CHAPTER 2

REVIEW OF RELATED LITERATURE

This chapter presents literature reviews and studies related to the present study. It covers

different conceptual literature, research literature, theoretical framework, conceptual framework,

and definition of terms. The following literature gives the researcher a deeper understanding

about the study and consists of studies in both local and foreign studies.

Description of Emergency Response

Emergency Response is a vital way to lessen mortality rate after a major accident that

may occur anytime and anywhere. Such measures should be effectively and appropriately

arranged to be able to have functional outcomes. Emergency response is described as a rapid

response in testing the efficiency and productivity of a first responder or a first aider.

Furthermore, it is described as an immediate response to an unforeseen accident occurrence that

aims to reduce the impact of the condition on the people who are involved in the accident.

Conceptual Literature

Age

Statistics of all the people in the world gives census of how many male and female and

their growth over the years. According to Global Population (2022), there have consistently been

more men than women on the earth throughout the past 22 years. Four billion men and 3.95

billion women made up the planet's population of 7.95 billion in 2022. By 2022, one-fourth of

the world's population would be under the age of 15. The population's gender distribution is

depicted on the map as a proportion of the overall population. Within one percentage point of

parity, the female population share ranges from 49 to 51 percent in the majority of nations. In
many South and East Asian nations, particularly in India and China, there are a lot fewer women

than men. These are nations where the sex ratios at birth differ significantly from one another

(Ritchie & Roser, 2019). In lieu to this, Statistics Times (2021) gave a statistics that males make

up 3,970,238,390, or 3,970 million, or 3.97 billion, of the world's population as of 2021, or 50.42

percent of the total. According to estimates, there are 3,904,727,342 females in the globe, which

equates to 3,905 million or 3.905 billion people and accounts for 49.58 percent of the total

population. There are 65,511,048 or 65.51 million more men than women in the globe.

Globally, college students' demographics have been evolving quickly in recent years. 43% of

college students were male and 57% were female in 2020. Additionally, the age range of the

majority of college students was between 18 and 24. However, articles that gives relation to the

given study is as follows: the proportion of older students has recently increased, with about 22%

of college students being over the age of 30 (Reyes, 2023). Moreover, shifting to the focus of

medicine, it is crucial for nursing students to become more professional while in school. During

training, when students acquire the information and abilities that set nurses apart from laypeople

as professional healthcare providers, is a crucial time in the professional development of nursing

students. In a study of Antonio Jesús Ramos-Morcillo et al.,(2020), a total of 32 interviews were

conducted, and they lasted between 17 and 51 min. The shortest interviews corresponded to the

more advanced academic years (3rd and 4th year students). It reveals that 80.2% of second-year

nursing students are age range of 19 to 21 students; all nursing students in 100% of the study's

participants were women. a large proportion of nursing 99.4% of students were single, and

85.2% of the total 4.3% of nursing students lived with their families, while alone (Kandil et al.,

2021). Moreover, 173 of the 447 invited students responded to the survey and were counted in

the statistical analysis (participation rate: 38.7%). The majority (93.1%) of the population was
female, and the average age was 25. Pre-licensure undergraduate students made up the majority

(76.8%) and were mostly white (578.%) (Son Chae Kim et al., 2021). The sample sizes of the

studies ranged from 8 (De Guzman et al., 2009a,b,c) to 916 (Cheng et al., 2015) with a mean

sample size of 307 participants and a combined total of 8608 participants. The mean ages of

study participants ranged from 20 years for student nurses (Usta et al., 2012). Another study

from Sheroun et al., (2020), Most participants were between the ages of 21 and 25 years (60.2).

From a total of 427 11 entrants were men, and the remaining females. The greatest amount of

participants were in their last academic year (31.9%) of nursing students.

Year Level

A complete applied discipline with a focus on patient care, nursing uses scientific

methods. In the health system, the nursing profession holds a very significant place as well. The

first steps in the process of nursing education involve teaching fundamental ideas, fundamental

nursing knowledge, and fundamental nursing skills (Wei, 2006). While in the study of Deng

(2015), there are no standardized teaching resources in America. The emphasis of the curriculum

is not on "teaching material" instruction. To ensure that the students can achieve the educational

standard, the teacher chooses the kind of textbooks to use, and the usage of textbook cycles is

restricted (Hu & Zhang, 2013).

First year of Nursing School according to Jean (2023) is it resembles learning a new

language while also engaging in art and science. You'll pick up new vocabulary from the medical

field. Studying the human body, science, and pharmacology (the use and effects of

pharmaceuticals on the body) will help develop the art of patient care. In a study of Wang et al.,

(2022) wherein the first-year nursing student are being assessed in the initial contact with the
clinical learning environment on the impacts of empathy levels and perceptions of professional

identity. It resembles learning a new language while also engaging in art and science. Pick up

new vocabulary from the medical field. Studying the human body, science, and pharmacology

(the use and effects of pharmaceuticals on the body) will help you develop the art of patient care.

Moreover, in the study of Stenberg et al., (2022), the purpose was to investigate first-year

undergraduate nursing student collaboration during clinical skills lab exercises in a three-year

bachelor program. 140 first-year undergraduate nursing students were divided into 16 groups for

the nursing and preclinical skills course.

Additionally, statement from nurses.co.uk (2022) should be capable of managing the care

of one to two patients by the end of second year. Official second-year assignments were therefore

in two distinct hospitals, first on a sort of general medical surgical ward and then on a real

surgical ward. This focus group study sought to learn more about the clinical simulation training

experiences of second-year undergraduate nursing students who were practicing in the field of

acute mental health care. In the spring of 2020, three focus groups with second-year

undergraduate nursing students from a Norwegian institution were held utilizing a

semi-structured interview guide (Øyvind Lockertsen et al., 2023). The study of (Arpanantikul &

Pratoomwan (2017), second-year nursing students pursuing a bachelor's degree find clinical

learning tough since it is frequently the first opportunity for them to put their nursing knowledge

and abilities to use in a real patient care environment. The study's objective was to investigate the

clinical learning experiences of 30 second-year Thai students who worked in clinical settings at a

Bangkok university hospital.

In the study of Grimes et al., (2020) they assessed disaster preparedness and resilience in

a group of 66 nursing students in their second and third years at James Cook University,
Australia. They used the Disaster Preparedness and Evaluation Tool along with the 10-point

Connor-Davidson Resilience Scale. The findings indicated that the student nurses exhibited

insufficient knowledge regarding disaster preparedness. However, they expressed a readiness to

dedicate their time and limited skills in the event of a disaster. Moreover, In Burden et al.'s 2018

study, the focus was on understanding how mentors form their judgments and make summative

assessment decisions related to the competency of third-year nursing students during their

clinical practice. Assessing competence is a crucial aspect of pre-registration nursing programs

in the United Kingdom. The study raised concerns about the subjectivity and lack of consistency

in these assessments, as well as the tendency of mentors to avoid rating students as

unsatisfactory. It was observed that the assessment strategies and documentation provided by the

course had limited impact on shaping mentor judgments and decisions. Instead, mentors relied

on their overall impressions, which were influenced by their expectations of an 'idealized student'

based on the practice area and the stage of the program, ultimately affecting how they managed

and concluded the assessment process.

Lastly, Moloney et al., (2020) conducted a study on fourth-year nursing students'

perceptions of their educational preparation for drug management are identified in this research

study. Park et al., (2022) In order to create a uniform curriculum, this study examined the state

of nursing informatics education in South Korea at the time on fourth-year nursing students.

Consequently, in Vitale et al.'s (2020) study, they explored the impact of the rapidly spreading

global pandemic, known as Coronavirus Disease (Covid-19), which was declared a pandemic by

the World Health Organization in December 2019. The study highlighted the lack of focus on

emergency response in basic nursing education and the reported inadequacy of faculty members

in preparing students for this subject. The primary objective of their research was to examine
how the Covid-19 pandemic affected the psychological well-being of third and fourth-year

nursing students in Italy.

Sex

The genetic distinctions between men and women are at the foundation of the sex

disparities in disease prevalence, manifestation, and response to treatment. When an ovum and a

sperm cell having an X or a Y chromosome combine, an embryo carrying either a XX or an XY

chromosome is created. This is when genetic sex differences begin (Mauvais-Jarvis, et al. 2020).

In addition, although the idea of two separate biological categories of sex served as the

foundation for our concepts of gender, gender as a social construct is not always perceived as a

"either-or" reflection of femininity or masculinity. In fact, categorizing gender into only two

separate categories invariably excludes or pathologized a portion of the population. Many people

believe they fall somewhere on a continuum between the classic masculine and feminine

classifications rather than fitting cleanly into one of them or identifying with them (Lips, 2020).

Gender differences—which should be separated from biological sex differences—are variations

between men and women that are impacted by sociocultural influences. The course of disease

and its underlying fundamental biological variation are influenced by sex and gender variances

(Leonardo, et al. 2019). In line with the context, the case for taking sex and gender into account

in preclinical, clinical, and population research has been made in numerous convincing

publications. Sex, which refers to the biological characteristics of males and females, and gender,

which refers to a range of socially constructed roles, behaviors, and identities, including

femininity and masculinity, all have an impact on cellular and molecular processes, clinical traits,

treatment response, health, and disease (Rich-Edwards, et al. 2018). The most significant
predictors of health and disease outcomes include sex, the biological and physiological

characteristics that distinguish males from females, and gender, a continuum of socioculturally

constructed roles and behaviors associated with men, women, and gender diversity. These

fundamental elements, however, are rarely taken into account in clinical care and are frequently

overlooked in biomedical research (Spagnolo, et al. 2020). Gender disparities in interests seem to

be moderated by national cultural factors independent of the effects of national gender inequality.

In particular, gender disparities in interests in people (versus things) tend to be greater in

countries with higher levels of indulgence and uncertainty avoidance, whereas gender disparities

in ideas (versus data) tend to be greater in countries with higher levels of indulgence, uncertainty

avoidance, and lower power distance. This study emphasizes how career counselors, gender

studies researchers, and vocational psychologists' work with men and women in understanding

their vocational interests can be informed by a better conceptualization of the influences of

culture (Tao, et al. 2022). In this Perspective, we highlight areas of behavioral, cellular, and

systems neuroscience where fundamental sex differences have been identified, illustrating that

gender diversity is necessary for truly rigorous science. In order to produce a more equitable,

representative, and consequently translational body of knowledge, we demand a cultural and

structural shift in how we conduct research and assess scientific advancement (Shansky &

Murphy, 2021). The sex differences in asthma incidence, prevalence, and severity have been

linked to a variety of important factors, including sex hormones, genetic and epigenetic

variations, social and environmental factors, and responses to asthma treatments. Asthma

pathogenesis is linked to changes in sex hormone levels in females during puberty, the menstrual

cycle, and pregnancy. The incidence, prevalence, and symptoms of asthma

vary depending on the gender due to differences in gene expression, epigenetic modifications,

and responses to environmental factors, including SARS-CoV-2 infections (Chowdhury, et al.

2021). Since 2011, reporting on sex- and gender-based medical issues has increased along with

emergency medicine scholarship. Sex and gender are rarely reported as controls or independent

variables in emergency medicine research, despite a federal mandate and a specialty-specific

consensus conference stressing their significance for research design, analysis, and

generalizability (Safdar, et al. 2018). Why do gender disparities in science still exist when the

causes have been thoroughly studied and widely disapproved? partly because there are many

facets to equality. We present eight definitions of gender equality and demonstrate how each is

significant but fall short. Therefore, rigid application of any one equality indicator may result in

undesirable results (O’Brien, et al. 2019).

Assessing the level of responsiveness during an emergency

According to Ferrand, et al. 2018, in a service system that deals with patients who have

varying priorities, Emergency Departments (EDs) frequently experience capacity imbalances and

lengthy wait times. These issues are particularly significant for patients with low priority who

frequently wait a long time in line. We look into two different strategies—fast track (FT) and

dynamic priority queue (DPQ)—to overcome these problems. In the past, EDs have strictly or

partially allocated resources to different ESI patient classes by utilizing an Emergency Severity

Index (ESI) in conjunction with FT to prioritize patients. Using ESI and additional real-time
operational data, such as the patient's wait and flow times, our suggested DPQ would prioritize

patients based on their needs.

Providing Definitive Medical Care

Providing definitive medical care is commonly considered as the realm of the medical

facilities that aims to imply the resolution of the situation of the condition that is in need of such

treatment. However, a lot of factors in early care provided in terms of emergency treatment can

be considered as definitive (McCord et al., 2018). Furthermore, definitive care is described as the

care given to definitely assess the patient’s condition that includes curative and rehabilitative

medical care (Bramlett, 2019). However, in cases of emergency which can occur anywhere, the

patient’s location at the time of the accident can be a significant factor for quickly receiving

definitive care. Schiller 2022 notes that rural trauma is defined as the trauma care where the

patients experience delays into receiving definitive care. On the other hand, as stated by Bouzat

P. et al., definitive care is highly related to survival in most of the trauma patients in emergencies.

It is the key such trauma networks and reported that as definitive medical care is delayed,

mortality rates increase.

According to Michelson 2020, all parts of the United States from the year 2008 to 2016

the hospital provision of definitive care lessened and is least likely to provide definitive care.

Thus, improvements are needed to support such hospital-based care. Providing definitive

emergency care for patients has been declined in Massachusetts, California, Florida, and New

York (McManus ML. et al., 2018). Moreover, according to the study of Chiang et al., 2021, a

shorter period of two (2) hours to definitive care leads to better outcomes and it positively

corresponds with the patient's survival especially in major emergency trauma or injuries.
Moreover, according to the National Disaster Medical System 2023, they are in partnership with

the different healthcare facilities to guarantee a network is in a good condition to provide

definitive care in cases of other public health emergencies. In the event of a health emergency,

NDMS can manage the medical evaluation from the affected areas. Different studies of lack of

first aiding death are critical into advancing emergency care as the casualties have different

significant implications for the development of such strategies. With this, definitive medical care

is needed to avoid any major complications in time of emergency conditions (Medrano et al.,

2019).

According to Kanney, MD. et al., 2023, patients who are presenting to the hospital’s

emergency department are more likely to be transferred to definitive care. As it is described that

it is in the need of such attention to be able to reach the best possible outcome for the patient.

Moreover, in Nepal, according to Hoffman J. 2022, there is a delay in accessing definitive care

for patients and that most of them visit only one facility that causes the different hindrance in

them having definite care with their conditions. Thus, early definitive treatment increases the

rates of shorter hospital stay, fewer surgical interventions and any other further unforeseen

complications (Peterson et al., 2020). However, for the patients who have undergone critical and

more complicated injury, they may experience longer time to receive definitive care (Jones A.,

2023). According to Kevin M. et al., 2021, any delays in definitive care management for an

incident on where lower extremities are involved, it may be more likely to result in morbidity. In

line with this, high rates of injuries related to ankle sprains were found to have a correlation

between lateral ligament injuries and deltoid injuries. In cases like these, such interventions must

be rendered to the patient to avoid further complications (Mansur et al., 2020).

 On the way hospitalization is a type of medical care that requires definitive care for the

patients while they are being moved from a hospital to a hospital. This is one of the factors

needed in responding to an emergency case (Joint Health Services, 2018). Additionally,

according to Haslam et al., 2020, timely transfer of ill patients to definitive medical care is a

major element of a trauma network performance. In line with these, most of the trauma

emergency systems were developed from urban areas. However, rural areas and the rurality itself

has been continuously identified to be a risk factor for the shortcomings of reaching definitive

care (Swanton et al., 2020). Furthermore, it is also being said that the choice of an accurate

destination hospital from the field itself is important in determining the possible outcomes

related to giving care to the patient (Gamberini, 2022). To add, according to Yadav et al., 2022,

the distance is one of the major factors in being the barrier to be able to achieve definitive

medical care. Improving access to different health services and promoting the practice of early

treatment and first aid are highly recommended to be able to develop such clinical outcomes.

According to Bouamra et al., 2020, seriously ill patients who are undergoing secondary

transfer to definitive care have experienced delays in imaging and surgery that leads to increased

mortality. With this, it is said that direct transfer may result in injured patients receiving

appropriate care and interventions more quickly and may improve the quality of life. In England,

remarkable improvements in survival rate have been noticed since the implementation of the

national major trauma when it comes to applying direct definitive medical care (Lockey DJ,

2018). Moreover, improvements in the field have also been demonstrated in other European

countries as well in Australia and USA (Moran et al., 2019). Furthermore, according to Calleja et

al., 2020, emergency traumas is globally a public health concern that results in higher mortality

rates that were being acknowledged by the rural and remote populations. In addition with these
challenges are the financial problems that the patients are facing, but sometimes, they are being

required to leave their places to receive definitive medical care (Morgan et al., 2020)

Applying the Practice First Aid

Basic First Aid Skills (BFA) increases a person’s opportunity to save a life (KB Kearney,

2020). According to the World Health Organization (2018), there is an estimated number of

180,000 deaths per year because of burn cases that are not being supervised by first aid. With

regard to this, the knowledge of the people towards applying the practice of first aid is suspected

to be low in spite of having most of the respondents that has a positive attitude in first aiding

(AlQantani et al., 2019). Furthermore, according to the study of Baker A. et al., (2020), first aid

providers who undergo the training are those who have the skill and knowledge to be able to

handle life-threatening situations. A lot of studies were being published in assessing the

knowledge of students when it comes to applying the practice of first aid. One of which is the

study that was carried out among the medical students at King Saud University in Riyadh and it

was reported that 47.4% were aware of the first aiding skills (Almoammar N. et al., 2018). In

line with this, a study was also conducted at the Saudi Female University with regards to that

matter and showed that only 34.7% had good knowledge, 57.7% with moderate knowledge, and

7.8% with poor knowledge. This very same study implies that 20% of the students have

encountered emergency scenes that require the use of their first aid knowledge and skills

(Halawani LM. et al., 2019). On top of that, according to the study of Al-Johani 2018, he

assessed the knowledge of the parents attending primary health care centers in Madina, Saudi

Arabia. Since that they were to be the first responders in such cases. Nevertheless, it was
presented that several number of 97.2% of the parents were aware of first aid. In addition, a

study conducted for the incidence of snakebite in Myanmar resulted that 39% of the population

of 30 respondents are the ones who knew about the correct methods of first aid (Mahmood M. et

al., 2019)

In everyday life, many people die because of cardiac arrest. This large number of people would

be lower if there were also more people who are trained in providing first aid practices

(Semeraro F. et al., 2018). In agreement with these studies, Hasan M. et al., 2018 stated that in

emergency cases, the absence of the practice of first aid can literally lead to injury and if worse,

to unnecessary death. First aiding includes recognizing life-threatening situations and taking an

effective action to be able to keep the patient in the best possible condition as soon as the

medical treatment arrives. Avau B. 2019 also added that having a background in first aid

education is vital in helping to rebuild resiliency in the society. What’s more is that the World

Health Organization advocates the involvement of lay people in the field of giving prehospital

care (Ndile M. et al., 2020).. Such training programs have already been implemented and

reported to help in having improvements of the participants in such first aiding skills (Boeck MA

2018). One of the training under this program is providing basic knowledge and skills to police

officers in cases of them being the first responders in managing injured victims at a crash

situation and on the way to the hospital (Lukumay GG. Et al., 2018). Emergency training for the

practice of first aid must be given to all people as a form of awareness of such emergency

situations (Efendi P. et al., 2023). This is because we cannot determine for sure when and where

emergencies may occur. Thousands of people experience and witness medical emergencies and it

will be very helpful to have at least one person who can perform first aid before such help arrives

(Gharsan M. et al., 2019). According to Alarfaj 2019, some people’s knowledge with first aid
was not primarily associated with their personal characteristics. It is said that improving and

upgrading information when it comes to the practice of first aid in textbooks will further improve

the knowledge of both students and instructors.

In the study of Villovino 2020, it is said that being able to provide education on basic first

aiding skills on students gives us also the chance for the urgency in having first aid kits in

classrooms in college settings. Moreover, such studies cover the importance of effective

communication and coordination to have reliable data and facilitate resource allocations for

emergency response through first aiding (Tuazon A. et al., 2018). However, with the continuous

learning challenges experienced by the different educational institutions in the Philippines amidst

the Covid-19 pandemic, challenges on different first aid emergency response also arise. Lack of

supervision has been encountered due to the implementation of online classes especially in

medical courses. With this study, it has been concluded that it revealed multiple factors with

regards to the shortcoming on preparedness and first aid response (Race, 2020). More than that,

aside from the challenges in the present first aiding disaster response in the Philippines, different

issues also occur in the current first aid emergency preparedness practices in the country. These

challenges are said to be having the need for more training to address the gaps in emergency

response and preparedness (Gundran C. 2023). Still, amongst these challenges, different

development, implementation, and evaluation of lay people in responding to emergency

conditions through first aid has been being studied for the past years. It is reported that the

knowledge, behavior, and perceived threat for school instructors were significantly developed

after the assessment and the level of fear on the other side was lower (Salita C., et al., 2019).

With this, it is subject that a lot of effort has been made and developed in order to assess the level
of competency of lay people and others in cases of providing the practice of first aid in such

emergency conditions (Tse E., 2023).

Furthermore, a study also shows that students revealed that there are high levels of

assessments in performing such first aid skills in burns, wounds, and bleeding (Perez, 2021). It is

still accountable to recommend that a regular emergency awareness campaign must be

implemented to maintain and improve the skills to the best possible capacity (Majal B. 2021).

Research Literature

Age

The majority of nursing students are female and 19 years old. The typical mean score

across all nursing. The mean grade for Care Management (NCM) is an acceptable 2.31. NCM

100: Nursing Foundations Practice) takes the top spot and is vocally understood as excellent. The

remaining NCM grades are all acceptable (Mejilla, n.d.). A total of 113 carefully selected

nursing students in their second year at a nursing Philippines colleges took part in the survey.

The participants' average age was 19. 68.1% of them were women, while 31.9% were men

(Michael & Oducado, n.d.). 550 nursing students from a Manila comprehensive university. Other

noteworthy results included older participants scoring higher on ego-resilience and well-being

than students aged 20 to 25 and having lower burnout levels (Spurr et al., 2021). Moreover, the

fact that there are 15 respondents (100%) indicates that the majority of respondents are female

and the majority of responders (83.3%) are between the ages of 21 and 25. totaling 12 (80%) in

the study of Rivera et al., (2022).

Year Level
 Around the world, nurses are essential to disaster management. Disaster nursing

education and training programs have become more widespread worldwide in response to the

urge for all nurses to be disaster-ready. The evolution and coverage of disaster nursing education

and training programs, however, are not well understood and 3395 possibly relevant articles

yielded a total of 75 qualifying studies. Over the past 20 years, there has been a gradual increase

in the number of disaster nursing education and training programs.(Alice Yuen Loke et al.,

2021). While, According to Songwathana and Timalsina (2021), nurses in developing nations are

still not fully trained in all areas of disaster nursing capabilities. The improvement of disaster

readiness and the retention of pertinent skills among nurses in all sectors depend on offering

well-designed disaster nursing educational packages, training manuals, and support to attend

catastrophe exercises or participate in actual disaster events. It strengthen when Emaliyawati et

al., (2021) analyzed that the period from May to August 2020 was used for a cross-sectional

investigation. 142 nurses from six public health centers in Pangandaran, West Java, Indonesia,

made up the sample. The entire sampling approach was used to draw in participants. A high level

of readiness was demonstrated by 54.24% of the 142 responders. The participants who was

lacking disaster training were less likely to have a high degree of disaster preparedness

Respondents who had not previously served as volunteers for disasters were also less likely to

have disaster preparedness, according to multivariate analysis. Nurses with higher levels of

preparedness had worked for between six and ten years.

Sex

In American psychology, the theory of male sex-role identity (MSRI) has dominated

understanding of the male experience. This theory states that in order for people to acquire a
male or female "sex-role identity," which is demonstrated by having the sex-appropriate traits,

attitudes, and interests that psychologically "validate" or "affirm" their biological sex, they must

first become psychologically mature as members of their sex (Pleck, J. 2018). Furthermore sex

and gender analysis aims to advance responsible, accountable, and rigorous science. Many

disciplines have advanced as a result of the inclusion of sex and gender analysis in experimental

design, including heart disease treatment and understanding the social effects of algorithmic bias.

Here, we talk about how sex and gender analysis can promote scientific research, enhance the

effectiveness of experiments, and promote social equality. We offer a road map for sex and

gender analysis across scientific disciplines and encourage researchers, funding organizations,

peer-reviewed journals, and universities to work together to put effective sex and gender analysis

techniques into practice (Tannenbaum, et al. 2019). The "gender binary," or the idea that there

are only two types of beings in the human species—women and men—has had a significant

impact on psychological science throughout history. Recent academic research and social

activism have both raised significant issues with the gender binary (Hyde, et al. 2019). Males and

females respond differently to alcohol and other drugs' immediate and long-term effects due to a

variety of biological factors. These variations are a result of sexually diverse brain, endocrine

(such as ovarian hormones), and metabolic systems. The fact that males and females metabolize

alcohol differently is one of the most frequently observed trends in this area (McHugh, et al.

2018). The accurate description of sex and gender as sample demographics and their inclusion in

scientific research aiming to distinguish health disparities due to biological systems, gendered

experiences, or their social and environmental interactions have been hindered by

misunderstanding and conflation of sex and gender (Rioux, et al. 2022). Chromosomes, gonads,

genitalia, and secondary sexual characteristics (female, male, or intersex, when a combination of
female and male characteristics is present) all contribute to the biological state of sex. A person's

identity as a woman, man, person of another gender, or of no gender is linked to a set of

emotions, attitudes, and behaviors known as gender. Humans begin to experience the effects of

their gender and sex from the time that sex is assigned antenatally or at birth, even though sex is

determined at conception (Leslie & Kasza 2020). Understanding gender and sex in health

research can raise scholarly standards and improve patient outcomes. Two important gatekeepers

of knowledge production and dissemination, including whether and how sex/gender is

incorporated into health research, are funding organizations and scholarly journals. Despite the

fact that sex/gender accounting for key issues and practices in health funding agencies and

academic journals have received attention, to date there hasn't been a systematic analysis

examining whether and how agencies and journals should pay attention to sex/gender, what

conceptual justifications and practical advice are provided for such inclusion, and whether

current practices reflect the reality that sex/gender cannot be separated from other axes of

inequality (Hankivsky, et al. 2018). The differences between sexes and between genders in

psychopathology have not received enough attention, despite the fact that doing so is crucial for

developing comprehensive etiological models as well as for accurately assessing and treating

psychopathology in all people (Hartung & Lefler 2019). The purpose of the current systematic

review was to ascertain the experiences of SGM individuals with discrimination and staff

attitudes toward SGM in healthcare settings. The review was conducted between May and

September 2016 using keywords related to sexual and gender minorities, such as "gay,"

"lesbian," "bisexual," "transgender," "LGB," "LGBT," "health care discrimination," "stigma,"

"homophobia," and "transphobia," as well as "attitudes of healthcare professionals" in three

databases (Ayhan, et al. 2020). Lesbian, gay, bisexual, transgender, and queer (LGBTQ)
individuals as well as other SGM individuals are underrepresented in research and understudied.

There is a critical knowledge gap regarding how sexual orientation and gender identity (SOGI)

questions affect inclusion and accurate empirical representation, and current SOGI questions do

not sufficiently engage SGM people (Suen, et al. 2020).

Assessing the Level Treatment Needed to be Given in an Emergency

According to Maghfiroh, et al. 2018, the majority of ambulances are currently stationed

close to hospitals and are dispatched or retrieved on demand by the patient's friends or family,

resulting in time-consuming round trips. Pre-positioning of the ambulances could be a solution to

shortening the ambulances' response times, which would improve the emergency service. Two

methods were used in this study to tackle the issue. By maximizing the coverage of demand, the

location-allocation problem was first solved to determine the ideal number of ambulance

locations. In order to systematically improve the ambulance positioning in small clusters close to

demand points, separate location-allocation for the peak and off-peaks was applied using

K-means clustering. The emergency response time could be significantly increased with these

strategies.

Providing Definitive Medical Care

According to Magnusson et al., 2020, the patient’s transfer to definitive care should

require a fast management especially patients with critical diagnosis and conditions such as

myocardial infarction, stroke, or sepsis. However, in agreement with Ray KN et al., 2018

different national efforts together with the National Pediatric Readiness Project must be more

focused in implementing the improvement of the accessibility of different resources in

emergency departments. Moreover, when It comes to transferring a patient, transfers from one

hospital to another represents a baseline to measure the capacity of such resources since

transferring a patient suggests that definitive care did not take place at the referring hospital

(McManus et al., 2018). Moreover, according to the study of Kotsiou et al., 2018, there are such

steps before transferring a patient into a definitive medical care. First is that in emergency

medical services, it must encompass a spectrum of care with the participation of pre-hospital and

in-hospital medical facilities. In such cases, it must undergo first to the triage initial assessment

and lastly is in the transport to definitive care.

According to Alstrup et al., 2019, the patient's time to transfer in definitive care is

considered as a vital part of treatment in the patient’s outcome. However, a study of Moss MD.,

et al 2021, reported that during the Covid-19 pandemic, patients from all over Utah, Nevada,

Wyoming, Idaho, and Western Colorado are being referred to the emergency department to

receive definitive medical care since that in the times of Covid-19 pandemic, all area of the

hospitals are usually not available for all of the patients. Moreover, unforeseen events on the

spread of Covid-19 and changing in different recommendations are generated with confusion and

fear with the residents as they are disconnected with other patients (Jama, 2020). In line with

this, challenges still continue as the demand for more guidance is urgently needed on delivering

such medical services effectively in different healthcare facilities (Brindle M., 2020).

Furthermore, different prehospital care that is provided by a physician is said to be associated

with increased chance of survival at thirty (30) days as compared to the care provided by an

ambulance as to transferring in definitive care (Maddock et al., 2020). According to Lam N.N. et

al., 2018, first aid and appropriate initial management are known to be important steps in

assessing such emergencies. Being able to be transported to the emergency department for initial
assessment before the referral to the closest unit for applying definitive care. In these cases,

nurses working in the following departments are sometimes required to assist and help local

teams (Tuan C.A. 2018).

Furthermore, according to Eastridge et al., 2019, the majority of must-be preventable

deaths after such trauma and lack of response to emergency are related to hemorrhage that occurs

early after injury takes place. Such these can be preventable and should’ve a good patient

outcome and definitive care. But, it still remains the leading cause of potentially preventable

death because of trauma and results can be irreversible (Zaffer, 2022). Nevertheless, according to

Bailey at al., 2021, on the study of clinical activity at the UK military level two (2) hospital in

Bentiu, South Sudan, 175 cases (61%) are provided with definitive care and other 128 cases

(45%) were also provided with one. Moreover, definitive care is still rampant in present time

especially in cancer patients. This is because such definitive care must be rendered with no

delay because delay in diagnosis could result in worse conditions for the patient and the family

(British Journal of Surgery, 2020).

According to McKenna at al., 2019, overcrowding on the hospitals is one of the major

problems being faced by the hospitals worldwide that leads to transferring to another healthcare

facility for a definitive medical care. Emergency departments have been negatively affected by

the overcrowding of patients as defined by the American College of Emergency Physicians and

the need for emergency services increases the availability of resources for patient care in

emergency departments and hospitals (American College of Emergency Physicians, 2018). As

the emergency departments is known to be the gateway to the hospital, United States reported a

total of 131 million ED visitations that resulted in almost 14.6 million admissions in the year

2012 on where 13# were admitted to a critical care unit (US Department of Health & Human
Services, 2018). However, ED expansion into more definitive care increases the visit of more

patients that will further result in adding more workloads to the overwhelmed healthcare

providers (Mallon 2019).

According to Schell et al., 2018, patents with such critical illness require care and must

have it quickly. Such emergencies and critical care into the implementation of definitive care

must be focused on resuscitating unstable patients and giving them more time for recovery.

Different illnesses can occur in anyone despite their age, gender, and social status (Baker et al.,

2019). Furthermore, according to Villarreal, 2019, there is still no standard steps in order for the

assessment of time to definitive medical care to be implemented after an injury among

prehospital deaths happened.

Applying the Practice First Aid

In agreement with the study of Cao B., 2018, in cases of emergencies, the appropriate and

convenient practice of first aid by non-medical personnel at the situation of an accident before

the response of medical professionals is one of the keys to help minimize the recurrent accidental

induced death and injuries. According to Hepler 2018, first aid is a medical practice of the first

course of treatment in saving a life. In an instance of a serious medical emergency, being able to

know the basic knowledge in first aid may be a big factor in avoiding accidents from getting

worse. Moreover, it is the care that is being provided to a victim of such injury until they can be

taken care of by medical professional personnel (Alahakoon et al., 2022). The initial course of

treatment for incidents such as first aiding is extremely necessary for it identifies the future

course of complications (Kumar V., et al., 2022).

 In the article entitled “First Aid Awareness and Training is the Key” (2018), it is

acknowledged that the role of understanding the importance of first aid awareness makes a big

difference and impact on people’s lives. There is this common misconception that people usually

say, “it won’t happen to me”. But it is said in the study that thousands of Australians get injured

and hospitalized every year because of unforeseen emergency events. In line with this,

adolescents are one of the major populations who must have knowledge about first aid education.

According to the study of Sharif 2018, adolescents are provided with very minimal first aid

education and in need of complying with learning about first aid in order to promote a safer

community and to prevent any further complications when it comes to responding for

emergencies. The aim of applying the practice of first aid is said to the study of Felman A. 2018.

It is said that first aid aims to preserve life, prevent further harm, and promote recovery. As for

the emergency situations are unforeseen events, the first few minutes of it can have a lot of

difference if there is someone who knows how to respond appropriately and effectively (Niraj,

2023). To add, being a first aider is both a rewarding and useful career. They are being taught

how to respond in such medical emergencies and assist an injured person prior to the arrival of

further help. (McCulloch S., 2021)

It is a given fact that most adolescents have a lack of knowledge when it comes to

applying first aid in emergency situations. But when it comes to medical students, a study of

Algethami et al., 2022 was conducted in assessing the level of knowledge in first aiding among

medical students in the work environment. According to the study, it was concluded that the

level of knowledge improved with the advancement of years, but still, it was not enough to just

settle for what the result is. It is said that more training should be given to all medical students on

first aiding. The results were shown as: out of 326 students, 10 scored excellent (3.1%), 99 were
good (30.4%), 136 average (41.7%), 75 poor (23%) and 6 very poor (1.8%). Moreover, as with

the study of Huy L. 2022, it was reported that the level of willingness to perform first aid among

high school students in the present population was found to be just moderate. For that reason,

integrating activities to promote self-efficacy when it comes to first aid training could be

considered a stepping stone into the improvement of the student’s eagerness to provide life

saving practices.

According to Sumaiyah T., et al., 2018, applying the practice of first aid in every person

in the scene of an emergency is pivotal in helping people to prevent the risk for any major

complications that may lead to morbidity and mortality worldwide. Additionally, Halawani et al.,

2019 said that even though the students have a positive attitude with regard to first aid, they still

do not have the knowledge that is needed to be able to respond in emergency situations. There is

still a need for increased and developed public awareness and it is also recommended to have

first aid courses in all universities and secondary schools. However, when it comes to

kindergarten teachers, it is said that one must create an awareness including the knowledge of

first aid courses among instructors to be inclined with the curriculum that is needed to be

considered (Ganfure, 2018).

In the study of Rosaceae 2021, first aid is described as the practice that is being applied to

injured persons in any health threatening settings to be able to save a life and prevent any major

casualties that may come through. It is involved in providing care to an injured or sick individual

that is commonly rendered by a non-medical and with limited skills personnel (Guereno et al.,

2023). A lot of efforts have been applied in the educational field in order to exemplify the

importance of such actions when it comes to first aid practices (Tse, E. et al., 2023). Different

reasons with regards to the importance of applying the practice of first aid were explained as
follows: can save a person’s life, relieves pain, prevents infection and chances of it, keeps

children safe, helps communicate better with medical professionals, reduces recovery time, and

save from mounting healthcare costs (Wadhwani, 2022)

In accordance with Monge et al., 2021, applying the practice of first aid is an invaluable

skill that a person must learn. Different methods of giving knowledge and awareness when it

comes to first aid is vital most especially in incidents requiring the skill under it since that it was

a given fact that emergency cases may happen anytime and anywhere. Moreover, with

accordance to the partnership of Department of Health (DOH) and Department of Education

(DepEd) 2023, the training for the knowledge of the practice of first aid must be included in the

curriculum movement of the scout as it is said that it would be good for them to learn about it.

With that, Vergeire (2023) said that the first aid training for scouts may be considered as a

compulsory subject in the field of scouting in the Philippines. Furthermore, Solon et al., 2022 of

the Department of Science and Technology conducted a study about the student scholars in

Dumaguete City, Negros Oriental on participating in training emergency first aid. It is said that

having the basic knowledge and skills when it comes to first aid is essential for emergencies all

the time and it is the best response to be prepared.

In applying the practice of first aid, it is important for us to have a basic knowledge on

this. According to the Philippine Red Cross 2022, they are encouraging every Filipino Family to

have at least one member of the family to have knowledge and be the first aider in their

respective households. In this case, PRC also included in this that accidents may also occur at

home and the presence of a family member who is knowledgeable enough into applying the

practice of first aid. Furthermore, PRC also added that a number of 43, 206 first aiders were

trained from January to October in line with the battling of the country versus the COVID
19-Pandemic (PRC, 2021). Moreover, there is this first aid training where such education was

specifically provided in the community for preparedness and resilience. It is done by using

teaching techniques that aim to save lives and reduce the burden of injuries (Flores et al., 2022).

Theoretical and Conceptual Framework

Table 1. Conceptual and Theoretical Framework

This study applied the concept of input-process-output that provides the basis of the

impact of Assessing the Level of Competency based on Emergency Response of Nursing

Students at Batangas State University - TNEU.

In input stage, the researchers will assess the Level of Competency based on Emergency

Response in terms of: Knowledge, Skills, Attitude. Additionally, the mediating variable such as

the Prior training, Self-efficacy, and Supervision will affect the input and output stages in which
helps explain the relationship between the two. The process stage comprised the distribution of

questionnaires and conduct of interviews to the respondents concerning the input stage of the

framework. Moreover, the output of this study is the overall Level of Competency based on

Emergency Response of Nursing Students at Batangas State University -TNEU

Definition of Terms

The following are the terms used by the researchers in this study to have parallel

understanding with the readers.

Emergency. An emergency is a pressing, unanticipated, and frequently dangerous

situation that puts people's safety, property, or the environment at risk right away and necessitates

quick action.

Emergency Response. An emergency response is a prompt, organized reaction to a

threatening or unexpected situation. A procedure for responding to emergencies aims to lessen

the effects of an incident on people, property, and the environment.

First Aid. When someone is hurt or ill, you should give them emergency or immediate

care until full medical attention is available. This is known as first aid. First aid treatment may be

sufficient for minor ailments. First aid treatment should continue for serious issues until more

advanced care is available.

Competency. Competency is defined as the ability to apply or use the collection of

related knowledge, skills, and abilities needed to successfully complete "critical work functions"

or tasks in a specific work environment.

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