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CHAPTER I

THE PROBLEM AND ITS SETTING

INTRODUCTION

Being able to work in a clinical setting is a fulfilling experience for professional nurse Some of the

plenty responsibilities of nurses are to promote health, prevent illness, restore health and alleviate suffering

of individuals under his care. Thus, all patients deserved to be given holistic care. They need to address all

aspects of life like their physical, psychological, social, emotional and spiritual needs. This endeavor becomes

a challenging experience for volunteer nurses as they provide quality care to the clientele.

Due to oversupply of nurses in the country and lack of vacancies, volunteerism is a common

modality for new nurses to gain experience and practice what they have learned in the entire four years of

studying. It is also inevitable that pediatric patients are handled by volunteer nurses.

One of the challenges for the volunteer nurses is to handle pediatric patients without them having

any special background in handling pediatric care. These volunteer nurses assume multiple roles in the

ward: adapt quickly to change, be creative and possess the ability to think critically. In order to meet the

demands, the supervisor, head nurses, and staff nurses must evaluate the volunteer nurses ability to

perform competently in the setting. In that case, competency to handle pediatric patients is imperative.

BACKGROUND OF THE STUDY

Nursing involves not only our ability to master the science that drives the profession but also the

ability to touch lives in a meaningful way. The dramatic increase in the scope of practice, the ever-greater

evidence of diseases, the complexities involved in the practice and the endless opportunities for

improvement gave greatly high lightened the interest of every Filipino for Nursing.

Pediatric Nursing is one of the many fields in the nursing profession. This entails and offers variety of

skills and expertise that makes it unique to other fields. It is the branch of nursing concerned with the care

of infants and children. Pediatric nursing requires knowledge of normal psychomotor, psychosocial, and

cognitive growth and development, as well as of the health problems and needs of people in this age group.

Preventive care and anticipatory guidance are integral to the practice of pediatric nursing.


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Oftentimes as observed by some nurses, newly registered nurses enter volunteerism to be able for

them to practice their profession. They are assigned in areas for training, without having a formal trainer

that makes it very hard for them to adjust and learn the vitals in a certain area. A new trainee or volunteer

may find it difficult because her care must demand closer supervision. Oftentimes, they lack confidence and

are unprepared to the rigors of the practice, therefore, they experience anxiety. These nurses who lack

experience may not be competent enough to implement quality are to the patients.

THEORETICAL FRAMEWORK

This research is guided by concept based from the theory of Huber and Stuart Dreyfus (1986) and

Patricia Benner (1984; 2004).

Hubert and Stuart Dreyfus (1986) proposed a model of skill acquisition that posited five progressive

stages of development: Novice, Advanced Beginner, Competent, Proficient, and Expert. Furthermore, based

on in-depth interviews with nurses, Benner (1984; 2004) adapted the Dreyfus model of skill acquisition to

define comparable stages in the development of clinical competence through five levels of proficiently.

Benner reflects changes in three general aspects of skilled performance. One is a movement from

reliance on abstract principles to the use of past concrete experience as paradigms. The second is a change

in the learners perception of the demand situation, in which the situation is seen less and less as a

compilation of equally relevant bits, and more and more as a complete whole in which only certain parts are

relevant. The third is a passage from detached observation to involved performer. The performer no longer

stands outside the situation but is now engaged in the situation. On the contrary, Dreyfus believes that as

individuals begin learning a skill, they first master the rules governing the situation and then how and when

to apply them. As their level of skill improves, they tend to rely less and less on these rules, and can handle

more complex situations with facility. At the higher levels of skill development, actions stem more from

intuition that simply applying rules and accepted standards. At these levels, individuals perceive patterns in

the situations they encounter and reflexively know what actions are appropriate.

According to these models, Novice is the first stage that an individual is going through. Dreyfus

describes these nurses to be rigid in adherence to taught rules or plans with a little situational perception

and no discretionary judgment. Additionally, Benner believed that nurses on this stage had no experience

and base what they do on principles and rules that they were taught. She further added that nurse entering

a setting with a new patient population will be dealing with the same issues as nursing students where in


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entering a new clinical area, they have little understanding of the contextual meaning of the recently

learned textbook terms.

Upon completing the stage, one will now enter the advanced beginner stage. Guidelines for action

are based on attributes or aspects are treated separately and given equal importance. Nurses situational

perception is still limited. On the other hand, advanced beginners according to Benner, are those who can

demonstrate marginally acceptable performance, those who have coped with enough real situations to

note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These

components require prior experience in actual situations for recognition. Principles to guide actions begin to

be formulated. The principles are based on experience.

The two models agreed upon that the third stage is the competent stage wherein nurses start to

cope with crowdedness. This is typified by the nurse who has been on the job in the same or similar

situations two or three years, when they begin to see his or her actions in terms of long-range goals or plans

in which he or she is consciously aware. For the competent nurse, a plan establishes a perspective, and the

plan is based on considerable conscious, abstract, analytic contemplation of the problem. The conscious,

deliberate planning that is characteristic of this skill level helps achieve efficiency and organization. The

competent nurses lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery

and the ability to cope with and manage the many contingencies of clinical nursing. The competent person

does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of

which aspects are most salient, most important.

The proficient performer perceives situations as a while rather than in terms of chopped up parts or

aspects, and performance is guided by maxims. Proficient nurse understands 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 and

perceives all deviations from the pattern. This holistic understanding improves the proficient nurses

decision making; it becomes less labored because the nurse now has a perspective on which of the many

existing attributes and aspects in the present situation are the important ones. The proficient nurse uses

maxims as guide. They can mean one thing at one time and quite another thing later. Once one has a deep

understanding of the situation overall. However, the maxim provides direction as to what must be taken

into account.


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The expert performer no longer relies on an analytic principle to connect her or his understanding of

the situation to an appropriate action. The expert nurse, with an enormous background of experience, now

has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful

consideration of a large range of unfruitful, alternative diagnoses and solutions. The expert operates from a

deep understanding of the total situation. The performer is no longer aware of features and rules; his/her

performance becomes fluid and flexible and highly proficient.

FIGURE 1. SKILLS ACQUISITION STAGES BY DREYFUS AS ADAPTED BY BENNER

CONCEPTUAL FRAMEWORK

The researcher envisioned nurses to provide quality care to pediatric patients. This research dealt

with the study of the Competency Level of Volunteer Nurses in the Pediatric Ward in Quirino Memorial

Medical Center.

Critical competencies are the statement attributes not only limited to knowledge and skills but

judgment, attitudes, values and beliefs. It describes behaviors that a nurse believes to be important in

providing safe, effective and ethical care to individual. Competencies were used to determine how volunteer

nurses handle pediatric patients according to standards of practice and their professional attributes required

in a given nursing role, situation, and/or practice setting.


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The research wanted to know the relationship of the competency of the nurse in handling pediatric

patients enhancing quality care. The variable in the first column of the given research paradigm is the head

nurses evaluation on the competency of the volunteer nurses on pediatric care competencies. These

pediatric care competencies represent the lower box in the second column in which the first two variables is

connected. The following competencies are professional behavior/ethics/ attitudes, safety/ therapeutic and

professional relationship, clinical skills, clinical knowledge and clinical integration/critical thinking.

On the upper box of these pediatric care competencies, the variables are the demographic profile of

the volunteer nurses that consist of the following: age, gender, length of service as professional nurse,

previous assignment, educational attainment and training attended relevant to handling pediatric patients.

The whole process lead to the development of training programs for the enhancement of quality care being

rendered to the patients.

RESEARCH PARADIGM

FIGURE 2: Competency Level of Volunteer Nurses in the Pediatric Ward of Quirino Memorial Medical Center

STATEMENT OF THE PROBLEM

The research focused on the assessment of competency level of volunteer nurses in the pediatric

ward of Quirino Memorial Medical Center.

Specifically, this sought to answer the following questions:

1. What is the profile of the respondents in terms of:1.1Age1.2Gender1.3Length of Service as Professional Nurse1.4Previous Area of Assignment1.5Highest Educational Attainment1.6Training attended relevant to handling pediatric patients

2. What is the level of competency of volunteer nurses in handling pediatric patients as evaluated bythe head nurses and supervisor in terms of:

a. Professional behavior/ethics/attitudesb. Safety/therapeutic and professional relationshipc. Clinical Knowledge


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d. Critical Knowledgee. Clinical Integration and Critical thinking

SIGNIFICANCE OF THE STUDY

This research dealt with the competency level of volunteer nurses in handling pediatric patients to

enhance quality care. Specifically this would be beneficial to the following:

PATIENT. The results of this study may serve as baseline information to the volunteer nurses on how

they should provide quality care to the patients and what patients expect from a competent nurse

VOLUNTEER NURSES. This study will help them become more aware of the different provisions in

rendering quality care to the pediatric patients and to be more ready in the performance of their job

responsibility as to their knowledge, decision making and critical thinking. It will further improve their

abilities to care for a pediatric patient thus enhances self confidence. It will serve as a tool for self-evaluation

for their strengths and weaknesses for the improvement of service, thus being more aware of the needs and

the proper care to be rendered to the pediatric patients.

NURSING SERVICE ADMINISTRATORS. This research will help them evaluate the volunteer nurses as

regard to their capabilities in handling pediatric patients. This will also aid the administrators to identify the

needs of the volunteer nurses in order to develop more competent nurses in handling pediatric patients.

FUTURE RESEARCHERS. This research can be a basis for further studies as the results can be used to

investigate the details of how the nurses perform based from the expected competencies.

SCOPE AND LIMITATION

This research dealt with the competency level of volunteer nurses in the pediatric ward of Quirino

Memorial Medical Center.

Purposive sampling was utilized since not all volunteer nurses from the pediatric ward chose what

area they would like to be exposed into. The volunteer nurses who did not chose to be assigned in the

Pediatric Ward are used as subjects of the study.


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The study focused on volunteer nurses in Quirino Memorial Medical center in Quezon City who

renders direct nursing care to the pediatric patients that are admitted in the Pediatric Ward. A total of 15

volunteer nurses were evaluated by 2 head nurses who have direct supervision on them. These volunteer

nurses were those assigned in the Pediatric Ward in this institution who handled pediatric patients. These

volunteer nurses were evaluated by their head nurses who are assigned in that particular ward using a

validated assessment tool prepared by the researcher.

These volunteer nurses were the ones who render care to pediatric patients who are confined in the

pediatric ward of Quirino Memorial Medical Center, Quezon City, Philippines. This is one of the tertiary level

government and non-profitable hospitals giving medical services to all residents in Quezon City. They also

cater to patients from the neighboring cities with various health conditions.

DEFINITION OF TERMS

For parallel understanding of the study, the following terms are hereby defined operationally.

COMPETENCY. It refers to cluster of knowledge, skills and attitude. It is a personal characteristic an

individual must possess to be successful in performing a specified work.

COMPETENCE. The ability of a nurse to integrate the professional attributes required to perform in a

given role, situation, or practice setting. Professional attributes include, but are not limited to knowledge,

skills, judgment, attitudes, values and beliefs.

COMPETENCY LEVEL. It refers to classification of the competency of nurses which can be ascertained

using the scale below.

6.5 7.0 = EXCELLENT Carries out procedures efficiently, systematically and

independently.

5.5 6.49 = VERY GOOD Carries out the procedures efficiently and systematically but

requires minimal guidance and supervision

4.5 5.49 = ABOVE AVERAGE Carries out procedures efficiently and systematically but

requires moderate guidance and supervision

3.5 4.49 = AVERAGE Carries out the procedures efficiently and systematically but

requires close guidance and supervision


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2.5 3.49 = BELOW AVERAGE Carries out the procedures inefficiently and

unsystematically and requires close guidance and

supervision

1.5 2.49 = POOR Carries out the procedures inefficiently and


supervision and recommended for further orientation and

training

1.00 1.49 = VERY POOR Carries out the procedures very inefficiently and


supervision and recommend for dismissal

For the computation, the qualitative interpretation of the numerical value was established using

Benners competency level:

5.80 7.00 Expert

4.60 5.79 Proficient

3.40 4.59 Competent

2.20 3.39 Advanced Beginner

1.00 2.19 Novice

PROFESSIONAL BEHAVIOR/ETHICS. The nurses demonstration of accountability to the public and

responsibility in his/her practice to meet legislative requirements and demonstrate high standards of

profession. This includes ensuring and respecting client choices in decision making, promoting client well-

being, assuring privacy and maintaining confidentiality, maintaining commitment to the client, self,

profession, and employer and respecting sanctity and quality of life.

SAFETY/ THERAPEUTIC AND PROFESSIONAL RELATIONSHIP. The nurses action is to promote safety

and avoiding injury for clients. It also includes the establishment of a therapeutic nurse-client relationship,

which focuses on the need of the client.

CLINICAL KNOWLEDGE. These are expertise and skills by a person through experience or education;

the theoretical or practical understanding of a subject, what is known in a particular field or in total; facts

and information or awareness or familiarity gained by experience of a fact or situation.


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CLINICAL SKILLS. This is the excellent nursing practice through integration of knowledge and skills in

order to perform nursing intervention competently. Interventions include thorough patient assessment, safe

practice in patient care, medication administration and appropriate documentation.

CRITICAL THINKING. These are activities of organizing and analyzing information, recognizing

patterns and gathering data to support and make good decisions that will ensure better health for the

clients.

CLINICAL INTEGRATION. It is the network implementing an active and ongoing program to evaluate

and modify practice patterns by the network health team participants and create a high degree of

interdependent and cooperation among the health care provider to control cause and ensure quality.

PEDIATRIC PATIENT. They are the clients within 1 day old to 18 years of age suffering from an illness.

QUALITY OF CARE. It refers to a safe, efficient, effective and least cost performance of interventions

given to patient in a given scenario. It is also an acceptable and competent performance of skills, knowledge

and attitudes toward patients.

VOLUNTEER NURSES. They are licensed nurses who qualify with the standards of the institution and

are hired as trainees in the clinical setting.

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the summary of related literature and studies which the present study got

insights on how this research was conducted.

COMPETENCY

In the competency standards approach to professional education and practice, it is defined as a

combination of attributes enabling performance of a range of professional tasks to the appropriate


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standards. (Gonczi, Hager & Oliver, 1990: 62). It may describe the attributes of knowledge, abilities, skills

and attitudes that underlie competent performance. (Gonczi et al. 1990: 62)

Competency encompasses more than just a psychomotor skill. However, nurses know that

psychomotor skills are important, but, performed without knowledge, they do not constitute nursing.

Nurses abilities to plan and organize work are of little benefit to patients or clients if the attitudes, values

(such as caring and patience) are not present; therefore, integration of the knowledge, skills and attitudes of

nursing is the essential key to understanding and performing their tasks.

Competence is a standardized requirement for an individual to properly perform a specific job. It

encompasses a combination of knowledge, skills and behavior utilized to improve performance. More

generally, competence is the state or quality of being adequately or well qualified, having the ability to

perform a specific role.

Benner was one of the first nurse researchers to address the issue of competency in nursing. Benner

(1984) wrote that expertise in nursing practice develops only after the nurse has tested and refined nursing

hypotheses and principles in actual clinical practice settings. She applied the Dreyfus Model of Skill

Acquisition to the practice of nursing. Dreyfus had developed his model through the study of airline pilots

and chess players and believed that in order to master the skills related to a profession, an individual must

pass through a series of five levels. These levels were novice, advanced beginner, competent, proficient, and

expert. According to Benner (2004), the Dreyfus Model of Skill Acquisition was appropriate as a guide in

describing how nurses acquire skills and utilize proper clinical judgment in the practice setting. Benner

conducted three studies which sought to determine how nurses attain skills and develop knowledge in the

clinical area while progressing through the five levels. The first level is the novice in which the nursing

student lacks clinical experience and does not have the background to understand or deal with a clinical

situation. The novice normally relies on the textbook for answers to clinical problems.

The next level is the advanced beginner which is the newly graduated nurse. There is a great deal of

stress and anxiety associated with this level. The advanced beginner uses the textbook and is dependent

upon others for information and assistance in patient care.

The nurse enters the competent stage one-to-two years into practice. How a nurse develops

competence depends on the type of patient population for whom they care, and the quality of clinical

education they receive. Emotionally, competent nurses feel great satisfaction when their clinical judgment is


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correct and great remorse when their clinical judgment is not satisfactory. These nurses are now able to

recognize competency or a lack thereof in others. They purchase more comprehensive and complex books

to utilize as references in the work environment.

The proficient nurse is the fourth level of skill acquisition. In this level the nurse is comfortable with

the clinical setting, exercises good clinical judgment, and possesses the ability to easily articulate clinical

findings to others.

The final level is considered the level of expertise. In this level, the nurse, through clinical

experience, has developed an intuitive stance to patient care. This nurse can respond to a clinical situation

with ease and change as the situation changes. Benner defined good nursing practice as skilled in ethical

practice along with scientifically based clinical judgment. Good clinical judgment and performance requires a

sound educational foundation combined with experiential learning. She believed that clinical research is

necessary to ensure best practices in nursing.

Using Benners competency framework, Meretoja (2004) developed the Nurse Competence Scale.

They stated that the assessment of competence in the clinical setting should be the foundation for quality

assurance, planning workforce, strategies and management of human resources in the hospital

environment. The Nurse Competence Scale consisted of 73 items divided into seven category headings

which included helping role, teaching-coaching, diagnostic function, managing situations, therapeutic

interventions, ensuring quality and work role.

Zhang, Luk, Arthur and Wong (2001) examined the underlying nurse competencies that are

instrumental in effective nurse practice. They considered the terms competence and competency as two

distinct concepts. Competence was defined as more job-related, in relation to the individuals ability to meet

job requirements through the production of quality work. Competency was defined as person-centered,

meaning the characteristics or attributes of the individual that lead to effective job performance. Nursing

competencies were defined as sets of knowledge, skills, traits, motives and attitudes that were required for

effective performance in a wide range of nursing jobs and various clinical settings. In this study, 50 hospital

nurses from various departments were interviewed and asked to report one successful incident and one

unsuccessful incident in dealing with patients. As part of this reporting, the nurses were asked to describe

their behavior during the incident, actions taken in the situation, and the outcome of their actions in

providing patient care. A panel of experts coded the incidences and determined a total of 10 competencies,

or nurse characteristics that were most evident in the successful patient incident interactions. These


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competencies were interpersonal understanding, commitment, information gathering, thoroughness,

persuasiveness, compassion, comforting, critical thinking, self-control and responsiveness. Interpersonal

understanding was found to be the most important attribute related to good nursing performance and

effective nursing care for the patient.

According to Ebue (2006), as assessed by nurse supervisors, the novice nurses generally performed

very much their work related to management of care, management of patient care and documentation.

Beginning graduate nurses may be a little slow completing total patient care, e somewhat limited in the

range of skills they can perform, not possess a great deal of specialized knowledge but they are easily

distinguished from someone who is not a nurse, or even a novice student nurse.

Beginners are rarely expert, but they can be competent. They perform a wide range of nursing

activities methodically and well. They may be slow but develop further skills and speed in time. In the

community setting, nursing skills of assessment and decision-making are often invisible, but are reflected in

the delivery on patient care.

Benner (2004), suggested that competent nurse, establishes a perspective, and the plan is based on

considerable conscious, abstract, analytic contemplation of the problem. The experienced competent nurse

works quickly and capably, able to care for a highly complex and dependent patient in the critical care unit,

or nurse several high dependency patients in a busy surgical or medical ward.

Kozier (2002), stated that a sense of personal competence grows out of sequence of successes.

Experiences and expert nurses have amazing memories, seem to do twenty things at once, cope with

interruptions and can deal with emergencies, all calmly and expertly. The expert nurse, with an enormous

background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region

of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and

solutions. The expert operates from a deep understanding of the total situation. Schon (1988) has described

such expert performance as professional artistry. The expert knows the goal to achieve and how to achieve

it. The best of experts think before they act on it (Craven and Hirnle, 2003).

Expert nurses, demonstrating integration of all the attributes of competency at an advanced level,

make their nursing look easy and effortless, especially to the lay person (Benner, 1984; 2004). However,

another nurse can recognize the knowledge behind the decisions, the attitudes underlying the care, the


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abilities that permit the multitude of activities to be managed and the skills that demonstrate the expertise

of a senior and experienced nurse.

According to HockenBerry (2005), gender roles are changing as a result of the changing economy

and increased opportunities for women. As the role of women changed, the complementary role of the man

has also changed. Women are now achieving equality with men in education; more of them are entering in

the work force.

As to length of service, Taiko et al (2006) in their study Relationships between Years of Nursing

Experience, Assignment to the Desired Ward and Nurse Morale states that rapid turnover of novice nurses

eventually in the shortage of veteran nurses.

However, Chanco (2008) said that the manpower industry official explained that most Filipino

nursing graduates are not qualified for these jobs abroad because they are either not trained well enough or

did not have two years of work experience in big hospitals.

As to previous area of assignment, Venzon (2003) said that knowledge of this process assures them

of the smooth functioning of their units to attain their goals of quality care through the judicious use of

available human resources within specified period.

Working in the ward can give the best possible opportunity for the nurse to develop a sense of

personal responsibility. Through her daily care of patients, the nurse provides concrete evidence of the

thoroughness and proficiency with which she meets the specific needs of each individual. It gives her a

chance to prove how good she is as a nurse. Work well-done results in a definite feeling of accomplishment

and satisfaction which in turn stimulates greater effort on the part of the doer. (Helen Nicholson, Education

Through Clinical Assignments. http://www.jstor.org/pss/3417022).

A professional nurse must complete a basic nursing education program and is licensed in his/her

country in order to practice professional nursing. Furthermore, graduation from a school or college of

nursing marks only the beginning of a lifelong process of enriching nurses knowledge, skills and attitudes

(Benson, 2004). Joint Commission on Accreditation of Healthcare Organizations further requires that nurses

meet minimum educational requirements and verify their knowledge through competence based

assessments and actual performance in the nurses environment (Bristol Royal Infirmary Inquiry, 2001).


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Nursing Program states that BSN degree is an entry-level of educational preparation for students

with little or of no college background and MAN degree combine masters level of major available to suit

their academic and professional needs. University of the Philippines Manila, College of Nursing (Master of

Arts in Nursing), states that MAN nurses have a heightened competence on major fields of nursing and

therefore had developed critical thinking about current problems and issues affecting the nursing profession

and the health care delivery system.

A study done by Davies (1994) on Effects of Experience in Nursing in Different Levels of Education

Care with Increasing Years of Experience without Refresher Course, findings elaborated that the quality and

quantity of nursing care by all practitioner were found to decline. This study also found out that three to five

years of experience was no longer a significant factor in determining the quality and beneficial for nurses to

function effectively and competently.

It is vital that continuing education be implemented for the patient to receive optimum care, and

the patient had the right to expect the kind of nursing care given to them that will help them regain or

maintain their health. To do this, the nurse must have the necessary education, training, experience and

personality to carry out the services for which they are responsible. Lacking of these, they may be charged

with incompetence, Venzon (2003).

In the study done by Alarilla (2001) regarding work performance and caring behaviors of nurses it

was discovered that nurses who are found effective in their work performance will need to improve their

skills by motivating them to attend seminars, workshops and special trainings concerning nursing practice.

They should realize that there is no end for attaining improvement in their work. It is true that gaining

continuing education is very important to develop skills and confidence in caring for the pediatric patients.

PROFESSIONAL BEHAVIORS

Behaviors are observable actions. It also refers to the actions or reactions of an object or organism,

usually in relation to the environment. Behavior can be conscious or unconscious, overt or covert and

voluntary or involuntary.

The development of professional values occurs along a continuum, which begins with professional

education in nursing and continues throughout years of nursing practice (Shank, 2001). In an article written

by Fahrenwald et al (2005) entitles Teaching Core Nursing Values, the authors outlined a proposed


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curriculum for teaching nursing values. The five core values were human dignity, integrity, autonomy,

altruism, and social justice. The authors proposed several methods of teaching these values including one

called the particularist approach which allowed the student to use his or her own personal issues and

emotions to influence value-based behavior. The authors described caring as a professional behavior that

uses both science and art to address all dimensions of patient care and that professional value provide the

foundation for professional practice. The authors go on to suggest that integration of value-based education

in nursing courses is essential in order to provide the foundation for nurses to practice value-based nursing

care.

Another study by Shank and Weis (2001) examined the differences in the values of Baccalaureate

nursing students and practicing nurses. Weis (1995) stated that if nursing is to remain a major contributor to

healthcare design, the professional values possessed by nurses must be a part of nurses decision making

and critical thinking process. The authors also stated that the development of professional values seemed to

mirror development on Benners Novice to Expert model. This study supports the current study in that it

examines the professional development of competency of nurses and further supports the validity and

reliability of the tool used in the study.

UNDERSTANDING HUMAN BEHAVIOR

Mental perceptions are influences by everything that has passed through an individuals mind. That

includes all of a persons experiences, knowledge, biases, emotions, values, stress and attitudes. No two

people have identical perceptions because no two people have precisely the same experiences. Stress

related can alter the course of human behavior in dealing with human beings and to the surroundings.

Mental perceptions may sometimes lead to conflict. Each person has formed mental perceptions

relating to a number of controversial issues. For example, most workers have an opinion on abortion and

capital punishment, among other issues. When proponents and opponents clash in voicing mental

perceptions of controversial issues, conflict occurs. If the issue is one pertinent to the workplace, such as

affirmative action, human values have the potential to lead to problems.

In the study by Alarilla (2001) entitled Work Performance and Caring Behavior of Nurses: An

Analysis, the following findings revealed that, 1. For the nurses who are found effective in their work

performance, there is still a need for them to improve their skills by motivating them to attend seminars,

workshops and special trainings concerning nursing practice. They should realize that there is no end for

attaining improvement in their work. 2. That psychological and adaptability assessment, be a part of


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admission criteria, by all colleges of nursing to all applicants, and those whose results are not compatible to

the task in nursing is advised to reconsider other course. Lastly, the staff nurses are encouraged to undergo

self awareness process through various means, such as group discussion, role playing, and feeling reactions,

so as to make them more aware of their personality traits and thus be capable of controlling undesirable

ones.

Saarmann, Daugherty, and Rigel (2000) point out; the nursing goal is not necessarily to change

behavior but to advance the client to the next stage of change. The social dimension of behavior is

determined by a persons personality, attitudes, needs, and wants. An individuals personality is the totality

of complex characteristics, including behavior and emotional tendencies, personal and social traits, self-

concept and social skills.

The objective of many training sessions for employees and supervisors is to improve a persons

ability to get along with others. A persons personality has a major impact on human relations skills.

The organization provides an opportunity for individual satisfaction. To achieve such satisfaction,

and to continue as a successful member in the organization, the individual must comply with organizational

policies, procedures and rules. The organization requires certain behaviors from its employees. The rewards

for such behaviors are demonstrated in the form of raises, promotions and continued employment. When

the organization promotes an employee, it is relating to the individual.

ETHICS

Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing.

Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and

respect for autonomy. It can be distinguished by its emphasis on maintaining dignity and collaborative care.

Nurses, in the performance of the practice, are confronted with a lot of ethical dilemmas. One must

have to realize, that the nursing profession is a commitment both to God and people. They have to

emphasize the importance of spirituality as a vital aspect in the performance of nursing care and uphold the

sanctity of human life. (Benson, 2004)


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The New Code of Ethics for Filipino Nurses by Dionisio (2003) reiterated that Filipino nurses believe

in the worth and dignity of each human being and recognize the primary responsibility to preserve health at

all costs and uphold the principles of bioethics. Furthermore, nurses are called to the profession by a desire

to provide a safe, highly competent and compassionate care to people in needs and that no one becomes a

nurse for the money.

Ethics has been a part of nursing practice from the early foundations of modern nursing in the late

nineteenth century. This has always entailed a respect for human rights of the person in their care.

However, early attempts to define ethics in nursing were focused more on the viruses of the nurses

themselves, rather than looking at how the rights of the patient or client might be promoted in particular. In

the modern era, the ethics of nursing has shifted more toward the promotion of these rights and the duties

of the nurse. The International Councils of Nurses have four principal elements that outline the standards of

ethical conduct such as Nurses and people, Nurses and practice, Nurses and profession.

In a literature review examining ethical competency, Andrews (2004) stated that the nursing

profession is grounded in an ethical model. Andrews further stated that it is imperative to address the

development of the professional skills of nurses to ensure they have the ability to function in todays

healthcare environment and that moral values are inherent in this process. Andrews highlighted that

becoming a nurse is an integration of the attitudes and values of the nursing profession and that

continuing professional development of the nurse is imperative to ensure they will have the skills to practice

in their environment. Andrews suggested that it is the responsibility of leaders in nursing to understand how

new nurses acquire and actuate the ethical component of their role in order to advocate for them through

the transition into the professional role. It is important that nurse educators are taking students who have

developed their own values and beliefs over their lifetime, and mold them into the professional practice,

based on these values and beliefs, which are inherent to every person.

The presence of the code of ethics in an institution is felt through the support of staff nurses to the

goals of the organization and ethical consciousness in performing assigned tasks. The mere presence of the

code of ethics appears to have a positive impact on perceptions of ethical behavior in organization, even

when respondents cannot recall any specific content of the code. Support of ethical and moral behaviors,

freedom to act, and solve ethical problems were impacted by the mere presence of a code (Adams, 2001).

Ethical problems in nursing practice include reference to the nurses particular position within the

social and hierarchical structure of the employment setting. Dr. Victoria Monzon (2004), states that role


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conflict, professional loyalty, personal conscience, obedience and dissent and coercion are some of the

problems being confronted by nurses in the performance of his practice. She further discussed that nurses

often times find it difficult to make decisions when there is a conflicting interest between the physicians

orders and the patients rights. Robert Beach supports this notion when he said that one moral problem for

any ethical theory is what an individuals moral obligations are when the person feels an act is wrong, but

that act has been ordered by someone else. Occasionally situations arises where the nurse has reason to

suspect that a certain order may be erroneous and could cause harm to the patient, legally as well as

morally you are obligated to question the order for this may represent a negligent act. Some nurses in order

to resolve this conflict applies his subordinate position in the organization by doing what is expedient rather

than what might be the best interest of the patient. Such behavior in turn becomes destructive influence to

individuals integrity, morality and allowing them to be absolved with guilt feelings by placing blame and

responsibility to others (Monzon, 2004).

Ethics also play a role in interpersonal conflict. Ethics refer to moral rules or values governing the

conduct of a person or group. Perhaps more than anything else, an individuals adherence to values related

to what is morally right determines the respect that others hold for that person. Lack of respect for one

individual by another is likely to lead to poor human relations between the two (ANA, 2001).

The ANA House of delegates approved these nine provisions of the new Code of Ethics for Nurses at

its June 30, 2001 meeting in Washington, DC. In July, 2001, the Congress of Nursing Practice and Economics

voted to accept the new language of the interpretative statements resulting in a fully approved revised Code

of Ethics for Nurses With Interpretative Statements.

1. The nurse, in all professional relationships, practices with compassion and respect for theinherent dignity, worth and uniqueness of every individual, unrestricted by considerations of

social or economic status, personal attributes, or the nature of health problems.

2. The nurses primary commitment is to the patient, whether an individual, family, group orcommunity.

3. The nurse promotes, advocates for, and strives to protect the health, safety and rights ofthe patient.

4. The nurse is responsible and accountable for individual nursing practice and determines theappropriate delegation of tasks consistent with the nurses obligation to provide optimum

patient care.


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5. The nurse owes the same duties to self as to others, including the responsibility to preserveintegrity and safety, to maintain competence and to continue personal and professional

growth.

6. The nurse participates in establishing, maintaining and improving healthcare environmentsand conditions of employment conducive to the provision of quality health care and

consistent with the values of the profession through individual and collective action.

7. The nurse participates in the advancement of the profession through contributions topractice, education, administration and knowledge development.

8. The nurse collaborates with other health professionals and the public in promotingcommunity, national and international efforts to meet health needs.

9. The profession of nursing, as represented by associations and their members, is responsiblenursing values, for maintaining the integrity of the profession and its practice, and for

shaping social policy.

ATTITUDES

Critical thinking in nursing requires active participation. Nurses must assume the responsibility for

learning. The desire to ask why, to develop inquisitiveness and to question promotes lifelong learning, a

positive attitude that a person can develop to promote skills in learning (Paul, 2001).

Nurses felt most competent in their ability to manage childrens pain and least competent to talk

with children and their families about dying. After adjusting for several factors, greater number of years in

nursing practice, more hours of palliative care education, were significantly associated with more comfort

working with dying children and their families, less difficulty talking about death and dying, and feeling more

competent in providing palliative care (Feudtner, Santucci, Feinstein, 2007). In their study on hopeful

thinking and level of comfort regarding providing pediatric palliative care they suggested that, improving

hopeful patterns of thoughts and feelings about the challenges confronted during end-of-life care for

children might result in improved quality of pediatric palliative care. This kind of attitudes will help patient

to recover and have a peaceful death.

SAFETY/THERAPEUTIC AND PROFESSIONAL RELATIONSHIPS

Nurses are knowledge workers whose main responsibility is to provide safe and effective care within

constantly evolving health care systems. Nurses collaborate with one another, as well as doctors, aides and


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technicians, to provide holistic care to patients. Although advocating for patient safety is a nurses role, it is

also necessary for the patient to be an active participant in their safety. Patient safety is a collaborative goal

that requires concerted efforts from the patient and all members of the health care team. It is also a means

to foster communication between the patient and the nurse including other health care members to attain

better patients health (Kozier, 2004).

Nursing is the protection, promotion and optimization of health and abilities, prevention of illness

and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the

care of individuals, families, communities and populations (ANA, 2003).The nursing method is the basis of

all clinical judgments and includes all dealing made by nurses in providing care to patients. Considerations

for culture, safety, education, health and wellness, patient care, self-health promotion and planning for

long-term health maintenance are included in nursing measures (Potter et al, 2005).

According to the Ebright et al (2005), several factors related to safety influence a nurses ability to

make logical and accurate decisions are knowledge base, attention, barriers to care (like workplace

obstacles), number of tasks, missing essential information, and behaviors not encouraging of productive

thought.

Due to the increasingly complex nature of the role of nurses, everyday nursing duties are also a

challenge in protecting the safety of every patient. Ebright et all (2005) found out the following are the

factors related to safety of delivering patient care were variety of supply locations, locating supplies when

not found in designated areas or not adequately stocked, repetitive travel (to patients rooms, nurses

stations, supply locations, etc.), unexpected situations, interruptions and distractions, pauses to wait for

system services (computers or medication carts), inadequate resource access for further care and new

procedures, miscommunication and errors due to handwriting and labeling.

PROFESSIONAL RELATIONSHIPS

The nurse, in all professional relationships, practices with compassion and respect for the inherent

dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic

statues, personal attributes or the nature of health problems (ANA, 2001). In addition, the American Nurses

Association Code of Ethics for Nurses identifies areas to develop professional relationships. These were

enumerated as to, respect for human dignity, relationships to patients, the nature of health problems, the

right top self determination and relationships with colleagues and others.


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Professional boundaries separate therapeutic behavior of the registered nurse from any behavior

which, well intentioned or not, could lessen the benefit of care to clients, families and communities. The

ethical limits of relations between registered nurses giving care and those persons who receive nursing care

are defined, and boundary violations are described. Information on resources to help registered nurses and

others with questions about professional boundaries is also provided.

Professional boundary issues also arise for registered nurses outside of therapeutic relationships

with clients. These are registered nurses in teaching relationships with students, working with research

participants, managing staff, and in working relationships with co-workers or in other roles. These

relationships are not therapeutic ones, but they also require trust. Registered nurses in any role can ensure

that professional boundaries are respected by applying the following guidelines to their nursing practice as

appropriate for their role. Guidance for appropriate conduct should also be sought in policies for faculty

conduct in educational institutions, in research guidelines for researchers, and in personnel policies, labor

law and collective agreements for managers and staff.

It is crucial for all health-care professional to recognize the differences between therapeutic

relationships and other types of non-professional relationships. Boundary violations can harm the client, the

professional and even possibly others. While the incidence of boundary violations reported is very low, they

should never occur in a therapeutic relationship. The potential for harmful boundary incidents is decreased

when there is good understanding of the issues involved.

Boundaries give each person a sense of legitimate control in a relationship. Professional boundaries

set limits to the nurse-client relationship, which establish a safe, therapeutic connection between the

professional and seeks care.

CLINICAL KNOWLEDGE

One of the primary purposes of clinical knowledge is to achieve understanding. By qualifying points

of view and solving problems through questioning, understanding becomes clear. The nursing process is a

discipline-specific approach that uses clinical knowledge.

Benner and Wrubel (1982) referred to clinical knowledge as the knowledge that is embedded in the

practice of nursing. The authors have taken the strategies for clinical knowledge development, for


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documenting, conserving and enhancing the unique and intuitive knowledge of the experienced clinician

and presented them as a means of job enrichment and retention opportunities of the experienced nurse.

The difference of practical and theoretical knowledge and the implications for enhancing the practical

knowledge gained from clinical experience were examined.

The many dimensions include the dedication to provide quality care to all patients (holistic in nature

to meet the perceived, actual, or potential needs), sharing of knowledge on the development of training

standards, standards of care and quality assurance, promotion of safety and competence during transport

(Holleran, 1996 & 2003). It is a unique specialty which has taken to new heights along with a diverse and

dynamic operational environment hospital and prehospital. For practice, knowledge in many areas of

medicine is necessary: care, emergency care, pediatric, neonatal, obstetric, orthopedic, geriatric and

prehospital care. The multidimensional practice promotes collaboration with these specialties to enhance

patient care (Holleran et al., 1996 & 2003).

CRITICAL INTEGRATION AND CRITICAL THINKING

Critical thinking is a discipline process that requires validation of data, including assumptions that

may influence your thoughts and then careful reflection on the entire process while evaluating the

effectiveness of what you have determined is the necessary action to take. Critical thinking is related to self

appraisal, professional development and the value of evidence and research for practice. Reflecting on

practice, feelings and beliefs and the consequences of these for individuals/groups is an important

professional benchmark.

In the study of Mishoe (2004), entitled Critical Thinking in Respiratory Care Practice: A Qualitative

Research Study the findings suggest the critical thinking in respiratory care practice involves the abilities to,

prioritize the expected and the unexpected, anticipate problems and solutions, troubleshoot technical

problems, communicate according to the therapists styles and the demads of the situation, negotiate

responsibilities and medical orders for patient care, make individual, shred and consultative decisions,

reflect on the patients , the decisions and personality traits and the organizational context also affected

critical thinking in respiratory care practice, but these additional findings are beyond scope of this report.

According to ANMC (2005), they identified practices to develop critical thinking is of relative

importance that is based on the practices within an evidence-based framework. The council enumerated

practices to enhance quality care.


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y Identifies the relevance of research to improving individual/group health outcomesy Uses best available evidence, nursing expertise and respect for the values and beliefs of

individuals/groups in the provision of nursing care

y Demonstrates analytical skills in accessing and evaluating information and research evidencey Support and contributes to nursing and health care researchy Participates in quality improvement activitiesy Uses best available evidence, standards and guidelines to evaluate nursing performancey Participates in professional development to enhance nursing practicey Contributes to the professional development of othersy Uses appropriate strategies to manage own responses to the professional work environment

CHAPTER III

METHODS AND PRACTICE

This chapter deals with the method of research, research design, tools and instruments,

respondents of this study and treatment of data.

RESEARCH METHOD/RESEARCH DESIGN

The researcher used descriptive method of study to gather information on the competency level of

volunteer nurses in the pediatric ward of Quirino memorial Medical Center to enhance quality care


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According to Polit, (2004), descriptive research focuses on understanding the cause of behavior,

conditions and situations and in which data gathering is done through observation, survey and interview.

This was employed to gather the necessary data about the evaluation of the nurses competency. Thus, the

purpose of this was to systematically describe the competency level of volunteer nurses as to their

Professional Behavior, Ethics, and Attitudes; Safety/Therapeutic and Professional Relationship; Clinical

Knowledge; Critical Knowledge; Critical Integration and Critical Thinking. This was done to test the

hypothesis or answer questions that linger in the mind of the researcher concerning the current status of

the subject (Travis, 1999).

Polit (2004), also emphasized that this is not merely the gathering and tabulating of data but also

involves the element of interpretation of meaning or significance of the study. Hence, it will determine the

competency level of volunteer nurses handling pediatric patients, enhancing quality care based on

Professional Behavior, Ethics and Attitudes; Safety/Therapeutic and Professional Relationship; Clinical

Knowledge; Critical Knowledge; Critical Integration and Critical Thinking.

RESEARCH TOOLS AND INSTRUMENTS

This study utilized a checklist questionnaire as the main instrument in gathering data. Confidentiality

was assured by attaching a cover letter, which established cooperation from the head nurses and the

supervisor who evaluated the volunteer nurses included in this research work. The questionnaire includes

the competencies needed by the volunteer nurses in handling pediatric patients to provide quality of care to

patients.

The instrument undergone pre-testing using 5 respondents from the Pediatric Ward of Quirino

Memorial Medical Center with the head nurses evaluating the volunteer nurses using the same instrument

as to those that were involved in the study. This was done to find out if the questions could be clearly

understood and for the researcher to illicit additional information. Moreover, those who participated in the

pre-testing were excluded in the actual study.

A two-part questionnaire was developed by the researcher to be answered by the head nurses. The

first part was intended for the volunteer nurses demographic profile (Age, Gender, Length of Service as a

Professional Nurse, Previous Area of Assignment, Educational Attainment and Trainings attended relevant to

handling pediatric patients).


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The second part was on the competency level that includes Professional Behavior, Ethics and

Attitude; Safety/Therapeutic and Professional Relationship; Clinical Knowledge; Critical Knowledge; Critical

Integration and Critical Thinking.

A 7-point Likert Scale was utilized to evaluate the competency level of volunteer nurses in the

pediatric ward based on the evaluation of their head nurses. The head nurses who assessed their volunteer

nurses were asked to rate according to the degree of their agreeability and disagreeability expressed on the

said scale.

6.5 7.0 = EXCELLENT Carries out procedures efficiently, systematically and

independently.

5.5 6.49 = VERY GOOD Carries out the procedures efficiently and systematically but

requires minimal guidance and supervision

4.5 5.49 = ABOVE AVERAGE Carries out procedures efficiently and systematically but

requires moderate guidance and supervision

3.5 4.49 = AVERAGE Carries out the procedures efficiently and systematically but

requires close guidance and supervision

2.5 3.49 = BELOW AVERAGE Carries out the procedures inefficiently and


supervision

1.5 2.49 = POOR Carries out the procedures inefficiently and


supervision and recommend for further orientation and

training

1.00 1.49 = VERY POOR Carries out the procedures very inefficiently and


supervision and recommend for dismissal

To transmute the following to Benners competency level, the scale below was utilized.

5.80 7.00 Expert

4.60 5.79 Proficient

3.40 4.59 Competent

2.20 3.39 Advanced Beginner


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1.00 2.19 Novice

RESPONDENTS OF THE STUDY

A purposive sampling was utilized by the researcher in this study wherein, the sample selected

becomes the representative of the whole population. According to Adanza (2002), this gives the researcher

an opportunity to decide purposely to handpick the cases to be included in the samples and often used

when the researcher wants a sample of experts.

The respondent of this research study were the head nurses assigned in the Pediatric ward of

Quirino Memorial Medical Center who directly supervised their volunteer nurses that render direct nursing

care to pediatric patients.

TREATMENT OF DATA

The following statistical computation was utilized to answer the queries that the researcher

established in Chapter 1.

For problem Number 1, percentage and frequency were used and the formula was:

P = F x 100%

N

Where: P = Percentage

F = Frequency

N = Number of Respondents

For problem Number 2, the weighted mean was applied using the formula:

WM TW

N

Where: WM = Weighted Mean

TW = Sum of all Weights

N = Sum of the Frequency


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termpaper. final

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