CHAPTER II PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter presents, analyzes and interprets the data. I.

The Nurses Abilities and The Identi ied Fa!t"rs Two key informants make use of focused assessment to arrive at better judgment in prioritizing nursing care. Focused assessment is problem oriented and may be the initial assessment or an ongoing assessment. Focused assessment is frequently performed on an ongoing basis to monitor and evaluate the patients progress, interventions, and response to treatments. ven when a focused assessment is performed, it is important to look at the entire picture. ! problem in one system will affect or be affected by every other system so scan your patient from head to toe and note any changes in other systems. The nurse will look for clues or pertinent data that will help them formulate nursing diagnosis. "ey informant number #$ Gi basehan kung unsa ka grabe ang pasyente like maglisod ba ug ginhawa. I-check ang ABC. Kung kinsay mas grabe, tabangunon na ud mao to amu unahon. Kung pa check-up lang, uwahi lang pud sila. !a triage ana man gud pero more on ABC ud amua."

Translation$ %&e use the patients status as bases in prioritizing. ' assess using the !()s then evaluate who needs help first. 'f the patient is there only for check*up, they are usually attended later.+ "ey informant number ,-$ #irst nato sir, I do assessment. $roper assessment ud labi na i% a%ter trans out sa patient. Ang amu patient mamn gud kay usually gikan sa &' so e(ery a%ter trans out , mag assessment kung unsa ud ang higher priority namu ba." Translation$ %The first thing ' do is assess the patient. .roper assessment is done especially if the patient is a trans*out from the /0. (efore the patient is released from the /0 into their rooms, assessment is always done.+

/ne of the e1amples of focused assessment is the !() 2ethod 3!irway, (reathing, )irculation4. 'n this method, the respondents checks first the airway followed by the breathing and the last is circulation of blood. This involves a lot of steps. 5evertheless, this assessment technique is used in many acute care settings especially in the emergency department, intensive care unit, coronary care unit and outside the hospital when there are motor*vehicle accidents.

"ey informant number 6$ In our case sa IC), since it is * on *, our priority ud is still to %ollow the ABC Airway, Breathing, Circulation. #or e+ample, intubated ang patient, we see that ,-- or -rach is clear para walay mubara. .ala syay airway %irst. !econd is I/ lines, iyang circulation. -hen mga meds. I% %or e+ample naa pud mi Glasgow coma scale specially sa mga neuro patients. Kung 0 and below, kinahanglan hud sila like I priority ud namu sila %rom turning, %rom %eeding nga basic needs nila. !o kung amu nalang kung ambulatory na sila, naa gihapon silay prioriti1ation pero amu ud I prioriti1e ang katong critical na ud. Katong bati na kayo ug /ital !igns." Translation$ %'n the ')7, we also follow the !() to prioritize patients. 'ntubated patients are attended first. &e make sure all the tubings, tracheostomy and '8 lines are patent and that there is no obstruction. Then we administer medications. 'f there are patients with a low 9lasgow )oma scaling, we attend to them, turn them, feed and bath them. The critical patients are attended first more than the ambulatory ones.+ "ey informant number :$ Kung kinsa ud na patient ang nangayo ud ug tabang kanang naglisod ud ug ginhawa. 2as I prioriti1e ud namu ang naa sa 3IC) compared sa mga transition labi nag intubated. Buhaton namu ang tana para maka sur(i(e ang baby. 4aku kayo na na point sa amu %ul%illment." Translation$ %' base the prioritization on the patients vital signs especially the one with difficulty in breathing. &e prioritize the ones in 5')7 especially the intubated ones than the patients in transition.+

"ey informant number ;$ 2ag cite sa ko ug e+ample. It5s an old patient, ako gamiton ana kay ABC Airway, Breathing, Circulation. #or e+ample nag blockage ang airway, unahon pa nimu ang suction usa ka mutawag ug lain kauban ka yang setting gud ana, mu attend sa ka sa imu patients kung mada pa nimu, mutawag lain tabang para makatawag kag resident kung asa mas delikado sa patient, mao nay basis." Translation$ %'f ' may cite an e1ample. ' would use the !()s to assess an old patient. 'f there is an airway obstruction, suctioning is to be done more than anything. !s a nurse you only ask help when needed so that your co*nurses can attend to the needs of other patients.+

!nother ability of nurses is to make use of patient acuity level. .atient acuity or patient classification system measures the patients< needs for care and care activities, have been used since the ,=>-s in hospitals as the basis of workload monitoring systems that determine staffing. .atient acuity or patient classification system is a concept that is very important to patient safety. .resumably, as acuity rises, more nursing resources are needed to provide safe care. .atients whose acuity placed them in the ?emergent category were more satisfied with their care than patients in either the ?urgent or ?routine acuity groups. @owever, when perceived throughput time was controlled, acuity did not

predict satisfaction with

A care. The importance of patient 't is

perceptions was clearly in effect in determining satisfaction.

possible that factors other than patient acuity may contribute more to patient outcomes. @owever, it remains important to derive a much better grasp of the relationship between patient acuity, outcomes, and patient safety. "ey informant number B$ !a ako e+perience dire, amu na gi base sa patients needs. ,+ample, bati imu pasyente, mao na unahon. .a nakoy lain ikasulti." Translation$ %(ased on my e1perience, we base it on patients need. The critically and moderately ill patients are attended first. Thats all.+ "ey informant number C$ Actually, sa &B, stable ra man ang mga patient post partum so depende lang during our rounds, we check sa bleeding kung naa. I% e(er naa, I re%er namu sa doctor. I monitor ilang I/ primary care nila, muattend mi sa ila daily needs or pinaka latest nga nag post partum. ,+ample i% naa mi nauna na natrans-out sa 4', mao amu I prioriti1e ug (ital signs, monitoring sa bleeding. Katong mga bati na patient, usually katong mga pre eclamtic, mag 2g!& 6 in ection mi, deep I2. 2onitoring ud sa B$ regarding pud sa bleeding nila. Blood trans%usion kung nay hemorrhage."

Translation$ %!ctually, here at he /( ward , our patients are generally stable. &e do our rounds and check if a patient is bleeding. 'f there is, we refer them to the doctor. /ur primary nurse monitors them and their '8s . Those requiring constant monitoring are the pre eclamptic patients who require administration with 2gD/:. &e also monitor their (. and administer blood transfusion to those who are requiring.+

!nother theme that emerges is the use of Triage. Triage nursing involves the care of more injured individuals than the available resources can handle. Triage, which comes from ?trier, a French word meaning ?to sort, is the system used by emergency and medical personnel when it is necessary to ration medical resources. Triage nurses can work at the scene of an accident, such as on a battlefield or at the scene of a major disaster site, like a train accident or building bombing. 'n some of the triage cases, patients require immediate transport to a hospital to save their lives, while other people might be too severely wounded to treat. &hen a patient is admitted to a hospital, the triage nurse assesses the patients condition and determines where the patients injury fits into the priority list. Dometimes that involves treating the patient directly, while other times patients may be referred to more staff for primary care. ! triage nurse is skilled in cardiac care

and can offer immediate

)9s to reduce the need to refer to the

patient to the ne1t department for further assessment. "ey informant number ,$ 4epende man sa kaso gud. #or e+ample i% nay muabot na patient sa ,', ang problem niya kay di%%iculty in breathing, ato ud na o+ygenan pag abot. -hen, I adto sa cardiac monitor nya I prioriti1e nato according sa iyang kinahanglan. $wede sad nato pa kuhaan ug laboratory dayon bisan wala pay re7uest sa doctor. 2ag agad pud ta sa doctor kung unsay buhhaton pero at %irst, muapply sa tag %irst aid sa pasyente kung unsa iya %irst priority pag abot. 3aa pud tay gitawag na triage, depende kung unsa atong emergency cases or diie kaayo emergency. 4epende sa kaso sa pasyente. 3aa nay guidelines sa triage mga guidelines nga, kanang naa man gud mi gitawag na triage nurse. !ila may mu priority ana. Kung ang kaso sa pasyente dile ra kayo kinahanglan ug immediate action, dile ra tabangunon, ok ra ang pasyente, stable ra ang (ital signs, dile ra kayo na siya I prioriti1e. ,+ample, nay gihilantan unya nay naglisod ug ginhawa, unahon ud to nimu ang naglisod ug ginhawa kaysa sa gihilantan." Translation$ %'t depends on the case of the patient when they arrive in the 0. 'f the problem is difficulty in breathing then we administer o1ygen and place himEher is a cardiac monitor. Fabs will be taken ne1t. !lthough the doctor decides what to do, we provide independent nursing interventions like First !id. &e also use the guidelines in Triage. 'f the patient is stable then heEshe is not prioritized.+

"ey informant number =$ 4epende mana sa case sa patient i% e(er kinsa to ang mas grabe, mao hud to ang imu I prioriti1e. Ang kadtong mga a(erage lang iya case, kadtong dile kayo kinahanglang ug pagtagad, I disprioriti1e sa nato. 2ura ba ug triage, I prioriti1e nato ang kadtong mas nanginahanglan ug needs. 4epende sa case nila, e+ample naa ko sa ,' naay naglisud ginhawa nya naay gihilantan, ang imu hud unahon ang kato ud ang naglisod ug ginhawa kaysa sa gihilantan ra."

Translation$ %'t depends on the case. Those with greater severity are catered first. Those who are mildly ill are catered later. 'ts like Triage. Those with severe conditions are attended first followed by less severe conditions.+

II. Nurses Attend T" Patients Needs /ne of the themes that emerged in their answer to this particular question is that of caring behaviour and altruism. 5ursing is a caring profession. )aring encompasses empathy for and connection with people. !ltruism is the ability of oneself to be selfless and have a dedication to the welfare of others. 'n nursing, altruism is a main key characteristic that needs to be present within the nurse*patient relationship to ensure and secure

appropriate care and a healing environment for their patient. 'f a nurse performs care to a patient without their full attention and

being, the patient will be susceptible to a negative environment causing a negative outlook and outcome for the patient. This is evident in the answer of key informant number ,$ 4epende ra unsay chie% complaint sa imu pasyente. Kung ang pasyente nanginahanglan ug para nursing lang, imu nalang dayon na siya tabangon. Kung ang pasyente muabot %or e+ample (ehicular accident, imu sad pangutan-on ang pasyente kung ok ra ba siya, unsay nakabangga, unsa na siya na kaso kung mga medico legal na cases, imu ud na siya tagaan ug pri(acy para in case mu %ile ang patient. Ibutang na siya ug pri(ate room niya imu na siya e+plainan pilay downpayment sa hospital para makahibaw pud sila ba kung pila ila kwarta na I prepare para maadmit sila dire sa hospital bisag pobre kayo ba, ang wala uy kwarta, ad(isan namu na trans%er to another hospital. $ag emergency cases na ud %or 1ero-1ero (ital signs na ud so immediately kuhaan ud na sya ug (ital signs. Kung 1ero-1ero ud, mutawag mi ug code sa ,'. Code red ang tawag namu ana. -abangon namu ang pasyente to prepare para ma intubate. )sually, pag mutawag ug code red, managan man dayon na ang mga doctors ana." Translation$ %'t depends on the chief complaint of the patient. 'f the patient needs your nursing intervention, then attend to his needs. 'f the patient suffered a motor* vehicle accident then it is a must that you conduct emergency assessment. Then e1plain to the patient the process of admission and hospitalization so that they may know about it. ven those who are financially challenged are attended. (ut if they cannot afford the dues, they are advised to transfer. 'f the patient arrives at the 0 with poor vital signs we call in a )ode 0ed for resuscitation.+

There are other ways the patients needs are answered by the nurses. !nother is active listening. !ctive listening involves

cognitively processing all verbal and non*verbal information in a way that ensures accurate understanding of the patients

psychological and physiological health.

!ctive engagement in

listening can lead to better customized assessments and a higher level of patient satisfaction with their healthcare achievements. The ability to listen is an essential component of leadership in nursing, but only few nursing leaders know just what it takes to become a good listener. This theme clearly emerged from the key informants answers. "ey informant number >$ 4epende ra sa ila problem. #irst gyud, maminaw ka sa complaint sa patient. Ang physical e+amination pud sa ila complaints, I address pud nimu siya immediately kung unsa man ang ila gi complain. -agaan nato silag meds kung unsa man ila gi complain or kung naglisod syag ginhawa, naay standing order, I %ollow like pro(idan nato silag 89. I positioning pa." Translation$ %'t may depend on their problem. First, you have to listen to their complaints. Then verify the complaints using physical e1amination. 'f the patients condition warrants a medication, giving o1ygen, or positioning a patient and there is a standing order, we give it.+

"ey informant number 6$ #irst, we do assessment be%ore we rounds, be%ore mu handle. Basing on nursing rounds, we can now address problems sa patient na we need to address immediately. #rom that, we

%ormulate nursing plans then we implement dayon. !o %irst is assessment gyud." Translation$ %First, we do assessment and the nursing rounds before we handle patients. (asing on nursing rounds, we can now address problems of the patients especially the ones needing immediate attention. From that, we formulate nursing plans then we implement at one. Do assessment always comes first.+ "ey informant number =$ 2aminaw ka sa ilang mga complains, sa ila mga case. #or e+ample, kung unsa ila gipangbati, sa ila mga sakit, maminaw ka. -hen, muhatag kag mga inter(entions na maka address sa ila mga kinahanglan." Translation$ %First, you listen to their complaints and their case. Gou need to listen to their physical complaints. Then give interventions based on their physical needs.+

III. Di i!ulties #et $% The Nurses In Pri"riti&in' Patient Needs Time management and organizational skills are essential for nurses and yet they are not often even discussed in nursing curriculum. 'f the nurse seriously lacks organizational or time management skills, he or she may benefit tremendously from one of those classes that teach organizational or time management skills.

'n the review of the literature that was included in this research, it was not possible to identify any previous scientific publications within the field of prioritization in nursing care. There are ethical problems faced when provision of care and welfare are described. The researcher wishes to create awareness that the choices made and the stand taken are based on our values. 't is worth noting the fact that very little attention has been given to prioritization in nursing care, considering the fact that prioritization in other parts of the health care system has been given so much attention. /ne reason is that all nursing care is viewed as so basic that no prioritization is possible. @owever, in the conte1t of this study, one theme emerged and that is understaffing. This understaffing may result in poor quality of nursing care and dissatisfaction of patients. The hospital owners resort to hiring volunteer workers as a solution.

8olunteerism in nursing in the .hilippines is rampant. 't is through the volunteers that staff nurses get e1tra hand. "ey informant number C have this theme.

I% grabe ang census, magdungan ang patients, usually i% post partum, i% understa%% mi, ang mga (olunteers ra ang dako kaayo ug

help. I% gamay ra ang (olunteers ma delay ud usahay ang mga meds but dili pud siya incon(enient ud sa patients. 2ga monitoring lang sa (ital signs sa post caesarian, diha ra mi maglisod pag monitor 7 hourly." Translation$ %There are times when the patient census is high, and patients rush to the hospital, its usually the nurse volunteers that offer big help. 'f there are less volunteers, some medications are given a little late but that may not cause undue complications. &e may become preoccupied though with monitoring of post*)aesarean patients.+ "ey informant number #$ 4aghan pasyente niya di man ud malikayan diri sa ,' nga madugay ug atiman, ang uban mag yawyaw so amu buhaton ana, i-e+plain lang ud nila nga unahon tong mga nanginahanglan ud ug tabang ud ba. )sahay bitaw, Ang doctor dugay parehas sa surgery kay duha raman kabuok doctor diri sa ,' kay muadto paman silag CC2C, walay mu &' nila. 2aghuwat ud. 3ay uban di makasabot sa sta%%. Ang lab personnel, dugay kaayo pud. -ime na kung makaari sila." Translation$ %&hen the patient census is high in the 0, a lot of patients will complain. &hat we do is to e1plain to them that critical patients are attended first. Dometimes the doctors are not around. The lab technicians also are delayed in giving out lab results.+

I(. O)er!"*in' Di i!ulties &hen the key informants were asked how are they able to overcome difficulties, some of their answers reflected that end*of* shift endorsements make nursing prioritization easier. nd*of*shift

endorsement is a report given to all nurses of the ne1t shift. 't may be written or given orally, either in a face to face e1change or by audiotape recording. 'ts purpose is to provide continuity of care for patients providing the new caregivers a quick summary of patient needs and details of care to be given. !t the end of a long day of caring for patients, its time to give the end*of*shift report to the oncoming nurses. !lthough it may be tempting to rush through this routine duty, patient safety hinges on a complete and correct e1change of information. !t the end of a long day of caring for patients, its time to give the end* of*shift report to the oncoming nurses. !lthough it may be tempting to rush through this routine duty, patient safety hinges on a complete and correct e1change of information. "ey informant number ,-$ 2ag bedside endorsement ud mi para makahibaw pud sila. )sually %rom time to time, muadto hud mi sa patient. Amu sila I remind, each time na muadto mi like maghatag mi ug medications :6 or :; amu hud sila I remind labi na katong mga 3$& or kadtng mga sip lang sa li7uid ang ila imnun amu hud sila I remind." Translation$ %&e do bedside endorsement though we visit the patient from time to time. &e always remind the patients that we have to because we need to give medications, remind them that they are on 5./ and the like.+

!nother key informant has another take on overcoming difficulties. !ccording to her planning says it all. .lanning

is setting goals to improve the outcomes for the patient. 't is a primary focus of the nursing process. This not about nursing goals. They are patient goals. This is about improving the health status and quality of life for your patient. This is about what your patient needs to do to improve his health status andEor better cope with his illness. .lanning also involves making plans to carry out the necessary interventions to achieve those goals. The use of formal care plans or care maps and protocols is highly advised though. The planning phase of the nursing process is 05 level practice and involves setting prioritiesH forming realistic goalsH identifying outcomesH writing nursing actionsH and developing nursing care plans. "ey informant number 6$ #or me, base sa e+perience, you plan ahead. I% tan aw nimu ing ani iya case, medyo critical, plan one step ahead nalng so that dile ka maabtan sa time and can sa(e more li(es kay kung ma late kag hatag sa inter(entions, planning hud na siya, time management gihapon." Translation$ %For me, based on e1perience, you plan ahead. 'f the patient is critical, you plan ahead so that you wont run out of time an you can save more lives. Gou

must not be late in rendering interventions. .lan ahead and manage your time.+ !nother key informant has another thought. Dhe placed

emphasis on overcoming difficulties by teamwork. !ccording to her teamwork plays a vital role together with delegation and good relationship with co*staff. The practice of teamwork has gained in popularity. This is especially true for professional nurses. &hen nurses function as part of a unit, and when they act as part of a team, the job itself is easier and more efficient. 2oreover, overall patient care is enhanced. 'n nursing, when teamwork is emphasized and valued, every member works together to meet their patients needsH improved patient outcomes is their common goal. There are many relevant clinical e1amples of how teamwork improves patient care. First, consider teamwork in the case of hospitalized patients. The relationship between the nurse and the physician is

paramount. The physician orders necessary intervention, and the nurse or therapist is responsible for carrying it out. .hysical therapists, speech therapists, respiratory therapists, all perform patient care. !nd, it is crucial that all team members work together and communicate effectively. !ny changes in the

patients status, whether deterioration or improvement, should be shared between team members. &hen attending physicians, hospitalists, and nurses work together and communicate effectively, teamwork is epitomized. Teamwork is a key component of many professionsH when employees feel as if they are part of a unit, relevant outcomes are improved. 5urses report enhanced job satisfaction and patient care outcomes are met. 5o longer can nurses function in

isolation.

Their profession mandates teamwork and effective

communication. This theme is identifiable in the response of key informant number C. Today as a nurse, it seems like there is so much to do, so little time to do it, and more added to your workload every day. That is why there is a thing called delegation. Aelegation means transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation. !ll nurses delegate tasks while at work. 5urses remain responsible for any and all delegated tasks. 'nappropriate delegation may lead to liability claims against the nurse, disciplinary actions, or license revocation. ntrusting others will only enhance the care of patients, so we must take advantage

of what they have to offer that contributes to the provision of healthcare. Those who have e1perience and self*confidence to delegate comfortably will need to be role models for the less e1perienced nurses as they gain confidence in their ability to delegate tasks. The third theme that emerged is health work environment as evidenced by nice staff relationships. ! healthy work environment is that which is conducive to healing as well as to the safety and well*being of the patients. ! healthy work environment is

necessary for nurses as well. @ealthy work environments is defined as Isupportive of the whole human being, are patient*focused, and are joyful workplaces.I 'n this kind of environment, nurses are able to meet the needs of their patients and their families as well as the goals of the unit and the organization. ! healthy work environment leads to improved patient outcomes and increased nursing

satisfaction. 'n a healthy work environment, the healthcare team works together to deliver quality patient care and create an atmosphere conducive to healing for patients and increased well* being for nurses.

"ey informant number C$ -eamwork, delegation sa task, nice relationships with other sta%%. !o kung charge nurse ka, then imu immediate subordinates, mu %ollow ra pud sila sa mga delegations." Translation$ %Teamwork, delegation of tasks, nice relationships with other staff. Do if youre the charge nurse, your immediate subordinates will perform the tasks delegated.+

!nother way a nurse handles or overcomes the difficulties in prioritizing is direct matter*of*fact e1planation. 1plaining means

discussing to the patient any care made upon him or her. !ll procedures no matter how minor or major it would seem has to be e1plained to the patient thoroughly. /ne of the patients rights in his or her (ill /f .atients 0ights is to o be informed of the names and functions of all physicians and other health care professionals who are providing direct care to the patient. These people shall identify themselves by introduction or by wearing a name tag. !nother right is to receive from the patients physician3s4 J in terms that the patient understands J an e1planation of his or her complete medical condition,

recommended treatment, risk3s4 of the treatment, e1pected results and reasonable medical alternatives. 'f this information would be

detrimental to the patients health, or if the patient is not capable of understanding the information, the e1planation shall be provided to his or her ne1t of kin or guardian and documented in the patients medical recordH Thirdly, his or her right to be informed of the hospitals policies and procedures regarding life*saving methods and the use or withdrawal of life*support mechanisms. Duch policies and procedures shall be made available promptly in written format to the patient, his or her family or guardian, and to the public, upon requestH to be informed by the attending physician and other providers of health care services about any continuing health care requirements after the patients discharge from the hospital. The patient shall also have the right to receive assistance from the physician and appropriate hospital staff in arranging for required follow*up care after discharge. "ey informant number ,$ 2ga pasyente na di kahuwat, e+plainan na sad sila. 4i lang pud ta mag minaldito dire, kay kung pri(ate hospital gane, masuko gane ka sa pasyente, ikaw pay dautan. 2usabot nalang pud ka, di nalang pud ka mutingog. Katong way kwarta, di nalng pud namu pabayron sa consultation %ee na $*88.88 para maka trans%er nalng ug lain hospital. Ang kato naalng nagamit nga gamit ang amu I charge. $asensya lang ud ang kinahanglan."

Translation$ %For patients who are impatient, all they need is an e1planation without being harsh. 'n private hospitals nurses must contain their temper. Gou have to understand. Those who cannot afford are waived of their responsibility to pay the consultation fee of ,--.-- .hp just so they can transfer to an affordable hospital. &hat we charge are those supplies that have been used. .atience is a must.+ "ey 'nformant number #$ ,storyahan, e+plainan lang ang mga !& para makasabot ud sila na busy pa ang mga doctor or naa pay unahon. Importante, wala namu gi pabayaan ang pasyente. Kung tabangunon, naa man mi code, muabot man dayon ang uban doctor."

Translation$

% 1plain to the significant others so thay they can understand how busy the doctor is or that there are more critical cases to attend to. The important thing is never leave the patient unattended. !nyway, we have a code team who immediately responds. +

!nother way the key informants handle or overcome the difficulties is learning from previous e1periences and getting used to it. 'n case of inadequacy of supplies and equipment, they

simply borrow from another ward or unit. The recognition of previous learning process involves reflecting on your past

e1periences, being able to show what you have learned and the e1tent to which this learning is transferable to another conte1t. !a kadugayon nimug %ace ug same na problem, makahibaw na hud ka kung unsa angay nimu buhaton. 2u borrow nalng pud ug gamit sa laing wards. 2agdali nalang ud. 2ugawas nalang. #ocus lang ud, mangayo lang ud kag tabang then %ocus lang ud ka kung unsa angay nimu buhaton para dile mag ka guliyang ang setting kay mao may maka da ug hasul." Translation$ %'f you face similar problems for a long time, you get to learn from those e1periences and you will know what to do. &e tend to borrow from other wards if we lack the equipment. 'f you need it fast, you visit other wards and borrow from them. Focus on your work and reflect which one needs attention first.+ /ne key informant has another view of overcoming.

'mprovisation seems to be the answer to the difficulties met in prioritizing care. 5ursing has always demonstrated improvisation because it is often required to meet the needs of patients in a rapidly changing environment. @owever, little has been done to identify improvisation in the practice of nursing or to teach improvisation as a nursing knowledge*based skill. "ey informant number >$ 2ag impro(ise ka ug gamit or kung unsay a(ailable na resources. Kung dili na ud mada, ask help nalang sa imu kauban kung lisod na. )nya dili na mada nimu, I mean ang imu mahatag nga care."

Translation$ %'f there are supplies needed but not available, you improvise. 'f you really cannot do it. Gou may ask help from your co*staff.+