Professional Documents
Culture Documents
This chapter presents literature and studies that have certain relations to the
current study. Presumably, the quality of service in hospitals pertains to the overall
manpower competency of the health care team alongside the availability of resources
and patient compliance as well. That includes the quality nursing care provided to
patients. Health economics would not generally dictate which type of agency provides
better nursing care; rather, it is affected by other factors such as patients’ perceived
effectiveness but the perception of the health care providers- doctors, nurses and other
hospital personnel- and the general public as well. Nursing education has its own
aspire to be part of the health care delivery system. This depends also with factors
Related Literature
additional services, it requires a larger health workforce. These doctors, nurses and
allied health workers are likely to come from public hospitals, thus further depleting
the capacity of the public system. Dr. Herr (2008) compared the cost and technical
efficiency of three types of German hospitals: public, profit, and non-profit private. Its
main finding was that “both private and non-profit hospitals are less efficient than
public hospitals in Germany”. One of the reasons is that private hospitals were paid on
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daily rate, thus increasing the hospitals incentive to increase the hospital length of
stay. Herr stressed that health economics tend to ignore hospital quality. Being a
hospitals might have facilities and equipment that patients may value but do not affect
the private hospitals offer better facilities they are extremely costly at times; although
there are abundant qualified doctors in a public hospital, a private hospital offers a
Lee and Wan (2008) said that it is important in research to know which aspects
of efficiency are being compared between private and public hospitals. The authors
three aspects of efficiency: financial, technical and service. Private hospitals in Korea
have higher financial efficiency due to clarity of their organizational goals while
evaluation purposes. Meanwhile, public hospitals’ service efficiency from private ones
is indifferent. Using the 2002 data from 32 Korean hospitals and using a matching
method (16 public versus 16 private hospitals), this study compares Financial
Efficiency (FE), Technical Efficiency (TE) and Service Efficiency (SE) between
public and private hospitals. This research tests three hypotheses. The first hypothesis,
that private hospitals will have higher FE than public hospitals is supported by the
empirical findings. The second hypothesis, that public hospitals will have higher TE
than private hospitals is also supported. The third hypothesis, that private hospitals
will have higher levels of SE than public hospitals have, is not supported. Private
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hospitals have clear organizational goals that lead to higher FE. Public hospitals, in
contrast, are less eager to improve FE than to improve TE because they are evaluated
based on TE. The quality of services (i.e. SE) provided by public hospitals is
efficiency we are dealing with when comparing between public and private hospitals.
As found in a website, Boston College (2007) stated that the Roy adaptation
model believes that human system has a cognitive and regulatory component
(AACN, 2006) has a significant impact on the knowledge and competencies of the
nurse clinician, as it does for all health care providers. Nurses are prized for their skills
in critical thinking, leadership, case management, and health promotion, and for the
ability to practice across a variety of inpatient and outpatient settings. The Brown
report of 1948 (Daniels, 2004) paved the way for the continuing evolution of nursing
with the function of providing care, Kozier (2004) defined other functions of hospitals
Private hospitals are further classified as profit or non- profit. The economics
surrounding the health care delivery system may create a relationship between cost
and technical efficiency of hospitals. Other papers such as Brown (2003) found that
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non-profit hospitals are the most technically efficient. Public hospitals, therefore, have
the possibility to have an edge over private hospitals in terms of efficiency, due to the
variety of services they render and the wider scope of client accommodation.
Related Studies
The nurse is the ambassador towards health and wellness, simply because it is
the nurse who is in constant and close contact with clients. The success and failure of a
therapeutic regimen depends on the accomplishment of the nursing care process. With
this, Jordan et. al. (2007) stated that nurses should be geared with adequate nursing
skills (with knowledge and attitude). This includes not only the actual delivery of
nursing interventions in the hospital setting, but also the efficient use of technology
graduates exceed the demand however, some patient needs are still not met. It really
takes extra time management vis - a- vis proper nursing skills to accommodate every
need of patients. Hospital policies vary and therefore may hinder or improve patient
The thesis of Jordan, et. al. added that there are limitations to the nursing
students’ capacity to perform in the actual hospital setting, in both the private and
public hospitals. Such are differences in equipment available, the guidelines imposed
by the agencies in relation to performing procedures and protocols that may either
allow or hinder students to maximize their related learning experiences, and the
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private and public hospitals are significantly different in the development of skills and
service quality between public and private hospitals in Turkey. The study had 200
the use of a Likert-type scale, two questionnaires containing 80-items were developed.
One measured patients' expectations prior to admission to public and private hospital
service quality and another measured patient perceptions of provided service quality.
As a turnout, patients in the private hospitals were more satisfied with service quality
than those in the public hospitals, also with doctors, nurses and supportive services in
the private ones. Satisfaction in public hospitals was only determined by patients’
The study by Andrews and Salamonson (2006) was on the influence of age,
ethnicity and part- time employment on nursing students’ performance for second year
Based on the study, 78% of the students were partly employed while studying and
knowledge, age and the place of exposure positively affects the said experiences in the
hospital setting, there is increasing pressure for nursing students to participate in part-
time employment while undertaking higher education and this may negatively affect
evaluation of NCM 104 Related Learning Experience program of CLDH- EI for the
first semester of 2005- 2006, problems of the students affecting their performance was
mainly financial; clinical instructors had problems on imparting learning due to non-
descriptive study with 50 respondents, it was concluded that students are satisfied with
their clinical instructors and problems were tolerated such that they were able to
competencies in NCM 104 students of CLDH- EI. It was similarly a descriptive study
involving a five- point Likert scale patterned on the five phases of the Nursing Process
respondents, the study proved the efficiency of NCM 104 students in applying the
Nursing Process. Also, facilities in school, the teacher- learning process and
and skills.
affecting the clinical performance of fourth year students from CLDH- EI in their
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respondents, the main factor determined that affects correct and efficient performance
of the respondents in the clinical area is the student- related variable. This
learning and own personalities. Then again, competence of clinical instructors greatly
influences students to perform effectively. Despite the determination of the factors, the
Synthesis
Croakey (2008) discussed the decreased capacity of the public work force due
to shifting of health workers to private sectors. This reveals that if private sectors
provide additional services, additional health workers are also needed. His study
differs from the current study in terms of overall manpower competency of health care
team between private and public hospitals while the current study focused more on the
common procedures performed between public and private hospitals. The literature by
Dr. Herr (2008) was based on the concept of health economics versus efficiency of the
health care facilities, which tends to be inversely proportional. Dr. Herr’s main finding
was that both private and non-profit hospitals are less efficient than public hospitals in
Germany. The current study reveals that nursing procedures commonly performed by
their respondents can be affected in terms of the availability of the equipments and
facilities between private and public hospitals. Lee and Wan (2008) became more
specific in terms of comparing the efficiency between private and public hospitals by
limiting their study in terms of three particular aspects of efficiency. Furthermore, the
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above mentioned study stated how factors such as facilities and quality of treatment
affect the aspects of efficiency between a public and private hospitals. Hence the
concept of their study is somehow related to the current study in which aspects of
different health care settings. This shows a relationship with the current study wherein
Furthermore, the evolution of nursing education such as the Brown Report as stated by
Daniels (2004), and the participation of hospitals in research and teaching accelerated
control, hence, having a relationship between cost and efficiency. Along with this
study Kozier defined other functions of hospitals as institution providing sources for
health related research and teaching same as with the current study wherein the
researchers used both public and private hospital to come up a difference with the
nursing procedures commonly performed. The studies of Jordan (2007), Taban (2005),
Sanchez (2005), and De Guzman (2004) best suit the current study because they
determined the efficiency of the student nurses in their academic and RLE
Taner and Anthony (2006) determined the service quality between private and
public hospital in Turkey through an examination. As with the current study, the
researchers tried to compare the nursing procedures that are commonly performed
between a public and private hospital and how they are being influenced by certain
Theoretical Framework
Based from the related literature and studies known to the research as
presented hereafter, the suitable model for this researchers’ study is Roy’s “Adaptation
Model” which views the person as an adaptive system in constant interaction with
changing environments. It merely cites that a nurse must adapt to any situation she is
in, no matter where or when it is. This is why Roy’s Adaptation Model was most
suitable framework for the study. There are some factors to which the nurse should
whole comprised of parts that function as unity for some purpose (Delaune and
Ladner, 2006).
interaction with changing internal and external environment. Nursing attempts to alter
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the environment when the person is not adapting well nor has ineffective coping
responses.
nursing students are exposed to a public health care facility or private. These
intermingle with environmental and motivational factors that may create an impact in
performing nursing procedures. NCM 104 students are allowed by their instructor to
do their procedure knowledgably with assistance and also with the permission of the
patient that varies in different hospitals such as TPH and CLDH. The environmental
factors then affect the students’ performance in the availability of the equipments and
Availability of the resources permits the students on actual learning than merely
reading on or looking on text books. The motivational factors cite that the students do
the procedure confidently when their clinical instructor teaches them thoroughly.
Motivation from the patients also affects the performances of the students by
entrusting them the procedure. Staff nurses, when they allow students to carry out the
Sister Calista Roy’s adaptation model has gained wide acceptance in nursing
practice, research and education. Roy’s view of the person and the person-
Paradigm
ADAPTATION
Environmental
Factors
Hospital Procedures
Motivational
Factors
Figure 1
Paradigm based from Sister Calista Roy’s Adaptation Model
Tarlac Provincial Hospital being a public hospital and Central Luzon Doctors’
Hospital representing a private hospital, as signified by the solid black figures. This
the dashed red figures. The nursing procedures performed are directly affected by the
difference between TPH and CLDH. Meanwhile, the factors may affect the nursing
procedures performed in the two hospitals directly or indirectly; therefore the figures
performed have direct relationship on one another while the private and public
hospitals have no relationship, only differences. That is why in the paradigm, the black
figures do not overlap on each other, only the other figures overlap with one another.