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CHAPTER 2

REVIEW OF RELATED LITERATURE This chapter aims to present the related literature borrowed materials written by authorities in the field which the current study discussed.

Related Literature

Definition of competency The number of definitions and descriptions of the term competence is innumerable, and, therefore, impossible to cover all of the variations. As a result, a select few have been chosen to reflect the aspects most often related to nursing and the health care education environment. According to Norman (1985) competency is more than knowledge. It includes the understanding of knowledge, clinical, technical, and communication skills, and the ability to problem solve through the use of clinical judgment. Axley (2009) noted that competency is clearly more than the mere attainment of skills as it also involves other qualities such as attitudes, motives, personal insightfulness, interpretative ability, receptivity, maturity, and selfassessment (p. 218). Black and Wolf (1990) describe competence as the ability to perform in effective ways on different occasions including in differing and unexpected contexts [cited in While, 1994]. However, even if performance can be measured, there is a lack of evidence to suggest that good performance is always an adequate indicator of high degrees of competence [Stedman 1985, cited in While 1994, 9]. This example illustrates the case of a false positive where a nurse can answer a question correctly on an exam but from a false premise. A false

negative example is that of a nurse who may have the skill or knowledge to perform a task but fails to perform the task correctly in an examination situation. These examples suggest that performance alone may not be an adequate indicator of competence.

According to Rhodes (2011), that with competence comes confidence, once a nurse is competent in critical thinking, clinical judgment, and performing skills, the nurse would become confident. Competencies can be thought of as underlying characteristics of individuals that result in effective performance. Competencies delineate the unique aspects of a particular area of practice and provide a model for entry into that practice (Emergency Nurses Association,2008). Competency standards are necessary balance against an over intellectual approach to education and practice in nursing (Eraut, 1998) A nurse is competent when (s)he possesses the skills and abilities required for lawful, safe and effective professional practice without direct supervision The registered nurse practises independently and interdependently, assuming accountability and responsibility for their own actions and delegation of care to enrolled nurses and health care workers. Thus, nurses needs to be competent in terms of knowledge, skills and attitude.

Legal basis for nursing core competencies According to Article 3 Sec.9 (c) of R.A. 9173/ Philippine Nursing Act 2002 Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation this serve as the legal basis of core competency in nursing practice. That serves as a unifying framework for nursing practice, education, regulation; guide in nursing curriculum development; framework in developing test

syllabus for nursing profession entrants; tool for nurses performance evaluation; basis for advanced nursing practice, specialization; framework for developing nursing training curriculum; public protection from incompetent practitioners and Yardstick for unethical, unprofessional nursing practice.

According to Board of Nursing, Board Resolution No. 425 Series of 2003, Republic Act 9173, Article 5 Sec. 25 Nursing Education Program, The nursing education program shall provide sound general and professional foundation for the practice of nursing taking into consideration the learning outcomes based on national and universal nursing core competencies. The learning experience shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Educations policies and standards of nursing education. According to Ched Memorandum Order, No.14, Series of 2009, Article 1 Sec.1, .BSN program therefore, aims to prepare a nurse, who, upon completion of the program, demonstrate beginning professional development and utilizes research findings in the practice of the profession. According to Ched Memorandum Order, No.14, Series of 2009, Article III Sec.4, BSN program provides intensive nursing practicum that will refine clinical skills from the first year level to ensure basic clinical competencies required of the beginning nurse practitioner. According to Ched Memorandum Order, No.14, Series of 2009, Article III Sec. 4.1, BSN program aims to produce nurse who is able to perform the competencies under each of key areas of responsibility as enumerated in Article IV sec 5 herein.

Standards of Practice and Competency

According to American Nurses Association (2010), The Standards of Practice describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Accordingly, the nursing process encompasses significant actions taken by registered nurses and forms the foundation of the nurses decision-making.

According to American Nurses Association (ANA) Standards of Professional Performance describes a competent level of behavior in the professional role, including activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization, this document serves as objective guidelines for nurses to be accountable for their actions, their patients, and their peers. The standards provide a method to assure clients that they are receiving high-quality care, that the nurses know exactly what is necessary to provide nursing care, and that measure are in place to determine whether the care meets the standards.

Ethics and Competence Ethics and competence involve two related aspects; first is the ethical nurse who practices competently and second, there is a component of being ethically competent. The development of ethical competence is of importance when it comes to being able to both reduce practice errors and retain nurses in health care. Ethics in perioperative practice has become especially prominent

as a focus on patient safety has come to the forefront. Perioperative nurses have a tradition of promoting patient safety by intervening to minimize the risks related to surgical infection and injury (Beyea, 2002). The action of intervening in high-risk situations may be motivated by practice standards, professional duty, ethical values and beliefs. When surgical errors happen, there is the responsibility or duty to report the errors and that is where the ethical imperative enters into nursing practice. Ethical practice is important to nursing as it underpins the fiber of the practice itself by providing an action guide for nurses. With the increased awareness of medical malpractice in general, and surgical or perioperative errors in particular, it has become imperative for nurses to be able to speak out when errors, or the potential for errors, become evidenced. According to Hettiarchy (2001), surgical errors often appear the worstthe end points in surgery are often more concrete and immediate than in medicine survival or death, cure or failure.

The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2001) third provision asserts that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. This relates to the ANA Code statement that as an advocate for the patient, the nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practice... (p. 14). This provision specifically directs nurses to take some type of action to support the rights of their patients. The concept of ethics as an action guide is inherent in nursing practice and nursing practice involves nurses having the power and knowledge to competently care for patients.

Working position and Competence The competence, as well as the incompetence, of staff nurses has been studied for years. It is, and always will be, a concern of many who advocate for safe patient care and outcomes. Activities related to identifying and establishing nursing competencies have been the focus of state nursing associations, regulatory boards, educators, professional associations, external stakeholders and individual registered nurses. The Washington State Nurses Association (WSNA) put forth recommendations that nurses from all practice areas must be actively involved in decisions about professional competence determination within their own practice settings. As a constituent of the American Nurses Association, the Washington State Nurses Association supports continued efforts by ANA to define continued competency in nursing, as well as continuing efforts by individual registered nurses to participate in activities related to competency in their workplace settings. The ANA Code presently supports the concept of continued competency in nursing for Nurses and professional nursing standards within the discipline of nursing. Hasson and Arnetz (2008) in a study of nursing staff competence, work strain, stress and satisfaction in elderly care found that the lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff have been associated with high turnover. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. Obviously this information has relevance to clinical practice as lack of competence development may have significant negative implications for work satisfaction.

A 2006 study by Farrand, McMullan, Jowett, and Humphreys sought to examine whether the implementation of competency recommendations has led to improvements in the confidence of nursing students in their clinical skills. They found the positive effect that the competency recommendations had upon levels of confidence in nursing practice. Not surprisingly, they discovered that there is a relationship between competence and confidence. The rapid expansion of computer-driven technologies into multiple aspects of modern health care suggests that many of the important competencies of the 21st century nurse will encompass mastery of computer technology. Little agreement was found regarding specific computer-focused competencies necessary for nurses. Taken as a whole, however, there is consensus that the computer-competent nurse possesses a general knowledge and understanding of computer technology, coupled with a positive attitude toward computers and software. In addition, such a nurse is skillful in the use of computer hardware and software and able to grasp how such technology benefits nursing, patient care and the overall health care environment. Traditionally, emotional competencies may have been placed under the umbrella called, professionalism; a term often overused and under-explained by nursing faculty when communicating about soft skills, or emotional competencies. Performance criteria inherent to professionalism such as self-awareness, initiative, empathy, conflict management, integrity, team management and other emotional competencies commonly referred to as soft people skills are typically missing from the evaluation checklist. In fact, these soft people skills are often cited by administrators as being noticeably missing from nursing practice. Yet, the very skills necessary to manage self and others are grounded in emotional competence and are

essential to the delivery of excellent patient care. The competence of the clinical nurse encompasses a wide variety of practice areas from generic to specialty. There is much room for further research when examining the intricacies of competence (e.g. emotional to technical).

Competence based on the Level of Experience According to Patricia Benner in her theory of from Novice to Expert model nurses was classified based on their level of nursing experience. This composed of five levels, as the individual progress through these levels, they demonstrate changes using experiences. Second, they move from analytic, rule based thinking to intuition. Third, the learners perception changes from a situation composed of equally relevant parts to a complex whole in which certain parts are more relevant than others. Fourth, they move from a detached observer to an actively involved performer. (Benner & Wrubel 1989).

Stage I (Novice), they are the beginners, they have no experience of the situations in which they 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 behaviour typical of the novice is extremely limited and inflexible. As such, novices have no life experience in the application of rules. Stage II (Advance Beginner), they 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. Stage III (Competent ), 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 terms of long-range goals or plans of 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 levels help achieve efficiency and organization. The competent nurse 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. Stage IV( Proficient), 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 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. Stage V (The Expert), expert performer no longer relies on an analytic principle (rule, guideline, 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. The expert operates from a deep understanding of the total situation.

Related Studies

A study of Flanagan et al 2000 describes an approach to work- based learning and competence assessment and recommended that the nurse education needs to work towards workbased approaches to education and training which form a basis for equal partnerships between service providers and higher education.

A study of Kalb et al, 2006, it shows that the competence assessment tool has strong support from supervisors and nurses believe tool effectively describes/evaluates their practice.

A descriptive study of Meretoja et al, 2004, with population of 593 Registered nurses shows that the operating room nurses reported lower levels of competence and lower frequency of using competencies in several categories and have a positive correlations between age and length of work experience and level of competence. The study recommended that the Competence assessment should be continuous and a tool to recognise and reward nurses.

According to the comparative study of Meretoja and Leino-Kilpi 2003, with population of 81Nurses and 81 managers, shows that the overall level of competence rated as good by both nurses and manager. Overall, managers rated nurse competence higher (70.8 19.3 vs. 63.9 13.7) (p<0.05) with high degree of similarity between frequency of use of competencies. Work experience correlated positively with nurse self-assessments of competence. The study recommended that the manager expectations and communication with nurses are important for effective performance.

According to Meretoja et al 2004, a descriptive study with the population of 498 nurses shows that there is high level of self-assessed competence and higher frequency of use correlated with higher level of competence. The age and length of work experience had a positive but not strong correlation with level of competence. The study recommended that there must be further concept analysis of nurse competence and need for more research to explore connection between nurse competence, nursing outcomes and quality of care.

Synthesis

The definition of competency according to Axley (2009), noted that competency is clearly more than the mere attainment of skills as it also involves other qualities such as attitudes, motives, personal insightfulness, interpretative ability, receptivity, maturity, and selfassessment (p. 218). And according to Rhodes (2011), that with competence comes confidence, once a nurse is competent in critical thinking, clinical judgment, and performing skills, the nurse would become confident. In legal basis for nursing core competencies which is Republic Act 9173 Philippine Nursing Act 2002, Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation this serve as the legal basis of core competency in nursing practice.

In standard of practice and competency, according to American Nurses Association (ANA) Standard of Practice describe a competent level of nursing care as demonstrated by the

critical thinking model known as the nursing process. And also the ANA Standards of Professional Performance describes a competent level of behavior in the professional role, including activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization, this document serves as objective guidelines for nurses to be accountable for their actions, their patients, and their peers.

In ethics and competence, the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2001) third provision asserts that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. This relates to the ANA Code statement that as an advocate for the patient, the nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practice... (p. 14).

In competence based on the level of experience, according to Patricia Benner in her theory of from Novice to Expert model a nurse was classified based on their level of nursing experience. This composed of five levels, as the individual progress through these levels, they demonstrate changes using experiences. Second, they move from analytic, rule based thinking to intuition. Third, the learners perception changes from a situation composed of equally relevant parts to a complex whole in which certain parts are more relevant than others. Fourth, they move from a detached observer to an actively involved performer. (Benner & Wrubel 1989).

Theoretical framework The study is focus on the level of awareness of the Filipino nurses on the nursing core competencies and the extent of its application in the nursing care practice. The study was based on the relevant theories such as the following: Nursing Core competency Model is a competency-based education and practice partnership model, created by The Massachusetts Department of higher Education in response to the challenge of increasing capacity of nurses; it says that nursing core competency is come-out with the foundation of nursing knowledge. Nursing is a scholarly profession and practice-based discipline and is built on a foundation of knowledge that reflects nursings dual components of science and art. Nursing knowledge in conjunction with a liberal education prepares learners to enter practice with identified core competencies. A solid base in liberal education provides the distinguishing cornerstone for the study and practice of professional nursing (American Association of Colleges of Nursing [AACN], 2008, p. 11). A strong foundation in liberal arts includes a general education curriculum that provides broad exposure to multiple disciplines and ways of knowing. As defined by the Association of American Colleges and Universities (AAC&U), a liberal education is one that intentionally fosters, across multiple fields of study, wide ranging knowledge of science, cultures, and society; high level intellectual and practical skills; an active commitment to personal and social responsibility; and the demonstrated ability to apply learning to complex problems and challenges (AAC&U, 2007, p. 4). A liberal education includes both the sciences and the arts (AACN, 2008, p.10).

As a scientific discipline, nursing draws on a discrete body of knowledge that incorporates an understanding of the relationships among nurses, patients, and environments within the context of health, nursing concepts and theories, and concepts and theories derived from the basic sciences, humanities, and other disciplines. The science of nursing is applied in practice through a critical thinking framework known as the nursing process that is composed of assessment, diagnosis, planning, implementation, and evaluation. The steps of the nursing process serve as a foundation for clinical decision-making and evidence-based practice. Nurses use critical thinking to integrate objective data with knowledge gained from an assessment of the subjective experiences of patients and groups, and to apply the best available evidence and research data to the processes of diagnosis and treatment. Nurses use clinical reasoning to respond to the needs of the populations they serve and to develop strategies to support optimal outcomes that are most appropriate to the patient or situation while being mindful of resource utilization. Nurses continually evaluate the quality and effectiveness of nursing practice and seek to optimize outcomes (American Nurses Association [ANA], 2004).

Likewise, The Quality and Safety Education in Nursing (QSEN) led by Dr. Linda Cronenwett, identified the knowledge, skills, and attitudes (KSAs) that nurses must possess to deliver safe, effective care (Smith, Cronenwett, & Sherwood, 2007)

Research Paradigm

This study will be conducted based on the facts and informations acquired from nursing personnel of Dr. Paulino J. Garcia Memorial Research and Medical Center through direct distribution of questionnaires. This study focuses on the Level of Awareness and Extent of Application of the Nursing Core Competencies in Selected Hospitals in Nueva Ecija: A Basis for Performance Evaluation of Nursing Service The study discussed the nursing core competency being practiced by the nursing personnel, to determine the level of awareness, extent of application, compliance and to improve the performance of nursing service. The following is the paradigm of the study

INPUT

PROCESS

OUTPUT

1. Respondents Profile age gender working position working area years of service/experience time shifting highest educational attainment 2. Level of Awareness in the nursing core competencies in terms of: Safe and quality nursing practice Communication Collaboration and teamwork Health education Legal responsibility Ethico moral responsibility Personal and professional development Record management Management of resources and environment Quality improvement Research 3. Extent of application of the nursing core competencies by the nursing personnel in terms of: Safe and quality nursing practice Communication Collaboration and teamwork Health education Legal responsibility Ethico moral responsibility Personal and professional development Record management Management of resources and environment Quality improvement Research

Assessment Data are obtained by providing set of questionnaires to each respondent.

1. Determines the evaluation in terms of:

Level of awareness Extent of application Compliance

Analysis Statistical treatment is provided to show accurate data. 2. Improved performance of nursing service.

Figure 1. Paradigm of the Study

Findings of the Study

The findings of this review mirror those of previous reviews of the literature about the competency in nursing. While a range of competency indicators were identified, few of the articles included described the competence of nurses to ensure nursing standard practice. Given the current lack of empirical evidence in this area, there is an opportunity to include some form of evaluation component into the competency framework that may contribute valuable information to the hospital. In broad terms, competency standards recommend expected levels of knowledge, attitudes, skills and behaviours. Competencies for professional nursing should reflect the multifaceted nature of nursing practice.

CHAPTER 3 METHODOLOGY This chapter is concerned with the presentation of the method and procedures used in gathering, consolidating, and statistically quantifying the information which served as basis for the establishment of the trend of reactions to be discussed in the study.

Research Design The researchers will use a descriptive method of research to obtain information about the awareness and extent of application of the 11 nursing core competencies in nursing practice in a selected hospital in particular. They will utilize a quantitative research to comprehensively present and statistically interpret the data yielded from the participants. Furthermore, they will apply a survey research, through paper-pen questionnaire to study a representative characteristic of nurses regarding their awareness and extent of application of 11 nursing core competencies in nursing practice in a hospital set-up.

Participants/Respondents of the Study The participants will be the nursing personnel of Dr. Paulino J. Garcia Memorial Research and Medical Center. These will include the nurse supervisors, staff nurses assigned from the different areas as well as the RN Heals. The participants are limited only from the population of 326 nurses who are working on a regular basis. The researchers will not include those nurses who are volunteers and trainees on the said hospital.

Sampling Procedure The researchers plan to obtain the samples by means of stratified random sampling. Using the stratified random sampling, the researchers will first divide the population into groups based on a relevant characteristic that is according to employment status. After doing so, the group will be divided further from their working area the staff nurses and the RN Heals in particular, then each group will be divided again according to participants gender: male and female. The researchers will then select the sample population within each subgroup to ensure that the primary group are adequately represented. Since, there is only one Nurse VII, one Nurse VI, two Nurse IV, and eight Nurse III, the researchers will consider all of them as a sample in the group that they represent because they are very few. Then the rest of the group will be randomly selected using either the hat-and-draw method or a random number table. The researchers will select randomly the requisite number of males and do the same for the females of each subgroup of nursing personnel. The number of sections drawn from the population will be determined by using the Slovins formula: n=N/1+Ne2, where n is the number of sample, N is the number of population and e is the margin of error. The researchers will use .05 as a margin of error in the study. A total of 184 sample participants will be included in the study, since the researchers will not include Nurse VII, Nurse VI, Nurse IV and Nurse III in random selection of sample.

Instrumentation The researchers will primarily use a questionnaire, a paper-and-pencil self-report instrument in gathering data for the study. They will use formulated questionnaire by the researchers that will depict the level of awareness and extent of application of 11 nursing core competencies in nursing practice in the hospital. The formulated questionnaire will be based on PRCBON National Core Competency Standards of Filipino Nurses latest edition. It will consist

of three parts. The first part will consist of the personal profile of the participants, which includes the age, gender, position, working area, year(s) of experience, time shifting and highest educational attainment; the second part will contain the questions that will measure the level of awareness and the third part will contain the questions also the extent of application of the participants to the 11 nursing core competencies in the hospital. The researchers will use the Likert Scale as a tool to measure the level of awareness and extent of application of the participants.

Table 1. Likert Scale to be Used in Interpreting Weighted Mean on Level of Awareness Unit Weight : Weighted Mean 5 : 4.5 5.49 4 : 3.5 - 4.49 3 : 2.5 - 3.49 2 : 1 .5 - 2.49 1 : 0.49 1.49 Verbal Interpretation Extremely Aware Moderately Aware Somewhat Aware Slightly Aware Not at all Aware Meaning Very conscious at all times Conscious Fairly conscious Minimal consciousness Not at all conscious

Table2. Likert Scale to be used in Interpreting Weighted Mean on Extent of Application Unit Weight : Weighted Mean 5 : 4.5 5.49 4 : 3.5 - 4.49 3 : 2.5 - 3.49 2 : 1 .5 - 2.49 1 : 0.49 1.49 Verbal Interpretation Every time Almost Every time Sometimes Almost Never Never Meaning On all occasion, repeatedly Frequently, in many instances Occasionally Seldom, not often, in frequent Not at all , surely not

Data Gathering Procedure First, the researcher will formulate a questionnaire that will describe the level of awareness and extent of application of 11 nursing core competencies in nursing practice in the hospital. The questionnaire will be laboriously checked and validated by the adviser. After examining, the corrected instrument will be reproduced for pilot testing to selected nurses who

will not be included to the sample, to figure out if there will be still questions necessary for revisions and corrections. Then, after the formulated questionnaire has been proven and corrected, the researchers will seek the approval of Mrs. Pinky Miriam D. Canlas, the Chief Nurse of Dr. Paulino J. Garcia Memorial Research and Medical Center, to allow the researchers to conduct the study and to distribute the formulated questionnaire to the participants. A letter to the participants will then be given to them requesting for their participation in answering the questionnaires. After that, the researchers will distribute the questionnaires to them and will be collected after they answered all the questions. The administered questionnaire will then be retrieved with the reactions to the items being tallied, consolidated, and presented in tabular form and to be used as basis for establishing the general sentiment of the participants towards the topics opened for evaluation in the study. The actual data collection will be held on August 2013 in Dr. Paulino J. Garcia Memorial Research and Medical Center at Cabanatuan City, Nueva Ecija.

Statistical Tools To interpret the findings and data gathered, frequency count and percentage will be used to determine the profile variables of the participants. % = F/N x 100 Where: % = Percentage F = Frequency of each item or response N= Total number of participants

The weighted mean will reveal the overall average of the responses of the participants. It will be used to address their answers on the level of awareness and extent of application of 11 nursing core competencies in nursing practice. x = Wi/Xi n

Where: x Wi Xi n

= weighted mean = weight of each item value = total number of participants = total number of weights

In dealing with the significant relationship between the profile variables and the level of awareness of the participants on 11 nursing core competencies in nursing practice in a hospital setting the researchers will use chi square. The chi-square is the sum of the squared difference

between observed (o) and the expected (E) data (or the deviation, d), divided by the expected data in all possible categories.

X2 = (o-E)2 E Where: X2 = Chi square O = Observed data E = Expected data

The researchers will use t-test to calculate the significant difference between the level of awareness and extent of application of the 11 nursing core competencies in nursing practice. This will be used in testing the significance of a correlation between the observed data from the participants. In simple terms, the t-test compares the actual difference between two means in relation to the variation in the data. t = x1-x2 d Where t = test of correlation

x1 = sample mean 1 x2 = sample mean 2 d = standard deviation of the difference between the means

Central Luzon Doctors Hospital-Educational Institution Master of Science in Nursing Tarlac City, Tarlac July, 2013

Pinky Miriam D. Canlas, R.N., M.A.N. Chief Nurse, Dr. Paulino J. Garicia Memorial Research and Medical Center Cabanatuan City, Nueva Ecija Dear Madam: The undersigned are Master of Science in Nursing Students of Central Luzon Doctors Hospital Educational Institution and are undergoing a research study entitled Level of Awareness and Extent of Application of the Nursing Core Competencies in Selected Hospitals in Nueva Ecija: A Basis for Performance Evaluation of Nursing Service as a partial fulfilment of the subject Nursing Research. In this connection, the researchers are soliciting your favorable permission to allow us to conduct a survey among the fellow nurses as our correspondent. We have prepared questionnaires for them to answer We assure that the findings of the study will benefit everybody; especially the nurses and also that information to be provided by your nursing personnel will be held in strictest confidence and shall serve no purpose except of the study. We hoped that this request will merit consideration and favorable action from your honorable office. Thank you very much. Respectfully yours, The Researchers

Noted by: JAY MANUEL T. GALEON, MSN, MAN Research Professor

Approved by: PINKY MIRIAM D. CANLAS, R.N., M.A.N. Chief Nurse

August,

2013

Dear Respondents, We, Second Year Master of Science in Nursing Students of Central Luzon Doctors Hospital Educational Institution are presently conducting a research entitled Level of Awareness and Extent of Application of the Nursing Core Competencies in Selected Hospitals in Nueva Ecija: A Basis for Performance Evaluation of Nursing Service, as a requirement of the subject Nursing Research.

Therefore, we would like to ask for your assistance in answering this survey questionnaire. Your honest answer will be very much appreciated. Rest assured that your responses would be kept confidential.

Thank you very much for your time and cooperation.

Respectfully yours,

The Researchers

LEVEL OF AWARENESS AND EXTENT OF APPLICATION OF THE NURSING CORE COMPETENCIES IN SELECTED HOSPITALS IN NUEVA ECIJA: A BASIS FOR PERFORMANCE EVALUATION OF NURSING SERVICE

1. Respondents Profile Name (Optional): ________________________ Age: __________ Gender: __________ Position: _____________ Working Area: _____________ Year(s) of Experience: ______ Time Shifting: __________ Highest Educational Attainment: _______________________ 2. What is your the level of awareness on 11 nursing core competencies in your nursing practice in this hospital? Direction: Below are items on the question about the 11 nursing core competencies to test the level of awareness. Please put (/) check mark to choose any of the number to the space provided to best express your honest opinion by using the following scale: Category Weight Extremely Aware 5 Moderately Aware 4 Somewhat Aware 3 Slightly Aware 2 Not at all Aware 1 I. PATIENT CARE COMPETENCIES 1.1. Safe and quality nursing practice 1.1a. Demonstrates knowledge base on the health /illness status of individual / groups 1.1b. Provides sound decision making in the care of individuals / families/groups considering their beliefs and values 1.1c. Promotes safety and comfort and privacy of clients 1.1d. Sets priorities in nursing care based on clients needs 1.1e. Ensures continuity of care 1.1f. Administers medications and other health therapeutics 1.1g. Utilizes the nursing process as framework for nursing 1.1g.1 Performs comprehensive and systematic nursing assessment 1.1g.2 Formulates a plan of care in collaboration with clients and other members of the health team 1.1g.3 Implements planned nursing care to achieve identified outcomes 1.1g.4 Evaluates progress toward expected outcomes 1.2 Communication

1.2a. Establishes rapport with client, significant others and members of the health team 1.2b. Identifies verbal and non-verbal cues 1.2c. Utilizes formal and informal channels 1.2d. Responds to needs of individuals, family, group and community 1.2e. Uses appropriate information technology to facilitate communication 1.3 Collaboration and Teamwork 1.3a. Establishes collaborative relationship with colleagues and other members of the health team 1.3b. Collaborates plan of care with other members of the health team 1. 4 Health Education 1.4a. Assesses the learning needs of the client-partner/s 1.4b. Develops health education plan based on assessed and anticipated needs 1.4c. Develops learning materials for health education 1.4d. Implements the health education plan 1.4e. Evaluates the outcome of health education

II. EMPOWERING COMPETENCIESPOW 1.5 Legal Responsibility 5 1.5a. Adheres to practices in accordance with the nursing law and other relevant legislation including contracts, informed consent. 1.5b. Adheres to organizational policies and procedures, local and national 1.5c. Documents care rendered to clients 1.6 Ethico-moral Responsibility 5 1.6a. Respects the rights of individual / groups 1.6b. Accepts responsibility and accountability for own decision and actions 1.6c. Adheres to the national and international code of ethics for nurses 1.7 Personal and Professional Development 5 1.7a. Identifies own learning needs 1.7b. Pursues continuing education 1.7c. Gets involved in professional organizations and civic activities 1.7d. Projects a professional image of the nurse 1.7e. Possesses positive attitude towards change and criticism 1.7f. Performs function according to professional standards

III. ENHANCING COMPETENCIES 1.8 Records Management 1.8a. Maintains accurate and updated documentation of client care 1.8b. Records outcome of client care 1.8c. Observes legal imperatives in record keeping 1.9 Management of Resources and Environment 1.9a. Organizes work load to facilitate client care 1.9b. Utilizes financial resources to support client care 1.9c. Establishes mechanism to ensure proper functioning of equipment 1.9d. Maintains a safe environment IV. ENABLING COMPETENCIES 1. 10 Quality Improvement 1.10a. Gathers data for quality improvement 1.10b. Participates in nursing audits and rounds 1.10c. Identifies and reports variances 1.10d. Recommends solutions to identified problems 1.11 Research 1.11a. Gather data using different methodologies 1.11b. Analyzes and interprets data gathered 1.11c. Recommends actions for implementation 1.11d. Disseminates results of research findings 1.11e. Applies research findings in nursing practice

3. How often do the participants apply the nursing core competencies in their nursing practice? Direction: Below are items on the question about the 11 nursing core competencies use in nursing practice. Please put (/) check mark to choose any of the number to the space provided to best express your honest opinion by using the following scle: Category Every time Almost Every time Sometimes Almost Never Never Weight 5 4 3 2 1

I. PATIENT CARE COMPETENCIES 2.1. Safe and quality nursing practice 2.1a. Demonstrates knowledge base on the health /illness status of individual / groups 2.1b. Provides sound decision making in the care of individuals / families/groups considering their beliefs

and values 2.1c. Promotes safety and comfort and privacy of clients 2.1d. Sets priorities in nursing care based on clients needs 2.1e. Ensures continuity of care 2.1f. Administers medications and other health therapeutics 2.1g. Utilizes the nursing process as framework for nursing 2.1g.1 Performs comprehensive and systematic nursing assessment 2.1g.2 Formulates a plan of care in collaboration with clients and other members of the health team 2.1g.3 Implements planned nursing care to achieve identified outcomes 2.1g.4 Evaluates progress toward expected outcomes 2.2 Communication 2.2a. Establishes rapport with client, significant others and members of the health team 2.2b. Identifies verbal and non-verbal cues 2.2c. Utilizes formal and informal channels 2.2d. Responds to needs of individuals, family, group and community 2.2e. Uses appropriate information technology to facilitate communication 2.3 Collaboration and Teamwork 2.3a. Establishes collaborative relationship with colleagues and other members of the health team 2.3b. Collaborates plan of care with other members of the health team 2. 4 Health Education 2.4a. Assesses the learning needs of the client-partner/s 2.4b. Develops health education plan based on assessed and anticipated needs 2.4c. Develops learning materials for health education 2.4d. Implements the health education plan 2.4e. Evaluates the outcome of health education II. EMPOWERING COMPETENCIESPOW 2.5 Legal Responsibility 2.5a. Adheres to practices in accordance with the nursing law and other relevant legislation including contracts, informed consent. 2.5b. Adheres to organizational policies and procedures, local and national 2.5c. Documents care rendered to clients 2.6 Ethico-moral Responsibility 2.6a. Respects the rights of individual / groups

2.6b. Accepts responsibility and accountability for own decision and actions 2.6c. Adheres to the national and international code of ethics for nurses 2.7 Personal and Professional Development 5 2.7a. Identifies own learning needs 2.7b. Pursues continuing education 2.7c. Gets involved in professional organizations and civic activities 2.7d. Projects a professional image of the nurse 2.7e. Possesses positive attitude towards change and criticism 2.7f. Performs function according to professional standards III. ENHANCING COMPETENCIES 2.8 Records Management 2.8a. Maintains accurate and updated documentation of client care 2.8b. Records outcome of client care 2.8c. Observes legal imperatives in record keeping 2.9 Management of Resources and Environment 2.9a. Organizes work load to facilitate client care 2.9b. Utilizes financial resources to support client care 2.9c. Establishes mechanism to ensure proper functioning of equipment 2.9d. Maintains a safe environment IV. ENABLING COMPETENCIES 2. 10 Quality Improvement 2.10a. Gathers data for quality improvement 2.10b. Participates in nursing audits and rounds 2.10c. Identifies and reports variances 2.10d. Recommends solutions to identified problems 2.11 Research 2.11a. Gather data using different methodologies 2.11b. Analyzes and interprets data gathered 2.11c. Recommends actions for implementation 2.11d. Disseminates results of research findings 2.11e. Applies research findings in nursing practice ES

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