1

CONCEPTUAL MAP

Figure 1. Conceptual Map of the Study

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CHAPTER III

RESULTS AND DISCUSSIONS

The presentation, analysis, and interpretation of the findings

of the research study Hospital Experiences of Level IV Student

Nurses are presented in this chapter. The data gathered were

analyzed and interpreted accordingly.

The conceptual map was formulated according to the data

gathered. The conceptual map consisted of three major themes,

namely: Knowledge, Skills, and Attitude. The first major theme

Knowledge was further divided into subthemes learning from

Experience, Learning Enhancement, and Psychological Preparation.

The second major theme Skills was further divided into the

subthemes Application of Theories Learned from Lectures and

Communication Skills. Last but not the least, the third major

theme Attitude was further divided into subthemes

Responsibility, Caring Attitude, Flexibility, Patience, Respect

to Superiors, and Personality Development.

KNOWLEDGE

Box 1.0
First Major Theme – Knowledge
3

Knowledge is not only based on facts to be learned but on

the ability to apply critical thinking and problem solving

skills to the care of client. When nurses have the theoretical

base of knowledge, they have professional autonomy. That is

nurses make decisions on the basis of nursing theory as opposed

to always taking direction from another profession.

Learning from Experience

To learn is to acquire knowledge through a variety of ways.

It can either be in the classroom or through the everyday

experiences one has. To learn from experience is different from

what has learned in the classroom because by experience, there

is an actual application of what was being taught and what has

learned. The participant in this study reported that learning is

not just through reading books but also through their

experiences. Learning from experience made the participant

become more knowledgeable of what is being taught.

Ms. Blue:
“Hindi lang sapat na libro libro libro ka. Parang 50%
nga of our learning is experience. ‘Yong mga natutunan
mo, kung hindi mo siya naa-apply, wala din. So dapat
learn from experience talaga.”
(It is not enough to always rely on books. It is like
50% of learning is through experience. If what has
learned is not being applied, it is useless. Indeed,
one must learn from his/her experiences.)

The participants, although did not actually do the skill,

have still learned through what their group mates have

4

accomplished. Some of the participants have learned through

observing other’s experiences. In spite of not doing the actual

action, the participants still have learned from this and would

apply what have learned.

Ms Blue:
“We’re all excited to do the CPR and so on pero
unfortunately, some of our classmates lang ang
nabigyan ng privilege to perform the CPR although we
were there to watch it and learn about it.”
(We were all excited to do the CPR and so on.
Unfortunately, only some of our classmates were given
the privilege to perform the CPR. However, we
still have learned by watching it.)

To learn from experience does not always mean to experience

something by the individual him/herself. A skill, for instance,

has been done by a group mate while the rest of the members were

there observing it. By this, it can already be considered to be

an experience because the one verbalizing this was there during

that event. And from this event, this student has seen and

observed the actual application of the skill for instance that

has been taught which makes it a learning experience to him/her.

Learning from experience can also be by means of improving

what one has erroneously done before. The participant was aware

of his shortcomings in the hospital that made him become mindful

the next time the same thing happens.

Mr. Orange:
“…parang sa pagpi-prepare na lang ng drugs, sa pag-e-
endorse…nagkaroon ako ng patient na naka-PRN. Uhm, na-
prepare ko ‘yong gamot na ‘yon for that specific time.
IV kasi siya. Nakalagay na sa tray. Ngayon hindi ko
5

siya na-endorse sa staff nurse na ready na. Tapos for

3 days na ‘yon, paulit-ulit ko na lang na
nakakalimutan. Parang…nangyari na nga sa akin, inulit-
ulit ko pa. Parang…’Ano ba? Natuto ba ako doon o
hindi?’ Pero from that time on, hindi naman na ako
nagkamali.”
(In the preparation of the drugs alone and in the
endorsement, I had a patient with PRN medications. I
have prepared the medication for the specific time it
is needed. It was intravenously given. It was already
in the tray. I haven’t endorsed to the staff nurse
that it was ready to be given. Then for 3 days, I
repeatedly forget the medication to be given. I
thought to myself, I have already done it but I’m
still doing the same mistake. It is like, ‘Hey! Did I
learn from that experience or not?’ From then on, I
never had any mistakes.)

Kolb defined learning as a human adaptation process. “It is

a process whereby knowledge is created through the

transformation of experience”. He cited Lewin’s (1951) work as

the empirical evidence for supporting a learning cycle theory

that begins with the experiences of the learner. Learning takes

place, according to Lewin, when a learner (person) interacts

with, or is stimulated by, an environment. Others adopt the same

‘human adaptation process’ explanation for learning, but cast it

in different ways. Jarvis (1987), for example, put it this way:

“…there is no meaning in a given situation until we relate our

own experiences to it”.

Nursing students assigned to have duties in the hospital

have much exposure to its scenario. There is the presence of the

situations where everything that has been taught in the

6

classroom will be applied. Unexpected events occur which account

to experiences. Student nurses acknowledge such unexpected

events as experiences that can be a source of additional

knowledge apart from what has been taught in the classroom.

Learning Enhancement

Learning enhancement is also described as an act of

improving and reinforcement of the things that you know and

learn.

There are many ways for us to be able continue learning. As

a student nurse, we are learning through our lectures, return

demonstration, reading books and researching through on line

access. Student nurses must become research minded in order to

be able to monitor, reflect upon and assess their everyday

nursing practice

Ms. Purple:
“Continue learning lang . . . yun kunwari kapag
nakalimutan mo yung isang bagay dapat iresearch mo pa
din siya . . . Ang gagawin ko na lang is magreread ako
more . . .”
(Just continue learning. For instance you forgot
something; you have to research about it. I will just
read more.)

Ms. Blue:
“…i-observe mo na lang para pag ikaw naman ‘yong
naging staff nurse, pwede mong gawin ‘yong mga ‘yon.
Observation na rin.”
(You just have to observe so that when you become the
staff nurse, you’ll be allowed to do such things. It’s
merely observation.)
7

The participants would just like to emphasize that learning

is a continuous process that even though you had learned it. It

also requires enhancement and refreshment so that the knowledge

acquired would be improved. The knowledge would be enhanced

through lots of reading and doing thorough researches.

To observe is to gather data by using the senses. Observation

has two aspects- noticing the data and selecting, organizing and

interpreting the data. Nursing observation must be organized so

that nothing significant is missing. Observation is a conscious,

deliberate skill that is developed through effort and with

organized approach. The beginning nurse must learn to make

observations and complete task completely (Kozier et.al. 2008).

In the domains of learning, the cognitive domain is the

ability to make sense and use information. It includes acquiring

knowledge and comprehension (Kozier et.al. 2008).

Mr. Yellow:
“…kung ano yung mga tinuro sa iyo, parang yun yung
fundamentals mo so pagka may bagong topic,naiko-
connect mo ‘yong mga dati, naiintindihan mo yung mga
complex things with the use of past knowledge. For
example sa cardiac arrest, dati iniisip mo na basta
hindi gumagana yung heart pero habang tumatagal
naiisip mo din kung ano ‘yong cause, what triggers the
arrest. ‘Yong next na maiisip mo eh nagkakaroon siya
ng MI. You can think of complex things kung bakit siya
nag-cardiac arrest.”
(Whatever you learned in the lower years, it serves as
your fundamentals so if you had a new topic, you can
already connect it to one another so you can
understand the complex knowledge you’ve learned from
the past. Example here is the kind of thinking about
cardiac arrest, before you just know that cardiac
8

arrest is when the heart would stop beating. But for

now, you also think of the things that cause it, its
triggering factor and the next you think is the
occurrence of MI.)

As part of the learning process, we always start with the

basic ones which serve as our fundamentals to complex things. As

a student nurse, we start our learning with discussions of the

things that we need to know and likewise with the basic skills

that we must learn. These fundamentals of learning would serve

as our first step in learning the things we want to. As what the

participant is implying, step by step learning is done for us to

fully appreciate things. Or something the learner is concerned

about and learns the basics before proceeding to the variations.

There are some guidelines that help the nurse in sequence

learning which involves starting with variations or adjustments.

The last thing would be schedule the time for review of contents

and to clarify information (Kozier et al, 2008).

This implies that nursing students should always read and make

more researches so that knowledge they had will be broaden and

to refresh the things they learned. In addition, reading and

making researches would make you more aware to the new things

about the profession you are in. Furthermore, our basic

knowledge should be at least in focused because these will be

our guide for new ideas that we will be encountering. It will

also serves as our instrument for whenever there is a change on

9

a certain matter so as not to have confusion because it is

confusing to have consider an adjustment and variations before

mastering the basic concepts.

Psychological Preparation
Psychological preparation is defined in this study as done

by student nurses in preparation before going to duty. This

includes reviewing past theories learned, familiarizing with the

ward and studying possible cases which can be encountered in the

ward.

Mr. Orange:
“Hindi ako nagka-cram. I don’t cram. Minsan
nagtatanong lang ako sa mga kasama ko if nakapasok na
sila sa ward na to and ano yung mga na-encounter nila
sa ward na yun.”
(I don’t cram. sometimes, I just ask my fellow student
nurses if they have been to this ward and what have
they encountered in this ward)

The participant indicates preparation before duty as

familiarizing with the ward where they are going to have their

duty. The preparation done by the participant is ensuring that

they have the knowledge before going to duty. The participant

makes sure that proper data are gathered regarding the area

where they will be assigned. Also, the participant makes early

preparation for the duty since the participant wants to feel

confident before the duty.

10

Ms. Purple:
“During hospital exposure pag pinapagalitan dapat
huwag masyadong dibdibin. Instead, dapat we learn from
it na kunwari pag pinapagalitan, at least alam mo na
yung mistakes mo. Tapos lagi kang open-minded, hindi
yung n
ag-iisip ka ibang bagay, dapat focused ka lagi sa
ginagawa mo.” (During duties, do not take them
seriously when you are being reprimanded. Be open-
minded and be focused on what you are doing.)

The above statements show that a student should be ready to

whatever can happen in the hospital. This includes new

experiences that may be positive or negative. It also shows that

student nurses should not be distracted with what would happen

in the hospital. Instead, they should be focused with what they

should really do or what their true role is in the hospital.

Being open minded would help the student absorb the events that

would happen in the hospital. Also, it is important to reflect

on what happened after the duty to be able to prepare for the

next duty.

The participant’s preparation before going to duty is being

open minded. In addition, a stable temperament is also needed.

The participant uses this to tolerate any inevitable situation

and to adapt to the stressful conditions in the hospital. Open-

mindedness is also used to maintain professional relationship

with other members of the health team.

11

The response of the participant shows that a stable

temperament is needed. Also, the participant learns from these

experiences and will then be used in preparation for other

duties. The participant is determined to learn from the hospital

exposure, due to this, an open mind is always elicited. The

participant sees the mistakes they make as an opportunity to

improve their knowledge.

According to Peter Carter, chief executive of the RCN,

‘many nursing roles are demanding and involve increasingly

advanced levels of practice and clinical knowledge’ (Press

Association, 2009). Due to this nurses are expected to prepare

in advance before going to duty. As nursing becomes more

advanced, therefore, so too will the professional preparation

that students are expected to undertake (Sturgeon, 2010).

Psychological preparation is a vital activity before going

to duty. It makes the student more confident in his own ability

and knowledge. It also boosts their self esteem by being ready

for whatever may happen during the exposure. Preparations

include reading in advance, familiarizing with the area or

gathering data about the area and cases to anticipate. Student

nurses are not the only ones who need to prepare, this also

applies to RNs and other health workers. For the students, it

would be beneficial for them to prepare in advance. It would

12

lessen mistakes and would make the student comfortable since

they already know what to expect and have the basic knowledge on

different interventions that has to be done.

SKILLS
Skill as the second major theme is defined as the ability

to do something well which can be gained through trainings.

Under this major subtheme are the Application of theories

learned from lectures and communication skills.

Box 2.0
Second Major Theme - Skills

Application of Theories Learned from Lectures

The subtheme application of nursing theories learned from

lectures means how the student nurses apply the different

nursing theories like for example the environmental theory by

Nightingale that they have learned during their hospital duty.

Nursing theories entails different nursing skills which they may

apply in the clinical area. This subtheme is exemplified by the

statements below:

Mr. Yellow:
13

“kung mahina ka sa lecture or RD, syempre alam ko na

yung mistakes ko nung lecture and RD. What I do is I
read the book before I go to duty then kung ano yung
mga kahinaan ko nung lecture and RD, mababasa ko din
sa book. pagka nabasa ko na sa book, I think about it
over and over again para pag andun na ako sa duty alam
ko na kung ano yung mali ko. For example, yung sa
bedmaking, may mga mistakes ka sa bedmaking, meron
kang mga kulang na steps. heto yung sinsasabi ko na
kahit mahina ka dun, nalalaman mo yung mali mo through
that evaluation sheet tapos maiisip mo yung mali mo
over and over again then sa duty, kahit mahina yung
lecture mo, mababawi mo siya kasi kahit hindi perfect
yung performance mo sa RD, sa hospital duty mo na siya
maiaapply.”
( If you are not good in lecture or RD, of course I
already know my mistakes . what I do is I read the
book before I go to duty then from those mistakes, I
can read them from books then I think about it over
and over again so that when I am on duty I already
know my mistakes. For example in bed making, you
forgot some steps. this is what I am saying that if
you’re not good in that, you already know your
mistakes through that evaluation sheet then you will
think of those mistakes over and over again, then on
duty you will regain it, though your performance in RD
is not perfect)

Though he has mistakes during his return demonstration, but

during duty hours the participant has the opportunity to correct

this since he already know his mistakes. Lecture and return

demonstration is not the only way for him to learn skills. He

also learns from his hospital duty. The participant is learning

from his mistakes. From this mistake, he is able to improve his

skills while on duty. Learning of skills from his return

demonstration makes him to improve his performance on duty.

14

Mr. Green:
“Sa service di ba as nurses, you are dealing with life
so . . . hindi ka pwedeng magkamali dun na pag
nagkamali ka magbigay ng gamot ieerasin mo na lang, so
dapat competent ka sa pagbigay ng gamot saka
interventions.”
(As nurses, we are dealing with life so, as much as
possible, you must not commit mistakes when giving
medication, you must be competent about it.)

Student nurses must be competent in their duty. They need

to bear in mind that they are dealing with lives so they should

think first before doing such things to avoid errors. Competence

must be applied by nurses during duty hours since patients

deserve good service from nurses while they are on hospital.

Procedures and techniques practiced in clinical facilities

by nursing students provide a better example of applied learning

than their performance in campus laboratories (Oermann &

Gaberson, 1999). However, skills laboratories held on campus are

a necessary means of teaching all students at one time with a

consistent approach and allow students to practice on a manikin

rather than actual patients. Students learn psychomotor skills

with a variety of instructional methods including video, CD-ROM,

demonstration, simulations, role-play, practice, and skills

textbooks, as well as return demonstration in laboratory

settings using manikins and occasionally fellow students for

practice (Roberts et.al, 2009)

Lectures and return demonstration serve as a ground for

nurses to be competent since this is the foundation of skills

15

before they go on for duty. During lectures student nurses learn

theories which they apply when on duty. Lectures and Return

demonstration must be enhanced so that student nurses must apply

the things that they have learned with competence.

Communication Skills

Communication skill is defined, as the process in which two

or more people are interconnected in verbal or non-verbal way in

which understanding of a message between them is achieved. This

subtheme includes experiences of the participants in

communicating to their patients in the hospital and their

feelings about these experiences.

It is the process by which humans meet their survival

needs, build relationships, and experience emotions. It is a

dynamic process used to gather assessment data, to teach and

persuade, and to express caring (Kozier et al, 2008).

Ms Pink:
“Yung iniisip ko noon was, kakausapin ko ba yung
patient na ito in Tagalog or Ilocano kasi I, I can’t
speak talaga Ilocano.”
“Oo, marami akong natutunan socially. Isa na dun was I
learned Ilocano, kung papaano makikisalamuha sa mga
natives dito, ganun. Naimprove nun yung pakikipag-usap
ko sa mga patients . . .uhm . . .na dati hindi ko
makausap dahil nga magkaiba kami ng language. Ngayon,
mas nakakakwentuhan ko na sila and. . .nakakausap ng
mabuti yung mga patient.”
(I was thinking before if I’ll talk to the patient in
Tagalog or Ilocano because I really can’t speak
Ilocano. Indeed, I learned many things socially. One
of those was speaking Ilocano and how to socialize
16

with the natives. What has improved in me was the way

I speak Ilocano to the patients whom I never
communicated with due to our differences in dialect. I
can already communicate with them better.)

The participant considers the language used in every

communication process. Language barrier largely affects the

communication between the student nurse and the patient during

the nursing process since language is commonly the medium of

communication. The participant tends to learn and use the

patients’ dialect or language in order to establish well-

structured way of communication during their interactions with

their patients. The participant thought that there is a need of

anticipating the client’s needs which includes knowing and

speaking the client’s language to have a pleasant medium of

communication and develop a well-established interaction. This

is exemplified by the above statements.

Mr. Yellow:
“You learn how to interact with different kinds of
people because you learn to adjust your attitude and
how you communicate with them properly according . . .
to the way they like to talk to you. Kasi, merong
different types of people, meron yung type of person na
pagalit, pabiro naman pala, pero yung way ng
pagsasalita nila parang galit. For others naman minsan
parang ayaw nila yung masyadong robust yung
communication, yung gusto nila parang discreet.”
(You learn how to interact with different kinds of
people because you learn to adjust your attitude and
how you communicate with them properly according to . .
. the way they like to talk to you. Because there are
different types of people, there are persons who seem
angry when they talk but then they are not. For others,
sometimes they do not like having a robust
communication, they prefer discreet)
17

Differences in the attitude may affect the communication

of the student nurses to their patients. Some patients interact

with the participant in some acceptable ways but some interact

negatively which may also affect the relationship negatively.

The participant tends to have strong relationship with their

patients if the patient shows a good attitude in interacting

with their student nurse. The participant also adapts

positively to the patients’ attitudes in such way that it would

maintains a good communication between the participant and the

patient. This is exemplified by the above statement.

Mr Orange:
“The 1st day talagang nangapa ako dun sa lip sinc niya
and the next day buti nalang nkapag adjust ako..
nakapa ko yung kanyang lip sinc so kahit sobrang haba
na ng lip sing niya nagegets ko pa din yung point
niya. And kapag nakuha ko na yung point niya.. parang
may facial expession siya na sinasabi or parang
pinapakita sakin..and kapag mali naman parang
ginagalaw niya yung mata niya.”
(One time, when I was at the orthopedic ward I was
assigned to a patient who is paralyzed from neck down.
. .and he could not speak. I have to adapt to his
condition in which I interpret what he wants by means
of lip reading)

Some patients are unable to vocalize needs because of

their condition. The participant tries to adapt in

communicating to the patient’s condition by applying other

alternative interventions. For instance, when a patient could

not utter words, the student nurse tries to understand the

18

needs and message of the patient through his/her non-verbal way

of communicating and behavior. Participant considers his

patient’s condition as a basis in generating plan of care and

in the implementation of every nursing intervention. This is

exemplified by the above statements.

Ms. Blue:
“You have to talk to the patient, so, hindi lang yung,
kayo-kayo lang nag-uusap. Tapos, kapag nagsusungit ang
mga patient, well, you have to adjust because they’re
in pain . . . When they don’t understand you, you have
to talk in their language, in general.”
(When the patient is anxious, you have to include your
patient in your discussion. When your patient is in
bad mood, you should understand that they are in pain.
And when they don’t understand you, you have to talk
in their language.)

The condition of the patient may either hinder or

facilitate communication but participant applies learned

interventions that fit to every patient’s condition. Some

conditions may put the patients in their worst attitude but

participant understands if the patient speaks negatively to

them and just relates this to the condition of the patient, not

judging the individual’s personality. The participant also

understands that the attitude of the patient may vary because

of their condition. The participant adapts to the patient’s

condition in order to provide adequate nursing care in spite of

any interferences. The participant considers when the patient

is unable or refuses to talk and speak, wherein the participant

19

gives the patient a time for break and do interventions when

the patient is ready for them or when most necessary. This is

exemplified by the above statements.

Mr. Orange:
“Clueless sila with regards to the operation na
ibibigay dun sa bata coz parang un uh..ung tomorrow na
yung operation so clueless yung mother with regards to
what to expect so medyo nagtagal kami dun sa parang
health teaching . . .parang in a layman’s term ung
explain nalang kasi kung minsan sa field natin, may
mga jargons na hindi alam nung mother ung sinasabi
natin so it’s better na i-explain nalang in layman’s
term ang mga sinasabi natin so para magkaintindihan
kami.”
( One time, when I was at the pedia ward, a child
patient was about to undergo an operation. but then, I
had a hard time in explaining to the mother on what is
the operation all about and the health teaching
needed because in our profession, there are some
jargon words that only nurses like us can understand.
so, it’s better to use layman terms when explaining.)

Lastly, the participants adapt to the level of

understanding of their patients and their significant others by

using appropriate terms or language that they both understand

and use them in the health teaching they conduct to their

patients. The participants anticipate the use of simplified

words for their patient and their patient’s significant others

for them to have better understanding of the patient’s condition

and intervention being done by the health care team. This is

exemplified by the above statements.

Imogene King’s Goal Attainment theory would include

communication in her ten concepts in this framework as essential

20

for use by nurses in concrete nursing situations where nurse-

patient interaction leads to goal-attainment – which nurses

purposefully interact and mutually set, explore, and agree to

means to achieve goals. This theory highlights the importance of

the client’s participation in decisions that influence care and

focuses on both the process of nurse-client interaction and the

outcomes of care. (Kozier et al, 2008). This theory implies that

student nurses communicate with their patient such as attaining

positive results of a particular intervention wherein both the

student nurse and the patient interact with one another to

achieve the objectives of specific intervention.

Communication is a critical skill for nursing. It is an

integral part of the helping relationship. It can be a

transmission of feelings or a more personal and social

interaction between people. (Kozier et al, 2008) Nurses

communicate daily in every interaction with their patients.

Nurse also communicates identified problems to other members of

the health team in order to meet client’s needs. The nurse-

patient communication process may be affected by various factors

that include language, condition and level of understanding of

the patient. Nurses should learn to adapt to this factors in

order to facilitate communication and attain objectives in every

interventions they provide to their patient. Nurses should

always consider these factors in order to attain successful

21

communication with their patients and be successful in applying

the nursing process. Nurses should apply specific interventions

to avoid or minimize the effects of their patient’s condition.

Nurses should also learn and use words that are simplified and

understood by their patients.

ATTITUDE

Attitude refers to the thought or the feeling which an

individual conveys to other persons. Attitude may be negative or

positive depending on how one accepts it from the individual who

conveyed it.

Box 3.0
Third Major Theme - Attitude

Responsibility

Responsibility is being accountable for one’s own actions.

The participants shared how they became accountable for

their actions during their hospital exposures.

Ms. Blue:
“Sinamahan ko na siya sa room niya na, can I talk to
you kasi, like this like that, I’ve misplaced your
denture. Pwede, can I pay it or change it? Ganun. So,
22

mabuti na lang mabait yung patient. pumayag siya.

Binayaran ko alone.”
(I accompanied her to the room and asked if i can talk
to her. I explained that i lost her denture and if i
can just replace it or change it. It’s a good thing
that the patient is kind and she agreed. I paid for it
alone.)

In addition, she said:

“Uhm . . . not exactly pero . . . isasuggest ko pa rin

din na akong magbabayad kasi, tinake ko ng
responsibility ko yun.”
(Not exactly. Maybe, even if I committed the same
mistake while being handled by another CI, I would
still suggest that I would pay for it, because I have
already taken that as my responsibility.)

The participant thought that in case she is placed in the

same situation with another CI, she would still offer to pay or

change whatever was lost. Through her statements, the

participant has manifested an acceptance of the consequences of

her action and portrays a responsible attitude towards the

mistake she has done. Even if she felt unsupported, she still

took responsibility over her actions.

It is clear that for every choice or step you make, there

is a consequence. We are responsible for our actions, all of

them. We are responsible for our thoughts and behavior, whether

deliberate or unintentional. A responsible person makes

mistakes, but when they do, they take responsibility and make it

right. (http://www.ehow.com/how_4802685_responsibility-

actions.html) Taking responsibility means that you acknowledge

23

your role in the chain of events, you have a good idea why it

happened, and you know what to do to change your actions (or how

to keep them as they are) in the future to get your desired

outcome. (http://www.sedona.com/responsibility.aspx)

Ms. Blue:
“Sa kin parang . . . parang . . . ok lang siguro, ok
lang. Pero, kung iisipin mo rin, parang unfair kasi
sometimes, nagbabayad ka rin naman pag iba yung
nakakawala. Pero . . . kasi nga ganun yung CI kaya,
iniintidi mo na lang na, kailangan mong bayaran kasi
wala namang ginagawa yung CI mo. Wala namang
sinasuggest. Ayun.” (For me, it’s ok to take the
responsibility alone. However, I also feel that it’s
unfair because sometimes, I also pay whenever my
groupmates commit the same mistake. But since my CI is
not doing or suggesting anything about it, I need to
do something about it, to pay for it.)

The participantsaid that it is alright for her to take the

responsibility alone. However, even if she showed the initiative

to take responsibility for her mistake, in the absence of her

CI’s support, her words can’t deny her feeling of unfairness for

what have happened. It is evident that she is blaming her CI for

letting her to take the responsibility alone. So many people

look to blame others or circumstances for the things that are

not right in their lives. This attititude is self-delusional;

pretty much every long term situation that happens to us in

adult life can be traced back to some decision or lack of

decision made by us either at a conscious or subconscious level

sometime in the past. Once we stop denying,blaming and whining

24

and accept that we had our part to play in the circumstance,

then we are in a better position to move forward and to learn

from our mistakes. Once you feel you are in charge (instead of a

victim), you will act like you are in charge, and your life will

act accordingly.

Mr. Yellow:
“Taklesa din kasi ako dati, tapos yun, kunwari, ever
since na I took up nursing, napansin ko din na I am
responsible for my actions. Lately ko lang na kwan, na
. . . siguro 3rd year na napansin ko na I’m taking
responsibility for all my actions, kung may nangyari,
sige, kasalanan ko na lang, or kung may ipapagawa,
initiative ko na na gawin yun, hindi na kailangan
utusan ka, yung parang, kusa ka nalang gagalaw.” (I am
also tactless but since I took up nursing, I’ve begun
to take responsibility for all my actions. If
something happened, okay, it’s my fault. If there’s
something needed to be done, there’s no need to be
instructed anymore. I act according to my own
initiative.)

In general, bearing burdens of responsibility can give the

nurse worries, but at the same time make her feel needed and

increase her job satisfaction (Clancy et al., 2007). Levinas

(1995) describes ethical responsibility as a type of

responsibility you cannot share or give away. There is no one to

take your place. The demand of the Other has to be met. Response

is demanded from each and every one of us in relationships.

These nurses give the impression that they have no choice, and

that it is up to them to take responsibility for their clients.

At the same time, a public health nurse cannot claim to have

total responsibility for the Other. In some issues, the nurses’

25

responsibility must be toned down. Levinas (1993) reminds us

that we can only go so far in our crusade to help. ‘The face of

the other’ should always restrict our involvement. The nurses’

feeling of being alone and feeling personally responsible are

consistent with Levinasian ethics (Clancy et al., 2007).

Responsibility is being accountable for something. Whatever

the consequences are, the one involved is the one held liable.

Since student nurses are handling patients on their own, they

should therefore be wathcful at all times because the care of

the patient and his/her life is the issue. Proper nursing

interventions should always be kept in mind in giving care so

that errors will be eliminated.

Caring Attitude

Caring attitude is the mutual relationship between

individuals which involves understanding one's feelings. For the

participants, the caring attitude is a part of the nursing

profession. That nurses are responsible for their patient's

lives, nurses should provide tender, love and care. It is innate

for the nurses to care therefore; nurses must always consider

the mutual commitment between them and their patients. This is

exemplified by the following statements:

Ms. Gray:
“Bilang miyembro ng society, parang naging medyo
responsible, may konting responsibility na ako towards
26

other people kasi di ba apathetic tayo na kung meron

nangyari diyan di ba hinayaan na lang natin, eh kung
halimbawa me nahulog oh at least alam ko kung
halimbawa ako kasi naexperience ko naman iyan sa ER at
least alam mo na kung papano ka rumesponse.”
(As a member of the society, I become responsible
towards other people. Isn’t it that we are apathetic
that when something happens, we tend to just ignore.
Before, we are not that allowed to care for others
right? But for now, the law is we have to care or
develop concern towards others, towards the society.)

Caring involves every member of the society, as a nurse,

we are expected to care not only for our patients but to all the

members of the society. As nurses provide mutual relationship

with the clients, it’s not usual for the nurse to just ignore

situations in the area because that not what we're trained for.

We are to care for our patient that is what we're supposed to do.

Ms. Purple:
“sa care of the client it includes dun yung pagiging
caring sa patient mo so hindi lang about sa vital
signs, sa giving medications pati siyempre yung
feelings din nila, yun . . . siyempre yung mga nasa
hospital so lagi silang in pain, so kinoconsider mo
iyon so parang ano, so lumalabas yung taking care of
the patient.”
(The care of the client includes not only about the
vital signs and administration of medications but more
on focusing on their feelings. Since patients are
always in pain, you also have to consider it.)

Caring is not only mere monitoring and giving medications

but instead, it’s our responsibility to care for our patient

who’s in pain. The simple gesture of “caring” may alleviate the

patient's feelings. Patients expect us to care for them in the

27

most concerning way. Caring for the patients would mean we

should empathize with our patients and focus more on their

feelings. When they are in pain, we should find a way to relieve

their condition because that is what they expect from us.

Watsons's theory of human care views as the essence and the

moral ideal nursing. Human care is the basis for nursing's role

in the society; indeed, nursing's contribution to society lies

in its moral commitment to human care. Nursing as human care

goes beyond the realm of ethics (Watson, 1990). Caring in

nursing is “an altruistic, active expression of love, and is the

intentional and embodied recognition of value and connectedness”

(Boykin and Schoenhofer, 2001).

This implies that caring attitudes are of significance to

nursing since it is not only a responsibility for nurses to

care, it is their duty. Nurses are expected to provide care to

their patients, and to the society. The moment a patient enters

to an institution nurses are expected to provide care for them

and build a mutual commitment. Nurses are known for their caring

attitude, and for that, caring for nurses are not only intended

for the patients in the hospital, but for all who needs care in

the society.

Flexibility
28

Flexibility is the ability to respond to the changing

demands of the environment. It includes one’s ability in reusing

or recycling resources needed in the hospital and adapting from

the ideal setting to the real hospital setting.

Ms. Blue:
“We have to, yung parang recycled materials, in
performing uhm, our interventions. Dapat, always
nakakaadapt ka. Kung sakali kulang yung cotton ball,
anung gagawin mo? side a, side b. di ba, yun lang yung
logic. Una hindi ko talaga maappreciate. Eh kasi
siyempre napag-aralan mo ideal tapos. Eh, sayang naman
yan, pinag-aralan ko ideal pero hindi naman magagamit.
Pero siyempre in the long run, marerealize mo din na,
ganun talaga, nasa third world country kasi tayo.
Kaya nga natin pinag-aaralan sa school kasi, at least
alam natin yung ideal. Para kapag pumunta ka na sa
hospital setting talaga, lalo na kung public, at least
pwedeng-pwede kang magrecycle, magreuse ng, pwedeng
gamitin pa.
(We have to recycle materials in performing our
interventions. We have to adapt. For example, if you
lack cotton balls, use side a and side b. At first, I
can’t appreciate it but in the long run, I’ve realized
that I really need to adapt since we are in a third
world country.)

Hospital exposure shows the difference between the ideal

setting and the real setting. It teaches a student nurse to be

flexible in recycling some hospital materials since these are

lacking in most of the government hospitals in our country. The

participant admitted that at first, she cannot appreciate

recycling materials in the hospital since she cannot apply the

“ideal” thing that she has learned in the school. However, she

has learned to adapt.

29

Mr. Green:
“Wala, kailangang mag-adjust ka talaga, sa akin
kailangang mag adjust ka talaga kasi hindi naman na
masama yung ginagawa nila. Yun mas ideal lang kasi
yung tinuturo sa classroom, yung reality kasi mas
practical. Yung mga ginagawa pagdating natin sa
hospital setting, we have to cope up. (You really have
to adjust. For me, you really have to adjust because
what you are doing is not really bad at all. It’s just
that the one they are teaching in classroom is the
ideal, and that the reality is more practical.)

Flexibility in terms of the transition from the ideal to

the real hospital setting is necessary. Practicality and

creativity in performing nursing interventions that are lacking

in materials should be learned during hospital exposures.

Flexibility with one's career is an essential aspect of a

job that most workers value. Job flexibility helps maintain

career satisfaction, which leads to better productivity and a

lower employee turn around rate.

Nurses work in different areas. Ward rotation happens not

only to student nurses, but also to registered nurses employed

in a hospital setting. Therefore, nurses handle different kinds

of patients and experience being rotated in different kinds of

situations from time to time. To be able to handle different

kinds of situations, flexibility should be developed by an

aspiring competent nurse.

30

Patience

Patience is the capacity to endure difficulties without or

with minimal complaints. It includes the ability to endure

caring for a patient who is in a critical condition, and being

able to tolerate the complaints of your patients.

Mr. Orange:
“Magiging pasensyoso kasi mahirap talaga na magkaroon
ng patient na hindi nakakapagsalita pero alam mong
buhay, parang ang dating is total paralysis. Ang
nagagalaw lang niya is yung mata niya, bibig para sa
lipsinc, and ang labas nun is parang naging pasensyoso
ako dahil hindi madaling maging nurse sa pasyenteng
ito. Mabilis lang yung breaks ko noon kasi kelangan
talaga ng close care para sa patient na ito.
Natulungan ko rin naman yung pasyenteng ito kahit na
ganito yung sitwasyon niya.”
(I learned to be patient when I handled a patient who
cannot speak and is paralyzed. I had to have my breaks
as fast as possible so as to provide close supervision
to this patient. In a way, I have helped this patient
even if he is paralyzed and difficult to handle.)

There comes a time wherein a student nurse is placed in a

difficult situation. He or she may be given a patient who is in

critical condition, just like the case of the participant who

was given a paralyzed patient. In cases like this, a student

nurse should learn to be patient, since these kinds of patients

are physically incapacitated, leading to their self-care

deficits. Thus provision of total care by the student nurse is

very much required. The participant felt how difficult it is to

be placed in that kind of situation but then, he felt the need

to be patient that is why he even sacrificed the length of time

31

he spent for his breaks in order to provide the proper care

necessary for the patient.

Ms. Purple:
“Yung syempre naeexperience ko na yung andun sila
nagrereklamo pero ano,kahit medyo naiinis na ako,
dapat nakangiti ka rin tapos kahit kunwari sabay-sabay
mga pasyente mo, isa-isahin mo pa rin yun para maging
maayos pa rin yung care mo sa patient.”
(I have been in a situation where in my patients were
complaining at the same time but then, even if I felt
irritated, I still have to smile and attend to them
one at a time so that proper care would still be
delivered.)

A student nurse should maintain a relaxed attitude, even in

the midst of receiving lots of complaints from his / her

patients. One should still manage to smile while attending to

the complaints of each patient so that what is being complained

about would be properly addressed and appropriate care asked by

the patients would still be rendered. The participant felt

irritated when placed in this kind of situation but then, she

learned to be patient by attending one at a time to the demands

of her patient, thus, she was still able to provide proper care

to her patients.

M.J. Ryan, author of The Power of Patience: How to Slow the

Rush and Enjoy More Happiness, Success, and Peace of Mind Every

Day said, "In medical care, nurses are asked to be doing more

and more with less and less. Keeping a cool head on your

shoulders and having compassion is clearly something that helps.

32

It helps create answers and solutions and it helps the body

physiologically."

Thus, patience is a virtue that every nurse should have

since they work with different kinds of patients. It is

necessary for a nurse to be patient in order to be able to carry

out a task successfully.

Respect to Superiors

Respect is the act of taking into consideration the

feelings of others in speaking and doing particular actions.

This subtheme includes verbatims of patient that talks about the

respect rendered by the participants to their patients and to

other members of the health team during their hospital

experiences. This includes their feelings to the attitudes of

those whom they had the experience with in the hospital.

Ms. Blue:
“Di ba after nawala nung denture, so, parang yung CI
namin, ‘Bahala ka diyan!’.”
“Hindi ko alam kung nasa akin yung problem o nasa CI
kasi buong 4th years medyo may issue sa kanya. So, oo
naaapektuhan. Medyo, hindi siya ganun kaopen sa aming
grupo. Pero kapag ano, kapag nasa school, CI pa rin
siya. CI ko pa rin siya so, you have to respect pa rin
kahit ayoko siya. Ganun.”
(After I lost the denture, our CI only said, ‘you’re
responsible for that’. so . . .
I do not know if the problem is in me but almost all
4th years have issues to that CI. I was affected by
that. That C.I. is not open with the group which
became one of our problems.)
33

The participant felt that after a particular incident in

her hospital duty, her clinical instructor had not supported her

with the mistake she had committed. In spite of that, the

participant still maintained the respect that the clinical

instructor deserves whenever there is a need to interact with

that clinical instructor. The participant tends to respect her

mentor even if he or she had a bad experience with that

instructor and disregards negative attitudes as long as it does

not degrades the student nurse’s personality.

Ms. Purple:
“Minsan, yung pag toxic yung mga doctors hindi mo
maiwasan na sayo mababaling yung stress nila, ganun,
yung stress nila.”
“Uhm, wala lang, basta iniignore pero andun pa rin
yung parang respect pa din.”
(Sometimes, when the doctors are under stress, they
cannot avoid displacing the stress to us. I just
ignore it as a sign of respect to them.)

Mr. Yellow:
“Noong una akong nasigawan hindi naman ako nagalit
pero nainis lang saka curious din kung bakit ganoon
iyong attitude niya. That was early in the morning
tapos pagkapasok pa lang niya saka ng patient galit na
agad siya. Iniisip ko na lang na hindi pa siya umuuwi
kaya ganoon. Kasi nga 36 hours ang duty ng doctor sa
ospital kaya siguro ganoon. Pero I respect din naman
iyong mga doctors na pasigaw-sigaw.”
(During the first time I was shouted at, I didn’t get
mad but I got pissed off and curious about the reason
why his attitude was like that. I just thought that he
has not yet gone home because doctors usually have 36
hours of duty in the hospital. I respect the doctors
whenever they are shouting.)

Doctors in the hospital experience stressful situations and

sometimes, whenever student nurses are involved, the doctors

34

reflect the stress to the student nurses. The participant may

sometimes feel that they are embarrassed but this feeling is

relieved when the participant understands that the doctors

encounter hectic situations that need adequate patience in the

student nurse’s part. Despite of this attitude, the participant

still respects these doctors and treats them well enough to

maintain professional relationship.

A study entitled Moral Responsibility: A Relational Way of

being states that a good worth striving for was respect for self

and others in concrete situations. Respect has been identified

in other studies as the most central value in nursing. In the

present study, respect was made visible as practical wisdom

strategies of balancing used by student nurses in their

endeavour to find a way that achieves the good they want. This

strategy was exhibited, for example, in balancing concern for

others and concern for self in a relational way, through self-

respect and respect for others. Student nurses thought that the

quality of patient care would be likely to suffer without

concern for them and the team. This study concludes that if

student nurses are to continue striving to do well in a way that

respects themselves and other people, it is important that they

do not feel forced to compromise their values. This study is

also related to the respect rendered by the student nurse to

other members of the health team that are considered to be

35

superior that them in terms of decision making and implementing

plan of care in the hospital. Respect is given to members of the

health team as long as it ensures their development as a future

nurse. The participants showed respect to the clinical

instructors and doctors they have encountered, whether they had

a negative or positive feedback, because they understand that

some situations are inevitable and that every member of the

health team deserves a respect whether they are superior to the

student nurse or they are of the same level.

Respect is an attitude that emphasizes the other person’s

worth and individuality. It conveys that the person’s hopes and

feelings are special and unique even though similar to others in

many ways. (Kozier et al, 2008) Nurses are expected to respect

every individual especially those that are included in the

health care system. This includes their respect to patients,

fellow nurses, doctors and other members of the health team.

Nurses should convey respect through communicating

therapeutically, following appropriate orders, correcting

questionable ones politely and listening open-mindedly to what

the other person is saying. Nurses should also accept and

respect every individual’s belief, perception and actions as

long as these do not affect negatively the provision of the

nursing care and do not provide a wrong health belief.

36

Personality Development

Personality development can be defined as the increasing

needs for change of own self into a more acceptable individual

in a certain society. For the participants their personality

development are centered through their attitudes, moral values

are exemplified, positive attitudes have developed and

undesirable attitudes have been replaced by desirable ones.

Mr. Yellow:
“In general parang nakaaffect siya sa akin sa
pakikitungo ko rin, pakikitungo ko, actually yung
dati, parang, mahiyain din akong tao, dahil dun, ewan
ko, bakit ako nagtransform ng ganun, pero lahat lahat
ng I am today, hindi ko kasi ma-explain in general,
pero kung ano ako dati, as in lahat, kabaglitaran.
kasi dati, pangit kaya ugali ko, yung ngayon after 4
years, yun, medyo ok naman na, hindi nakikipag
socialize, yung interview ayoko din, ngayon ok na, ok
na sakin yung socialize, interview, tapos yung mga
designated na trabaho, yung parang lahat lahat na
aspect sa akin na negative, nagawa kong positive din.”
(In general, it really affected my personality.
before, I was a shy type of person but after four
years of being exposed to different kind of areas and
persons, I gain self confidence and I was able blend
to different kind of persons. I became an optimistic
person.)

Experience is the best teacher. Nurses gain personality

development as they tend to adapt to the changes of their

environment. Exposure to different wards would be the best

example. The feeling of difficulty and shyness will eventually

disappear as nurses tend to be exposed to different areas

because mastery was achieved.

37

Mr. Yellow:
“Taklesa din kasi ako dati, tapos yun, kunwari, ever
since na I took up nursing, napansin ko din na I am
responsible for my actions. Lately ko lang na kwan, na
. . . siguro 3rd year na napansin ko na I’m taking
responsibility for all my actions, kung may nangyari,
sige, kasalanan ko na lang, or kung may ipapagawa,
initiative ko na na gawin yun, hindi na kailangan
utusan ka, yung parang, kusa ka nalang gagalaw.”
(I am also tactless but since I took up nursing, I’ve
begun to take responsibility for all my actions. If
something happened, okay, it’s my fault. If there’s
something needed to be done, there’s no need to be
instructed anymore. I act according to my own
initiative.)

The feeling of confidence was manifested as skills and

attitudes are being developed through the constant practice. And

since nurses are responsible for their own actions, nurses also

should be initiative in doing everything in the ward.

Mr. Yellow:
“And difference niya dun eh yung guidance
ng instructor... laging may guidance ng instructor,
ngayong 4th yr na, if you know what you're doing, ang
need mo nalang siguro ay assertiveness. Like in the
ER, hindi mo na kelangan hintayin ang instructor mo na
sabihin yung mga kailangan mong gawin. For example,
may dumating na patient sa ER, kailangan kung ano
problem niya, you must attend to it immediately, kung
kailangan mo munang iassess, or i blotter, nasa iyo na
yun kung ano uunahin mo”
(The difference is that there is the guidance of the
instructor. There always is. Now in 4th yr, if you
know what you're doing, what you may only need is
assertiveness... like in the ER, you don't need to
wait for the instructor to tell you what to do. For
example, a patient came into the ER, whatever the
problem is, it must be attended immediately. Whether
you need to assess or to blotter first, that will
already depend you.)
38

The feeling of independence and assertiveness is

exemplified by the following statement; nurses are expected to
act immediately to a situation without any verbalization of the
clinical instructor. Nurses must have the initiative act in the
area.

Ms. Purple:
“Uhm . . . yung nung una laging umiiyak pag ano, pag
pinapagalitan, ngayon hindi na so parang pasok dito
labas doon. . . . During hospital exposure, pag
pinapagalitan dapat huwag masyadong dibdibin instead
dapat we learn from it na kunyari pag pinapagalitan,
ok, at least alam mo na yung mistakes mo.”
(At first, I am always crying when I am being scolded
but now, not anymore.)

The feelings of sadness are experienced by nurses when

mistakes are done. Learning through our mistakes is usual for

nurses. It is good that nurses would able to decide on their

own, because it’s better that wrong decisions are made instead

of making no decisions at all. And because of that, nurses

learn.

Ms. Blue:
“Uhm, yun nga na you have to . . . trust only
yourself. Kahit na may CI ka, dapat alam mo pa rin
yung ginagawa mo. Alam mo yung gamot na ibibigay mo,
alam mo yung mga skills na ginagawa mo. Para . . .
para hindi ka na . . . nagtatanung-tanung dun sa CI
kasi bilang 4th year, dapat, dapat alam mo na lahat
eh. Parang guide lang yung CI mo kung sakali. Ganun.”
(You have to trust yourself that even though your C.I.
is around you must still know what you are doing.
Especially that we are already 4th year, we should
already know almost everything. Your C.I. will only
serve as you guide.)
39

Mmaturity in terms of values has been developed, self

esteem increased and a positive outlook in life was exemplified.

Growth in terms of morality was visible and change was done for

improvement.

Psychosocial theories according to Sigmund Freud wherein

the personality is composed of the id, ego, and superego are the

concepts of the unconscious mind. It is the pleasure principle

and ego balances id and superego pressures, superego is the

perfection principle. Personality can be defined as the outward

expression of inner self. It encompasses a person's temperament,

feelings, character traits, independence, self-esteem, self

concept, behavior, ability to interact with others, and ability

to adapt to life changes. (Kozier, 2008).

Personality is defined as the enduring personal

characteristics of individuals. Personality Development

quintessentially means enhancing and grooming one’s outer and

inner self to bring about a positive change to your life. Each

individual has a distinct persona that can be developed,

polished and refined. This process includes boosting one’s

confidence, improving communication and language speaking

abilities, widening ones scope of knowledge, developing certain

hobbies or skills, learning fine etiquettes and manners, adding

style and grace to the way one looks, talks and walks and
40

overall imbibing oneself with positivity, liveliness and peace.

The whole process of this development takes place over a period

of time. Even though there are many crash courses in personality

development that are made available to people of all age groups,

implementing this to your routine and bringing about a positive

change in oneself takes a considerable amount of time. It is not

necessary to join a personality development course; one can take

a few tips and develop his or her own aura or charm.

This implies that personality development in nurses is a

process wherein moral values are being developed. People need

societal values to have a sense of individuality ( Kozier, 2008).

Personality development involves a change in the person’s

attitude and characteristics in order to become a better

individual. Improvement on the individual’s part is exemplified

once attitude and characteristics becomes more acceptable to the

society.

CHAPTER IV

CONCLUSIONS AND RECOMMENDATIONS

CONCLUSION
41

Based from the findings of the study, the researchers have

concluded the following

1. Student nurses must anticipate the need of improving

their knowledge to provide adequate health teaching to

patients and share ideas to the health team, and perform

skills that are based on learned concepts.

2. Student nurses should continue their positive adaptation

to different situations in the hospital to constantly

provide adequate care to patients and maintain effective

professional relationship to both patients and other

members of the health team experience different

situations which significantly affected them

holistically.

3. Student nurses adapt to experiences which may involve

their learning from the classroom and actual experience

in the hospital.

4. Hospital experiences enhance the decision making and

critical thinking abilities of the student nurses.

5. Student nurses take responsibility of the result of their

own action in the hospital.

6. Student nurses responds to clinical exposure through

improving readiness to apply learned skills and

knowledge.
42

7. Student nurses apply positive adaptation to different

situations in the hospital. These adaptations are

utilized to improve their relationship with the patients

and other members of the health.

8. Student nurses apply attitudes that would promote an

effective relationship with other members of the health

team.

RECOMMENDATIONS

1. Student nurses must anticipate the need of improving

their knowledge to provide adequate health teaching to

patients and share ideas to the health team, and

perform skills that are based on learned concepts.

2. Student nurses should continue their positive

adaptation to different situations in the hospital to

constantly provide adequate care to patients and

maintain effective professional relationship to both

patients and other members of the health team.

3. Student nurse should also maintain positive attitude

when dealing to both patients and other members of the

health team. This is to improve and promote effective

professional relationships with these individuals.

43

4. Administration should enrich the nursing process by

strengthening the focus on interpersonal relationship

and adaptation to different stimuli experienced in

every hospital exposure.

5. Administration should enhance the knowledge and skills

that are being taught to the student to provide

adequate nursing education and that would promote

health care provided to patients.