ABSTRACT Success Indicators in the Eleven Key Core Competencies of the Graduating Nursing Students: Patterns for Clinical

Skills Enhancement Program Dr. Cyruz P. Tuppal, Head Faculty Researcher Dr. Virginia T. Daliposa, Member Dr. Yolanda A. Ortiz, Member Introduction The evaluation of students¶ outcomes has been imperative to all universities and colleges. There has been a verge need to produce quality and effective graduates to sway with the global demands and transnational level of education. With the trends in nursing education and clinical practice, students¶ assessment and evaluation through multiple indicators should be integrated specifically the clinical competencies essential in practicing professionals. In this study, though limited in one university, it can shed light to other institutions to commit their volition admirable aplomb in developing competent graduates. Background of the Study One of the major challenges in nursing education is evaluating clinical competencies because it reflects students' abilities to select the necessary elements from their own repertoire of resources and apply them to unique situations (Bergevin, 1999). The evaluation of nursing students' clinical competencies in a wide array of situations is essential to the educational process because students are exposed to various patient health issues in the clinical area. To meet the needs of today's graduates, nursing education must reexamine the academic and clinical preparation of nurses (Hickey, 2010). Since there is a dearth of evidence in evaluating the competencies of the graduating students based on the CHED standards, it was chosen by the researchers to provide outcome based findings that further enhance the competencies of the students and prepare them to the realms of nursing practice. Problem Statement 1. What is the profile of the graduating students in terms of: 1.1 Related Learning Experience areas of exposure; 1.2 Status; 1.3 Students¶ clinical experiences of patient care; 1.4 Number of patients allotted for the students; 1.5 Tools used in the measurement of competencies; and 1.6 Nursing skills procedures performed in the clinical areas? 2. What is the level of competencies and agreement based on ratings by: 2.1 Graduating nursing students; and 2.2 Clinical instructors? 3. To what extent to the nursing procedural skills are performed by the graduating nursing students?

4. correlation analysis in determining factors affecting competencies and exploratory factor analysis. an interrater reliability analysis using the Kappa statistic was performed to determine consistency among raters. using principal component analysis with a varimax rotation in determining success indicators in the core competencies. and 4.857). What clinical skills enhancement program and guidelines can be proposed based on the findings of the study? Methods and Procedures Descriptive research design was employed in the study. AY 2009-2010.838) and factors affecting competencies ( C = 0.2 Clinical Instructors¶ related. Descriptive statistics was used to describe the data responses. Samples were graduating students (n=230) who were selected using stratified sampling technique and clinical instructors purposively chosen (n=30 from affiliated institutions. The researchers treated the data statistically aided by SPSS Version 17.4. What success indicators can be inferred in the core competencies of the graduating nursing students? 6. To what extent to the following variables affect the competencies of the graduating students: 4. .892). The instruments used were researchers constructed survey to identify the students¶ characteristics.3 Clinical Area related.1 Students¶ related. the levels of competencies that made used of 11 key core competencies. Reliability analysis was performed in the instruments that described levels of competencies ( C = 0. Second. 4. Results of this study design were tailored to the specific core competencies based in 11 key area indicators. factors affecting the competencies and nursing skills procedures performed in the clinical areas of assignment.4 School related? 5. this study was specific to the undergraduate program and covered only 2nd Semester. nursing skills procedures ( C = 0.

45± 3. SD 5. 11 Key Areas of Core Competencies were considered as shown and guided the study in developing clinical enhancement program and guidelines. 1 shows the conceptual model of the study that was tailored and anchored from CHED Memo 30. Findings of the Study Table 1 Profile Characteristics % Related Learning Experience Areas of Exposure General MS OR NICU ICU CHN OB 6 18 10 14 8 4 M.Conceptual Framework Safe & Quality Care Graduating Students Profiles Collaboration & Team work Management of Resources & Environment Health Education Communication SKILLS ENHANCEMENT Factors Affecting Competencies Eleven Core Competencies Records Management Legal Responsibility PRACTICE GUIDELINES Nursing Skills Procedures Research Ethico Moral Responsibility Quality Improvement Personal and Professioanl Development Figure 1 Conceptual Framework of the Study Fig.09 .

Infection control (basic medical asepsis. graduating students (65%). checklist (32%). bed making.Psychiatric Nursing Pedia Head Nursing DR Graduating Status Graduating Irregular Students' Clinical Experience Observation Partial Care Total Care Number of Patient allocated to the students Zero Patient 1-2 Patients 3-4 Patients > 5 Patients Tools Used in Measurement of Competencies Observation Checklist Learning Feedback Clinical Report Oral Revalida 9 5 6 20 65 35 78 15 7 7 44 40 10 44 32 3 13 9 0. provided with 1-2 patients (44%) with an average of patients allocated of 2 (SD = 0.11±1. Table 2 Nursing Skills Inventory of the Graduating Nursing Students Nursing Skills Inventory Performance 1.35± .82 3. Bowel management 6. Exercise and ambulation 18.97 2. and discharge planning 2. Mucous Membrane medication Administration.28±. Tools that were used in measuring their competencies were observation (44%).17 3. Medication administration Medication Preparation. and maintaining skin integrity 5. Tracheostomy care 12.763 2. Fetal monitoring 15. Orthopedic interventions Application of Immobilizing Cast Care Mean 3. patient care was mostly observed (78%). Incident reporting 11.479 1. blood pressure) 3.763).39 3. Chest physiotherapy 19.77 3. Parenteral Medication Administration) 14.71 3. Documenting in the client record 17.06 2. Oral Medication Administration. transfer. Preoperative care 13.14 3.79 3.578 1. clinical report (13%) and oral revalida (9%).76 3. Body mechanics and positioning (moving and turning) 7.99 2.34 Samples were mostly exposed in DR (20%) and OR (18%). Specimen collection (urine. pulse rate.51 3. sputum.25 3. Communication and nurse-client relationship 4.41 3.17 3. Bathing. Admission. Topical Medication Administration. blood. standard precautions. respirations.53± . Vital signs (temperature.97 Adjectival Often Often Often Often Seldom Often Seldom Seldom Seldom Seldom Seldom Seldom Often Often Seldom Seldom Seldom Seldom Seldom .32 3. Emergency life support measures 16.30 3. isolation) 8. stool. Discharge postoperative care 9. throat and wound specimen) 10.81 3.

69 2.52 4. Vital signs (3.07 0.50 Only Once. 23.51). Anxiety 6. Time management Clinical Instructors Factors 1.06 . oxygen administration (3.00 0. and maintaining skin integrity (3.50 Often. 37.58 2.80 2.81 2. 33.05 0.64 2. 32. specimen collections in closed system.03 r 2 Sig.02 0. Table 3 Factors Affecting Core Competencies Factors Student Factors 1. endoscopic studies.45 4. 21. and discharge planning (3.50 Seldom.63 4.81).05 0. catheterization. Communication and nurse-client relationship (3. Motivation 3.11 0. Preparation 5. Gastrointestinal Tube Therapies.00 Almost Every Duty Findings showed that that Admission.00 0. renal replacement therapy) Nutritional management and intubation Modified Therapeutic Diets. 24.11 0. Health and mental status 4. Self confidence 5.96 0. Performance 2.79).06 0. perineal and genital care and eye and ear care) Urinary elimination (intake and output.77 2.53 Seldom Often Seldom Seldom Seldom Often Seldom Seldom Seldom Seldom Seldom Seldom Seldom Seldom Seldom Seldom Often Seldom Often Note: DR (Descriptive Rating) 1. bed making and maintaining skin integrity (3.64 3.40 4.00 -0. they should be expected to perform basic nursing skills that were acquired before the actual exposure to the clinical setting. bathing. 35.53 3. 34.57 4.04 0.13 0. 3. 31.56 4. Barium studies. Relationship with students 6. urinary elimination (3. Bathing. Individual preparation 2. fetal monitoring (3.51-3.51-5. Attitudes 4.06 0.05 0.07 0. 25. 28. transfer.81 2.52 4.58) and wound care and dressings (3.66 2. body mechanics and positioning (3. Diagnostic procedures (contrast media.87 4.64 2. 1.00-1. bladder irrigation. suprapubic catheter care.05 -0. 26. urinary diversion.51-2.43 4. 36. 30.64 2. Personality 3.50 Not at All. 0. Nutrition Maintenance.77).82).13 3. Preventive and Maintenance Measures Blood transfusions Total parenteral nutrition/total nutrient admixture Oxygen administration intubated airways Lipid emulsion therapy Wound care and dressings 2. 4.99 4.76).53).01 0.53) were often performed by the graduating nursing students however. medication administration and preparation (3.51-4.65 2.74 2. 22. 29.94 3.19 0.82 2. physical assessment (3.44 0.47 0. fluid analysis and microscopic studies) Pain management (nonpharmacological pain relief and pharmacological pain management) Suctioning Monitoring fluid balance Circulatory maintenance Control of Bleeding Circulatory Maintenance Safe client environment and restraints Respiratory care.71) and Fecal Ostomy Pouch Application (3.20.80).71). 38. pediculosis.03 -0. hair.82). x ray studies. 27. Postmortem care Physical assessment Disaster preparedness Heat and cold therapies Personal hygiene (oral.66 2. 2.80 3. Subjectivity Clinical Area Factors Mean 3. bed making. Enteral Feeding. foot care.06 0. external urine collection system.

in terms of clinical area factors including activities in the ward r=0. Scheduling 2. self confidence r=0.70 4.07.17 0.05. Information dissemination 6.26 4.17 0.00 VGE (Very Great Extent) *p<0.30 4.01.34 Clinical Instructors 3. anxiety r=0.77 3.30 4. in terms of clinical instructors¶ related factors including performance r=0. nurses need to have interest in patients and their well being to offer effective care thus. this lessens the anxiety that can be a barrier in rendering care.50 E (Extent).11 3.25 0.03. Patients and family's preparation 7.06.09 0. 1. in terms of school related factor including scheduling r=0.20 Interrater Reliability Analysis ** Coefficients 0.01 were significantly influence the core competencies.01 0. p<0. Safe and Quality Care Graduating Nursing 3. p<0.000 .01 0.94 3.05 and number of students r=0. Number of students 8.06 0.17.01. p<0. patient¶s severity r=0.05.12 0. student factors including motivation r=0.00-1. Staff management 9.24.16 0.24 0. Patients' treatment schedules School Related 1. p<0. 4.05.01 Factors Affecting Competencies of the Graduating Nursing Students As revealed by the findings. limited patient cases r=0.12.04 0.12 4. As students became interested. p<0.58 0.522** Sig. Continuous duty shift 4.14 0.51-2.03 4. p<0. p<0. Subject Loads 3.42 4. Table 4 Overall Ratings on Core Competencies and Levels of Agreement Ratings * Eleven Core Competencies 1.19. clinical set up r=0. p<0.08 0. 0.30 4. health and mental status r=0.20 -0.00 0.1. p<0.05.09 0.06 0.05. On the other hand. Clinical set up 4.17.47 4. Subject requirements 4.16 Note: DR (Descriptive Rating) 1.01.09 0. Memarian (2007) found that skillful use of knowledge in practice is a fundamental element of clinical care.04.51-4.21 0.51-3. p<0.05 0.50 NAA (Not At All). Equipment availability 2.01 and preparation r=0.06 0.50 HE (High Extent).00 0. they put up with all the difficulties in their work environment.38 0.3. **p<0.38 4. An interest in the profession is one of the main indicators of professional competency. Patients' severity 5.05.12 0.08 -0. Limited patient cases 6.51-5. p<0.11 -0.17 0.17 0.50 ME (Moderate Extent).82 4.03.40 4. Activities in the ward 3. always turn up for shifts and offer loving care to their patients regardless of time spent with the patients.01 and unanticipated adding and changing of clinical duties r=0. The distinction between having knowledge and its skillful utilization should not be overlooked and the significant factor in becoming a competent practitioner is being able to apply the knowledge gained to caring for patients.25.03 0.93 3.04 0. Unanticipated adding and changing of clinical duties 5.06.07. Communication skills 10. p<0. p<0. 2.38 0. Support from group members 11.01.97 -0.21 0.

880 4. Performs comprehensive and systematic p values 0.037 0. 4. 1.000 0.000 0.00-1.03 0. 95% CI (0.373 Cumulative % 19.01 (2-tailed) Adjectival Rating 1. Management of Resources and Environment 3. Collaboration and Teamwork 3. Kappa = 0. 1.59 are considered moderate.2.100 4.45) for Collaboration and Teamwork. and values less than zero signify that agreement is even less than that which could be attributed to chance.0 where large numbers mean better reliability.99 3. The aforementioned findings revealed that components were identified have moderate to substantial reliability coefficients.000 0.76 (p < 0.19 3.413 38.49 (p < 0.22 3.04.02 0.78 0.000 0. Table 5 Factor Analysis in Identifying Success Indicators in the Core Competencies Items 1.138 0.11 2.483 47. 1.39) for safe and quality nursing care. Promotes safety and comfort and privacy of patients 3. values near zero suggest that agreement is attributable to chance.07 0.47 3.351 0.50 HC (Highly Competent).071 7.317 % of Variance 19.50 PC (Poorly Competent). The interrater reliability for the raters was found to be Kappa = 0.40 to 0.51-3.030 9.000 Eigen values 10. Most statisticians prefer for Kappa values to be at least 0. As a rule of thumb values of Kappa from 0.15 3. 2.00 VHC (Very Highly Competent) The study utilized the interrater reliability analysis results using the Cohen¶s Kappa which ranges from -1. Kappa =0. 0.98 2.50 MC (Moderately Competent).678** 0.056 26.413 0.60 to 0.437 2.215 0.172 3.481 11.6 and most often higher than 0.106 0.000 0.05. 5.000).21 2.000 * p<0.000 0.02 0.66 (p < 0.57 0. Utilizes the nursing process as framework for nursing 6.586 2.872 6. Communication 2. Kappa = 0.190 4. and Kappa = 0.22.425 10. 4. ** p<0.595** 0.17.51-2.751 2.51-5.000 0. Records Management 3. and 0.51-4.0 to 1.030 0.50 VPC (Very Poorly Competent).063 8.52 3.14. 1. Quality Improvement 3.62).000). Competencies of the graduating nursing students were clearly understood that both raters agreed on the assessment to some key indicators. 2. 95% CI (5. Research 3.50 (p <.17 3. 95% CI (8. Administers medications and other health therapeutics 5. 4. 1977).484 5. 6.34 3.04 3. 95% CI (6.80 outstanding (Landis & Koch.17.02). Health Education Legal Responsibility Ethico Moral Responsibility Personal and Professional Development 3.57) for health education.99 2.855 .000 0.056 7.581** 0.79 substantial.46 3.7 before claiming a good level of agreement.42) for Ethico Moral Responsibility.51(p < 0.001).501* 0.603 43.928 33. 3. 95% CI (4.0. Sets priorities in nursing care based on patients' needs 4. Provides sound decision making in the care of individuals / groups considering their beliefs and values 2.000).

management of resources and environment. maintaining skin integrity.544 2.376 70.000 1. 01 and 0. Participates in nursing audits and rounds 0. personal and professional development and quality improvement were among success indicators.000 1. Identifies own learning needs 0.579 3. unanticipated adding and changing of clinical duties affected the competencies of the graduating nursing students.348 civic activities 13. Kaiser Criterion Eigen values < 1 4. Recommendations Based on the findings of the study. 95% of confidence interval as expected and p values less than 0.222 standards 14. anxiety and time management. This concludes that there is again a verge need to develop more realistic components that are not too broad and could easily be performed as expected from the graduates.668 65.918 Findings showed that 53 Items indicators were loaded in testing the level of significance using the exploratory factor analysis with varimax normalization.000 2. urinary elimination. the ff is recommended: .000 1. fetal monitoring. direct observation was rendered to 1-2 patients and performance was measured based on observation. oxygen administration.000 1. Documents care rendered to patients 0. health and mental status.000 1. transfer. There should have continuous assessment of the competencies of the graduating nursing students to ensure that objectives in developing the standards of the curriculum are met and achieved.717 59.188 patients and other members of the health team 8.983 55.372 3.00.897 10. patients¶ severity. 15 items were identified to have eigenvalue of 1-10 that had been considered to have significance in the competencies of the graduating students. In the Eleven Core Competencies. Organizes work load to facilitate patient care 0. Gets involved in professional organizations and 0. safe and quality nursing care. legal responsibility. communication. Formulates a plan of care in collaboration with 0.000 1.054 Varimax with Kaiser Normalization. self confidence. Though. Recommends solutions to identified problems 0.nursing assessment 7.248 1. the realization that among indicators that are loaded in the factor analysis.128 3.000 1.305 2. the aforementioned showed minimal number of key indicators that were significantly correlated with one another.295 62.832 68. medication administration. limited patient case and number of students.929 74. Kaiser Criterion. bathing. discharge planning.979 identified outcomes 9.677 12. bed making. Performs function according to professional 0. clinical set up. clinical instructors¶ related factors including performance and preparation. clinical area related factors including activities in the ward. Admission. vital signs monitoring.000 1. Students¶ related factors including motivation.989 51. Conclusions Graduating nursing students were mostly exposed in DR. Graduating nursing students are moderately competent in the 11 key areas.164 2. and school related factors including scheduling. physical assessment and wound dressings were often performed by the graduating nursing students. Implements planned nursing care to achieve 0.05.681 72.733 3.787 11.192 15.

1 Comparative study on the core competencies under old and new curriculum 5.2 Correlate success indicators in the NLE performance 5. Further studies on the following: 5. 5.3 Identify other factors affecting development of competencies of the students 5. Intensive clinical enhancement program before the conferment of the degree. 2. Provision of appropriate measures to address the factors identified that affect competencies. 4. Monitoring of the core competencies of the graduating nursing students both old and new revised curriculum.5 Consider a larger frame of population as respondents from all other clinical areas not included in the present study.4 Enhancement program for clinical instructors along with cognitive. 3. psychomotor and affective 5. .1. Utilization of various pedagogical modalities in the assessment and evaluation of competencies.

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