitioners. (Gladstone,

1995). In Sumatra’s thesis, she quoted that when medication is being

administered, “The Ten Rights” safety rules should be followed: right medication,

right amount, right time, right route, right patient, right assessment, right

education, right evaluation, right documentation and right to refuse the

 22

medication. (Lilley, et al, 2001). These rights are usually forgotten to apply in the

hospital setting per experienced. The researchers formulated reasons such as that

the medicine nurse relies on the patient’s name tag so they will no longer ask for

the patient’s name. Sometimes, the name, the indication, general action and

adverse reaction of the drugs are already explained to the patient on the first

administration therefore, medicine nurse will not repeat its explanation on the

next administration. So this variable is often done.

Providing safe, error-free care is the number one priority of all health care

professionals. On the other hand, the first objective of the professional practice

environment for nurses is to put the patient first and focus on patient’s safety and

quality care. (Rosenstein, 2005). According to Sumatra’s thesis, Watson suggests

that the nurse must provide comfort, privacy, and safety as part of this carative

factor. (George, 1995). It’s the hospitals prerogative to set safety precautions and

control any hazardous materials to ensure the safety of their patients therefore this

variable has a weighted mean of 3.6.

The decision to establish a health promotion program must be base on the

health needs of the people; also, specific health promotion, goals must be set.

Nurses may offer an abundance of information less formally. To do so, however,

nurses need up to date knowledge, the ability to assess learning needs, and

effective teaching skills. (Kozier, et al, 1997). Therefore, health teachings is often

done by the nurses to the patient with a weighted mean of 3.5. As observed, the

doctors would give information to the patients about their condition, food

restrictions and practices that would affect their health as well as the treatment
 23

needed for their sickness during the Doctor’s visit, so nurses will serve as health

educators to reinforce the doctor’s order.

Personal hygiene is the self care by which people attend to such functions

as bathing, toileting, general body hygiene and grooming. It is important for

nurses to know exactly how much assistance a client needs for hygienic care.

(Kozier, et al, 2004). Nurses sometimes encourage the patients to perform their

personal hygiene because it is already part of their activities of daily living.

Because people are usually confined to bed when ill, often for long

periods, the bed becomes an important element in the client’s life.(Kozier, et al,

2004). Since, most of the respondents were confined for at least two days,

changing of bed linens are sometimes done because the hospital’s protocol for

changing linens is every other day.

A place that is clean, safe, and comfortable contributes to the client’s

ability to rest and sleep and to a sense of well-being. (Kozier, et al, 2004).

Promotion of cleanliness are often neglected and sometimes done by the nurses

because they usually rely on the hospital’s own institutional workers to maintain

the cleanliness of the surroundings.

 24

Table 1
The Quality of Care Perceived by Patients in Private Rooms

Indicators Weighted Mean Verbal Description

Rounds 4.6 Always
IVF Monitoring 4.8 Always
Vital Signs 4.56 Always
Drug Administration 3.9 Often
Bed Linen 2.96 Sometimes
Cleanliness 2.93 Sometimes
Proper Hygiene 3.16 Sometimes
Health Teachings 3.5 Often
Attending Needs 4.16 Always
Ensuring Safety 3.6 Often

Problem 2: What is the quality care perceived by the patients in

wards?

Table 2 presents that taking rounds (4.8), taking vital signs (4.66),

monitoring IV fluids (4.56), ensuring safety (4.26), and attending needs (4.23) has

excellent quality nursing care. Administering of medication (4.13) has a good

quality routine nursingcare, while health teachings (3.33), promoting of proper

hygiene (3.1), changing of bed linen (2.66), and encouraging cleanliness (2.53)

has a fairly quality nursing care in wards.

Taking rounds is routinely done at the beginning of the shift for the

purpose of endorsement by the nurse on duty to the next shift. This nursing

responsibility is important for the next nurse on duty to know so that she could
 25

plan her care for her shift, thus, taking rounds is always done, regardless of

accommodation.

Health status is reflected in the indicators of vital body functioning. A

change in vital signs might indicate a change in health. Assessing vital signs is

part of nursing care in any setting. Institutional and agency policies govern when

and how frequently vital signs are to be assessed routinely. Vital signs are

assessed at least every four hours in hospitalized patient. Thus, this variable is

always done too in wards.

As discussed previously, monitoring of Intravenous fluid and attending

needs are important nursing responsibility and part of the nurses’ daily routine

regardless of type of Hospital room accommodation; therefore, it is always done.

Unlike in private rooms, ensuring safety in wards is always done since

many patients are being accommodated in one room where the space is limited

thus increasing the risk for accidents and harms. For instance, a patient having

oxygen therapy while other patients are using nebulizer and other equipments that

need electricity are at higher risk for fire related accidents.

As discussed above, drug administration is one of the highest risk areas of

nursing practice and a matter of considerable concern for both managers and

practitioners. (Gladstone, 1995). In Sumatra’s thesis, she quoted that when

medication is being administered, “The Ten Rights” safety rules should be

followed: right medication, right amount, right time, right route, right patient,

right assessment, right education, right evaluation, right documentation and right

to refuse the medication. (Lilley, et al, 2001. These rights are usually forgotten to
 26

apply in the hospital setting per experienced. The researchers formulated reasons

such as that the medicine nurse relies on the patient’s name tag so they will no

longer ask for the patient’s name. Sometimes, the name, the indication, general

action and adverse reaction of the drugs are already explained to the patient on the

first administration therefore, medicine nurse will not repeat its explanation on the

next administration to maximize the time since there are a large number of

patients that needs to be attended. So, this variable is often done.

In wards, giving of health teachings, promoting of proper hygiene,

changing of bed linens, and encouraging cleanliness are sometimes done due to

the same reasons discussed in the result in private rooms.

Table 2
The Quality Care Perceived by Patients in Wards
Indicators Weighted Mean Verbal Description
Rounds 4.8 Always
IVF Monitoring 4.56 Always
Vital Signs 4.66 Always
Drug Administration 4.13 Often
 27

Bed Linen 2.66 Sometimes

Cleanliness 2.53 Sometimes
Proper Hygiene 3.1 Sometimes
Health Teachings 3.33 Sometimes
Attending Needs 4.23 Always
Ensuring Safety 4.26 Always

Problem 3: Is there a significant difference in the quality of care as

perceived by the patients in private rooms and in the wards?

The table shows that the average score of the quality care in wards is 3.83

with a qualitative description as often which is equivalent to good while the

average score of the quality care in private rooms is 3.82 with a qualitative

description as often which also equivalent to good. This presents that there is no

significant difference of quality care between private rooms and wards.

The researchers identified factors that would probably interfere in the

result of the study. The first one was the nurse-patient ratio which is a maximum

of one charged nurse, one medicine nurse; one nurse aide is to 18 patients

(1:1:1:18). When there are enough nurses to take care of the patients, quality care

is most likely to be achieved.

The second factor is quality control. It is a fact that quality of patient care

is the number one issue in nursing (Bueno & Fralic, 2008). This is supported in

the article about the issue of quality which has been focus of industries and

business enterprises from immemorial in attempt to capture the market for their

producers. The concept of quality and demand for quality care has been moved

into all levels of the health care industry. (Bergborn, 2008). “The patient is the
 28

best, sometimes the only, judge of the interpersonal aspect of care including the

surroundings of patient care such as rooms and foods often called the “hotel”

service. The patient’s satisfaction is an essential goal of health care and therefore

a part of quality care. It is assumed that if the patient is satisfied with his care,

then it must be favorable good. (Venzon & Nagtalon, 2006)

Since Valencia Sanitarium & Hospital passed the requirement of

Department of Health for tertiary level, it is assumed that the hospital maintains

quality care.

Third, we have identified that the length of confinement could be one of

the factors. Most of the patients who participated in the study were confined for at

least two days; quality care is most likely to be achieved because the nurses are

still apt to do their responsibility. On the other hand, patients who have longer

period of confinement may have a lesser quality care basing on the variables used

by the researchers due to the following reasons: Nurses would no longer ask for

their name because they were already known; routine procedures, health teachings

and information about medication are less emphasized unlike on the first few days

of patient’s admission, since it has been habitually done by the nurse.

Table 3

Difference of Quality Care in Private Rooms and Wards as Perceived by the

Patients

WARDS PRIVATE ROOMS

Weighted Mean Qualitative Weighted Qualitative
 29

Description Mean Description

3.83 Often 3.82 Often

CHAPTER 5

SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter presents the summary of the study, the conclusions and

recommendations base on the results.

Summary
 30

This study was about the quality of care in private rooms and wards as

perceived by the patients, and the significant difference in the quality of care as

perceived by patients in the private rooms and in the wards.

The study utilized the descriptive research design with 30 respondents

from private rooms and wards of Valencia Sanitarium & Hospital respectively

chosen through the criteria imposed by the researchers. The instrument used for

the study was a survey questionnaire formulated by the researcher and subjected

to a reliability test done by the research adviser and two clinical instructors. The

questionnaire was composed of ten identified routine nursing care which are the

following, taking rounds, intravenous fluid monitoring, taking vital signs,

administration of medication, changing of bed linens, promoting cleanliness and

proper hygiene, giving of health teachings, attending needs and providing safety.

The study subjects were instructed properly and answered the

questionnaires in the presence of the30researchers.

The data was presented to the school’s statistician for interpretation. The

result of the study shows that both patients in private rooms and wards perceived

that the quality care was often practiced but there is no significant difference in

the quality of care in terms of the variables identified above which are the routine

nursing care.

Conclusion

Based on the result of the study and the interpretation of the data gathered,

there is no significant difference in the quality of care in terms of the kind of

accommodation except for the variable ensuring safety that shows in the
 31

Asymp.Sig. (2-tailed) in test statistics with a result of .048. Therefore the

hypothesis which is “There is a significant difference in the quality of care in

private rooms and in the wards as perceived by the patients” is partially rejected.

Recommendation

The following are the recommendations based on the findings and

conclusions drawn from the study:

1. Valencia Sanitarium & Hospital should continue in upholding their

standard delivery of care. We also recommend that they should give more

emphasis on the variables in which the rating is low such as promoting

cleanliness, proper hygiene, changing bed linens and health teachings.

2. Nurses play a vital role in the delivery of care, so to further improve the

quality of their service, we recommend that they should always be

reminded of their responsibilities towards their patients. They should not

overlook small tasks such as promoting cleanliness in the environment,

changing bed linens and proper hygiene especially giving of health

teachings since these variables are sometimes done.

3. The upcoming researchers are recommended to add more variables to the

research questionnaire, to increase the number of respondents and expand

the research locale to other private and government hospitals to attain

more reliable results.

 32

REFERENCES

Bergborn, I. (2008). Factors Influencing Health Care. Scandinavian Journal of

Caring Sciences, 152.

Bueno, M.C. & Fralic, M.F. (2008). Current Issues in Nursing,401.

De Laure, S.C. & Ladner, P.K. Fundamentals of Nursing: Standards and

Practice. London: Lippincott Williams & Wilkins.

Etches, W.K. (2007, January 27-30). Improving Ward Management. Nursing

Standard,21(20), 35-40.

Gedder, S.C. & Grosset R.B. (2005). Webster Universal Dictionary & Thesaurus.
Scottland: David dale House.

Hilton, L. (2004).The Nurse’s Role. Nursing Spectrum and Nurses Week, 42-43.
Johnson, B.M. & Webber, P.B. (2005). An Introduction to Theory and Reasoning
in Nursing (2nd ed.). Philadelphia: Lippincott Williams & Wilkins Inc.
 33

Kozier, B., Erb, G. & Blais, K. (1997). Professional Nursing Practice Concepts
& Perspectives. (3rd ed.). California: Addiso-Wesley Longman, Inc.

Kozier, B., Erb, G., Berman, A. & Snyder, S. (2004). Kozier & Erb’s Techniques
in Clinical Nursing Basic to Intermediate Skills. (5th ed.). New Jersey: Pearson
Education, Inc.

Taylor, C., Lillis, C. & LeMone, P. (2005). Fundamentals of Nursing .New York:
Lippincott Williams & Wilkins.

Venzon, N.L. & Nagtalon, J.M.V. (2006). Nursing Management Towards Quality
Care (3rd ed.). Quezon: C & E Publishing Inc.
 34

APPENDICES
 35

APPENDIX A

Research Questionnaire
 36

RESEARCH QUESTIONNAIRE

Nagahangyo mi sa inyong gamay nga oras sa pagtubag niining mga pangutana kabahin sa
pag atiman sa mga nurse kaninyo. Ug para sa inyo ng tubag, palihog i-check ang kahon sa matag
pangutana. Salamat sa inyong partisipasyon.
Permanente kasagara usahay kausa wala
Accommodation: ( ) private rooms
( ) wards
1. Gina-anhaan ba ka sa imong nurse sa
pagsugod, sa tunga-tunga ug sa kataposan
sa iyang duty?
2. Gina-monitor ba sa imong nurse ang
imo IV fluid o dextrose sama sa kung pila
ang nahabilin, sakto ang tulo ug kung
walay bara ang linya ug ang kamot na
ginatauran sa dextrose?
3. Ang imong nurse ba gapananghid, ga
obserbar sa imong privacy, gaatag ug
saktong pag-atiman, ug gahatag ug respeto
isip usa ka pasyente sa dili pa siya
magkuha ug vital signs.
4. Ang imong nurse ba gapangutana sa
imong pangalan? Ginaingon ba niya kung
unsa ugpara asa ang tambal na iyang
ginahatag?
5. Ginadasig ba ka sa imong nurse sa
pag-ilis sa ug hapin sa imong katre.
6. Ginaplastar ba niya ang imong gamit
apil ang imong katre ug nagapahinumdum
na imentinar ang kahinluon sa imong
palibot?
7. Ginadasig ba ka sa imong nurse sa
pagbuhat sa saktong pag-atiman ug pag-
hinlo sa imong lawas?
8. Ang nurse ba nagahatag ug saktong
impormasyon ug eksplinasyon bahin sa
imong sakit ug pagkaon ug praktis angay sa
imong lawas?
9. Ang nurse ba nagagahin sa iyang
panahon ug gina aksyonan ang tanan
nimong panginahanglanon?
10. Ang nurse ba naay panglantaw sa
imong seguridad pinaagi sa paglikay sa
mga aksidente sulod sa hospital?

Please check:
Gender: ( ) lalaki
( ) babae
Age:
Date of Admission:
 37

APPENDIX B
Request Letter
38
 39

APPENDIX C
Summary Data
 40

Summary Data from Private Rooms

Patients rounds IVF Vital Medicine Bed cleanliness hygiene teachings needs safety
signs linen
1 5 5 5 5 5 5 5 5 5 5
2 5 5 4 4 5 4 1 4 4 3
3 4 4 4 4 4 4 1 4 4 4
4 4 5 5 4 5 5 4 4 4 3
5 5 5 5 5 5 3 3 3 4 5
6 5 5 5 5 5 5 4 5 5 5
7 5 5 5 4 5 5 4 4 5 5
8 5 5 5 5 5 5 5 5 5 5
9 5 5 5 3 1 1 1 1 3 1
10 3 5 3 3 1 3 3 3 3 3
11 5 5 5 5 2 3 3 4 5 1
12 4 4 3 1 1 1 1 1 1 2
13 5 5 4 4 4 4 1 4 5 4
14 4 4 3 1 1 3 3 3 3 3
15 3 3 3 2 1 1 1 1 1 1
16 5 5 5 3 1 1 1 1 3 1
17 5 5 5 5 5 5 5 5 5 5
18 5 5 5 3 3 4 4 4 5 5
19 5 5 5 2 1 1 1 1 5 1
20 5 5 5 5 5 5 5 5 5 5
21 3 5 5 4 1 2 5 5 4 5
22 5 4 5 3 3 1 3 1 4 5
23 5 5 5 4 1 1 4 4 4 3
24 5 5 4 5 5 4 5 4 5 4
25 4 5 4 4 3 5 5 5 5 4
26 5 5 5 5 5 3 5 5 5 4
27 5 5 5 5 3 1 4 4 4 4
28 5 5 5 5 1 1 3 5 5 4
29 5 5 5 5 1 1 1 1 5 5
30 4 5 5 4 1 1 4 4 4 3

Summary Data from Wards

Patients rounds IVF Vital Medicine Bed cleanlines hygiene teachings needs Safety
signs linen
s
1 5 5 5 5 5 4 5 5 5 5
2 3 4 3 3 1 1 2 2 3 5
3 5 5 5 1 3 3 5 3 3 5
4 3 4 4 3 2 1 4 5 3 3
5 5 5 4 5 5 4 5 1 3 3
6 4 4 4 3 4 1 1 1 5 4
7 5 5 5 5 5 5 5 5 5 5
8 4 3 4 4 3 4 5 4 5 5
9 5 4 4 3 2 3 1 3 4 4
10 5 5 5 5 2 1 1 5 5 3
11 5 4 4 4 3 3 4 4 4 4
 41

12 5 3 5 5 1 3 4 1 5 5
13 5 5 5 3 1 2 3 5 5 5
14 5 5 5 4 4 3 5 5 5 5
15 5 4 5 5 1 1 1 1 5 5
16 5 5 5 4 4 1 1 3 3 4
17 5 4 5 4 1 1 1 1 3 4
18 5 5 5 5 1 1 1 5 5 5
19 5 5 5 5 1 1 1 1 4 5
20 5 4 4 5 1 1 1 1 5 1
21 5 5 5 5 2 1 5 5 3 5
22 5 5 5 5 1 1 1 1 3 3
23 5 5 5 5 5 5 2 5 5 5
24 5 5 4 4 2 4 5 4 3 4
25 5 5 5 5 5 5 5 5 5 5
26 5 5 5 5 4 4 5 5 5 5
27 5 5 5 1 1 3 5 5 5 5
28 5 5 5 4 2 1 1 1 3 1
29 5 5 5 4 3 3 3 3 5 5
30 5 5 5 5 5 5 5 5 5 5

APPENDIX D
Statistical Studies
 42

Descriptives(a)
Statistic Std. Error
rounds Mean 4.60 .123
95% Confidence Lower Bound 4.35
Interval for Mean Upper Bound
4.85

5% Trimmed Mean 4.67

Median 5.00
Variance .455
Std. Deviation .675
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.473 .427
Kurtosis .957 .833
IVF Mean 4.80 .088
95% Confidence Lower Bound 4.62
Interval for Mean Upper Bound
4.98

5% Trimmed Mean 4.87

Median 5.00
Variance .234
Std. Deviation .484
Minimum 3
Maximum 5
Range 2
Interquartile Range 0
Skewness -2.499 .427
Kurtosis 6.057 .833
vital signs Mean 4.57 .133
95% Confidence Lower Bound 4.29
Interval for Mean Upper Bound
4.84

5% Trimmed Mean 4.63

Median 5.00
Variance .530
Std. Deviation .728
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.397 .427
Kurtosis .493 .833
medicine Mean 3.90 .222
95% Confidence Lower Bound 3.45
 43

Interval for Mean Upper Bound

4.35

5% Trimmed Mean 4.00

Median 4.00
Variance 1.472
Std. Deviation 1.213
Minimum 1
Maximum 5
Range 4
Interquartile Range 2
Skewness -1.037 .427
Kurtosis .348 .833
bed linen Mean 2.97 .330
95% Confidence Lower Bound 2.29
Interval for Mean Upper Bound
3.64

5% Trimmed Mean 2.96

Median 3.00
Variance 3.275
Std. Deviation 1.810
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness .016 .427
Kurtosis -1.871 .833
cleanliness Mean 2.93 .307
95% Confidence Lower Bound 2.31
Interval for Mean Upper Bound
3.56

5% Trimmed Mean 2.93

Median 3.00
Variance 2.823
Std. Deviation 1.680
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.028 .427
Kurtosis -1.704 .833
hygiene Mean 3.17 .292
95% Confidence Lower Bound 2.57
Interval for Mean Upper Bound
3.76

5% Trimmed Mean 3.19

Median 3.50
 44

Variance 2.557
Std. Deviation 1.599
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.345 .427
Kurtosis -1.443 .833
teachings Mean 3.50 .279
95% Confidence Lower Bound 2.93
Interval for Mean Upper Bound
4.07

5% Trimmed Mean 3.56

Median 4.00
Variance 2.328
Std. Deviation 1.526
Minimum 1
Maximum 5
Range 4
Interquartile Range 3
Skewness -.812 .427
Kurtosis -.833 .833
needs Mean 4.17 .204
95% Confidence Lower Bound 3.75
Interval for Mean Upper Bound
4.58

5% Trimmed Mean 4.30

Median 4.50
Variance 1.247
Std. Deviation 1.117
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.624 .427
Kurtosis 2.547 .833
safety Mean 3.60 .265
95% Confidence Lower Bound 3.06
Interval for Mean Upper Bound
4.14

5% Trimmed Mean 3.67

Median 4.00
Variance 2.110
Std. Deviation 1.453
Minimum 1
Maximum 5
 45

Range 4
Interquartile Range 2
Skewness -.755 .427
Kurtosis -.687 .833
a room_priv.ward = 1

Tests of Normality(b)

Kolmogorov-Smirnov(a) Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
rounds .423 30 .000 .626 30 .000
IVF .494 30 .000 .471 30 .000
vital signs .424 30 .000 .622 30 .000
medicine .233 30 .000 .823 30 .000
bed linen .261 30 .000 .760 30 .000
cleanliness .242 30 .000 .810 30 .000
hygiene .212 30 .001 .821 30 .000
teachings .295 30 .000 .781 30 .000
needs .272 30 .000 .736 30 .000
safety .208 30 .002 .822 30 .000
a Lilliefors Significance Correction
b room_priv.ward = 1

Descriptives(a)

Statistic Std. Error

rounds Mean 4.80 .101
95% Confidence Lower Bound 4.59
Interval for Mean Upper Bound
5.01

5% Trimmed Mean 4.89

Median 5.00
Variance .303
Std. Deviation .551
Minimum 3
Maximum 5
Range 2
Interquartile Range 0
Skewness -2.758 .427
Kurtosis 6.731 .833
IVF Mean 4.60 .113
95% Confidence Lower Bound 4.37
Interval for Mean Upper Bound
4.83

5% Trimmed Mean 4.67

Median 5.00
 46

Variance .386
Std. Deviation .621
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.330 .427
Kurtosis .831 .833
vital signs Mean 4.67 .100
95% Confidence Lower Bound 4.46
Interval for Mean Upper Bound
4.87

5% Trimmed Mean 4.72

Median 5.00
Variance .299
Std. Deviation .547
Minimum 3
Maximum 5
Range 2
Interquartile Range 1
Skewness -1.407 .427
Kurtosis 1.201 .833
medicine Mean 4.13 .208
95% Confidence Lower Bound 3.71
Interval for Mean Upper Bound
4.56

5% Trimmed Mean 4.26

Median 4.50
Variance 1.292
Std. Deviation 1.137
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.486 .427
Kurtosis 1.987 .833
bed linen Mean 2.67 .285
95% Confidence Lower Bound 2.08
Interval for Mean Upper Bound
3.25

5% Trimmed Mean 2.63

Median 2.00
Variance 2.437
Std. Deviation 1.561
Minimum 1
Maximum 5
 47

Range 4
Interquartile Range 3
Skewness .367 .427
Kurtosis -1.416 .833
cleanliness Mean 2.53 .278
95% Confidence Lower Bound 1.96
Interval for Mean Upper Bound
3.10

5% Trimmed Mean 2.48

Median 3.00
Variance 2.326
Std. Deviation 1.525
Minimum 1
Maximum 5
Range 4
Interquartile Range 3
Skewness .307 .427
Kurtosis -1.429 .833
hygiene Mean 3.10 .333
95% Confidence Lower Bound 2.42
Interval for Mean Upper Bound
3.78

5% Trimmed Mean 3.11

Median 3.50
Variance 3.334
Std. Deviation 1.826
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.122 .427
Kurtosis -1.906 .833
teachings Mean 3.33 .319
95% Confidence Lower Bound 2.68
Interval for Mean Upper Bound
3.99

5% Trimmed Mean 3.37

Median 4.00
Variance 3.057
Std. Deviation 1.749
Minimum 1
Maximum 5
Range 4
Interquartile Range 4
Skewness -.385 .427
Kurtosis -1.654 .833
 48

needs Mean 4.23 .171

95% Confidence Lower Bound 3.88
Interval for Mean Upper Bound
4.58

5% Trimmed Mean 4.26

Median 5.00
Variance .875
Std. Deviation .935
Minimum 3
Maximum 5
Range 2
Interquartile Range 2
Skewness -.503 .427
Kurtosis -1.728 .833
safety Mean 4.27 .209
95% Confidence Lower Bound 3.84
Interval for Mean Upper Bound
4.69

5% Trimmed Mean 4.41

Median 5.00
Variance 1.306
Std. Deviation 1.143
Minimum 1
Maximum 5
Range 4
Interquartile Range 1
Skewness -1.755 .427
Kurtosis 2.715 .833
a room_priv.ward = 2

Tests of Normality(b)

Kolmogorov-Smirnov(a) Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
rounds .508 30 .000 .411 30 .000
IVF .407 30 .000 .656 30 .000
vital signs .429 30 .000 .623 30 .000
medicine .277 30 .000 .750 30 .000
bed linen .199 30 .004 .840 30 .000
cleanliness .276 30 .000 .818 30 .000
hygiene .251 30 .000 .752 30 .000
teachings .263 30 .000 .766 30 .000
needs .360 30 .000 .679 30 .000
safety .339 30 .000 .684 30 .000
a Lilliefors Significance Correction
b room_priv.ward = 2
49
 Test Statistics(a)

rounds IVF vital signs medicine bed linen cleanliness hygiene teachings needs safety
Mann-Whitney U 378.000 375.000 436.500 397.500 414.000 386.000 441.000 449.500 446.000 325.000
Wilcoxon W 843.000 840.000 901.500 862.500 879.000 851.000 906.000 914.500 911.000 790.000
Z -1.481 -1.468 -.248 -.827 -.554 -.989 -.139 -.008 -.065 -1.980
Asymp. Sig. (2-tailed) .139 .142 .804 .408 .580 .323 .890 .994 .948 .048
Exact Sig. (2-tailed) .191 .194 .841 .420 .577 .330 .901 .991 .951 .052
Exact Sig. (1-tailed) .096 .097 .421 .210 .289 .165 .450 .496 .476 .026
Point Probability .030 .040 .029 .005 .002 .010 .008 .001 .005 .004
a Grouping Variable: room_priv.ward

Test Statistics(a)

vital bed
rounds IVF signs medicine linen cleanliness hygiene teachings needs safety
Most Extreme Absolute
.167 .167 .100 .100 .167 .133 .133 .133 .133 .233
Differences
Positive .167 .000 .100 .100 .067 .000 .133 .133 .067 .233
Negative .000 -.167 .000 .000 -.167 -.133 -.133 -.133 -.133 .000
Kolmogorov-Smirnov Z .645 .645 .387 .387 .645 .516 .516 .516 .516 .904
Asymp. Sig. (2-tailed) .799 .799 .998 .998 .799 .952 .952 .952 .952 .388
Exact Sig. (2-tailed) .233 .233 .583 .770 .522 .737 .738 .708 .595 .151
Point Probability .176 .161 .164 .164 .228 .373 .363 .303 .324 .075
a Grouping Variable: room_priv.ward