.
Level of Competency on Neonatal Resuscitation and
Cavite
DEDICATION
I wholeheartedly dedicate this study to my
mother, who have been there for me throughout
my life and gave me strength when I thought of
giving up. To my brother, who did beautiful things
in my life. To my friends who encouraged me to
finish this study. And lastly, to our Almighty God
for giving me strength and knowledge to finish
this study
-Angela Monique S. Timbol
1
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
TABLE OF CONTENTS
Title page
Dedication ......................................................................1
Table of Contents ...........................................................1
Introduction .....................................................................2
Comprehensive Research Literature ..............................3
Conceptual Framework ...................................................4
Research Paradigm ....................................................... 5
Statement of the Problem .............................................. 6
Research Deign and Sampling Scheme ........................ 6
References ......................................................................8

. Level of Competency on Neonatal Resuscitation and
Cavite
Level of Competency on Neonatal
Resuscitation and Critical Life Support of
Nurses on Neonatal Intensive Care Unit in
Cavite
Angela Monique S. Timbol
Introduction
Nurse’s role in the neonatal intensive care unit
involves more than simply administering medications,
monitoring vital signs, and providing nutrients to
newborns. Being a nurse is one of the most complicated
jobs today. Nurses in neonatal intensive care unit is even
more challenging. It demands broad knowledge including
life-sustaining care. Strong knowledge and skills in
performing critical life support in infant aims to lowers the
infant mortality rate and Improve survival in infants. In a
study, it was found that rates of childhood mortality
decline, neonatal deaths account for nearly half of under-
5 deaths worldwide. Inevitable intrapartum related events
such as birth asphyxia contribute to approximately one-
quarter of neonatal deaths, many of which can be
prevented by simple resuscitation and newborn care
interventions (Kamath-Rayne et. al, 2017).
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Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Nursing competency is considered as a factor in
assessing the performance of a nurse. Knowledge, skills
and attitude of a nurse is crucial in achieving the goal in
every patient.
This study focuses on the nurses in neonatal
intensive care unit in Cavite. This study is conducted to
identify and assess the level of competency of nurses in
selected hospital in Cavite. The respondents are the
nurses who have been exposed to neonatal intensive
care unit. Also, this study yearns to identify on how the
researchers can develop and assist the nurse to be self-
reliant and responsible in identifying and dealing with
critical life support. The assessment was focused on
skills and knowledge to neonatal resuscitation and critical
life support.
This study will benefit those nurses who are front
liners in rendering care and health services. They will be
able to identify their weaknesses thru the assessment
instrument used to assess their competencies and
improve the weak spot so that the quality of care or
service would not be compromised. Hence, they will
attend training that could enhance and develop their
skills. The result of the study will show the competency
level of the nurses. Hospital administration could be
aware on the standard competency requirements which
can be used as a guide on the recruitment of new nurses.
This research study reports the level of
competency of nurses in neonatal resuscitation and
critical life support in neonatal intensive care unit in
 . Level of Competency on Neonatal Resuscitation and
Cavite
Cavite. This will serve as basis for developing nurse
enhancement programs. Nurse practice programs are
designed to support nurses as they play a vital role in
patient’s life.
Comprehensive Research Literature
Competency is crucial in nursing practice because
nurses deals with the life of individuals. Competency of a
nurse is a factor that is considered in assessing the
performance of the nurse. Competency also affects the
nurses’ job. Knowledge and skills is a key to achieve the
goal of a nurse for the patient, on the other hand
competency involves care that saves the patient from
harm. According to research carried out by Feliciano et
al. (2019), competencies are important part of the
continuous process for being a competent professionals
in acquiring the knowledge, skills and attitude that are
necessary to perform task and has the ability to perform
professionally in an environment that lives with
organizational roles and guidelines. A nurse should
participate frequently on events that will supplement
one’s competency and clinical performance. To execute
competency in the field, a nurse should seize knowledge,
skills and abilities prerequisite for permissible, safe and
effective practice. Ensuring the quality of care to the
patients is one of the crucial roles of a competent
healthcare workers including nurses. The aim of serving
competently is to improve the well-being of the patient,
maintain health, promote health, and prevent diseases
Nurses are skilled in all aspects of basic nursing
care, competent nurse can meet the patient’s needs
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Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
through their cognitive, interpersonal and ethical skills.
Nurses are also responsible for evaluating their own
strengths and weaknesses so patient will receive holistic
care. Competency evaluation for nurses allows them to
focus on their strength and weaknesses, some aspects
and nuances of their performance in the clinical area
(Mangubat et. al, 2014). Furthermore, self-assessment
helps in increasing awareness about job description to
fulfil goals, evaluate progress and gain professional
development (Heathfield, 2014).
In a study Benner (2020), developed a concept
known as from novice to expert. The theory
Conceptual explains that
Framework
nurses develop skills and understanding of patient
through education and personal experiences from clinical
exposure. Benner’s theory identify 5 stages of nursing
experience it starts from novice, advanced beginner,
competent, proficient and expert. A novice is a nurse
without experience. A novice nurse follows what they are
told to do and follows instructions. The advanced
beginner has gained experience in actual clinical duties.
Based on those experience the nurse begins to enhance
their skills and knowledge. When the nurse becomes
competent, they gained more than 2 years of experience
in the same field. These nurses becomes aware of the
long term goals and they begins to formulate plans and
execute their own action. Therefore, helps the nurse
achieve goals, efficacy and organization. A proficient
nurse perceives situation as whole parts. The nurse has
a more holistic understanding of nursing, decision making
was also improved. Nurses learned from their own
experience and can modify plans and intervention as
 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

needed. Lastly, the expert nurses have their own

principles, no longer rely on rules and guidelines in a
situation and determine actions. They have enough
experience in clinical situation. With many levels of
nursing, they should have a clear idea of scope of
practice of their level.
Critical thinking is a competency need for nurses,
the ability to respond quickly and make decisions. Each
and every area in the hospital have different knowledge
and skills to be competent enough. Therefore, nurses are
required to apply and understand principles and
techniques of physical assessment, safety of the patient
and nursing process. According to Hood (2015), nurses
hold their client’s lives, in their hand, they have to render
a holistic care. Every performance or activities of nurses
in every area were guided by a supervisor. They will also
guide them and tell them what to do.
Neonatal resuscitation is an intervention done after
a baby is born to help it breathe and to help its heart to
beat. It is defined as an intervention at the first minute of
newborns life to support breathing and circulation. As
stated by Sarwa (2015) series of actions of which are
used to assist newborn who have difficulty with making
the physiological transition between the womb and the
outside world. Cardiac arrest in neonatal intensive care
unexpected event of a cardiac arrest in the ward, being
unit is not preventable. Therefore, nurses in this area
ready to provide the initial rescue maneuvers, including
should be prepared to action as soon as possible, proper
BLS and oxygen administration.
knowledge and skills in resuscitation will save the
neonates life. In this setting, neonatal critical care nurses
are quite often the first to witness any cardiac arrest The basis of the conceptual framework of the
episode. Thus, they should be prepared for the current study is from American Heart Association (AHA)

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

neonatal life support. The purpose of AHA was to provide questionnaire, survey, and specific competency
information about neonatal cardiopulmonary resuscitation assessment. The output of this study is to propose a
with treatment recommendation. Figure 1 shows the training program to improve the level of competency of
associated variables in the study. Nurses’ demographic neonatal intensive care unit nurse.
data is connected to the level of competency. It
demonstrates that the demographic data will affect the
assessment of the respondents. The level of competency
corresponds the factors that will be assessed. It will
assess the following categories: anticipation and
preparation, initial assessment and intervention,
physiological monitoring and feedback devices,
oxygenation and ventilation, circulatory support, drug and
fluid administration, prognostication of CPR, and post
resuscitation care.
Research Paradigm
Figure 1.2 shows the Input-Process-Output model.
The input of the study consisted the following variables:
what is the demographic data of the respondents in terms
of age, sex, length of work experience, hospital type and
category it also includes the competency level of nurses
in terms of anticipation and preparation, initial
assessment and intervention, physiological monitoring
and feedback devices, oxygenation and ventilation,
circulatory support, drug and fluid administration,
Statement of the Problem
prognostication of CPR, and post resuscitation care. The
process of the study is by determining the competency The main purpose of the study is to determine the
level of nurses in selected hospital in Cavite on neonatal competency level of nurses in neonatal intensive care
resuscitation and critical life support with the use of unit in Cavite.

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

Specifically, the study aimed to answer the 3. Is there a significant relationship between the
following questions: demographic profile of the respondents and the neonatal
resuscitation competency in terms of:
1. What is the demographic data of neonatal intensive
care unit nurses in Cavite? 3.1 Anticipation and preparation
1.1 Age 3.2 Initial assessment and intervention
1.2 Sex 3.3 Physiological monitoring and feedback
devices
1.3 Length of Work
3.4 Oxygenation and ventilation
1.4 Hospital Type
3.5 Circulatory support
1.5 Hospital Category
3.6 Drug and fluid administration
2. What is the perceived level of neonatal resuscitation
and critical life support competency of the respondents in 3.7 Prognostication of CPR
terms of:
3.8 Post resuscitation care
2.1 Anticipation and preparation
4. What is the general level of competency of the
2.2 Initial assessment and intervention respondents in neonatal resuscitation and critical life
support?
3.3 Physiological monitoring and feedback devices
5. What nurses’ training program should be
3.4 Oxygenation and ventilation recommended to improve the level of neonatal
3.5 Circulatory support resuscitation and critical care competency of nurses?

3.6 Drug and fluid administration Research Design and Sampling Scheme

3.7 Prognostication of CPR A quantitative research design approach is used in

this study. A quantitative research design not only
3.8 Post Resuscitation Care
focuses on insights of a person, it focuses more on
collecting user data and so this approach has been
chosen as an appropriate research method. The

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

researcher utilized the descriptive research design as it
includes all the studies before that needs an answer
concerning the nature and status group of persons, acts,
condition, or any phenomenon which was the point of
study.
The target population for this research includes the
registered nurses in Cavite who has been designated in
neonatal intensive care unit. The researcher used
convenience sampling which is a type of non-probability
sampling technique. This technique is used to select
respondents based on a criterion. The use of this
sampling technique has two criteria. The first one was for
the determination of hospital and the other one was for
the determination of the respondents. The basis for the
hospital should belonged to secondary and tertiary
hospital levels in Cavite. For the respondents, some
basis includes their availability and the areas where they
are assigned to.
complete the task and formulate plans with minimal
guidance. Highest competent (4), the nurse can execute
the task without assistance competently.
The questionnaire is designed to gather
information about the level of competency on neonatal
resuscitation and critical life support of nurses in neonatal
intensive care unit. The question were modified from
American Heart Association (AHA); Neonatal Life
Support. The questionnaire is divided into 9 parts. The
first part is about the demographic data of the
respondents in terms of age, sex, length of work
experience, hospital category and hospital type. The
following parts of the questionnaire has a 4 question
each. 32 competency related questions encompasses 8
category Anticipation and preparation, initial assessment
and intervention, physiological monitoring and feedback
devices, oxygenation and ventilation, circulatory support,
drug and fluid administration, prognostication of CPR and
post resuscitation care.

The researcher used a self-made questionnaire to

gather the data needed. The researcher used Likert scale
because this can be used for measuring the knowledge,
skills, and attitude of a nurse in neonatal intensive care
unit. The level of competency was indicated in a scale of
1-4, 1 as the lowest and 4 as the highest. Not competent
(1), the nurse is not competent enough to perform the
said skills. Less competent (2), the nurse has experience
in actual clinical duties, but still expected to need more
knowledge or experience. Competent (3), the nurse can

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

REFERENCE:

Benner, D. P. (2020, January). Nursing Theory. Retrieved from Dr.

Patricia Benner Novice to Exper - Nursing Theorist:
https://nursing-theory.org/nursing-theorists/Patricia-
Benner.php

Heathfield S. M. (2014). Importance of Self Evaluation. Use an

Employee Self Evaluation. Retreived from
http://humanresources.about.com/od/performancemanage
ment/a/self_evaluation.htm

Hood, L. J. (2015). Providing Holistic Care. In L. J. Hood,

Leddy&Pepper's Conceptual Basis of Professional Nursing
7th Edition (pp. 150-172).

Feliciano et. al. (2019). Journal of Patient Care. Understanding

Philippines Nurses’ Competency in the Delivery of
Sarwa, J. (2015). Acute Care Testing. Fetal-to-neonatal transition:
Healthcare, 2.
What is normal and what is not?
Mangubat. (2014). CAM Research Journal. Level of Competency of
New Registered Nurses as Perceived.

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

Kamath-Rayne, B. et. al. (2017). National Library of Medicine .

Neonatal resuscitation in global health settings: an
examination of the past to prepare for the future.

Wyckoff, M. H. (2020). American Heart Association. Neonatal Life

Support: 2020 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendations.

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

Demographic Data:
Age:
Sex:
Length of Work Experience:
Hospital Type:
Hospital Category:
1 2 3 4
Anticipation and Preparation Not Less Competent Highest
competent competent competent
1. Predicts the need of respiratory support in the delivery room
2. Knowledge on the effect of briefing/debriefing following
neonatal resuscitation.
3. Demonstrate knowledge of initial steps in resuscitation.
4. Rapidly assemble team members with skills that are
appropriate to the anticipated need for resuscitation
1 2 3 4
Initial Assessment and Intervention Not Less Competent Highest
competent competent competent
1. Maintaining normal temperature of the newborn with radiant
warmer.
2. Maintaining normal temperature of the newborn with limited
resources.
3. Suctioning immediately after birth, whether with a bulb
syringe or suction catheter when the airway appears
obstructed.
4. Demonstrate ability to assist in endotracheal intubation as
per institutional policy.
1 2 3 4
Physiological Monitoring and Feedback Devices Not Less Competent Highest
competent competent competent
1. Heart rate monitoring during neonatal resuscitation

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

2. Use of ECG to provide a rapid and accurate estimation of

heart
3. Use of oximetry and auscultation to provide a rapid and
accurate estimation of heart
4. Demonstrate knowledge of use of equipment

- Anesthesia bag
- Bulb suction
- Mask
- Resuscitation bag
- Self-inflating bag
- Suctioning device
- Wall suction
1 2 3 4
Oxygenation and Ventilation Not Less Competent Highest
competent competent competent
1. Demonstrate knowledge of ventilating the infant.
2. Demonstrate knowledge and ability to recognize the
indications for administration of oxygen.
3. Demonstrate safety precautions when using and maintaining
oxygen therapy from wall outlets, portable tanks, and oxygen
concentrator.
4. Oxygenation for pre term/term infant
1 2 3 4
Circulatory Support Not Less Competent Highest
competent competent competent
1. 3:1 Chest compression for neonatal resuscitation
2. 2 thumb compression for neonatal resuscitation
3. Maintaining normal perfusion and blood pressure.
4. Identifying the most effective compression-to-ventilation
ratio for neonatal resuscitation.

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

1 2 3 4
Drug and Fluid Administration Not Less Competent Highest
competent competent competent
1. Administering epinephrine for neonatal resuscitation.
2. Administration of volume during resuscitation of newborns
who have not responded to chest compressions and
epinephrine (adrenaline).
3. document administration of medication immediately after
administering
4. Demonstrate knowledge and ability to administer
medications according to agency policy and procedures:
- enteral - oral, tube feed, nasogastric delivery
- parenteral - subcutaneous, intramuscular, intradermal
and intravenous
- percutaneous - skin application (topical), mucous
membranes, sublingual, against cheek, eyes, ears,
nose, inhaled, vaginal and rectal.
1 2 3 4
Prognostication of CPR Not Less Competent Highest
competent competent competent
1. Knowledge on the prognosis during neonatal resuscitation.
2. Comfort the parents when the newborn is in critical
condition.
3. Can decide when the infant has a potential to survive
4. Demonstrate knowledge and understanding of how critical
thinking influences clinical judgement and decision making.
1 2 3 4
Post Resuscitation Care Not Less Competent Highest
competent competent competent
1. Rewarming of newborn infants who are hypothermic.
2. Induced hypothermia in setting with limited resources.

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 . Level of Competency on Neonatal Resuscitation and
Critical Life Support of Nurses on Neonatal Intensive
Care Unit in
Cavite

3. Maintain vigilance for neonatal hypoglycemia and

hyperglycemia in the aftermath of resuscitation.
4. Demonstrate knowledge of importance of warmth and
dryness.

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