NURSING PROCEDURES APPRAISAL AND BARRIERS TO CLINICAL PERFORMANCE IN AFFILIATED TERTIARY HOSPITALS AMONG BSN LEVEL III STUDENTS

OF CAVITE STATE UNIVERSITY, A.Y. 2011-2012

An undergraduate research paper presented to the faculty of College of In Nursing in partial fulfillment of the requirement for the degree of Bachelor of Science in Nursing under the supervision of Mrs. Nenita B. Panaligan.

INTRODUCTION

The related learning experience (RLE) is a curricular requirement in a nursing degree. It is intended to develop competencies and skills of nursing students in utilization of the nursing processes in varying health situation. Nursing students must complete fifty-one (51) hours of RLEs for every one subjects requiring RLE. The Commission on Higher Education Memorandum Order (CMO) No. 9, professionals wish to take up Bachelor of Science in Nursing must complete a total of 37 units of nursing subjects and 1,887 hours of related learning experiences in those nursing subjects/ areas. Related learning experience is essential to becoming a competent professional nurse. Although a theoretical and research-based education is essential for nursing, on its own, is not enough. Learning in the clinical setting provides the real world context where nursing students develop the knowledge, skills, attitudes and values of a registered nurse. Students have experiences on RLE that cannot be realistically provided in a classroom or laboratory setting. They communicate with patients and their families, interact with and learn from the health-care team, practice skills under supervision and learn to deal with

the complexity of competing priorities. When students are on clinical placements they receive feedback on their real world performance and are guided to reflect on their lived experiences as individuals and nurses (Clare et al. 2003; Madjar et al. 1997). Given the importance of clinical placements it is imperative that universities find ways to work within the constraints imposed by contemporary practice to maximize the benefits of clinical experiences in terms of student learning.

It is through clinical practice that the students learn more because it is where they apply the theories and principles that they have learned. Related learning experiences also contribute in enhancing their skills and help them to master it. A mastered skill is a very important aspect that nursing students should posses because it avoids malpractices and it boosts competence and confidence. Hence, clinical exposure should be given of much importance.

From now, it will always be a challenge to the countrys nursing schools to produce health care graduates of high quality. Among the fore mentioned three best ways of producing reliable nurses, the return demonstrations and the on-the-job training program seem to have greater influences to the students with regards to the acquisition of knowledge. This had put the practicality and actualization of the theoretical concepts worthy of a bigger concern for educators. Students learning of the recent time becomes more on the application of the theoretical learning. Students exposure may not be enough to supplement training needs of the students due to factors related to hospital policies, clinical instructors protocol, and students refusal to perform a certain skill, patients right to refuse and anxiety.

As an example, the catheterization procedure will be more meaningful to a student if he will be able to demonstrate it by himself. Facilities such as the foley catheter, syringe and a dummy was provided by the nursing school for demonstration of procedure. But it is the exposure that is needed for the application of the procedure. The affiliated hospitals are then held responsible to facilitate the learning process of the student with the guidance of the clinical instructors.

It was given emphasis that the clinical exposure in actual settings play an important role in better acquisition of the theoretical knowledge in the course of nursing. This provides familiarization of a certain nursing procedure. Moreover, it somewhat provide the student a chance to experience the act of doing the procedure without the need for assuming the actual manner of an intervention. In this way the information becomes more significant to a learner.

In this, there is a felt need to address the factors that could affect the enhancement of skills and acquisition of knowledge and correct attitude while conducting their related learning experience duties.

Learning as a process needs to be well supported in order for it to attain efficiency. Every nursing institution should realize the value of having adequate exposure in sustaining the students with a more effective learning experience as to provide the society with competent and more reliable future nurse professionals.

Statement of the Problem Generally, this study will be conducted to investigate the nursing procedures appraisal and barriers to clinical performance in affiliated tertiary hospitals among BSN level III students of Cavite State University, A.Y. 2011-2012.

Specifically, it will seek to answer the following questions: 1. What is the demographic profile of the students in terms of: a. Age and; b. Gender 2. How frequent is the application of skills in the different affiliated tertiary hospitals? 3. What is the level of performance of student nurses in terms of frequency exposures to procedures? 4. What are the barriers for learning opportunities in clinical areas as perceived by the students in terms of : a. Students anxiety b. Patients right to refuse c. Students refusal to perform a certain procedure d. Clinical instructors protocol e. Hospital Policies?

5. Is there any difference between the frequencies of exposure among BSN level III students in terms of performance of skills identified? 6. Is the level of performance of student nurses significantly affected in terms of : a. frequency of exposure b. barriers in performing a certain skill and;

c. hospital affiliation?

Objectives of the Study

Specifically, this study aimed to:

1.

Determine the demographic profile of the students in terms of: a. Age and; b. Gender

2. Determine the frequency of the application of skills in the different affiliated tertiary hospitals. 3. Determine the level of performance of student nurses in terms of frequency exposures to procedures 7. Identify the barriers for learning opportunities in clinical areas as perceived by the students in terms of : a. Students anxiety b. Patients right to refuse c. Students refusal to perform a certain procedure d. Clinical instructors protocol e. Hospital Policies?

8. Find out if the level of performance of student nurses significantly affected in terms of : d. frequency of exposure e. barriers in performing a certain skill and; f. hospital affiliation? 4. Find out if there is a relationship between the identified barriers between the:

a. frequency of performing the procedures in the clinical areas and; b. hospital affiliation in the areas.

Hypothesis

Ho1: There is no difference between the frequencies of exposure among BSN level III students in terms of performance of skills identified. Ho2: There is no relationship between the identified barriers between the frequency of performing the procedures in the clinical areas and hospital affiliation in the areas.

Significance of the Study The purpose of the study is to determine the nursing procedures appraisal and barriers to clinical performance in affiliated tertiary hospitals among BSN level III students of Cavite State University, A.Y. 2011-2012. The result of the study will contribute useful information to the following:

Nursing students. Preparedness for the exposure at different hospitals and to mold CvSU-CoN students into globally competitive future nurses by shaping their performance suited for the demands of local and foreign institutions.

Nursing education. From the result of this study, the faculty and students may identify various strategies and to enhance teaching-learning relationship in able to

facilitate the enhancement of students skills, knowledge, and attitude by identifying the barriers and resolved areas that can be intervened by the College of Nursing.

Clinical instructors. Strengthen their teaching strategies to meet the academic needs of students and provides awareness as contributing elements on performing the skill acquisition of students and identify areas where they can collaborate to enhance and promote learning.

Future researchers. The research may be used as reference of future researcher/s with the same line of topic or ideas.

Scope and Limitations

The study will mainly focus on the nursing procedures appraisal and barriers to clinical performance in affiliated tertiary hospitals among BSN level III students of Cavite State University, A.Y. 2011-2012. There will be 100 third year nursing students in each section who will serve as respondents. Survey type will be used in collecting data. Questionnaire will be used to ensure reliability and consistency of data. The study will be conducted on the first semester of S.Y. 2011-2012 at Cavite State University- College of Nursing.

Definition of Terms

Affiliated hospital- refers to the clinical placement of nursing students or any healthrelated course with an opportunity to use the theory and skills they have learned in

the classroom and laboratory settings. In this study this refers to General Emilio Aguinaldo Memorial Hospital and Batangas Regional Hospital.

Tertiary hospital- It is a major receiving hospital in a particular area. Smaller facilities will use it as their resource center. They usually have a full complement of the specialty services, such as neuro-surgery, NICU, PICU, open heart surgery, etc. In this study this refers to General Emilio Aguinaldo Memorial Hospital and Batangas Regional Hospital. Clinical instructor- refers to the faculty employed at Cavite State University- College of Nursing who supervises, guides and teaches students during the clinical practice in the hospital.

Clinical practice- refers to the related learning experience of the students in the hospital as prescribed in their curriculum guided by the Commission on Higher Education Memorandum Order.

Nursing- is a profession that utilizes a body of knowledge integrating physiological and biopsychosocial sciences. It is a practice discipline using a holistic, caring approach across the Health Illness continuum.

Theoretical Framework Independent Variable INPUT Theories and skills learned in the y y y Classroom lectures Return Demonstrations RLE duties y y y Moderate Variable PROCESS Barriers: Students anxiety Patients right to refuse Students refusal to perform a certain procedure y Clinical instructors protocol y Hospital Policies y y Dependent Variable Level of performance: y Level of knowledge Level of skills Level of attitude

Figure 1. A paradigm showing the relationships of the input, process and output of the study.