CHAPTER I

THE PROBLEM AND ITS BACKGROUND

This chapter aim to present the introduction, statement of the problem,

hypothesis, significance and importance of the study, scope and delimitations,

conceptual framework and research paradigm, and definition of terms.

Introduction

There is a growing consensus among leaders in higher education for the

need to change the general education curriculum to meet the changes in society

and technology.

For instance, in May of 2005, the board of nursing created a committee on

core competency standard development in collaboration with the commission on

higher education technical committee on nursing education with the primary goal

to develop the competency standards for nursing practice in the country. The new

competency standards will reuse as a unifying framework for nursing education.

Lifted from the article, in March of 2006 the Massachusetts board of

higher education and the Massachusetts organization of nurse Executives

(MONE) convened a facilitated working session entitled creativity and

compulsions building framework for the future of nursing education and

practices.
 Indeed, they all focused to enhance nursing competencies that include

transitioning nurses into their practice.

Background of the Study

Lifted from the thesis book of group 1-10 batch 2007, since development

is every bit as important as theoretical knowledge in any professional education.

In the nursing education, this practicum is refused to as clinical learning

experience.

The clinical experience of a student nurse is considered the core of his/her

overall nursing education. The clinical area is where the student nurse put into

application all the theories they learned in the classroom. A clinical instructor

plays a crucial role in the student nurses’ development and learning in the clinical

area.

The clinical instructor’s performance of his/her role will determine the

student nurse’s clinical performance. Thus, it is essential that a clinical instructor

is efficient, competent and well-experienced to carry out his/her responsibilities

The proponents of this research wanted to determine the extent of

integration of the four core competencies by the clinical instructor among nursing

student in selected nursing institution, in addition, the study will relate to the

clinical performance of nursing student, in order to prove the extent of integration

of the four core competencies which set by the higher commission on education

as standard competency guide. The clinical performance of the student will

determined by the result of the end of semester’s WGA.

 The researcher’s believes that nursing students experiences of their

clinical practice provide greater insight to develop on effective teaching strategy

in nursing education.

Conceptual Framework

The direction of this study is anchored to the standard core competency set

by the commission on higher education technical committee on nursing education

(CHED-TCNED) collaborated with the bound of nursing under the committee on

core competency standards development (CCCSD) promulgated under resolution

no. 112 S2005.

Another model that will be employed to achieve the proponent goals is the

competency outcome and performance assessment (COPA) model by Redman,

R.W, and Lenburg. (1999), her model will provide design as guide in doing self-

made questionnaires cited in her article.

Competent performance by health care professionals is expected

throughout society. However, defining what it is and teaching students how to

perform competency forces many challenges.

Moreover, increased accountability has become a common theme in

contemporary society. In the public market places, the theme of “let the buyer

beware” has been replaced with the philosophy of “excellence is defined by the

costumer”.
 Therefore, whether the focus is on public officials, health care

professionals, on educators, the expectation is that standards of acceptable

performance will be adhered to and the public trait will be safeguard.

Four key core

Clinical Performance of Selected Institution
competencies:
Nursing Students
1. Enhancing

2. Enabling

3. Empowering

4. Patient care

Table 1.1 Research Paradigm

The above framework has two boxes that represent the variables that will

undergone analysis, at the box at the left side presented the four key core

competencies which are the enhancing, enabling, empowering, patient care

competencies. The proponents will determine the extent of integration of these

competencies by the clinical instructor as perceive by the nursing students. On the

right side, the box presented the clinical performance of nursing students gather

after the end of semester WGA. The arrow with double head pointing in both

boxes is a sign to determine if there is relationship between the extents in which

the four core competencies was integrated by clinical instructor and the clinical

performance of nursing students.

 Lastly, the arrow pointing to the box at far right the selected nursing

institutions which are the following: Manila Doctors College, Arellano University

College of Nursing, Olivarez College of Nursing.

Statement of the Problem

The study aims to determine the extent of integration of Four Key Cppore

Competencies by clinical instructor and relate it to the clinical performance of the

Nursing student in selected institution.

Specifically, the following research queries will be answered:

1. What is the level performance of nursing students from selected institution?

2. To what extent of the following Four key core competencies integrated

by clinical instructor to the nursing standards for selected institution?

2.1. Enabling

2.2. Enhancing

2.3. Empowering

2.4. Patient care competencies

3. Is there a significant relationship between the perceive Extent of

integration of Four key core competencies by clinical instructor and the

clinical performance of nursing standards in selected nursing institution.

 4. Is there a significant difference among selected nursing institution in

terms of clinical performance of nursing student in selected nursing

institution?

Hypothesis

The following hypothesis will be tested in.05 level of significance.

Ho. There is no significant relationship between the perceive extent of

integration of four key core competencies by clinical instructor and the clinical

performance of nursing student in selected institution.

Ho. There is no significant difference among selected institution in terms

of nursing student clinical performance.

Significance of the Study

The study is significant to the following.

• To the nursing Administration- This study will provide valid measurement of

clinical Instructors and nursing students’ competency to develop a design to

enhance their K.S.A competing to produce excellent graduate to compete

globally.

• To the Clinical Instructor- The study will provide unbiased insight of nursing

student that affect their clinical performance. The result is expected to make

changes, enhancement or even new strategy in teaching and learning.

• To the Nursing Students- The study will show result of their perceived evaluation

to their clinical instructor. May this study inspire them to continue to strive to

attain excellence in their S.K.A competency to be prepared to become a

professional nurse.

• To the Future Researcher- This study will serve as their reference. May they find

study interesting to develop, enhance betterment.

Scope and Delimitation

The researchers aims to determine the Extent of Integration of Four key

Core Competencies by clinical instructors among nursing students and relate it to

the Clinical performance of nursing students in selected nursing institution,

determining the difference between related Institute in their student clinical focus

is limited to the result of end of semester W.G.A of nursing. The respondent will

be 3rd yr nursing students of Manila Doctors College, Arellano University, San

Juan de Dios College of batch 2012, male and female no inclusion criteria, a

random sampling technique will be applied.

The respondent will answers the self made questionnaires, pertaining and

limited to the four key core competencies which are the following; Enabling,

Enhancing, Empowering, Patient care Competency. A Four point likest scale will

determine each key core competencies. Extent of integration by the clinical

instructor to the respondent.

 The questionnaire will be validated by three nursing professors, expert on

this field after which, a pilot testing will be done.

Definition of Terms

The following terms are operationally defines to help the readers to

understand the content of the study.

Clinical Instructor- refers to the role, competency of a professional nurse

educator that the student will evaluate their Extent of Integration of Four

key Core competencies among nursing students.

Clinical Performance- refers to the evaluated end of semester W.G.A –

skills, knowledge and attitude competency of nursing student in selected

Institution.

Four Key Core Competencies- refers to the following Standard Sore

Competency in nursing practice.

Enabling- Refers to the doctor - patient relationship and the dynamic

exchanges that occurs before, during, and after the medical encounter.

Enhancing - refers to the accurate and updated documentation of client

care.

Empowering- refers to the practices in accordance with the nursing law

and other relevant legislation including contracts, informed consent.

Patient care competencies- refer to the knowledge base on the health

/illness status of individual / groups.

 CHAPTER II

REVIEW OF RELATED LITERATURES AND STUDIES

This chapter is composed of the present study into the context of preceding,

related research. Materials were scanned from various libraries and were collated to

provide understanding of the subject under discussion. The purpose of this review of

literature is to analyze methods of assessing competence to practice in nursing and draw

conclusions on their validity.

Local Literature

In order to be a competent nurses, a good performance must be done.

Performance is what is done and how well it is done to provide health care. It is a

degree to which an organization does the right things and does them well. But this

is influenced strongly by its design or operation. The value in health care is

appropriate good balance between good outcome and excellent care and services.

There is a law (RA 7164) which is generally unheard of by registerend nurses that

recognizes the nurse to function independently and encourages clinical

specialization competence in nursing practice which is focused more on

demonstrating and implementing rather than assessment and evaluation (Yap,

2000). This is why there is a need for reorientation on the scope of nursing

practices which revolved around nursing process, including training in such areas

like assessment and evaluation.

According to RA 9173 Article III Section IX, also known as the Philippine

Act of 2002, “An act providing for a more responsive nursing profession,
repealing for the purpose Republic Act No. 7164, otherwise known as "The

Philippine Nursing Act of 1991" and for other purposes”

To help in the clinical competence of student nurses who will become

future registered nurses in the Philippines, assessment and evaluation should be

done. Assessment of clinical competence is generally based on observed

performance of skills. Evaluation of competence of students is needed and it

involves several raters (clinical instructors and staff nurses, etc) who will assess

different areas of competencies encompassing the three domains of learning -

knowledge, skills and attitudes (Caparas, 2001). Assessment results should be

used to provide feedback to both students and faculty to improve clinical

evaluation of students’ performance during clinical area work.

The Commission on Higher Education is the governing body covering

both public and private higher education institutions as well as degree-granting

programs in all tertiary educational institutions in the Philippines. In accordance

with pertinent provisions of Republic Act (RA) No. 7722, otherwise known as the

Higher Education Act of 1994 and pursuant to Commission en Banc Resolution

No. 170 dated April 19, 2009, and for the purpose of rationalizing Nursing

Education in the country to provide relevant and quality health services locally

and internationally, policies and standards for Bachelor of Science in Nursing

(BSN) program are adopted and promulgated by the Commission.

According to Article IV Section 5 of CHED Memorandum Order (CMO)

Series of 2009, “Graduates of Bachelor of Science in nursing program must be

able to apply analytical and critical thinking in the nursing practice. The nurse

must be competent in the following Key Areas of Responsibility and its respective

core competency standards and indicators” (www.ched.gov.ph).

In 2005, the Board of Nursing created the Committee on Core

Competency Standards Development in collaboration with the Commission on

Higher Education Technical Committee on Nursing Education with the primary

goal to develop the competency standards for nursing practice in the country.

New expectations for contemporary nursing practice competencies are emerging

which is heightened by the escalating complexity of globalization, the dynamincs

of health science and information technology demographic changes, healthcare

policy reforms, and the increasing and more exacting demands from the

consumers of health care. The new competency standards will serve as a unifying

framework for nursing education regulation and practice. Specifically, it will

serve as a guide in developong curriculum in nursing, framework in developing

test syllabus for entrants into the nursing profession, tool for performance

evaluation among nurses, basis for advanced nursing practice and specialization,

framework for developing a training curriculum for nurses, protect the public

from incompetent nurses and a yardstick for unethical and unprofessional practice

of nursing. There are Eleven Core Competency Standards for nursing practice

were identified: a) safe and quality nursing care, b) management of resources and

environment, c) health education, d) legal responsibility, e) ethico-moral

responsibility, f) personal and professional development, g) quality improvement,

h) research, i) record management, j) communications, and k) collaboration and

teamwork.

There are seven (7) Core Competencies under Safe and Quality Nursing

Care and each of the seven (7) core competencies have indicators that would

deem a nursing student a competent. First, there is demonstrating knowledge

based on the health /illness status of individual / groups. This can be indicated by

a nursing student who identifies the health needs of the clients (individuals,

families, population groups and/or communities) and who explains the health

status of the clients / groups. Second, the nursing student shoud provide sound

decision making in the care of individuals / families/groups considering their

beliefs and values, wherein he or she identifies wellness potential and/or health

problem of clients, gathers data related to the health condition, analyzes the data

gathered, selects appropriate action to support/enhance wellness response;

manage the health problem and monitors the progress of the action taken. Third,

there is promoting safety and comfort and privacy of clients. This can be done by

a nursing student who performs age-specific safety measures in all aspects of

client care, performs age-specific comfort measures in all aspects of client care

and performs age-specific measures to ensure privacy in all aspects of client care.

Fourth, there is setting priorities in nursing care based on clients’ needs. In this

core competency, the nursing student identifies the priority needs of clients,

analyzes the needs of clients and determines appropriate nursing care to address

priority needs/problems. Fifth, there is the ensurance of continuity of care. This

can be achieved by a nursing student who refers identified problem to appropriate

individuals / agencies and establishes means of providing continuous client care.

Sixth, is by administering medications and other health therapeutics, wherein a

nursing student must conform to the 10 golden rules in medication administration

and health therapeutics. Lastly, the seventh core competency is by utilizing the

nursing process as framework for nursing. This can be done by a nursing student

by obtaining informed consent and by completing appropriate assessment forms.

There are some interesting sex-specific pattern in the choice of academic

programs among college and graduate students. Male students tend to pursue

degrees in engineering, physical and natural science and business. Women, in

contrast, are heavily concentrated in nursing, home economics, education, social

sciences and humanities (Detablan, 2000).

Fundamental responsibility of the nurse is fourfold: to promote health, to

prevent illness, to restore health and to alleviate suffering. In carrying out

responsibilities, nurses assist individuals and families and communicate in the

prevention of illness. They minister to the needs of the patient, help them to

regain full health, provide comfort and support in the events of chronic or

incurable diseases. In doing so, a nurse should work competently to provide

proper and sufficient health services for the people (Buenaventura-Tungpalan, et

al., (2000).

Nurses should have a good foundation of learning for them to give quality

care to their patients. It is because, according to Mansibang (2006), “nursing is an

advocacy to secure people’s health through competence and high standard of

education.” He added that school must embody its dedication to nurses as

vanguards of healthcare and societal transformation. He also explained that

students must be taught how to develop critical thinking skills and conceptual

retention. In addition, when they become registered nurses, they should know how

to use their own judgments in dealing with difficult situations.

In fact, according to Cuevas (2001), “nurses should go back to the noble

reason of compassion and caring.” The emergence of nursing as a very lucrative

profession has taken its toll on the quality of service of the country’s nurses. She

further explained that bringing back the passion for money could overshadow the

passion for nursing is very important, because the passion for money could

overshadow the passion for nursing. The passion for work affects the nurse’s

approach toward the patients, thereby affecting the patients’ recovery time.

Second, we have to have the caring attitude towards our patients and finally, we

should have the passion in our profession. We are known worldwide for our

caring nurses, our so-called “new heroes” who contribute substantially to our

country by ensuring at all times there is high quality and integrity of our nursing

profession (Osit, 2006).

The following local literatures provided the researchers foundation on the

responsibility of nurses and what competence is, why competence should be

assessed and how it can be measured. It is important to improve the quality of

nursing in the Philippines so that the country could produce globally competitive

nurses (Vitriolo, 2006). But it wasn’t only about competitiveness why Filipino

nurses are sought after in other countries, also because of the caring attitude they
possess. Nursing remains as a perceived female role and requires certain basic

qualities that are innate in females and males need to work on them such as

empathy, caring, relationships, communication and that general ability to manage

thru all adversity.

Foreign Literature

Nursing student's experiences of their clinical practice provide greater

insight to develop an effective clinical teaching strategy in nursing education. The

main objective of this study was to investigate student nurses' experience about

their clinical practice.

Focus groups were used to obtain students' opinion and experiences about

their clinical practice. 90 baccalaureate nursing students at Shiraz University of

Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly

from two hundred students and were arranged in 9 groups of ten students. To

analyze the data the method used to code and categories focus group data were

adapted from approaches to qualitative data analysis.

Four themes emerged from the focus group data. From the students' point

of view," initial clinical anxiety", "theory-practice gap"," clinical supervision",

professional role", were considered as important factors in clinical experience.

The result of this study showed that nursing students were not satisfied

with the clinical component of their education. They experienced anxiety as a

result of feeling incompetent and lack of professional nursing skills and

knowledge to take care of various patients in the clinical setting.

 Clinical experience has been always an integral part of nursing education.

It prepares student nurses to be able of "doing" as well as "knowing" the clinical

principles in practice. The clinical practice stimulates students to use their critical

thinking skills for problem solving.

Awareness of the existence of stress in nursing students by nurse

educators and responding to it will help to diminish student nurses experience of

stress.

Clinical experience is one of the most anxiety producing components of

the nursing program which has been identified by nursing students. In a

descriptive correlational study by Beck and Srivastava 94 second, third and fourth

year nursing students reported that clinical experience was the most stressful part

of the nursing program. Lack of clinical experience, unfamiliar areas, difficult

patients, fear of making mistakes and being evaluated by faculty members were

expressed by the students as anxiety-producing situations in their initial clinical

experience. In study done by Hart and Rotem stressful events for nursing students

during clinical practice have been studied. They found that the initial clinical

experience was the most anxiety producing part of their clinical experience. The

sources of stress during clinical practice have been studied by many researchers.

The researcher came to realize that nursing students have a great deal of

anxiety when they begin their clinical practice in the second year. It is hoped that

an investigation of the student's view on their clinical experience can help to

develop an effective clinical teaching strategy in nursing education.

 A focus group design was used to investigate the nursing student's view

about the clinical practice. Focus group involves organized discussion with a

selected group of individuals to gain information about their views and

experiences of a topic and is particularly suited for obtaining several perspectives

about the same topic. Focus groups are widely used as a data collection technique.

The purpose of using focus group is to obtain information of a qualitative nature

from a predetermined and limited number of people.

Using focus group in qualitative research concentrates on words and

observations to express reality and attempts to describe people in natural

situations.

The group interview is essentially a qualitative data gathering technique. It

can be used at any point in a research program and one of the common uses of it

is to obtain general background information about a topic of interest.

Focus groups interviews are essential in the evaluation process as part of a

need assessment, during a program, at the end of the program or months after the

completion of a program to gather perceptions on the outcome of that program.

Kruegger (1988) stated focus group data can be used before, during and after

programs in order to provide valuable data for decision making.

The participants from which the sample was drawn consisted of 90

baccalaureate nursing students from two hundred nursing students (30 students

from the second year and 30 from the third and 30 from the fourth year) at Shiraz

University of Medical Sciences (Faculty of Nursing and Midwifery). The second

year nursing students already started their clinical experience. They were arranged

in nine groups of ten students. Initially, the topics developed included 9 open-

ended questions that were related to their nursing clinical experience. The topics

were used to stimulate discussion.

The following topics were used to stimulate discussion regarding clinical

experience in the focus groups.

1. How do you feel about being a student in nursing education?

2. How do you feel about nursing in general?

3. Is there anything about the clinical field that might cause you to feel

anxious about it?

4. Would you like to talk about those clinical experiences which you

found most anxiety producing?

5. Which clinical experiences did you find enjoyable?

6. What are the best and worst things do you think can happen during the

clinical experience?

7. What do nursing students worry about regarding clinical experiences?

8. How do you think clinical experiences can be improved?

9. What is your expectation of clinical experiences?

 The first two questions were general questions which were used as ice

breakers to stimulate discussion and put participants at ease encouraging

them to interact in a normal manner with the facilitator.

The following steps were undertaken in the focus group data analysis.

1. Immediate debriefing after each focus group with the observer and

debriefing notes were made. Debriefing notes included comments about

the focus group process and the significance of data

2. Listening to the tape and transcribing the content of the tape

3. Checking the content of the tape with the observer noting and

considering any non-verbal behavior. The benefit of transcription and

checking the contents with the observer was in picking up the following:

a. Parts of words

b. Non-verbal communication, gestures and behavior...

The researcher facilitated the groups. The observer was a public health

graduate who attended all focus groups and helped the researcher by taking notes

and observing students' on non-verbal behavior during the focus group sessions.

Observer was not known to students and researcher.

The methods used to code and categorize focus group data were adapted

from approaches to qualitative content analysis discussed by Graneheim and

Lundman and focus group data analysis by Stewart and Shamdasani For coding

the transcript it was necessary to go through the transcripts line by line and
paragraph by paragraph, looking for significant statements and codes according to

the topics addressed. The researcher compared the various codes based on

differences and similarities and sorted into categories and finally the categories

was formulated into a 4 themes.

The researcher was guided to use and three levels of coding. Three levels

of coding selected as appropriate for coding the data.

Level 1 coding examined the data line by line and making codes which

were taken from the language of the subjects who attended the focus groups.

Level 2 coding which is a comparing of coded data with other data and the

creation of categories. Categories are simply coded data that seem to cluster

together and may result from condensing of level 1 code.

Level 3 coding which describes the Basic Social Psychological Process

which is the title given to the central themes that emerge from the categories.

The documents were submitted to two assessors for validation. This action

provides an opportunity to determine the reliability of the coding. Following a

review of the codes and categories there was agreement on the classification.

The study was conducted after approval has been obtained from Shiraz

university vice-chancellor for research and in addition permission to conduct the

study was obtained from Dean of the Faculty of Nursing and Midwifery. All

participants were informed of the objective and design of the study and a written
consent received from the participants for interviews and they were free to leave

focus group if they wish.

Most of the students were females (%94) and single (% 86) with age

between 18–25.

The qualitative analysis led to the emergence of the four themes from the

focus group data. From the students' point of view," initial clinical anxiety",

"theory-practice gap", clinical supervision"," professional role", was considered

as important factors in clinical experience.

This theme emerged from all focus group discussion where students

described the difficulties experienced at the beginning of placement. Almost all of

the students had identified feeling anxious in their initial clinical placement.

Worrying about giving the wrong information to the patient was one of the issues

brought up by students.

One of the students said:

On the first day I was so anxious about giving the wrong information to

the patient. I remember one of the patients asked me what my diagnosis is. ‘I said

'I do not know', she said 'you do not know? How can you look after me if you do

not know what my diagnosis is?'

From all the focus group sessions, the students stated that the first month

of their training in clinical placement was anxiety producing for them.

One of the students expressed:

 The most stressful situation is when we make the next step. I

mean...clinical placement and we don't have enough clinical experience to

accomplish the task, and do our nursing duties.

Almost all of the fourth year students in the focus group sessions felt that

their stress reduced as their training and experience progressed.

Another cause of student's anxiety in initial clinical experience was the

students' concern about the possibility of harming a patient through their lack of

knowledge in the second year.

One of the students reported:

In the first day of clinical placement two patients were assigned to me.

One of them had IV fluid. When I introduced myself to her, I noticed her IV was

running out. I was really scared and I did not know what to do and I called my

instructor.

Fear of failure and making mistakes concerning nursing procedures was

expressed by another student. She said:

I was so anxious when I had to change the colostomy dressing of my 24

years old patient. It took me 45 minutes to change the dressing. I went ten times

to the clinic to bring the stuff. My heart rate was increasing and my hand was

shaking. I was very embarrassed in front of my patient and instructor. I will never

forget that day.

 Sellek researched anxiety-creating incidents for nursing students. He

suggested that the ward is the best place to learn but very few of the learner's

needs are met in this setting. Incidents such as evaluation by others on initial

clinical experience and total patient care, as well as interpersonal relations with

staff, quality of care and procedures are anxiety producing.

The category theory-practice gap emerged from all focus discussion where

almost every student in the focus group sessions described in some way the lack

of integration of theory into clinical practice.

I have learnt so many things in the class, but there is not much more

chance to do them in actual settings.

Another student mentioned:

When I just learned theory for example about a disease such as diabetic

mellitus and then I go on the ward and see the real patient with diabetic mellitus,

I relate it back to what I learned in class and that way it will remain in my mind.

It is not happen sometimes.

The literature suggests that there is a gap between theory and practice. It

has been identified by Allmark and Tolly. The development of practice theory,

theory which is developed from practice, for practice, is one way of reducing the

theory-practice gap. Rolfe suggests that by reconsidering the relationship between

theory and practice the gap can be closed. He suggests facilitating reflection on

the realities of clinical life by nursing theorists will reduce the theory-practice

gap. The theory- practice gap is felt most acutely by student nurses. They find
themselves torn between the demands of their tutor and practicing nurses in real

clinical situations. They were faced with different real clinical situations and are

unable to generalize from what they learnt in theory.

Clinical supervision is recognized as a developmental opportunity to

develop clinical leadership. Working with the practitioners through the milieu of

clinical supervision is a powerful way of enabling them to realize desirable

practice. Clinical nursing supervision is an ongoing systematic process that

encourages and supports improved professional practice. According to Berggren

and Severinsson the clinical nurse supervisors' ethical value system is involved in

her/his process of decision making.

Clinical Supervision by Head Nurse (Nursing Unit Manager) and Staff

Nurses was another issue discussed by the students in the focus group sessions.

One of the students said:

Sometimes we are taught mostly by the Head Nurse or other Nursing staff.

The ward staff are not concerned about what students learn, they are busy with

their duties and they are unable to have both an educational and a service role

Another student added:

Some of the nursing staff have good interaction with nursing students and

they are interested in helping students in the clinical placement but they are not

aware of the skills and strategies which are necessary in clinical education and are

not prepared for their role to act as an instructor in the clinical placement
 The students mostly mentioned their instructor's role as an evaluative

person. The majority of students had the perception that their instructors have a

more evaluative role than a teaching role.

The literature suggests that the clinical nurse supervisors should expressed

their existence as a role model for the supervisees.

One view that was frequently expressed by student nurses in the focus

group sessions was that students often thought that their work was 'not really

professional nursing' they were confused by what they had learned in the faculty

and what in reality was expected of them in practice.

We just do basic nursing care, very basic. ...You know...giving bed baths,

keeping patients clean and making their beds. Anyone can do it. We spend four

years studying nursing but we do not feel we are doing a professional job.

The role of the professional nurse and nursing auxiliaries was another

issue discussed by one of the students:

The role of auxiliaries such as registered practical nurse and Nurses Aids

are the same as the role of the professional nurse. We spend four years and we

have learned that nursing is a professional job and it requires training and skills

and knowledge, but when we see that Nurses Aids are doing the same things, it

cannot be considered a professional job.

The result of student's views toward clinical experience showed that they

were not satisfied with the clinical component of their education. Four themes of
concern for students were 'initial clinical anxiety', 'theory-practice gap', 'clinical

supervision', and 'professional role'.

The nursing students clearly identified that the initial clinical experience is

very stressful for them. Students in the second year experienced more anxiety

compared with third and fourth year students. This was similar to the finding of

Bell and Ruth who found that nursing students have a higher level of anxiety in

second year. Neary identified three main categories of concern for students which

are the fear of doing harm to patients, the sense of not belonging to the nursing

team and of not being fully competent on registration which are similar to what

our students mentioned in the focus group discussions. Jinks and Patmon also

found that students felt they had an insufficiency in clinical skills upon

completion of pre-registration program.

Initial clinical experience was the most anxiety producing part of student

clinical experience. In this study fear of making mistake (fear of failure) and

being evaluated by faculty members were expressed by the students as anxiety-

producing situations in their initial clinical experience. This finding is supported

by Hart and Rotem and Stephens. Developing confidence is an important

component of clinical nursing practice. Development of confidence should be

facilitated by the process of nursing education; as a result students become

competent and confident. Differences between actual and expected behavior in

the clinical placement creates conflicts in nursing students. Nursing students

receive instructions which are different to what they have been taught in the

classroom. Students feel anxious and this anxiety has effect on their performance.
 The existence of theory-practice gap in nursing has been an issue of

concern for many years as it has been shown to delay student learning. All the

students in this study clearly demonstrated that there is a gap between theory and

practice. This finding is supported by other studies such as Ferguson and Jinks

and Hewison and Wildman and Bjork. Discrepancy between theory and practice

has long been a source of concern to teachers, practitioners and learners. It deeply

rooted in the history of nurse education. Theory-practice gap has been recognized

for over 50 years in nursing. This issue is said to have caused the movement of

nurse education into higher education sector.

Clinical supervision was one of the main themes in this study. According

to participant, instructor role in assisting student nurses to reach professional

excellence is very important. In this study, the majority of students had the

perception that their instructors have a more evaluative role than a teaching role.

About half of the students mentioned that some of the head Nurse (Nursing Unit

Manager) and Staff Nurses are very good in supervising us in the clinical area.

The clinical instructor or mentors can play an important role in student nurses'

self-confidence, promote role socialization, and encourage independence which

leads to clinical competency. A supportive and socializing role was identified by

the students as the mentor's function. This finding is similar to the finding of

Earnshaw. According to Begat and Severinsson supporting nurses by clinical

nurse specialist reported that they may have a positive effect on their perceptions

of well-being and less anxiety and physical symptoms.

 The students identified factors that influence their professional

socialization. Professional role and hierarchy of occupation were factors which

were frequently expressed by the students. Self-evaluation of professional

knowledge, values and skills contribute to the professional's self-concept. The

professional role encompasses skills, knowledge and behavior learned through

professional socialization. The acquisition of career attitudes, values and motives

which are held by society are important stages in the socialization process.

According to Corwin autonomy, independence, decision-making and

innovation are achieved through professional self-concept. Lengacher (1994)

discussed the importance of faculty staff in the socialization process of students

and in preparing them for reality in practice. Maintenance and/or nurturance of

the student's self-esteem play an important role for facilitation of socialization

process.

One view that was expressed by second and third year student nurses in

the focus group sessions was that students often thought that their work was 'not

really professional nursing' they were confused by what they had learned in the

faculty and what in reality was expected of them in practice.

The finding of this study and the literature support the need to rethink

about the clinical skills training in nursing education. It is clear that all themes

mentioned by the students play an important role in student learning and nursing

education in general. There were some similarities between the results of this

study with other reported studies and confirmed that some of the factors are
universal in nursing education. Nursing students expressed their views and

mentioned their worry about the initial clinical anxiety, theory-practice gap,

professional role and clinical supervision. They mentioned that integration of both

theory and practice with good clinical supervision enabling them to feel that they

are enough competent to take care of the patients.

The result of this study would help us as educators to design strategies for

more effective clinical teaching. The results of this study should be considered by

nursing education and nursing practice professionals. Faculties of nursing need to

be concerned about solving student problems in education and clinical practice.

The findings support the need for Faculty of Nursing to plan nursing curriculum

in a way that nursing students be involved actively in their education.

The nursing industry has established eleven key areas of responsibility that

provide a framework for unifying nursing education, practice and regulation. This

comprehensive list of key areas and core competencies within each key area

furnishes the industry with a standardized measure that is used in all aspects of the

nursing profession (Landford, 2010).

Safety and Quality - The first key area of nursing responsibility focuses on

providing nursing care that is safe and of high quality. Under this key area, core

competencies include demonstrating knowledge about the health status and illness

of a patient; making appropriate decisions when caring for patients and

their families; and ensuring patient safety, privacy and comfort. Competencies

also include setting appropriate priorities in patient care, working with the
medical team to ensure stability of care, effectively administering medications

and other treatment modalities and performing assessments and nursing services

against a background of established nursing guidelines. The nurse also works with

the medical team and patient's family to develop a plan of care. Identifying the

goals of care and evaluating progress toward those goals are also core

competencies within this key area.

Resources and Environment - the next key area is the management of

resources and environment. Core competencies in this area include identifying

tasks that need to be completed, developing financially effective programs,

ensuring that equipment performs adequately and maintaining safety in the

environment.

Health Education - educational core competencies include assessing the

educational needs of the patient and family, developing and implementing health

education plans and learning materials and evaluating the outcome of education

administered.

Legal Responsibilities - core competencies in the legal key area include

following legally mandated state and federal processes and procedures, such as

obtaining informed consent from patients and adequately documenting all

procedures performed for patients.

 Ethical Responsibilities - in this key area that concerns morals and

ethics, core competencies include respecting the rights of all individuals and

groups, accepting responsibility for individual decisions and adhering to the

nurses' national and international code of ethics.

Professional Development - the professional development key area

includes core competencies of identifying personal needs for education and

pursuing those goals, participating in professional organizations and

community activities, presenting a professional image and positive attitude as

well as performing work duties in a professional manner.

Quality Improvement - in the quality improvement key area, core

competencies include identifying areas for improvement, participating in

nursing rounds and audits, staying aware of variances in treatment and

recommending solutions to improve quality.

Research - core competencies in the research key area include

gathering and analyzing research data, sharing results and applying findings

to work functions.

Records Management - the records management key area includes core

competencies of maintaining appropriate documentation using the

appropriate system and staying within legal boundaries in the area of patient

privacy.
 Communication - in this key area, core competencies include

establishing communication with the patient and treatment team, learning to

read verbal and nonverbal cues, using visual aids and other resources when

necessary, responding to patient and group needs and effectively using

technology to facilitate communication.

Teamwork - the teamwork and collaboration key area includes core

competencies of establishing beneficial working relationships with peers and

colleagues and communicating care plans with health team members.

Bellosillo et al (2008) postulated that due to the foregoing, new

expectations for contemporary nursing practice, competencies are emerging,

which is heightened by the escalating complexity of globalization, the dynamics

of health science and information technology, demographic changes, health care

policy reforms and the increasing and more exacting demands from the

consumers of health care. Moreover, the surge of overseas employment

opportunities for Filipino nurses creates depletion in the reservoir of competent

professional to serve the health needs of the country. These changes are spawned

by the multitudes of forces converging in the national as well as international

levels, which impact on the quality of nursing practice in the country.

Accordingly, the Board of Nursing had created a committee which is

responsible for developing competency standards for nursing practice in the

country and this is called: Committee on Core Competency Standards

Development (CCCSD) together with collaboration in the Commission on Higher

Education Technical Committee on Nursing Education (CHED-TCNED).

Furthermore, Bellosillo et al (2008) elaborated that the Committee was composed

of leaders from nursing education, nursing practice and nursing regulation. The

whole gamut of developing the standards were made possible through the

participation of representatives of professional nursing organizations, consumers

of nursing practice such as doctors, administrators and patients, senior nursing

students and in consultation with nurse executives from regulatory authorities in

three countries.

Most health care providers begin their health profession education

expecting to acquire the knowledge and skills needed to provide high-quality care.

However, as they advance through their education and begin their careers, they

discover that health care systems are exceedingly complex, with a myriad of

system issues that often make the provision of high-quality care difficult.

In addition, Bates et al (1995) discussed that nurses are uniquely

positioned to serve as change agents within health systems. By partnering with

other health care providers who share their vision for improving care and by

linking with institutional quality professionals, the impact of nursing

improvement efforts is heightened. As health care systems increasingly recognize

the value of this work, nurses find that their contributions to care improvement

lead not only to a sense of personal reward, but may lead to professional

advancement. Investment in the development of skills in quality improvement

provides a means for nurses to improve the lives of patients, build their own

careers, and improve the joy they derive from their work.
 Since then, the Board of Nursing had released a Resolution No. 112 Series

of 2005 which centers on “A Resolution Adopting and Promulgating the

Competency Standards for Nursing Practice in the Philippines” which give

emphasis that the 11 core competency areas of nursing should be utilized as a

framework for the development of Instructional Standards in the Curriculum, the

formulation of course syllabi and questions in the Integrated Comprehensive

Nurse Licensure Examinations and the development of standards and

performance evaluation in the practice of nursing (Bellosillo, 2008).

After this resolution number had taken effect, different nursing schools in

the Philippines had adopted the application and incorporation of the eleven

nursing core competencies in their curriculum specifically in Nursing Care

Management and Related Learning Experience. The Mindanao Sanitarium and

Hospital College had already followed and applied these eleven nursing core

competencies as a model principle of nursing practice. The institution had

incorporated this in the related learning experience and part of their teaching

syllabi on the subject Nursing Care Management.

According to Scott (2008) developing meaningful competency

requirements for registered muses continues to confound the sing profession. The

challenge it presents for healthcare regulators is learning how to objectively

measure competencies across various settings, specialties, years of experience and

geographic regions. According to Oppewal et al. (2006), core competencies have

been developed in different specialty areas, but even nurses' awareness and

implementation of such standards vary. The National Council of State Boards of

Nursing (NCSBN) has worked, through their committees of Research and

Practice, Regulation, and Education, to develop a program to transition graduate

nurses into the profession; this program has been a culmination of research and

defines the needs of new nurses. Spector and Li (2007) discuss this ongoing

research that is being completed to assess the design of this program.

At the Center for American Noses LEAD Summit 2008, Dr. May Arm

Alexander, Chief Offices of Nursing Regulation for the NCSBN, will present

current research and findings about past, present and future issues related to

continued nursing competence.

According to J Allied Health (2006) this paper describes the amalgamation

of the core competencies identified for medicine, nursing, physical therapy, and

occupational therapy and the "harmonization" of these competencies into a

framework tor interprofessional education. The study was undertaken at a

Canadian university with a Faculty of Health Sciences comprised of three schools

(namely, medicine, nursing, and rehabilitation therapy). Leaders in

interprofessional education began to identify the common standards for the core

competencies expected of learners in all three schools at commensurate levels to

facilitate the integration of educational curricula aimed at interprofessional

education across the Faculty. The model that was created serves as a basis for

curriculum design and assessment of individuals and groups of learners from

different domains across and within the four professions. It particularly highlights

the relevance of cross-disciplinary competency teaching and 360-degree

evaluation in teams. Most importantly, it provides a launch pad for clarifying

performance standards and expectations in interdisciplinary learning.

While in the early stages of creating an academy of educators skilled at

teaching and evaluating interprofessional practice and education at a Canadian

university, two needs emerged as crucial to the success of a change in culture in

academic health sciences, namely: 1) to identify the common standards for the

core competencies expected of learners in all three schools at commensurate

levels and 2) to develop and evaluate a curriculum that can he delivered at the

appropriate levels and with appropriate standards for the four professions in the

faculty. These critical issues arose out of the expressed desire of teaching faculty

to have a shared vocabulary and better understanding of objectives, expectations,

and standards in their health care professions.

Consensus emerged that a logical place to begin would be with a

description of the vital competencies required tor the four professions. This paper

describes the amalgamation of the core competencies identified for medicine,

nursing, physical therapy, and occupational therapy and the 'harmonization' of

these competencies into a framework for interprofessional education.

A competency model that defines a set of expected skills both "vertically"

and "horizontally" between health care professions does not exist. A major barrier

to the success of interprofessional education has been the lack of understanding of

shared competencies for the members of the health care education team and a lack

of common vocabulary that can be used interchangeably for teaching and

evaluation.2
 Consensus on core competencies in health care provides a common

framework and language for discussing how to teach and evaluate the

expectations for interdisciplinary performance in health care teams. Common core

competencies provide a shared understanding of the scope and requirements of a

specific role and mutual organization wide standards for performance.

A systematic review of the literature was conducted of MEDLINE,

CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED

(Allied and Complementary Medicine), and the Cochrane Database of Systematic

Reviews. The search terms included: education, competency-based; education,

interdisciplinary; interprofessional relations; professional competence; delivery of

health care, integrated; clinical competence; and patient care team. The yield from

this intensive search was extremely limited.

Although there were various articles about the importance of shared

learning,3 interprofessional education,4-6 working together as teams,7-9 and

integrated health delivery systems,10 there were few articles that outlined specific

competencies across disciplines. One paper11 outlined the need for allied health

professionals to shift educational paradigms to articulate common competencies

across several disciplines and recommended a proposal for achieving and

measuring competencies in an interdisciplinary manner.

Barr (2006) suggested that the case for competency-based

interprofessional education rests on the need to:

 * Reposition interprofessional education in the mainstream of

contemporary professional education;

* Enable students to relate professional and interprofessional

studies coherently;

* Enable students on interprofessional courses to claim credits as

part of their professional education.

In nursing school, we are taught to respect the rights and dignity of all

clients. As the “world becomes smaller” and individuals and societies become

more mobile, we are increasingly able to interact with individuals as a competent

nurses. Competence becomes important for us as nurses and patient advocates.

Competence is the ability to provide effective care for clients who came from

different cultures. It requires sensitivity and effective communication, both

verbally and non-verbally (Anderson, 2009).

Competency, as discussed in the Competency standards approach to

professional education and practice, is defined as a combination of attributes

enabling performance of a range of professional tasks to the appropriate standards

(Gonczi, Hager & Oliver, 1990). Competency encompasses more than just a

psychomotor skill. It describes the attributes of knowledge, abilities, skills and

attitudes that underlie competent performance. Nurses know that psychomotor

skills are important but, performed without knowledge, they do not constitute

nursing. Nursing knowledge of health and disease processes is of little use

without appropriate nursing skills to implement. The abilities to plan and organize
our work are of little benefit to patients or clients if the attitude that nurses value

such as, caring and patience is not present. Therefore, integration of the

knowledge, abilities, skills and attitudes of nursing is the essential key to

understanding and performing competencies.

Competence does not mean expert. There exist various levels of

competence but each of these has a minimum acceptable level or standard.

Beginners are rarely expert, but they can be competent. They perform a wide

range of nursing activities methodically and well. They may be slow but develop

further skills and speed in time. They have to ask many questions but they know

which questions to ask. Beginning graduate nurses may be a little slow

completing total patient care, be somewhat limited in the range of skills they can

perform, not possess a great deal of specialized knowledge but they are easily

distinguished from someone who is not a nurse, or even a novice student nurse.

The experienced competent nurse works quickly and capably, able to care

for a highly complex and dependent patient in the critical care unit, or nurse

several high dependency patients in a busy surgical or medical ward. In the

community setting, nursing skills of assessment and decision-making are often

invisible, but are reflected in the delivery of patient care. Experienced and expert

nurses have amazing memories, seem to do twenty things at once, cope with

interruptions and can deal with emergencies, all calmly and expertly. Yet behind

the smooth performance we recognize the knowledge, abilities, skills and attitudes

that are integrated into the professional demonstration of excellent nursing. If you
have recognized an example of nursing such as this, then you can recognize

nursing competency.

In order for nurses to successfully design and build systems that support

the highest levels of nursing development, it must first understand it’s core

competencies. Competencies has been defined in the article, People Are Critical

to Success, as a set of behaviors that encompasses skills, knowledge, abilities, and

personal attributes that, taken together, are critical to successful work

accomplishment (Avilar, 2000). In addition, an ongoing process for change

management must be in place that addresses feedback, learning, and process

flexibility. A learning culture must be of prime importance to top leadership and

must flow throughout the organization. Responsiveness to cultural and climatic

change within the industry must be identified quickly, specifically, and accurately

to reduce the margin of error for profitability and growth.

Competency in nursing has a direct influence on the health and safety of

all patients. Unfortunately, the absence of competency may lead to serious

medical errors resulting in serious consequences for the patient. Medical error is

the failure to complete a planned action as intended or the use of a wrong plan to

achieve an aim (Institute of Medicine, 2002). It was determined in their report that

medical errors lead to the deaths of nearly 98,000 hospitalized patients each year.

The Agency for Healthcare Quality and Research annual report determined that

the quality of care and safety factors associated with care of patients in the United

States continue to cause concern in 2004.

 Competence is a generic term referring to a person’s overall capacity,

while competency refers to specific capabilities, such as leadership (Eraut, 2001).

It is therefore important to be able to identify and measure the relevant

competencies that contribute to overall competence, and that each specific

competency is measured by a set of valid and reliable items representing the

appropriate knowledge, skills and abilities.

The safety of patients receiving medical care is clearly associated with the

competency of the healthcare providers, and quality care can only be

accomplished if the providers are deemed competent to provide the best possible

standard of care (Axley, 2008).

According to Joint Commission on Accreditation of Healthcare

Organizations (2006), competency is defined as a “determination of an

individual’s skills, knowledge, and capability to meet defined expectations”.

Furthermore, they require measuring the competency of the nurses.

Competency models have been implemented in both primary and

secondary education as a measure of success in a program of study. Specific

competencies are identified as role outcomes, or knowledge, skills, and attitudes,

or both, required for role performance, and then assessed by a criterion, usually a

behavioral standard (Rampey, et al., 2006). In accordance to that, core

competencies refer specifically to a group or compilation of skills or procedures

requiring the ability of an individual to successfully or competently perform the

requisite action and it differentiates quality and expertise in the identified

situation or individual (Hamel & Pahalad, 2006). However, competence is an

observable concept that is measurable, uniformed and validated through

examinations, assessment tools and rating scales (Coates & Chambers, 2004). In

contrast to that, competence is something more than the performance of skills and

accentuates the effects of skills on students and patients (Benner, 2002).

Assessment of nursing competence should be grounded in actual practice

and should include such dimensions as: ability to cope under pressure and over

time; delivery of compassionate, safe care of helpless patients; ability to solve

problems in crisis situations; ability to cope with the person in pain; and sensitive

care of the person who is dying. Other requirements for assessing competence are:

nursing competencies should be related to patient outcome; the criterion level for

competence should be established; and the assessment method should have

predictive validity in that it can predict competent performance in real-life

situations (Benner, 2002). It should be context-specific, therefore.

Although Abdellah spoke of the patient-centered approaches, she wrote of

nurses identifying and solving specific problems. This identification and

classification of problems was called the typology of 21 nursing problems.

Abdellah’s typology was divided into three areas: (1) the physical, sociological,

and emotional needs of the patient; (2) the types of interpersonal relationships

between the nurse and the patient; and (3) the common elements of patient care.

Adbellah and her colleagues thought the typology would provide a method to

evaluate a student’s experiences and also a method to evaluate a nurse’s

competency based on outcome measures (Tomey & Alligood, Nursing theorists

and their work 4th ed., p. 115).

A gender role is a set of behavioural norms associated particularly with

males or females in a given social group or system, often including the division of

labour between men and women. Gender-based roles coincident with sex-based

roles have been the norm in many traditional societies, with the specific

components and workings of the gender system of role division varying markedly

from society to society. Gender role is a focus of analysis in the social sciences

and humanities.

Alice Eagly’s “Social Role Theory” offers an explanation of gender

development that is based on socialization. She suggests that the sexual division

of labour and societal expectations based on stereotypes produced gender roles.

She distinguishes between the communal and agentic dimensions of gender-

stereotyped characteristics. The communal role is characterized by attributes, such

as nurturance and emotional expressiveness, commonly associated with domestic

activities, and thus, with women. The agentic role is characterized by attributes

such as assertiveness and independence, commonly associated with public

activities, and thus, with men. Behaviour is strongly influenced by gender roles

when cultures endorse gender stereotypes and form firm expectations based on

those stereotypes.

Florence Nightingale believed that most women would be required to

nurse, as part of their role as wife, mother or family caregiver (Torres, 2001).

Nursing remains a female dominated occupation and it has been regarded by

many societies as an innate feminine skill, which by being a natural part of the

woman's role required little in the way of development or reward.

On the other hand, male nurses are treated a bit better than the female

nurses on the floor. Female nurses tolerate a lot of abuse from administration and

from some doctors, whereas when men speak, complaints, concerns, findings,

assessments are heard sometimes louder than a female. In addition, he noted that

male nurses get paid more than female nurses. Male nurses do tend to move more

than females. Females get settled in and are afraid of change (Joey, 2006).

From the article entitled Dilemmas Facing Males in Nursing, it is stated

there that there will always be a gender issue in any treatment as long as patients

are allowed to have a preference. No one has the desire to remove that privilege.

There are advances in males taking on roles normally considered for female only

– e.g.: male midwives. The general perceptions of those mothers-to-be who meet

one have been generally receptive to the idea but it’s a big change in philosophy

for staff and patient alike. Change takes time and this one will not happen over

one generation. If a student or any nurse cannot accept that patients have a choice

in who treats them, then they are in the wrong profession, male or female. Where

logistics do not allow for a choice (e.g.: only female nurses and patient prefers a

male) then the service has a responsibility to improve that – not overcome the

issue by changing patient’s belief systems. The most frequent ’sexism’ of this

nature I have seen in healthcare is between staff and not patients- e.g.: using only

male staff to deal with an aggressive patient. Overall, the shortage on males in

nursing is because guys generally don’t choose nursing, not because the
profession is making it difficult for them. It remains a perceived female role and

requires certain basic qualities that are innate in females and males need to work

on them such as empathy, caring, relationships, communication and that general

ability to manage thru all adversity.

A person's gender role comprises several elements that can be expressed

through several factors, like clothing, behaviour, personal relationships, and

occupation. These elements are not fixed and have changed through time. Gender

roles traditionally were often divided into distinct feminine and masculine gender

roles, until especially the twentieth century when these roles diversified into many

different acceptable male or female roles in modernized countries throughout the

world. Thus, in many modern societies one's biological gender no longer

determines the functions that an individual can perform, allowing greater freedom

and opportunity for all people to achieve their individual potential and offer their

talents and abilities to society for the benefit of all.

Continuity of care is the comprehensive, coordinated and integrated

provision of health services. The focus of continuity of care is on the needs of the

client family, acknowledges clients and informal caregivers as partners in care,

and requires an interdisciplinary approach by formal caregivers (Bull & Roberts,

2001). Registered nurses are leaders in implementing collaborative practice. The

registered nurse, as a direct caregiver, has the most consistent presence in

providing care to a client and has knowledge of a client’s continuing care needs.

Therefore, a registered nurse can contribute significantly to the coordination and

 planning for continuity of care for a client. (Wells, LeClerc, Craig, Martin &

Marshall, 2002).

Local Studies

According to Armento (2008) a lack of qualified nursing educators and an

increasing workload in colleges may exacerbate problems between students and

instructors, greatly undermining the learning environment. The most common

problems arising between nursing students and their instructors are lack of

communication, misunderstandings and social/cultural problems.

Lack of Communication

In nursing school, it can be easy for students to have poor

communication with their instructors. Often, the instructor-to-student ratio shows

a large disparity, so students may not always get their questions or concerns

addressed. Student unions and organizations work to address this issue, but there

may still be problems.

At the beginning of the school year, get your instructors' contact numbers,

email addresses and office hours. Make sure to ask questions whenever

applicable. Nursing instructors encourage their students to be proactive, so if a

question is not urgent, seek out the answer yourself during self-guided study time,

or even create an informal study group, as a classmate may be able to assist.

Do not be intimidated, however. When you need clarification of a nursing

procedure or disease process, ask for it.

Misunderstandings

Long hours and the general pressures of a clinical environment can lead to

misunderstandings between students and nursing instructors. Sometimes nursing

instructors give too little feedback and may inadvertently contribute to student

mistakes. Other times, nursing instructors seem impossible to please, which may

leave students discouraged. Both teaching styles have negative effects on students'

enthusiasm. In fact, they can promote hostility.

Whenever possible, ask nursing instructors exactly what they are looking

for during clinical rotations. Instructors, regardless of how harried they may be,

will prefer that a nursing student fully understand concepts and techniques rather

than risk patient safety by guessing the appropriate course of action.

Social/Cultural Problems

Sociocultural problems are less common in nursing school than in other

educational environments because the material is so health-focused. The most

prominent concern may be cultural bias in textbooks and on certain exams.

Certain textbooks and exam questions may be uncomfortable for some students

because most nursing baselines are derived from European norms, rather than

encompassing a broad sociocultural perspective. Many nursing schools have

sought to remedy this by using textbooks that address differences among a variety

of cultures.

Cultural and religious awareness is important in providing sensitive

nursing care, so if nursing instructors are not adequately addressing diversity

issues, students should ask that such topics be considered. Nursing students

should also try to find and read books that address diversity and its place in the

clinical environment.

According Basa (2009) the responsibility for which a nurse should

demonstrate competence in:

1. Safe and quality nursing care

2. Management of resources and environment

3. Health education

4. Legal responsibility

5. Ethico-moral responsibility

6. Personal and professional development

7. Quality improvement

8. Research

9. Record Management

10. Communication

11. Collaboration and teamwork

I. Patient Care Competencies

1. Safe and Quality Nursing Care

 Core Competency 1: Demonstrates knowledge base on the health /illness status of

individual / groups

• Identifies the health needs of the clients (individuals, families, population groups

and/or communities)

• Explains the health status of the clients/ groups

Core Competency 2: Provides sound decision making in the care of individuals /

families/groups considering their beliefs and values

• Identifies clients’ wellness potential and/or health problem

• Gathers data related to the health condition

• Analyzes the data gathered

• Selects appropriate action to support/ enhance wellness response; manage the

health problem

• Monitors the progress of the action taken

Core Competency 3: Promotes safety and comfort and privacy of clients

• Performs age-specific safety measures in all aspects of client care

• Performs age-specific comfort measures in all aspects of client care

• Performs age-specific measures to ensure privacy in all aspects of client care

Core Competency 4: Sets priorities in nursing care based on clients’ needs

• Identifies the priority needs of clients

• Analyzes the needs of clients

• Determines appropriate nursing care to address priority needs/problems

 Core Competency 5: Ensures continuity of care

• Refers identified problem to appropriate individuals / agencies

• Establishes means of providing continuous client care

Core Competency 6: Administers medications and other health therapeutics

• Conforms to the 10 golden rules in medication administration and health

therapeutics

Core Competency 7: Utilizes the nursing process as framework for nursing

7.1 Performs comprehensive and systematic nursing assessment

• Obtains informed consent

• Completes appropriate assessment forms

• Performs appropriate assessment techniques

• Obtains comprehensive client information

• Maintains privacy and confidentiality

• Identifies health needs

7.2 Formulates a plan of care in collaboration with clients and other

members of the health team

• Includes client and his family in care planning

• Collaborates with other members of the health team

• States expected outcomes of nursing intervention maximizing clients’ competence

• Develops comprehensive client care plan maximizing opportunities for prevention

of problems and/or enhancing wellness response

• Accomplishes client-centered discharge plan

• Implements planned nursing care to achieve identified outcomes

• Explains interventions to clients and family before carrying them out to achieve

identified outcomes

• Implements nursing intervention that is safe and comfortable

• Acts to improve clients’ health condition or human response

• Performs nursing activities effectively and in a timely manner

• Uses the participatory approach to enhance client-partners empowering potential

for healthy life style/wellness

7.3 Evaluates progress toward expected outcomes

• Monitors effectiveness of nursing interventions

• Revises care plan based on expected outcomes

2. Communication

Core Competency 1: Establishes rapport with client, significant others and

members of the health team

• Creates trust and confidence

• Spends time with the client/significant others and members of the health team to

facilitate interaction

• Listens actively to client’s concerns/significant others and members of the health

team

Core Competency 2: Identifies verbal and non-verbal cues

• Interprets and validates client’s body language and facial expressions

Core Competency 3: Utilizes formal and informal channels

• Makes use of available visual aids

• Utilizes effective channels of communication relevant to client care management

Core Competency 4: Responds to needs of individuals, family, group and

community

• Provides reassurance through therapeutic touch, warmth and comforting words of

encouragement

• Provides therapeutic bio-behavioral interventions to meet the needs of clients

Core Competency 5: Uses appropriate information technology to facilitate

communication

• Utilizes telephone, mobile phone, electronic media

• Utilizes informatics to support the delivery of healthca

3. Collaboration and Teamwork

Core Competency 1: Establishes collaborative relationship with colleagues and

other members of the health team

• Contributes to decision making regarding clients’ needs and concerns

• Participates actively in client care management including audit

• Recommends appropriate intervention to improve client care

• Respect the role of other members of the health team

• Maintains good interpersonal relationship with clients , colleagues and other

members of the health team

Core Competency 2: Collaborates plan of care with other members of the health

Team

• Refers clients to allied health team partners

• Acts as liaison / advocate of the client

• Prepares accurate documentation for efficient communication of services

4. Health Education

Core Competency 1: Assesses the learning needs of the client-partner/s

• Obtains learning information through interview, observation and validation

• Analyzes relevant information

• Completes assessment records appropriately

• Identifies priority needs

Core Competency 2: Develops health education plan based on assessed and

anticipated needs

• Considers nature of learner in relation to: social, cultural, political, economic,

educational and religious factors.

• Involves the client, family, significant others and other resources in identifying

learning needs on behavior change for wellness, healthy lifestyle or management

of health problems
• Formulates a comprehensive health education plan with the following

components: objectives, content, time allotment, teaching-learning resources and

evaluation parameters

• Provides for feedback to finalize the plan

Core Competency 3: Develops learning materials for health education

• Develops information education materials appropriate to the level of the client

• Applies health education principles in the development of information education

materials

Core Competency 4: Implements the health education plan

• Provides for a conducive learning situation in terms of time and place

• Considers client and family’s preparedness

• Utilizes appropriate strategies that maximize opportunities for behavior change

for wellness/healthy life style

• Provides reassuring presence through active listening, touch, facial expression and

gestures

• Monitors client and family’s responses to health education

Core Competency 5: Evaluates the outcome of health education

• Utilizes evaluation parameters

• Documents outcome of care

• Revises health education plan based on client response/outcome/s

II. Empowering Competencies

 5. Legal Responsibility

Core Competency 1: Adheres to practices in accordance with the nursing law and

other relevant legislation including contracts, informed consent.

• Fulfills legal requirements in nursing practice

• Holds current professional license

• Acts in accordance with the terms of contract of employment and other rules and

regulations

• Complies with required continuing professional education

• Confirms information given by the doctor for informed consent

• Secures waiver of responsibility for refusal to undergo treatment or procedure

• Checks the completeness of informed consent and other legal forms

Core Competency 2: Adheres to organizational policies and procedures, local and

national

• Articulates the vision, mission of the institution where one belongs

• Acts in accordance with the established norms of conduct of the institution/

organization/legal and regulatory requirements

Core Competency 3: Documents care rendered to clients

• Utilizes appropriate client care records and reports.

• Accomplishes accurate documentation in all matters concerning client care in

accordance to the standards of nursing practice.

6. Ethico-moral Responsibility
 Core Competency 1: Respects the rights of individual / groups

• Renders nursing care consistent with the client’s bill of rights: (i.e. confidentiality

of information, privacy, etc.)

Core Competency 2: Accepts responsibility and accountability for own decision

and actions

• Meets nursing accountability requirements as embodied in the job description

• Justifies basis for nursing actions and judgment

• Projects a positive image of the profession

Core Competency 3: Adheres to the national and international code of ethics for

nurses

• Adheres to the Code of Ethics for Nurses and abides by its provision

• Reports unethical and immoral incidents to proper authorities

7. Personal and Professional Development

Core Competency 1: Identifies own learning needs

• Identifies one’s strengths, weaknesses/ limitations

• Determines personal and professional goals and aspirations

Core Competency 2: Pursues continuing education

• Participates in formal and non-formal education

• Applies learned information for the improvement of care

Core Competency 3: Gets involved in professional organizations and civic

activities

• Participates actively in professional, social, civic, and religious activities

• Maintains membership to professional organizations

• Support activities related to nursing and health issues

Core Competency 4: Projects a professional image of the nurse

• Demonstrates good manners and right conduct at all times

• Dresses appropriately

• Demonstrates congruence of words and action

• Behaves appropriately at all times

Core Competency 5: Possesses positive attitude towards change and criticism

• Listens to suggestions and recommendations

• Tries new strategies or approaches

• Adapts to changes willingly

Core Competency 6: Performs function according to professional standards

• Assesses own performance against standards of practice

• Sets attainable objectives to enhance nursing knowledge and skills

• Explains current nursing practices, when situations call for it

III. Enhancing Competencies

8. Records Management
 Core Competency 1: Maintains accurate and updated documentation of client care

• Completes updated documentation of client care

• Applies principles of record management

• Monitors and improves accuracy, completeness and reliability of relevant data

• Makes record readily accessible to facilitate client care

Core Competency 2: Records outcome of client care

• Utilizes a records system ex. Carded or Hospital Information System (HIS)

• Uses data in their decision and policy making activities

Core Competency 3: Observes legal imperatives in record keeping

• Maintains integrity, safety, access and security of records

• Documents/monitors proper record storage, retention and disposal

• Observes confidentially and privacy of the clients’ records

• Maintains an organized system of filing and keeping clients’ records in a

designated area

• Follows protocol in releasing records and other information

9. Management of Resources and Environment

Core Competency 1: Organizes work load to facilitate client care

• Identifies tasks or activities that need to be accomplished

• Plans the performance of tasks or activities based on priorities

• Verifies the competency of the staff prior to delegating tasks

• Determines tasks and procedures that can be safely assigned to other members of

the team

• Finishes work assignment on time

Core Competency 2: Utilizes financial resources to support client care

• Identifies the cost-effectiveness in the utilization of resources

• Develops budget considering existing resources for nursing care

Core Competency 3: Establishes mechanism to ensure proper functioning of

equipment

• Plans for preventive maintenance program

• Checks proper functioning of equipment considering the:

- intended use - safety

- cost benefits - waste creation and disposal storage

- infection control

- Refers malfunctioning equipment to appropriate unit

Core Competency 4: Maintains a safe environment

• Complies with standards and safety codes prescribed by laws

• Adheres to policies, procedures and protocols on prevention and control of

infection

• Observes protocols on pollution-control (water, air and noise)

• Observes proper disposal of wastes

• Defines steps to follow in case of fire, earthquake and other emergency situations.
 IV. Enabling Competencies

10. Quality Improvement

Core Competency 1: Gathers data for quality improvement

• Identifies appropriate quality improvement methodologies for the clinical

problems

• Detects variation in specific parameters i.e. vital signs of the client from day to

day

• Reports significant changes in clients’ condition/environment to improve stay in

the hospital

• Solicits feedback from client and significant others regarding care rendered

Core Competency 2: Participates in nursing audits and rounds

• Shares with the team relevant information regarding clients’ condition and

significant changes in clients’ environment

• Encourages the client to verbalize relevant changes in his/her condition

• Performs daily check of clients’ records / condition

• Documents and records all nursing care and actions implemented

Core Competency 3: Identifies and reports variances

• Reports to appropriate person/s significant variances/changes/occurrences

immediately

• Documents and reports observed variances regarding client care

Core Competency 4: Recommends solutions to identified problems

• Gives an objective and accurate report on what was observed rather than an

interpretation of the event

• Provides appropriate suggestions on corrective and preventive measures

• Communicates solutions with appropriate groups

11. Research

Core Competency 1: Gather data using different methodologies

• Specifies researchable problems regarding client care and community health

• Identifies appropriate methods of research for a particular client /community

problem

• Combines quantitative and qualitative nursing design through simple explanation

on the phenomena observed

Core Competency 2: Analyzes and interprets data gathered

• Analyzes data gathered using appropriate statistical tool

• Interprets data gathered based on significant findings

Core Competency 3: Recommends actions for implementation

• Recommends practical solutions appropriate to the problem based on the

interpretation of significant findings

Core Competency 4: Disseminates results of research findings

• Shares/presents results of findings to colleagues / clients/ family and to others

• Endeavors to publish research

• Submits research findings to own agencies and others as appropriate

 Core Competency 5: Applies research findings in nursing practice

• Utilizes findings in research in the provision of nursing care to individuals

groups / communities

• Makes use of evidence-based nursing to enhance nursing practice

According to Bartolome et. al (2009) this study will give insight about

teaching competency among instructor as perceived by BSN level in students in

MDC. The group conducted this study with the objective and finding the

significant differences in the perceived level of competence of the instructors

when grouped according to the people. This study tested the null hypothesis that

there is no difference in all perceived level of competence of the instructor when

group according of their profile. The study sough to answer the following

questions. What is the profile of the respondents in terms of gender and socio

economic status? Is there a significant difference in the perceived level of the

instruction when grouped according to the profile of the respondents?

The method employed in this study is descriptive comparative quantitative

research method. The respondents were chosen by the purposive sampling

technique. Respondents are all BSN level III regardless of their gender. Professor

in NCM 102 who has at least 5 years of experience and a master degree holder.

The primary instrument used for data collection was questionnaire which focuses

on its teaching competency of the instructor in terms of personal and professional

aspects as perceived by BSN Level III students in MDC. The questionnaire was

sent to an experienced lecturer for validation and approval and then handed out to

the dean of college. The data gathered from the survey questionnaire were
tabulated analyzed and interpreted with the use of the following statistical

technician frequency and percentage distribution T-Test and ANOVA.

After through interpretation of analysis and data gathering, we were able

to come up with the following conclusion. The profile of the respondents revealed

that there are more female respondents and a socio economic status of P50000

and up monthly income predominate the respondents. There is no significant

relationship between the perception and competency of instructor in terms of

professional and personal aspect when grouped according to the respondent’s

gender and socio economic status. This study revealed an adjectival rating of

“Agree” in all question pertaining to the perception of instructors professional and

personal aspects. Therefore from the study made by the respondents, the null

hypothesis is accepted.

Based from the finding and conclusion drawn from this study, the

following recommendations are made to the nursing administration, thus would

enable them to analyze what aspects of as profession and the appropriate

methodologies in teaching would ensure efficacy and high competence in

teaching that would lead to the students learning and apply then after. To the

faculty instructor, it ----- to promote learning by having a good interpersonal

relationship between the students and instruction understanding what it takes to

keep the students interested and motivated to excel in their academic studies. To

the nursing students, it aims to assess the coordination and cooperation between

instructors and students in Manila Doctors College to upgrade knowledge and

skills if nursing through involvement and assistance in discrimination of the new

trends in nursing lectures and discussion to facilitate learning. To the Further

Researcher, this study gives guidance, inspiration, and better understanding for

their research about nursing education. This will give opportunity to the future

researcher to share information and concepts leading to good interpersonal

relationship between the learner and the educator.

The care competence of the fourth year students was determined in a study

conducted at Tiangha in 2007. The research made use of observation that

emphasized the importance of student nurses developing knowledge and skill

competence in applying theory learned in the classroom.

To support the study mentioned above, the study of Mangaoang in 2000

aimed to find out the level of performance of staff nurses along competency in

caring, decision making, moral responsibility/accountability, assertiveness and

interpersonal relations as perceived by staff nurses, immediate supervisors and

patients. Regularly, Colleges of Nursing should assess the clinical exposure and

implementation of the curriculum to identify the strengths and weaknesses.

Nursing service administration should develop or improve their tool to assess

performances of nurses. While nurse educators should imbibe to their students the

essence of developing their competency in caring, becoming morally responsible,

good decision maker, and establish a therapeutic interpersonal relationship for a

better quality care and to be carried on in their work.

According to Adversario (2003), “Quality care begins from one’s training

in school but even here the quality of training is slipping”. Medication errors in
the hospital are common though it can be prevented. The role of nurses in caring

for patients has also expanded to include her clinical skills in caring for clients

receiving somatic therapies like medication administration. The nurse has to be

knowledgeable not just in the interactive interventions but also in the use of the

medications to treat the illness. They must know the mechanism of action and side

effects of each medication (Basa, 2007).

On the survey done by Fonteyn and Flaig (2003) on bachelor of science in

nursing students with the usefullness of the written nursing process as means of

fostering nursing and individualizing client care, revealed that the respondents

gave negatives feedbacks regarding the value of nursing process bacause it would

be time consuming to write a good process instead of really understanding the

patient’s health problems.

Foreign Studies

According to Park (2007), in nursing, the clinical education experienced

by a student greatly affects future performance as a nurse. The clinical experience

provides opportunity for the student to integrate classroom theory and laboratory

skill. It is also often the time when a clinical instructor makes a decision about

whether the student will make a satisfactory nurse or not. The integration of

knowledge and skill and student evaluation is powerful factors in the preparation

of a nurse. These factors are influenced by the clinical instructor's ability to

facilitate a smooth transition from learner to practitioner. It would be of value to

know what clinical instructors do to assist students in making this transition.

 These courses include both clinical educations, in the form of in-class

application of integrated care, as well as "real-world" clinical experiences

where students engage in supervised clinical practice and gain experience. In

order to be well prepared as Athletic Trainers, students must work diligently in

the classroom to understand the material presented AND they must also work

diligently in the clinical setting to apply their knowledge to real-world clinical

situations and to develop a high level of clinical skill. Clinical experiences are

NOT "work" experiences. Instead, they are educational experiences where

classroom knowledge is applied in real-world settings.

A search of the literature pertaining to clinical instruction leads to the

conclusion that little research has ken directed toward the basic analysis of

clinical teaching behavior. What ace the behaviors associated with the clinical

instructor role? Which behaviors are effective? Which are ineffective?

For example, "Instead of judging the student's practice, the teacher assists

the student in investigating his own practice and leaves the valuing process and

the decisions to change to the student" (Infante, 1975: 27). None have reported

actual descriptions d clinical instruction and those with suggestions on teaching in

the clinical area are not specific.

According to an article in the American Journal of Nursing, a standard

part of a nursing school curriculum is the clinical rotation, where a small group of

nursing students, supervised by a nursing clinical instructor, receives hands-on

training in a clinical or laboratory setting. A key component in this rotation is

evaluation: instructors evaluate students' ability in each lesson, and students

evaluate the instructor's effectiveness. Building an assessment strategy to evaluate

a nursing clinical instructor relies on a few key considerations.

1.) Evaluation format is an important consideration when thinking about

strategies to evaluate a nursing clinical instructor. Although nursing

schools have historically relied on paper forms for student and instructor

evaluation, the advent of technology in various health-care settings has led

some nursing instructors to use handheld computers for evaluation,

according to a Journal of Nursing Education article by Lehman and

colleagues. Other kinds of formatting can determine how much detail you

provide as you evaluate a nursing clinical instructor. For example, an

evaluation that offers pre-set multiple choices will provide less detail than

one that features open-ended questions. Brief evaluations will allow less

opportunity for constructive feedback than evaluations with dozens of

questions.

2.) Developing a strategy to evaluate a nursing clinical instructor will

invariably involve defining the categories of skills and abilities for which

students will evaluate the instructor. The Journal of Nursing Education has

published two helpful articles that review evaluation strategies: Kirschling

and colleagues suggest using a tool that evaluates both teacher

effectiveness and the course itself. The article recommends evaluating an

instructor on knowledge and expertise, teaching methods, communication

style, use of own experiences and opportunity for feedback. Tang and
 colleagues, on the other hand, suggest evaluating instructors based on four

categories: professional competence, interpersonal relationships,

personality characteristics and teaching ability.

A study entitled “Assessing Competence to Practice in Nursing” was

conducted to assess the competence to nursing practice. Researchers made use of

questionnaire rating scales, ratings by observation, criterion-referenced rating

scales, simulations including the objective structured clinical examination

(OSCE), Benner’s model of skill acquisition, reflection in and on practice, self-

assessment and multi-method approaches as the study’s method.

Competence is an objective concept that can be measured, standardized

and validated with examinations, assessment tools and rating scales (Coates &

Chambers, 2002). There is a strong view that student-based evaluation is

essential (Rolfe, 2001).

Benner identifed competencies within a framework of seven domains of

nursing practice: the helping role; the teaching–coaching function; the diagnostic

and patient-monitoring function; effective management of rapidly changing

situations; administering and monitoring therapeutic interventions and regimes;

monitoring and ensuring quality of health care practices; and organizational and

work-role competencies.

The study “Assessing competency in nursing: a comparison of nurses

prepared through degree and diploma programs” conducted in the year 2004,

aimed to investigate the competencies of qualifiers from three-year degree and

three-year diploma courses in England at one, two, and three years after

qualification. It made use of a cross-sectional design. The instrument used was a

revised version of the Nursing Competencies Questionnaire, and a shortened

version of the said scale. Competence and competencies have been assessed using

observation, supervisory assessments, ability and knowledge tests, portfolios and

selfassessment.

A quantitative study performed by Towns, Couch and Sigler (2001),

determined if there exist perceptions of masculinity or feminity in various

professional occupations. The researchers concluded that some occupations are

classified as masculine, those that can be associated with power and control, while

the feminine occupations, are those connected to care giving. The results of their

study indicate significance not only because professional occupations possess

qualities that are associated with one gender over another but because nursing was

identified as being feminine.

Nursing has traditionally been a woman’s domain and may have its origins

in the evolution of man. The female has been regarded as the nurturer, while the

male was regarded as a hunter (Kumar, 2007, October). The foremost symbol is

Florence Nightingale.

Nurses and all health care professionals constantly struggle to maintain

patient safety a priority (Byers, 2004). Since the patient’s safety is an essential

part of the delivery of quality care, attaining a satisfactory standard of patient

safety obliges that all health care setting widen inclusive patient safety systems,
together with both of culture of safety and organizational supports for safety

procedures (Aspden, 2004).

Individuals need comfort, rest and sleep for physical and emotional well-

being, health and wellness. Comfort is a condition of physical and emotional well

being. Supporting patients with their comfort desires is a chief nursing assistant

responsibility. And as a matter of fact, supporting patients with physical or

emotional comfort needs is at the heart of nursing care (Hegner, 2004). Nurses

and all of the health care organization have the liability to hold information in a

way that does not put in danger the person or institutional rights of privacy and

confidentiality. Privacy and confidentiality uphold the nurse-patient rapport for

the reason that it brings about open communication and trust among the patients

and health care community. The defense of privacy of patients and providers

involve that records be kept back confidential and protected (Taylor, 2000).

Competence is a complex concept, political and often misunderstood

(Watson, 2002). In accordance with the study, the nurse’s encouraging words of

support and nurse’s calm and decisive approach establish a presence that builds

trust and well-being (Potter & Perry, 2005). Patients have reported that the

presence of nurses and their care giving activities contributes to a sense of well-

being and provides hope for faster recovery (Hegner, 2004). According to Aspden

(2004), “respect for persons involves treating people with considerations, i.e.,

listening to others, understanding them and responding with appreciation of their

intention”. In addition, nursing care looks also in all perspectives in giving

wellness to the patient. It is not only on providing medication and procedures, but
also to consider the emotional support in health teachings, as well as

compassionate service and caring are motivated by love (Watson, 2002).

A consistent recommendation has been to avoid a reductionist approach to

the study of competence, in which only work tasks and roles are considered

(Manley & Garbett, 2000; Watkins, 2000). Instead, a more holistic approach is

used whereby the concepts of knowledge and understanding are considered.

Regarded in this way, holistic competence cannot always be directly observed,

but rather inferred through the competent performance of tasks (Redfern et al.,

2002). As such, measurement of the underlying competencies requires the

evaluation of the constructs that underpin the accessible and quantifiable

performed tasks.

Priority setting is the process of establishing a preferential sequence for

addressing nursing diagnoses and intervention. Nurse can group them as having

high, medium, or low priority instead of rank-ordering diagnoses. The nurse and

the client then begin planning by deciding which nursing diagnosis requires

attention first, which second, and so on. (Kozier & Erb, 2008)

Nurses frequently use Maslow’s hierarchy of needs when setting priorities.

It provides each nurse with a priority of client care needs organized to provide the

best care to your client directed toward preventing any type of harm. The highest

priority ranked is physiologic needs, then down to safety, love, esteem, and self-

actualization being the lowest priority. The nurse also need to rank your patient

care on specific needs of each client to provide care to which client is in need of
your attention first. This can be obtained by following your ABC’s of care:

Airway, Breathing, and Circulation (Maji, 2009). Priorities change as the client’s

responses, problems, and therapies change. A nurse must consider a variety of

factors when assessing priorities, two these are the client’s priorities and the

urgency of the health problem. Involving the client in prioritizing and care

planning enhances cooperation, and regardless of the framework used, life

threatening situations require that the nurse assign them high priority (Kozier &

Erb, 2008).

In a study conductee at Harvard College and the Massachusetts Institute of

Technology (2003), entitled “Performance in Competitive Environments: Gender

Differences” states that the behavior of men and women in a competitive

environment may differ because of differences in skill, talent, and beliefs. A

competitive environment may produce differences in behavior as subjects adjust

their best choices to different strategic environments. Competition has a positive

effect on performance. This effect is stronger on boys than it is on girls, and the

gender composition of the competing pair is important. The crucial element in

this argument is that male’s and female’s preferences are affected differently by

changes in the institution - competitiveness, gender composition, etc.

Core competencies are the source of competitive advantage and enable the

firm to introduce an array of new services (Prahalad & Hamel, 2001). Hence,

Competence in nursing practice is complex and that involves cognitive and

kinesthetic aspects. It involves action and demonstration of both the physical and

cognitive skills used by nurses in the practice environment. (American Board of

Internal Medicine Foundation, 2002). In relation to that, according to the Institute

of Medicine or IOM (2001), the main focus of competence in nursing has

primarily been in the area of the clinical practice setting. It is in this setting where

there exists the highest risk of harm and/or poor patient outcomes that can be

directly linked to nursing practice activities.

Relevance to the Present Study

The presented Related Literature and studies from different foreign and

local resources are relevant to the study conducted because they demonstrated the

researchers’ comprehensive grasp of the issues and contemporary knowledge

about the subject matter, provided a substantive framework of reference, justified

and supported the ideas being tested and determined the researchability and

feasibility of the problem under study. In the process of implementing the study

and analyzing the gathered data, the above resources served as a ground for

conclusions and recommendations that made the study more meaningful and

useful, not just to other researchers but also to other people who find interest in

the topic of this research.

 CHAPTER III

METHOD AND PROCEDURE

This chapter discuss in detail the research design and methodology, also the

method of research, population of the study, sampling design and the sampling technique,

the data gathering procedure and the statistical treatment to be used.

Research Method

The research design to be utilized in this study is descriptive type design. As

defened by Connie Mcnabb, descriptive type means gathering data that describes events

and then organizes, tabulates depicts , and describes the data and maybe used to reveal

summary statistics by showing responses to all possible questionnaire items. The

researcher assess the extent of integration of four key core competencies by clinical

instructors among third year BSN students in Manila Doctors College.

This study is a quantitative type of research wherein the gathered data will be

tested, measured and analyzed using specific statistical tools.

 Sample and Sampling Technique

Simple random sampling techniques will be employed in choosing the

respondent. The number of sample will be determine through the use of sloven’s

formula.

Research Instrument

The questionnaire is the primary instrument in gathering data that will be used

for this study. The self- made questionnaire based from the four key core of

competencies by clinical instructors, structured with questions and corresponding

questions regarding to four key core competency. The variables will be measured

using an ordinal scale.

Not categorical because this is INTERVAL of four key core can be

quantified with no adherence to zero, wherein each question will be answered using

score value of 1 to 4 , in which 1 is the highest possible score which correspond to the

adjectival description of always , 2 for often , 3 for sometimes, and the lowest possible

score is 4 for seldom. Holistic interpretation of the composite team is the following: for

the corresponding adjectival rating of 1.00 – 1.50 as less extent of integration, 1.52 – 2.50

as moderate extent of integration, 2.51 – 3.50 greet extent of integration, 3.51 – 4.00 as

very great extent of integration.

 Validation of the instrument

The survey questionnaire will be validated by three clinical instructors

who are expert in the field of nursing. Researchers self-made questionnaire will

be utilized to gather the needed data. This self-made questionnaire will be

formulated as extracted from the related literature and studies will undergone

validation by three clinical instructors who are expert in the field of nursing.

To ensure validity and reliability after the self made questionnaire will be

validated by three clinical instructors who are expert in the field of nursing, the

proponents will conduct pilot testing.

Data Gathering Procedure

The researchers will seek permission from the respective presidents of Manila

Doctors College, Arellano University College of Nursing , Olivarez College of Nursing

through the respective deans , in order to conduct the study and administer questionnaire.

Statistical Treatment of Data

The date gathered will be analyzed quantitatively, specifically the following

statistical tool will be used to answer problem number 1, frequency count and weighted

mean will be applied to determine the level of performance of nursing students from

selected nursing institution; to answer problem number 2 with regards to what extent

are the four key core competencies integrated by clinical instructor to the nursing
students from selected nursing institutions, weighted mean will be employed; To test the

relationship between the perceive extent of integration of four key core competencies by

clinical instructor and the clinical performance of nursing students in related nursing

institution; pearson’s and will be applied; and to test the difference among selected

institution in terms of clinical performance of nursing student in selected nursing

institutions, Analysis of variance (ANOVA) will be applied.