Nursing Care Modalities Employed in Selected Hospitals in ...

Asia Pacific Journal of Allied Health Sciences, Vol. 2, 2019

34 ISSN 2704-3568

Nursing Care Modalities Employed in Selected

Hospitals in Batangas Province, Philippines

Karen Shiela Ann D. Quesea, Bella P. Magnaye

College of Nursing, Lyceum of the Philippines University,

Batangas City, Philippines

Abstract –A care modality is a method of organizing and

delivering nursing care in a hospital setting in order to achieve

desired patient outcomes. The study intended to identify nursing

care modalities employed in selected hospitals in Batangas to

assess the functional and primary nursing care in terms of

effectiveness and efficiency; competency based on eleven key

areas of nursing responsibilities; and management in the

delivery of care in order to improve and or redesign the

workloads and management in hospitals so that the tasks can be

accomplished with fewer nurses yet still more effectively and

efficiently. This study used the descriptive research design to

compare Primary and Functional Nursing Care in general ward.

The population for this study consisted of 100% total

respondents, 59 registered nurses who were employed in

Hospital A (functional nursing modality) and 45 registered

nurses in Hospital B (primary nursing care modality) working

particularly in ward unit within the institution. In addition to

that, in order to validate the result, triangulation of the

respondents were used. Additional respondents who volunteered

to participate in the study involved 25 patients/relatives and 5

physicians/ nursing supervisor, for each institution. The study

revealed that primary nursing excels more than functional

nursing in all three aspects of care delivery. Furthermore,

primary nursing care, when it comes to management of delivery

of care has a substantial variance with functional nursing.

Meanwhile, both modalities have no difference when it comes to

competency, efficiency and effectiveness in care delivery. Also,

profile variables which included age, gender, and marital status,

length of service, and monthly income, and functional nursing

had no substantial variance with effectiveness and efficiency,

competency, and management in the delivery of functional care.

This was almost the same in primary nursing modality except


35 ISSN 2704-3568

that there is difference between length of service and

management, requiring practice and training to execute the

primary nursing properly. In addition, action plan in enhancing

primary and functional nursing care models was developed for

future implementation.

Keywords – functional care, primary nursing care

INTRODUCTION

Nurses or healthcare providers who are working in a hospital

make sure to put their heart, mind and soul in giving quality care

to people who need their attention. However, in order to attain

excellence in organizing and in providing care, nurses must work

in a system or structured approach guided by values and beliefs

called nursing care modalities.

There are different care modalities used in different hospital

settings worldwide permissible to establish and deliver nursing

care to achieve optimum patient outcome. The study of Harris

and McGillis (2012) found that current research has extended the

field of knowledge regarding nursing care delivery models,

providing evidence of the need to capture other aspects of care in

studies linking nurse staffing to patient outcomes. Also,

traditional care delivery models, such as primary nursing and

functional nursing, appear to have mixed effects on patient and

nurse outcomes, highlighting the importance of considering

specific populations and care settings.

In the Philippines, two modalities of care have been practiced

in different hospitals, the primary and functional nursing care.

Because there was undeniably shortage of nurses and limited

funding to hire more nurses, hospitals were forced to compress

available staff in order to give care to patients. Despite that some

hospitals focus on giving care to patients without considering the

quality and risks among the nurses or healthcare providers. It is

only proper that some hospitals should value the persons

involved in giving nursing care in order to lessen the workload

of nurses or job exhaustion, and at the same time to give

appropriate care to admitted patients.

Subsequently, primary and functional nursing care varies in

some other ways, therefore, they need to be evaluated and

assessed. They have different advantages and disadvantages.


36 ISSN 2704-3568

Since there is a gap or negative effect, it is appropriate to asses

each modality in order to improve or resolve this gap. Also,

nurse managers need a concrete basis to apply appropriate

nursing care model in their hospitals. For this reason, there is a

need for an in depth study on the methods of nursing

management is necessary. Consequently, there is no generic

system used by the hospitals in the country, specifically in

Batangas province. Thus, research must be conducted to figure

out which is the best method that the hospital institution can

adopt to give more quality patient care. Furthermore, this study

can be a reference of Department of Health in order to give more

credit to nurses considering nurse patient ratio in their

deployment in hospital settings.

OBJECTIVES OF THE STUDY

This study aimed to identify nursing care modalities

employed in selected hospitals in Batangas to assess functional

and primary nursing care model in clinical setting. Specifically,

it intended to determine the profile of the nurse respondents in

terms of gender, age, marital status, length of service, monthly

income; to assess the functional and primary nursing care in

terms of effectiveness and efficiency; competency based on

eleven key areas of nursing responsibilities; and management in

the delivery of care; to test the significant differences between

functional and primary nursing care modalities; to determine the

significant differences between the profile variable and

functional nursing care modality; and the profile variable and

primary nursing care modality; to propose an action plan to

enhance primary and functional nursing care modalities.

METHODS

Research Design

For the researcher to come up with the solutions necessary to

solve the identified research problems, this study used the

descriptive research design to assess Primary and Functional

Nursing Care in hospital ward. Descriptive research, also known

as statistical research, describes data and characteristics about

the population or phenomenon being studied.


37 ISSN 2704-3568

This method ascertains the condition that prevails in the

group and obtains the facts regarding existing conditions, the

purpose of which is to find new truth [2]. It utilizes the

questionnaire with the aid of study guide as means of obtaining

the needed information.

Participants of the Study

The population for this study consisted of 100% total

respondents, 59 registered nurses who have been employed in

Hospital A, have practiced functional nursing care and 45

registered nurses in Hospital B, who have practiced primary

nursing care, in clinical settings particularly in ward unit within

the institution. Also, to verify the results given by nurses,

additional respondents included doctors, nurse supervisors,

patients and relatives presently available and affiliated in the said

hospitals during the conveyance of the questionnaires. For that

instance, 25 patients or relatives volunteered and 5 doctors or

nurse supervisors available for each hospital answered the

questionnaires.

Instrument

In the development of the questionnaire, the researcher made

a thorough reading and analyzed the variables involved in the

study through books, journals and other references related to the

study. These data and information helped the researcher to

formulate a self-made questionnaire that was used as a tool to

gather facts and essential data to answer the research problems.

The questionnaire consisted of two parts: the first part was

about the profile of the respondents in terms of gender, age,

marital status, length of service and, monthly income; the second

part tackled effectiveness and efficiency; competency based on

eleven key areas of nursing responsibilities; and management in

the delivery of care which have been applied in primary and

functional nursing care modalities.

The researcher used Likert Scale in the questionnaire to

obtain participants’ preferences or degree of agreement with a

statement or set of statements. Likert scales are a non-

comparative scaling technique and are unidimensional (only

measure a single trait) in nature (―Likert scale‖, 2014).


38 ISSN 2704-3568

In describing the effectiveness and efficiency in the delivery

of care that were applied in primary and functional nursing care

modalities, the following numerical scales below were used: 3.50

– 4.00: Highly effective; 2.50 – 3.49: Effective; 1.50 – 2.49: Less

effective; 1.00 - 1.49: Not effective.

For the level of competency based on eleven key areas of

nursing responsibilities in the delivery of care that were used in

primary and functional nursing care modalities, the subsequent

likert scale were followed: 3.50 – 4.00: Highly competent; 2.50 –

3.49: Competent; 1.50 – 2.49: Less competent; 1.00 - 1.49: Not

competent.

The extent of management in the delivery of care which

pertains in primary and functional nursing care modalities were

measured using the following range: 3.50 – 4.00: (Always) All

the time; 2.50 – 3.49: Often; 1.50 – 2.49: Rarely; 1.00 - 1.49:

Never.

Procedure

In conducting this research study, the researcher made use of

a self-structured questionnaire based from books, internet-related

studies and previous theses. The questionnaires were tested and

validated by the experts which included the adviser, dean of

nursing and statistician. Pre-test, also known as pilot test of

questionnaire, was done within a small sample of participants to

check respondents’ understanding and ability to answer the

questions before use. After the approval of the questionnaire, the

researcher submitted a letter of request, which had been signed

by the Dean of Graduate School, research adviser and the

researcher. The researcher distributed the questionnaires to the

participants assuring confidentiality and protected information

through utilization of informed consent within the institution.

Same set of questionnaire were used for both primary and

functional nursing care participants.

However, additional respondents were needed to validate the

results of the first participant (nurses). For this, second

distribution of questionnaires was done to different respondents

in the same institutions to confirm the previous gathered data,

the data triangulation method. Clear directions were given in the

questionnaire to guide the participants in answering the items,


39 ISSN 2704-3568

ensuring a favorable response from the participants. Data

retrieved were tabulated, interpreted and analyzed.

Data Analysis

All data needed were encoded, tabulated and interpreted

using different statistical tools. Frequency distribution was used

to describe the profile of the respondents. Also, weighted mean

was used to assess the functional and primary nursing care. In

addition, t-test and eta2

were used to test the significant

difference and relationship on the variables tested. The obtained

data were also supported using PASW version 18 to further

analyze the result using 0.05 alpha level.

RESULTS AND DISCUSSIONS

Table 1. Percentage Distribution of the Respondents’ Profile

Profile

Variables F % Profile Variables F %

Age

Length of service in Primary of

Functional nursing care setting

20-25 55 52.88 1 month- 6mos. 8 7.69

26-30 30 28.85 7mos- 1 year 15 14.42

30-35 6 5.77 1year- 2 years 23 22.12

36-40 4 3.85 3years-5years 24 23.08

41-50 9 8.65

Gender

5years-10years 27 25.86

Male 23 22.12 10years and above 7 6.73

Female 81 77.88 Monthly Income

Marital

Status Php 3,000-6,000 30 28.85

Single 77 74.04 Php 6,000-10,000 43 41.35

Married 25 24.04 Php 10,000-15,000 27 25.96

Divorced 2 1.92 Php 15,000- 20,000 4 3.85

Widower 0 0 Php 20,000-30,000 0 0

Table 1 depicts the distribution of nurse respondents

according to the demographic profile in terms of age, gender,

marital status, length of service in primary and functional

nursing care settings and monthly income in both nursing care

modalities used in selected hospitals in Batangas.


40 ISSN 2704-3568

In the breakdown of the nurse respondents, most of them

were single as accounted by 74.0 percent, which reflects to the

age of the nurse respondents that almost half of the total

population were in their early 20’sin both institutions using

primary and functional modalities. The age bracket of 36-49 had

the smallest portion of 3.58 percent as recorded.

Furthermore, the distribution of nurse participants regarding

gender was dominated by female (77.88%), while male

composed almost a quarter of the entire population of nurses

respectively. Most nurses are female as observed in the world

history of nursing. This conforms to Thompson and Vertein

(2008) statement that Nightingale transformed nursing into an

acceptable and respectable occupation for women. Both believed

that women were naturally better at nurturing the sick, more

affectionate and more caring than men despite the fact that men

had shown compassion and caring as nurses throughout history.

With regards to the length of service in primary and

functional nursing care settings, over three-fifths of the nurse

respondent were up to 5 years in their respective organization got

the greater portion. Meanwhile, few of the nurse respondents

(6.73%) were in the service for more than 10 years respectively.

This point towards that a very large majority (70%) of the nurse

respondents acquired the monthly income of PHp 3,000-10,000

only, which is the basic salary for nurses with 5 years experience

as seen in the result.

This findings contradict to the Health Human Resources

Production, Utilization and Development, Article VII, Sec. 32

that in order to enhance the general welfare, commitment to

service and professionalism of nurses the minimum base pay of

nurses working in the public health institutions shall not be lower

than salary grade 15 ( approximately PHp 24,000-26,000)

prescribes under Republic Act No. 6758, otherwise known as the

―Compensation and Classification Act of 1989.″ However,

Republic Act No. 6758 is self-contained in government

institutions alone and private sectors are not required to follow.

This verdict that nurses in the Philippines regardless of

employment in primary or functional modality were underpaid.

In fact, this is one of the reasons why most of the Philippine

nurses chooses to work overseas after gaining definite years of


41 ISSN 2704-3568

experience which is also reflected in the outcome of this study.

This implies that most nurses acquire low compensation

throughout their hard work that reflects poor general welfare.

As illustrated in table 2.1 on page 25, functional nurses have

little confusion regarding responsibilities which reflected in the

results because functional nursing is tasked-oriented in which a

particular nursing function is assigned to each worker (Venzon

& Nagtalan, 2010).

That is why ―nurses remain calm, think clearly and constantly

deal with stressful situations including emergencies, traumatic

events and tragic illnesses‖ and ―nurses values standard of

nursing practice for safe and effective delivery of care without

direct supervision‖. This clearly implies that defined policies and

procedures are used to complete the physical aspects of care in

an efficient and economical manner (Dadich, 2007).

This conforms to Paulino (2007) statement that the health

care delivered by a nurse to a patient must be harmonious

integration of knowledge and skill, maintained and nurtured to

ensure each efficiency and effectiveness.

Certainly, to achieve positive outcome and wellness of the

patient, nurses must guarantee accurate and effective

implementation of nursing practice which according to Paulino

(2007) could be reflected in the nonexistence of patient’s

incidents and in the absence of avoidable adverse patient

outcome during nursing.

However, the outcomes of the study which is highly effective

contradicts to what Williams and Wilkins (2009) presumed that

employees in functional nursing modality often focus only on

their own efforts, with less interest in overall results.

Also, the findings refutes that nurses’ accountability and

responsibility are diminished; evaluation of nursing care is poor

and outcomes are rarely documented (Venzon & Nagtalan,

2010). Indeed, the result likely to oppose the disadvantages of

functional nursing which includes fragmentation of nursing care

and therefore holistic care is not achieved (Venzon & Nagtalan,

2010), and there is no overall plan for assuring that all the

patient’s needs are met (Hayne & Baily, 2004). Anticipating

patient’s needs and providing patient care were both efficient

although not highly efficient based on the results. Overall, the


42 ISSN 2704-3568

functional nursing care in terms of effectiveness and efficiency

in the delivery of care was highly effective since the computed

mean values of each indicator were all greater than 3.50

respectively with the composite mean of 3.54.

Table 2.1. Effectiveness and Efficiency in the Delivery of

Care

Functional Nursing Care Primary Nursing Care

Nu

rse

Pa

tien

t/

Rel

ati

ve

Ov

er-a

ll

Nu

rse

Pa

tien

t/

Rel

ati

ve

Ov

er-a

ll

Indicators

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

1. Nurses

identify

patient needs

in a holistic

manner.

3.5

8

HE

7

3.2

8

E

8

3.5

5

HE

4.5

3.7

8

HE

2

4.0

0

HE

5.5

3.8

6

HE

2

2. Nurses

advocate for

their patients

and anticipates

their needs.

3.5

8

HE

7

3.5

2

HE

2.5

3.4

9

E

9

3.8

2

HE

1

4.0

0

HE

5.5

3.8

9

HE

1

3. Nurses keep

track of and

record minor

changes in a

patient’s

health or

behavior.

3.5

6

HE

9.5

3.2

4

E

9.5

3.5

4

HE

6

3.7

3

HE

4

4.0

0

HE

5.5

3.8

3

HE

4


43 ISSN 2704-3568

4. Nurses

remain calm,

think clearly

and constantly

deal with

stressful

situations

including

emergencies,

traumatic

events and

tragic

illnesses.

3.6

6

HE

2.5

3.3

6

E

6

3.6

1

HE

1

3.7

1

HE

5

4.0

0

HE

5.5

3.8

2

HE

5

5. Nurses

ensure patients

are free from

accidental or

preventable

injuries

produced by

medical care.

3.6

3

HE

4.5

3.5

2

HE

2.5

3.5

6

HE

3

3.7

6

HE

3

4.0

0

HE

5.5

3.8

5

HE

3

6. Nurses

value standard

of nursing

practice for

safe and

effective

delivery of

care without

direct

supervision.

3.7

1

HE

1

3.3

2

E

7

3.6

HE

2

3.6

9

HE

6

4.0

0

HE

5.5

3.8

1

HE

6

7. Nurses

practice high

degree of

autonomy in

clinical

decision

making.

3.6

6

HE

2.5

3.5

2

HE

2.5

3.5

5

HE

4.5

3.4

7

E

10

4.0

0

HE

5.5

3.6

7

E

10

8. Nurses are

able to provide

quality patient

care.

3.6

3

HE

4.5

3.2

4

E

9.5

3.4

8

E

10

3.6

7

HE

7

4.0

0

HE

5.5

3.7

9

HE

7


44 ISSN 2704-3568

9. Nurses

attain

maximum

patient

outcomes

across the

continuum of

care.

3.5

6

HE

9.5

3.4

8

E

5

3.5

2

HE

7

3.6

2

HE

8

4.0

0

HE

5.5

3.7

6

HE

8

10. Nurses

gain the

patient's

satisfaction

after nursing

care has been

performed.

3.5

8

HE

7

3.5

2

HE

2.5

3.5

1

HE

8

3.6

HE

9

4.0

0

HE

5.5

3.7

5

HE

9

Composite

Mean 3.6

1

HE

3.4

0

E

3.5

4

HE

3.6

8

HE

4.0

0

HE

3.8

HE

Legend: HE= highly effective; E=effective; LE=less effective; NE= not

effective

The result, when it comes to primary nursing care in terms of

effectiveness and efficiency, were in connection to Hayne and

Baily (2004) indicating that primary nursing has come to

recognize as a superior method for providing patient care as

reflected by highly effective in most of the items under the

aforementioned aspect. It was undeniable that both functional

and primary nursing care modalities were outstanding in the

aspect of effectiveness and efficiency, yet they were ranked in

different patterns as seen in the table, which publicized that

Philippine nursing in both modalities were good when it comes

to aforementioned aspect. Indeed, among the items in primary

nursing, ―nurses advocate for their patients and anticipates their

needs‖ was on top with weighted mean of 3.89.

This conforms to Venzon and Nagtalan (2010) statement that

primary nurse assesses the patient’s needs for care and primary

nursing assures continuity of care; makes available the increased

knowledge of the patient’s psychological and physical needs.

Moreover, direct patient care by relatively few nursing staff

allows for holistic, high quality patient care (Williams &

Wilkins, 2009). Also, primary nursing focuses on the nurse-

patient relationship, strengthening accountability for care and

facilitating patient and family involvement in the planning of


45 ISSN 2704-3568

care (Manthey, 2013). As concluded by Maratning (2004), the

presence of nurses along with their patients as regarded to

contribute significantly to the attainment of a better feeling of

satisfaction among patients. Nurses in primary nursing regarding

patient safety in accordance to standard nursing practice were

also greatly observed in the outcome.

On the other hand, ―nurses practice high degree of autonomy

in clinical decision making‖ was only effective in primary

nursing and got the smallest in number by 3.47 among the items.

This is due to the fact that the primary method required high

degree of responsibility and autonomy that the implementation

became challenging.

Likewise, Cherry and Joven (2014) pointed out that an

inadequate prepared primary nurse may not be able to make the

necessary clinical decisions or communicate effectively with the

health care team which needs proper training.In this same

reason, once nurses develop skill in primary nursing care

delivery, they feel challenged and rewarded (Williams &

Wilkins, 2009) by gaining patient’s satisfaction which revealed

in the output of this study as proven by the result.

To sum up, although there were items that were verbally

interpreted in both functional and primary nursing, still, after

getting the composite mean of each modalities, they were both

verbally interpreted as highly effective. However, it is obvious

that primary nursing care (3.80) was greater than functional

nursing care (3.54) with the difference of 0.26 in number.

As shown in table 2.2, functional nursing, as well as, primary

nursing competency in delivery of care were both rated ―highly

competent‖. It seemed to collaborate with the statement made by

Llanes (2011), in which the existing competencies are

considered to be very comprehensive, and that even after five

years from the time of promulgation are still found to be very

relevant and frequently used based on the perspectives of the

nursing experts. In point of fact, the first in rank in functional

delivery of care was shared by ―nurses perform roles utilizing the

nursing process in the interdisciplinary care of clients that

empower and promote safe quality nursing,‖ and ―nurses

maintain complete, accurate and up to date recording and

reporting system,‖ garnered the weighted mean of 3.73, followed


46 ISSN 2704-3568

by demonstrating responsibility for safe nursing practice with

3.72 respectively. On the other hand, in primary delivery of care,

nurses administer medication safely and accurately obtained the

highest score as reflected by the weighted mean of 3.86. Nurses

maintain complete, accurate and up to date recording and

reporting system; communicate effectively in the level of health

in various cultural setting both secured weighted mean of 3.82.

As clearly seen from the table, different weighted mean and

ranking of functional and primary method did not affect the

overall result. This implies that Philippine nurses excel when it

comes to competency that is guided by the standard of nursing

practice together with nursing process that adheres to the nurses'

national and international code of ethics. Certainly, this nursing

process assists the nurse to manage each patient’s nursing care

intelligently, scientifically and judiciously (Paulino, 2007).

In fact, according to Article IV of Competency Standards,

Section 5, graduates of Bachelor of Science in Nursing program

must be able to apply analytical and critical thinking in the

nursing practice. The nurse must be competent in Key Areas of

Responsibility with their respective core competency standards

and indicators. This includes providing nursing care that is safe

and of high quality. Moreover, Philippine nurses must be aware

of their duties and responsibilities in the practice of their

profession as defined in the ―Philippine Nursing Act of 2002‖. In

addition, the respondents made sure that the nursing practice of

safe and quality nursing care meet the optimum standard as

presented by the findings.

However, the fact that the Philippines is facing shortage in

nurses due to decrease general welfare coming from the

government and the presence of gap or disadvantages of

functional and primary care in the delivery of quality care. Still,

this is not a hindrance to Filipino nurses to give optimum care,

and provide value in their work to the extent that they push their

limits. This was proven, as seen on the above table, that the

second set of respondents, doctors and nurse supervisor, give an

average scores to the nurses in primary and functional nursing

care. Still, Philippine nurses were able to be competitive when it

comes in caring despite of obstacles.


47 ISSN 2704-3568

Table 2.2. Competency in the Delivery of Care


Nu

rse

Do

cto

r/ N

urs

e

Su

per

vis

or

Ov

era

ll

Nu

rse

Do

cto

r/ N

urs

e

Su

per

vis

or

Ov

era

ll

Indicators

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

1. Nurses

perform roles

utilizing the

nursing process

in the

interdisciplinar

y care of clients

that empower

and promote

safe quality

nursing.

3.7

3

HC

3

3.8

0

HC

1.5

3.7

3

HC

1.5

3.7

8

HC

4.5

4.0

0

HC

5.5

3.8

0

HC

4.5

2. Nurses

administer

medication

safely and

accurately.

3.6

9

HC

4

3.6

0

HC

2.5

3.6

9

HC

4

3.8

4

HC

1

4.0

0

HC

5.5

3.8

6

HC

1

3.Nurses

maintain

complete,

accurate and up

to date

recording and

reporting

system.

3.7

6

HC

1

3.4

0

C

7.5

3.7

3

HC

1.5

3.8

HC

2.5

4.0

0

HC

5.5

3.8

2

HC

2.5


48 ISSN 2704-3568

4. Nurses

establish

collaborative

relationship

with colleagues

and other

members of the

health team to

enhance

nursing and

other health

care services.

3.6

1

HC

9

3.4

0

C

7.5

3.5

9

HC

9

3.7

1

HC

8

4.0

0

HC

5.5

3.7

4

HC

8

5. Nurses

demonstrate

responsibility

for safe nursing

practice.

3.7

5

HC

2

3.4

0

C

7.5

3.7

2

HC

3

3.7

8

HC

4.5

4.0

0

HC

5.5

3.8

0

HC

4.5

6. Nurses

promote

personal and

professional

growth and

development

by engaging in

lifelong

learning to

keep abreast

with the

national and

global trends in

nursing.

3.5

3

HC

10

3.8

0

HC

1.5

3.5

5

HC

10

3.7

3

HC

6.5

4.0

0

HC

5.5

3.7

6

HC

6.5

7. Nurses

practice

leadership

skills in the

delivery of

health care

programs.

3.6

3

HC

8

3.4

0

C

7.5

3.6

1

HC

8

3.6

HC

9

4.0

0

HC

5.5

3.6

4

HC

9


49 ISSN 2704-3568

8. Nurses

demonstrate

capacity to lead

and supervise

nursing support

staff. 3

.68

HC

5.5

3.4

0

C

7.5

3.6

6

HC

6

3.5

3

HC

10

4.0

0

HC

5.5

3.5

8

HC

10

9. Nurses

collaborate for

referral to other

medical health

team.

3.6

6

HC

7

3.6

0

HC

2.5

3.6

6

HC

6

3.7

3

HC

6.5

4.0

0

HC

5.5

3.7

6

HC

6.5

10. Nurses

communicate

effectively in

the level of

health in

various cultural

setting.

3.6

8

HC

5.5

3.4

0

C

7.5

3.6

6

HC

6

3.8

HC

2.5

4.0

0

HC

5.5

3.8

2

HC

2.5

Composite

Mean 3.6

7

HC

3

.52

HC

3

.66

HC

3

.73

HC

4

.00

HC

3

.76

HC

Legend: HC= highly competent; C=competent; LE=less competent; NE= not

competent

To compare, it is clearly seen from the above table that in

primary nursing care (3.76) nurses were more competent than in

functional nursing care (3.66), as found in the composite mean of

each modalities yet they were verbally interpreted as highly

competent.

As demonstrated in table 2.3, respondents always experienced

breaking down tasks, utilizing available sources, working

cooperatively in health care team and having job satisfaction in

functional nursing care under management proven by the

weighted mean between 3.50 and 4.00. The rest of the items

were perceived by the respondents to be experienced as

oftentimes. It is a fact that functional nursing was developed of

tasks analysis and proper division of the nursing workload

(Deutschendorf, 2006).


50 ISSN 2704-3568

Table 2.3. Management in the Delivery of Care


Nu

rse

Pa

tien

t/

Rel

ati

ve

Ov

era

ll

Nu

rse

Pa

tien

t/

Rel

ati

ve

Ov

era

ll

Indicators

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

WM

VI

Ra

nk

1. Nurses are

adequate in

number to meet

patient’s needs.

3.2

5

O

10

3.2

8

O

8

3.2

6

O

10

3.5

8

A

7

4.0

0

A

5.5

3.7

3

A

7

2. Nurses

prioritize day-

to-day planning

to meet short

term and long

term unit goals.

3.4

7

O

6.5

3.5

2

A

2.5

3.4

9

O

5

3.5

3

A

8

4.0

0

A

5.5

3.7

A

8

3. Nurses

complete the

highest-priority

task whenever

as possible and

finishing one

task before

beginning

another.

3.5

3

A

5

3.2

4

O

9.5

3.4

4

O

7

3.6

7

A

4

4.0

0

A

5.5

3.7

9

A

4

4. Nurses work

cooperatively

with other

health care

members to

maximize time

use.

3.6

1

A

1

3.3

6

O

6

3.5

4

A

3

3.7

6

A

1

4.0

0

A

5.5

3.8

4

A

1

5. Nurses break

down large

tasks into

smaller ones

that can more

easily be

accomplished

by unit

members.

3.5

9

A

2

3.5

2

A

2.5

3.5

7

A

1

3.6

9

A

3

4.0

0

A

5.5

3.8

A

3


51 ISSN 2704-3568

6. Nurses

organize work

load to facilitate

client care.

3.4

6

O

8

3.3

2

O

7

3.4

2

O

8

3.7

1

A

2

4.0

0

A

5.5

3.8

1

A

2

7. Nurses utilize

all available

resources to

support client

care.

3.5

6

A

3

3.5

2

A

2.5

3.5

5

A

2

3.6

2

A

6

4.0

0

A

5.5

3.7

6

A

6

8. Nurses work

a number of

successive days

with a client to

ensure that there

is time to

formulate and

evaluate a plan

of care.

3.4

4

O

9

3.2

4

O

9.5

3.3

8

O

9

3.4

9

O

9

4.0

0

A

5.5

3.6

7

O

9

9. Nurses are

able to finish

work

assignment on

time.

3.4

7

O

6.5

3.4

8

O

5

3.4

8

O

6

3.3

8

O

10

4.0

0

A

5.5

3.6

O

10

10. Nurses have

job satisfaction

and fulfilment

in giving quality

patient care.

3.5

4

A

4

3.5

2

A

2.5

3.5

4

A

4

3.6

4

A

5

4.0

0

A

5.5

3.7

7

A

5

Composite

Mean 3.4

9

Oft

en

3

.40

Oft

en

3

.47

Oft

en

3

.60

7

Alw

ay

s

4

.00

Alw

ay

s

3

.75

Alw

ay

s

Legend: A=always; O=often; R=rarely; Never

Furthermore, delegation of work assigned by senior nurse

was used as an approach to this kind of modality. For instance,

one nurse may be assigned to give medication, charting, and

another in taking vital signs which agreed to the result that

―nurses break down large tasks into smaller ones that can more

easily be accomplished by unit members‖.

Likely, as one of the advantages, tasks are repetitive so that

nurses gain skill faster in the particular assignment (Venzon &

Nagtalan, 2010). Also, greater control over work activities was

demonstrated by utilization of all available resources to support

client care. ―Nurses work cooperatively with other health care


52 ISSN 2704-3568

members to maximize time use‖ since, in functional nursing,

nurses could be able to learn to work fast which could possibly

accomplished work in shortest time as possible, therefore they

can have spare time to help others in medical team. Williams and

Wilkins (2009) cited that due to the fact that because some

workers feel unchallenged and under stimulated in their roles,

functional nursing also may result in own job satisfaction was

similar to what respondents perceived, because according to

them, nurses always gain job satisfaction and fulfilment in giving

quality patient care. At the last spot, ―nurses are adequate in

number to meet patient’s needs‖ in which most of the

respondents experienced it frequently (often) as evidenced by

weighted mean of 3.26 respectively. This implies what Venzon

and Nagtalan (2010) mentioned that functional method is best

system that can be used when there are many patients and

professional nurses are few. Overall, in functional nursing care,

nurses often experienced quality management with the

composite mean of 3.47.

Meanwhile, the respondents in primary nursing practiced

quality management in delivery of care at all times or

always(3.75).To dissect the findings, the respondents in primary

nursing derived that ―nurses work cooperatively with other

health care members to maximize time use‖ as the top item with

weighted mean of 3.73 among statements under management of

care. The result agreed to Carter and colleagues (2012) report

that delivery of collaborative services by an inter professional

team will assist to better meet patients’ needs and has potential

to improve patient outcomes. The clear communication among

all members of the health team is the fundamental responsibility

of the nurses in the primary nursing care model. Since, there is

high in authority, accountability an autonomy of nurses in this

method, nurses communicates directly to health care team to

facilitate coordination in patient care management. Hence,

primary care nurses directs patient plan of care within the hours

of duty, ―nurses can organize work load to facilitate client care‖

to be fulfilled within the working hours. This is supported by

Venzon and Nagtalan (2010), in which the primary nurse

assesses the patient’s needs for care, sets care goals, writes a

nursing care plan, evaluates the outcomes of care, and makes the


53 ISSN 2704-3568

necessary changes or adjustments as necessary. However, as

experienced by the respondents, the shortage of nurses in the

institution could affect the nurse’s number of successive days

with a client to ensure that there is time to formulate and

evaluate a plan of care. In addition, the heavy nursing workload

due to scarcity of nurses collaborates to what Gurses (2011)

identified, in which, it affects the time that a nurse can allot to

various tasks. Therefore, nurses may not have sufficient time to

perform tasks within the span of duty. That is the reason why

nurses often finish work assignment on time as perceived by the

respondents.

In general, there were differences in approach when it comes

to the administration of both functional and primary nursing care

modalities. Also, as what obtained from the findings, primary

nursing is greater than functional nursing care modality. In terms

of quality management of delivery of care, primary nursing was

always experienced by the respondents while functional nursing,

often experienced by the respondents.

Table 2.4. Summary of Aspects in Delivery of Care in

Functional and Primary Nursing Care Modalities

Functional

Nursing Care

Primary Nursing

Care Overall

W

M VI R

W

M VI R

W

M VI R

Compete

ncy in the

Delivery

of Care

3.6

6

Highly

Compet

ent

1 3.7

6

Highly

Compet

ent

1

3.7

1

Highly

Compet

ent

1

Effective

ness and

Efficienc

y in the

Delivery

of Care

3.5

4

Highly

Effecti

ve

2 3.8

Highly

Effectiv

e

2

3.6

7

Highly

Effectiv

e

2

Managem

ent in the

Delivery

of Care

3.4

7 Often 3

3.7

5 Always 3

3.6

1

Always

(All the

time)

3

Composit

e Mean

3.5

6

3.7

7

3.6

6


54 ISSN 2704-3568

Table 2.4 shows the summary of aspects in delivery of care in

functional and primary nursing care modality as perceived by the

respondents within their respective institutions. It revealed that

both functional and primary nursing care in terms of competency

in the delivery of care was highly competent (3.71) which

outranked the two other aspects, since, both of the respondents

under the two modalities of care perceived the abovementioned

aspect as highly competent. Philippine nurses were guided by

nursing laws, both functional and primary nursing proves that

Philippine nurses were highly competent when it comes to the

delivery of care, despite that there were differences in the

methodology. This demonstrates that there is excellence in the

competitiveness of Philippine nurses with the help of nursing

process which adheres to the nurses' national and international

code of ethics. Certainly, this nursing process assists the nurse to

manage each patient’s nursing care intelligently, scientifically

and judiciously (Paulino, 2007).

Furthermore, as supported by Carter [15], includes that a

clear understanding of each healthcare provider’s unique

knowledge, skills or competencies as well as commonalities will

improve understanding of scope of practice, assist with role

delineation, promote the optimal utilization of providers, and

ultimately result in positive outcomes for patients. As a matter of

fact, there are eleven key areas of nursing responsibilities

recognized by the Philippine Regulatory Commission in order to

produce a more competent nurses and establish a standard

nursing practice which were highly competent regardless of

modalities of care that ensure accurate and effective nursing

action for the recovery and wellness of the patients as proven in

the study.

However, primary nursing care(3.76) was greater than

functional nursing care(3.66) in the aspect of competency.

Unlike in functional nursing, primary nursing care registered

nurses were responsible for the total care of a small group of

patients from admission to discharge. Also, the primary nurse

assesses the patient’s needs for care, sets care goals, writes a

nursing care plan, evaluates the outcomes of care, and makes the

necessary changes or adjustments as necessary (Venzon &

Nagtalan, 2010).


55 ISSN 2704-3568

Additionally, according to Manthey (2013), the registered

nurse in partnership with the patient, identifies the patient’s

unique health needs and priorities, establishes an individualized

plan of care, provides direct care as appropriate, and

communicates the plan to other members of the team.

Second in ranking was effectiveness and efficiency in the

delivery of care in which both modalities were highly effective.

However, it is clearly seen that primary nursing care (3.80) was

higher than functional nursing care (3.54). Indeed, primary

nursing has come to recognize as a superior method for

providing patient care as reflected by highly effective in most of

the items under the aforementioned aspect (Hayne & Baily,

2004). Henceforth, there is also a need in functional nursing to

apply harmonious integration of knowledge and skill, maintained

and nurtured to ensure each efficiency and effectiveness in

health care by nurses to a patient (Paulino, 2007). The value of

safe nursing practice was greatly implemented in both functional

and primary nursing care modalities. Undeniably, both

functional and primary nursing care modalities were outstanding

in the aspect of effectiveness and efficiency, yet they were

ranked in different patterns, which publicized that Philippine

nursing in both modalities were excellent when it comes to

aforementioned aspect.

Moreover, primary nursing was greater than 0.26 points than

functional nursing in terms of effectiveness and efficiency.

Unlike primary nursing, functional nursing was not fully

maximized since anticipating patient’s needs and providing

patient care were both efficient and not highly efficient based on

the results that reflect to the disadvantages. This same goes to

primary nursing that, on the other hand, was only effective in the

implementation of high degree of autonomy in clinical decision

making as perceived by the respondents. However, it does not

greatly affect the composite mean due to the fact that the primary

method required high degree of responsibility and autonomy that

the implementation became challenging.

Lastly, functional nursing care nurses oftentimes practiced

quality management (3.47), whereas, the respondents in primary

nursing care always experienced the aforementioned aspect as

accounted by the result of 3.75. Although as mentioned by Jost


56 ISSN 2704-3568

et al. (2010 that nursing care delivery model, informed by values

and beliefs, has been described as a structured approach for

organizing and providing nursing care to clients. Even though

functional and primary were under nursing care delivery model,

there were differences in approach when it comes to the

management of both nursing care modalities. Functional

modality is task-oriented while primary modality directs care to

the patient.

Furthermore, according to Williams and Wilkins (2009),

primary nursing, also known as relationship-based nursing, uses

some of the concepts of total patient care, and this is one type of

patient care delivery that requires a one-to-one relationship

between a registered nurse and a patient, with responsibility for

planning and managing care clearly established. Meanwhile, in

functional nursing, breaking down tasks, utilizing available

sources, working cooperatively in health care team, and having

job satisfaction were only those perceived by the respondents to

be done always, proven by the weighted mean between 3.50-

4.00, while the rest are experienced oftentimes which also

reflected in the overall result. It is a fact that functional nursing

was developed of tasks analysis and proper division of the

nursing workload (Deutschendorf, 2006).

In the aspect of management, primary nursing administered

the system well than functional nursing as grounded by the

result. As deliberated from the result, primary nursing excels

most in all three aspects of delivery of care, known to be a

superior method in providing patient care.

Table 3 shows the differences between primary and

functional care modalities. Based from the result, there are no

significant differences between functional and primary nursing

care in terms of effectiveness and efficiency and competency in

the delivery of care since the computed p-values greater than

0.05 level of significance. However, there are differences

between functional and primary nursing care in terms of

management in the delivery care since the computed p-value is

less than 0.05 level of significance. Thus, the hypothesis that

there are no differences between functional and primary nursing

care in terms of Management in the Delivery of Functional Care

is rejected.


57 ISSN 2704-3568

It is clearly seen from the table that there were no substantial

variance in both models of care (functional and primary) in

relation to effectiveness and efficiency and; competency in the

delivery of care. As mentioned by Jost et al. (2010), nursing

care delivery model, informed by values and beliefs, has been

described as a structured approach for organizing and providing

nursing care to clients. Even though functional and primary were

under nursing care delivery model, there were differences in

approach when it comes to the management of both nursing care

modalities. As Koloroutis (2004) mentioned that in functional

care, nursing assignments are task-based, nurses are assigned to

tasks rather than patients, while, in primary care, nurse

assignments are patient-based to ensure continuity of care.

Therefore, nurse approach management in functional and

primary nursing models in different ways as proven by the result

of computed p-value is less than 0.05 level of significance. It

was noted that when it comes to management of delivery of care,

there was a substantial variance between the two models of care.

Table 3. Differences between the Primary and Functional

Nursing Care Modalities

Mean F-value p-value

Effectiveness and Efficiency

in the Delivery of Care

Functional 3.53 3.57* 0.06

Primary 3.80

Competency in the Delivery

of Care

Functional 3.66 2.52 0.12

Primary 3.76

Management in the Delivery

of Care

Functional 3.47 7.436* 0.01

Primary 3.75

Legend:* Significant at p-value < 0.05

Table 4.1 presents the differences between the profile of the

respondents and functional nursing care modality. It can be

observed from the table that effectiveness and efficiency in the

delivery of functional care, competency in the delivery of

functional care and management in the delivery of functional

care have no significant difference with the profile variable since

the computed p-values greater than 0.05 level of significance.


58 ISSN 2704-3568

Table 4.1. Differences between the Profile of the Respondents

and Functional Nursing Care Modality

Effectiveness and

Efficiency in the

Delivery of

Functional Care

Competency in the

Delivery of

Functional Care

Management in the

Delivery of

Functional Care

Profile

Variables

F-

value

p-

value I

F-

value

p-

value I

Age 0.976 0.428 NS 0.308 0.871 NS 1.034 0.398 NS

Gender 2.01 0.162 NS 0.6 0.441 NS 0.759 0.387 NS

Marital Status

0.871 0.871 NS 0.123 0.128 NS 0.288 0.288 NS

Length of service

0.092 0.092 NS 0.188 0.188 NS 0.275 0.275 NS

Monthly

Income 0.568 0.638 NS 0.819 0.489 NS 0.489 0.091 NS

Legend: Significant at p-value < 0.05

The result shows that in terms of profile variables which

include age, gender, marital status, length of service, and

monthly income, there was no substantial variance that arises

with effectiveness and efficiency, competency, and management

in the delivery of functional care. There was no known related

studies regarding the differences of functional nursing and

demographic profile. Gender, age, marital status, length of

service and monthly income do not affect the nurses in

functional nursing care.

The result does not correlate on what Zakład (2009) had

mentioned that career ambitions and offensive problem-solving

strategies are associated with length of service and competence

increased with seniority. This could be due to the fact that this

type of modality is task-and-activity oriented, and uses auxiliary

health workers trained in variety of skills, which focuses on task

rather than client (Deutschendorf, 2006).

Similarly, as what Venzon and Nagtalan (2010) cited that

functional nursing allows most work to be accomplished in the

shortest time as possible; workers learn to work fast; and because

the tasks are repetitive they gain skill faster in the particular task.

Despite the fact that there should be a maximized effectiveness

in health-care deployment and or delivery of care, the

abovementioned profile variables were not required in order to

evaluate the method of providing patient care in functional

nursing as proven by the findings.


59 ISSN 2704-3568

Table 4.2 presents the differences between the profile of the

respondents and primary nursing care modality. It can be

observed from the table that effectiveness and efficiency in the

delivery of care and competency in the delivery of functional

care have no differences with the profile variable since the

computed p-values greater than 0.05 level of significance.

However, management in the delivery of care shows significant

differences in the length of service in primary nursing care

setting since the p-values is less than 0.05 level.

Table 4.2. Differences between the Profile of the Respondents

and Primary Nursing Care Modality

Effectiveness and

Efficiency in the Delivery

of Primary Care

Competency in the

Delivery of Primary Care

Management in the

Delivery of Primary Care

Profile

Variables

eta-

value

p-

value I

eta-

value p-value I

eta-

value p-value I

Age 1.320 0.279 NS 1.348 0.269 NS 1.293 0.284 NS

Gender 2.556 0.117 NS 3.794 0.058 NS 1.455 0.234 NS

Marital

Status

0.726 0.490 NS 0.373 0.691 NS 0.400 0.673 NS

Length of

service

0.954 0.458 NS 1.363 0.259 NS 2.831 0.028 S

Monthly Income

0.971 0.416 NS 0.592 0.624 NS 0.861 0.469 NS

Legend: Significant at p-value < 0.05

The table reveals profile variables which include age, gender,

marital status, and monthly income, have no substantial variance

in respect with effectiveness and efficiency and; competency in

the delivery of primary care. However, when it comes to length

of service and management in the delivery of care in primary

nursing, there was a substantial variance. This was supported by

Williams and Wilkins [8], wherein, primary nursing

implementation may be difficult because the primary nurse is

required to practice with a high degree of responsibility and

autonomy. An inadequate by prepared primary nurse may not be

able to make the necessary clinical decisions or communicate

effectively with the health care team which needs proper

training. Moreover, in the study by Salehi and colleagues [20], it

was demonstrated that there is a correlation between the clinical

decision making ability and working background and the critical


60 ISSN 2704-3568

thinking and clinical decision making in nurse. Likely, it was

found that career ambitions and offensive problem-solving

strategies correlate with length of service.

Nurses with the shortest length of service were least active in

coping with problems revealing that competence increased with

seniority (Zakład, 2009). It seems that as the nurses have higher

work experience, their clinical decision making ability and

management of delivery of care improves. Thus, if there is an

increase in experience, the primary nurse will be likely to be

more autonomous in providing patient care.

Proposed Action Plan in Enhancing Primary and Functional

Nursing Care Modalities

The rationale for this proposed action plan is to improve safe,

competent, quality care that meets client needs and maximize

client outcomes across the continuum of care; to utilize health-

care providers effectively through maximizing the effectiveness

of health-care worker deployment and or delivery of care; to

reflect an understanding of nursing work processes while also

considering the evolving role of nurses in care delivery models;

thus, to promote quality work environments. This focuses more

on functional nursing care since this is the weakness of the study.

CONCLUSIONS AND RECOMMENDATION

The female dominates the respondents in primary and

functional care settings. Most of the respondents were single

which greatly reflects the age of the respondents which is in their

early 20’s. Moreover, the minimum salary for nurses was Php

3,000-10,000 for the length of service up to 5 years. Primary

nursing excel more than functional nursing in all three aspects of

care delivery. Primary nursing care, when it comes to

management of delivery of care has a substantial variance with

functional nursing. Both modalities had no difference when it

comes to competency, efficiency and effectiveness in delivery of

care. Profile variables which include age, gender, marital status,

length of service, and monthly income, and functional nursing

had no substantial variance with effectiveness and efficiency,

competency, and management in the delivery of functional care.

This was almost the same in primary nursing modality except


61 ISSN 2704-3568

that there is difference between length of service and

management which requires practice and training to execute the

primary nursing properly. Action plan in enhancing primary and

functional nursing care models was developed for future

implementation.

It is recommended that the Department of Health may

consider primary nursing modality as the standard hospital

setting and serve basis to deploy nurses appropriately without

compromising both the nurse and patient. Hospitals may

implement the utilization of proposed action plan which may be

appropriate for the institution. Further research may be

conducted to measure the extent to which the benefits, or

potential benefits, of the model of care will be sustained in the

future.

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―Optimizing Collaborative Practice of Nurses in Primary Care

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Cherry, B. and Jacob, S. (2014). Contemporary Nursing, Issues, Trends,

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Dadich, K. (2007). Care Delivery Strategies. (12) 241-265

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Gurses, A. & Carayon, P. (2011). Nursing Workload and Patient

Safety—A Human Factors Engineering Perspective. 30.

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Llanes, M. (2011). Thesis: Core Competency Standards for Nursing

Practice in the Philippines: Development and Validation.

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