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THE LEVEL OF IMPLEMENTATION OF RELATED LEARNING

EXPERIENCE PROCEDURES IN THE AFFILIATING AGENCIES OF


THE LEVEL III AND LEVEL IV NURSING STUDENTS OF SAINT
JOSEPH INSTITUTE OF TECHNOLOGY

By:
Lyra A. Viajar, RN
Kris Carlo R. Buloron, RN
Neilmer M. German, RN
Introduction

The future of Nursing promises dynamic change and continual

challenges. Nurses of tomorrow need a broad knowledge base from

which to provide care. The role of the nurse includes assuming the lead

in preserving nursing practice and demonstrating its contribution to

health care of our nation. Nurses of tomorrow, therefore, need to

become critical thinkers, clients advocates, clinical decision makers,

and client educators within a broad spectrum of care services.(Potter &

Perry, 2002)

American Nurse’s Association (ANA) in collaboration with the

National Specialty Nursing Organizations has established standards of

nursing practice for both generic and specialty nursing practice. The

various standards describe a competent level of nursing care; reflect

the values and priorities of the profession; provide direction for

professional practice; and a form of basis of accountability for all

nurses regardless of practice setting. ANA’s Standards of Clinical

Nursing Practice focuses on the process of providing care (Standards of

Care) and performing professional role activities (Standards of

Professional Performance). The standards of care describe a competent

level of nursing care based on a critical thinking model known as the

nursing process and include: assessment, diagnosis, outcome

identification, planning, implementation and evaluation. The Standards

of Professional Performance describe a competent level of behavior in


the professional Nursing role and include: quality of care, performance

appraisal, education, collegiality, ethics, collaboration, and research

and resource utilization. Each standard consists of a standard

statement (e.g., assessment – the nurse collects patient health data)

and various measurement criteria (e.g., data collection involves the

patient, family and other health care providers as appropriate) for

meeting the standard. These criteria are essential indicators of

professional nursing practice and all identified measurement criteria

must be met in order for the standard to be met. (Vallano, 2003)

Students in nursing must learn the nursing process and care plan

development from the beginning of their education. Each step in the

nursing process and care plan development is explained at a level

appropriate to a beginning nursing student. Clinically, students may be

using critical pathway and not developing individual care plans, but

“thinking like a nurse” is dependent on learning the process of

disciplined thinking resulting from the use of the nursing process. The

product, whether it is a traditional care plan, a critical pathway, or

whatever form may evolve I future, is based on this fundamental,

structured form of clinical reasoning (Murray & Atkinson, 2003).

In the Philippines, there is an ever growing population of nursing

school and students enrolled in the BSN program because of the

demand abroad. The Philippines Bachelor of Science in Nursing

program curriculum had been reviewed and updated to answer this


growing scope of market. According to CMO 14 (2009), graduates of

Bachelor of Science in Nursing program must be able to apply

analytical and critical thinking in the nursing practice. The nurse must

be competent in the following key areas of responsibility and its

respective core competency standards and indicators. The key areas of

Responsibility are Safe and Quality Nursing Practice, Management of

Resources and Environment, Health Education Legal, Responsibility,

Ethics-Moral Responsibility, Personal and Professional Development,

Quality Improvement, Research, Record Management,

Communications, Collaboration and Team work.

The core competencies under Safe and Quality Nursing care are

for students to demonstrate knowledge based in the health/illness

status of individual/groups. Provide sound decisions making in the care

individuals/families/groups considering their beliefs and values.

Promotes safely and comfort and privacy of clients, lets priorities in

nursing care based on clients needs. Ensure continuity care,

administers medications and health therapeutics. Utilizes the nursing

process as framework for nursing performs comprehensive and

systematic nursing assessment, formulates a plan of care in

collaboration- clients and other members of the health team.

Implement planned nursing care to achieve identified outcomes.

Evaluates progress towards expected outcomes. Under management

of resources and environment.


These are the expected core competencies: Organizes work load

to facilitate clients’ care, Utilizes financial resources to support client

care. Establishes mechanism to ensure proper functioning of

equipment. Maintains a safe environment. In legal responsibility the

core competencies that are expected are the following: Adheres to

practice in accordance the nursing law and other relevant legislation

including contracts, enjoined consent. Adheres to organizational

policies and procedures, local and national. Documents care rendered

to clients. And in collaboration and teamwork the competencies are

establishes collaborating relationship and colleagues and other

members of the health team. Collaborates plan of care and other

members of the health team.

In many countries today, nursing groups are working either for

the passage and/or revision of laws affecting the practice of nursing

enlightenment on such questions as: what is the scope of nursing

practice? What acts of nurses in relation to their work as such

constitute negligence or imprudence? (Philippine Nursing Law,

Jurisprudence and ethics, 2001) according to Philippine nursing law,

article VI section 28, describe to be practicing nursing with in the

meaning of this act. When she/he singly or in collaboration with

another, initiates and performs nursing services to individuals, families

and communities in any health care setting.

Review of Related Literature


According to the American Nurses Association (2000), nursing

process should be competently carried out with consideration to the

full range of human experience and responses to health and illness

without restriction to a problem-focused orientation, further it

integrates objective data with patient’s subjective experience and

applies scientific knowledge to the processes of diagnosis and

treatment. The nurse uses the five (5) steps of the nursing process in

every interaction with a patient, no matter how brief the contact.

Expert nurses have mastered this process to such a high degree that

they are unaware of using the separate steps in the process. In fact, in

describing expert nursing practice, Benner(2001) states:

“It is not possible to recapture the explicit formal steps, the

mental processes that go into expert’s capacity to make rapid

assessments... to assume that it is possible to capture all the steps in

nursing practice is to assume that nursing is procedural rather than

holistic. Attempts maybe made to model or make explicit all the steps

that go into a nursing decision, but experts do not actually make

decisions in this elemental, procedural way. They do not build up their

conclusions, element by element; rather, they grasp the whole, even

when they into their decisions, essential elements are left out.”

It is not that experts’ do not use the nursing process but rather

that they are so skilled in using it that it has integrated into their

thinking. Nurse critical thinking is one important element in applying


the nursing process to determine the patient’s needs. Critical thinking

in nursing is defines as purposeful, disciplined, reflective reasoning,

focused on finding meaning, deciding what to believe and do, and

improving the current situation. It is based on evidence (data) rather

than personal values, biases or guesswork. Nursing process used

critical thinking and is part of the process viewed as a whole. The

nursing process is the framework around which the nurse does critical

thinking. Without critical thinking, the steps in the nursing process

would be like a recipe, with no creativity. It would be a narrow,

potentially biased focus that would overlook subtle patient concerns

and be limited to obvious problems wherein all patients is treated in a

standard way, with no consideration of the uniqueness of the patient.

Uninspired and minimally safe is how the nursing process would seem

without critical thinking occurring during each step. Critical thinking

and the nursing process combine to result in the most complete,

effective, and efficient nursing care for each unique patient. In the

clinical setting, the ability to think critically and develop good clinical

judgment is based on the five integrated components.

Knowledge + clinical experience + reasoning skills + standards

using nursing process = Good Clinical Judgment in Nursing


Assessment (data collection) is both the initial step in the nursing

process and an ongoing component in every other step in the process.

It is a systematic, deliberate process by which the nurses collects and

analyze data about the patient. Assessment is part of each activity the

nurse does for and with the patient. The initial nursing assessment is

the basis of the patient care plan, and later assessments contribute to

revisions of and updates in the plan as the patient condition changes.

Nurses also constantly seek information about the patient through

their senses and process it to identify changes in status and intervene

appropriately.

Likewise, assessment is both the most basic and the most

complex nursing skill. At the fundamental level, it is a beginning point

for all nursing intervention. Without an assessment, the nurse has no

idea to begin helping a patient. At the most advanced level,

assessment is a skill that distinguishes an expert nurse. Assessment is

a complex and high level skill that must be practiced to achieve

excellence. It is infinitely more complex than changing a sterile

dressing or inserting an intravenous line.

Beginning nursing students often are required to complete

patient data collection assignments. Often, these assignments are very

lengthy and time consuming. The purpose of such an assignment is to

assist a student in doing nursing care.


Conceptual Framework

Related learning experience is the experience a student nurse

must comply in order to acquire and have the skills and knowledge in

actual setting. The idea that individuals need experiential learning was

suggested by Kolb’s research and different learning styles. Kolb (1976)

identified for learning styles – three of which requires nontraditional

(non-lecture-listener format) methods for teaching to be effective.

Basically, the four different learning styles are (1) concrete

experiences, (2) reflective observation, (3) abstract conceptualization

and (4) active experimentation.

Research paradigm

Input Process Output

Skills learned Related Efficient


in the Skills Learning performance
laboratory Duties / 1. Polished
Return Hospital Skills
Demonstration Exposure 2. Applied
, knowledge
Knowledge and 3. Enhanced
information attitude
learned in the
classroom
1. What is the extent of implementation of Related Learning
Experience Procedures in terms of:
1.1 Theories Learned in the classroom
1.2 Skills Acquired in the Nursing skills laboratory/Simulation

2. What is the level of nursing students’ performance in terms of:


2.1 Safe and Quality nursing care

3. Is there a significant difference in the implementation of Related


Learning Experience when analyzed according to:
3.1 Year Level

4. Is there a significant difference in the performance of SJIT when


analyzed according to:
4.1 Year Level

5. Is there a significant relationship between the Related Learning


Experience and student’s performance of SJIT?

Hypothesis

1. There is no significant difference in nursing students in the


implementation of related Learning Experience when analyzed
according to:
1.1 Gender
1.2 Year level

2. There is no significant difference in the performance of nursing


students of SJIT when analyzed according to:
2.1 Gender
2.2 Year level

3. There is no significant relationship between Related Learning


Experience and students’ performance of SJIT.

SCOPE AND LIMITATION

The population will involve the level III and level IV nursing

students’ of the college of Nursing, school year 2010-2011 of Saint

Joseph Institute of Technology that are exposed in the hospital on their

clinical duties. The study is focused on the factors chosen by the

investigators and the implementation of the learning outcomes in the

Related Learning Experience procedure learnt base on the third year

related concept. Confine on the ideal procedures and the

implementation of it in the affiliating agencies

Significance of the Study

The study is of great significance to the following:


ADMINISTRATION. Results of the study shall provide the

administration better insights on producing highly competitive and

skillful nursing graduates.

FACULTY. Results of the study shall give the Clinical Instructors

the assurance of safe nursing practice in the affiliating agencies.

STUDENTS. Results of the study shall benefit the students in

terms of their confidence and easy applications of implementation of

ideal RLE procedures thereby provide them safe practice of it in the

affiliating agency.

OTHER RESEARCHERS. The study shall stimulate other

researchers to conduct further investigation on the importance of ideal

implementation and application of the Related Learning Experience

procedures learnt in every institution.


Chapter 2

METHODOLOGY

In this chapter presents the research design, research setting,

the respondents, the research instrument, data gathering procedure,

and statistical techniques of the study.

Research Design

The investigators will utilize descriptive design to determine the

factor that most significantly contributed to the extent of

implementation of related learning experience procedures in the

affiliating agencies.

Research Setting
The site of the study is Saint Joseph Institute of Technology

College of Nursing. The researchers will select the said location for its

accessibility and convenience, as well as to the sample population

concerned. It will be also preferred because of the evident connection

between the chosen topic and the sample in focus.

The Respondents

Convenient sampling method will be used. Total population of

Level II and III Nursing students is 50. The sample populations will be

24 students with the same RLE procedures and are exposed in

affiliating agencies where these procedures are applied and

implemented in an actual setting; the population comprises 48% of the

total population. Sample population will be chosen because they are

the ones available and have already been exposed to various affiliating

agencies. They also took the concept of Related Learning Experience

at the same time, with the same lecturers and with the same

evaluation criteria thus same inputs had been acquired by the sample

population in terms of their theory in the classroom.

Statistical treatment

The following statistical tools were employed in the study:

Percentage. This tool was utilized to derive the percentage of

the respondents in terms of gender and level.

Statistical tasks to be utilized are percentage distribution, mean

computation and t-test.


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