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Republic of the Philippines
University of Cabuyao
(Pamantasan ng Cabuyao)
College of Health and Allied Sciences
Katapatan Mutual Homes, Brgy. Banay-banay, City of Cabuyao, Laguna, Philippines 4025
A Correlational Study on the Nurse-Patient Ratio and Infection Control Protocol In
Rendering Bedside Practices in Selected Hospitals in Laguna
A Research Proposal Presented to the College of Health and Allied Sciences Faculty in Partial
Fulfillment of the Requirements for NCM 111 – Nursing Research I
By
3BSN – B / Group No. 1
Abalos, Justine Mhekaela B.
Aldueza, Charina R.
Angeles, Cyrenne L.
Angustia, Alyanna Mae C.
October 2023
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CHAPTER I
THE PROBLEM AND ITS SETTING
Introduction
Is infection control in the ward maintained despite the hospital's nursing shortage?
Different studies provide significant evidence that establishes a strong correlation
between the number of nurses on staff and the results experienced by patients. Inadequate
nurse staffing and excessive workloads have been associated with poor hand hygiene,
inadequate equipment cleaning, and improper utilization of personal protective equipment (PPE),
which may result in intravenous cannulas, wound infections, bacterial infections of the urinary
tract, and respiratory infections. Further extensive research is needed on how different staffing
models affect specific infection prevention behaviors, such as wound dressing, oral hygiene, or
patient education. (Tencic, M. et al., 2023)
This study examines the relationship between the nurse-patient ratio and infection
control protocol in rendering bedside practices in selected hospitals in Laguna. Moreover,
researchers will assess the current nurse-patient ratio in selected hospitals and the problems
encountered by the respondents. Lastly, the study will provide recommendations to enhance the
healthcare system regarding the nurse-patient ratio and infection control for patient safety.
The Department of Health of the Philippines oversees hospital infection control. The
DOH establishes standards for environmental sanitation, hand hygiene, PPE use, and waste
management in order to prevent infection. Healthcare personnel are educated on infection
control, and numerous hospitals have infection control committees tasked with supervising the
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implementation of protocols. Consistent surveillance and monitoring of healthcare-associated
infections (HAIs) is in accordance with global benchmarks established by reputable
organizations such as the WHO. Hospitals emphasize response to epidemics by implementing
protocols to identify, isolate, and treat contagious patients. Although resource limitations pose a
challenge to upholding stringent infection control protocols, progress can be made in certain
areas, including the integration of monitoring technology and cooperation with regulatory
agencies.
Hospital nurse-to-patient ratios are regulated by the Philippine Department of Health.
These suggestions enhance the quality and safety of patient care. Resource availability, patient
circumstances, and treatment intricacy all influence the nurse-to-patient ratio. Ongoing efforts
are made to advocate for adequate personnel levels in order to ensure the provision of high-
quality care and the well-being of nurses. Implementation of ratios may be hampered by
resource limitations. A sufficient number of nurses enhances patient outcomes. Advocacy
groups and nursing associations advocate for staffing policies.
With regard to patient-centered care, hospitals in the Philippines prioritize bedside
medication administration, wound care, and vital sign monitoring. Hygiene, infection prevention,
and effective multidisciplinary collaboration are critical components of holistic treatment. Patient
education, effective communication, and privacy are all key components of bedside interactions.
Patient safety, technology, and cultural sensitivity all contribute to the enhancement of bedside
procedures. The objective of quality enhancement methods such as training and assessments
is to harmonize practices with standards that are grounded in empirical evidence. To obtain up-
to-date information, please consult the Department of Health.
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Hospital bedside infection control is crucial in the Philippines. Hand cleanliness, PPE
use, and other healthcare-associated infection prevention practices are covered by DOH
standards. Strict compliance with these criteria affects patient safety, especially for vulnerable
groups. Adequate staffing helps infection control and nurse-patient ratios work together.
Healthcare professionals receive infection control training. Bedside care integrates infection
control into normal tasks. Resource restrictions and emerging infectious dangers present
opportunities for education and technology integration to improve. Continuous monitoring and
evaluation maintain bedside infection control effectiveness. Trust authoritative sources like the
Department of Health for the latest information.
To enhance comprehension regarding the determinants impacting the standard of
patient care within a healthcare setting, investigators opted to undertake an investigation
concerning the correlation between the nurse-to-patient ratio and infection protocols in bedside
practices. This research aimed to compare the infection rates among patients in hospitals with
varying ratios of nurses to patients.
Background of the Study
The researchers aim to study the connections between nurse-patient ratios and infection
control procedure adherence. It will discuss the inadequate nurse staffing and excessive
workloads that have been associated with poor hand hygiene, inadequate equipment cleaning,
and improper utilization of personal protective equipment (PPE), which may result in
intravenous cannulas, wound infections, bacterial infections of the urinary tract, and respiratory
infections. Further extensive research is needed on how different staffing models affect specific
infection prevention behaviors, such as wound dressing, oral hygiene, or patient education.
(Tencic, M. et al., 2023) Utilizing the Environmental Theory of Florence Nightingale and the Self-
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Care Deficit Theory of Dorothea Orem, this study investigates how staffing levels affect patient
outcomes and infection control.
The nurse-to-patient ratio in the Philippines typically stands at 1:20 but can escalate to
1:50, far exceeding the recommended ratio of 1:12. A study conducted in an urban hospital in
Manila found that the number of patients per nurse was estimated to be 1:1 or 2:1 in the ICUs,
5:1 or 6:1 in the obstetrics/gynecology and cancer wards, and approximately 16:1 in the
cardiology ward. (Alibudbud, R. (2023)
According to the data released by the Department of Health (DOH), The nurse-to-patient
ratio in the general ward in the Philippines is set at 1:12, according to the prevailing guidelines
of the Department of Health. However, a 2022 study conducted at the Philippine General
Hospital revealed that the standard nurse-to-patient ratio in some hospitals can be as high as
1:20, and in extreme cases, one nurse may attend to 20 to 50 patients per shift. This high-
volume ratio is attributed to inadequate staff and high patient workload. The shortage of nurses
in the Philippines has led to concerns about the safety and adequacy of the healthcare system.
The research holds importance for its potential to enhance patient safety, healthcare
practices, and nurse advocacy. The results can help patients, nurses, medical facilities, and
educational initiatives. They can also provide important new information for studies on patient
safety and healthcare management in the future.
Theoretical Framework
The study will be based on Florence Nightingale's Environmental Theory, which
highlights the significance of a clean environment in giving patient care. Furthermore, the
relevance of Orem's Self-Care Deficit Theory will be considered, with a specific focus on the
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patient's ability to participate in self-care activities, such as infection control procedures. These
widely applied theories have influenced research, education, and practices in the field of study.
Environmental Theory
The relevance of Florence Nightingale's Environmental Theory to the research is evident,
as it emphasizes the influence of the physical environment on health outcomes. Within the study
involving nurse-patient ratios and infection control measures, Nightingale's theory emphasizes
the vital significance of a clean and properly managed setting in preventing infections. Florence
Nightingale stated that five factors were important for attaining a healthy living: "pure air,
uncontaminated water, effective sewage system, hygiene, and lights." (Gonzalo, 2023)
The Environmental Theory includes the following key concepts: Infection Control, Patient
Safety, and Nurse-Patient Ratio.
Infection Control: Nightingale's environmental theory emphasizes the significance of
cleanliness and personal hygiene in minimizing infections. The study assesses the impact of
different nurse-patient ratios on the ability to maintain a clean environment and comply with
infection control protocols.
Patient Safety: The theory highlights the need for a clean environment to ensure the safety of
patients. An analysis of the nurse-patient ratio in relation to infection control protocols enables
the evaluation of its potential impact on maintaining an optimal environment for patients.
Nurse-Patient Ratio: Nightingale's theory prompts attention to resource allocation, including
staffing. The study explores how optimizing nurse-patient ratios aligns with creating and
maintaining the ideal environmental conditions for infection control.
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Self-Care Theory
The researchers include Dorothea Orem's Self - Care Deficit Theory. Orem’s Self-Care
Deficit Theory focuses on patient empowerment and nursing interventions. Orem's theory
centers on patients' ability to perform self-care activities. (Gonzalo, 2023) The research delves
into how variations in nurse-patient ratios influence patients' capacity for self-care, especially in
terms of infection control practices.
Moreover, the theory shows that adequate staffing contributes to patients' ability to
actively participate in their care, including following infection control protocols. The study also
examines the role of nursing interventions when patients are unable to meet their self-care
needs, exploring the effectiveness of these interventions in preventing infections and supporting
patients in their self-care efforts.
Research Paradigm/Operational Framework
INPUT: PROCESS: OUTPUT:

1. Demographic Profile
2. Nurse-Patient Ratio 1. Gathering of data
3. Correlation of nurse- through interviews,
patient ratio in
implementation of
observations, and
infection control protocols surveys.
in bedside care practices. 2. Analyzing gathered Significant differences in
4. Specific infection control data using statistics infections rates among
measures in hospitals. tools patients in hospitals with
5. Nurse-patient ratio 3. Drawing hypothesis varying nurse-patient ratios
influence towards and plan for
healthcare professional improvement
FEEFBACK
Figure 1 shows the specific research approach that the researchers considered.
This model followed the Input-Process-Output (IPO) model. The inputs were the
necessary data to be collected that the researchers will use to reveal the underlying
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issues. In this process are the involved strategies and tools to analyze the data. Lastly is
the output where the researchers will be able to pinpoint the outcome of the in-depth
analyzation of data.
Research Questions
The purpose of this study is to perform a correlational analysis to examine the complex
relationship between the nurse-patient ratio and adherence with protocols for infection control
during bedside practices in selected Laguna hospitals. By addressing the relationships between
these important variables, the researchers aim to learn more about the possible effects of
staffing levels on infection control strategies and, in the process, advance the knowledge of the
variables affecting the standard of patient care in a healthcare setting.
The researchers would like to seek the following questions:
1. What is the demographic profile of the respondents according to:
1.1 Age
1.2 Sex
1.3 Name of Hospital
1.4 Years of experience as a Nurse
2. What is the range of patients handled by the respondents during their duty hours/ shift?
3. What is/are the problem/s encountered by the respondents in the nurse-patient ratio in
relation to rendering bedside care in terms of:
3.1 Quality of Care
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3.2 Nursing Interventions
3.3 Patient Care Outcomes
4. What is/are the measure/s conducted to address the problems encountered in the nurse-
patient ratio in relation to patient care in terms of:
4.1 Quality of Care
4.2 Nursing Interventions
4.3 Patient Care Outcomes
5. Is there a significant relationship between the nurse-patient ratio and the quality of patient
care given by the respondents?
6. What is/are the recommendation/s to improve the quality of patient care in relation to the
nurse-patient ratio?
Hypothesis/Assumptions
Null Hypothesis (H0): There is no significant correlation between nurse-patient ratios and
the implementation of infection control protocols within selected hospitals in Laguna.
Scope and Limitations
This study will emphasize a correlation between the nurse-patient ratio and infection
control protocols in rendering bedside practices in selected hospitals in Laguna. Furthermore,
the study determines the progress action plan using the Environmental Theory of Florence
Nightingale and Orem’s Self-Care Deficit Theory.
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The study will limit only the services offered by the selected hospitals in Laguna, such as:
UniHealth Southwoods Hospital and Medical Center, Healthserv Los Baños Medical Center,
Ospital Ng Cabuyao, and San Pablo City District Hospital. The respondents are the registered
nurses in selected hospitals in Laguna who render bedside care practices. Also, the researchers
included the demographic profile of the respondents in terms of age, gender, name of hospital,
and years of experience as a nurse. The study will involve collecting data through surveys to
analyze whether the nurse-patient ratio correlates with infection control protocol in rendering
bedside care practices.
Moreover, it will not include infection cases in other hospital departments such as
intensive care units, emergency room, operating room, outpatient department, recovery room,
heamodialysis, OB ward, and Pediatric ward. The researchers involved the registered nurses of
top 4 hospitals with the highest number of patients in Laguna. The study focuses on assessing
the current nurse - patient ratio in selected hospitals in Laguna and the problems encountered
by the respondents.
Significance of the Study
The results of this study will benefit the following by providing valuable insights into the
correlation between nurse-patient ratios and infection control protocols, thereby contributing to
enhanced healthcare practices, patient safety, and overall well-being:
Patients. The purpose of the study is to investigate the correlation between infection control
procedures and nurse-patient ratios. Positive results could influence the development of better
infection control strategies, which would lower the incidence of hospital acquired infections and
increase patient safety in general. The study's conclusions may lead to the adoption of infection
control procedures that are more successful. Therefore, this could lead to a lower risk of
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infections for patients while they are in the hospital, promoting a more stronger recuperation.
Patients can gain from prompt, more focused care, which creates an atmosphere that is
favorable to improved health results.
Nurses. This study of the correlation between nurse-patient ratios and infection control
practices holds particular relevance for nursing professionals. Comprehending this relationship
has the potential to elevate patient safety through the proficient implementation of infection
control measures. Additionally, the research may empower nurses to advocate for optimal
staffing levels, thereby enhancing the overall caliber of patient care. Beyond its immediate
impact on patient outcomes, nurse involvement in this research could contribute to professional
advocacy initiatives, potentially influencing policies about nurse staffing and infection control.
This knowledge can shape nursing education, enlightening future fellows of healthcare
professionals and fostering opportunities for career advancement within the nursing field.
Healthcare Institutions. The study highlights the pivotal role of nurse-patient ratios in
upholding high-quality care and effective infection control within hospital wards. By recognizing
the impact of adequate staffing on the implementation of infection control measures, healthcare
institutions acquire insights that can mitigate the risk of hospital-acquired infections and elevate
the overall quality of patient care. The research will provide information to optimize staffing
levels, empowering institutions to make well-informed decisions regarding resource allocation,
policy development, and strategic planning. Centered on selected hospitals in Laguna, the
study's localized relevance enhances its practical applicability for institutions, providing a
valuable instrument to infection control practices and enhance healthcare outcomes within their
specific institutional contexts.
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CHAS. The College of Health and Allied Sciences would benefit significantly from this research
since this study aligns with the college's educational goals by offering valuable insights into the
vital connection between nurse-patient ratios and effective infection control in healthcare
settings. This research enriches the curriculum, providing students with real-world applications
and preparing them for the challenges of their future careers. Additionally, the findings
contribute to the college's academic and research standing, offering opportunities for faculty
development and enhancing teaching methodologies.
PNC-UC. Pamantasan ng Cabuyao - University of Cabuyao would have significant benefits from
this research as this study aligns with the university's commitment to practical education,
offering an opportunity to enrich healthcare curriculum with real-world insights. By incorporating
the research findings, the university ensures that its healthcare students are well-equipped to
navigate challenges in infection control and patient care.
Researchers. Researchers stand to benefit significantly from this research since this study
provides a valuable opportunity for researchers to contribute to the healthcare field by
examining the relationship between nurse-patient ratios and infection control practices. The
findings can advance evidence-based practices, guiding the development of guidelines and
recommendations to optimize nurse-patient ratios and improve patient care while minimizing
hospital-acquired infections. The study's focus on selected hospitals in Laguna offers context-
specific insights, allowing researchers to analyze regional variations and implications.
Future Researchers. Future researchers will benefit from this research by inheriting a
foundational understanding of the critical interplay between nurse-patient ratios and infection
control practices in healthcare settings. This knowledge serves as a cornerstone for future
investigations and contributes to the evolving body of research in healthcare management,
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patient safety, and infection prevention. The insights gained from this study can guide future
researchers in designing more targeted studies, potentially uncovering nuanced aspects of the
relationship between staffing levels and infection control. Moreover, the research's focus on
selected hospitals in Laguna provides a contextual framework for future researchers to explore
regional variations and tailor their inquiries to specific healthcare environments.
Definition of Terms
The following identified terminologies that were vague to understand by the readers.
This part of the study tended to unlock difficult words that will help the readers to understand the
meaning and concept of the study. The terms identified were based on how they are used in the
study.
Bedside Practices. Various clinical tasks performed by nurses directly at the bedside,
encompassing activities such as patient assessment, medication administration, wound care,
and other tasks associated with direct patient care.
Empirical. Information derived from real-world experiences or observation, rather than
theoretical considerations.
Global Benchmark. An international standard or measure used as a reference point for
evaluating healthcare practices.
Healthcare-Associated Infections (HAIs). Infections acquired by patients during healthcare
treatment, crucial for understanding infection risks in healthcare settings.
Infection Control Protocol. Guidelines and measures in healthcare settings to prevent and
manage infections, particularly during bedside practices in selected hospitals in Laguna.
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Intricacy. The complexity or detailed nature of certain aspects, such as healthcare procedures
or protocols.
Multidisciplinary Collaboration. Involves professionals from various healthcare disciplines
working together to achieve common goals.
Nuanced. The presence of subtle distinctions within a particular context, emphasizing the need
for detailed consideration in interpreting information.
Personal Protective Equipment (PPE). Garments and accessories designed to protect
healthcare workers from potential exposure to infectious agents during patient care.
Recuperation. The process of recovery or regaining health, particularly within healthcare
practices and patient care.
Stringent Infection Control Protocol. Denotes strict procedures and measures to prevent and
manage infections, particularly within healthcare settings.
Nurse-Patient Ratio. A quantitative measure indicating the number of patients assigned to a
nurse at a given time, serving as a key variable for analysis in relation to bedside practices and
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CHAPTER II
REVIEW OF LITERATURE AND STUDIES
This chapter consists of review of literature and studies related to the correlation of
nurse-patient ratio and infection control protocol in rendering bedside practices. This chapter will
also present the conceptual and research literature along with the synthesis and the research
gap for better comprehension of the study.
Conceptual Literature
Hospital - Acquired Infections
The global impact of COVID-19 has placed immense strain on healthcare systems,
leading to increased hospitalizations and complexities in crisis management (Abbas M., et al.,
2021). Despite these challenges, efforts made during the pandemic to improve infection control
procedures are highlighted, demonstrating a commitment to addressing the pressing issues in
healthcare (Abdullah, M., 2023). These efforts also set the stage for subsequent research, such
as a study on bedside wiping in multi-patient rooms, which aims to correlate nurse-to-patient
ratios with infection control procedures (Dadon, M., et al., 2023). The urgency of implementing
successful tactics and interventions for hospital-acquired infections (HAIs) is underscored,
considering their high morbidity, mortality, and economic costs (Liu J., et al., 2020). The
correlational study on the nurse-patient ratio and infection control protocol in selected hospitals
in Laguna, both sets of information underscore the critical need for effective infection control
measures.
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Healthcare-associated infections(HAIs) represent the most common adverse events in
healthcare, significantly impacting patient safety and contributing to substantial morbidity,
mortality, and financial strain on patients, their families, and healthcare systems. (Sikora, A.,
2023) Furthermore, the study conducted by Bhandari, T. (2023) underscores the complex
interactions between medical interventions, inflammation, and bacterial activation, providing
valuable insights for refining infection prevention strategies in hospital settings. This insight
complements the broader theme of understanding the intricacies of HAIs and highlights the
need for multifaceted approaches to infection prevention in healthcare settings.
The importance of universal face masking and hand hygiene in preventing COVID-19
transmission among hospital-acquired patients is emphasized, linking the need for adequate
nurse-patient ratios in infection and HAI prevention (Lo, S., et al., 2021) Moreover, Knepper, B.,
et al., (2020) examined the effects of an automated hand hygiene monitoring system integrated
with performance improvement interventions on hospital-acquired infections in 2020. A detailed
analysis will determine if the combination intervention improves hand hygiene and reduces
hospital HAIs. Hospital logistics staff’s primary duties include cleaning and disinfecting the
hospital environment and medical products for the cleanliness and safety of the
hospital.(Honghui Z., et al., 2022) It suggests a potential research study that could explore the
relationship between nurse-patient ratios and infection control protocols in selected hospitals in
Laguna. This shift implies a broader concern for infection control measures within healthcare
settings, emphasizing the need for comprehensive strategies to address and mitigate the risk of
nosocomial infections. By examining the practices and awareness of healthcare workers, the
research contributes valuable insights that may inform interventions aimed at enhancing hand
hygiene protocols and the effective use of disinfectants in healthcare settings. The findings of
this study are valuable for advancing the understanding of infection control practices among
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healthcare professionals, thereby potentially improving patient safety and reducing the risk of
healthcare-associated infections. (Ahmed, J., 2020)
Exploring healthcare workers' compliance and knowledge regarding hand hygiene and
disinfectant use is directly relevant to maintaining high-quality care and effective infection
control. The research aligns with the importance of sufficient staffing, as emphasized in the
nurse-patient ratio, enabling effective infection control measures and reducing the risk of
hospital-acquired infections. The comprehensive approach in the initial study, considering
various parameters and influential factors, aligns with the need for a nuanced understanding of
infection control practices, providing a foundation for effective policy and protocol development
(Lyu X., et al., 2021). Furthermore, the lack of significant differences in morbidity and mortality
based on the specific type of virus suggests a uniform impact regardless of the viral strain,
reinforcing the broader implications of infection control measures (Manchal N., et al., 2020).
Specific studies and interventions contribute to the overall exploration of HAIs. For
example, a systematic review investigates the risks of infections from peripheral intravenous
catheters, highlighting the need for well-studied approaches in common medical interventions
(Mermel. L., 2020). Another study evaluates the effect of hand hygiene practices on HAIs,
addressing determinants impacting adherence and critical approaches to enhance compliance
(Mouajou, V., et al., 2022). The study analysis examines hand hygiene determinants, which may
affect hospital infection management.
This study examines nurse-patient ratios and bedside infection control methods. The
findings obtained can offer valuable insights. Mouajou et al.'s research on hand hygiene
compliance is relevant to the correlational study's goal of identifying healthcare infection control
variables. A meta-analysis provides valuable insights into the prevalence and characteristics of
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HAIs globally, setting the stage for exploring the correlation between nurse-patient ratios and
infection control protocols in subsequent studies (Raoofi S., et al., 2023). Additionally, a
retrospective observational cohort analysis in a Chinese hospital focuses on nosocomial
infections among senior patients during the COVID-19 pandemic, emphasizing the need for a
sophisticated medical management system beyond epidemic prevention and control (Wu S., et
al., 2022).
The pivotal role of surveillance systems and infection control in mitigating the impact of
HAIs was emphasized, linking it to the adoption of strategic measures such as proper use and
care of urinary catheters, vigilant management of vascular access lines, thorough surveillance
of surgical procedures, and adherence to stringent hand hygiene standards (Reddy P., et al.,
2020). The consequences of nosocomial infections (NCIs), including prolonged hospital stays,
ongoing impairment, increased antibiotic resistance, disturbance to the socioeconomic system,
and higher death rates, further stress the importance of preventative measures (Salu, S., et al.,
2023). Ongoing training and professional development opportunities for nurses are identified as
crucial in preventing and controlling nosocomial infections, aligning with the broader theme of
healthcare-associated adverse events and their impact.
Hospitals' efforts to minimize patient infections over the past few decades, including
strict policies and advanced technologies, are acknowledged, reinforcing the commitment to
ensuring patient safety (Monegro, A. F., 2023). The emphasis on research, assessment, and
management underscores the healthcare sector's dedication to enhancing patient outcomes
and reducing the impact of hospital-acquired infections on both individual and community levels.
Identifying individuals at risk becomes crucial in preventing and minimizing the frequency of
infections, connecting with the need for a sophisticated medical management system (Monegro,
A. F., 2023). Collaboration, multidimensional investigations, and a comprehensive approach to

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utilizing biomarkers for sepsis are essential, further emphasizing the importance of diverse
research approaches and strategies in addressing nosocomial infections (Póvoa, P., et al.,
2023).
In conclusion, the studies provide valuable insights that can help healthcare institutions
improve their infection prevention protocols and enhance the quality of healthcare delivery. The
relationship identified in these studies underscores the complex nature of hospital-acquired
infections (HAIs) and emphasizes the importance of employing comprehensive methods to
address and mitigate their impact effectively. This acknowledgment of complexity highlights the
thorough and precise strategy in creating and executing interventions to prevent and manage
hospital-associated infections (HAIs), particularly in the constantly changing hospital
environment. By combining several research studies, these findings establish a basis for
continuously improving processes, strengthening the healthcare system's ability to protect
patient health and reduce the impact of hospital-acquired infections.
Bedside Practices
The study conducted by Pervez, S., Kousar, R., Asif, M., and Asghar, S. (2022)
examines the impact of nurses' workloads on patient satisfaction with nursing care. The findings
of this research were published in NURSEARCHER (Journal of Nursing & Midwifery Sciences).
By conducting an exhaustive examination, this research endeavors to clarify the correlation
between the work pressure nurses encounter and the patient's perception of the standard of
nursing care. This study investigates the possibility of a relationship between the level of patient
satisfaction and the workload imposed on nursing personnel. The results obtained from this
inquiry provide significant contributions to the understanding of the complex relationship
between the burdens of nurses and the satisfaction of patients. These findings have implications
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for improving nursing practices in healthcare environments to enhance patient experience and
satisfaction.
Asghar et al. evaluate the effect of the burden of nurses on the satisfaction of nursing
care patients in their 2022 study. This study emphasizes the significance of adequate personnel
levels, as indicated by the nurse-to-patient ratio, in guaranteeing high-quality patient care and
efficient infection control. In addition to enhancing patient safety and overall health outcomes,
the research offers valuable insights into the correlation between patient satisfaction and the
burden of nurses. The study could provide insights into optimizing personnel levels and
strengthening infection control protocols, ultimately enhancing healthcare outcomes and patient
safety.
The 2020 Infection Control and Hospital Epidemiology article by Godbout, E., Madaline,
T., Casadevall, A., Bearman, G., and Pirofski, L. A. applies damage response to healthcare
infection prevention. The study "The Damage Response Framework and Infection Prevention:
From Concept to Bedside" links its concept to its implementation. The damage response
paradigm, created to define human reactions to microbial illnesses, is studied for infection
prevention. The framework's theory and infection control implications are reviewed. We address
healthcare infection control theory and practice.
Comprehensive literature review employing damage response and infection prevention
approaches. The authors demonstrate damage response paradigm infection therapy using
theory and evidence. Application concept-to-bedside analysis. They discuss how healthcare
practitioners might prevent infections to increase patient safety and reduce healthcare-
associated infections. Infection Control and Hospital Epidemiology reported the statistics to
avoid infections. The study helps doctors, academics, and policymakers prevent diseases by
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applying damage response paradigms. This article may affect patient treatment and infection
prevention.
In relation to this study, both studies employ comprehensive literature reviews and
emphasize integrating theory and evidence in healthcare practices. The Godbout et al. article's
application of concept-to-bedside analysis resonates with the practical implications explored in
the nurse-patient ratio and infection control protocol study. Both studies address challenges and
possibilities associated with implementing frameworks in healthcare, offering insights for
practitioners and policymakers.
According to Karapanou (2020) and his co-researchers, the CVC insertion and care
bundle failures in a high CLABSI rate hospital with high bed occupancy. CLABSI is a well-known
complication associated with using central venous catheters, an essential medical intervention.
The research context involves a challenging hospital setting with high rates of CLABSI and high
occupancy levels, adding difficulties to infection control. The study aims to identify particular
reasons for unsuccessful CVC insertion and performance of the Care Bundle to highlight
appropriate areas to address to enhance patient safety outcomes.
The approach used for this study is broad to understand the problems associated with
implementing CVC and care bundles. This suggests that the methods involve a review of the
CLABSI incidence, a thorough scrutiny of CVC insertion practices, and an assessment of care
bundle compliance. Data collection may involve a review of medical records, observational
studies, and interaction with healthcare providers. Healthcare providers’ understanding and
implementation of asepsis principles and high bed ratio in some hospitals are the main issues
that the researchers should evaluate. This multi-faceted approach helps provide a
comprehensive understanding of how multiple factors have caused these failures.
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As part of this study, both studies seek to address issues of infection prevention
specifically relating to CLABSI rates and care bundles, according to Karapanou (2020) with his
co-researchers. This concurs with a more extensive picture outlook of the Laguna study relating
nurses-to-patient ratios and bedside care quality regarding infection control. These studies
provide in-depth information on the intricate nature of implementing care bundles and infection
control policies. Further, they show the connection between staffing and infection prevention for
healthcare improvement.
The study by LaValley (2022) sheds light on one of the critical challenges of reducing
central line-associated bloodstream infections (CLABSI) in the setting of a rural Midwestern
hospital. The research demonstrates a thorough, evidence-based methodology for assessing a
nurse-led practice change intervention. The multi-faceted approach of the intervention involves
several elements, including strict hand hygiene, thorough site disinfection, and the utilization of
sterile barrier precautions during the insertion of a central line.
The study recognizes that healthcare practices evolve constantly, and therefore, it puts
in significance the continuous education and training for the healthcare staff. Therefore, through
a comprehensive literature review, the research can ground the intervention on best practices
related to CLABSIs and make a meaningful contribution to existing knowledge on effective
prevention and management strategies that minimize the development of CLABSIs. The
methodology of the study is based on an extensive data analysis applying statistical tests to the
calculated CLABSI rate and compliance with the used bundle. The results show a significant
CLABSI decline, revealing the real impact of nurse-driven programs on safer care practices and
patients’ well-being.
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The focus of this study is centered on enhancing patient care by minimizing health-
related infections. The research will likely involve an exploration of infection control practices at
the bedside in relation to the nurse-patient ratio. LaValley (2022) concentrated on implementing
an evidence-based approach to decreasing CLABSIs. The two studies underscore the
importance of evidence-based practices and nursing-based interventions in improving patient
safety. In this regard, LaValley’s (2022) intervention may provide some insights that can guide
practical changes in bedside practice similar to what we have seen among the study findings on
the relationship between bed turnover rates and infection control practices. Although set in
different settings, both studies add to comprehensive healthcare discussion, making clear points
that it is vital to introduce relevant protocols to reduce infection risk.
According to the study conducted by McCook and Cynthia (2021), entitled “Reducing
CRBSI among patients receiving outpatient hemodialysis,” is a significant issue within the
vulnerable category of healthcare service users. End-stage renal disease patients who utilize
catheters as their means of vascular access increase the prevalence of CRBSIs. The study has
potential findings to prevent CRBSI, especially concerning the incidence of infection in the
hemodialysis outpatient scenario. It is a multi-faceted approach using evidence-based practices
and infection control measures. Researchers may evaluate the level of compliance by
health care personnel to standards of practice towards infection prevention practices among
patients receiving hemodialysis. The research could also investigate patient education,
educating individuals on best practices that will prevent the infections associated with using
catheters when conducting hemodialysis.
This research will be significant because it can form a basis of knowledge about
healthcare practices in outpatient hemodialysis environments. In doing so, the study could
formulate pragmatic suggestions for medical practitioners, decision-makers, and scholars

Page 23 of 41
engaged in patient affairs with the viewpoint of improving healthcare results in managing CKD
patients. Ultimately, by decreasing CRBSIs, one contributes to reducing complications,
improving patient’s lives, and possibly lowering health care expenses. This study can
significantly help in discussing the ideal practice for outpatient hemodialysis, thus making proper
decisions to protect the vulnerable patient community.
In relation to this, both studies consider specific aspects of infection prevention and aim
at enhancing patient safety practice. CRBSIs in outpatient hemodialysis highlight personalized
interventions within various clinic subpopulations as the component of comprehensive health
policy we discuss – linkage between staffing mix, bedside care, and the prevention of infections.
However, the individual studies raise various questions on the effects of staffing ratios and
adherence to infection control in different care settings and their impacts on patient outcomes.
According to Mervyn Mer (2022), intravascular devices are essential to the practice of
medicine today. They are employed in the administration of parenteral nourishment, drugs,
blood products, and intravenous fluids. They might also be a helpful addition to keeping an eye
on critically sick patients' hemodynamic conditions. In terms of patient comfort and care, the
introduction and development of CVCs have marked a significant advancement; nonetheless,
problems, such as a range of local and systemic infectious issues, have also been associated
with them. There are numerous recommendations for the treatment and avoidance of infections
linked to intravascular catheters (CRI).
Nonetheless, CRIs continue to rank highly among the leading sources of hospital-
acquired infections and are linked to longer hospital stays, higher medical expenses, and
mortality. Numerous simple steps combined with strict adherence to them will go a long way
toward addressing issues connected to CVC care and reducing infective consequences related
Page 24 of 41
to the line. The pathophysiology and infection pathways associated with infections connected to
central venous catheters. The basic processes and procedures needed to increase and improve
CVC care and lessen the burden of CRIs and their aftereffects are supported by the recognition
of these factors. When it comes to cleaning the skin before inserting a catheter, two recent trials
show that chlorhexidine-alcohol works better than povidone-iodine-alcohol. Some guidelines
have recently recommended the use of antimicrobial-impregnated catheters to prevent CRI
infections, especially in environments with high incidence of infection. The results of a massive
SA randomized prospective study showed that conventional catheters were not significantly
superior to those impregnated with antimicrobials. The catheter needs to be taken out if a
CRBSI is suspected or confirmed. In most situations, 5 to 7 days of proper antibiotic treatment is
sufficient for simple infections in confirmed cases of CRBSI.
The study by Shivani and Joseph (2023), titled "Perception toward Peripheral Venous
Catheter Care Guidelines among Nurses Working in Paediatric Wards of a Tertiary Care
Hospital," investigates how nurses in pediatric This indicates that the study may be intended to
explore how nurses view standard rules for providing PVC care to pediatric patients which plays
a vital role in health services rendered in these unique clinical settings. Proper care of the
peripheral venous catheters has become crucial since it is crucial for administering intravenous
therapies to pediatric patients. This entails investigating what nurses think and believe about
current standards and explaining why they do not follow them as they provide pediatric patient
care.
Nurses' perceptions of issues relating to experience, education, and specific challenges
in caring for PVC are also explored. Such data is indispensable in determining various potential
improvement avenues within PVC management that lead to improved practice guidelines
compliance toward providing excellent care outcomes to pediatric patients. This study also
Page 25 of 41
shows that it has been reviewed by peers and accepted by the medical society as valuable.
These findings would be helpful to pediatric healthcare institutions so that they develop
appropriate training programs and interventions that will address specific challenges nurses
encounter in following PVC care guidelines.
In the relation to this, both studies are about the linkage between patient ratio and
infection prevention and control protocol in some hospitals. Both studies add to what is known
about nursing practices within particular health service areas and clinical nursing in general.
This means this study is almost comparable to Shivani and Joseph's (2023) research on PVC
care guidelines and nurses' opinions. Both studies highlighted a complex relationship between
various nursing activities and their associated challenges with staffing, guidelines, and
optimization of nurse-patient ratio as well as infection control protocol, and all implied significant
impacts on the quality of healthcare, particularly in this area.
Research Literature
Nurse-Patient Ratio and Its Importance
Most of the bedside patient care in hospitals is provided by nurses, who are the largest
occupational group (Blume et. al, 2021). In the past few years, hospitals have faced significant
and repeated budget cuts, impacting the presence of highly skilled nurses. These cost-saving
measures involve increasing the patient-to-nurse ratios, assigning more patients to each nurse,
and, in some cases, substituting registered nurses with less trained and skilled aides (Levins,
2023). In the Philippines, nurse-to-patient ratios can vary based on factors such as the type of
healthcare facility, the availability of resources, and the specific unit within the facility. However,
the Philippines, like many countries, may face challenges related to nursing shortages and
resource constraints. This can impact the ability to maintain ideal nurse-to-patient ratios. While
Page 26 of 41
there may be general guidelines, the actual ratios experienced by nurses in the Philippines can
be influenced by factors such as the specific hospital's policies, the region, and the demand for
healthcare services. It's not uncommon for nurses in the Philippines to handle a larger number
of patients compared to their counterparts in regions with more stringent regulations (Kluwer,
2020).
The optimal ratio of nurses to patients is a global concern for many nursing leaders. This
ratio holds advantages for both nurses and patients, playing a crucial role in ensuring patient
safety and the delivery of high-quality care (Sharma, 2020). The well-being and recovery of
patients are intricately linked to the quantity and composition of the nursing staff providing care.
Essentially, the number of nurses on duty and the organizational structure of the nursing team
play pivotal roles in shaping the outcomes for patients (Wang et. al, 2020). The relationship
between patient-staff ratios and care outcomes for patients is an important issue concerning the
health sector and why changes in the ratio of patients and staff affect the quality of medical
services provided. This is especially important since sufficient staffing for positive patient
outcomes is acknowledged in the importance of patient-to- nurse ratios, safety, quality,
satisfaction, and health outcomes in hospital care (Timothy, 2020).
Nurse-to-patient ratios are crucial to evaluating the quality of care hospitals provide. That
suggests that balanced nurse work environments in all health care settings deliver better
outcomes and improve nurse and patient satisfaction (Mueller, 2021). The majority of studies
addressing shortages in hospital staff concentrate on staffing ratios, particularly in relation to
nurses. The underlying assumption is that staffing ratios are primarily caused by and can thus
be calculated through staff shortages. Nevertheless, multiple studies suggest that reduced
staffing ratios stem from hospital staffing policies rather than shortages in the healthcare
workforce (Winter et. al, 2020).

Page 27 of 41
In the Philippines, where nursing staffing concerns persist, understanding the
importance of these ratios becomes particularly relevant. Firstly, nurse-to-patient ratios
significantly impact patient safety and outcomes. States or countries with high ratios may
struggle to provide optimal care, potentially compromising patient well- being. On the other hand,
those with lower ratios tend to offer better care as nurses can more effectively identify and
respond to changes in a patient's condition when they have fewer attending patients. In the
Philippines, where healthcare resources may be strained, implementing appropriate staffing
ratios becomes vital for ensuring patient safety and positive outcomes (Staffing, 2023).
According to Griffiths et. al (2021) trying to make the most of limited nurse resources by
minimizing regularly scheduled staff through flexible staffing plans may end up hurting patients.
The problem arises when temporary staff isn't readily available on short notice. Despite having
enough temporary staff, this approach doesn't really cut costs or reduce the overall need for
staff. The provided statement underscores the significant impact of nurse staffing on patient
outcomes within hospital settings. Indicates that hospitals with higher nurse staffing levels tend
to have more favorable patient outcomes. One strategy to enhance nurse staffing is the
implementation of minimum nurse-to-patient ratio mandates (McHugh et. al, 2021). In the face
of strong opposition from health systems, nurses nationwide are collaborating with union
officials to advocate for safer nurse staffing conditions. Some argue that regulations governing
the nurse-patient ratio fail to address some of the root causes of understaffing, like inadequate
compensation and benefits. Mandatory ratios' detractors contend that they put hospitals in
danger financially and increase their reliance on hired labor. Some states use public reporting
systems in place of required staffing ratios. By forcing states to submit their staffing ratios
regularly, these systems are intended to hold them responsible for maintaining safe staffing
levels (Roberts, 2023).
Page 28 of 41
The reality that fifty nurses resigned, citing "poor working conditions," clearly indicates
the issue's seriousness. Hiring enough personnel to satisfy the advice nurse-to-patient ratios
throughout each shift is a crucial suggestion in the article to guarantee safe nurse staffing. It
entails carefully considering several variables, such as keeping track of each employee's sick
and vacation days and managing the fluctuating need for patient care during different shifts
(Faerstain, 2023). The rationing of nursing care, which means denying essential nursing
intervention for different reasons, including financial constraints or lack of time that deliberate
restriction of care carries far-reaching consequences regarding patients’ well-being and the
integrity of health care (Tamayo et. al, 2021). Simulated increases in care also intensify the
stress experienced by nurses, which is a pervasive component within healthcare professions.
Understanding these stressors is crucial for developing targeted initiatives to improve the mental
health of nursing professionals. The essential goals are improving job satisfaction and
maintaining a workforce consistently providing standardized quality patient care (Vasel, 2020).
In conclusion, the studies provided evidence-based legislation by providing a
comprehensive knowledge of the connection between nurse staffing levels and infection control
outcomes. The studies yield an insightful perception regarding the problems nurses encounter
in different healthcare settings and support the significance of adjusting workload, infection
prevention, and reduction of cognitive load, clinical judgment, stress, and medical error for
effective nursing practice. In the Philippines, where the healthcare system faces resource
challenges, preventing nurse burnout is crucial for maintaining quality care. Therefore,
maintaining reasonable nurse-to-patient ratios can contribute to lower staff turnover. In a
country like the Philippines, where healthcare facilities may grapple with limited resources,
retaining experienced nursing staff is essential for providing consistent, high-quality care.
Understanding and implementing appropriate nurse-to- patient ratios is crucial for addressing
Page 29 of 41
nursing staffing issues in the Philippines promoting patient safety, satisfaction, and overall
healthcare quality.
Infection Control
The limited number of nurses were the most important problems. Hospitals with a bed
capacity of greater than 1000 beds had higher rates of Health care-associated Infection (HAIs).
Certified Infection prevention and Control (IPC) specialists, frequent feedback, and enough
nurses reduced HAIs. The most common HAIs were central line-associated bloodstream
infections. Most HAIs were caused by gram negative bacteria, which have a high Antimicrobial
Resistance (AMR) . Increasing nurses and reducing workload can prevent HAIs and AMR.
Nationwide “Antibiotic Stewardship Programme” should be initiated (Azak E., et al.,2023). The
implementation of this nurse practice guideline to reduce the incidence of phlebitis made a
clinically significant impact by reducing the incidence of phlebitis in patients receiving peripheral
intravenous infusions of amiodarone. (Crottrill K., 2022)
Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI
rates but did improve the frequency of cleaning, reduce MDRO environmental contamination,
and was associated with reduced incidence of new MDRO acquisitions and reduced mortality.
This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.
(Dadon M., et al., 2023) The main perceived mode of transmission was not maintaining
protection when working at a close distance and having intimate contact with infected cases.
Positive psychological intervention is necessary. The main factor affecting transmission was not
using protective equipment when working at a close distance and having intimate contact with
infected persons. Most staff experienced psychological stress or emotional changes during
their isolation period after diagnosis. Protective equipment should be upgraded in hospitals at
Page 30 of 41
the onset of a new disease especially for staff conducting procedures involving close contact
and caring for high risk patients. Also, learning from these lessons is expected to help the
Chinese government and other parts of the world to better respond to future unexpected
infectious disease outbreaks. (Jin Y., et al., 2020)
The researchers found that the factors associated with central line-associated
bloodstream infections (CLABSI) were higher Acute Physiology and Chronic Health Evaluation
II (APACHE II) scores, longer ICU stays, and longer durations of catheter insertion. The results
of the study suggest the need to avoid unnecessary catheterization and encourage timely
removal. (Kiyoshi M., et al., 2022) The results showed blood as the most common site of
infection, n=110 (79.7%) and eye and wound sites as the second leading n=30 (21.7%). The
most common blood sites could be associated with the use of central lines. Special attention
needs to be paid to the collection of blood specimens and aseptic techniques by healthcare
workers to minimize contamination. (Ndlovu B., 2021)
Nursing hours per patient day increased in both time periods. However, the differential
change in rate of nursing hours per patient day following implementation of the Directive was
not statistically significant. On average, we found a statistically significant decrease of 0.05 units
in the post-Directive central line-associated bloodstream infection rates associated with a unit
increase in nursing hours per patient day. (Van T., et al., 2020) The researchers findings
suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions
can be prevented through vigilant basic infection control measures, including wearing of surgical
masks, hand and environmental hygiene. (Wong S., et al., 2020) The study shows the
suggested improvements in the ergonomic design of delivery rooms, including convenient
availability of sinks, soap, hand gel, hand towels and gloves, may be a low-cost way to reduce
the infection burden from poor hand hygiene. (Kahabuka C.,et al., 2021)
Page 31 of 41
Synthesis of the Study
In this comprehensive synthesis of diverse healthcare studies, we delve into critical
aspects of infection control strategies, nurse-patient ratios, bedside practices, hospital-acquired
infections, and their influence on patient outcomes, drawing insights from investigations into
nurse shortages, preventive measures, and interventions to enhance high-quality patient care.
Nurses, who constitute the largest occupational group in hospitals, are responsible for
bedside patient care. Nonetheless, budget reductions over the last few years have meant a
decline in highly qualified nurses working with patients. In the Philippines, in particular,
measures like increasing patient-to-nurse ratios and replacing registered nurses with less
qualified aides have been taken. The nurse-to-patient ratio is an international issue. It's a safety
and quality issue for patients. Addressing staff problems is very important, and shows the
necessity for balanced nurse work environments. In the Philippines, where resource constraints
remain a major issue, maintaining adequate nurse-to-patient ratios is a key factor in ensuring
safety and positive outcomes for patients.
The global spread of COVID-19 has brought infection control procedures to the forefront
in hospitals. Studies on nurse-to-patient ratios and infection control during the pandemic make it
clear that effective interventions are key to combating HAIs. These infections pose a danger to
patient safety, leading to morbidity and mortality. They also create huge economic costs. This
research highlights the intricate connections between medical intervention, inflammation, and
bacterial activation, providing important information on which to base infection prevention
strategies. The study examines healthcare workers 'compliance and understanding of hand-
washing, with disinfectant usage following suggested infection control practices. Together, the
Page 32 of 41
findings form a basis for integrated approaches to risk control and prevention of nosocomial
infections. This enhances patient safety while improving healthcare quality at home.
Some studies point out important strategies for infection control in healthcare settings.
Another serious obstacle is the shortage of nurses, particularly in large hospitals with more than
a thousand beds. The greater number of people using these facilities translates into higher rates
of healthcare-associated infections (HAIs). The presence of certified Infection Prevention and
Control (IPC) specialists and adequate feedback on HAIs achieved an 80 % reduction in both
central line-associated bloodstream infections caused by gram-negative bacteria with high
antimicrobial resistance. The studies focus on the preventive role of strengthening nursing staff
and cutting workloads, calling for the launch nationwide Antibiotic Stewardship Programme.
One study showed that to decrease phlebitis in patients who are amiodarone through
peripheral intravenous infusions the use of nurse practice guidelines was clinically significant.
Still, another study recommended the practical measure of having cleansing wipes placed next
to each bed. Although it had no direct effect on HAI rates, increasing cleaning frequency
reduced environmental contamination and was associated with lower mortality as well as a
reduction in new multidrug-resistant organism (MDRO) acquisitions; thus its use is encouraged
especially for multi-patient rooms.
Protective measures are very important in close contact These studies indicate that
protective equipment should be renovated and improved upon at every hospital to prevent
nosocomial transmissions, especially with the outbreak of a new disease. Factors connected
with central line-associated bloodstream infections (CLABSI) were established, including the
need to avoid unnecessary catheterization and removal as early as possible. The most
Page 33 of 41
prevalent sites of infection, largely in blood, reflect the essential importance that aseptic
techniques be practiced conscientiously to protect against contamination.
Studies of bedside practices and patient satisfaction yield important insights into the
complex link between nursing workloads and quality care. Studies into the link between nurses
'work pressure and patient satisfaction point to positive changes in nursing as a way of
improving patients' experience. Applying the damage response paradigm to infection control
illustrates why human responses to microbial-borne illnesses are important, reiterating that
theory has its place in healthcare.
A nurse-based practice change intervention had indeed reduced CLABSI rates.
Therefore, the education and training of healthcare staff can not be neglected at any time. On
the subject of reducing catheter-related bloodstream infections (CRBSI) among outpatient
hemodialysis patients, articles stress that this is a particularly vulnerable patient group and
direct attention to evidence-based practices as well as infection control measures. Studies on
nurses 'perceptions of peripheral venous catheter care guidelines in pediatric wards further
enrich the existing studies and provide some insight into compliance with, as well as problems
faced by these documents in a specific clinical setting.
The findings of these studies together yield information on nurse-patient ratios, infection
control strategies, and bedside practices as well as their effects on patient outcomes. This
points to the necessity of evidence-based practice, lifelong education for care providers, and
comprehensive health measures to achieve better healthcare results.
Research Gap
There have been various aspects of nurse-patient ratio and infection control that have
been studied in the past, however, in addition, this research "A Correlational Study the Nurse-
Page 34 of 41
Patient Ratio and Infection Control Protocol In Rendering Bedside Practices." covers a number
of unexpected features that recently have drawn research interest in other disciplines. In the
previous research and literature, the researcher found few significant gaps. First is the impact of
budget reductions on nurse qualifications and subsequent effects on patient care emerge as
crucial research gaps, necessitating an exploration of the specific consequences of financial
constraints on the skills of nursing staff. Additionally, the international variation in nurse-to-
patient ratios is acknowledged as a global issue, prompting a call for research to delve into
specific country-wise comparisons and their implications on patient safety.
The Philippines' context introduces a unique research gap, with a focus on
understanding the challenges and outcomes associated with nurse shortages, increased
patient-to-nurse ratios, and the utilization of less qualified aides. The COVID-19 pandemic
underscores the importance of exploring integrated approaches that combine infection control
strategies, nurse staffing, and preventive measures to enhance patient safety during global
health crises.
Furthermore, investigating the impact of certified Infection Prevention and Control (IPC)
specialists and nationwide Antibiotic Stewardship Programmes on reducing Hospital-Acquired
Infections (HAIs) could offer valuable insights. Practical measures for infection control,
improvements in protective equipment, and the link between nursing workloads and patient
satisfaction present additional avenues for research. Examining the long-term effects of nurse-
based practice change interventions and understanding human responses to microbial-borne
illnesses contribute to the evolving landscape of evidence-based healthcare practices.
Addressing these research gaps promises a more nuanced understanding of healthcare
dynamics, infection control strategies, and their collective impact on patient outcomes, ultimately
advancing the quality of healthcare provision.

Page 35 of 41
CHAPTER III
RESEARCH METHODOLOGY
This chapter presents the descriptions of research methodology including research
design, research locale, respondents of the study, sampling design, research instrument, data-
gathering procedure, treatment of quantitative data, and ethical considerations.
Research Design
This study focuses on determining the infection rates among patients in different
hospitals with varying nurse patient ratios. The objective is to assess inadequate nurse staffing
and excessive workloads that have been associated with poor hand hygiene, inadequate
equipment cleaning, and improper utilization of personal protective equipment that may result in
infection in intravenous cannula insertion, wound infection, bacterial infection of urinary tract and
respiratory infection.
The researchers used a descriptive and survey approach in quantitative research. For
collection of data, the researchers used online and paper survey questionnaire methods. The
study will focus on nurses as primary respondents. Descriptive research, according to Siedlecki
(2020), can explore multiple variables and can look at the characteristics of a population;
identify problems that exist within a unit, an organization or a population; or look at the variation
in characteristics or practices between institutions or events.
Research Locale
The study will be conducted in selected hospitals in Laguna, including UniHealth
Southwoods Hospital and Medical Center, Healthserv Los Baños Medical Center, Ospital Ng
Page 36 of 41
Cabuyao, and San Pablo City District Hospital. The study will be conducted in these hospitals
due to their accessibility, as they are affiliated with the University of Cabuyao (PNC) Nursing
Department. Moreover, researchers chose these hospitals as they observed a high number of
patients during their related learning experience (RLE) duty in the general ward.
Participants of the Study
The study will focus on nurses as respondents. The main respondent of the study were
the ten (10) nurses from different hospitals that are assigned in the general ward. They differed
in profile– respondents such as (1.1) Age, (1.2) Sex, (1.3) Name of hospital, and (1.4) Years of
experience as a Nurse. The respondents are from UniHealth Southwoods Hospital and Medical
Center, Healthserv Los Baños Medical Center, Ospital Ng Cabuyao, and San Pablo City District
Hospital. The researchers wanted to find out from respondents what is the infection rate in
general ward in inadequate nurse staffing and excessive workloads that have been associated
with poor hand hygiene, inadequate equipment cleaning, and improper utilization of personal
protective equipment (PPE).
Sampling Design
The researchers will employ stratified random sampling in their sampling design. Under
this approach, respondents from each hospital will be randomly selected. Specifically, nurses
assigned to general wards in various hospitals will have an equal opportunity to be included in
the study. The researchers will develop a robust inferential and action plan to ensure the
collection of valid and reliable data.
In order to determine the exact sample size of the study, the researchers will be using
Slovin’s Formula. The formula used is:
Page 37 of 41
�
� =
1 + �� 2
Where:
N = Population
n = Sample
e = Margin of error (at 0.05 or 95% confidence interval)
Research Instrument
This study will use the following instrumentation to contribute distinct perspectives and
insights to evaluate the current tracking system comprehensively, gather employee feedback,
identify potential areas for improvement, and facilitate informed decision-making for the
proposed changes.
Surveys. These surveys are meticulously designed to collect comprehensive feedback from
employees. The aim is to understand their experiences and perceptions of the current infection
control protocol while rendering bedside practices. This instrument allows for a wide-reaching
assessment, gathering diverse opinions and insights from the employee base.
Questionnaires. Complementary to surveys, questionnaires provide a structured approach to
gathering specific information. They might focus on targeted aspects such as usability,
effectiveness, or any other key metrics relevant to the study—these help in obtaining
quantifiable data and specific responses from participants.
Face-to-Face Interviews. These interviews serve as a more personalized and in-depth
exploration of individual experiences and perspectives. They allow for a qualitative assessment,
Page 38 of 41
enabling researchers to delve deeper into the nuances of employee opinions, concerns, and
suggestions regarding this study.
Observation. This method involves direct observation of employees interacting with the general
ward. Observational data can provide insights into user behavior, patterns, and any challenges
faced during bedside practices. It helps identify practical issues that might need to be apparent
through other means.
Data Gathering Procedure
The researchers will use survey questionnaires to gather the desired data. The
researchers will ask permission from the university's Vice President for Academic Affairs,
college dean, research advisor, and instructor to facilitate the study "A Correlational Study on
the Nurse-Patient Ratio and Infection Control Protocol in Rendering Bed Side Practices in
Selected Hospitals in Laguna" and distribute the copies of questionnaires to the selected
hospitals in Laguna.
After obtaining approval, researchers will distribute questionnaires to the selected
hospitals in the general ward. Respondents will answer the respective questions based on their
knowledge using the questionnaires validated by the research panelists.
The researchers will ensure the confidentiality of the gathered data for the respondents.
Subsequently, they will interpret the results using various statistical tools after tabulating the
data.
Treatment of Data/Thematic Process
In analyzing the data that will be gathered, frequency count, percentage, range, mean,
Pearson’s Chi Square Test and Pearson’s correlation coefficient will be used.
Page 39 of 41
Percentage will be used to determine the percentage of the total observation falling under a
given category.
�
�= × 100
�
Where:
P = Sample Proportion
f = frequency of observation or value of the sample
n = sample size
Ethical Consideration
This study is committed to upholding ethical standards, prioritizing the confidentiality and
privacy of employees who choose to participate. All collected data will be handled with the
utmost sensitivity, and rigorous measures will be implemented to safeguard participant
information. Identifiers will be removed or anonymized to prevent any possibility of individual
identification. Secure data storage protocols, including encryption and restricted access, will be
employed to mitigate the risk of unauthorized access.
Informed consent is a foundational principle of this research. Participants will be
provided with comprehensive information about the study's purpose, procedures, potential risks,
and benefits. They will have the opportunity to ask questions and fully understand the
implications of their involvement. Importantly, participants will retain the unequivocal right to
withdraw from the study at any stage without facing any consequences. This commitment
ensures that participants can make decisions about their involvement freely and without
coercion.
Page 40 of 41
By incorporating these ethical considerations, this study seeks to not only contribute
valuable insights to the field but also to uphold the principles of respect, integrity, and protection
of participant rights.
Page 41 of 41

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Republic of the Philippines

A Correlational Study on the Nurse-Patient Ratio and Infection Control Protocol In

Rendering Bedside Practices in Selected Hospitals in Laguna

Fulfillment of the Requirements for NCM 111 – Nursing Research I

3BSN – B / Group No. 1

Abalos, Justine Mhekaela B.

Angustia, Alyanna Mae C.

THE PROBLEM AND ITS SETTING

Different studies provide significant evidence that establishes a strong correlation

patient education. (Tencic, M. et al., 2023)

control protocol in rendering bedside practices in selected hospitals in Laguna. Moreover,

management in order to prevent infection. Healthcare personnel are educated on infection

implementation of protocols. Consistent surveillance and monitoring of healthcare-associated

infections (HAIs) is in accordance with global benchmarks established by reputable

organizations such as the WHO. Hospitals emphasize response to epidemics by implementing

Hospital nurse-to-patient ratios are regulated by the Philippine Department of Health.

resource limitations. A sufficient number of nurses enhances patient outcomes. Advocacy

groups and nursing associations advocate for staffing policies.

With regard to patient-centered care, hospitals in the Philippines prioritize bedside

to-date information, please consult the Department of Health.

Department of Health for the latest information.

To enhance comprehension regarding the determinants impacting the standard of

patient care within a healthcare setting, investigators opted to undertake an investigation

varying ratios of nurses to patients.

Background of the Study

outcomes and infection control.

cardiology ward. (Alibudbud, R. (2023)

safety and healthcare management in the future.

The study will be based on Florence Nightingale's Environmental Theory, which

The relevance of Florence Nightingale's Environmental Theory to the research is evident,

Safety, and Nurse-Patient Ratio.

Infection Control: Nightingale's environmental theory emphasizes the significance of

infection control protocols.

Nurse-Patient Ratio: Nightingale's theory prompts attention to resource allocation, including

maintaining the ideal environmental conditions for infection control.

terms of infection control practices.

patients in their self-care efforts.

​ Research Paradigm/Operational Framework

INPUT: PROCESS: OUTPUT:

variables affecting the standard of patient care in a healthcare setting.

The researchers would like to seek the following questions:

1. What is the demographic profile of the respondents according to:

1.3 Name of Hospital

1.4 Years of experience as a Nurse

relation to rendering bedside care in terms of:

3.1 Quality of Care

3.2 Nursing Interventions

3.3 Patient Care Outcomes

patient ratio in relation to patient care in terms of:

4.1 Quality of Care

4.2 Nursing Interventions

4.3 Patient Care Outcomes

care given by the respondents?

the implementation of infection control protocols within selected hospitals in Laguna.

Scope and Limitations

control protocols in rendering bedside practices in selected hospitals in Laguna. Furthermore,

Nightingale and Orem’s Self-Care Deficit Theory.

bedside care practices.

​ Significance of the Study

enhanced healthcare practices, patient safety, and overall well-being:

favorable to improved health results.

levels, empowering institutions to make well-informed decisions regarding resource allocation,

Research Paradigm/Operational Framework

Significance of the Study