nursing research final submission of chapter 1-3

51
Level III Far Eastern University Institute of Nursing students Clinical Exposure to private and government hospitals A Research Study Submitted In Partial Fulfillment of the Requirements For the degree of Bachelor of Science in Nursing To Institute of Nursing Far Eastern University Proponents: Aldrin Ian O. Alpe Jericho D. Arago Kris M. Arcenio Jessica L. Cabbuag Krisslene H. Cuevas Kristine Jane G. Garcia Janine S. Gonzaga Regie S. Gonzaga Evalyn A. Lacsamana Chiberie H. Orgino (BSN 137 Group145)

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Page 1: Nursing Research Final Submission of Chapter 1-3

CHAPTER I

Level III Far Eastern University Institute of Nursing students Clinical Exposure to

private and government hospitals

A Research Study Submitted In Partial Fulfillment of the Requirements

For the degree ofBachelor of Science in Nursing

To Institute of Nursing

Far Eastern University

Proponents:Aldrin Ian O. AlpeJericho D. AragoKris M. Arcenio

Jessica L. CabbuagKrisslene H. Cuevas

Kristine Jane G. GarciaJanine S. GonzagaRegie S. Gonzaga

Evalyn A. LacsamanaChiberie H. Orgino

(BSN 137 Group145)

Submitted to:Barbara Michelle De Guzman RN, MSN

Research Adviser

Page 2: Nursing Research Final Submission of Chapter 1-3

INTRODUCTON

I. The Problem and its Background

Exposure of nursing students to hospitals are said to be of great help in nurturing the

student’s potential in providing a holistic and quality care to patients especially in these times

wherein different issues arise questioning or concerning health care services (Srinivasan, 1997).

Hospitals in the Philippines are divided in two categories; these two major groups are the

government and the private hospitals. These serve as the primary health care setting for everyone

in the country. Public and private hospitals are similar in a number of ways. A comparison of the

types of diagnoses most frequently treated by public and private hospitals indicates that the two

sectors offer many of the same hospital services, particularly chemotherapy, renal dialysis and

medical obstetrics. More broadly, a number of large metropolitan private hospitals offer a range

of services on par with large government hospitals including, in some instances, accident and

emergency treatment and clinical training. Differences between public and private hospitals in

terms of hospital size, location and services are, in part, a function of their business models,

government requirements and community expectations. The government hospital sector handles

the majority of acute care separations and accounts for most regional and remote hospitals, while

private hospitals are more concentrated in metropolitan areas and are more likely to treat patients

of higher socioeconomic advantage. The government sector’s activity is concentrated on medical

cases (including those typically admitted through emergency departments) while the private

sector’s activity is more concentrated on surgical (typically elective) procedures. (Philippine

Centre for Health Research, 2007)

Page 3: Nursing Research Final Submission of Chapter 1-3

Hospitals in and around Manila often offer high-quality medical care. However, other

hospitals may not meet the standards of medical care, sanitation, and comfort provided by private

hospitals in the Philippines. Many hospitals outside major urban areas may offer only

basic medical care in rudimentary conditions. (Marquez, 2009).

In government hospitals, there is a deficiency of certain medical equipments and other

infrastructures. These equipments are needed for the clients’ procedures and nursing students’

practices. Government hospitals’ health practitioners, as well as the students, should come up

with alternatives if any equipment or material is unavailable. A public health approach to

planning of secondary care services can encourage a more objective and strategic assessment of

health needs and how these are best met. (Wright J, et al, 2002). The students develop the sense

of resourcefulness and creativity from what they had learned from their studies. In terms of the

privilege of nursing students, the midwives, doctors, and registered nurses allow the student

nurses to perform the procedures hands-on, such as handling the delivery of a newborn baby.

This allows the students to practice certain procedures effectively. On the other hand, private

hospitals with more sophisticated equipment and a more extensive service range are more

attractive not only to patients, but also to medical practitioners. This is likely to partially explain

the notable decline in the number of privately insured patients receiving treatment in public

hospitals. (Victoria, 1994). This provides a quality healthcare for the patients, and mastery of

students to the equipments and modern technology. In private hospitals, they perform once of the

procedures by availability of resources are more indeed. Furthermore, most of the private

hospitals do not allow the students to perform certain hands-on procedures, and they only allow

the students to observe on how the procedures have been done. The students can not apply in

practices what they had learned from studies (Mikkeal, 2005).

Page 4: Nursing Research Final Submission of Chapter 1-3

The healthcare services of the nation offered by the government hospitals, such as

Valenzuela Medical Center (VMC), Taguig Pateros District Hospital (TPDH) and Jose Reyes M.

Medical Center (JRMMC) are with good quality of care, despite the fact that the facilities may

not be as impressive as those found in private hospitals like the FEU-NRMF, Castro Maternity

and General Hospital and Medical City. These are some hospitals that the level III nursing

students of Far Eastern University are having their duties.

Studying nursing practices in both government and private hospitals is a way to help

nursing students in the advancement of learning so that they can apply these into a real setting.

As for the fact that nursing practice is the actual provision of nursing care, it is also based around

a specific nursing theory which will be selected as appropriate for the care setting. Expertise in

nursing practice will bring a unique function of the nurse to assist the individual, sick or well, in

the performance of those activities contributing to health or its recovery that he would perform

unaided if he had the necessary strength, will or knowledge. Nursing practice is a complex and

varied field that requires precision, dedication, care, and expertise. Clinicians must have both the

skills and the tools to attend to changes in patients' responses, recognize trends, and understand

the nature of their patients' conditions over time. Expertise in the plan of care of every nurse can

have a positive result if she/he has been exposed in every clinical setting either private or

government hospitals. Exposure of nursing students in a Government or Private hospitals will

determine the effectiveness in developing their knowledge, skills and attitude. This could help to

evaluate the capacity of hospitals in educating nursing students thus building a better foundation

of learning for nursing students that may help them acquire the qualities and values that a

knowledgeable, skilled & humanistic nurse must possess. Furthermore, this can also contribute

in the enhancement and development of health services the hospitals can provide, as well as to

Page 5: Nursing Research Final Submission of Chapter 1-3

the quality of care and effectiveness and appropriateness of nursing interventions that our nurses

render to their clients.

Exposure of nursing students in the different clinical area is essential to every nursing

students, because from the different clinical exposure from private and government hospitals will

enable the nursing students to acquire knowledge from the natural, social, medical, and nursing

sciences; develop critical thinking and professional decision-making abilities; utilize current

research in the application of the nursing process; develop leadership potential and accountability

in professional practice; become aware of the emerging roles of the professional nurse and of the

social forces and trends affecting health and health care systems; and to learn to balance

professional and personal growth and values. Knowledge is also enhanced as when the students

have learned new information, which then they must be guided in relating the new knowledge to

what they already know, organizing that information, and then making it a part of their long-term

memory. Students acquire knowledge when performing meaningful tasks.

A skill of every nursing student in exposing in the different clinical area is an important

part of nursing education. The challenge within universities is to expose and provide a clinical

skills program that is cost effective and adequately prepares students to practice within an

increasingly complex health care system. The adoption of programs that are based on principles

of self-direction would appear to meet the challenge (Purdy, 2003). Skills is developed when

students are acquiring new skills and processes, they must learn a model (or set of steps), then

shape the skill to make it appropriate for them, and finally, internalize ad practice the skill so

they can perform it easily, efficiently and effectively.

Page 6: Nursing Research Final Submission of Chapter 1-3

On the other hand, attitude is also a very important part of nursing profession because

attitudes and perceptions affect students' ability to learn; also it is a key element of effective

instruction, then, is to help establish positive attitudes and perceptions about learning. If students

have negative attitudes and perceptions about learning, then they will likely learn little. If they

have positive attitudes and perceptions, they will learn more and learning will be easier. (Olive,

2007)

II. Statement of the Problem

The researchers were motivated to undertake this study to differentiate the exposure

between private and government hospital of level III nursing student in terms of acquiring

knowledge, skills and attitude.

The research study aims to compare the knowledge, skills and attitude that every nursing

student could acquire from their exposure to a government or private hospital. Knowledge can be

in terms of the nursing theories, principles and rationales for every procedure, and how they

apply these to practices. Skills can be in terms of the nursing practices such as maintaining sterile

technique. Attitude can be in terms of morality of the nursing students such as honesty,

obedience, confidence and more which are needed for effective nursing care and learning. There

are many differences between the government and private hospitals in terms of providing the

three aspects of learning needed by the students.

In general, this study aimed to differentiate the level and amount of clinical exposure of

level III nursing students of FEU in acquiring knowledge, skills and attitude.

Page 7: Nursing Research Final Submission of Chapter 1-3

Specifically, the study sought to answer the following questions:

1. What is the status of clinical exposure of Student Nurses in Private Hospital in

term of the following:

a. Knowledge

b. Skills

c. Attitude

2. What is the status of clinical exposure of Student Nurses in Government Hospital

in term of the following:

a. Knowledge

b. Skills

c. Attitude

3. Is there a significant difference between the clinical exposure in Private Hospital

and Government Hospital?

4. Is there a relationship between hospital status and clinical experience?

III. Significant of the studies

Nursing Practice

Page 8: Nursing Research Final Submission of Chapter 1-3

Nursing practice can help in the primary caring relationship between the nurse and the

person in their care. Exposure in a private and government hospital will let the students perform

different kinds of skills; these skills may vary according to what the hospital setting has. Students

may be limited or have freewill to do variations of procedure depending on the hospital protocol

that will train the students to be expert in their field. Some hospital setting restrict students to

perform some medical procedure these hospitals are more of the private ones but they also has

advantage due to advance technologies.

Nursing Administration

Studying nursing administration can contribute to the skill of every nursing student.

Nursing administration is an instrument for the nurse’s work and to increase the quality of

assistance, as well as for the development of the nursing staff and, the administrative functions as

a role which has to be developed in the nursing professional practice. Studying nursing

administration can help in developing nursing leaders, empowering people through

education/mentoring, in advocating the benefits in every member and the communities that the

nurse serve, in promoting the significance of the role of nursing administrators, in anticipating

and acting in response to a changing environment, in partnering with other entities for the benefit

of our organization, by being guided by integrity in all the nurses actions, in promoting/providing

opportunities for networking within our organization, and lastly by sharing/promoting best

practices that promote/ensure the highest quality of care and quality of life. One way to

strengthen critical thinking skills of nursing students is through adequate training. Student nurses

should participate in training to improve their competency and communication skills. Their goal

Page 9: Nursing Research Final Submission of Chapter 1-3

should be to determine when you can exercise critical thinking skills and hands on skills. Also

consider online programs designed for nurses, such as "Sharpening Critical Thinking Skills".

Training should expose nursing students to various scenarios or hypothetical situations so they

can practice reflecting about possible options and get feedback, particularly about critical

thinking errors and practices.

Nursing Education

This knowledge will help educators evaluate the capacity of Hospitals in educating

nursing students thus building a better foundation of learning for nursing students that may help

them acquire the qualities and values that a knowledgeable, skilled & humanistic nurse must

possess. This study will give certain understanding on what really affect the learning of the

nursing students during their related learning experiences especially in terms of their exposure in

different hospitals. This study will also serve as a discussion point and even reference for clinical

instructors and administration especially those who are involve in RLE. With this, interventions

can be made by probably doing rotations in terms of the areas where the students will be

exposed, so each can equally experience exposure from both government and private hospitals.

Clinical Instructors can also take part by utilizing and maximizing the resources and equipments

available and that the affiliating hospital can offer to students thus making the exposure more

educational and fruitful.

Nursing Research

Page 10: Nursing Research Final Submission of Chapter 1-3

The future researchers who plan to conduct a study on the same plane may use the study

result as a framework for further studies. This could put interest and a new knowledge that can

improve the field of nursing. It can also serve as a related literature for the future study. The

result of the study may also be used as a foundation and as a supplemental reference. This study

can also be done to different level of Institute of Nursing and compare their results to be able to

come up with a more complex and systematized body of knowledge. Furthermore, this research

can also give a background for other related researches in the future.

IV. Scope and limitation

The focus of the study was to find out if there is a significant difference between

clinical exposure to government and private hospitals and acquiring knowledge, skills and

attitudes among level III IN students of Far Eastern University. The researchers include

participants, both males and females from the institute of Nursing level III students enrolled at

FEU, in the school year of 2010-2011, ranging from 17-20 years old. Scope of the study

includes the level and amount of exposure of level III IN student in both private and

government hospital in acquiring knowledge, skills and attitude. The limitation of the study

includes the population of FEU students in the Institute of Nursing, the availability of the

students and the short span of time in conducting this research. The results and the sample is

only limited to those students of FEU especially the nursing students.

Page 11: Nursing Research Final Submission of Chapter 1-3

CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter includes a review of related literature and studies both foreign and local

which are related to the variables under study. Each study offers a specific and valuable

contribution in the exposure of nursing student in both private and government hospitals in

acquiring knowledge, skills and attitudes.

V. Literature Review

Government versus Private

Several studies investigated show the differences of private and public hospitals with

regards to their facilities and equipments that they use. It is about the government hospitals

having more advance equipments provided by the government versus the private hospitals owned

by a company.

Darden, WR, Perrault, WD. (1975) conducted a study comparing the quality of services

provided by public and private hospitals in Bangladesh. A total of 207 surveys were analyzed

with respondents indicated visiting 57 hospitals and clinics in the area. Combination of multiple

analysis of variance (MANOVA) and two-group discriminant analysis (DA) were used for data

analysis because if the overall test of group differences using MANOVA is significant, DA can

help determine the direction and intensity of each criterion variable’s impact on the overall group

Page 12: Nursing Research Final Submission of Chapter 1-3

differences Of the 207 responses, 191 cases were used in the MANOVA and discriminant

analysis procedures. Of these, 91 respondents reported using a public hospital, while the

remaining 100 used a private hospital or clinic. On responsiveness, the results indicate that

private hospitals are perceived as more responsive than public hospitals. Similarly, on

communication and discipline, private hospitals obtained a significantly higher rating than public

hospitals. This contention was reasonably supported: private hospitals were evaluated better on

responsiveness, communication, and discipline. By responding to these needs, hospitals in

Bangladesh can improve their image and be perceived more favourably. Market, competitive,

social, internal and regulatory incentives are to be considered to promote higher quality in

hospitals.

Andaleeb, (2000) conducted a study about the quality of services provided by the

hospitals is contingent on market incentives because private hospitals are not subsidized and

depend on income from clients, they will be more inclined than public hospitals to provide

quality services and to meet patients’ needs better. The researcher conducted the study through

survey and questionnaires By doing so, they will not only be able to build satisfied and loyal

clients who will revisit the same facility for future needs; the clients will also serve as a source of

referrals to recommend the private establishments to friends and family, thereby sustaining the

long-term viability of private hospitals. In public hospitals, on the other hand, there is little or no

market incentive to motivate the staff to take extra initiative or effort to improve the condition of

patients and ameliorate their suffering. Tax subsidies and other sources assure these

organizations of their survival. Harsh as this may sound, evidence of their lack of

responsiveness, dedication, or quality assurance in media reports is often stark. This suggests that

their service quality will be rated lower than private hospitals.

Page 13: Nursing Research Final Submission of Chapter 1-3

Daniele Guisti, Bart Criel and Xavier De Bethune conducted a study in sub-Saharan

Africa to determine the difference between private and public health care delivery. Through a

group discussion or debate, they determine the service offered by the private and public in terms

of health care delivery. There are different frame of classification between private and public

health care proposed: one is based on the purpose of the health service pursues and on the

outputs it yields. It was concluded that the distinction between private and public based on the

institutional set-up of a given service is not always adequate in defining the very nature of the

service offered, the latter being of paramount importance to the health planner at any level of the

health system. For example, many private hospitals and health centers in developing countries

operate according to a rationale which could be defined as public; at the same time, lucrative

goals are being introduced into public health services which, eventually, endanger their

adequacy, relevancy and accessibility.

Clinical Exposure

Several studies investigated shows that clinical exposure affects the learning of every

nursing student and greatly affects the improvement of their knowledge skills, and attitude.

Henderson S., Happell B. and Martin T. (2007) conducted a study about the Impact of

theory and clinical placement on undergraduate students' mental health nursing knowledge,

skills, and attitudes. 192 students from the University of Victoria averaged 84%, decreasing to

71% at the second date collection point and to 65% at the final data collection point.

Questionnaires were distributed in class time with an envelope so that respondents could pass

sealed envelopes to the front of the classroom on completion.. Findings shows that both the

Page 14: Nursing Research Final Submission of Chapter 1-3

theoretical and clinical segments of the mental health component did increase nursing students’

self-reported knowledge, skills, attitudes in nursing people experiencing mental health problems.

In terms of clinical experience, all students, regardless of duration of the theoretical component,

reported higher knowledge, skills, attitudes compared with baseline and made the greatest

improvement in specialist mental health knowledge and skills, such as mental status assessment

and risk assessment. This supports the available literature in suggesting that clinical experience is

highly influential on the extent to which students are able to acquire the desired knowledge,

skills, and attitudes.

Needham and De Sousa, (2002) conducted a study about Student nurses' attitudes

towards adolescents and their care in hospital. Using a self-administered questionnaire

comprising a series of open-ended questions among a sample of 14 child branch degree level

students in their second, third or fourth year at a West Midlands university, this study found that

the students had a good knowledge of young people and of their needs while in hospital. They

did not report strong negative attitudes towards adolescents but suggested that a number of

factors affected their attitudes towards nursing young people, including media reports and the

attitudes of mentors. Most of the students expressed a preference for working with younger

children, partly because the students lacked experience and confidence, and partly because of a

lack of age appropriate resources in ward areas, which made caring for adolescents more

challenging. It was concluded that more could be done to improve student exposure to adolescent

patients and that inadequate inpatient facilities, rather than staff attitudes and knowledge, may

prevent some young people receiving good quality care in hospital.

Page 15: Nursing Research Final Submission of Chapter 1-3

Sharif & Masoumi (2005) conducted a study with 90 baccalaureate nursing students from

Shiraz University of Medical Sciences in order to investigate the nursing student's views and

experiences about their clinical practice. The researchers use focus group discussion in collecting

data among the participants which determine that nursing students were not satisfied with the

clinical component of their education. It had come up with a four themes that arisen from the

focus group data. From the students' point of view," initial clinical anxiety", "theory-practice

gap", clinical supervision"," professional role", was considered as important factors in clinical

experience. All in all students felt unsatisfied and incompetent due to lack of nursing skills and

knowledge to practice care to patients, therefore, experiencing anxiety.

Clinical Exposure and Government vs. Private

Edwards, Smith, Courtney, Finlayson and Chapman (2004) conducted a study using a

quasi-experimental design using a pre-test post-test survey aimed to determine the relationship

between the location of clinical placements and competence and preparedness for practice from

the perspective of the nursing students. The population consisted of all final year Bachelor of

Nursing students at Queensland University of Technology, who undertook their clinical

placement in either a rural or metropolitan location. They have to undertake a four week clinical

placement. The pre and post survey contains 3 sections which are the demographic information,

questions related to the students’ preparedness for the clinical experience and issues that were

important for them during the clinical experience and lastly is the questions related to the

students’ satisfaction with their clinical placements and factors likely to influence their future

career plans. It had also high lightened the importance of both rural and metropolitan clinical

Page 16: Nursing Research Final Submission of Chapter 1-3

environments in developing not only student competency but also students’ satisfaction with

their clinical experience.

Libbin J., Linnea S. and Millikan W., (2001) conducted a study about Student Experience

and performance in a surgical clerkship. Phase I of this study compared students' experiences

regarding patient demographics, surgical content, and clinical skill practice in three different

hospital settings: university, community, and public. Phase II examines the aspects of clerkship

performance that contribute to students' final grades. An instrument to track the experiences of

students on their surgical clerkship was developed and piloted. Eighty medical students

successfully completed the tasks required for participation in the second phase of this study

during academic year 2000-2001. The purpose of this phase of the study was to identify the

extent to which performance factors affected the students' final clerkship grades. Data were

analyzed to compare the frequency of common surgical tasks performed and exposure to various

surgical topics and patient demographics as well as to identify factors that explain variance on

student grades. Students performed an average of 33 clinical tasks per week and were exposed to

a broad range of surgical topics. Analysis of variance results demonstrated no significant

differences between public, private, or university settings with respect to students' clinical

practice opportunities or content exposure. Clinical evaluations and National Board of Medical

Examiners scores account for 75.5 per cent of the variance in students' final grades. There was no

significant correlation between patient load and clinical task load with final clerkship grades. The

common clinical and didactic components of a surgical clerkship can balance a student's

experience with surgical topics and tasks performed. It is important to utilize this information in

program review of multisite clerkships to ascertain and enhance the validity of student

Page 17: Nursing Research Final Submission of Chapter 1-3

performance measures. It is important to utilize this information in program review of multisite

clerkships to ascertain and enhance the validity of student performance measures.

Berntsen K. and Bjørk IT. (2010) conducted a study about the Nursing students'

perceptions of the clinical learning environment in nursing homes. They have conducted a study

through a cross-sectional survey design in which nursing students in clinical placements at eight

nursing homes completed a questionnaire on one occasion. A cohort of first-year nursing

students in a bachelor degree nursing program were invited to participate in the study (N = 92).

The final sample comprised 74 students (80%). Forty-one students (55%) were younger than age

25, 16 students (22%) were between ages 25 and 35, and 17 students (23%) were older than age

35. Approximately half of the students (54%) had experience from working in nursing

institutions before entering nursing studies, and 13 students (18%) confirmed former higher

education. Clinical studies for the target group were organized in a 4- week module, with a 30-

hour workload per week. During placement, students were supervised and guided by both

teachers and nurses. Each student was allocated an RN as a preceptor. Both the preceptor and the

teacher supervised each student twice during morning care. The teacher also organized and

facilitated reflection in groups at each nursing home two times during placement. Findings show

that the students’ total mean score on the instrument indicated that students perceived their

learning environment in nursing homes as moderately positive. One reason for this may be the

supervisory system that included supervision and guidance from both nurses and clinical

teachers. The supervisory system may emphasize the ward as a context for both learning and

performance by Saarikoski et al. (2002) in which Finnish students’ positive evaluation of the

learning environment was partly explained by good supervision. A limitation of this study is the

small number of respondents, although the sample included nearly the total population of first-

Page 18: Nursing Research Final Submission of Chapter 1-3

year nursing students at the university college. Using only the scale exploring students’

perceptions of their actual learning environment, and not the scales for preferred clinical learning

environment, may also be viewed as a limitation. This study assessed only the students’

perspectives of the clinical learning environment. Including perceptions from the perspectives of

clinicians and clinical teachers would provide a broader perspective to complete the picture.

Stark P. (2007) conducted a study about the clinical learning teaching and learning in the

clinical setting. They have conducted a qualitative study using focus groups with undergraduate

medical students and semi structured interviews with hospital consultant clinical teachers. The

School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK, in which

Fourth year medical students and consultant clinical teachers were studied. Two focus groups

were convened with 10 students in each.11 Each group met once. The participants were

purposefully selected for certain variables (gender and ethnicity), and not for their

representativeness. Purposeful sampling was considered important as ethnicity and gender12

may affect perceptions and expectations of clinical teaching and relationships with senior staff.

Finding shows that Students believed in the importance of consultant teaching and saw

consultants as role models. However, they perceived variability in the quality and reliability of

teaching between physicians and surgeons. Some traditional teaching venues, especially theatre,

are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt

under severe pressure from other commitments. They taught in a range of settings and used

various teaching strategies, not all of which were perceived to be teaching by students. While

students and teachers are educational partners, they are not always in agreement about the

quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide

more high quality teaching, there needs to be support, opportunities and incentives to understand

Page 19: Nursing Research Final Submission of Chapter 1-3

curricular developments and acquire teaching skills. The methodology of this research had a

number of strengths. Most importantly, the researcher’s access to, and knowledge of the

respondents and the organizations enabled purposeful sampling to encompass the selected

variables. No consultant refused to be interviewed. It is not clear whether an unknown researcher

would have gained such easy access to the consultant participants.

Synthesis:

The mentioned studies and literatures help the researchers to understand the study and

gave a clear view of the phenomenon that the researchers were discussing. The study on

government vs private hospitals stated that there is a difference when it comes to learning in

nursing student with regards their knowledge, skills and attitudes.

Page 20: Nursing Research Final Submission of Chapter 1-3

II. Research Paradigm

Figure 1.1 Figure 1.1 Paradigm of the dependent and independent variable in correlation with the exposure of Level III IN Students to Private and Public Hospitals

III. Conceptual Framework

Nursing students are always exposed to different areas in the hospital either

private hospital or government hospital. The students clinical exposure is always

accompanied by learning which will help the students develop and enhance their

knowledge, skills, and attitude as a nurse.

Level III

IN Students

EXPOSURE

PRIVATE HOSPITAL

GOVERNMENT HOSPITAL

KNOWLEDGE

SKILLS

ATTITUDE

KNOWLEDGE

SKILLS

ATTITUDE

Page 21: Nursing Research Final Submission of Chapter 1-3

In every hospital exposure there is always a difference in government hospital

exposure and private hospital exposure regarding their learning and the enhancement of

their knowledge skills and attitude.

IV. Research Hypotheses

There are significant differences that exist between the treatments that may affect the

enhancement of skills of every nursing student that being exposed in different areas.

There are significant difference between private and government hospital exposure

among level III nursing students.

There are significant differences between private and government hospital among level

III nursing student in acquiring their knowledge, skills and attitude.

V. Variables

The Independent variable:

The independent variable of this study is the exposure of level 3 FEU nursing students in

private and government hospitals. This variable could give an affirmative or negative relation

with the dependent variable of the study. This is considered as the independent variable because

the researchers can not modify this variable, which could be exposure in private hospitals alone,

public hospitals alone, both hospitals, and even neither of the two. Private hospitals have

different advantages and disadvantages from the government hospitals. Both hospitals have

different strategies in developing the knowledge, skills and attitude of the students.

The Dependent variable:

Page 22: Nursing Research Final Submission of Chapter 1-3

The development of knowledge, skills and attitude is the dependent variable of this study.

Acquiring knowledge, skills and attitude of level 3 FEU nursing students depends on their

exposure to different kinds of hospitals because private and government hospitals offer different

kinds of learning.

VI. Definition of terms

Private Hospital

The conceptual definition of private hospital according to Webster Dictionary is a

hospital which is owned by a company which caters services which is funded through

payment by the patients.

The operational definition of private hospital a non-government owned hospital where

students are assigned to have their clinical exposure.

Government Hospital

The conceptual definition of government hospital according to Webster Dictionary is a

hospital which is owned by the government which caters services for patients for free and

is funded by the government.

The operational definition of government hospital is a government owned hospital where

students are assigned to have their clinical exposure.

Clinical Exposure

The conceptual definition of clinical exposure according to Webster Dictionary is

engaging on different areas in the hospital to gain or acquire experience.

Page 23: Nursing Research Final Submission of Chapter 1-3

The operational definition of clinical exposure is the time wherein nursing students are

having their related learning experience to acquire experience and knowledge.

Knowledge

The conceptual definition of knowledge according to Webster Dictionary is a

confident understanding of a subject which is acquired through experience and education

with the ability to use it for a specific purpose if appropriate.

The operational definition of knowledge is person’s ability to answer or react to a

situation or to something that’s been ask.

Skills

The conceptual definition of skill according to Webster Dictionary is the technique and

expertise of an ability to do something or to get something well.

The operational definition of skill is a particular ability to do something well in the

exposure.

Attitude

The conceptual definition of attitude according to Webster dictionary is a person’s way of

expressing himself which greatly affects the way she talks, move and act.

The operational definition of attitude is a person’s perspective in doing or saying things.

Page 24: Nursing Research Final Submission of Chapter 1-3

Chapter III

Research Methodology

Research Design

A correlational design was selected as the research design for this study which is a non-

experimental design. This will assess the relationship between the exposure of the level III Far Eastern

University – Institute of Nursing (FEU-IN) students in government and private hospitals, and the

development of their knowledge, skills and attitude.

Population and Sample

The participants in this study will be all the students from the FEU - Institute of Nursing who are

in the fourth level. The researchers will choose them as the participants since they have been exposed to

different private and government hospitals. With this, they can share their experiences upon having their

Related Learning Experiences (RLE) in the said hospitals during the implementation.

The population will be consisting of male and female students regardless of their age. The

researchers will use a purposive sampling technique wherein 44 sections will be clustered into four (4).

Among these four clusters, the researchers will choose the sections which had have their RLE in

government and private hospitals.

The Slovin’s formula will be used to determine the ideal sample size with a margin of error from

the population size, as shown below.

n = N/(1 + N·e²)

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where, n = sample size

N = population size

e = margin of error

The researchers will need sections, where each are composed of four (4) RLE groups which are

composed of one (1) leader, and a minimum and maximum of seven (7) and eleven (11) members each

group, respectively. Considering the possible maximum number of participants which is there will be 44

sections composing 4 groups each section with 12 members each group, therefore, the population size

will be 2112. Using the formula with 5% margin of error, the ideal sample size will be 336 participants,

or 7 sections.

Given, N = 2112

e = 5% = 0.05

n = 2112 / (1 + 2112 · 0.05²)

n = 2112 / (1 + 18000 · 0.0025)

n = 2112 / (1 + 5.28)

n = 2112 / 6.28

n = 336 students or 7 sections, since the maximum number of students each section will be 48.

Research Locale

The study will be conducted inside the campus of Far Eastern University located at

Nicanor Reyes St., Sampaloc, Manila, within the University Belt. It is a private non-sectarian

institute of learning in the Philippines. It has nine institutes that include the Institute of Nursing

that offers the Bachelor of Science in Nursing. The Institute of Nursing has level one to level

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four students and are holding classes in the Law building, the Science building and the Nursing

building.

Research Instruments

The instruments which will be used in this study are the following: the samples’ RLE grades from

their first semester in their third level, which will be used to measure the knowledge and skills; and a

modified questionnaire, provided by the researchers, which will be used to measure the attitude.

The research instrument that will be used to measure the attitude will be a modified research

questionnaire from Rebols (1996), which is a Likert-type questionnaire. The questionnaire contains 6

parts. Part I, informed consent, contains the details regarding the informed consent and profile of the

participant. It includes name (optional), age, sex and section of the participants. Part II-A contains

questions regarding quality of experience. Part II-B of the tool contains questions regarding professional

attributes of the clinical instructors who supervise the students in RLE. Part II-C contains questions

regarding variety of practices. Part II-D of the tool contains regarding professional socialization.

The participants will be asked to rate their experiences toward clinical exposures by indicating

whether they strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree with the

given statements presented.

This instrument was found out to be adequate and useful from a previous study, and was ensured

the validity of the content using the following validation techniques:

1. Consultation with the Research Specialists. The questionnaire was given to a

statistician and qualified nursing professor. They were asked if all the items are clear and

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unequivocal and suited the level of comprehension of the participants. Additionally, they were

consulted whether the instrument used answered the problems presented in the statement of the

problem. The comments and suggestions elicited where incorporated to the final questionnaire.

2. Reliability. In determining the level of accuracy of how the contents of the questionnaire

measures the quality of experiences, characteristics of clinical instructors, variety of practices

and professional socialization, a set of questions from a portion dissertation of Rebolos, M.D.

(1996) was used with little modifications. This ensured that the contents of the questionnaire

where sufficient in addressing of the objectives of the study thus making the questionnaire valid

in content wise.

On the flip side, reliability of the questionnaire ensures the consistency of results over time.

Fifteen randomly selected 3rd year students were used in the reliability analysis. The randomly chosen

respondents were not included in the actual data gathering. Moreover, Coefficient of Internal Consistency

was used to determine whether the questionnaire is reliable or not. Coefficient of Internal Consistency is

the coefficient obtained when two equivalent halves of the same test where correlated. A formula was

used to estimate the reliability of the test. Items in the questionnaire were divided according to their

assigned numbers, either odd or even. The scores of add numbered responses were correlated with the

total scores of the responses to even numbered responses.

The reliability of one half of the questionnaire was computed by using the Pearson R. Further

more, the spearman-brown split half reliability coefficient was also computed and this indicates the

reliability of the questionnaire. With the entire spearman-brown split half reliability coefficient of the four

categories greater than 0.90, we can conclude that the questionnaire and scales is reliably good.

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Category Number of

statements

Pearson Rho Split-half coefficient

Quality of experience 8 0.87 0.930

Characteristics of CI 7 0.822 0.902

Variety of Pac 11 0.965 0.982

Professional 10 0.871 0.931

Table1. Summary of Reliability Analysis.

The researches then personally distributed the copies of the questionnaire to the participants, and

approximately collected it after 10 minutes.

Data Collection

The letter for permission will be submitted to Dean Glenda Arquiza of Institute of Nursing for

validation and approval.

Prior to data collection, the researchers will be divided into two groups so that the implementation

will be done faster. The first group will be asked for the permission of the professor, will give the

introduction, and will explain the purposes of the study. The second group will be distributing the

questionnaires. Both groups will be then scouting for participants around the FEU campus for possible

sections to be interviewed. In addition, the questionnaires will be strictly given for level four nursing

students only.

The researchers will focus on the Law building, Nursing building and Science Building since level

four nursing students mostly have their classes in these buildings. After finding the sections, the

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researchers will introduce themselves and the purpose of the study to the professor. After gaining the

consent of the professor, researchers then will make an introduction to the respondents. Then, the purpose

of the study is to explore the difference between clinical exposure to government and private hospitals in

acquiring knowledge, skills and attitudes. Participants were assured of anonymity and confidentiality.

They will be given a choice to participate or refuse in the study. Along with handing out the

questionnaires, the consents will be also given. They will be then instructed to answer the questionnaires

according to their own perspective and not from other’s answers. No time limit will be given, so that the

respondents could answer the questions about the different clinical exposure of nursing student in both

private and government hospital without pressure. After all of the respondents are finished, the

questionnaires were collected. The researchers will then check if there were any missing or incomplete

data, and some incomplete data will be brought back to the respondent who answered it through

communicating with their class mayor.

A statistician was then hired to compute for the demographic profile of the respondents by the use

of a percentage calculation. Next, the effects of networking sites on academic performance of students

were also calculated and tabulated. Lastly, the computation for Pearson scale was done to determine the

relationship between the variables and verify or invalidate our hypothesis.

Statistical Treatment of Data

The data gathered from the actual RLE grades and the questionnaires will be presented in charts,

tabulated, classified, and tallied in tables using frequency and percentage.

To answer the research questions: “Is there significant difference between the status of

government hospital and private hospital?”; “Is there a significant difference between the clinical

exposure in Private Hospital and Government Hospital?”; and “Is there a difference between hospital

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status and clinical experience?”, the statistical test which will be used is the independent group t-test or

also known as the pooled t-test.

Independent group t-test (Pooled t-test)

A statistical test used to compare the means of two independent groups (e.g., 1 and 2, where

1 and 2 are population 1 mean and population 2 mean, respectively). The assumptions will be the

following: 1 and 2 are unknown but assumed to be equal; the samples are selected randomly; the

samples are selected independently; and the samples are from normally distributed populations, where 1

and 2 are the population variances of groups 1 and 2, respectively.

First, select the level of significance, , where 0.05 is commonly used. Then define 1 and 2

in the context of the problem. The 1 for this study will be the exposure of nursing students in

government hospitals, and 2 will be the exposure of nursing students in private hospitals, where both are

in relation to the acquirement of the students’ knowledge, skills and attitude.

Then, the null hypothesis (Ho) will be stated as follows:

Ho: 1 = 2 (means of the two groups are equal)

And then, an alternative hypothesis will be chosen from the following:

a. Ha: 1 ≠ 2 (means of the two group are not equal)

b. Ha: 1 < 2 (mean of group 1 is less than the mean of group 2)

c. Ha: 1 > 2 (mean of group 1 is greater than the mean of group 2)

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The test statistic for this is the t (t statistic), with n1 + n2 - 2 degrees of freedom, where n1 and n2

are the sample sizes for groups 1 and 2. A low p-value for this test (e.g., less than 0.05) means that there

is evidence to reject the null hypothesis in favor of the alternative hypothesis, or there is evidence that the

difference in the two means is statistically significant.

The test statistic can be calculated by first computing for the pooled standard deviation using the

formula:

, where s1 and s2 are sample 1 and sample 2 standard deviations, then

calculate the test statistic using the formula:

, where and are the sample means of group 1 and 2.

Finally, find the P-value (observed significance level) using a t distribution with degrees of

freedom (df ):

Each case corresponds to the alternative hypotheses listed above.

a.) b.) c.)

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The conclusion would be: Reject H0 if the P-value is less than the level of significance; otherwise, do not

reject H0. When H0 is rejected the result is “statistically significant”.

Ethical Consideration

The researchers emphasized the need for major ethical considerations in performing the study to

make sure that confidentiality, safety privacy, and right of the objects are protected. Ethical principles

used are the principle of justice, beneficence, and of human dignity.

a. Principle of Justice

In this research we will treat every participant the right to receive fair treatment and the right

to privacy. The Privacy is maintained by which individuals will be informed of uses and disclosures

of their confidentiality information for research purposes, and their rights to access information about

them held by covered entities. Where research is concerned, the Privacy protects the privacy of

individually identifiable health information, while at the same time ensuring that researchers continue

to have access to information necessary to conduct vital research. Fair treatment will be provided by

giving each and everyone the same questionnaire with the same instructions in it.

The researchers have treated each respondent equally and fairly, same treatments and

procedures were done to all other respondents. The researchers made it sure that all the information

about the subjects will be kept confidential by disclosing the information between the researchers and

the respondent only.

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b. Principle of Beneficence

The researchers aims to provide this principle as doing no harm and actively contribute to the

health and well being of their participants, wherein all participants in this study will be free from

harm both physically and psychologically. The researchers won’t induce stress and fear

psychologically through proper explanation, providing comfort and entertained questions and

answering it appropriately and completely in every person who will participate in the study. Every

participant has the free will to drop out if they feel too.

c. Principle of respect for Human Dignity and Autonomy

In this research the participants is communicated a decision based on their understanding.

Informed consent is a vital part of the research process, and as such entails more than obtaining a

signature on a form. Inform consent will give the participants the capacity to intentionally understand

and have no control influences that will initiate a free and voluntary act and can withdraw the

research any time they wish too. The researchers will give informed consent depends on: 1) adequate

disclosure of information; 2) patient freedom of choice; 3) patient comprehension of information; and

4) patient capacity for decision-making. The researchers aim to achieve three necessary conditions: 1)

that the individual’s decision is voluntary; 2) that this decision is made with an appropriate

understanding of the circumstances; and 3) that the patient’s choice is deliberate insofar as the patient

has carefully considered all of the expected benefits, burdens, risks and reasonable alternatives.