Thesis Whole | Nursing | Competence (Human Resources)

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 selfmade 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”.

health care professionals. Four key core competencies: 1. 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. Empowering 4. On the right side. on educators. empowering. Enhancing 2.1 Research Paradigm The above framework has two boxes that represent the variables that will undergone analysis. the expectation is that standards of acceptable performance will be adhered to and the public trait will be safeguard.Therefore. the box presented the clinical performance of nursing students gather after the end of semester WGA. The proponents will determine the extent of integration of these competencies by the clinical instructor as perceive by the nursing students. at the box at the left side presented the four key core competencies which are the enhancing. Enabling 3. . enabling. patient care competencies. whether the focus is on public officials. Patient care Clinical Performance of Nursing Students Selected Institution Table 1.

Specifically. .2. 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. Empowering 2.3. 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. Olivarez College of Nursing. the following research queries will be answered: 1. Enabling 2.1. Arellano University College of Nursing.Lastly. What is the level performance of nursing students from selected institution? 2. Enhancing 2. To what extent of the following Four key core competencies integrated by clinical instructor to the nursing standards for selected institution? 2. the arrow pointing to the box at far right the selected nursing institutions which are the following: Manila Doctors College. Patient care competencies 3.4.

Ho. There is no significant difference among selected institution in terms of nursing student clinical performance. 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.A competing to produce excellent graduate to compete globally.S. • To the Clinical Instructor. Ho. The result is expected to make changes. Significance of the Study The study is significant to the following. enhancement or even new strategy in teaching and learning. • 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.The study will provide unbiased insight of nursing student that affect their clinical performance. 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.4.05 level of significance.

. May this study inspire them to continue to strive to attain excellence in their S.The study will show result of their perceived evaluation to their clinical instructor.K. determining the difference between related Institute in their student clinical focus is limited to the result of end of semester W. pertaining and limited to the four key core competencies which are the following. Extent of integration by the clinical instructor to the respondent. enhance betterment. San Juan de Dios College of batch 2012.A competency to be prepared to become a professional nurse. Empowering. • To the Future Researcher.• To the Nursing Students. 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. a random sampling technique will be applied. May they find study interesting to develop.G.This study will serve as their reference. A Four point likest scale will determine each key core competencies. The respondent will answers the self made questionnaires. The respondent will be 3rd yr nursing students of Manila Doctors College. Enabling. Patient care Competency. Arellano University. male and female no inclusion criteria. Enhancing.A of nursing.

expert on this field after which. Enabling.G. a pilot testing will be done. informed consent.The questionnaire will be validated by three nursing professors. Clinical Instructor. during.patient relationship and the dynamic exchanges that occurs before. Definition of Terms The following terms are operationally defines to help the readers to understand the content of the study. .refers to the role. knowledge and attitude competency of nursing student in selected Institution. Empowering.refers to the accurate and updated documentation of client care. Four Key Core Competencies. and after the medical encounter. competency of a professional nurse educator that the student will evaluate their Extent of Integration of Four key Core competencies among nursing students.refers to the practices in accordance with the nursing law and other relevant legislation including contracts. Enhancing .Refers to the doctor .A – skills. Clinical Performance.refers to the evaluated end of semester W.refers to the following Standard Sore Competency in nursing practice.

refer to the knowledge base on the health /illness status of individual / groups.Patient care competencies. .

including training in such areas like assessment and evaluation. It is a degree to which an organization does the right things and does them well. 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. . Performance is what is done and how well it is done to provide health care. According to RA 9173 Article III Section IX. a good performance must be done. Local Literature In order to be a competent nurses. The purpose of this review of literature is to analyze methods of assessing competence to practice in nursing and draw conclusions on their validity. The value in health care is appropriate good balance between good outcome and excellent care and services. related research. also known as the Philippine Act of 2002. But this is influenced strongly by its design or operation. This is why there is a need for reorientation on the scope of nursing practices which revolved around nursing process. Materials were scanned from various libraries and were collated to provide understanding of the subject under discussion.CHAPTER II REVIEW OF RELATED LITERATURES AND STUDIES This chapter is composed of the present study into the context of preceding. 2000). “An act providing for a more responsive nursing profession.

2009. Assessment of clinical competence is generally based on observed performance of skills. 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. “Graduates of Bachelor of Science in nursing program must be . 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. otherwise known as the Higher Education Act of 1994 and pursuant to Commission en Banc Resolution No. Evaluation of competence of students is needed and it involves several raters (clinical instructors and staff nurses. 7722. 7164.repealing for the purpose Republic Act No. 170 dated April 19. According to Article IV Section 5 of CHED Memorandum Order (CMO) Series of 2009. In accordance with pertinent provisions of Republic Act (RA) No. Assessment results should be used to provide feedback to both students and faculty to improve clinical evaluation of students’ performance during clinical area work. 2001). skills and attitudes (Caparas. assessment and evaluation should be done. etc) who will assess different areas of competencies encompassing the three domains of learning knowledge. 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.

c) health education. and the increasing and more exacting demands from the consumers of health care.ched. tool for performance evaluation among nurses. In 2005.able to apply analytical and critical thinking in the nursing practice. framework for developing a training curriculum for nurses. There are Eleven Core Competency Standards for nursing practice were identified: a) safe and quality nursing care. basis for advanced nursing practice and specialization.ph).gov. framework in developing test syllabus for entrants into the nursing profession. b) management of resources and environment. . 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. g) quality improvement. Specifically. New expectations for contemporary nursing practice competencies are emerging which is heightened by the escalating complexity of globalization. protect the public from incompetent nurses and a yardstick for unethical and unprofessional practice of nursing. The nurse must be competent in the following Key Areas of Responsibility and its respective core competency standards and indicators” (www. it will serve as a guide in developong curriculum in nursing. healthcare policy reforms. the dynamincs of health science and information technology demographic changes. d) legal responsibility. e) ethico-moral responsibility. The new competency standards will serve as a unifying framework for nursing education regulation and practice. f) personal and professional development.

and k) collaboration and teamwork. First. families. Fourth. 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. i) record management. In this core competency. there is demonstrating knowledge based on the health /illness status of individual / groups. analyzes the needs of clients and determines appropriate nursing care to address priority needs/problems. wherein he or she identifies wellness potential and/or health problem of clients. there is promoting safety and comfort and privacy of clients. population groups and/or communities) and who explains the health status of the clients / groups. 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. This can be indicated by a nursing student who identifies the health needs of the clients (individuals. This can be achieved by a nursing student who refers identified problem to appropriate . This can be done by a nursing student who performs age-specific safety measures in all aspects of client care. there is setting priorities in nursing care based on clients’ needs. there is the ensurance of continuity of care. Third. the nursing student shoud provide sound decision making in the care of individuals / families/groups considering their beliefs and values. gathers data related to the health condition. Second. j) communications.h) research. the nursing student identifies the priority needs of clients. analyzes the data gathered. manage the health problem and monitors the progress of the action taken. selects appropriate action to support/enhance wellness response. Fifth.

(2000). is by administering medications and other health therapeutics. to prevent illness. This can be done by a nursing student by obtaining informed consent and by completing appropriate assessment forms. are heavily concentrated in nursing. a nurse should work competently to provide proper and sufficient health services for the people (Buenaventura-Tungpalan.individuals / agencies and establishes means of providing continuous client care. Fundamental responsibility of the nurse is fourfold: to promote health. according to Mansibang (2006). There are some interesting sex-specific pattern in the choice of academic programs among college and graduate students. in contrast. provide comfort and support in the events of chronic or incurable diseases. home economics. physical and natural science and business. et al. to restore health and to alleviate suffering. In carrying out responsibilities.. Nurses should have a good foundation of learning for them to give quality care to their patients. In doing so. It is because. social sciences and humanities (Detablan. wherein a nursing student must conform to the 10 golden rules in medication administration and health therapeutics. Lastly. Sixth. the seventh core competency is by utilizing the nursing process as framework for nursing. “nursing is an advocacy to secure people’s health through competence and high standard of . education. Male students tend to pursue degrees in engineering. Women. 2000). help them to regain full health. nurses assist individuals and families and communicate in the prevention of illness. They minister to the needs of the patient.

We are known worldwide for our caring nurses. It is important to improve the quality of nursing in the Philippines so that the country could produce globally competitive nurses (Vitriolo. 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). we should have the passion in our profession. 2006). we have to have the caring attitude towards our patients and finally. according to Cuevas (2001). He also explained that students must be taught how to develop critical thinking skills and conceptual retention. She further explained that bringing back the passion for money could overshadow the passion for nursing is very important. But it wasn’t only about competitiveness why Filipino nurses are sought after in other countries. also because of the caring attitude they . The passion for work affects the nurse’s approach toward the patients. In fact.” The emergence of nursing as a very lucrative profession has taken its toll on the quality of service of the country’s nurses. because the passion for money could overshadow the passion for nursing. they should know how to use their own judgments in dealing with difficult situations. The following local literatures provided the researchers foundation on the responsibility of nurses and what competence is.” He added that school must embody its dedication to nurses as vanguards of healthcare and societal transformation. why competence should be assessed and how it can be measured. In addition. when they become registered nurses. Second. “nurses should go back to the noble reason of compassion and caring.education. thereby affecting the patients’ recovery time.

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. caring. relationships. Focus groups were used to obtain students' opinion and experiences about their clinical practice. communication and that general ability to manage thru all adversity. . Four themes emerged from the focus group data. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis. were considered as important factors in clinical experience. The main objective of this study was to investigate student nurses' experience about their clinical practice." initial clinical anxiety". 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. 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. From the students' point of view. Foreign Literature Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. professional role". The result of this study showed that nursing students were not satisfied with the clinical component of their education.possess." clinical supervision". "theory-practice gap".

Clinical experience is one of the most anxiety producing components of the nursing program which has been identified by nursing students. 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. . It prepares student nurses to be able of "doing" as well as "knowing" the clinical principles in practice. In a descriptive correlational study by Beck and Srivastava 94 second. difficult patients. In study done by Hart and Rotem stressful events for nursing students during clinical practice have been studied. 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. The clinical practice stimulates students to use their critical thinking skills for problem solving. The sources of stress during clinical practice have been studied by many researchers.Clinical experience has been always an integral part of nursing education. fear of making mistakes and being evaluated by faculty members were expressed by the students as anxiety-producing situations in their initial clinical experience. unfamiliar areas. The researcher came to realize that nursing students have a great deal of anxiety when they begin their clinical practice in the second year. third and fourth year nursing students reported that clinical experience was the most stressful part of the nursing program. They found that the initial clinical experience was the most anxiety producing part of their clinical experience. Lack of clinical experience.

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). 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. Focus groups interviews are essential in the evaluation process as part of a need assessment. The purpose of using focus group is to obtain information of a qualitative nature from a predetermined and limited number of people. Focus groups are widely used as a data collection 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. during and after programs in order to provide valuable data for decision making. Kruegger (1988) stated focus group data can be used before. The second . 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. 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.A focus group design was used to investigate the nursing student's view about the clinical practice.

The topics were used to stimulate discussion. How do you feel about being a student in nursing education? 2. Which clinical experiences did you find enjoyable? 6. the topics developed included 9 openended questions that were related to their nursing clinical experience. How do you think clinical experiences can be improved? 9. What do nursing students worry about regarding clinical experiences? 8. They were arranged in nine groups of ten students. What is your expectation of clinical experiences? . How do you feel about nursing in general? 3.year nursing students already started their clinical experience. What are the best and worst things do you think can happen during the clinical experience? 7. Initially. Would you like to talk about those clinical experiences which you found most anxiety producing? 5. Is there anything about the clinical field that might cause you to feel anxious about it? 4. 1. The following topics were used to stimulate discussion regarding clinical experience in the focus groups.

Checking the content of the tape with the observer noting and considering any non-verbal behavior.. The following steps were undertaken in the focus group data analysis. 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. gestures and behavior. Non-verbal communication. The researcher facilitated the groups. 1. Listening to the tape and transcribing the content of the tape 3. 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 . Parts of words b. The benefit of transcription and checking the contents with the observer was in picking up the following: a.. Observer was not known to students and researcher.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. Debriefing notes included comments about the focus group process and the significance of data 2. Immediate debriefing after each focus group with the observer and debriefing notes were made.

Following a review of the codes and categories there was agreement on the classification. All participants were informed of the objective and design of the study and a written . Level 2 coding which is a comparing of coded data with other data and the creation of categories. Three levels of coding selected as appropriate for coding the data. The documents were submitted to two assessors for validation. This action provides an opportunity to determine the reliability of the coding.paragraph by paragraph. 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. looking for significant statements and codes according to the topics addressed. The researcher was guided to use and three levels of coding. 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. 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 researcher compared the various codes based on differences and similarities and sorted into categories and finally the categories was formulated into a 4 themes.

Worrying about giving the wrong information to the patient was one of the issues brought up by students. clinical supervision"." professional role". 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." initial clinical anxiety". The qualitative analysis led to the emergence of the four themes from the focus group data.consent received from the participants for interviews and they were free to leave focus group if they wish. One of the students said: On the first day I was so anxious about giving the wrong information to the patient. was considered as important factors in clinical experience. Most of the students were females (%94) and single (% 86) with age between 18–25. ‘I said 'I do not know'. the students stated that the first month of their training in clinical placement was anxiety producing for them. "theory-practice gap". One of the students expressed: . This theme emerged from all focus group discussion where students described the difficulties experienced at the beginning of placement. From the students' point of view. Almost all of the students had identified feeling anxious in their initial clinical placement. I remember one of the patients asked me what my diagnosis is.

I was very embarrassed in front of my patient and instructor.clinical placement and we don't have enough clinical experience to accomplish the task. I noticed her IV was running out. I was really scared and I did not know what to do and I called my instructor. I mean. She said: I was so anxious when I had to change the colostomy dressing of my 24 years old patient.. One of them had IV fluid. I will never forget that day. My heart rate was increasing and my hand was shaking. . and do our nursing duties. 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. I went ten times to the clinic to bring the stuff. One of the students reported: In the first day of clinical placement two patients were assigned to me.The most stressful situation is when we make the next step. When I introduced myself to her. Fear of failure and making mistakes concerning nursing procedures was expressed by another student. It took me 45 minutes to change the dressing. Almost all of the fourth year students in the focus group sessions felt that their stress reduced as their training and experience progressed..

He suggested that the ward is the best place to learn but very few of the learner's needs are met in this setting. I have learnt so many things in the class. but there is not much more chance to do them in actual settings. It is not happen sometimes. The theory. The literature suggests that there is a gap between theory and practice. 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. Incidents such as evaluation by others on initial clinical experience and total patient care. theory which is developed from practice.practice gap is felt most acutely by student nurses. I relate it back to what I learned in class and that way it will remain in my mind. They find . The development of practice theory. 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. quality of care and procedures are anxiety producing. 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. for practice.Sellek researched anxiety-creating incidents for nursing students. as well as interpersonal relations with staff. is one way of reducing the theory-practice gap. It has been identified by Allmark and Tolly.

One of the students said: Sometimes we are taught mostly by the Head Nurse or other Nursing staff. 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 . According to Berggren and Severinsson the clinical nurse supervisors' ethical value system is involved in her/his process of decision making. Working with the practitioners through the milieu of clinical supervision is a powerful way of enabling them to realize desirable practice.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. The ward staff are not concerned about what students learn. Clinical nursing supervision is an ongoing systematic process that encourages and supports improved professional practice. Clinical Supervision by Head Nurse (Nursing Unit Manager) and Staff Nurses was another issue discussed by the students in the focus group sessions. Clinical supervision is recognized as a developmental opportunity to develop clinical leadership.

.giving bed baths. The majority of students had the perception that their instructors have a more evaluative role than a teaching role. We spend four years and we have learned that nursing is a professional job and it requires training and skills and knowledge. 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.. Anyone can do it. We just do basic nursing care. .The students mostly mentioned their instructor's role as an evaluative person. Four themes of . We spend four years studying nursing but we do not feel we are doing a professional job. keeping patients clean and making their beds. it cannot be considered a professional job...You know. The result of student's views toward clinical experience showed that they were not satisfied with the clinical component of their education. but when we see that Nurses Aids are doing the same things. The literature suggests that the clinical nurse supervisors should expressed their existence as a role model for the supervisees. very basic. 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.

Students feel anxious and this anxiety has effect on their performance. Neary identified three main categories of concern for students which are the fear of doing harm to patients. . Nursing students receive instructions which are different to what they have been taught in the classroom. The nursing students clearly identified that the initial clinical experience is very stressful for them. Development of confidence should be facilitated by the process of nursing education. Initial clinical experience was the most anxiety producing part of student clinical experience. 'clinical supervision'. This was similar to the finding of Bell and Ruth who found that nursing students have a higher level of anxiety in second year. Differences between actual and expected behavior in the clinical placement creates conflicts in nursing students. In this study fear of making mistake (fear of failure) and being evaluated by faculty members were expressed by the students as anxietyproducing situations in their initial clinical experience. as a result students become competent and confident. 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. Students in the second year experienced more anxiety compared with third and fourth year students. and 'professional role'. 'theory-practice gap'. Jinks and Patmon also found that students felt they had an insufficiency in clinical skills upon completion of pre-registration program. Developing confidence is an important component of clinical nursing practice.concern for students were 'initial clinical anxiety'. This finding is supported by Hart and Rotem and Stephens.

In this study. . instructor role in assisting student nurses to reach professional excellence is very important.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. 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. practitioners and learners. This finding is supported by other studies such as Ferguson and Jinks and Hewison and Wildman and Bjork. The clinical instructor or mentors can play an important role in student nurses' self-confidence. All the students in this study clearly demonstrated that there is a gap between theory and practice. It deeply rooted in the history of nurse education. According to participant. 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. 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. promote role socialization. A supportive and socializing role was identified by the students as the mentor's function. the majority of students had the perception that their instructors have a more evaluative role than a teaching role. Discrepancy between theory and practice has long been a source of concern to teachers. and encourage independence which leads to clinical competency. This finding is similar to the finding of Earnshaw. Theory-practice gap has been recognized for over 50 years in nursing.

The finding of this study and the literature support the need to rethink about the clinical skills training in nursing education. Maintenance and/or nurturance of the student's self-esteem play an important role for facilitation of socialization process. The professional role encompasses skills. Professional role and hierarchy of occupation were factors which were frequently expressed by the students.The students identified factors that influence their professional socialization. Self-evaluation of professional knowledge. knowledge and behavior learned through professional socialization. decision-making and innovation are achieved through professional self-concept. It is clear that all themes mentioned by the students play an important role in student learning and nursing education in general. independence. values and skills contribute to the professional's self-concept. values and motives which are held by society are important stages in the socialization process. Lengacher (1994) discussed the importance of faculty staff in the socialization process of students and in preparing them for reality in practice. There were some similarities between the results of this study with other reported studies and confirmed that some of the factors are . The acquisition of career attitudes. According to Corwin autonomy. 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.

professional role and clinical supervision. The results of this study should be considered by nursing education and nursing practice professionals. Under this key area. working with the . Safety and Quality . privacy and comfort. 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. The result of this study would help us as educators to design strategies for more effective clinical teaching. making appropriate decisions when caring for patients and their families. Nursing students expressed their views and mentioned their worry about the initial clinical anxiety. Faculties of nursing need to be concerned about solving student problems in education and clinical practice. and ensuring patient safety. 2010). Competencies also include setting appropriate priorities in patient care. 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. 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 nursing industry has established eleven key areas of responsibility that provide a framework for unifying nursing education.universal in nursing education. core competencies include demonstrating knowledge about the health status and illness of a patient.The first key area of nursing responsibility focuses on providing nursing care that is safe and of high quality. theory-practice gap. practice and regulation.

. Health Education . ensuring that equipment performs adequately and maintaining safety in the environment. effectively administering medications and other treatment modalities and performing assessments and nursing services against a background of established nursing guidelines.the next key area is the management of resources and environment. developing financially effective programs. Identifying the goals of care and evaluating progress toward those goals are also core competencies within this key area. such as obtaining informed consent from patients and adequately documenting all procedures performed for patients. The nurse also works with the medical team and patient's family to develop a plan of care. Legal Responsibilities .core competencies in the legal key area include following legally mandated state and federal processes and procedures.educational core competencies include assessing the educational needs of the patient and family. Resources and Environment .medical team to ensure stability of care. developing and implementing health education plans and learning materials and evaluating the outcome of education administered. Core competencies in this area include identifying tasks that need to be completed.

participating in professional organizations and community activities. core competencies include identifying areas for improvement. Professional Development .the professional development key area includes core competencies of identifying personal needs for education and pursuing those goals. presenting a professional image and positive attitude as well as performing work duties in a professional manner.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. Records Management . core competencies include respecting the rights of all individuals and groups. Quality Improvement . . accepting responsibility for individual decisions and adhering to the nurses' national and international code of ethics.core competencies in the research key area include gathering and analyzing research data. participating in nursing rounds and audits. sharing results and applying findings to work functions. Research .in the quality improvement key area.in this key area that concerns morals and ethics.Ethical Responsibilities . staying aware of variances in treatment and recommending solutions to improve quality.

Teamwork . 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. competencies are emerging. . 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). demographic changes. which is heightened by the escalating complexity of globalization. using visual aids and other resources when necessary. These changes are spawned by the multitudes of forces converging in the national as well as international levels. health care policy reforms and the increasing and more exacting demands from the consumers of health care.in this key area. learning to read verbal and nonverbal cues.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. Accordingly. core competencies include establishing communication with the patient and treatment team. which impact on the quality of nursing practice in the country. the dynamics of health science and information technology. Moreover. responding to patient and group needs and effectively using technology to facilitate communication. new expectations for contemporary nursing practice.Communication .

and improve the joy they derive from their work. with a myriad of system issues that often make the provision of high-quality care difficult. Investment in the development of skills in quality improvement provides a means for nurses to improve the lives of patients. As health care systems increasingly recognize the value of this work.Furthermore. as they advance through their education and begin their careers. . senior nursing students and in consultation with nurse executives from regulatory authorities in three countries. Bellosillo et al (2008) elaborated that the Committee was composed of leaders from nursing education. nurses find that their contributions to care improvement lead not only to a sense of personal reward. administrators and patients. Bates et al (1995) discussed that nurses are uniquely positioned to serve as change agents within health systems. nursing practice and nursing regulation. However. build their own careers. consumers of nursing practice such as doctors. the impact of nursing improvement efforts is heightened. they discover that health care systems are exceedingly complex. By partnering with other health care providers who share their vision for improving care and by linking with institutional quality professionals. but may lead to professional advancement. In addition. The whole gamut of developing the standards were made possible through the participation of representatives of professional nursing organizations. Most health care providers begin their health profession education expecting to acquire the knowledge and skills needed to provide high-quality care.

the Board of Nursing had released a Resolution No. specialties. 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). According to Oppewal et al.Since then. The challenge it presents for healthcare regulators is learning how to objectively measure competencies across various settings. core competencies have been developed in different specialty areas. 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. 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. After this resolution number had taken effect. The Mindanao Sanitarium and Hospital College had already followed and applied these eleven nursing core competencies as a model principle of nursing practice. years of experience and geographic regions. (2006). 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 National Council of State Boards of . but even nurses' awareness and implementation of such standards vary.

present and future issues related to continued nursing competence. Dr. through their committees of Research and Practice. Regulation. and Education. Chief Offices of Nursing Regulation for the NCSBN. 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. will present current research and findings about past. nursing. and occupational therapy and the "harmonization" of these competencies into a framework tor interprofessional education. nursing. The study was undertaken at a Canadian university with a Faculty of Health Sciences comprised of three schools (namely. Spector and Li (2007) discuss this ongoing research that is being completed to assess the design of this program. this program has been a culmination of research and defines the needs of new nurses. According to J Allied Health (2006) this paper describes the amalgamation of the core competencies identified for medicine. physical therapy. May Arm Alexander. and rehabilitation therapy). 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. medicine. At the Center for American Noses LEAD Summit 2008. It particularly highlights the relevance of cross-disciplinary competency teaching and 360-degree .Nursing (NCSBN) has worked. to develop a program to transition graduate nurses into the profession.

While in the early stages of creating an academy of educators skilled at teaching and evaluating interprofessional practice and education at a Canadian university. Most importantly. expectations. two needs emerged as crucial to the success of a change in culture in academic health sciences.evaluation in teams. These critical issues arose out of the expressed desire of teaching faculty to have a shared vocabulary and better understanding of objectives. 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. and occupational therapy and the 'harmonization' of these competencies into a framework for interprofessional education. physical therapy. A competency model that defines a set of expected skills both "vertically" and "horizontally" between health care professions does not exist. This paper describes the amalgamation of the core competencies identified for medicine. and standards in their health care professions. 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. Consensus emerged that a logical place to begin would be with a description of the vital competencies required tor the four professions. it provides a launch pad for clarifying performance standards and expectations in interdisciplinary learning.2 . nursing.

competency-based. and the Cochrane Database of Systematic Reviews. education. The search terms included: education. Common core competencies provide a shared understanding of the scope and requirements of a specific role and mutual organization wide standards for performance. clinical competence. Barr (2006) suggested that the case for competency-based interprofessional education rests on the need to: . A systematic review of the literature was conducted of MEDLINE.3 interprofessional education. CINAHL (Cumulative Index to Nursing and Allied Health Literature). Although there were various articles about the importance of shared learning.10 there were few articles that outlined specific competencies across disciplines. professional competence. interprofessional relations. integrated. delivery of health care.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.7-9 and integrated health delivery systems. AMED (Allied and Complementary Medicine). and patient care team. The yield from this intensive search was extremely limited. 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.4-6 working together as teams. interdisciplinary.

Competence becomes important for us as nurses and patient advocates. both verbally and non-verbally (Anderson. Competency encompasses more than just a psychomotor skill. Nursing knowledge of health and disease processes is of little use without appropriate nursing skills to implement. Hager & Oliver. The abilities to plan and organize . 1990). Nurses know that psychomotor skills are important but. As the “world becomes smaller” and individuals and societies become more mobile. In nursing school. Competence is the ability to provide effective care for clients who came from different cultures. is defined as a combination of attributes enabling performance of a range of professional tasks to the appropriate standards (Gonczi. It describes the attributes of knowledge. * Enable students on interprofessional courses to claim credits as part of their professional education. we are increasingly able to interact with individuals as a competent nurses.* Reposition interprofessional education in the mainstream of contemporary professional education. 2009). as discussed in the Competency standards approach to professional education and practice. we are taught to respect the rights and dignity of all clients. skills and attitudes that underlie competent performance. It requires sensitivity and effective communication. abilities. * Enable students to relate professional and interprofessional studies coherently. Competency. they do not constitute nursing. performed without knowledge.

cope with interruptions and can deal with emergencies. Yet behind the smooth performance we recognize the knowledge. skills and attitudes that are integrated into the professional demonstration of excellent nursing. The experienced competent nurse works quickly and capably. abilities. Therefore. be somewhat limited in the range of skills they can perform. but are reflected in the delivery of patient care. abilities. There exist various levels of competence but each of these has a minimum acceptable level or standard.our work are of little benefit to patients or clients if the attitude that nurses value such as. not possess a great deal of specialized knowledge but they are easily distinguished from someone who is not a nurse. integration of the knowledge. able to care for a highly complex and dependent patient in the critical care unit. They perform a wide range of nursing activities methodically and well. skills and attitudes of nursing is the essential key to understanding and performing competencies. If you . or nurse several high dependency patients in a busy surgical or medical ward. but they can be competent. seem to do twenty things at once. In the community setting. Beginners are rarely expert. or even a novice student nurse. nursing skills of assessment and decision-making are often invisible. 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. caring and patience is not present. Experienced and expert nurses have amazing memories. all calmly and expertly. Competence does not mean expert. Beginning graduate nurses may be a little slow completing total patient care.

In order for nurses to successfully design and build systems that support the highest levels of nursing development. specifically. taken together. as a set of behaviors that encompasses skills. learning. and personal attributes that. an ongoing process for change management must be in place that addresses feedback. and accurately to reduce the margin of error for profitability and growth. A learning culture must be of prime importance to top leadership and must flow throughout the organization. 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. Competency in nursing has a direct influence on the health and safety of all patients. are critical to successful work accomplishment (Avilar. the absence of competency may lead to serious medical errors resulting in serious consequences for the patient. 2000). Responsiveness to cultural and climatic change within the industry must be identified quickly. . knowledge. abilities.have recognized an example of nursing such as this. 2002). Unfortunately. People Are Critical to Success. In addition. 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. then you can recognize nursing competency. It was determined in their report that medical errors lead to the deaths of nearly 98.000 hospitalized patients each year. Competencies has been defined in the article. and process flexibility. it must first understand it’s core competencies.

Furthermore. and quality care can only be accomplished if the providers are deemed competent to provide the best possible standard of care (Axley. According to Joint Commission on Accreditation of Healthcare Organizations (2006). while competency refers to specific capabilities. Specific competencies are identified as role outcomes. et al. skills. and attitudes. they require measuring the competency of the nurses. usually a behavioral standard (Rampey. such as leadership (Eraut. It is therefore important to be able to identify and measure the relevant competencies that contribute to overall competence.. 2008). 2006). or knowledge. 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 .Competence is a generic term referring to a person’s overall capacity. The safety of patients receiving medical care is clearly associated with the competency of the healthcare providers. knowledge. Competency models have been implemented in both primary and secondary education as a measure of success in a program of study. or both. and then assessed by a criterion. skills and abilities. In accordance to that. required for role performance. and capability to meet defined expectations”. competency is defined as a “determination of an individual’s skills. 2001). and that each specific competency is measured by a set of valid and reliable items representing the appropriate knowledge.

sociological. and the assessment method should have predictive validity in that it can predict competent performance in real-life situations (Benner. the criterion level for competence should be established. Assessment of nursing competence should be grounded in actual practice and should include such dimensions as: ability to cope under pressure and over time. Although Abdellah spoke of the patient-centered approaches. ability to cope with the person in pain. delivery of compassionate. 2004). 2006). and sensitive care of the person who is dying. 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 . she wrote of nurses identifying and solving specific problems. Other requirements for assessing competence are: nursing competencies should be related to patient outcome. therefore. and emotional needs of the patient. (2) the types of interpersonal relationships between the nurse and the patient. 2002). competence is an observable concept that is measurable. However. In contrast to that. ability to solve problems in crisis situations. 2002). It should be context-specific. Abdellah’s typology was divided into three areas: (1) the physical. assessment tools and rating scales (Coates & Chambers. safe care of helpless patients. This identification and classification of problems was called the typology of 21 nursing problems. uniformed and validated through examinations. competence is something more than the performance of skills and accentuates the effects of skills on students and patients (Benner. and (3) the common elements of patient care.situation or individual (Hamel & Pahalad.

She distinguishes between the communal and agentic dimensions of genderstereotyped characteristics. with men. such as nurturance and emotional expressiveness. commonly associated with domestic activities. and thus. She suggests that the sexual division of labour and societal expectations based on stereotypes produced gender roles. Florence Nightingale believed that most women would be required to nurse. 115). often including the division of labour between men and women. mother or family caregiver (Torres. and thus. Nursing remains a female dominated occupation and it has been regarded by . with women. A gender role is a set of behavioural norms associated particularly with males or females in a given social group or system. Behaviour is strongly influenced by gender roles when cultures endorse gender stereotypes and form firm expectations based on those stereotypes. The agentic role is characterized by attributes such as assertiveness and independence. p. with the specific components and workings of the gender system of role division varying markedly from society to society. as part of their role as wife. Gender-based roles coincident with sex-based roles have been the norm in many traditional societies. 2001). Gender role is a focus of analysis in the social sciences and humanities.competency based on outcome measures (Tomey & Alligood. Nursing theorists and their work 4th ed.. Alice Eagly’s “Social Role Theory” offers an explanation of gender development that is based on socialization. commonly associated with public activities. The communal role is characterized by attributes.

There are advances in males taking on roles normally considered for female only – e.many societies as an innate feminine skill.g. 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. Females get settled in and are afraid of change (Joey.e. In addition. The most frequent ’sexism’ of this nature I have seen in healthcare is between staff and not patients. complaints.: using only male staff to deal with an aggressive patient. Overall. Change takes time and this one will not happen over one generation. 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. then they are in the wrong profession. From the article entitled Dilemmas Facing Males in Nursing. male or female.: 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. No one has the desire to remove that privilege. the shortage on males in nursing is because guys generally don’t choose nursing. assessments are heard sometimes louder than a female. Where logistics do not allow for a choice (e. not because the . findings. On the other hand. male nurses are treated a bit better than the female nurses on the floor. whereas when men speak.g. 2006). Male nurses do tend to move more than females. Female nurses tolerate a lot of abuse from administration and from some doctors.g. he noted that male nurses get paid more than female nurses.: male midwives. which by being a natural part of the woman's role required little in the way of development or reward. If a student or any nurse cannot accept that patients have a choice in who treats them. concerns.

until especially the twentieth century when these roles diversified into many different acceptable male or female roles in modernized countries throughout the world. as a direct caregiver. 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. Continuity of care is the comprehensive. like clothing. in many modern societies one's biological gender no longer determines the functions that an individual can perform. communication and that general ability to manage thru all adversity. personal relationships.profession is making it difficult for them. a registered nurse can contribute significantly to the coordination and . coordinated and integrated provision of health services. relationships. has the most consistent presence in providing care to a client and has knowledge of a client’s continuing care needs. The registered nurse. Therefore. and occupation. The focus of continuity of care is on the needs of the client family. These elements are not fixed and have changed through time. Registered nurses are leaders in implementing collaborative practice. behaviour. Thus. 2001). 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. and requires an interdisciplinary approach by formal caregivers (Bull & Roberts. A person's gender role comprises several elements that can be expressed through several factors. caring. Gender roles traditionally were often divided into distinct feminine and masculine gender roles. acknowledges clients and informal caregivers as partners in care.

but there may still be problems. (Wells. it can be easy for students to have poor communication with their instructors. the instructor-to-student ratio shows a large disparity. however. 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. Lack of Communication In nursing school. At the beginning of the school year. email addresses and office hours. Martin & Marshall. Student unions and organizations work to address this issue. Make sure to ask questions whenever applicable. ask for it. or even create an informal study group. . so students may not always get their questions or concerns addressed. so if a question is not urgent.planning for continuity of care for a client. Nursing instructors encourage their students to be proactive. Often. When you need clarification of a nursing procedure or disease process. seek out the answer yourself during self-guided study time. 2002). get your instructors' contact numbers. Craig. as a classmate may be able to assist. LeClerc. misunderstandings and social/cultural problems. Do not be intimidated.

Both teaching styles have negative effects on students' enthusiasm. Sometimes nursing instructors give too little feedback and may inadvertently contribute to student mistakes.Misunderstandings Long hours and the general pressures of a clinical environment can lead to misunderstandings between students and nursing instructors. they can promote hostility. The most prominent concern may be cultural bias in textbooks and on certain exams. Instructors. which may leave students discouraged. In fact. nursing instructors seem impossible to please. Many nursing schools have sought to remedy this by using textbooks that address differences among a variety of cultures. Social/Cultural Problems Sociocultural problems are less common in nursing school than in other educational environments because the material is so health-focused. will prefer that a nursing student fully understand concepts and techniques rather than risk patient safety by guessing the appropriate course of action. ask nursing instructors exactly what they are looking for during clinical rotations. Whenever possible. regardless of how harried they may be. Other times. rather than encompassing a broad sociocultural perspective. so if nursing instructors are not adequately addressing diversity . Certain textbooks and exam questions may be uncomfortable for some students because most nursing baselines are derived from European norms. Cultural and religious awareness is important in providing sensitive nursing care.

Collaboration and teamwork I. Safe and Quality Nursing Care . Personal and professional development 7. students should ask that such topics be considered. Quality improvement 8.issues. Management of resources and environment 3. Safe and quality nursing care 2. Health education 4. Research 9. According Basa (2009) the responsibility for which a nurse should demonstrate competence in: 1. Patient Care Competencies 1. Record Management 10. Nursing students should also try to find and read books that address diversity and its place in the clinical environment. Legal responsibility 5. Communication 11. Ethico-moral responsibility 6.

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. families. 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 1: Demonstrates knowledge base on the health /illness status of individual / groups • Identifies the health needs of the clients (individuals.

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 .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.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.

• • • 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. Communication Core Competency 1: Establishes rapport with client.3 Evaluates progress toward expected outcomes • • Monitors effectiveness of nursing interventions Revises care plan based on expected outcomes 2. 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 .

electronic media Utilizes informatics to support the delivery of healthca 3. group and community • Provides reassurance through therapeutic touch. family. 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. 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 .• 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.

cultural. educational and religious factors. • Involves the client. political. significant others and other resources in identifying learning needs on behavior change for wellness.• Maintains good interpersonal relationship with clients . economic. family. 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. 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. healthy lifestyle or management of health problems . Health Education Core Competency 1: Assesses the learning needs of the client-partner/s • • • • Obtains learning information through interview.

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.• Formulates a comprehensive health education plan with the following components: objectives. 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. Empowering Competencies . content. time allotment. touch.

informed consent. local and national • • Articulates the vision.5. Legal Responsibility Core Competency 1: Adheres to practices in accordance with the nursing law and other relevant legislation including contracts. • • • 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. 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. 6. Ethico-moral Responsibility . Accomplishes accurate documentation in all matters concerning client care in accordance to the standards of nursing practice.

privacy.e. etc. 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 .) 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.Core Competency 1: Respects the rights of individual / groups • Renders nursing care consistent with the client’s bill of rights: (i. confidentiality of information.

Enhancing Competencies 8.• Applies learned information for the improvement of care Core Competency 3: Gets involved in professional organizations and civic activities • • • Participates actively in professional. civic. when situations call for it III. Records Management . social. 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.

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 . 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. 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.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. 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. safety. access and security of records Documents/monitors proper record storage.

earthquake and other emergency situations.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.safety cost benefits . 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.• 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 . .

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 .IV.e. 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.

• 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 .

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 . 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.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. Professor in NCM 102 who has at least 5 years of experience and a master degree holder. Respondents are all BSN level III regardless of their gender. al (2009) this study will give insight about teaching competency among instructor as perceived by BSN level in students in MDC. The respondents were chosen by the purposive sampling technique. 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 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. 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 study sough to answer the following questions.

Therefore from the study made by the respondents. 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. After through interpretation of analysis and data gathering. 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. 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. This study revealed an adjectival rating of “Agree” in all question pertaining to the perception of instructors professional and personal aspects. the null hypothesis is accepted. 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 . Based from the finding and conclusion drawn from this study. the following recommendations are made to the nursing administration.tabulated analyzed and interpreted with the use of the following statistical technician frequency and percentage distribution T-Test and ANOVA. To the faculty instructor. we were able to come up with the following conclusion. To the nursing students.

and better understanding for their research about nursing education. moral responsibility/accountability. While nurse educators should imbibe to their students the essence of developing their competency in caring. the study of Mangaoang in 2000 aimed to find out the level of performance of staff nurses along competency in caring. 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. becoming morally responsible. and establish a therapeutic interpersonal relationship for a better quality care and to be carried on in their work. decision making.trends in nursing lectures and discussion to facilitate learning. “Quality care begins from one’s training in school but even here the quality of training is slipping”. Colleges of Nursing should assess the clinical exposure and implementation of the curriculum to identify the strengths and weaknesses. immediate supervisors and patients. this study gives guidance. To the Further Researcher. inspiration. Medication errors in . good decision maker. This will give opportunity to the future researcher to share information and concepts leading to good interpersonal relationship between the learner and the educator. According to Adversario (2003). Nursing service administration should develop or improve their tool to assess performances of nurses. Regularly. The care competence of the fourth year students was determined in a study conducted at Tiangha in 2007. assertiveness and interpersonal relations as perceived by staff nurses.

These factors are influenced by the clinical instructor's ability to facilitate a smooth transition from learner to practitioner.the hospital are common though it can be prevented. in nursing. the clinical education experienced by a student greatly affects future performance as a nurse. The integration of knowledge and skill and student evaluation is powerful factors in the preparation of a nurse. . 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. It is also often the time when a clinical instructor makes a decision about whether the student will make a satisfactory nurse or not. 2007). The nurse has to be knowledgeable not just in the interactive interventions but also in the use of the medications to treat the illness. 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. 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. They must know the mechanism of action and side effects of each medication (Basa. It would be of value to know what clinical instructors do to assist students in making this transition. The clinical experience provides opportunity for the student to integrate classroom theory and laboratory skill. Foreign Studies According to Park (2007).

In order to be well prepared as Athletic Trainers. receives hands-on training in a clinical or laboratory setting. a standard part of a nursing school curriculum is the clinical rotation. 1975: 27). 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. None have reported actual descriptions d clinical instruction and those with suggestions on teaching in the clinical area are not specific. where a small group of nursing students. According to an article in the American Journal of Nursing. they are educational experiences where classroom knowledge is applied in real-world settings. A key component in this rotation is . as well as "real-world" clinical experiences where students engage in supervised clinical practice and gain experience. supervised by a nursing clinical instructor. Instead. What ace the behaviors associated with the clinical instructor role? Which behaviors are effective? Which are ineffective? For example.These courses include both clinical educations. 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. "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. in the form of in-class application of integrated care. Clinical experiences are NOT "work" experiences.

) Evaluation format is an important consideration when thinking about strategies to evaluate a nursing clinical instructor. Other kinds of formatting can determine how much detail you provide as you evaluate a nursing clinical instructor. and students evaluate the instructor's effectiveness. teaching methods. 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. communication style. The article recommends evaluating an instructor on knowledge and expertise. 1. Tang and . 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. Building an assessment strategy to evaluate a nursing clinical instructor relies on a few key considerations. according to a Journal of Nursing Education article by Lehman and colleagues. use of own experiences and opportunity for feedback.) 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. 2. the advent of technology in various health-care settings has led some nursing instructors to use handheld computers for evaluation.evaluation: instructors evaluate students' ability in each lesson. For example. Although nursing schools have historically relied on paper forms for student and instructor evaluation.

interpersonal relationships. Benner identifed competencies within a framework of seven domains of nursing practice: the helping role. assessment tools and rating scales (Coates & Chambers. criterion-referenced rating scales. the diagnostic and patient-monitoring function. A study entitled “Assessing Competence to Practice in Nursing” was conducted to assess the competence to nursing practice. reflection in and on practice. the teaching–coaching function. 2001). administering and monitoring therapeutic interventions and regimes. Benner’s model of skill acquisition. The study “Assessing competency in nursing: a comparison of nurses prepared through degree and diploma programs” conducted in the year 2004. suggest evaluating instructors based on four categories: professional competence. effective management of rapidly changing situations. There is a strong view that student-based evaluation is essential (Rolfe. and organizational and work-role competencies. Researchers made use of questionnaire rating scales. personality characteristics and teaching ability.colleagues. ratings by observation. monitoring and ensuring quality of health care practices. simulations including the objective structured clinical examination (OSCE). on the other hand. aimed to investigate the competencies of qualifiers from three-year degree and . selfassessment and multi-method approaches as the study’s method. standardized and validated with examinations. Competence is an objective concept that can be measured. 2002).

while the feminine occupations. The foremost symbol is Florence Nightingale. while the male was regarded as a hunter (Kumar. 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. and three years after qualification. two. Since the patient’s safety is an essential part of the delivery of quality care. The instrument used was a revised version of the Nursing Competencies Questionnaire. and a shortened version of the said scale. A quantitative study performed by Towns. supervisory assessments. It made use of a cross-sectional design. Couch and Sigler (2001). 2004). 2007. those that can be associated with power and control.three-year diploma courses in England at one. The researchers concluded that some occupations are classified as masculine. Nursing has traditionally been a woman’s domain and may have its origins in the evolution of man. October). portfolios and selfassessment. Competence and competencies have been assessed using observation. attaining a satisfactory standard of patient safety obliges that all health care setting widen inclusive patient safety systems. Nurses and all health care professionals constantly struggle to maintain patient safety a priority (Byers. determined if there exist perceptions of masculinity or feminity in various professional occupations. ability and knowledge tests. . are those connected to care giving. The female has been regarded as the nurturer.

According to Aspden (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. Comfort is a condition of physical and emotional well being. 2004). but . 2004). It is not only on providing medication and procedures. 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). nursing care looks also in all perspectives in giving wellness to the patient. 2000). 2004).together with both of culture of safety and organizational supports for safety procedures (Aspden. The defense of privacy of patients and providers involve that records be kept back confidential and protected (Taylor. Patients have reported that the presence of nurses and their care giving activities contributes to a sense of wellbeing and provides hope for faster recovery (Hegner. Competence is a complex concept. Supporting patients with their comfort desires is a chief nursing assistant responsibility. political and often misunderstood (Watson.e. listening to others. health and wellness. understanding them and responding with appreciation of their intention”. 2002). In accordance with the study. “respect for persons involves treating people with considerations. Individuals need comfort. In addition. i. And as a matter of fact. rest and sleep for physical and emotional wellbeing. supporting patients with physical or emotional comfort needs is at the heart of nursing care (Hegner.

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 . 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. Watkins. measurement of the underlying competencies requires the evaluation of the constructs that underpin the accessible and quantifiable performed tasks. The nurse and the client then begin planning by deciding which nursing diagnosis requires attention first. 2000. 2008) Nurses frequently use Maslow’s hierarchy of needs when setting priorities. medium. 2000).also to consider the emotional support in health teachings. and selfactualization being the lowest priority. As such. 2002). in which only work tasks and roles are considered (Manley & Garbett. then down to safety.. Regarded in this way. Priority setting is the process of establishing a preferential sequence for addressing nursing diagnoses and intervention. as well as compassionate service and caring are motivated by love (Watson. Instead. which second. The highest priority ranked is physiologic needs. esteem. or low priority instead of rank-ordering diagnoses. (Kozier & Erb. but rather inferred through the competent performance of tasks (Redfern et al. a more holistic approach is used whereby the concepts of knowledge and understanding are considered. love. Nurse can group them as having high. 2002). and so on. holistic competence cannot always be directly observed. A consistent recommendation has been to avoid a reductionist approach to the study of competence.

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.

Not categorical because this is INTERVAL of four key core can be quantified with no adherence to zero.50 greet extent of integration. wherein each question will be answered using score value of 1 to 4 .52 – 2. structured with questions and corresponding questions regarding to four key core competency.51 – 4. .50 as less extent of integration.made questionnaire based from the four key core of competencies by clinical instructors.00 as very great extent of integration. The variables will be measured using an ordinal scale. The number of sample will be determine through the use of sloven’s formula.51 – 3. in which 1 is the highest possible score which correspond to the adjectival description of always . 2 for often . 3.Sample and Sampling Technique Simple random sampling techniques will be employed in choosing the respondent. 2. Research Instrument The questionnaire is the primary instrument in gathering data that will be used for this study.50 as moderate extent of integration. 3 for sometimes. The self. 1. Holistic interpretation of the composite team is the following: for the corresponding adjectival rating of 1. and the lowest possible score is 4 for seldom.00 – 1.

Researchers self-made questionnaire will be utilized to gather the needed data. 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. specifically the following statistical tool will be used to answer problem number 1. to answer problem number 2 with regards to what extent are the four key core competencies integrated by clinical instructor to the nursing . the proponents will conduct pilot testing. Olivarez College of Nursing through the respective deans .Validation of the instrument The survey questionnaire will be validated by three clinical instructors who are expert in the field of nursing. Arellano University College of Nursing . frequency count and weighted mean will be applied to determine the level of performance of nursing students from selected nursing institution. 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. Data Gathering Procedure The researchers will seek permission from the respective presidents of Manila Doctors College. Statistical Treatment of Data The date gathered will be analyzed quantitatively. in order to conduct the study and administer questionnaire.

. pearson’s and will be applied.students from selected nursing institutions. weighted mean will be employed. and to test the difference among selected institution in terms of clinical performance of nursing student in selected nursing institutions. 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. Analysis of variance (ANOVA) will be applied.

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