COMPETENCY OF THE FOURTH YEAR NURSING STUDENTS

INSIDE THE OPERATING ROOM AND ITS RELATIONSHIP TO BOARD EXAM

RATINGS AMONG BIG

UNIVERSITIES IN ANGELES CITY

_____________

A Thesis

Presented to the

Faculty of the College of Nursing

Philippine Rehabilitation Institute

____________

In Partial Fulfillment of the

Requirement for the Degree

Bachelors of Science in Nursing

____________

By:

David, Camille Z.Jingco, Ramquielle D.

Odiaman, Liza Vanessa Farhana O.Sarmiento, Kreinzy Ann B.

Tableza, Alvin S.

November, 2015

Chapter I

THE PROBLEM AND ITS BACKGROUND

“Being a nurse is to go above and beyond the call of duty…The first to

work and the last to leave. They are the heart and soul of caring.”

~Anonymous

The nurse competence of graduating nursing students is an important

issue in health care as it is related to professional standards, patient safety

and the quality of nursing care (World Health Organization 2010). When

approaching graduation, nursing students are expected to have adequate

nurse competence to fulfill their duties safely and effectively, as an

adequate supply of competent RNs is necessary to provide high-quality,

safe and patient-centered care. Benner (1982) has proposed that nurse

competence develops along a continuum from novice to expert. Novices

are nurses who have no experience in the situation they are practicing in.

Through being an advanced beginner, competent and proficient, a nurse

will finally become an expert. However, according to Benner, competent

nurses have usually been in the same job or situation for two to three

years. (Benner 1982). The RN4CAST study has reported that the

educational level of nurses is crucial as higher competence level among

nurses in hospital wards leads to reduced incidence of mortality, morbidity

and adverse events. The purpose of this empirical study is to improve the

level of competency of Filipino nursing graduates, potentially increasing the

passing rate in the Nursing Licensure Exam (NLE), and to produce nurses

that are highly qualified and globally competent in the health care field.

In the global setting, a problem faced by health care institutions is the

shortage of nurses (American Association of Colleges of Nursing). “Filipino

nurses” had been the preference of foreign employers especially in the

United States. Employers not only seek Filipino nurses for their caring

nature, but also because of the quality education Filipino nurses have.

However, with technology evolving together with health practices, the local

curriculum must keep up with the current innovations if we want our nurses

to meet the global demand.

In the local setting, the problem identified by CHED is the low passing

rate in the NLE .Only about half of the total examinees pass the local board

exam. The Professional Regulation Commission (PRC) announces that

9,707 out of 17,891 (54.26%) passed the Nurse Licensure Examination

(NLE) given by the Board of Nursing last May 30 and 31, 2015 (Philippine

Board Exam Results).

The solution of CHED to ensure a better passing rate is the Ched

Memorandum Order No.14 which is the curriculum being implemented

now. One particular interest of the researchers is how this can help in the

competency of students in the operating room or Perioperative Nursing.

To assess the effectiveness of the curriculum, the researchers will

investigate the performance of nursing students inside the operating room.

This is because Article V, section 7.2 of Ched Memorandum Order No.14

states that:

“At the end of the school year, the student shall have acquired the

holistic understanding of the human person as a bio-psycho cultural being

focusing on the concept of health and illness as it is related to Perioperative

Nursing in varied settings. The student shall be able to demonstrate the

competencies in the following key areas of responsibility such as safe and

quality nursing care, communication, collaboration and teamwork, health

education, legal responsibility, ethico-moral responsibility, personal and

professional development, quality improvement, research, management of

resources and environment, and record management.”

The Core Competency Standards, developed by the Board of Nursing

(BON) with the Technical Committee on Nursing Education (TCNE) of the

Commission on Higher Education (CHED), served as a basis in the

curriculum reform. By focusing on the Eleven (11) Core Competencies, the

new curriculum will ensure quality education for nursing students if it is

implemented well (Tamse, July-Dec 2012).

Using the Core Competency Standards as an evaluation tool, this

study will determine if the new curriculum Ched Memorandum Order No.14

2009 is effective in improving the level of competency of

(_________________) nursing students in Perioperative Nursing.

Statement of the Problem

This study aims to evaluate the competency of level 4 students of

(________________) in the operating room.

It seeks to answer the following questions:

1. What is the profile of the respondents in terms of the following:

a. Age and

b. Gender

c. University (present)

2. What is the level/rating of the competency of the 4th year students

in terms of the following:

a. Safety and quality nursing care

b. Management of resources and environment

c. Health education

d. Legal responsibility

e. Ethico-moral responsibility

f. Personal and professional development

g. Quality improvement

h. Research

i. Record management

j. Communication

k. Collaboration and Teamwork

3. Is there a difference between the competency level of male and

female level IV student nurses?

4. Is there a difference between the competency level of students age

18 and below, and 19 and above?

5. What is the implication of this research in the field of nursing?

SIGNIFICANCE OF THE STUDY

Nursing Practice. To the nursing profession, the study will test

the students’ competency in the operating room. This is to ensure

that the students’ competency level will be identified and efforts

will be made to help the students reach the highest level of

competence so that the school will be able to produce nurses

capable of delivering quality nursing services.

Nursing Education. To the students, instructors and the school,

this study will be beneficial in identifying the students’ weak points

in the 11 Core Competencies. Students and instructors can focus

on these weak points and strengthen learning in these aspects.

The core competencies are also the basis of the Nursing

Licensure Exam. By enhancing learning in the core competencies,

the students can improve their chances in passing the board

exam.

Nursing Research. To future researchers, this study will provide

information on the strengths and weaknesses of students in the

operating room in terms of the core competencies. Researchers

can use this information to examine other subjects and contribute

suggestions to improve the implementation of the new curriculum.

Scope and Limitation

The study aims to evaluate the competence of the level IV student

nurses in the operating room by using questionnaires based on the Eleven

(11) Core Competencies.

The respondents of the study will be all level IV student nurses of

(__________). Survey questionnaires will be used for data gathering. The

questions will cover concepts in Perioperative Nursing and will be based on

the Eleven Core Competencies. There will be 30 questions to be answered

by level IV students. Students will be given 1 hour to answer the questions.

The topic covered will only be about Perioperative nursing whileother

subject areas are not included in this study. The respondents of the study

will be limited to level IV student nurses of (___________) whoenrolled in

summer 2015. Other year levels will not be part of the study.

Definition of Terms:

Board of Nursing (BON). This is the regulatory body of the nursing profession in the Philippines.

Commission on Higher Education (CHED). CHED is the governing body covering both public and private higher education institutions as well as degree-granting programs in all tertiary educational institutions in the Philippines.

Competency. It is a combination of attributes enabling performance of a range of professional tasks to the appropriate standards.

Competent. This is used to describe a nurse who uses analysis and conscious deliberate planning that helps achieve efficiency and organization.

Core Competency Standards. This represents the minimum knowledge, skills and attitudes necessary to provide nursing care (Tamse, 2004).

Curriculum. It is an educational plan that spells out which goals and objectives should be achieved, which topics should be covered and which methods are to be used for learning, teaching and evaluation.

Expert. This is a nurse described as one who no longer relies on rules, guidelines or maxims to link their understanding of the situation with the correct action.

Perioperative nursing. It is a nursing specialty that works with patients who are having operative or other invasive procedures. 

Proficient. This is a term used to describe a nurse who has well-developed decision making skills and is able to discriminate quickly where the problem exists.

Chapter 2

REVIEW OF LITERATURE

Foreign Literature

Global Standards in Nursing and Midwifery Education

One of the reasons for the nursing curricular reform is to incorporate

global standards in the Philippines’ nursing curriculum. Implementation of

the standards will facilitate progress towards the highest level of education

attainable in a country or region, assure equitable and appropriate

placement of nurses in health-care roles and, potentially, simplify

recruitment practices throughout the world (WHO, 2009).

The goal of the global standards is to establish educational criteria and

assure outcomes that:

a. are based on evidence and competency

b. promote the progressive nature of education and lifelong learning;

and

c. ensure the employment of practitioners who are competent and

who, by providing quality care, promote positive health outcomes in

the populations they serve.

The global standards in the nursing curriculum are divided into four

areas. These are Curriculum Design, Core Curriculum, Curriculum

partnership, and Assessment of Students. Each has its own criteria as stated

below:

1. Curriculum Design

Take into account workforce planning flows

Meet national and international education criteria

Delivers the knowledge and skills required to meet the needs of

their respective populations.

Demonstrate balance between the theory and practice

components of the curriculum.

Use of recognized approaches to teaching and learning

Provide classroom and clinical learning based on established

competencies

Enable the development of clinical reasoning, problem solving

and critical thinking

Conduct regular evaluations of curricula and clinical learning

Offer opportunities for multidisciplinary content and learning

experiences

2. Core Curriculum

provide core content that will enable their graduates to meet the

established competencies

provide core content in nursing theory

provide core through the primary health-care approach

provide supervised clinical learning experiences

3. Curriculum Partnership

develop partnerships with other healthcare disciplines

use inter-professional teamwork approaches

have access to, and arrangements for, the clinical learning sites

4. Assessment of Students

assess student learning using reliable evaluation methodologies

use a variety of methods to assess the subject matter

have student retention systems in place

The new curriculum adopted the global standards in nursing

curriculum. The global standards was adopted to enhance global

competitiveness. The Core Competencies also have the same goal to

improve global competitiveness. Under the criteria of the core competencies,

the researchers will evaluate if the new nursing curriculum will or will not be

able to meet the goals of international standards.

Local Literature

The New Curriculum

CHED Memorandum Order No. 14, series of 2009 (CMO No.14, s. 2009)

contains provisions on the BSN course, including the course specification,

standard curriculum, competency standards, and other requirements. It is

the basis of implementation of the new nursing curriculum in the Philippines

which took effect on the academic year 2009-2010.

Core Competency Standards

Core Competency Standards, as defined by Tamse (July-Dec 2004),

“represent the minimum knowledge, skills and attitudes necessary to

provide nursing care. It reflects complex nature of nursing activities and

determines the level of accountability.” Graduate of the BSN program must

be able to apply analytical and critical thinking in the nursing practice. The

nurse must be competent in the eleven (11) core competency areas for

nursing practice that were identified as follows (CMO No.14, s.2009):

1. Safe and quality nursing care. The nurse must be able to

demonstrate knowledge base and provide safety and sound

decisions in the care of the client. The nurse must also utilize the

nursing process and prioritization in the care of the client.

2. Management of resources and environment. The nurse must

maintain a safe environment for the client and utilize resources

properly.

3. Health education. The nurse must be able to assess the client’s

learning needs and develop an educational plan for the client.

4. Legal responsibility. The nurse must adhere to practices in

accordance to the law.

5. Ethico-moral responsibility. The nurse must respect the rights of

the client and take responsibility for one’s decisions and actions.

6. Personal and professional development. The nurse must be able

to assess one’s own learning needs and pursue growth and

development in the field. The nurse must also project of

professional image of the nurse.

7. Quality improvement. The nurse must be able to identify

variances and recommend solutions to the identified problems.

8. Research. The nurse must participate in research studies and

utilize the research findings.

9. Record management. The nurse must maintain accurate and

updated documentation of client care.

10. Communication. The nurse must be able to establish rapport with

the client, client’s family, and members of the health team and

respond to their needs.

11. Collaboration and Teamwork. The nurse must establish

collaborative relationship with members of the health team and

plan a collaborative care for the client.

The Need for a Curriculum Reform

What prompted CHED to revise the nursing curriculum is the low

passing rate of graduates in the Nursing Licensure Examination (NLE). The

passing rate in December 2007 was 42.71%. There were only 28,924 passers

out of 67,728 total examinees. According to CHED acting chairman Romulo

Neri, international standards are adopted into the local curriculum. This is to

ensure better performance of nursing graduates in the NLE (GMANews.TV,

April 30, 2008).

Although the new curriculum is met with objections, UST College of

Nursing Dean Glenda Vargas points out needed changes in the old

curriculum in favor of the new. Patient assessment needs to be a “stand-

alone subject” rather than just be integrated in nursing professional subjects.

In abroad, nurses are expected to do a thorough health assessment and

students need to be trained more in this area (The Varsitarian Vol. LXXIX, No.

12 ; June 10, 2008).

In a press release by the Philippine Nurses Association (PNA), they

supported the new curriculum stating that “nursing leaders and educators

firmly believe that this curricular reform will improve the quality of current

Philippine nursing education products by honing critical competencies to

provide safe and high quality health care for their patients here and abroad.

Core competencies for 11 key areas of responsibilities that are important in

nursing are spelled out in the various nursing professional courses together

with their indicators.” (PNA, July 8, 2008)

The Board of Nursing (BON) also supports the implementation of CMO

No.14. Strengths of the new curriculum enumerated by the BON are as follow

(BON, April 6, 2009):

The Core Competencies with their indicators are spelled out in  the

various professional courses.

Common core values identified by the Board of Nursing and the various

professional organizations during the workshop on good governance

were also included in the curriculum. 

Total General Education Courses is 90 Units

Total Professional Courses is 115 Units

The following professional courses included in CMO NO. 5 were

retained. (CMO No. 5 was the prototype of CMO No. 14)

                >  Theoretical Foundations in Nursing 

                >  Health Assessment 

                >  Pharmacology 

                >  Nutrition and  Diet Therapy 

                > Nursing Research                                  

                > Competency Appraisal 

                > IV Therapy is introduced in NCM 106

Two Nursing Electives are included (6 Suggested Nursing Electives are

included for the third year and senior year level) 

Intensive Nursing Practicum both for community-based and hospital-

based experience are included

Guide for RLE are incorporated

The Intraoperative, Intrapartal and Immediate Care of the Newborn are

spelled out as part of the curriculum 

More Specific Admission policies are encouraged 

Guide for Hospital Affiliation are more specific

Proper Implementation of Nursing Education Standards is encouraged.

However, sanctions for schools who are not performing well are spelled

out.

One of the changes in the curriculum is the rearrangements of topics in

the Nursing Care Management (NCM) course. In the old curriculum based on

CMO No.30, NCM 101, 102 and 104 is an integration of Medical-Surgical

Nursing, Psychiatric Nursing, and Maternal and Child Health Nursing(MCN). It

means that in NCM 101, there are three subjects altogether. However, in the

new curriculum CMO No.14, Nursing Care Management Courses were

separated according to nursing specialties. For example, NCM 101 and 102

deals with only Maternal and Child Health Nursing.

Since CMO No. 14 was implemented only lately, the first batch under

the new curriculum is currently in the second year level. Article V, section 7.2

of CMO No. 14 states that:

At the end of the fourth year, the student shall have acquired the

holistic understanding of the human person as a bio-psycho cultural being

focusing on the concept of health and illness as it is related to Perioperative

nursing in varied settings. The student shall be able to demonstrate the

competencies in the following key areas of responsibility such as safe and

quality nursing care, communication, collaboration and teamwork, health

education, legal responsibility, ethico-moral responsibility, personal and

professional development, quality improvement, research, management of

resources and environment, and record management.

Specifically, the student shall:

a. describe the health care delivery system and the nurse’s role in it;

b. demonstrate ethico-moral, legal responsibilities in the care of

individual family and community;

c. demonstrate the beginning skills in the provision of independent and

collaborative nursing function;

d. relate the stages of growth and development in the care of clients;

e. demonstrate beginning skills in the preparation of healthy and

therapeutic diets in varied client cases;

f. explain the dynamics of the disease process caused by microbes and

parasites and the environment;

g. imbibe the core values cherished by the nursing profession such as

love of God, country and people, and caring;

h. design a plan that will focus on health promotion and risk reduction to

clients; and

i. utilize the nursing process in the care of the high risk mother and child

in the family.

Statements from several sources, such as CHED, PNA, and BON,

suggest that they support the implementation of the new curriculum. These

sources have enumerated the strengths of the new curriculum and

emphasized the relevance of incorporating the Core Competencies in the

new curriculum. According to Tamse (July-Dec 2004), the Core Competency

Standards serve as a framework for program development and also serve as

a tool for performance evaluation. With this information, the researchers will

use the same Core Competency Standards to evaluate the effectiveness of

the new curriculum with regards to Perioperative Nursing. The result of this

study may either support or refute the statements of the said sources.

Foreign Studies

A study by Richard W. Redman, et al. Deals with competency

assessment in nursing education.

Competency Assessment: Methods for Development and Implementation in

Nursing Education

Competent performance by health care professionals is expected

throughout society. However, defining what it is and teaching students how

to perform competently faces many challenges. This article provides a brief

overview of the contemporary focus on competency assessment in nursing

education. The redesigned nursing curriculum at the University of Colorado is

presented as an exemplar of a practice-oriented model that requires

competent performance among students. Methods for implementing a

competency-based curriculum and lessons learned during the process are

discussed.

Competency assessment is always outcome oriented; the goal is to

evaluate performance for the effective application of knowledge and skill in

the practice setting. Competency assessment techniques address

psychomotor, cognitive, and affective domains. Competencies can be

generic to clinical practice in any setting, specific to a clinical specialty, basic

or advanced.

Competency-based education has been found to be equally effective in

both didactic and self-learning approaches presents hallmarks of

competency-based education that make them applicable both in practice

and in educational settings. These include competencies based on validation

of what performance by competent practitioners actually comprises. In

addition, competency assessment is based on criterion-referenced

evaluation methods where the learner’s performance is evaluated against a

set of criteria provided to the learner so that both the learner and the

assessor are clear on what performance is required. Finally, competency-

based education is learner-centered in that outcomes are specified and

describe what the learner must do to demonstrate competency.

The experience in converting to a competency-based curriculum has

been both successful and challenging. Faculty and student experiences to

date have been positive. The redesigned curriculum is viewed as responsive

to the competency-oriented environment and employers believe the

transition of graduates into practice settings will be more effective, efficient,

and successful. This competency-based approach to education can serve as

a model which offers a wide variety of applications to education and service

environments.

The researchers adopted the criterion-referenced evaluation methods.

Competency is evaluated against a set of criteria. In this study, the criteria

to be used is the Eleven Core Competency Standards.

Local Study

A similar study of evaluating a curriculum was conducted by Helen

Villarico-Correa, RN, MN, EdD published in The Philippine Journal of Nursing

Volume 73 No.2.

The Associate in Health Science Education Curriculum: An Evaluation

This paper presents the result of a survey conducted in Region VI as to

the implementation of the Associate in Health Science Education (AHSE)

Curriculum. The survey was conducted among all the higher education

institutions in the region that offers the health-related professions and the

associate in health science education curriculum. The respondents were 35

deans of the health-related professions in the region which include Bachelor

of science in Nursing, Bachelor of Science in Medical Technology, Bachelor of

Science in Physical Therapy, Bachelor of Science in Pharmacy, Bachelor of

Science in Nutrition and Dietetics, Bachelor of Science in Radio Technology,

and the two-year Midwifery Program. In addition, this paper also provides an

overview of the AHSE curriculum including the views and experiences of the

deans who actually implemented the said programs since the academic year,

1998-1999.

Specifically, this study aimed to determine:

whether the objectives of the AHSE curriculum were met

the strengths and the weaknesses of the curriculum;

the problems encountered in implementing the program

the facilitating factors that help in the implementation of the

program; and

the preferred curriculum of the respondents

The results of the study show that majority of the respondents replied

that the objectives of the AHSE curriculum has not been met. Several

advantages and disadvantages of the AHSE curriculum were mentioned. And

according to the study, 85.71% of the respondents preferred the generic

curriculum over the AHSE curriculum.

Synthesis

CMO No. 14 mandates the implementation of the new nursing

curriculum. It contains the standard curriculum and syllabi of the nursing

subjects. This memorandum was developed to improve the competency of

Filipino nurses and produce highly qualified nurses.

From the literatures collected, the researchers are able to extract the

information that fourth year nursing students are expected to be

knowledgeable in Perioperative nursing and be able to develop competencies

in the 11 Core Competency areas. With this, the researchers will utilize the

Core Competencies to test the students’ knowledge in Perioperative nursing

that it can also be used as an evaluation tool.

PRC results

-----------------NOTHING FOLLOWS----------------------

The Performance of Schools in the May 2015 Nursing Licensure Examination in alphabetical order as per R.A. 8981 otherwise known as

PRC Modernization Act of 2000 Section 7(m) To monitor the performance of schools in licensure examinations and publish the results

thereof in a newspaper of national circulation” is as follows: (Any discrepancy in the report is not intentional on the part of the Commission,

but rather due to miscoding of school codes by the examinees themselves. Concerned schools may write the Commission for correction.)

HAU passing rate = 69.09%

Angeles University Foundation = 96.00 %

http://thenursingprofession.blogspot.com/2009/09/11-core-competencies.html