Академический Документы
Профессиональный Документы
Культура Документы
A Research Paper
Presented to
The Faculty of the College of Nursing
MANILA DOCTORS COLLEGE
Pasay City
In Partial Fulfilment
Of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING
24-1
October 2009
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APPROVAL SHEET
_________________________________
ARMEL B. GONZALEZ, RN MHA
Adviser
_______________________________ _______________________
MICHAEL LEOCADIO, RN MAN NORA NARON, RN MAN
Member Member
_______________________________
EMILIE M. LOPEZ, RN MAN
Officer-in-Charge, College of Nursing
Date: October 2009
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ACKNOWLEDGEMENT
We would like to express our deepest gratitude to the following to help and
To Mrs. Armel Gonzalez our thesis adviser for her unselfish time, effort,
encouragement that give us the strength to pursue this study and for sharing her
knpwledge, for guiding us and being patient with us despite her busy schedule.
To Ms. Emervic Gargoles, our statistician for her assistance in making this
research possible
To Ms. Rosie De Leon (Chief Nurse), Manila Doctors Hospital, for granting
To Mrs. Julita Fiesta, Mr. Demetrio Gamayon, Mr. Gregorio Mendoza III,
for imparting their knowledge and expertise in the validation of our questionnaires.
We would like to extent our warm thanks to our families and friends for
giving us a hand in all our difficulities and for giving their all-out support.
Above all, we would like to thank our Lord Almighty for his unconditional
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Dedication
We have conducted this study for eight (8) months. We went to different
support, belief and guidance ensured that we would be able to graduate for this
esteemed College. We would also like to dedicate this to our parents, guardians
who never failed us to give financial support in conducting this study. This is also
dedicated to the Lord Our God for his everyday blessing to us, and lastly, to our
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RESEARCH ABSTRACT
Nursing Practice in Manila Doctors Hospital. The study was conducted last May
2009.
to a total of thirty (30) nurses from selected floors at Manila Doctors Hospital
tabulated and presented using frequency tables with the use of Statistical Packaged
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The demographic data gathered for respondents were the following: age,
nursing practice of the staff nurses in Manila Doctors Hospital, researchers used
Leininger.
Majority of the nurses belongs to age 21-29 years old and have handled 1-2
foreign patients.
extent of transcultural nursing practice based on the given factors according to the
profile.
are hereby offered. Firstly, for the staff nurses of Manila Doctors Hospital (MDH),
to continue to develop the caring attitudes and provide the best quality nursing care
Thirdly, to the students wherein they can read cultures of other country to update
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Fourthly, to Nursing Service that they should monitor the knowledge of staff nurses
not only in terms of different nursing procedures they can perform or intervention
but also include in their training on providing care for foreign patients. Lastly, to
the future researchers, we recommend that they explore other data gathering
techniques for them to find the different result between the profiles of the
respondents. And test other factors like religion, economic status and others;
increase the number of respondents, if possible, all the nurses in the said institution.
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TABLE OF CONTENTS
Approval Sheet ii
Acknowledgment iii
Dedication v
Research Abstract vi
Table of Contents viii
List of Tables x
List of Figures xi
List of Appendices xiii
CHAPTER PAGE
Introduction 1
Conceptual Framework 6
Conceptual Paradigm 9
Statement of Hypothesis 11
Definition of Terms 15
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Local Literature 17
Foreign Literature 19
Local Studies 37
ix
Foreign Studies 38
Research Method/Design 43
Research Locale 43
Research Instrument 43
INTERPRETATION OF DATA 51
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5 SUMMARY OF FINDINGS, CONCLUSIONS
AND RECOMMENDATIONS
Summary of Findings 73
Conclusions 76
Recommendations 77
REFERENCES 79
APPENDICES 82
LIST OF TABLES
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TABLE PAGE
A Four Point Likert Scale 49
1 Frequency and Percentage Distribution of 51
Staff Nurse According to Age
2 Frequency and Percentage Distribution of 53
Staff Nurses According to Gender
7 Summary of Categories 63
8 Difference in the Extent of Transcultural 64
Nursing Practices Grouped According to Age
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LIST OF FIGURE
FIGURE PAGE
1 Conceptual Paradigm 9
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LIST OF APPENDICES
Appendix PAGE
C Statistical Analysis 93
D Communication Letters 103
E Certifications 110
F Gantt chart and Line Item Budget 117
G Photographic Documentations 119
H Curriculum Vitae 121
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CHAPTER I
Introduction
"..I will serve mankind with love and compassion, recognizing their dignity
and rights irrespective of color, caste, creed, religion and nationality.” - Florence
Nightingale.
strata. It is the fifth vital signs that nurses included in assessing their patients every
day. Nurse handles different people every day holding different beliefs, practices,
values, religion, and cultures of clients, thus nurses have to face, accept, and must
do their job in giving, providing, and fulfilling the needs of every client they have.
It is like nurses wearing a mask in every time they are going to attend to the needs
of their patients every day. No matter how kind or cruel the patient is, nurses
should smile, show goodness, and understand the condition of their client.
Different cultures of client is not a simple task for nurses, there are things to
official in Taipei said that there would be a self-payment ratio hike for out-patient
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on 16th of July in the same year. Taiwanese as well as other nationalities come to
the Philippines for medical professional help because aside from lower rates; they
patients with different culture patterned to their client’s culture, beliefs, values,
Visiting one place from another dictates a big adjustment on the part of
foreigners which, sometimes they cannot cope with changes around them affecting
their health. There are a lot of factors that can affect the health of foreigners such
As nurses and future professional nurse, taking care not only the health of
knowledge and skills in giving care and practicing nursing skills will be used as a
guide in assisting health needs of foreign clients. It will also support nurse’s duties
in maintaining care and in preventing both local and foreign clients from acquiring
patterned according to their cultural beliefs and practices that each professional
nurses and future nurses should have knowledge of. Studying their culture and
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practices, understanding their culture, and applying what the nurse’s learn will help
globally competitive is the aim of each nurse who is planning to practice their
prepare nurses and other practitioners to provide culturally competent care has
Taipei said that a self-payment ratio hike for out-patient and emergency patients
will be announced. DOH Secretary-General Lai Chin-Hosing also said that hike is
expected to be put into effect July 16, 2005. According to the fee hike plan
amount for outpatients as well as amount for emergency patients for district,
regional and national hospitals will be raised. Based on the information, their fees
are visibly higher than medical fees in our co untry. In relation to that,
Taiwanese as well as other nationality come to our country for medical professional
help because aside for lower rates; they can achieve wellness not mentioning the
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global competitiveness of our medical practitioners and the equipment available.
violating anything from their beliefs, values, practices, or even to their superstitious
beliefs. Nurses should respect their attitudes towards dealing with nurses, and
nurses should understand that cultures should consider in giving care to foreign
Hospital (MDH), there were foreign patients coming from different countries who
seek for medical assistance. With this record, it is evidently seen that nurses of
Manila Doctors Hospital handled foreign clients who needs medical assistance.
him to understand the student nurse and vice versa. But unfortunately, there was
no interpreter to relay and interpret the message to client. Action is the only means
instructions, and answer questions given to client; and for client to ask questions as
well. Even though actions were performed still there is a delay of understanding
instructions and questions. On the brighter side, putting the words into actions is
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Manila Doctors Hospital is the base hospital of students from Manila
amusement near the area where a lot of foreigners visit and stay. In mentioning
that situation, there is a high probability that Manila Doctors Hospital might have
foreign patients who might ask and consult for medical services once they need
medical assistance. Students from Manila Doctors College has a high probability
Handling different nationalities in the hospital is not an easy task. There are
a lot of things to consider especially when culture comes in the process of giving
care. Soon, student nurses will become professional nurse and will be facing
different people not only coming from different provinces but from other country
as well who have a different culture from Filipino nurses. Culture especially
and will be assessed by any patients as they leave the hospital. if nurses did not
satisfied the standards of every culture in receiving care it will only reflect that
which is the primary goal of nursing profession as well as any hospital institution.
In relation to this, this study was conceived in order to further assess the nursing
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know how wide is the practice of nurses in handling foreign clients in order to
serve as a guide and a model for future nurses in Manila Doctors College. In
handling foreign client who has different culture to nurses in said hospital. This
will be helpful for both registered nurses and future nurses. With this, the author
would like to know the extent of transcultural nursing practices in Manila Doctors
Hospital.
Conceptual Framework
Big responsibilities are on the shoulder of nurses since nurses serve as the
front liner in facing different client every day. Interventions that every nurse
employs are very important to help client improve and achieve optimum health as
well. Thus, nursing practice should be considered in dealing with different client
Sunrise Model of Transcultural Nursing, the author would like to investigate the
control that can affect the extent of delivery of care for foreign patients.
practice in nursing which focused upon differences and similarities among cultures
with respect to human care, health, and illness based upon the people’s cultural
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values, beliefs, and practices, and to use this knowledge to provide cultural specific
transcultural nursing in her study is to discover and explain diverse and universal
culturally based care factors influencing the health, well-being, illness or death of
individuals or groups. Leininger theorized that every culture had access to some
form of folk indigenous health care system and that some, but not all, had access to
transcultural visitor like the author to discover data about specific individuals,
(Leininger, 1997).
Sunrise Model. Sunrise Model will help the author to assess the extent of
transcultural practices that every nurse performs in handling foreign patients. The
factors chosen by the author are part of environmental context, language and
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movement and perception of space; and lastly in environmental, cultural health
communication is a way for people to express their selves and in order to maintain
and everyone especially between nurses and foreign patients. Leininger stated that
nurse should introduce her or himself and indicate to the foreign patients on how he
or she wants to be address by his or her nurse, it can either be by name, last name,
and or title. Nurse should elicit from the foreign client because this enables the
cross-cultural communication. Space and distance from the client will help nurses
Sunrise Model because there are culture that give values to space and distance like
for instance those from Latin America, Japan, and Middle East which they need the
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cultures might have different beliefs in relation to environment. Foreign patient’s
belief and attitude towards his treatment and prognosis might be influenced by his
or she believes which can control over events or whether he or she is more fatalistic
and believes that chance and luck determine what will happen to him or her.
Patients may cooperate with health regimens and can see the benefit of developing
behavior that could improve his or her health. Some American Indians and Asian
Americans believe in this category. With these factors to consider, it will help the
Hospital.
Conceptual Paradigm
Profile: Extent of Transcultural
Nursing Practices:
Gender
Age Communication
Number of Foreign Space
Patients Handled Environmental
Control
variable which is profile includes the age, gender, and the number of foreign
patients handled of staff nurses in Manila Doctors Hospital while the extent of
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communication, environmental control, and space that could affect nursing
1.1 Age,
1.2 Gender,
terms of:
2.1. Communication,
2.2. Space,
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Statement of Hypothesis
practices of staff nurses in providing care to foreign patients. The study will
For the Staff Nurses of MDH, The study will help the staff nurses in Manila
They can foster also cooperation to achieve an effective nursing care. Expertise in
will trust the nurse who is attending and providing to their needs. It will train them
on how to become more effective staff nurse in dealing with foreign patients.
Knowing the extent of transcultural nursing will help staff nurses to identify what is
missing and needs improvement of providing care to foreign patients. And for
nurses to be globally competitive who has plan of and planning to go back abroad
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and services to different patients of providing quality care. It can help nurses to
have an effective care if they will consider different practices and cultures of each
patient they encounter and handle regardless of their culture and country they come
from.
For the College of Nursing, since many staff nurses in Manila Doctors
Hospital are products of the College, this study will help and guide the College of
Nursing (CON) in Manila Doctors College to know how profound the knowledge
evidence of foreign patients comes to the Philippines to seek for medical help.
There is a greater probability that students would handle foreign patients. Having
the background of the extent of transcultural nursing practices of staff nurses will
help the faculty to determine the focus of learning that faculty should focus on as
well as to determine the other factors of transcultural nursing that students needs to
regardless of different cultures and country they come from. CON can lead their
For the Nursing Students, as this early stage, it is important for student
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administering care in order to encourage cooperation, and to have an effective care.
It might be the source for students to have the knowledge regarding the appropriate
knows approach or style to use in dealing with foreign patients. Handling foreign
patients in different hospitals will train students from Manila Doctors College who
have plans of practicing their profession as nurses, once they pass the nursing board
nursing practice to their future profession and to inform the students regarding the
Nursing Service, with this study, it will help the nursing service to
determine if they have the need to further develop their staff nurses in handling
foreign patients by giving seminars, trainings or even refreshment courses that can
develop the skills of staff nurses in facing, handling, and improve nursing practices
Future Researchers, with this study, future researcher will help determine
the coverage of their future study if they want to continue studying transcultural
nursing practices here in the Philippines. This study only covers the extent of
transcultural nursing practices. Future researchers can study the different indicators
that can affect staff nurses of providing care to foreign patients. They can also
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study the different factors that can affect transcultural nursing practices like if
politics, economics, and technological factors can affect staff nurses in giving and
The scope of the study was delimited to the extent of transcultural nursing
practices of staff nurses in Manila Doctors Hospital (MDH). The research does not
focus on the relationship among staff nurses and their employer rather on the extent
This study focused only to staff nurses of Manila Doctors Hospital (MDH)
who are working in different floors of the said hospital such as from 3rd up to 5th
floor of the old building, and from 3rd up to 11th floor of the new building.
Doctors Hospital (MDH). There are 11 floors in the new building and 5 floors in
the old building but the researcher focused on 30 staff nurses of private wards of
the said hospital due to limited time of the study. It would be difficult and
impractical to give questionnaires with all nurses of all floors of both building.
Thus, the findings may only hold true based on the results of interviews and
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questionnaire given to staff nurses of private wards that would obtain from the
addition, a purposive sample technique utilized in this study based on the author’s
criteria mentioned above. The author used a surveyed questionnaire with a format
(FlE), full extent (FE), moderate extent (ME), lesser extent (LE), and least extent
(LtE); which was used as basis of the degree of extent transcultural nursing
Definition of Terms
The following terms are defined as used in this study in order to provide
between client and nurse that includes use of verbal and nonverbal communication.
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Environmental Control refers to the totality of an event, situation, or
alien to the Philippines who seek help regarding their health problems.
Space refers to the distance between individuals (client and nurse), body
nurse) interact.
Doctors Hospital.
implements and practice in facing, dealing, and handling foreign patients. Nursing
practices like certain distance they implement when caring for patients which is
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CHAPTER II
local and foreign researchers, which gave the researchers a wider grasp and full
understand of the study. This summarizes the literature and studies that have
Local Literature
individual and the group to which he belongs with common point and reference for
behavior, enhancing the sharing values, norms, believes and practices. When held
in common the mention elements of behavior becomes establish into pattern that
form the basis of peoples ways of listening, feeling and acting as emphasized by
Linda Jocano(1999).
sociocultutral context that qualifies a person life, consequently, the context or the
climate when it stifles human life will demand a qualitative change for authentic
human development to happen. It takes the whole social reality economic, politic,
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religion-cultural in order to humanize this for it to sustain people’s total human
assist in people attaining a level of health and well being which enable them to live
In the special report of Fabon, Julia. M., (2006) he stated, in this area of
practice the nurse uses her knowledge of the dynamic of human behavior. He is
called upon to make “for purposeful use of the self”. Relationship between the
difficult and challenging. The nurse can be guided by the human behavior the
patient exhibits. She need to be sensitive not only to the verbal messages of the
patient but to the nonverbal expression of his abstract thought and feeling that
means he or she must know how to read the body language and hear the nuances of
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Foreign Literature
differences in healthcare values, beliefs, and customs. Nurses must acquire the
nursing care helps ensure patient satisfaction and positive outcomes. From the
growing concern that the cultural healthcare needs of minority ethnic group are not
many factors. These determinants can either be verbal or nonverbal factors. The
profile of staff nurses can affect the extent of transcultural nursing practices in
definitions in which cultural groups are compared and contrasted. The theoretical
are academically prepared to serve many cultures by respecting the worth, dignity
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and rights of individuals, families, groups and communities. Most important,
transcultural nurse are prepared to assess the cultural care needs of people and to
skillfully integrate the values, beliefs and lifeways of cultures for the health and
and/or restructure care in meaningful and beneficial ways for people of the world.
Transcultural nursing society believes that nurses and other health care
practitioners should provide and maintain humanistic care for people worldwide.
Focus of care of nurses is on preserving and maintaining the human right of all
people. Theses human rights should not be denied neglected or violated and
practices by individuals and institutions to enhance the care for people worldwide.
gender, sexual orientation, cultural values, age, and other diversities, people have
the following universal human rights. Transcultural nursing society named name
human rights that every person must achieve in providing a holistic care, this were
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healthcare providers; Respectful care with recognition for personal dignity,
decision making if desired by the care recipient; Accept or refuse care and
form healthcare treatments that involve coercion, bribery, and illicit activities that
place one’s well being at risk; Receive care in an environment in which physical,
psychological, spiritual and cultural safety is assured for the person and his or her
family, and significant others; and Receive care without putting one’s self or
loved ones in jeopardy or harm’s way. In relation to this, foreign patients receive
appropriate care even if they seek medical help outside their country. We as
Filipino nurses, is responsible to provide care that they deserve in order to achieve
optimum health.
Care is the heart of nursing; care is essential to healing or well being; care is
curing; care is or should be the central and dominant focus of nursing and
upholds these ideas because human beings are born, live, work and die within a
culture care context and viewpoint. To neglect cultural factors such as one’s
factors can lead to non-caring and cultural negligence with often non-beneficial
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Culture has a powerful influence on one’s interpretation of and responses to
health and everyone has the right to be respected for his or her uniqueness and
cultural heritage. Caregivers need both general and specific cultural information
and fits with cultural beliefs and life ways of the client. It refers to the use of
(local cultural knowledge and life ways) in meaningful and tailored ways that fits
whether ill, disabled, facing death or other human conditions (Leininger, 1999).
who are prepared to provide culturally congruent care. Many providers neither
paradigms that are widely valued and used. In addition, health providers are
do not fit into their own cultural frameworks of knowledge and experience.
Instead, they impose practices of care on people that are ineffective or harmful,
rather than working collaboratively across paradigms and care systems. Actions
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discriminations and sufferings must not continue given available resources,
healthcare providers throughout the world have the ability to address and redress
the inequities. Nurses in particular, have the potential to bridge gaps in cultural
knowledge about health and caring that will significantly reduce the impact of
intolerance, in full access, and decrease health inequities locally and globally.
education and preparation of nurses and other health care provides in order to
individuals may have in their experiences and responses due to their heritage,
is care that is based on understanding how those differences may inform the
responses of people and the processes of caring for them (Meleis, 1999).
There are seven components of nursing that were identified as the essence
1997. The essence was described as being synonymous with nature, core, gist,
the rational mind to bring transformation energy into all aspects of work of nurses.
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However, the literature suggests that Native American Nursing Practice might view
incompetence means there is knowledge but still not know how to use it; conscious
order for nurses to become culturally competent, they must identify their personal
values, clarify values of self and client and integrate those values into their own
professional practice. The nurse’s competence can be the basis on the extent of
thoughts, and environment; those does not let these factors have an undue effect on
those for whom care is provided. While the major assumptions of the model were
the following: all healthcare providers needs similar information about cultural
family, person and health; one culture is not better than another culture; all cultures
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share core similarities; differences exist among, between and within cultures; and
Care of Madeleine Leininger. Nurses who use this theory in nursing care often
care and similarities between patients and nurses exist in all human cultures
and use explicitly in appropriate and meaningful ways. The model avoids focus on
medical problems, and fragmenting client and looking at many important variables
affecting client. Giving care is the essence of nursing and distinct, central, and
unifying force.
can help a transcultural visitor to discover data about specific individuals, groups,
2004). It provide an ideal format for building trust in a transcultural context and
offered this observer a comprehensive and holistic view of health through the
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dimension of Sunrise Model can readily observe in terms of the present and ancient
culture.
Theory of Culture Care and Sunrise Model were the conceptual and
theoretical guides used to discover the worldview, lifeways, and cultural values.
The Sunrise Model depicts the components of a culture which include worldview,
cultural and environment context, and seven social structure factors (Lee, 1996).
Factors, Cultural Values and Lifeways, Political and Legal Factors, Economic
Factors and Educational Factors (Larson, 2004). Based on the Sunrise Model, the
seven social factors mentioned in under the influences care expression, patterns and
that can affect transcultural nursing. Among the three, communication is the most
other; followed by environmental control and space that could affect the culture of
foreigner whenever they seek medical assistance in the Philippines which nurses
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voice quality, pronunciation, and use of nonverbal communication not purely rely
one’s culture (Davidhizar and Giger, 1994). Verbal and nonverbal patterns of
communication vary across cultures, and if nurses do not understand the patient’s
be jeopardized (Davidhizar and Giger, 1994). This occurs not just from speaking
the same language, but also through body language and other cues, such as voice,
times nurses will be on their own interacting with patients and families who do not
name a few were greet the patient using his or her last name or complete name;
avoid being to casual or familiar; point to yourself (nurse) say your name and
smile; nurses should proceed in an unhurried manner and pay attention to any effort
the patient or his or her family makes to communicate; speak in a low, moderate
voice and avoid talking loudly because there is a tendency to raise the volume and
pitch of our voice when a listener appears not to understand. In result patient may
think that nurse is angry and shouting. Use short, simple sentences and speak in the
active voice. Use simple words, such as “pain” rather than “discomfort.” Avoid
medical jargon, idioms, and slang. Give instruction in the proper sequence like for
instance, rather than saying, “Before you take the medicine, get into bed,” you
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should say, “Get into your bed, then take your medicine. And lastly, the nurse
should check and see if the patient has another language in common. For instance,
many Indo-Chinese people speak French, and many Europeans know three or four
languages. Try Latin words or phases that if the nurse is familiar with the
language.
introduce her self or his self and indicate to the client how they prefer to be called
either by first name, last name, and or title. Nurse should elicit the same formation
from the client because this enables the nurse to address in a manner that is
be alert for cues that convey cultural differences in the use of silence, eye contact,
touch and space distance and facial expression. Wide cultural variation exists in
and make every effort to fill conversational lags with words. In contrast, many
professional cannot understand the patient. When the provider is not understood,
he or she often avoids verbal communication and does not realize the effect of
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nonverbal communication, which is all too often the painful isolation of patients
who do not speak the dominant language and who are in an unfamiliar
environment. Consequently, the patient experiences cultural shock and may react
2000). Culture not only determines the appropriateness of the message but also
nurse’s close into the space that is comfortable with close physical proximity to
theses client, they are perplexed by nurses distancing behavior and may perceive
Space refers to the distance between individuals when they interact. All
communication occurs in the context of space (Giger and Davidhizar, 2002). Space
movement, and perception of space. According to Spector, there are four distinct
personal distance vary from culture to culture. The extreme modesty practiced by
members of some cultural groups may prevent members from seeking preventive
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health care (Spector, 2000). For instance, some Afghans prefer closeness in space
with others and particularly with the same sex. When comfortable with others,
(Giger and Davidhizar, 2002). Giger and Davidhizar stated that comfort level is
movement, perception of space. Eye contact, space, and touch practices may be
themselves. The amount of space they prefer between themselves and others to feel
of their personal space requirements - it's just a feeling about what's comfortable for
them - and you may be unaware of what people from another culture expect. For
example, one patient may perceive your sitting close to him as an expression of
warmth and caring; another may feel that you're invading his personal space.
Research reveals that people from the United States, Canada, and Great
Britain require the most personal space between themselves and others. Those from
Latin America, Japan, and the Middle East need the least amount of space and feel
comfortable standing close to others. Keep these general trends in mind if a patient
tends to position himself unusually close or far from you and be sensitive to his
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Touch is a body movement that is culturally determined to a great degree.
For instance, in Hispanic and Arab cultures, male health care providers may be
prohibited from touching or examining certain parts of the female body; similarly,
females may be prohibited from caring for males. While among many Asian
Americans, touching a person's head may be impolite because that's where they
believe the spirit resides. Before assessing an Asian American patient's head or
evaluating a head injury, you may need to clearly explain what you're doing and
why.
when giving nursing care. For example, some Jewish and Islamic women believe
that modesty requires covering their head, arms, and legs with clothing. Respect
their tradition and help them remain covered while in your care.
with the environment. A patient’s attitude toward his treatment and prognosis is
influenced by whether he generally believes that man has some control over events
or whether he is more fatalistic and believes that chance and luck determine what
will happen. If your patient holds the former view, you are likely to see good
cooperation with health care regiments; he will see the benefit of developing
behavior that could improve his health. Some American Indians and Asian
Americans are likely to fall into this category. In contrast, Hispanic and
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Appalachian patients tend to be more fatalistic about nature, health, and death,
feeling that they cannot control these things. Patients who believe that they cannot
do much to improve their health through their actions may need more teaching and
reinforcement about how diet and medications can affect their health. Provide
plan and direct factors in the environment. It includes cultural health practices
illness. Some groups perceive man as having mastery over nature; others perceive
between humans and nature (Giger and Davidhizar, 2002). This particular cultural
experiences, including the ways in which they define an illness and seek and use
health-care resources and social supports. For instance, Asians and Native
Americans may perceive that illness is a disharmony with other forces and that
medicine is only capable of relieving the symptoms rather that curing the disease.
Theses groups are likely to look for naturalistic solutions, such as herbs and hot and
In addition, environmental context also has significant influence upon the client’s
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practitioners in primary care contexts. For instance, the setting of the office such as
are, literature, ambience or decor, client flow design or user friendliness, type or
composition or posture or language or tone, and means of meeting and greeting all
lend to the totality of the primary care experience of the client. The nurse’s
the client’s perspective of the nurse practitioner, the healthcare encounter, and
indeed, the healthcare system, and significantly affect the individual’s willingness
and ability to use the modalities of care mutually chosen as the plan of care
holistic, and include needs for both care and cure. Health equates to caring and
views, social structures, and cultural beliefs cannot be separated from the concepts
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of health, wellness and illness. The environment in which an individual participates
possible condition for healing to occur. The environment is all external conditions
and influences affecting the life and development of organisms and capable of
stated that the art of nursing is to provide an environment in which the patient is in
the best position for nature to act upon, and Martha Rogers, in turn, emphasized
that one part in nursing is to pattern the environment into a place where healing
Caring is the essence of nursing. Nursing care that is not congruent with the
beliefs and values of a patient’s culture will lead to noncompliance and stress. The
healthcare professional therefore has to take into consideration all of the factors that
pertain to each domain. The overall goal is to maintain equilibrium between the
The review of related literature indicates the facts on how culture influences
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differences in healthcare values, beliefs, and customs. The study helps us
practices that have been studied by different person who studied transcultural
nursing. Also it leads nurses to render appropriate care for certain individuals and
their beliefs for the client's maximum satisfaction. Leininger (1991) notes the main
culturally based care factors influencing the health, well-being, illness or death of
unique individual with unique beliefs and traditions and this promotes nurse-client
interaction, which is the best way to find out his cultural preferences.
This study gives knowledge to the healthcare providers on how to react and
deal when confronted by a situation which deals with the client's cultural
preferences. This is important because some cultures have rigid codes of behavior
It is said that the main goal of transcultural nursing “is to provide culturally
specific care.” The relevance of that statement reverberates more in our society
more than in any other period in the past. As the world increasingly becomes more
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globalized labor and services consequently become more and more flexible in
terms of location. Economically speaking, countries now ascribe to the “more for
less” maxim; they are now more open and more aggressive in terms of sourcing out
the cheapest labor and services, from any other country, just so long as they could
nursing, since nurses can work anywhere and everywhere—their labor and service
is not location-bound. In the Philippines, most nursing graduates aim to land a job
in other countries for the promised higher wages; and the countries that hire them,
in turn, see nurses as better investments as compared to those who trained locally,
for they demand higher salaries. As nurses, it is the conscientious route to take into
account the cultural differences in the country that they work in. It is ideal to have
situation, in a certain culture, for them to be able to deliver the most efficient and
effective healthcare possible, one that is in line with the culture that is in place. A
nurse who intends to pursue a job overseas should be aware of the ideas embedded
in the study of transcultural nursing, as this will help him or her acclimatize better
to the work environment of a new culture, and to better provide quality healthcare
services for patients. A good grasp of extent of transcultural nursing practice and
what transcultural nursing entails will go a long the way in terms of nurses being
more capable of providing better services, and in the long run, in fostering a more
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scenarios, can improve the atmosphere in the workplace and the overall satisfaction
Local Study
health warns that because of migrating nurse are usually the one with training
experiencing and skill, patient in hospital and other health institution in the
Philippines can expect a higher incidence of cross-infection. With the best among
nursing student often leaving as soon as they graduated, the less skilled are taking
the place of senior or relatively more experienced nurses who have also left for
other shores. In a year or two they too would be gone the void could be filled once
more by fresh graduates who would repeat the same cycle: get a few experienced in
In the relevance to the study of Chit Estella, Soon student nurses will
become professional nurse and will be facing different people not only coming
from different provinces but from other country as well who have a different
culture from Filipino nurses. And for nurses to be globally competitive who has
The study of Gadut, Ma. Carmelita et.Al (2006), in every institution there
are values in providing nursing care for their patient, in pursuing the Course of
Bachelor of Science. There are factors that may posses for better understanding
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what nursing is all about, most student took nursing because of other countries
Foreign Study
China’s reform and opening as well as the increasing of international exchanges the
persistently. Nurses face more and more patients from different countries, nations,
understand the transcultural nursing needs of the foreign patients in Pudong New
patients’ world outlook, value. Religion belief, living habits, nurse should take
different nursing measures to satisfy health care demands with different cultural
background. Madeleine Leininger pointed out that the culture care needs of people
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in the world will be met by nurses prepared in transcultural nursing. She considered
that the culture care is the essence and the central idea of nursing, the motivity of
cultural activities and it is the basic on which nurses provide patients nursing in line
nursing needs of the foreign patients. It shows there is a lot needs of the nursing
service (the nurse’s English translating service, privacy protection and so on).
Researcher’s data suggest that health care providers and nursing managers should
be improved in the nurse’s spoken English, transcultural nursing theory. And the
including the policy of privacy protection and aspect of customs and taboos,
nursing measures to satisfy patients’ needs and improve the service quality of
transcultural nursing.
biological reason to assume that women are the only gender suited to the nursing
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profession. Rather, women are nurses because nursing has been socially
the late nineteenth century was a strictly male occupation, was opened up, albeit
during the Crimean War. Men let Florence do her thing, thus turning over to
women hospital dirty work to make it women’s work. Regarded at that time to be a
radical departure from the accepted norm, nursing as a feminine role has acquired
an historical weight. The role of the nurse has been accepted as being especially
congruent with the traditional role of the female in western culture (Etkowitz 1971:
From the related literature gathered, the authors were able to derive
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Hospital such as communication, space and environmental control. The variables
mentioned will serve as a tool for measuring the extent of transcultural nursing
practices of these staff nurses. The related literature and studies are arranged in
such a way that given the subject matter, this will support author’s study based on
Therefore, there is a reason to conduct this study having cited literature as proof
practices.
The studies can be closely related to the topic under investigation. Local
studies will be focused on the demographical data of the population being studied.
The facts gathered clarified the extent of transcultural nursing practices of staff
significance with the current study since it gives support to the extent of
Theory, the author can relate the extent of transcultural nursing practices in terms
of staff nurses communication, space and environmental control with their foreign
adaptation towards existing problems like proper handling of caring for a foreign
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patient. Through this the author can determine measure of significance of their
study.
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CHAPTER III
researchers in answering the specific problems stated. It also tackled the research
design, the subject of the study, the instruments used in gathering the data, and the
staff nurses in providing and giving care to foreign patients. The reasons for extent
Research Locale
Staff nurses from private floors of Manila Doctors Hospital (MDH) are the
locale of study. Thirty (30) registered staff nurses from different private floors of
old and new building was the area of study. Entry in this hospital is possible
because Manila Doctors Hospital is the base hospital of Manila Doctors College.
criteria. Registered staff nurses selected based on the following criteria: nurses
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should be a registered nurse, should have experienced handling foreign patients,
and at least 20 years of age. Thirty (30) registered staff nurses respondent of
Manila Doctors Hospital (MDH) were the target population, since it was the
permitted number of respondents given by the chief nurse. Thirty registered staff
nurses’ working in private wards of both old and new building of the hospital was
selected in different floors namely, 3rd up to 5th floor of the old building, and from
3rd up to 11th floor of the new building. Using a survey in a form of questionnaire
was distributed to thirty registered staff nurses covering all morning and afternoon
Research Instrument
used a closed-ended question format, which was use to statistically measure the
survey questionnaire is composed of two (2) parts, one, profile of respondents; and
second, survey proper with three (3) categories to cover. The profile part is
composed of name which is optional, age, gender, and number of patient handled
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comprises of language spoken, voice quality, pronunciation, and use of nonverbal
illness.
Questions from the survey are written in English since a registered nurse is
Questions are answerable with adjectival ratings based on the degree of extent of
Adjectival rating is the following: fullest extent (FlE), full extent (FE), moderate
first draft to the thesis adviser and lecturer for comments and suggestions. The
questionnaires.
The final draft was prepared with the suggestions integrated. The final draft was
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These experts are those who have a mastered degree in arts of nursing
(MAN), a registered nurse who became supervisor in other country, and a professor
registered nurse in mentioned hospital use for the stability reliability analyses.
Results have been computed and interpret by the experts using a Crobach’s Alpha
which gave us a result of .958 with a total pilot population of 30 respondents. With
this result, it supported a high reliability test using the survey questionnaire
presented during pilot study. Respondent from the pilot study have the same
questionnaire had been given to respondents in pilot study but they will not be
duplication of answer.
A letter of request together with a copy of questionnaire has been sent to the
Nursing Service Office of Manila Doctors Hospital (MDH). Topic and objective of
the study are all stated in the letter. The Nursing Service of the said hospital gave
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an approval for research to conduct the study. A face-to-face contact between the
registered staff nurses and researchers was done in explaining the purpose of the
study and shown permit to head nurse of approved area to certain floors to conduct
morning and afternoon shift that pass the criteria set by the author to all private
floors of the hospital. Each respondent asked to self administer the questionnaire.
collected the data after 24 hours or less. The data immediately collated and entered
Manila Doctors Hospital (MDH) in which it had been resolute by the survey
questionnaire.
In seeking answers to the specific problems, the author used the following
statistical tools with the use of Statistical Package for Social Science (SPSS)
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Frequency and Percentage is the statistical treatment applied to answer the
statement of the problem number one (1) which is about the general profile in terms
of age, gender, and number of foreign patients handled by nurses at Manila Doctors
n x 100
Hospital (MDH). P = was the formula used to answer the
N
statement problem number one where in P represents the percentage, n represents
corresponds to the total number of respondents. On the other hand, to answer the
problem statement number two (2) which is the extent of transcultural nursing
control weighted mean is applied. The author used this statistical treatment to
tabulation is easy to interpret by the readers, and it is simple to crack down codes.
The weighted mean of the response was computed using the formula
X = Efx/N.
based on the adjectival rating which is fullest extent (FlE), full extent (FE),
moderate extent (ME), lesser extent (LE), and least extent (LtE). Each adjectival
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rating has corresponding mean score, range, and interpretation which are presented
Table A
5 Point Likert Scale
problem number three (3) which was to compare the significant differences in the
extent of transcultural nursing practices when they are grouped according to profile
such as age, gender, and number of foreign patients handled. The formula was
presented below wherein X1= the Mean of sample, X2= Mean of the 2nd sample,
S1= Standard deviation of the 1st sample, S2 = Standard deviation of the 2nd sample,
N1 = Number of items in the 1st sample, and N2 = Number of items in the 2nd
t=
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Further more, analysis of variance or ANOVA which refers to a comparison
test determined the difference of two or more groups. This study, ANOVA was
used to determine the significant difference in extent of transcultural nursing
practices when respondents are grouped according to number of patients handled
based on communication, space, and environmental control. The equation for
F = MSb
ANOVA test is MSw
where F is the Fisher’s ratio; MS b is mean of squared
variation between groups; and MSw is square variation within group.
The decision criteria of the study were based on the 0.05 level of
significant. If the result of the study is close or lesser than 0.05 level of significant
the study can be rejected. While if the result is greater than 0.05 level of significant,
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CHAPTER IV
classifying and tabulating the data gathered and analyzing the results. The findings
of the study was presented figuratively in manner of numerical values and rated
adjectively as well.
1.1 Age
staff nurses in Manila Doctors Hospital (MDH) in matters of age. This table was
the initial profiling of the respondents. This table merely represents the age
background of the respondents simplified into two which are the 20-29 and the 30-
39.
Table 1
Frequency and Percentage Distribution of Staff Nurses According to Age
Age Frequency (f) Percentage (%)
21-29 25 83
30-39 5 17
Total 30 100
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Table 1 shows that based on the thirty (30) total number of respondents,
there were five (5) respondents who belongs to age of 30-39 years old while there
Table 1 shows the profile of the respondents based on age. Majority (83%)
of the respondents belongs to the nurses with the age of 21-29 years of age, while
particularly Health Resources and Service Administration (HRSA), the average age
45.2 years in 2000, and 44.3 years in 1996. In relation to the result of the study, the
average age of nurses in Manila Doctors Hospital (MDH) was not under the age of
44.4 rather, it belongs to the younger age which is 21-29 years old. According to
the study, only nine percent (9%) of all registered nurses were under the age of 30
in 2000, while, the percent of nurses over fifty-four (54) years of age increased to
25.4 percent in 2004 which if it is going to compare with the result of nurse
respondent according to profile of age nurses from Manila Doctors hospital were
younger. Only seventeen percent (17%) from the 30 nurse respondents represent
the age of 30-39 years old who is working as staff nurses in the said
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hospital.Therefore, majority of staff nurses in Manila Doctors Hospital are age 21-
29 years old
1.2 Gender
nurses in Manila Doctors Hospital (MDH) in terms of gender. This was the second
Table 2
Frequency and Percentage Distribution of Staff Nurses According to Gender
Female 18 60
Total 30 100
Table 2 shows that out of thirty (30) respondents there were eighteen (18)
(60%) of the respondents belong to the female group, while minority (40%) of the
Same with the study done by Health Resources and Services Administration
(HRSA), male still comprise a very small percentage of total number of registered
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Table 3
Frequency and Percentage Distribution of Staff Nurses According to Number
of Foreign Patients Handled
Number of
Frequency Percentage
patient
1-2 11 37
3-4 10 33
5 and above 9 30
Total 30 100
Table 3 shows that out of thirty (30) respondents there were nine (9)
respondents who handled 5 and above foreign patients; ten (10) respondents who
have handled 3-4 foreign patients, and eleven (11) respondents who have handled
handled. Majority (37%) of the respondents handled 1-2 foreign patients, while
minority (30%) of the respondents belongs to 5 and above handled foreign patients.
patients with different cultures or even foreign patients as nurses each day deals
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and faces different patients. They are equipped and well-versed on proper handling
in caring of patients different to their cultures. With the nature of work of nurses
which they are the one who is with the patient most of the time, they are used to
with dealing and facing different patients while their wok as nurses in providing
and giving optimum care is not at risk but instead, they can still do their job
handling local patients which are different with their culture help them to manage
and provide a care that deserves and rightfully should be given to both local and
foreign patients.
2.1 Communication
instrument.
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Table 4
Extent of Transcultural Nursing Practices in Manila Doctors Hospital Based
on Communication
Interpretatio Adjectival
Communication Mean
n Description
1. I greet my foreign patient and his/her family 4.59 Often FE
before doing any procedure.
2. I establish rapport to my foreign patient 4.50 Often FE
3. If my foreign patient could not speak nor 4.60 Often FE
understand English I performed simple action
while verbalizing the instructions.
4. I speak softly and clearly when talking to 4.73 Often FE
my foreign patient.
5. I speak softly and clearly when talking to 4.67 Often FE
my foreign patient.
6. I perform simple action like sign languages 4.27 Often FE
or pantomime whenever my foreign patient
could not understand my instructions.
7. I use simple words rather than complicated 4.57 Often FE
words when talking to my foreign patient.
8. I courteously listen to concerns of my 4.53 Often FE
foreign patient.
9. I courteously listen to concerns of my 4.53 Often FE
foreign patient.
10. I use terminating words upon leaving the 4.13 Often FE
room of my foreign patient.
Composite Mean 4.51 Often FE
Legend: 5 and above Fullest Extent (FlE); 4.0-4.99 Full Extent (FE); 3.0-3.99 Moderate Extent (ME); 2.0-2.99 Lesser Extent
(LE); 1.0 and below Least Extent (LtE)
Table 4 shows that question number ten has a mean of almost four and
quarter (4.13) followed by question number six with a mean above four and
quarter (4.27), question number two with four and half (4.50), same mean of more
than four and half (4.53) in questions number eight and nine, question number five
with 4.57, question number one with 4.59, question number three with 4.60,
question number 5 with 4.67, and last but not the least, question number four with
4.73; with the overall mean of 4.51in which all have the values above four and half.
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In their rating and interpretation, all questions were in category of full extent and
lowest mean of less than four and quarters (4.13) on the contrary, 4th question got
the highest mean of higher than four and half (4.73) with the overall mean of four
The above data shows that the staff nurses at Manila Doctors Hospital
always speak softly and clearly to their foreign patients in relation according to
for the nurses to speak in a low, moderate and avoid talking loudly because there is
tendency to raise the volume and pitch of their voice when a listener appears not to
understand in result patient may think that nurse is angry and shouting. According
vary across cultures, and if nurses do not understand the patients cultural rules in
This occurs not just from speaking the same languages, but also through body
language and other cues, such as voice tone, and loudness. In contrary question
number 10 got the lowest mean which states that most of the staff nurses at Manila
Doctors Hospital do not use terminating words upon leaving the room of their
patient.
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2.2 Space
Table 5
Extent of Transcultural Nursing Practices in Manila Doctors Hospital Based
on Space
Adjectival
Space Mean Interpretation
Description
1. I recognize cultural difference of my foreign patients 4.17 Often FE
before providing care.
2. I talk to my foreign patient with a distance of three (3) 4.10 Often FE
feet away from patient’s bed.
3. I make sure that my foreign patient is relaxed when I 4.40 Often FE
am attending to his or her need.
4. As a nurse, I am aware that touching my foreign 4.40 Often FE
patient without permission is an indicator and can causes
an embarrassment or anger to him or her.
5. I avoid too much body movement when my facing 4.17 Often FE
foreign patients.
6. I avoid too much body movement when my facing 4.47 Often FE
foreign patients.
7. I maximize time and effort when I give care to my 4.60 Often FE
foreign patient.
8. I respect the time according to my foreign patient’s 4.37 Often FE
cultural practices if he or she has preferred time of
receiving care like in providing hygiene care.
9. I secure my foreign patient’s comfort when he or she 4.67 Often FE
is isolated.
10. I rarely touch my foreign patients as an indicator of 4.30 Often FE
respect to him or her.
Composite Mean 4.36 Often FE
Legend: 5 and above Fullest Extent (FlE); 4.0-4.99 Full Extent (FE); 3.0-3.99 Moderate Extent (ME); 2.0-2.99
Lesser Extent (LE); 1.0 and below Least Extent (LtE)
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In this table, question number two with a mean of above four (4.10)
followed by questions number one and five with a common mean of almost four
and quarters (4.17), questions number four and ten have a again the same mean of
more than four and quarters (4.30), question number eight with a mean also more
than four and quarters (4.37), questions number three and four with the same mean
of almosr four and half 4.40 as well, question number seven with a mean of more
than four and half 4.60, question number six and number nine with a mean almost
four and half respectively, (4.47 and 4.67) with an overall mean of greater than
four and quarters (4.36). All of queries in this category with its adjectival rating
and interpretation including the composite mean have the same result of full extent
In table 5 out of 10 questions in space category, 2nd question got the lowest
mean of lower than four and quarters (4.10) while 9th question got the highest
mean of more than four and half (4.67) with the overall mean of more than four
Data shows that the staff nurses at Manila Doctors Hospital practice the
the second question got the lowest mean, in relation according to the study of
Davidhizar and Giger (2002), most people aren’t conscious of their personal space
requirements-it’s just a feeling about what is comfortable for them and maybe
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unaware of what people from other culture expected. When comfortable with
zone of interpersonal space namely inmate zone, personal distance, social distance
and public distance. In relation, rules concerning personal distance vary from
groups may prevent members from seeking preventive care. This implicates nurses
the instrument.
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Table 6
Extent of Transcultural Nursing Practices in Manila Doctors Hospital Based
on Environmental Control
Adjectival
Environmental Control Mean Interpretation
Rating
1. I orient my foreign patient regarding the time, date 4.47 Often FE
even though he / she is unconscious.
2. I give needs of my foreign patient based on their 4.40 Often FE
preference pattern according to his or her culture.
3. I make sure that my foreign patient’s environment is 4.67 Often FE
contributing to his fast recovery by maintaining his room
clean and in order.
4. I make sure that my foreign patient feels comfortable 4.67 Often FE
with his or her room.
5. I assist my foreign patient and his family in all 4.70 Often FE
procedure needed to be done.
6. I explain the illness or health condition of my foreign 4.57 Often FE
patients to him or her as well as to his or her family
members.
7. I explain to my foreign patient the doctor’s order in 4.40 Often FE
order for him or her to have self control.
8. I ensure my foreign patient to maintain a quiet and 4.70 Often FE
peaceful environment.
9. I explain to my foreign patient’s and visitors regarding 4.60 Often FE
visiting hours.
10. I maintain room temperature appropriate for my 4.40 Often FE
foreign patient’s health condition.
Composite Mean 4.56 Often FE
Legend: 5 and above Fullest Extent (FlE); 4.0-4.99 Full Extent (FE); 3.0-3.99 Moderate Extent (ME); 2.0-2.99
Lesser Extent (LE); 1.0 and below Least Extent (LtE)
Table 6 shows that question number two, seven and ten has the same mean
of almost four and half (4.40) followed by question number one with a mean of
approximately nearly four anf half (4.47), question number six greater than four
and half (4.57), question number nine greater than four and half (4.60), questions
number three and four also with the same mean of greater than four and half 4.67,
and last but not the least, questions number five and eight with the same mean of
approximately five (4.70). The overall mean of table seven is slightly above four
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and half 4.56. The result of adjectival rating and interpretation in this category
were all the same including the composite mean such as full extent and often,
respectively.
seven and ten got the lowest mean of nearly four and half while question number
eight got the highest mean of greater than four and half respectively, (4.40 and
4.70).
possible condition for healing to occur. The environment is all external conditions
and influences affecting the life and development of organisms and capable of
stated that the art of nursing is to provide an environment in which the patient is in
the best position for nature to act upon, and Martha Rogers, in turn, emphasized
that one part in nursing is to pattern the environment into a place where healing
conditions are optimal. Thus, nurses in Manila Doctor’s Hospital provide amicable
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Table 7
Summary of Categories
Adjectival
Practices Mean Interpretation
Rating
Communication 4.51 Often FE
Table seven (7) shows that space has a mean of above four and quarters
(4.36), followed by communication with a mean of four and half (4.51), and
environmental control with a mean of above four and half (4.56). The overall
mean was almost four and half (4.48). Based on the result of mean in terms of
Table seven (7) shows the extent of transcultural nursing practice based on
mean with above four and half (4.56) compared to other practices, followed by
communication with four and half (4.51), and lastly, space with above four and
quarters (4.36).
factors under the umbrella of her theory in order to provide a competent care.
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Based on the result of extent of transcultural nursing practices environment got the
highest mean though space and communication have the same adjectival rating, full
extent, still can be observe that nurses in MDH practicing more on environmental
factor. Communication, space and environment should at least have the same mean
3.1 Age
Table 8
Difference in the Extent of Transcultural Nursing Practices Grouped
According to Age
Std. t- Decision
Category Age Mean Sig. Interpretation
Deviation value on HO
20-29 4.51 0.42
Communication -0.02 0.99 Accepted Not Significant
30-39 4.52 0.52
20-29 4.35 0.57
Space -0.32 0.75 Accepted Not Significant
30-39 4.44 0.69
Environmental 20-29 4.60 0.41
1.13 0.27 Accepted Not Significant
Control 30-39 4.36 0.54
20-29 4.49 0.42
Overall 30-39 4.44 0.57 0.21 0.83 Accepted Not Significant
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Table eight (8) shows that communication in age 20-29 has a mean of four
and half (4.51); and one point increased of mean with age 30-39 years old. On the
other hand, space with age 20-29 years old has a mean of four and quarters (4.35)
and close to four and half (4.44) under 30-39 years old. In environmental control
with a mean of above four and half (4.60) under 20-29 years old and above four
and quarters (4.36) in 30-39 years old. In overall those who belong to age 21-29
years old has a mean of approximately four and half (4.49) with adjectival rating
of full extent, while, those who belong to 30-39 years old has a mean of closer to
four and half (4.44) with adjectival rating same with 21-29 years of age.
Table eight (8) shows that the difference extent of transcultural nursing
practices based on age in over-all mean age 20-29 years old has a higher mean of
almost four and half (4.49) while those who belong to 30-39 years old with a mean
of closer to four and half (4.44). In terms of standard deviation, 30-39 years old
has a higher value of almost one (0.57) while 20-29 has a lower standard deviation
of closer to half of one (0.42). In t-value environmental control in terms of age has
a higer value of greater than one (1.13) while space in terms of age has a lower t-
value with less than one (-0.32). In level of significance, communication has a
highest value with approximately one (0.99) while environmental control in terms
of age has the lowest value with less than one (0.27). The overllall t-value lessens
than one (0.21) with the corresponding significant value of closer to one (0.83) is
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Based on the result of the study, it shows that age does not affect the
terms of communication, space, and environment. Both ages belongs to 21-29 and
30-39 years old practice the three factors (communication, space, and environment)
covered in this study adequately. Difference in age does not affect their
environment.
3.2 Gender
Table 9
Difference in the Extent of Transcultural Nursing Practices Grouped
According to Gender
Std. Decision on
Extents Gender Mean t-value Sig. Interpretation
Deviation HO
Communicatio Male 4.49 0.46
-0.21 0.83 Accepted Not Significant
n Female 4.52 0.42
Male 4.31 0.71
Space -0. 42 0.68 Accepted Not Significant
Female 4.40 0.49
Environmental Male 4.52 0.47
-0.41 0.69 Accepted Not Significant
Control Female 4.58 0.41
Male 4.44 0.52 Not
Oveall -0.39 0.70 Accepted
Female 4.50 0.40 Significant
(α) Level of significance = 0.05
In table nine (9) shows that communication in terms of gender in female has
a mean of four and half (4.52); and almost four and half (4.49) in male. On the
other hand, space in male has a mean of four and quarters (4.31) and close to four
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and half (4.40) under female. In environmental control, both male and female with
a mean of above four and half (4.52 and 4.58), respectively. In overall those who
belong to male a mean of approximately close to four and half (4.44) with
adjectival rating of full extent, while, those who belong to female has a mean of
practices based on gender in over-all mean, female has a higher mean of four and
half (4.50) while those who belong to male with a mean of closer to four and half
(4.44). In terms of standard deviation, male has a higher value of closer to one
(0.52) while female has a lower standard deviation of lower than half of one (0.40).
0.41) while environmental control in terms of gender has a lower t-value with less
value with approximately closer to one (0.83) while space in terms of gender has
the lowest value with less than one (0.68). The overllall t-value lessens than one (-
0.39) with the corresponding significant value of closer to one (0.70) is not
competent care. According to Leininger, both male and female should enjoy equal
rights in giving competent care with patients especially with foreign patients except
if it is contraindicated with their culture like for instance, United Arab of Emirates
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wherein male nurse can only take care of male patients which same rule applies
with female nurses. But if male or female nurses are needed by the patients
whether it is male or female, male or female nurse should attend to their needs.
The rule in giving care is they should ask permission to the patient and as much as
possible avoid closed distance, approximately should be at least 3 feet away from
the patients if it is opposite to the nurses gender, in giving competent care. Males
and females should have been treated with equal respect, rights, and role
that discrimination of task between male and female nurses should be avoided. In
relation to the study, both female and male nurses in Manila Doctors Hospital can
space, and environment. Gender does not affect the extent of transcultural nursing
practices. Although based on the result of the study, male nurses have the small
population compared to female nurses in Manila Doctors Hospital (MDH) still they
task is not an issue for argumentation as it does not have a significant relationship
environment.
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Table 10
Difference in the Extent of Transcultural Nursing Practices Grouped
According to Number of Foreign Patient Handled
No. of Std.
F- Decision
Category Patients Mean Deviatio Sig. Interpretation
Value on HO
Handled n
1-2 4.33 0.45
3-4 4.50 0.36
Communication 2.78 0.80 Accepted Not Significant
5 and 4.76 0.39
above
1-2 4.21 0.60
3-4 4.40 0.58
Space 0.69 0.51 Accepted Not Significant
5 and 4.51 0.56
above
1-2 4.45 0.50
Environmental 3-4 4.50 0.35
1.47 0.25 Accepted Not Significant
Control 5 and 4.76 0.39
above
1-2 4.33 0.49
3-4 4.47 0.38
Overall 1.60 0.22 Accepted Not Significant
5 and 4.68 0.41
above
mean of four and quarters (4.33), 3-4 with four and half (4.50) and 5 and above
with greater than four and half (4.76). While in terms of standard deviation,
communication under 1-2 is closer to haf of one (0.45), 3-4 closer to half of one
(o.36), and 5 and above with more closer (0.39) compared to 3-4 number of foreign
patients handled. In space, 1-2 has a standard deviation of closer to one (0.60), 3-4
with more than half of one (0.58), and 5 and above with less closer to one (0.56).
In environmental control, 1-2 has a standard deviation of half of one (0.50), 3-4
with less than half of one (0.35), and 5 and above with much higher value (0.39)
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compared to 3-4 number of foreign patients handled. The overall standard
handled, four and quarters (0.38) in 2-3, and closer to half of one (0.41) in 5 and
three (2.78), while space is almost one (0.69), and lastly, environmental control
almost one and half (1.47) with an overall F-value of one and more than half
(1.60). Lastly, the significant value of communication is almost one (0.80), space
with half of one (0.51), environmental control with quarter of one (0.25), and with
In table 10, communication in handling patients of 5 and above has the highest
mean of approximately five (4.75), while 1-2 foreign patients handled has the
lowest mean of above four and quarters (4.33). In space, still 5 and above foreign
patients handled has the highest mean of four and half (4.51) while the lowest is 1-
2 number of foreign patients handled with less than four and quarters (4.21). In
environmwntal control, 5 and above number of foreign patients handled holds the
highest number of mean with greater than four and half (4.76) while 1-2 foreign
patients is the lowest with a mean of almost four and half. On the other hand, 1-2
communication with a value of closer to half of one (0.45), while 3-4 is the lowest
with a value of less than half of one (0.36). In space, 3-4 number of foreign
patients handled is the highest with value of greater than half of one (0.60), while
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5 and above got the lowest with a value of slightly above half of one (0.56). In
environmental control, 5 and above number of foreign patients handled got the
highest value of standars deviation with half of one (0.50), while 3-4 got the lowest
control got the highest value of almost one and half (1.47), while space got the
lowest with less than one (0.69). In level of significance, communication has a
highest value with approximately closer to one (0.80) while environmental control
in terms of number of foreign patients handled has the lowest value with less than
half of one (0.25). The overllall F-value greater than one and half (1.60) with the
number of foreign patients handled. Number of foreign patients handled does not
affect the extent of transcultural nursing practices of staff nurses in Manila Doctors
Hospital (MDH). But in terms of their mean, patients who handled 5 and above has
the highest mean which means that those nurse respondents who belongs to that
group more or less practice transcultural nursing practices more or much aware of
patients. But it does not mean that foreign patients handled in group 1-2 and 3-4
does not practice transcultural nursing practices. Those who belong to 1-2 and 3-4
number of foreign patients also practice transcultural nursing practices but the
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degree of giving care was affected as they answer the questionnaire because they
might not practice some items in the survey questionnaire adequately for their own
reasons. It might be that they did not perform the task yet or often do not perform
the task that is why they answer a lower degree of extent in giving transcultural
Regardless of number foreign patients handled, it does not affect the extent
environment. All of the group according number of foreign patients handle can
give adequate and competent care to foreign patients. It does not affect in fulfilling
belief and values, they learn way to provide sensitive, compassionate, and
competent care that is beneficial and satisfying to the foreign patient. At the same
time the nurse discovers many nursing insights about her own cultural background
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CHAPTER V
This chapter presents the summary of findings, the conclusions and the
recommendations that evolved as a result of the study that was conducted to the staff
to the profile such as age, gender, and number of foreign patients handled. It
extent of transcultural nursing care practice rendered by the staff nurses in Manila
1.1 Age,
1.2 Gender,
terms of:
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2.1. Communication,
2.2. Space,
Summary of Findings
to:
1.1 Age
Manila Doctors Hospital belongs to 21-29 years old age groups; while the 17%
1.2 Gender
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percent (33%) have handled 3-4 foreign patients, ad lastly, thirty percent (30%)
of
2.1 Communication
description and interpretation, all questions were in categorized to full extent and
2.2 Space
and interpretation including the composite mean have the same result of full extent
2.3 Environment
rating and interpretation in this category were all the same including the composite
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3.1 Age
The T-test value of 0.213 and the significance of 0.833, accepted the null
nursing practices when group according to age because the p-value is greater than
3.2 Gender
The T-test value of 0.386 with the corresponding p-value of 0.702, accepted
the null hypothesis, since the value is greater than 0.05 level of significance,
The F-value of 1.600 with the corresponding p-value of 0.221, accepted the
null hypothesis, since the value is greater than 0.05 level of significance, therefore,
handled.
CONCLUSIONS
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1. Most of the respondents from manila Doctors Hospital are female, age
is in full extent.
RECOMMENDATIONS
Based on the findings and the conclusions drawn from the findings, the
caring attitudes and provide the best quality nursing care as possible to their
2. The Nursing Service can provide their own study regarding transcultural
nursing practices that studies other factors like considering the religion,
nursing practices for them to know how far and competent their nurses are
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encounter.
4. To the future researcher, they can test other factors under the umbrella of
more competent care not only to local but also to foreign patients. They can
also conduct the same study yearly in order to closely monitor the
knowledge and skills of nurses in said hospital in dealing with both local
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REFERENCES
Books
Andrew, M. and Boyle, J. (2007). Transcultural Concept via Nursing Care, 5th
edition.
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Magazines
Journals
Lorents-Madeleine. (2008). Home health care Nurse: the Journal for Home |Care
and Hospice professional, vol. 26, page 237-243.
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Electronics Resouces
Unpublished Materials
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APPENDIX A
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APPENDIX B
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College of Nursing
Dear Respondents,
Greetings!
We, undersigned, 3rd year Nursing Students from Manila Doctors College is
currently conducting our research as a partial requirement in the Degree of
Bachelor of Science in Nursing entitled “Extent of Transcultural Nursing
Practices in Manila Doctors Hospital”, and this study aims to assess the extent
of transcultural nursing practices in your hospital.
We are asking for your cooperation to answer our survey questionnaire base on
your availability for today. We are hoping for your kind consideration. Thank
you very much and God Bless.
Sincerely Yours,
Questionnaire
PART I
Name (Optional):__________________________________________
Age:
Gender
Male
Female
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1-2 patients
3-4 patients
5 or more patients
PART II
4 – FE – Full Extent
3- ME – Moderate Extent
2 – LE – Lesser Extent
5 4 3 2 1
A. 2. Establishes rapport to my
foreign patient.
A.3. If my foreign patient could not
speak nor understand English I
perform simple actions, and do sign
language for the patient to
understand me while verbalizing the
instructions.
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A.7. Uses simple words rather than
complicated words when talking to
foreign patient.
B. Space
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alone.
C. Environmental Control
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APPENDIX C
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GROUP 24-1
Frequencies
Statistics
NumberOf
Age Gender Patient
N Valid 30 30 30
Missing 0 0 0
Frequency Table
Age
Cumulative
Frequency Percent Valid Percent Percent
Valid 21-29 25 83.3 83.3 83.3
30-39 5 16.7 16.7 100.0
Total 30 100.0 100.0
Gender
Cumulative
Frequency Percent Valid Percent Percent
Valid Male 12 40.0 40.0 40.0
Female 18 60.0 60.0 100.0
Total 30 100.0 100.0
NumberOfPatient
Cumulative
Frequency Percent Valid Percent Percent
Valid 1-2 11 36.7 36.7 36.7
3-4 10 33.3 33.3 70.0
5 and above 9 30.0 30.0 100.0
Total 30 100.0 100.0
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Descriptives
Descriptive Statistics
Descriptives
Descriptive Statistics
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Descriptives
Descriptive Statistics
Descriptives
Descriptive Statistics
T-Test
Group Statistics
Std. Error
Gender N Mean Std. Deviation Mean
OverallTranscultural Male 12 4.4389 .51754 .14940
NursingPractices Female 18 4.5033 .39574 .09328
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I n d e p e n d e n t S a m p le s T e s t
L e v e n e 's T e s t fo r
E q u a lity o f V a r ia n c e s t- t e s t f o r E q u a lity o f M e a n s
9 5 % C o n fid e n c e
In t e r v a l o f th e
M e a n S td . E r r o r D iffe r e n c e
F S ig . t df S ig . ( 2 - ta ile dD) if fe r e n c e D iffe r e n c e L o w e r U p p e r
O v e r a llT r a n s c u ltu r a l E q u a l v a r ia n c e s
1 .4 0 1 .2 4 6 - .3 8 6 28 .7 0 2 - .0 6 4 4 3 . 1 6 6 8 0 - .4 0 6 1 0 .2 7 7 2 3
N u r s in g P r a c tic e s a ssu m ed
E q u a l v a r ia n c e s
- .3 6 6 1 9 .3 4 5 .7 1 8 - .0 6 4 4 3 . 1 7 6 1 3 - .4 3 2 6 3 .3 0 3 7 6
n ot a ssu m e d
T-Test
Group Statistics
Std. Error
Age N Mean Std. Deviation Mean
OverallTranscultural 21-29 25 4.4853 .42449 .08490
NursingPractices 30-39 5 4.4386 .57115 .25543
In d e p e n d e n t S a m p le s T e s t
L e v e n e 's T e s t fo r
E q u a lit y o f V a r ia n c e s t- te s t fo r E q u a lity o f M e a n s
9 5 % C o n fid e n c e
In te r v a l o f th e
M ean S td . E r r o r D iffe r e n c e
F S ig . t df S ig . ( 2 - ta ile dD) iffe r e n c e D iffe r e n c e L o w e r Upper
O v e r a llT r a n s c u ltu r a l E q u a l v a r ia n c e s
1 .9 1 2 .1 7 8 .2 1 3 28 .8 3 3 .0 4 6 7 1 .2 1 9 6 6 - .4 0 3 2 5 .4 9 6 6 8
N u r s in g P r a c tic e s a ss u m e d
E q u a l v a r ia n c e s
.1 7 4 4 .9 2 3 .8 6 9 .0 4 6 7 1 .2 6 9 1 7 - .6 4 8 4 8 .7 4 1 9 1
not assum ed
Oneway
D e s c rip t iv e s
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ANOVA
OverallTransculturalNursingPractices
Sum of
Squares df Mean Square F Sig.
Between Groups .597 2 .299 1.600 .221
Within Groups 5.041 27 .187
Total 5.639 29
GROUP 24-1
Frequencies
Frequency Table
Gender
Cumulative
Frequency Percent Valid Percent Percent
Valid Male 12 40.0 40.0 40.0
Female 18 60.0 60.0 100.0
Total 30 100.0 100.0
NumberOfPatient
Cumulative
Frequency Percent Valid Percent Percent
Valid 1-2 11 36.7 36.7 36.7
3-4 10 33.3 33.3 70.0
5 and above 9 30.0 30.0 100.0
Total 30 100.0 100.0
Descriptives
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Descriptive Statistics
Descriptives
Descriptive Statistics
Descriptives
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Descriptive Statistics
Descriptives
Descriptive Statistics
T-Test
Group Statistics
Std. Error
Gender N Mean Std. Deviation Mean
Communication Male 12 4.4917 .45619 .13169
Female 18 4.5265 .42319 .09975
Space Male 12 4.3083 .70512 .20355
Female 18 4.4000 .49229 .11603
Environmental Male 12 4.5167 .46677 .13475
Female 18 4.5833 .41480 .09777
OverallTranscultural Male 12 4.4389 .51754 .14940
NursingPractices Female 18 4.5033 .39574 .09328
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In d e p e n d en t Sa mp le s T e s t
Oneway
D e s c rip tiv e s
9 5 % C o n fid e n c e In te rva l fo r
M ean
N M e a n S td . D ev ia tio nS td . E rro r L o w e r B o u n dU p p e r B o u n d M in im u m M a xim u m
C o m m u n ica tio n 1 -2 11 4 .3 2 7 3 .4 5 1 8 6 .1 3 6 2 4 4 .0 2 3 7 4 .6 3 0 8 3 .5 0 4 .9 0
3 -4 10 4 .4 9 7 8 .3 6 3 1 8 .1 1 4 8 5 4 .2 3 8 0 4 .7 5 7 6 3 .9 0 5 .0 0
5 and above 9 4 .7 5 5 6 .3 8 7 6 6 .1 2 9 2 2 4 .4 5 7 6 5 .0 5 3 5 4 .0 0 5 .0 0
T o ta l 30 4 .5 1 2 6 .4 2 9 2 1 .0 7 8 3 6 4 .3 5 2 3 4 .6 7 2 9 3 .5 0 5 .0 0
Space 1 -2 11 4 .2 0 9 1 .5 9 9 0 9 .1 8 0 6 3 3 .8 0 6 6 4 .6 1 1 6 3 .1 0 4 .9 0
3 -4 10 4 .4 0 0 0 .5 8 3 1 0 .1 8 4 3 9 3 .9 8 2 9 4 .8 1 7 1 3 .2 0 5 .0 0
5 and above 9 4 .5 1 1 1 .5 6 2 2 4 .1 8 7 4 1 4 .0 7 8 9 4 .9 4 3 3 3 .5 0 5 .0 0
T o ta l 30 4 .3 6 3 3 .5 7 6 8 4 .1 0 5 3 2 4 .1 4 7 9 4 .5 7 8 7 3 .1 0 5 .0 0
E n viro n m e n ta l 1 -2 11 4 .4 4 5 5 .4 9 8 7 3 .1 5 0 3 7 4 .1 1 0 4 4 .7 8 0 5 3 .5 0 5 .0 0
3 -4 10 4 .5 0 0 0 .3 4 9 6 0 .1 1 0 5 5 4 .2 4 9 9 4 .7 5 0 1 3 .8 0 5 .0 0
5 and above 9 4 .7 5 5 6 .3 9 4 0 5 .1 3 1 3 5 4 .4 5 2 7 5 .0 5 8 5 3 .8 0 5 .0 0
T o ta l 30 4 .5 5 6 7 .4 2 9 6 6 .0 7 8 4 5 4 .3 9 6 2 4 .7 1 7 1 3 .5 0 5 .0 0
O v e ra llT ra n s cu ltu ra l 1 -2 11 4 .3 2 7 3 .4 8 6 4 4 .1 4 6 6 7 4 .0 0 0 5 4 .6 5 4 1 3 .4 7 4 .9 0
N u rsin g P ra c tice s 3 -4 10 4 .4 6 6 0 .3 8 3 9 2 .1 2 1 4 1 4 .1 9 1 3 4 .7 4 0 6 3 .8 7 4 .9 3
5 and above 9 4 .6 7 4 1 .4 1 0 5 5 .1 3 6 8 5 4 .3 5 8 5 4 .9 8 9 6 3 .7 7 5 .0 0
T o ta l
30 4 .4 7 7 5 .4 4 0 9 5 .0 8 0 5 1 4 .3 1 2 9 4 .6 4 2 2 3 .4 7 5 .0 0
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ANOVA
Sum of
Squares df Mean Square F Sig.
Communication Between Groups .911 2 .456 2.776 .080
Within Groups 4.431 27 .164
Total 5.342 29
Space Between Groups .472 2 .236 .694 .508
Within Groups 9.178 27 .340
Total 9.650 29
Environmental Between Groups .524 2 .262 1.465 .249
Within Groups 4.829 27 .179
Total 5.354 29
OverallTranscultural Between Groups .597 2 .299 1.600 .221
NursingPractices Within Groups 5.041 27 .187
Total 5.639 29
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APPENDIX D
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APPENDIX E
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CERTIFICATE OF REVISION
(PROPOSAL DEFENSE)
This is to certify that Group ______ has revised/modified the final paper
defended last _____________________ according to the suggestions of the
members of the panel.
______________________
Adviser
Date ____________
_____________________ ___________________
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CERTIFICATION
This certification is issued upon the request of members of Group 24-1 for
whatever purpose it may serve them best.
Certified by:
Emervic Gargoles
In-house Statistician
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117
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LINE ITEM BUDGET
GUEVARA, Ronalyn S.
IBASE, Francis D.
ORTEGA, Yessa P.
Items Amount
Transportation Expenses 1500
Communication Expenses 500
(Cellphone, internet prepaid etc.)
Supplies and Materials Expenses
a. Bond Papers 395
b. Printer inks 1320
c. Pencils, ballpens, erasers 150
d. Transparencies 120
e. Token for respondents 100
f. Survey forms 240
Professional expenses
a. Token for validators 300
b. Token for panel members
Snacks 900
Binding Expenses 450
Statistician 3000
Total 8975
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APPENDIX G
120
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….after defense…
121
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122
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APPENDIX H
123
Curriculum Vitae
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PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Malate Catholic School 1988-1994
1030 A. Mabini St., Malate, Manila, 1017
Secondary:
Malate Catholic School 1994-1998
1030 A. Mabini St., Malate, Manila, 1017
124
Tertiary:
BSBA Major in Marketing 1998-1999
University of the Philippines – Manila
Claro M. Recto, Manila
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Bachelor of Arts in Development Study 1999-2004
University of the Philippines – Manila
Padre Faura St., Ermita, Manila, 1017
Vice-Chairperson SY 2001-2003
Youth for Nationalism and Democracy
University of the Philippines – Manila 125
Secretary General SY 2000-2001
Youth for Nationalism and Democracy
University of the Philippines – Manila
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Finance Officer SY 1999-2000
Youth for Nationalism and Democracy
University of the Philippines – Manila
Others
SEMINARS ATTENDED
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Acting and Drama Workshop April 2001
Cultural Group of Youth for Nationalism and Democracy
Quezon City
University of the Philippines – Manila
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PERSONAL DETAILS:
Address: Camella North Springvilee, Molino, Bacoor, Cavite
EDUCATIONAL BACKGROUND:
Primary:
Friendship Learning Center 1995-1999
Angeles City
Mother Theresa School 1999-2001
Molino, Bacoor, Cavite
Secondary:
Don Bosco Technical Institute 2001-2002
Makati City
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Nazarene Academy 2002-2005
Salapungan, Angeles City
Tertiary:
Manila Doctors College 2006- Present
Bachelor Of Science In Nursing
Pres. Diosdado Macapagal Blvd.,
Metropolitan Park, Pasay City
Interest:
Bodybuilding, Cooking
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RONALYN S. GUEVARA
PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Royal Era Academy 1996-2002
10th Ave. HSG, Sgnal VillageTaguig City,
Metro Manila
Secondary:
Sto. Nino Catholic School 2002-2006
Sampaloc St. Signal Village Taguig City
Tertiary:
Manila Doctors College 2006-present
Bachelor of Science in Nursing 130
President Diosdado Macapagal Boulevard
Metropolitan Park, Pasay City
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AWARDS AND HONORS:
Cape Awardee (Sto. Nino catholicSchool)
INTEREST:
Likes to watch TV and movies. Listening to good music and also spend most of
her time surfing the net and reads books. She loves to draw, sing and hanging out
with friends.
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MANILA DOCTORS COLLEGE
FRANCIS D. IBASE
PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Celedonio Salvador Elementary School 1996 - 2001
Merced St, Paco, Manila
Secondary:
Manuel A. Roxas Highschool 2001- 2005
Quirino Ave Ext, Paco, Manila
Tertiary:
Arellano University 2005 – 2006
Bachelor Of Science In Nursing
RESEARCH CENTER
132
MANILA DOCTORS COLLEGE
Taft Avenue, Gil. Puyat, Manila
Interests
Music, Arts, Watching Movies, Playing Computer Games
RESEARCH CENTER
133
MANILA DOCTORS COLLEGE
PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Colegio De Sta. Monica De Angat 1996-2002
Poblacion Angat, Bulacan
Secondary:
Colegio De Sta. Monica De Angat 2002-2006
Poblacion Angat, Bulacan
Tertiary:
Manila Doctors College 2006- Present
Bachelor Of Science In Nursing
Pres. Diosdado Macapagal Blvd.,
Metropolitan Park, Pasay City
RESEARCH CENTER
134
MANILA DOCTORS COLLEGE
Interest:
Singing In Karaoke, Reading Pocket Books, Watching T.V, Eating
RESEARCH CENTER
135
MANILA DOCTORS COLLEGE
PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Elizabeth Seton-South 1996-2002
Anabu Ii-D Imus, Cavite
Secondary:
Statefields School Inc. 2002-2006
Molino Iii Bacoor, Cavite
Tertiary:
Manila Doctors College 2006- Present
Bachelor Of Science In Nursing
Pres. Diosdado Macapagal Blvd.,
Metropolitan Park, Pasay City
RESEARCH CENTER
136
MANILA DOCTORS COLLEGE
Interest:
Singing In Karaoke, Reading Pocket Books, Watching T.V, Eating
RESEARCH CENTER
137
MANILA DOCTORS COLLEGE
YESSA P. ORTEGA
PERSONAL DETAILS:
EDUCATIONAL BACKGROUND:
Primary:
Baclaran Elementary School Central 1996-2002
Secondary:
Manila High School 2002-2006
Victoria St. Intramuros Manila
Tertiary:
Manila Doctors College 2006-Present
Bachelor of Science in Nursing
Pres. Diosdado Macapagal Blvd.,
Metropolitan Park, Pasay City
RESEARCH CENTER
138
MANILA DOCTORS COLLEGE
Interest:
Surfing Net, Cooking and Watching Television
RESEARCH CENTER