thesis entitled "degree of competency of nursing students in the implementation of ethical...

7/29/2019 Thesis entitled "Degree of Competency of Nursing Students in the Implementation of Ethical Guidelines for Nursin

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Chapter 1

INTRODUCTION

Background of the Study

For the past 20 years, the National Council of State Boards

Nursing (NCSBN) has asserted its focus on continued competence,

although only within the past 11 years have formally defined

competence as the application of knowledge and the interpersonal,

decision-making and psychomotor skills expected for the practice role,

within the context of public health, safety and welfare. Theorists hold

that understanding the process of ethical competency acquisition and

applying its result is to be used to develop a profession, to modify job

description and employment, and to promote effective education. The

researchers prompted to conduct the study to assess the competency

of nursing students in the implementation of ethical guidelines for

nursing practice.

Since nursing is a unique health care profession that is

composed of a unique body of knowledge, standard clinical practices,

and healthy attitude towards caring, it is important to appreciate the

importance of these attributes in understanding the many concepts

related to the nursing profession. One should understand that the

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things nurses perform on, to, and for their patients are anchored on

well-established facts and principles. It means that, in order for nurses

to fully functional well, they should be well-equipped with all the

knowledge with which they can rationalize their nursing actions in the

clinical area.

Health care ethics is concerned with the rights, responsibilities,

and obligations of health care professionals, institutions of care, and

clients. Upon entering the profession of nursing, nurses accept the

responsibilities and trust that have accrued to nursing over the years

and also the obligation to adhere to the professions's code for ethics.

The Code for Nurses, published by the American Nurses Association, is

the standard by which ethical conduct is guided and evaluated by the

profession. It provides a framework within which nurses can make

ethical decisions and discharge their professional responsibilities to the

public, to other members of the health team, and to the profession.

Over the last 100 years, nursing has evolved into a very complex

professional field. Nurses are now faced with life and death decisions,

sometimes on an hourly basis. Medical care has advanced to the point

that new technology with its potential benefit or harm to a patient

changes constantly. Although the private conduct of a nurse is no

longer controlled by the employer, the effects of that lifestyle on the

nurse's ability to think and respond to patients while on duty falls

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under the code of ethics.

Indeed, the concern about code of ethics is very important for it

will give an assurance of competency for nursing students. The code

covers nurses' responsibilities toward clients' rights and to work toward

improving the practice of nursing. It requires protection for clients and

the public where ethical, practical and legal matters are concerned.

This study will help the student nurses to further their knowledge

regarding nursing practice for them to be a competent and qualified,

execute good judgment and improve the standards of quality nursing

care.

Theoretical Framework

According to Benner (2011), clinical nursing requires theoretical

knowledge and practical knowledge. Theoretical knowledge can be

acquired in an abstract fashion through reading; observing and

discussing. On the other hand, the development of practical knowledge

requires actual experience in a situation because it is contextual and

transactional. Benner stated that, Knowledge development in a

practice discipline consist of extending practical knowledge know-how

through theory-based scientific investigation and know-how develop

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through clinical experience in practice of that discipline. Clinical

embodies the notion of excellence by studying practice, nurses can

uncover new knowledge.

Benners Dreyfus model of skill acquisition and skill

developments are novice, advanced beginner, competent, proficient

and expert.

Stage 1: Novice

Beginners have had no experience of the situational in which

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

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

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

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

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

Stage 2: Advanced Beginner

Advanced beginner is those who can demonstrate marginally

acceptable performance, those who have coped with enough real

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

recurring meaning situational components. These components require

prior experience in actual situations for recognition. Principles to guide

actions begin to be formulated. The principles are based on

experience.

Stage 3: Competent

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

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

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

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

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

considerable conscious, abstract, analytic, contemplation of the

problem, The conscious, deliberate planning that is characteristics of

this skills levels help achieve efficiency and organization. The

competent nurse lacks speed and flexibility of the proficient nurse but

does have a feeling of mastery. The competent person does not yet

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

picture or in terms of which aspects are most silent, most important.

Stage 4: Proficient

The proficient performer perceives situations as whole rather

than in terms of chopped up parts or aspects, and performance is

guided by maxims. Proficient nurses understand a situation as a whole

because they perceive its meaning in terms of long term goals. The

proficient nurse learns from experience what typical events to expect

in a given situation and how plans need to be modified in response to

these events. The proficient nurse can now recognize when the

expected normal picture does not materialize. The holistic

understanding improve the proficient nurses decision-making; it

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becomes less labored because the nurse now has a perspective on

which of the many existing attributes and aspects in the present

situation are the important ones.

Stage 5: The Expert

The expert performer no longer relies on an analytic principle

(rule, guideline, and maxim) to connect her or his understanding of the

situation to an appropriate action. The expert nurse, with an enormous

background of experience, now has an intuitive grasp of each situation

and zeroes in the accurate region of the problem without wasteful

consideration of a large range of unfruitful, alternative diagnosis and

solutions.

We have used this theory because it introduces the concept of

each steps from novice to expert for the better understanding of what

it means to be a competent or those who provide the most exquisite

nursing care specially in using ethical guidelines that would served as a

guide in making this study.

Conceptual Framework

Figure 1 illustrates the conceptual framework of the study. The

input is composed of the profile of the students and clinical instructors

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and the degree of competency of nursing students in the

implementation of ethical guidelines for nursing practice which will be

gathered by collection, analysis, and interpretation of data through

questionnaires which will be rated using the Likert scale from highly

competent, moderately competent, competent, slightly competent,

and incompetent. The output are the proposed measures to improve

the degree of competency of nursing students in the implementation of

ethical guidelines for nursing practice.

Input Process Output

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I. Profile of nursingstudents

a. Age

b. Genderc. Civil status

d. Religion

e. Year level

f. Socio-economic statusII. Profile of nursing

instructors

a. Ageb. Gender

c. Civil status

d. Religione. Highest degree earned

f. Area of assignment

III. Degree of competencyof nursing students in

the implementation of

ethical guidelines for

nursing practice

Collection,

analysis, and

interpretation ofdata through

questionnaires that

will be rated usingLikert scale from

highly competent,

moderately

competent,competent, slightly

competent, andincompetent.

Proposed measures to

improve the degree of

competency of nursingstudents in the

implementation of ethical

guidelines for nursing

practice.


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Figure 1. Research Paradigm

Statement of the Problem

The study aims to determine the degree of competency of

nursing students in the implementation of ethical guidelines for nursing

practice. The study also aims to propose measures to improve the

degree of competency of nursing students in the implementation of

ethical guidelines for nursing practice.

The study seeks to answer the following queries:

1. How are the nursing student respondents characterized as follows:

a. Ageb. Genderc. Civil statusd. Religione. Year level, andf. Socio-economic status?

2. What is the profile of the clinical instructor respondents in terms of:

a. Ageb. Genderc. Civil statusd. Religione. Highest degree earned, andf. Area of assignment?

3. What is the degree of competency of nursing students in the

implementation of ethical guidelines for nursing practice?

4. What measures can be proposed to improve the degree of

competency of nursing students in the implementation of ethical

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guidelines for nursing practice?

Assumption

This study is premised on the following assumptions:

1. The possibility of miscommunication increases when the nurse and

patient speak different languages.

2. All patients need support toward health.

3. Nurses may be differentiated from other health care providers by

their approach to patient care, training, and scope of practice.

4. Religious belief contribute substantially to the formation of medical

practices of every individual.

Scope and Delimitations of the Study

The respondents of this study will be the 350 selected nursing

students and clinical instructors of Pangasinan who were chosen by

purposive sampling. The researchers will choose seven institutions

offering nursing such as Colegio de Dagupan, Lyceum Northwestern

University, Panpacific University North Philippines, Pangasinan State

University - Bayambang, University of Pangasinan, Urdaneta City

University, and Virgen Milagrosa University. The emphasis of this study

was placed on the Degree of competency of nursing students in the

implementation of ethical guidelines for nursing practice. The actual

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http://en.wikipedia.org/wiki/Health_care_providershttp://en.wikipedia.org/wiki/Nursing_theoryhttp://en.wikipedia.org/wiki/Nurse_educationhttp://en.wikipedia.org/wiki/Scope_of_practicehttp://en.wikipedia.org/wiki/Nursing_theoryhttp://en.wikipedia.org/wiki/Nurse_educationhttp://en.wikipedia.org/wiki/Scope_of_practicehttp://en.wikipedia.org/wiki/Health_care_providers


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study on the respondents will be conducted from June to October 2013

and was based on primary data sources which are information coming

directly from the respondents through the questionnaires; and from the

secondary data sources which came from the published and

unpublished materials such as books, journals, websites, theses and

dissertations.

Significance of the Study

The study was conducted mainly to determine the degree of


guidelines for nursing practice. This study was significant specifically to

the following:

Nursing Students. They will gain more knowledge on the different

ethical guidelines for nursing practice. They will be able to learn some

alternative techniques or actions on how to at least improve their

competencies. Nursing students will somehow be ready in handling

ethics. They will be competent and be effective nurses someday.

Clients. This study will enable them to become aware about the

practice of nursing as well as to improve the quality nursing care

needed for their improvement.

College of Nursing, Administrators, and Faculty. This study

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will give them knowledge on the current degree of competency of

nursing students regarding the implementation of ethical guidelines for

nursing practice. They must display the knowledge and skills required

to enhance nursing student competency, which will optimize the high

standards of patient care.

Future Nursing Researchers. This study will provide additional

information and new insight as well as on such topics in Student Nurse

Competency, which hopefully, will be developed by future researchers

to make it more responsive and updated to the needs of others with

similar situation. This study will also serve as guide and source of

information to the future researchers thus make them finish their paper

easier and faster.

Definition of Terms

The following are terms defined by the researchers to ensure

clearer understanding and appreciation of the study:

Degree of competency. Means the measure of the relative degree

or extent of that competency of nursing students for nursing practice

using ethical guidelines which will be rated using the Likert scale from

highly competent, moderately competent, competent, slightly

competent, and incompetent.

Ethical guidelines. This term refers to the principles that guide an

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individual, group, or profession in conduct. The study of ethics has led

to the identification of basic concepts including rights, autonomy,

beneficence, nonmaleficence, justice, and fidelity. Understanding these

concepts assists the nursing students with making decisions during

difficult situations.

Nursing students. The term refers to 350 individuals who belong

to the second, third, and fourth year students taking Bachelor of

Science in Nursing from Colegio de Dagupan, Lyceum Northwestern

University, Panpacific University North Philippines, Pangasinan State

University - Bayambang, University of Pangasinan, Urdaneta City

University, and Virgen Milagrosa University.

Nursing Practice. This term refers to the provision, at various

levels of preparation, of services essential to or helpful in the

promotion, maintenance, and restoration of health and well-being or in

prevention of illness, as of infants, of sick and injured, or of others for

any reason unable to provide such services for themselves.

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Chapter 2

REVIEW OF RELATED LITERATURE

This chapter deals with the significant information that improves

the study so as to establish a reliable source of understanding on the

research with adequate awareness by current literature about the

subject matter.

Conceptual Literature

People in every field are confronted with ethical issues of some

kind. However, these issues become high in magnitude and extent

when public officials are involved. An industry like health and medicine

holds ethics in highest regard due to the involvement of human life.

Oftentimes, health care practitioners like doctors and nurses face

ethical dilemmas in their professional lives. Although, they are often

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trained to manage issues of this kind, sometimes, they can have

lasting impact on their professional and personal lives. The general

awareness among masses regarding their rights during a medical

procedure often conflicts with the morals of this industry (Sule, 2010).

Ethics is concerned with right and wrong, although agreeing

what is right can be challenging. An understanding of ethics is

essential to the delivery of skilled professional care. It is vital that

nurses appreciate the value of ethics in their work. Ethics is relevant to

clinical, practice-based issues and affects all areas of the professional

nursing role. To apply ethics effectively, nurses must develop reasoning

skills and understand the concepts and principles that assist ethical

analysis (Chaloner, 2008).

Nurses need to distinguish between their personal values and

their professional ethics. Personal values are what nurses hold

significant and true for themselves, while professional ethics involve

principles that have universal applications and standards of conduct

that must be upheld in all situations. Nurses thus avoid allowing

personal judgments to bias client care. They are honest and fair with

clients, and they act in the best interest of and show respect for them

(2009).

According to the study, the most common situations that create

ethical and moral distress in nurses in the workplace include: issues

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concerning patient rights and advocacy, end of life care, conflicts,

balancing technology and care, and caring for the acute, chronic and

emergently ill. Many nurses also reported feeling conflicted in their

decision making or felt they were unable to carry out certain decisions,

contributing to the overall feelings of moral distress. Nurse leaders

believe that an unhealthy ethical climate may have far more negative

implications than anyone realizes (Melissa, 2009).

An award-winning journalist spoke to a group of students during

their first month in a baccalaureate nursing program, challenging the

nursing profession to abandon its image of nurses as angels and

promote an image of nurses as competent professionals who are both

knowledgeable and caring. This presentation elicited an unanticipated

level of emotion, primarily anger, on the part of the students. This

unexpected reaction prompted faculty to explore the students'

motivations for entering the nursing profession and their perceptions of

the relative importance of competence and caring in nursing. The

authors begin this article by reviewing the literature related to

motivations for selecting a profession and the contributions of

competence and caring to nursing care. Next they describe their

survey method and analysis and report their findings regarding student

motivations and perceptions of competence and caring in nursing.

Emerging themes for motivation reflected nursing values, especially

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altruism, and coincided with students' beliefs of self-efficacy and goal

attainment. Student responses indicated their understanding of the

need for competence and revealed idealistic perceptions of caring. The

authors conclude with a discussion of these themes and

recommendations for student recruitment, curricular emphasis, and

future research in this area (Rhodes, 2011).

Nursing practice is constantly evolving, particularly in relation to

prescribing, first contact and urgent care, and specialist practitioner

and nurse-specialist roles. The development of history taking skills is

fundamental for practitioners in these areas. The nurse must ensure

the patient is thoroughly assessed with a complete clinical and

medication history. A comprehensive history can provide more than 80

percent of the information on which to base a diagnosis (Fox, 2010).

The nurse-patient relationship can be complicated by a patients

fear that private health information will be revealed or incriminating

information given to law enforcement officials. It may help if the nurse

reviews privacy rights of the patient and explains that the only

information shared with others is that authorized by the patient or

required by law. In cases in which the nurses responsibilities to the

patient and public appear to diverge, its essential that the nurse avoid

offering legal advice and seek help of the hospitals risk managers and

legal counsel (Brous, 2008).

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Protection of patients privacy and the confidentiality of their

medical information has long been a tenet of nursing ethics and

practice. Its a central theme of the Nightingale Pledge, and the

American Nurses Associations Code of Ethics for Nurses says in

provision 3.1, in part, The need for health care does not justify

unwanted intrusion into the patients life. Provision 3.2 notes that,

The patients well-being could be jeopardized and the fundamental

trust between patient and nurse destroyed by unnecessary access to

data or by the inappropriate disclosure of identifiable patient

information (Wielawski, 2009).

Advanced - practice nurse are legally and ethically obligated to

obtain informed consent before performing risky or invasive treatments

or procedures within their scope of practice. All nurses are required to

explain nursing treatments and procedures to patients before

performing them. Nursing procedures do not need to meet all of the

requirements of informed consent if procedures are not risky or

invasive (Dempski, 2009).

It is now expected that errors involving serious, preventable

adverse events be reported to patients as well as to other

organizational reporting systems, on a mandatory basis. Reporting

"nearmisses" (errors that cause no harm to patients) are more

controversial. Some professionals tend to avoid telling patients about

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"nearmisses" errors since no harm was done to the patient, but

ethicists recommend disclosure of these events. Being honest and

forthright with patients promotes trust, and secrecy is unethical

(Jonsen and Winslade, 2010).

Tinkering with the medication regimen can have serious

consequences, including adverse drug interactions or treatment failure.

You need to get to the bottom of this pronto, keeping two points in

mind. First, the healthcare provider may have given this patient dosage

adjustment guidelines to follow depending on her condition. For

example, if a patient being treated for heart failure gains 3 pounds in 2

to 3 days, the patient may be instructed to increase the furosemide

dose for 1 day. Second, the need for more medication may signal

deterioration of the patients condition. The healthcare provider needs

to be informed to reevaluate the patients condition and modify the

treatment plan, if indicated (Salladay, 2009).

Most nurses are not legally responsible for prescribing the

correct medications but are obligated to ensure the appropriateness of

the medications patients receive. For example, nurses should review

culture-and-sensitivity results as soon as they are available and act

when a medication needs to be changed. Be proactive: make looking at

laboratory results a part of your practice when reviewing a chart for

the first time, then ensure that the culture - and sensitivity results are

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back whenever a new order is written (Flaherty, 2008).

Environmental safety is a priority. Keep all supplies that can

cause injury, such as small objects, cables, and cords, out of reach.

Choking hazards can be anywhere. Plastic bags or disposable

absorbent pads can also be a suffocation risk. Keep side rails or crib

rails up, as appropriate. Make sure your patient is wearing an ID band.

Many facilities use security bands that function to help locate patients.

Be familiar with your facilitys abduction prevention plan and institute

these measures as appropriate in your unit (Parsh and Sillman, 2010).

The combination of transitional care, necessitating care both

inside and outside the hospital, and the large number of chronically ill

persons who require care outside of the hospital highlight the

importance of community health as integral to nursing education.

Nurses are in positions to manage community health clinics, embracing

interprofessional practice with social workers, pharmacists, dentists,

physicians, among others. Nursing schools need to emphasize

community health and teach nurses about the various important ways

in which they can be involved in delivering health care (Olshansky,

2011).

Chronic illness is embedded in the local flow of moral

experience, in the struggles of individuals to craft a moral life, and in

the aspiration for ethical values that extend beyond a local world and

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that speak to questions of fairness, justice, doing good in the world and

the largely unmarket yet deeply pro-social value of caregiving

(Kleinman, 2010).

Quality teachers are the single greatest determinant of student

achievement. Studies have found that 40 to 90 percent of the

difference in student test scores can be attributed to teacher quality.

Knowing the subject matter, understanding how students learn, and

practicing effective teaching methods translate into greater student

achievement. Therefore, it is vitally important that teachers be well

prepared when they begin teaching and that they continue to improve

their knowledge and skills throughout their careers

(www.studymode.com, 2011).

Although each individual nurse educator can make a positive

impact, the greatest impact will be achieved through a coordinated,

holistic group effort that strategically integrates optimal cultural

competence development throughout all aspects of the nursing

program and addresses diverse students needs. The acronym

COMPETENCE is presented here to assist deans, directors, and faculty

in remembering several essential elements for cultural competence

development in academic settings. COMPETENCE refers to Caring,

Ongoing, Multidimensional, Proactive, Ethics, Trust, Education,

Networks, Confidence, and Evaluation (2012).

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The point to consider is that the competency of a nurse is judged

not on the basis of his or her theoretical performance, but on the

practical, clinical one while caring for his or her patients. This would

require that the nurse be able to handle a variety of clinical situations

with ease, and be able to make correct decisions in order to provide

the most proper treatment for the patient competency naturally

therefore has a very far reaching influence in the nursing as well as the

health care system (www.directorys.uniquearticles.info, 2008).

For the individual registered nurse, competence may mean

practice beyond the established contemporary or traditional scope of

practice to include new technology, increasingly autonomous roles,

management of health concerns with chronic conditions, and through

activities previously considered within the scope of other health

professional (Nursing Council of New Zealand, 2010).

Government health policy and employer-base initiatives may

also drive shifts in nursing scope of practice such as seen in recent

announcements of new and reallocated finding for a range of nursing

initiatives in rural, mental health and primary care areas (Rusell, 2010).

Research Literature

The aim of this literature study was to suggest a value ground

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for nursing anchored in two ethical principles: the principle of human

value and the right to experience a meaningful life. Previous nursing

research between the years 2000 and 2009 was analysed. Presented

values suggested in this value ground are thus in line with the nursing

context and science of today. Statements within ethical literature have

been used in order to formulate arguments aimed at supporting the

values that were found in the study. In the literature study six values

were found: trust, nearness, sympathy, support, knowledge and

responsibility. These values hold equal status and are not presented in

hierarchical order. They vary due to the persons involved, nursing

situations and cultural surroundings, but have the common

requirement of being non-excluding. In order to implement the values

within the value ground, two prerequisites are discussed and claimed

as essential: ethical dialogue and a caring encounter between care

provider & patients (Snellman, Ingrid and Gedda, Kersti M., 2012).

A quality health care system provides good health to the public

in forms that are delivered in the most convenient on client friendly,

cost-efficient and most effective system possible. The nursing

education, therefore, need to address those expectations in the light of

changing environment. Today's population is so diverse in terms of the

nature and the prevalence of illness and diseases requiring changes in

nursing practice from purity clinical. Programs experiences focus

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ethnographic approach capable of providing safe and competent care

in uncertain, rapidly changing and complex situations. Nurses should

be able to manage the extensive workload of patient care. Make

effective clinical judgments and decisions relevant to patient care has

minimum entry requirement, there is increasing trend among nurse

leaders of developing countries to endurance entry level of nursing

skills (Cruz, Simon L., 2012).

According to the study conducted that determined the

theoretical and clinical skill competencies of Lyceum Northwestern

University student nurses, the student nurses were perceived to be

weakest in the area of research, among all key areas of responsibility,

and strongest in the area of personal and professional development. In

terms of clinical skills competency, student nurses were found to be

least competent in ethico-moral responsibility but highly competent in

safety (Tabucao, Tagapulot, Tan and Tailit, 2012).

Chapter III

RESEARCH METHODOLOGY

This chapter of the study shows the method and procedures that

were utilized during the research. In this chapter includes research

design used by the researchers in the conduct of the study, source of

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data, instrument and data collection utilized, and tools for data

analysis.

Research Design

The researchers utilized the descriptive quantitative method of

research using survey questionnaire as data gathering tool in this

study. Descriptive survey method is a fact finding process with

adequate and accurate information and interpretation of the findings.

This design was used by the researchers because it describes and

documents aspects of a situation as it naturally occurs (Polit and Beck,

2008). The study determined the degree of competency of nursing

students in the implementation of ethical guidelines for nursing

practice.

Source of Data

The research was conducted in selected nursing schools in

Pangasinan such as the second, third, and fourth year students taking

Bachelor of Science in Nursing from Colegio de Dagupan, Lyceum

Northwestern University, Panpacific University North Philippines,

Pangasinan State University - Bayambang, University of Pangasinan,

Urdaneta City University, and Virgin Milagrosa University. The subject in

this study was two hundred eighty (280) nursing students. They, the

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researchers used the seventy (70) clinical instructors to evaluate the

students clinical performance. Forty (40) nursing students and ten (10)

clinical instructors will be the respondents in every nursing schools

selected in Pangasinan. There is a total of three hundred fifty (350)

respondents coming from seven institutions offering nursing in

Pangasinan.

The researchers used purposive sampling in determining the

sample size of the total population used in the study.

The data gathered reveal the degree of competency of nursing

students in the implementation of ethical guidelines for nursing

practice was emphasized in this study.

Instrumentation and Data Collection

The researchers first accomplished the letter of request to

conduct the study addressed to the president of the university, Dr.

Gonzalo T. Duque thru the dean of the College of Nursing Mrs. Judith M.

Manuel. Upon approval of the request, the researchers then gathered

the necessary information.

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Figure II. Map of Selected Nursing Schools in PangasinanA cover letter was provided on the questionnaire for guidance

and instruction in precise accomplishment of the tool. In order to

provide anonymity of the respondents, the researchers explained to

them that the indication of name was optional. Researchers also rest

26

Colegio DeUniversity of

Lyceum

Northwestern Panpacific University

North Philippines

Virgen

Milagrosa

Urdaneta

City

Pangasinan State

University -


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assured that the confidentiality of the results is observed all

throughout the study.

The researchers gathered the necessary information from

qualified level II, III, and IV nursing students of different schools

selected in Pangasinan. The researchers utilized a survey questionnaire

to gather these data. The researchers utilized the survey

questionnaires since they wanted extract specific information. The

researchers needed to collect the appropriate data, and make data

comparable and amenable to analysis. The researchers first asked

permission from the Dean of the College of Nursing after which it was

approved henceforth.

The survey questionnaire, which the researchers prepared, and

were critiqued and approved by their research professor, Dr. Marjorie

Fernandez, was based from the Nursing Core Competency that the

Board of Nursing enforced through "Article 3 Sec. 9 (c) of R.A. 9173 -

Philippine Nursing Act 2002."

The survey questionnaire has two parts. The first refers to the

profile of the respondents followed by the degree of competency of

nursing students in the implementation of ethical guidelines for

nursing practice.

Questionnaire guided the respondents in answering questions

relevant to the study. It is the most suitable method in gathering the

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data to measure and/or describe a mental concept or construct

according to specified variables.

Questionnaire using five point Likert scale was utilized to the

facilitation data gathering. It was used in both sex of participants and

offered in English form that is understandable by the respondents. The

study used the Likert scale to determine the degree of competency of

nursing students in the implementation of ethical guidelines for

nursing practice.

Tools for Data Analysis

The data gathered were tabulated, computed, and analyzed

using frequency and percentage and average weighted mean.

To answer sub-problem number one and two regarding the

profile of the nursing students and clinical instructors, the researchers

made use of frequency and percentage.

The percentage and frequency distribution will be used to

classify the respondents according to personal background variables

such as age, gender and religion. The frequency also presented the

actual response of the respondent to the specific question or item in

the questionnaire. On the other hand the percentage of that item is

computed by dividing it with the sample total number of respondents

and to be multiplied to 100%. This is being used in the study to

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facilitate and hasten understanding about the data gathered, and to

have better appraisals of the data. The formula use in application of

this technique is:

% = ( F/n)x100

Where:

% = Percentage

F= Frequency of observe phenomenon

n = Total number of cases

To answer sub-problem number three referable to the degree of


guidelines for nursing practice, the researchers will use the weighted

mean.

Weighted mean can be used when each individual data value

might actually represent a value that is used by multiple people in your

sample. The weight, then, is the number of people associated with that

particular value. The method is used in conjunction with the Likert

Scale. It was solved by the formula:

WM = wXw

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Where:

WM = Weighted mean

w = Weighted factor

X = Observed factor

The Likert scale method of summated rating will be used in the

study. The Likert scaling technique assigns one scale value of each of

the different responses. To analyze responses to a Likert scale, each

category is assign to a numerical value.

The total assigned value will be determined by using the

weighted mean. The scoring system for each item must be such a high

score consistently reflects a highly competent response and a low

score consistently reflects an incompetent response.

The consolidated points from the respondents answers to each

item over a five-point scale where follows:

Scale Arbitrary Value Descriptive Interpretation Symbol

5 4.20 5.00 Highly Competent HC

4 3.40 4.19 Moderately Competent MC

3 2.60 3.39 Competent C

2 1.80 2.59 Slightly Competent SC

1 1.00 1.79 Incompetent I

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Bibliography

1. Books

Sule, Ashwini. ETHICAL ISSUES IN NURSING, September 2010

Chaloner, Chris, ethics adviser, Royal College of Nursing, London.

AN INTRODUCTION TO ETHICS IN NURSING, 2008.

Melissa, Wirkus, associate editor. MORAL AND ETHICAL DISTRESS A

HEAVY BURDEN FOR NURSES, 2009. AMN Healthcare Inc.

Redman, Barbara K. ADVANCED PRACTICE NURSING ETHICS IN

CHRONIC DISEASE SELF-MANAGEMENT, 2010. Springer

Publishing Company. 11 West 42nd Street, New York, NY 10036.

Jeffreys, Marianne R., EdD, RN. INTEGRATING CULTURAL

COMPETENCE IN THE ACADEMIC SETTING, volume 33 # 3,

January February 2012

Andre, Kate. EVIDENCE OF CONTINUING COMPETENCE, 2011.

Elsevier Australia Company. Tower 1475 Victoria Avenue,

Chatswood, NSW 2067.

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Heartfield, Marie. EVIDENCE OF CONTINUING COMPETENCE, 2011.

Elsevier Australia Company. Tower 1475 Victoria Avenue,

Chatswood, NSW 2067.

2. Journal Article

Rhodes, Marilyn K., EdD, MSN, RN, CNM, et. al. ONLINE JOURNAL

ISSUES OF NURSING, 2011

Fox, Alecia S., MSN, FNP-BC. ADVANCE FOR NURSES, volume 10 # 5,

March 2010. Merion Publications Inc. 2900 Horizon Drive, Box

61556, King of Prussia, PA 19406-0956.

Brous, Edie A., MPH, MS, JD, RN. AMERICAN JOURNAL OF NURSING,

volume 109 # 8, August 2008. Lippincott Williams and Wilkins.

333 Seventh Avenue, 19th floor, New York, NY 10001.

Wielawski, Irene M., AMERICAN JOURNAL OF NURSING, volume 109

# 7, July 2009. Lippincott Williams and Wilkins. 333 Seventh

Avenue, 19th floor, New York, NY 10001.

Salladay, Susan A., RN, PhD. NURSING2009, volume 39 # 12,

December 2009. Lippincott Williams and Wilkins. 323

Norristown Road, Suite 200, Ambler, PA 19002-2758.

Flaherty, Ellen, PhD, GNP-BC. AMERICAN JOURNAL OF NURSING,

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volume 108 # 6, June 2008. 333 Seventh Avenue, 19 th floor,

New York, NY 10001.

Parsh, Bridget, EdD, MSN, RN, CNS and Sillman, Christina, BSN, RN.

NURSING2010, volume 40 # 5, May 2010. Lippincott Williams

and Wilkins. 323 Norristown Road, Suite 200, Ambler, PA

19002-2758.

Olshansky, Ellen, DNSc, RN. JOURNAL OF PROFESSIONAL NURSING,

volume 27 # 5, September October 2011. Elsevier Inc. 1600

JFK Blvd., Philadelphia, PA 19103-2899.

3. Theses and Dissertations

Snellman, Ingrid and Gedda, Kersti M. NURSING ETHICS, April 2012.

First Published Dissertation.

Cruz, Simon L. COMPETENCY OF NURSING STUDENTS IN

PRACTICING SAFE AND QUALITY CARE AMONG PATIENTS IN

FEMALE MEDICAL WARD AT DR. JOSE RODRIGUEZ MEMORIAL

HOSPITAL, May 2012. St. Vincent De Ferrer College of

Camarin. Unpublished Undergrad Thesis.

Tabucao, Angelica T., Tagapulot, Maria Katrina F., Tan, Kimberlee

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Anne A., and Tailit, Jennelyn V. LYCEUM

NORTHWESTERN UNIVERSITY STUDENT

NURSES' THEORETICAL AND CLINICAL SKILL

COMPETENCIES, October 2012. Lyceum Northwestern

University. Unpublished Undergrad Thesis.

4. Internet

http://www.buzzle.com/articles/ethical-issues-in-nursing.html

http://www.education.com/reference/article/nursing-ethics/

http://www.education.com/reference/article/nursing-ethics/

https://nurseconnect.com/Resources/ArticleProfile.aspx?Id=376670

Http://www.medscape.com/viewarticle/745298

http://www.studymode.com/essays/Competency-Level-Of-The-

Faculty-And-717348.html

https://www.ajj.com/services/publishing/deansnotes/jan12.pdf

www.directorys.uniquearticles.info

LYCEUM NORTHWESTERN UNIVERSITY

34
http://www.buzzle.com/articles/ethical-issues-in-nursing.htmlhttp://www.buzzle.com/articles/ethical-issues-in-nursing.htmlhttp://www.education.com/reference/article/nursing-ethics/http://www.education.com/reference/article/nursing-ethics/https://nurseconnect.com/Resources/ArticleProfile.aspx?Id=376670https://nurseconnect.com/Resources/ArticleProfile.aspx?Id=376670http://www.medscape.com/viewarticle/745298http://www.studymode.com/essays/Competency-Level-Of-The-Faculty-And-717348.htmlhttp://www.studymode.com/essays/Competency-Level-Of-The-Faculty-And-717348.htmlhttp://www.studymode.com/essays/Competency-Level-Of-The-Faculty-And-717348.htmlhttps://www.ajj.com/services/publishing/deansnotes/jan12.pdfhttps://www.ajj.com/services/publishing/deansnotes/jan12.pdfhttp://www.directorys.uniquearticles.info/http://www.buzzle.com/articles/ethical-issues-in-nursing.htmlhttp://www.education.com/reference/article/nursing-ethics/http://www.education.com/reference/article/nursing-ethics/https://nurseconnect.com/Resources/ArticleProfile.aspx?Id=376670http://www.medscape.com/viewarticle/745298http://www.studymode.com/essays/Competency-Level-Of-The-Faculty-And-717348.htmlhttp://www.studymode.com/essays/Competency-Level-Of-The-Faculty-And-717348.htmlhttps://www.ajj.com/services/publishing/deansnotes/jan12.pdfhttp://www.directorys.uniquearticles.info/


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Tapuac District, Dagupan City, [email protected]@lyceum.edu.phTel No. (63) (075) 516-2430Fax No. (63) (075) 516-2333 / 516-2434

June 10, 2013

Dr. Gonzalo T. DuquePresident

Thru: Mrs. Judith M. ManuelDean, College of Nursing

Dear Maam,

We, the fourth year nursing students of Lyceum NorthwesternUniversity are conducting research study entitled: Degree ofCompetency of Nursing Students in the Implementation of EthicalGuidelines for Nursing Practice. As a student in the subject school ofour study, we are requesting for your permission to conduct our study.We will float our questionnaires starting June until July 2013. Ourrespondents will be three hundred fifty (350) from seven institutionsoffering the nursing program.

Thank you for considering our request and we hope for favorableresponse regarding this matter.

Respectfully yours,

Balberan, Saro D.Balbin, Lea Marie N.Reyes, Christine N.

The Researchers (Group 6)

Noted by: Dr. Marjorie Joy Fernandez, RN, MANProfessor

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LYCEUM NORTHWESTERNUNIVERSITY

Tapuac District, Dagupan City, [email protected]@lyceum.edu.phTel No. (63) (075) 516-2430Fax No. (63) (075) 516-2333 / 516-2434

Dear Respondents,

We, the fourth year nursing students of Lyceum NorthwesternUniversity are conducting research study entitled: Degree ofCompetency of Nursing Students in the Implementation of EthicalGuidelines for Nursing Practice. As a student in the subject school ofour study, your response is important in providing relevant informationin the accomplishment of the research. We seek for your participationto complete the form handed to you and be assured that the detailsthat you share will be taken with strict confidentiality.

Thank you in advance for your valuable cooperation and wehope for favorable response regarding this matter.

Very truly yours,

Balberan, Saro D.Balbin, Lea Marie N.Reyes, Christine N.

The Researchers (Group 6)

Noted by: Dr. Marjorie Joy Fernandez, RN, MANProfessor

Approved by: Mrs. Judith Manuel, RN, MANDean, College of Nursing

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APPENDIX C

DEGREE OF COMPETENCY OF NURSING STUDENTS IN THEIMPLEMENTATION OF ETHICAL GUIDELINES FOR NURSING

PRACTICE

QUESTIONNAIRE

Part I: A. Profile of the Student RespondentsDirection: Put a check mark ( ) on the appropriate box of youranswer relevant to question being asked.

Name (optional): ____________________

A.) Age:

15 18 23 26 31 and above19 22 27 30

B.) Gender:

Male Female

C.) Civil Status

Single Married Widowed Separated

D.) Religion

Born Again Christian Roman CatholicIglesia Ni Cristo OthersJehovah's Witness Specify: _______________Protestant

E.) Year Level

Level II Level III Level IV

F.) Socio-economic Status

Above average Average Below average

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QUESTIONNAIRE

Part I: B. Profile of the Clinical Instructor RespondentsDirection: Put a check mark ( ) on the appropriate box of youranswer relevant to question being asked.

Name (optional): ____________________

A) Age:

17 20 29 32 41 and above21 24 33 3625 28 37 40

B.) Gender:

Male Female

C.) Civil Status

Single Married Widowed SeparatedD.) Religion

Born Again Christian Roman CatholicIglesia Ni Cristo OthersJehovah's Witness Specify: _______________

Protestant

E.) Highest Degree Earned

Bachelor's Degree Master's DegreeDoctorate Degree Others

Specify: ____________________F.) Area of Assignment

RLE Lecturer inClassrooms/Laboratory Hospital Ward

Special Area Community Duty

OthersSpecify: ____________________

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Part II: Degree of Competency of Nursing Students in the

Implementation of Ethical Guidelines for Nursing Practice

Direction: Put a check mark ( ) on the appropriate box of your

answer relevant to question being asked.

COMPETENCY RATING SCALE5(HC)4(MC) 3(C) 2(SC)1(I)

1. Safe, Competent and Ethical Care

a) Strives for the highest quality of careachievable

b) Maintains an acceptable level of healthand well-being

c) Practices within their own level of

competenced) Admits mistakes and takes all necessary

actions to prevent or minimize harm arisingfrom an adverse event

e) Strives to prevent and minimize adverseevents in collaboration with colleagues onthe health care team

f) Contributes to safe practice and supportivework environments

2. Health and Well - Being

a) Provides care directed first and foremost

toward the health and well-being of theperson, family or community in their care

b) Recognizes health is more than theabsence of disease or infirmity and worksin partnership with people

c) Fosters comfort and well-being whenpersons are terminally ill and dying toalleviate suffering and support a dignifiedand peaceful death

d) Respects and value the knowledge, skillsand perspectives of the persons in theircare as well as other health care providers

e) Recognizes the need to addressorganizational, social, economic andpolitical factors influencing health

f) Recognizes the need for a full continuum ofaccessible health services, including health

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promotion and disease preventioninitiatives

3. Choice

a) Builds trusting relations as the foundationof meaningful communication, recognizing

that building this relationship takes effortb) Provides the desired information and

support required so people are enabled toact on their own behalf in meeting theirhealth and health care needs to thegreatest extent possible

c) Respects the wishes of those who refuse,or are not ready, to receive informationabout their health condition

d) Ensures that nursing care is provided withthe person's informed consent

e) Provides opportunities for people to makechoices and maintain their capacity tomake decisions, even when illness or otherfactors reduce the person's capacity forself-determination

f) Provides appropriate care until alternativecare arrangements are in place to meet theperson's desires

4. Dignity

a) Relates to all persons receiving care aspersons worthy of respect and endeavor inall their actions

b) Recognizes the vulnerability of personsand not exploit their vulnerabilities for thenurse's own interest or in a way that mightcompromise the therapeutic relationship

c) Respects the physical privacy of personswhen care is given, by providing care in adiscreet manner and by minimizingunwanted intrusions

d) Intervenes if others fail to respect thedignity of persons in care

e) Advocates for appropriate use ofinterventions in order to minimizeunnecessary and unwanted proceduresthat may increase suffering

f) Avoids engaging in any form ofpunishment, unusual treatment or actionthat is inhuman or degrading towards the

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persons in their care and avoids complicityin such behaviours

5. Confidentiality

a) Respects the right of each person toinformational privacy, that is, the

individual's control over the use, access,disclosure and collection of theirinformation

b) Protects the confidentiality of allinformation gained in the context of theprofessional relationship, and practicewithin relevant laws governing privacy andconfidentiality of personal healthinformation

c) Intervenes if other participants in thehealth care delivery system fail to maintaintheir duty of confidentiality

d) Discloses a person's health informationonly as authorized by that person, unlessthere is substantial risk of serious harm tothe person or to other persons or a legalobligation to disclose

e) Informs the persons in their care that theirhealth information will be shared with thehealth care team for the purposes ofproviding care

f) Advocates for and respects policies andsafeguards to protect and preserve theperson's privacy

6. Justice

a) Doesn't discriminates in the provision ofnursing care based on person's race,culture, spiritual beliefs, social or maritalstatus, sex, age, health status, lifestyle,mental or physical disability and/or abilityto pay

b) Advocates for health policies and decision-making procedures that are consistent withcurrent knowledge and practice

c) Awareness of broader health concernssuch as environmental pollution, violationsof human rights, world hunger, violence,etc.

7. Accountability

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a) Respects and practices according to thevalues and responsibilities in the Code ofEthics for Nurses and in keeping with theprofessional standards, laws andregulations supporting ethical practice

b) Provides timely and accurate feedback to

other health providers and colleagues inother disciplines and about their practice,so as to support and recognize safe andcompetent practice, contribute to ongoinglearning and improve care

c) Takes steps to safeguard health and safetyof people during the course of the jobaction.

d) Advocates for discussion of ethical issuesamong health team members, patients andfamilies

e) Advocates for changes to policy,legislation or regulations

8. Quality Practice Environments

a) Takes preventive as well as correctiveaction individually or in partnership withothers to protect persons fromincompetent, unethical or unsafe care

b) Endeavours to keep patients and familiesinformed about potential and actualchanges to usual routines

c) Supports a climate of trust that sponsorsopenness, and supports those who speakout publicly in good faith

d) Seeks constructive and collaborativeapproaches to resolve differencesimpacting upon care among members ofthe health care team and commit tocompromise and conflict resolution

e) Collaborates with nursing colleagues andother members of health team to advocatefor health care environments conducive toethical practice and to the health and well-being of clients and others in the setting

Scale Arbitrary Value Descriptive Interpretation Symbol

5 4.20 5.00 Highly Competent HC

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4 3.40 4.19 Moderately Competent MC

3 2.60 3.39 Competent C

2 1.80 2.59 Slightly Competent SC

1 1.00 1.79 Incompetent I

thesis entitled "degree of competency of nursing students in the implementation of ethical...

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