1. Final Research Sample

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CHAPTER 1

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale

University of Cebu College of Nursing is the seat of quality

education in nursing. The University upholds the standards as center of

excellence in nursing The school assured that the quality of nursing

practice is evidenced not only through academic performance but

more so in the related learning experience (RLE) both clinical and

community. Clinical experience has been the vital part of nursing

education. Clinical practice is the avenue for the students to utilize the

theories that they’ve learned in their discussion. It prepares student

nurses to be able of "doing" as well as "knowing" the clinical principles

in practice. The clinical practice stimulates students to use their

critical thinking skills for problem solving. It is where the student

nurses enhance their knowledge in nursing concepts and principles as

well as to develop and improve their skills and attitude towards

rendering quality of nursing services.

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The main objective of this study are the following: to investigate

the level of competence of the level IV student nurses of Cebu –

Banilad in their related learning experience at the different affiliating

hospitals, to determine if the affiliating hospitals are able to provide

positive learning environment, to identify factors that hinders the level

of competence of the student nurses in their related learning

experience and lastly to serve as an aid developing an effective clinical

learning strategy in learning education.

There are so many hospitals here in Cebu that the nursing

students of University of Cebu can affiliate, from district hospitals like

Mingalanilla District Hospital, Bogo, District Hospital, Danao, District

Hospital, Sogod District Hospital, Daanbantayan Distict Hospital,

Bantayan Island District Hospita and Carcar District Hospital to tertiary

hospitals like Chong Hua Hospital and Visayas Community Medical

Center. Every hospital has their own policy regarding the affiliation of

the students in their institution. There is a big difference on how the

student nurses perform their competencies in different hospitals. Like

for example, in some hospitals student nurses are not allowed to plot

the vital signs of their patients in the chart, but in other hospital it is

allowed. In other words, student nurses have limitations in terms of

performing their duty depending on which institution they will be

assigned. The researchers view this aspect as a problem because it is

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some kind of a hindrance to the learning of the student nurses in the

area. They won’t be able to practice the procedures effectively.

Theoretical Background

The study is anchored on Patricia Benner’s Dreyfus model of Skill

acquisition. This model posits that in the acquisition and development

of a skill, a student passes through five levels of proficiency: novice,

advanced beginner, competent, proficient, and expert. These different

levels reflect changes in three general aspects of skilled performance:

One is a movement from reliance on abstract principles to the use of

past concrete experience as paradigms; The second is a change in the

learner's perception of the demand situation, in which the situation is

seen less and less as a compilation of equally relevant bits, and more

and more as a complete whole in which only certain parts are relevant;

The third is a passage from detached observation to involved

performer. The performer no longer stands outside the situation but is

now engaged in the situation (Dreyfus, 2009).

The process of competence development is a lifelong series of

doing and reflecting. As competencies apply to careers as well as jobs,

lifelong competency development is linked with personal development

as a management concept. And it requires a special environment,

where the rules are necessary in order to introduce novices, but people

at a more advanced level of competence will systematically break the

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rules if the situations require it. This environment is synonymously

described using terms such as learning organization, knowledge

creation, self organizing and empowerment (Dreyfus, 2009).

Beginners have had no experience of the situations in which they

are expected to perform. Novices are taught rules to help them

perform. The rules are context-free and independent of specific cases;

hence the rules tend to be applied universally. The rule-governed

behavior typical of the novice is extremely limited and inflexible. As

such, novices have no "life experience" in the application of rules.

"Just tell me what I need to do and I'll do it."

Advanced beginners are those who can demonstrate marginally

acceptable performance, those who have coped with enough real

situations to note, or to have pointed out to them by a mentor, the

recurring meaningful situational components. These components

require prior experience in actual situations for recognition. Principles

to guide actions begin to be formulated. The principles are based on

experience.

Competence, typified by the nurse who has been on the job in

the same or similar situations two or three years, develops when the

nurse begins to see his or her actions in terms of long-range goals or

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plans of which he or she is consciously aware. For the competent

nurse, a plan establishes a perspective, and the plan is based on

considerable conscious, abstract, analytic contemplation of the

problem.

The conscious, deliberate planning that is characteristic of this

skill level helps achieve efficiency and organization. The competent

nurse lacks the speed and flexibility of the proficient nurse but does

have a feeling of mastery and the ability to cope with and manage the

many contingencies of clinical nursing. The competent person does not

yet have enough experience to recognize a situation in terms of an

overall picture or in terms of which aspects are most salient, most

important.

The proficient performer perceives situations as wholes

rather than in terms of chopped up parts or aspects, and

performance is guided by maxims. Proficient nurses understand

a situation as a whole because they perceive its meaning in

terms of long-term goals. The proficient nurse learns from

experience what typical events to expect in a given situation and

how plans need to be modified in response to these events. The

proficient nurse can now recognize when the expected normal

picture does not materialize. This holistic understanding

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improves the proficient nurse's decision making; it becomes less

labored because the nurse now has a perspective on which of

the many existing attributes and aspects in the present situation

are the important ones.

The proficient nurse uses maxims as guides which reflect

what would appear to the competent or novice performer as

unintelligible nuances of the situation; they can mean one thing

at one time and quite another thing later. Once one has a deep

understanding of the situation overall, however, the maxim

provides direction as to what must be taken into account.

Maxims reflect nuances of the situation.

The expert performer no longer relies on an analytic

principle (rule, guideline, and maxim) to connect her or his

understanding of the situation to an appropriate action. The

expert nurse, with an enormous background of experience, now

has an intuitive grasp of each situation and zeroes in on the

accurate region of the problem without wasteful consideration of

a large range of unfruitful, alternative diagnoses and solutions.

The expert operates from a deep understanding of the total

situation. The chess master, for instance, when asked why he or

she made a particularly masterful move, will just say: "Because it

felt right; it looked good." The performer is no longer aware of

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features and rules;' his/her performance becomes fluid and

flexible and highly proficient. This is not to say that the expert

never uses analytic tools.

Highly skilled analytic ability is necessary for those situations

with which the nurse has had no previous experience. Analytic tools

are also necessary for those times when the expert gets a wrong grasp

of the situation and then finds that events and behaviors are not

occurring as expected. When alternative perspectives are not available

to the clinician, the only way out of a wrong grasp of the problem is by

using analytic problem solving.

Patient information centers were strategically placed throughout

the hospital, and nurses were give access to computerized patient

records, policies and procedures, medication information, patient

education tools and reference materials. Supply areas were also

strategically placed so that the patient care items would be readily

available (Donahue, 2008).

Access to information in the clinical setting can be found mainly

in the clients chart, kardex, and care plan. The chart is a document

that provides evidence of care and the patient’s response. The chart

itself contains several forms which are important to the preparation

and administration of nursing care. Documentation should indicate

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that the nurse did the following, assessed the patient for risk factors

for injury, plan strategies to protect the patient from harm,

implemented strategies to protect the patient from complication, such

as falls or skin breakdown, notified the physician of critical changes in

the patients status, and clearly documented the circumstances of an

incident or unusual event. (Kozier, 2002).

The kardex card represents the “hub” for all patient activities.

Physician orders are transcribed on the card. Lab tests medication and

activity levels are just few items documented in designated areas of

the kardex. Care plan identifies the patient’s usual or potential

problems, expected outcomes, and nursing actions. A discharge

criterion is also an integral part of the care plan. Patients chart

includes nurse’s notes. Clinical observations and nursing interventions

are documented in nurse’s notes. Medication records, it is where all

patient’s medication are documented. Temperature, pulse, and

respiration are graphed on the graphic sheet. Blood pressure readings,

intake and output records are also recorded on this form. Physicians

order are the orders indicated for the patient. Physician’s progress

notes contain daily observations and thoughts regarding treatments,

signs and symptoms experienced by the patient, operative risk

explained to the patient, and the patient’s response to therapy. History

and physical is the physician’s report of his assessment, and the

laboratory forms, are laboratory results sent from the laboratory to the

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unit. This sheet provides a valuable review of all laboratory results

(Smith, 2000).

According to Bordalba(2006) in his study on common problems in

Relating Learning Experience as encountered by level IV Nursing

students in X University, “There are hospitals everywhere; manned by

our qualified nurses and staff. These hospitals served as the training

ground for these nursing students. These training areas are expected

to enhance the capabilities and learning for these aspiring nurses. A

strong foundation for theoretical and practical experience is the

strongest weapon the society can give to nursing aspirants to prepare

themselves in the battle field both inside and out of the country.

Preceptorship may be used o help recruit, retain, orient, and

develop staff. They maybe used before students graduate to orient

them to the agency and to recruit them for hire. If students have

worked at an agency before graduation and are familiar with it, they

can make sounder decisions about where to work, are not as likely to

be unprepared for the work situation, and, consequently, are likely to

be retained longer. The preceptorship also gives agency personnel an

opportunity to evaluate students and determine if they are suitable

candidates for employment. During preceptorship faculty facilitate,

monitor, and evaluate student learning. Faculty direct students to

resources, offer suggestion regarding patient care problems, and lead

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discussions at conferences. The faculty member is responsible for

student learning and encourages students to apply class content. The

preceptor is responsible for the quality of patient care and facilitates

the student’s learning.

Preceptors are liaisons between the students and the agency.

They help students learn skills and learn how to organize their work.

They provide real-life experiences for students before graduation to

help reduce the difficulties of transition from school to work. There are

also disadvantages to preceptorships. They add to staff nurse

responsibilities and require time. Sometimes busy nurses have little

time to spend with students. It becomes difficult for faculty to evaluate

students because they have little direct observation of students’ work.

The use of preceptors requires considerable planning and

coordination. Role descriptions should clarify who chooses learning

experiences for the students, who supervises the student, and who

evaluates the student. Practical evaluation tools of the student,

preceptor, and faculty should be developed and used Educational and

service administrative support is needed.

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Providing hands-on care gives the students access to the patient.

Such care constitutes a legitimate reason for the students to be there

and satisfies the goal of helping the patients in a concrete, visible way.

At the same time, providing hands-on care opens the students to

committing an error that may harm the patient in some way, and so

technical skill development carries with it a high degree of anxiety that

may interfere with learning. By joining with students in their focus on

technical skills at the beginning of the clinical experience, and helping

them to broaden their vision of nursing care from technical skill

performance to the more salient skills of assessing and responding to a

variety of patient needs, the instructor capitalized on student’s

readiness to learn and makes clinical learning meaningful (Reilly,

2006).

Nursing students need sufficient practical experience to develop

full range of skills they need for effective practice has become a focus

in nursing education. Clinical education is a vital component in the

curricula of pre-registration nursing courses and provides student

nurses with the opportunity to combine cognitive, psychomotor and

affective domains (Henderson, 2009)

In the clinical setting, planning and selection of clinical learning

activities tends to be instructor- made. Depending upon the amount of

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experience and sense of self-efficacy held by the instructor, the nature

of clinical learning may become more student-centered. In either case,

the teacher guides the students in applying theory to patient care

clinical learning is aimed at knowledge application, skill acquisition and

professional role development (n Bradshaw & Lowenstein, 2007). The

clinical setting is identified as any setting where students provide

nursing care to real patients. Care of the patients in real life situations

reinforces that critical thinking is contextual. Instructors need to

empower students to think critically. Students who feel a sense of

empowerment take responsibility for the process of problem solving

(Bradshaw & Lowenstein, 2007).

As stipulated in Related Learning Experience Packet Guide, all

students’ encounters with the patient are expected to be supervised

by the clinical instructor. Before a student is allowed to perform a

nursing procedure, he/she is to review and recall the steps of the

procedure in detail with his clinical instructor. This is to assure both the

student and the clinical instructor that the former is prepare3d for the

responsibility. The dry run will also help relieve the anxiety and

promote self-confidence on the student.

Students are required a minimum number of performances for

each and having complied such does not mean he/she may not

perform same procedure any longer. Students learned best by

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observing and assisting at procedures, and when appropriate, by

guided performance of the procedure (RLE Packet guide, 2008).

Rolfe (1995) suggests that facilitating reflection on the realities

of clinical life by nursing theorists will reduce the theory-practice gap.

The theory- practice gap is felt most acutely by student nurses. They

find themselves torn between the demands of their tutor and

practicing nurses in real clinical situations. They were faced with

different real clinical situations and are unable to generalize from what

they learnt in theory.

Students in professional education programs do respond

positively to opportunities to choose or structure some of their learning

experiences. These approach should be used frequently by the

teacher, to not only promote active learning but to instill in the

students a sense of empowerment, which is an important attribute for

the clinical setting. Technology- based learning activities direct the

students to engage in independent learning, research, and use visual

cues, such as video, to enhance comprehension (Bradshaw &

Lowenstein, 2007).

According to Tagapan (2006), in her study on Performances in

Theory and in Related learning Experience of Level II, UC-College of

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Nursing Student, “Performance in the clinical area is determined by the

level of preparation and achievement of the student in the skills

laboratory and that evaluation helps determine from day to day what

the students know and what they do not know, which skills have and

which need more work.”

Factors affecting perception in the nurse-client relationship are

the capacity for attention (reception of sensation) by both the nurse

and the client, the perspective each brings to the relationship, and the

physical condition of the receptors. Anxiety (the actual or anticipated

negative appraisal by the other) in the nurse or the client limits the

ability to be attentive in the communication process, interferes with

the validation of individual perspectives, and decreases physical

capacities. Validated perceptions between nurse and client essential

to goal setting and achievement the nurse must constantly of

communication regardless its form (Hood, 2006).

Age is another factor that influences our perceptions. The older

a person get, the richer their perspective foe perceiving life and

people. Thus, compared with a person of 20 a 60 years-old has more

complex fund of experiences to draw on in perceiving situations to

people. As a person grow older and have more experiences, their

perspective or many things changes (Wood 2002).

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Women and men, as social groups have different stand points,

although not every individual man and woman shares the standpoint

typical for his or her sex, instance, the care giving we generally

associate with women results less from any maternal instinct than from

the social role of mother, which teaches women to care for others,

notice who needs what, and defer their own needs (Wood, 2000).

Factors affecting perception in the nurse-client relationship are

the capacity for attention (reception of sensation) by both the nurse

and the client, the perspective each brings to the relationship, and the

physical condition of the receptors. Anxiety (the actual or anticipated

negative appraisal by the other) in the nurse or the client limits the

ability to be attentive in the communication process, interferes with

the validation of individual perspectives, and decreases physical

capacities. Validated perceptions between nurse and client essential

to goal setting and achievement the nurse must constantly of

communication regardless its form (Hood, 2006).

Self-efficacy is a belief in one’s abilities to engage in courses of

action that will lead to desired outcome. These individuals with high

self-efficacy tend to be confident and self-assured and feel they are

likely to be successful in whatever endeavors they undertake (Mc

Shane of Von Glinow, 2002). Self-efficacy results from undertaking

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challenging realistic task and succeeding. According to Felson(1984),

“students who experience academic success develop higher appraisals

more. To do one’s best and achieve is to feel more confident and

empowered. (Myers, 2000).

According to Bandura (1986), “Self-efficacy mechanism plays a

central role in human agency.” Self-judgement of operative capabilities

function as one set proximal determinants of how people behave, their

thoughts patterns, and the emotional reactions they experience in

taxing situations. In their daily lives, people continuously have to make

decisions about what courses of action to pursue and how long to

continue those they have undertaken. People’s judgement of their

capabilities additionally influences whether their thought patterns are

self-hindering or self-enhancing, and how much stress they experience

during anticipatory and actual transaction with the environment.

(Bandura, 2009).

The theory of self-efficacy proposes behavior change occurs

because expectations or expected results of the new behavior and

one’s belief about his or her ability to perform a specific behavior in a

specific situation. There are four sources form which a person’s degree

of self-efficacy arises: performance accomplishment, vicarious

experience, verbal persuasion and physiological state. Performance

accomplishment refers to learning that occurs through personal

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mastery of a particular skill or task. Accomplishments attained through

personal mastery are the most powerful source of efficacy

expectations. The most important determinant of behavior change is

when people learn (master) a new behavior by doing it (De Young,

2003).

People also increase their belief in their own ability to perform a

specific behavior when they watch someone else perform the behavior.

This is vicarious experience or learning through observation. It enables

people to learn by watching, through demonstration. Verbal persuasion

involves acting as the coach and providing encouragement. Patients

may need to be prompted to continue trying to master the targeted

behavior (De Young, 2003). Physiological states, on the other hand

include how a person judge their capableness, strength and

vulnerability (Bandura, 2009).

Acting on one’s self-efficacy judgements brings success or

missteps requiring further self- reappraisals of operative competencies.

Thus, in their daily transactions, people act on their thoughts and later

analyze how well their thoughts have served them in managing events.

It is the one and the same person who is doing and thinking and later

evaluating the adequacy of one’s knowledge, thinking skills, and action

strategies (Bandura, 2009).

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A firm sense of self –efficacy is an important contributor to the

attainment of further competencies and success. According to Sanna

(1990) “high self-efficacy heightens the person’s motivation and

persistence and thereby increases performance. In contrast low self

efficacy lowers motivation and persistence, thereby impairing

performance (Baron and Kerr, 2003).

Perceived competence is concerned with judgment of personal

capabilities. Self-beliefs of efficacy affect action through several

interviewing processes. People’s self-beliefs of efficacy determine how

much effort they will exert in an endeavor and how long they will

persevere in the face of obstacles. The stronger the belief in their

capabilities the greater and more persistent are their efforts. When

faced with difficulties people who have self-doubts about their

capabilities about their attempts prematurely and settle for mediocre

solutions, whereas those who have a strong belief in their capabilities

exert greater effort to master the perception of one's own competence

is critical to individual functioning throughout life challenge. (Sternberg

and Kolligian, 2000).

With self-efficacy and perceived competence person's behavior

also plays a role in empowerment. According to social cognitive theory,

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human behavior is the result of an interaction among the person

(characteristics and personality), the environment (physical and social)

and behavior itself. In this theory, the interaction between the person

and behavior involves the influences of a person's thoughts and

actions. The interaction between the person and the environment

involves human beliefs and cognitive competences that are developed

and modified by social influences and structures within the

environment. And another interaction, between the environment and

behavior, involves a person's behavior in determining the aspects of

their environment and in turn their behavior is modified by that

environment. (Jones, 2003).

A change in one of those factors changes all of them, a

phenomenon called reciprocal determinism. Behavior, Personal factors

and Environmental influences all operate as interacting determinants

that influences each other (De Young, 2003). The Personal Behavior

segment reflects the interaction between thought, affect and action.

Expectations, beliefs, self-perceptions, goals and intentions give shape

and direction to behavior. What people think, believe and feel affects

how they behave. The natural and extrinsic effects of their actions, in

turn, determine their thought patterns and emotional reactions. The

personal factor also encompasses the biological properties of the

individual. Physical structure and sensory and neural systems affect

behavior and impose constraints on capabilities. Sensory and neutral

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systems and brain structure are in turn, modifiable by behavioral

experiences (Bandura, 2009).

The environmental – Personal segment is concerned with the

interactive relation between personal characteristics and

environmental influences. Human expectations, beliefs, emotional

bents and cognitive competencies are developed and modified by

social influences that may convey information and activate emotional

reactions through modeling instruction and social persuasion According

to Lerner (1982), “ People evoke different reactions from their social

environment by their physical characteristics, such as their age, size,

race, sex and physical attractiveness. “ People similarly activate

different social reactions depending on their socially conferred roles

and status (Bandura, 2009).

The behavior - environmental segment represents the two-way

influences between behavior and the environment. In the transactions

of everyday life, behavior alters environmental condition and is, in

turn, altered by the very conditions it creates (Bandura, 2009).

Environment defers to the factors that can affect a person’s

behavior. There are social and physical environments; social

environment includes family members, friends and colleagues. Physical

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environment is the size of the room, the availability of imperative, or

the availability of certain foods. Environment as well as situation

provides a framework for understanding behavior (Jones, 2003).

Most aspects of environment do not operate as an influence

students until they are activated by appropriate behavior. Lectures do

not influence students until they attend their classes. Hot stove tops do

not burn unless they are touched and parents usually do not praise

their children unless they do something praiseworthy. The aspect of

potential environment that becomes actual environment for given

individuals thus depends on how they behave. Because of bi-

directionality of influence between behavior and environmental

circumstances, people are both products and producers of their

environment. They affect the nature of their experienced environment

through selection and creation of situations. People tend to select

activities and associates from the vast range of possibilities in terms of

their acquired preferences and competencies. Behavior determines

which of the many potential environmental influences will come into

play and what forms they will take (Bandura, 2009).

Environment influences, in turn, partly determine which form of

behavior are developed and activated. Student learning environment

consists of all the conditions and forces within educational settings that

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impact learning. Shuell (1989) visualized the student-learning

environment as rich psychological soup comprised of cognitive, social,

cultural, affective, emotional, motivational and curricular factors in

which teachers and students work together toward learning. Student-

learning at the primary and secondary educational levels generally

takes place in the traditional classroom environment. In contrast, at

the secondary level, students experience an increasing number of

applied learning environments, of which clinical nursing education

experience is a prime example. Clinical components of nursing

education are critical to the over-all curriculum, as they allow learners

to apply knowledge to practice, to develop problem-solving and

decision making skills and to practice responsibilities for their own

action (Kari, 2000).

Students are so focused on the immediate requirements of the

skills they are to perform that they loss sight of the reason the

procedure is needed and what should be the result at its completion.

Visualizing the end-product of the procedure, it should enable the

student to see the skill as a whole rather than as a sequence of steps

to be performed. This awareness of the whole task moves the students

forward the visualized end and results in a smoothes performance

(Reilly, 2006).

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There are certain factors that influence what and how a person

perceives. One reason perception vary among people is that they

differ in their sensory abilities. The five senses are not the same for all

of us. Person’s physiological states also influence perception. If a

person is tired or stressed, then likely perceive things more negatively

than they normally would (Wood 2002).

In the clinical environment, nursing students were given the

opportunity to apply the theories they learned from the classroom

environment. The related learning experience competencies they have

to comply are based on different nursing theories (Delaune& Ladner,

2006). Virginia Henderson, together with Bertha Harmer attempted to

identify those basic human needs viewed as the basis of nursing care.

These needs included the need to maintain the physiologic balance to

adjust to the environment, to communicate and participate in social

interaction and worship according to one’s faith (Henderson, 2009).

Capinpuyan (2007), in her study on Anxiety Level and Related

Learning Experience Performance of the Student Affiliates of University

of Cebu, stated that, “it is highly recommended that staff nurses will

provide support and assistance to young student nurses. That nursing

affiliates should be given proper orientation prior to every clinical

exposure and given enough opportunity to learn the concepts in the

classroom and skills laboratory.

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THE PROBLEM

Statement of the Problem

This study is conducted to determine the empowerment of student

nurses in the performance of Related Learning Experience.

Specifically, this study aims to answer the following questions:

1. What is the profile of the respondent’s:

1.1. Age; and

1.2. Gender.

2. What are the factors that can affect the level o empowerment of

student nurses in the Related Learning Exposure in Affiliated

Hospitals in terms of:

2.1. access to information;

2.2. resources;

2.3. support; and

2.4. opportunity to learn and develop.

3. Is there a significant relationship between the level of

empowerment and the affiliated hospital?

4. What action plan may be proposed for the study to empower

Level IV nursing students in Related Learning Exposure in

affiliated hospitals.

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Statement of Null Hypothesis

There is no significant relationship between the level of

empowerment and the affiliated hospitals.

Significance of the Study

This study will benefit the following entities:

Administration. The result of the study will provide the

baseline data that will serve as the basis for organizing plans and

activities and promote a better working learning environment

that can enrich empowerment of Level IV nursing students in the

RLE in Affiliated Hospitals. In addition, the proposed action plans

of this study may help the administration to create an

environment that will favor good performance among student

nurses. This in turn, will contribute to the provision of a higher

quality education.

Clinical Instructors. This study will identify personal

strengths and weaknesses therefore it can effectively propose an

action plan that will promote an environment that gives them

wider opportunities. Furthermore, they can perceive their roles

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as instrumental in giving quality education to students and

become good role models to the student nurse.

Staff Nurse. As one of the mentors, staff nurse should be

able to establish a good rapport among nursing students so that

they will feel comfortable working their experiences and

problems to the students so that they can work it out how such

problems can be resolved.

Students. Students are recipients of services provided by

clinical instructors. Being role models to students, they must set

good examples from which students will be basing their future

actions and practices.

Patients. This study will benefit the patients because

healthcare can be improved by better performance shown by

nurses due by hospital administrators based on identified

problems. In this way, the patient’s right receives better service

because the healthcare team has already understood each

others limitations experiencing with regards to the students.

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Future Researchers. This study will serve as guide for

future researchers in their quest for in depth information and

valuable data in studies that focus on the different variables that

result in Empowerment of Level IV nursing student in

performance of the RLE competencies in affiliated hospitals.

Through this work, future researchers can implement techniques

that can implement techniques that can empower level IV

nursing students.

Research Methodology

This chapter presents the research design, the research

environment, the research instrument, the data gathering procedure

and the statistical treatment. The researcher utilizes the descriptive

method of research in which questionnaires will be used to collect data

to determine variables that affect empowerment of level IV nursing

students in the RLE.

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INPUT PROCESS OUTPUT

Figure 1. Research Flow

Research Respondents

The respondents of our study are the Level IV student nurses who

are officially enrolled at the University of Cebu Banilad which are

randomly selected.

In getting the total number of respondents of our study, we utilize

the Sloven’s Formula which is N/N +N (e)² and the result is 399: where:

N = total population of level IV nursing students

Profiles of the respondents. The following factors affect theEmpowerment of BSN Level IV in terms of access to information; resources; support; and opportunity to learn and develop.

A non experimental design is used in the study. University of Cebu-Banilad is the research environment.Questionnaires are used to collect data on level IV nursing students in UC-Banilad.Data GatheringData ProcessingAnalysis and Interpretation

Proposed Action Plan

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= 1,170

e = the margin of error

= 5%

Solution:

Nn = 1+Ne2

= 1170

1+1170 (.05)²

= 399

Research Environment

The research study will conducted at University of Cebu-Banilad

campus, located at North Rosd, Barangay Banilad, Cebu City, across

Gaisano Country Mall, beside North Gate on its right side.

It is well-facilitated nine storey building, which have different

courses. The ground composes of the accounting office, cashier, clinic,

chapel, guidance office and canteen. The mezzanine composes of

CESDEV office, Bob Lim's Photoshop, faculty of the allied teachers, ESL

office and the function room. Second floor compose of the rooms 201-

226. Third floor compose of the library and the rooms 313-326. Fourth

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floor compose of the NSBO's office, and the faculty of general

education teachers. The fifth floor is where you can find the Dean's

office, faculty of second year, third year, and fourth year clinical

instructor. You can also see the HRM department in there. Sixth floor is

where you can find the rooms 601-626. In seventh floor, you can find

the two skills laboratory, the canteen and the rooms 701-726. In eight

floor, you can see the AVR 1 and 2 and rooms 801-803. In ninth floor,

you can see the Laboratories.

Research Instrument

The researcher will be using a researcher made questionnaire.

The questionnaire consists 5 pages with three parts. The first page is

the letter to respondents; second page contains the part I which is the

profile of the respondents as well as the part II which is the area where

the respondents were mostly exposed in his/her related learning

experience. The third and last pages contain the part III which are the

instructions on how the students will answer and the questions to be

answered by the level IV nursing students. Respondents are also

encouraged to give any suggestion on what they think is important to

empower their Related Learning Experience in affiliated hospitals.

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The researchers used Likert scale of 1-4 as their choices, 4

means always, 3 most often, 2 seldom, and 1 never. In this manner,

the researcher will be able to obtain sufficient answer-basing on the

parameters given.

The researcher also conducted series of interviews to know the

side of each student about their outwork on the problem and as well as

to support the answer of the respondents.

Research Procedure

Data Gathering. The researcher started the study by making

proposed problems that the researchers saw with great importance to

determine the empowerment of the student’s nurses in the

performance of RLE competencies in affiliated hospitals. The proposed

problem was then submitted to one of our research instructor and was

then given to our research adviser for the selection of (5) possible

problems that is to be submitted to the Level IV Chairman, Ms. Ma

Estella P. Cabatana for the preliminary approval and was then

submitted to our Dean Dr. Helen C. Estrella for the final approval. After

which, a letter of request or transmittal letter was addressed to the

Level IV chairman of the College of Nursing in the University of Cebu,

asking for permission to allow the researchers to conduct a study

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pertaining to their different perceptions about empowerment of the

student nurses in the performance of RLE competencies in affiliated

hospitals.

After approval and obtaining the complete list of level IV student

population, a Simple Random Sampling was utilized by the researchers

for getting the sample wherein a researcher made a questionnaire,

was formulated and subjected for corrections from the experts. The

researchers located the respondents through the set of activity

schedules in the school for their lecture given by the Level IV chairman

of each level for the RLE rotation. The members of the research team

then distributed questionnaires at the school for the collection of data.

After which, the research team were gathered to collate and tally the

gathered data. It was then interpreted with the use of statistical tools,

tabulated, analyzed and conclusion was drawn based from the result

taken.

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DEFINITION OF TERMS

For better and clearer understanding of the study, some of the

terms are operationally defined:

Empowerment – is the opportunity of Level IV students to apply

theory into practice through Related Learning Experience in the


Related Learning Experience – is the experience of the Level

IV student nurses who are officially enrolled at the university of

Cebu Banilad; as they are expose to the affiliated hospital.

Level IV nursing students – are the fourth year nursing

students of University of Cebu Banilad who are officially enrolled

and who performs Related Learning Experience competencies in

the affiliated hospital and were chooses as the respondents of the

study.

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Affiliated Hospitals – either tertiary or secondary hospital

where level IV nursing students who are officially enrolled at the

University of Cebu Banilad are given the chance to apply theory or

skills that they have learned in the classroom and laboratory

settings.

CHAPTER 2

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

In this chapter, data are analyzed and presented to answer the

specific factors that can affect the empowerment of student nurses in

the related learning experience. In line with these factors, the following

topics are looked into:

AGE RANGE:

AGE RANGE NO. OF RESPONDENTS28 - 32 223 – 27 1018 – 22 388

TABLE I. Number of respondents according to their age range.

Table I shows that 388 out of 400 level IV student nurses of X –

university who answered the questionnaire fall under the age range of

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18 – 22, 10 fall under the age range of 23 – 27 and only 2 respondents

fall under the age range of 28 – 32.

GENDER:

GENDER NO. OF RESPONDENTS

MALE 122

FEMALE 278

Table II. Number of respondents according to their gender

Table II shows that 278 out of 400 respondents are female, and

only 122 are male.

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AFFILIATED HOSPITALS: Chong Hua Hospitals

ACCESS TO INFORMATION:

4 3 2 1 INTERPRETATION

1. I am given the chance to have access on my patient records so that I can provide better nursing care.

195 Most of the respondents were often given the chance to have access on patient’s records.

2. I am permitted to get information from my patient through interview.

224 Most of the respondents were always permitted to get information from their patient through interview.

3. I am allowed to perform physical

assessment to my patient.

188 Most of the respondents were always allowed to perform physical assessment to their patient.

4. I am free to scan the physician’s report of his assessment, and the laboratory forms of my patient.

192 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.

5. Facilities and equipments are readily available for

156 Most of the respondents answer that the facilities and

37

students use. equipments were often available for students use.

6. Supply areas were strategically placed so that the patient care items would be readily available.

212 Most of the respondents answer that the supply areas were always strategically placed so that the patient care items would be readily available.

7. Facilities and equipments are adequate in number for students use

160 Most of the respondents answer that the facilities and equipments were always adequate in number for them to use.

8. Facilities and equipments are properly maintained to guarantee service outcomes.

212 Most of the respondents answer that the facilities and equipments were always properly maintained to guarantee service outcomes.

9. Facilities and equipments are functional for better patient care.

208 Most of the respondents answer that the facilities and equipments were always functional for better patient care.

10.Facilities and equipments are labeled accordingly to increase students productivity.

156 Most of the respondents answer that the facilities and equipments were always labeled accordingly to increase student’s productivity.

11.My clinical instructor guides me in applying theory to patient care.

183 Most of the respondents were often guided by their clinical instructor in applying theory to patient care.

38

12.My clinical instructor empower me to

think critically in doing tasks.

192 Most of the respondents were always empowered by their clinical instructor in thinking critically in doing tasks.

13.My clinical instructor allows me to perform dry run prior to performing special procedures so as to relieve anxiety.

179 Most of the respondents were often allowed by their clinical instructor in performing dry run prior to perform special procedures so as to relieve anxiety.

14.The staff orients me not only to the physical set-up but as well as the routine activities of the agency.

153 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency.

15.The staff ensures quality of my patient care and facilitates my learning.

165 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.

16.The staff provides me real-life experiences to help reduce the

difficulties of transition from school to work.

136 Most of the respondents were provided always a real-life experience to help reduce the difficulties of transaction from school to work by the staff.

17.I am permitted to make decisions about what courses of action to pursue with regards to patient care.

135 Most of the respondents were often permitted to make decisions about what courses of action to pursue with regards to patient

39

case.18.I am allowed to observe nursing procedures in the area.

208 Most of the respondents were always allowed to observe nursing procedures in the area.

19.I am allowed to perform nursing procedures that I’ve learned in the school to the area.

186 Most of the respondents were always allowed to perform nursing procedures that they’ve learned in the school to the area.

20.I am competent in doing the nursing procedures in the clinical areas.

210 Most of the respondents were often competent in doing nursing procedures in the clinical areas.

40

AFFILIATED HOSPITALS: VCMC




276 183 4 0 Most of the respondents were always given the chance to have access on patient’s records.


332 141 4 0 Most of the respondents were always permitted to get information from their patient through interview.

3. I am allowed to perform physical assessment to my patient.

268 165 20 0 Most of the respondents were always allowed to perform physical assessment to their patient.


284 150 22 0 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.

5. Facilities and equipments are readily available for students use.

125 216 54 1 Most of the respondents answer that the facilities and equipments were often available for students use.

6. Supply areas were strategically placed so that the patient care

108 252 40 1 Most of the respondents answer that the supply areas

41

items would be readily available.

were often strategically placed so that the patient care items would be readily available.

7. Facilities and equipments are

adequate in number for students use

72 249 56 3 Most of the respondents answered that the facilities and equipments were often adequate in number for students use.


properly maintainedto guaranteeservice outcomes.

140 213 50 1 Most of the respondents answer that the facilities and equipments were often properly maintained to guarantee service outcomes.


functional for betterpatient care.

136 234 36 2 Most of the respondents answer that the facilities and equipments were often functional for better patient care.

10.Facilities and equipments are labeled accordingly to increase students productivity.

136 210 54 1 Most of the respondents answer that the facilities and equipments were often labeled accordingly to increase student’s productivity.

11.My clinical instructor guides me in applying theory to patient care.

216 195 24 1 Most of the respondents were always guided by their clinical instructor in applying theory to patient care.

12.My clinical instructor empowers me to think critically in doing tasks.

188 207 30 1 Most of the respondents were often empowered by their clinical

42

instructor in thinking critically in doing tasks.

13.My clinical instructor allows me to perform dry run prior to performing

special procedures so as to relieve anxiety.

156 195 46 5 Most of the respondents were often allowed by their clinical instructors in performing dry run prior to perform special procedures so as to relieve anxiety.

14. The staff orients me not only to the

physical set-up but as well as the routine activities of the agency.

128 156 82 7 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency..

15.The staff ensures quality of my

patient care and facilitates my learning.

104 195 76 3 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.

16.The staff provides me real-life experiences to help reduce the

difficulties of transition from school to work.

108 192 70 6 Most of the respondents were provided often a real-life experience to help reduce the difficulties of transaction from school to work by the staff.

17.I am permitted to make decisions

about what courses of action to pursue with regards to patient care.

104 216 54 7 Most of the respondents were often permitted to make decisions about what courses of action to pursue with regards to patient case.

18.I am allowed to observe nursing procedures in the

264 174 14 1 Most of the respondents were always allowed to

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area. observe nursing procedures in the area.

19.I am allowed to perform nursing procedures that I’ve learned in the school to the area.

248 165 30 0 Most of the respondents were always allowed to perform nursing procedures that they’ve learned in the school to the area.

20.I am competent in doing the nursing procedures in the clinical areas.

200 219 18 0 Most of the respondents were often competent in doing nursing procedures in the clinical areas.

AFFILIATED HOSPITALS: District Hospitals

44




430 147 6 0 Most of the respondents were always given the chance to have access on patients records.


492 93 6 1 Most of the respondents were always permitted to get information from their patient through interview.

3. I am allowed to perform physical assessment to my patient.

416 123 24 1 Most of the respondents were always allowed to perform physical assessment to their patient.


400 144 20 0 Most of the respondents were always free to scan the physician report of his assessment and the laboratory forms of my patient.

5. Facilities and equipments are readily available for students use.

136 183 120 3 Most of the respondents answer that the facilities and equipments were often available for students use.

6. Supply areas were strategically placed so that the patient care items would be readily available.

120 231 102 0 Most of the respondents answer that the supply areas were often strategically placed so that the patient care items would be readily available.


adequate in number

68$$ 180 154 4 Most of the respondents answered that the

45

for students use facilities and equipments were often adequate in number for students use.

8. Facilities and equipments are properly maintained to guarantee

service outcomes.

112 189 130 2 Most of the respondents answer that the facilities and equipments were often properly maintained to guarantee service outcomes.


functional for better patient care.

112 225 108 1 Most of the respondents answer that the facilities and equipments were oftenly functional for better patient care.

10.Facilities and equipments are labeled accordingly to increase students

productivity.

92 222 114 4 Most of the respondents answer that the facilities and equipments were often labeled accordingly to increase student’s productivity.

11.My clinical instructor guides me in

applying theory to patient care.

264 228 30 1 Most of the respondents were always guided by their clinical instructor in applying theory to patient care.

12. My clinical instructor empower me to

think critically in doing tasks.

268 26 26 1 Most of the respondents were always empowered by their clinical instructor in thinking critically in doing tasks.

13. My clinical instructor allows me to perform dry run prior to performing special procedures so as to

216 171 90 2 Most of the respondents were always allowed by their clinical instructor in

46

relieve anxiety. performing dry run prior to perform special procedures so as to relieve anxiety.

14.The staff orients me not only to the

physical set-up but as well as the routine activities of the agency.

136 195 108 5 Most of the respondents were often oriented by the staff not only to the physical set up but as well as the routine activities of the agency..

15.The staff ensures quality of my

patient care and facilitates my learning.

148 189 100 5 Most of the respondents were often ensured by the staff the quality of patient care and facilitates my learning.

16.The staff provides me real-life experiences to help reduce the difficulties of transition from school to work.

156 195 94 7 Most of the respondents were provided often a real-life experience to help reduce the difficulties of transaction from school to work by the staff.

17.I am permitted to make decisions

about what courses of action to pursue with regards to patient care.

132 222 100 1 Most of the respondents were always permitted to make decisions about what courses of action to pursue with regards to patient case.

18.I am allowed to observe nursing procedures in the area.

384 159 18 0 Most of the respondents were always allowed to observe nursing procedures in the area.

19.I am allowed to perform nursing procedures that I’ve learned in the

360 171 20 1 Most of the respondents were always allowed to perform nursing

47

school to the area. procedures that they’ve learned in the school to the area.

20. I am competent in doing the nursing procedures in the clinical areas.

252 252 22 0 Most of the respondents were always competent in doing nursing procedures in the clinical areas.

FACTORS AFFECTING EMPOWERMENT IN THE AFFLIATED

HOSPITALS

AFFILIATED HOSPITALS

ACCESS TO INFORMATION

RESOURCES

SUPPORT OPPORTUNITY TO LEARN

CHONG HUA HOSPITALS

3.28 3.15 3.01 3.09

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VCMC 3.5 3.01 3.02 3.26

DISTRICT HOPITALS

3.7 2.65 3.02 3.31

Table IV. Weighted mean of factors affecting empowerment in Affiliated Hospitals

Respondents who are mostly exposed to District Hospitals has a

weighted mean of 3.7 which means that students were more

empowered in terms of access to information compared to VCMC which

has 3.5 weighted mean and Chong Hua Hospitals which has 3.28

weighted mean.

Respondents who are mostly exposed to Chong Hua Hospitals

has weighted mean of 3.15 which means that the students were more

empowered in terms of resources compared to VCMC which has3.01

and District Hospitals which has 2.65 weighted mean.

Respondents who are mostly exposed to VCMC and District

Hospitals has a weighted mean of 3.02 which means that the students

were more empowered in terms of support compared to Chong Hua

Hospitals which has only 3.01 weighted mean.

Respondents who are mostly exposed to District Hospitals have a

weighted mean of 3.31 which means that the students were more

empowered in terms of opportunity to learn and develop compared to

VCMC with a weighted mean of 3.26 and Chong Hua Hospital has

weighted mean of 3.09.

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CHAPTER 3

SUMMARY

This study is conducted to determine the empowerment of

student nurses in the performance of Related Learning Experience.

Specifically, this study aims to answer the following questions:

50

3. What is the profile of the respondent’s:

1.3. Age; and

1.4. Gender.

4. What are the factors that can affect the level o empowerment of

student nurses in the Related Learning Exposure in Affiliated

Hospitals in terms of:

2.1. access to information;

2.2. resources;

2.3. support; and

2.4. opportunity to learn and develop.

3. Is there a significant relationship between the level of

empowerment and the affiliated hospital?

4. What action plan may be proposed for the study to empower

Level IV nursing students in Related Learning Exposure in


The respondents of our study are the Level IV student nurses who

are officially enrolled at the University of Cebu Banilad which are

randomly selected and n getting the total number of respondents of

our study, we utilize the Sloven’s Formula.

51

FINDINGS

Table I shows that 388 out of 400 level IV student nurses of X –

university who answered the questionnaire fall under the age range of

18 – 22, 10 fall under the age range of 23 – 27 and only 2 respondents

fall under the age range of 28 – 32

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Table II shows that 278 out of 400 respondents are female, and

only 122 are male.

Table IV shows the Weighted mean of factors affecting

empowerment in Affiliated Hospitals where Respondents who are

mostly exposed to District Hospitals has a weighted mean of 3.7 which

means that students were more empowered in terms of access to

information compared to VCMC which has 3.5 weighted mean and

Chong Hua Hospitals which has 3.28 weighted mean.

Respondents who are mostly exposed to Chong Hua Hospitals

has weighted mean of 3.15 which means that the students were more

empowered in terms of resources compared to VCMC which has3.01

and District Hospitals which has 2.65 weighted mean.

Respondents who are mostly exposed to VCMC and District

Hospitals has a weighted mean of 3.02 which means that the students

were more empowered in terms of support compared to Chong Hua

Hospitals which has only 3.01 weighted mean.

Respondents who are mostly exposed to District Hospitals have a

weighted mean of 3.31 which means that the students were more

empowered in terms of opportunity to learn and develop compared to

VCMC with a weighted mean of 3.26 and Chong Hua Hospital has

weighted mean of 3.09.

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CONCLUSION

Based on the finding of the study the researchers came up with

the following conclusions:

Out of 400 respondents 388 of respondents fall under the age

range of 18 – 22 and 277 of the respondents are females.

And showed that of the affiliated hospital where the respondents

are most exposed to, they are empowered in terms of access to

information at District Hospital, in terms of resources at Chong Hua

54

Hospital, in terms of support at Visayas Community Medical Center as

well as District Hospital, and in terms of opportunity to learn and

develop at District Hospital.

RECOMMENDATIONS

1. Final Research Sample

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