CHAPTER III METHODOLOGY

This chapter deals with the research design, place, and respondents of the study, the research instrument, the data processing procedure and the statistical tools used to analyze and interpret the gathered data.

Research Design The researchers used the descriptive correlational design as it is a more useful tool in finding out the relationship between clinical performance and patient satisfaction on the nursing care rendered by nursing students of Saint Anthony College of Roxas City. No interventions were introduced & performed during the course of the study. In addition, causal relationship between clinical performance & patient satisfaction was not established. Consequently, data gathering efforts were aimed at grouping & ranking patient satisfaction ratings as well as clinical performing grades. Determining the relationship between the two variables is possible only with the use of Spearmans rho, specific for comparison of non-parametric measures (ordinary system).

Population & Sample The study was conducted in St. Anthony College Hospital during the academic year 2011-2012. Inclusion criteria for the patient respondents were (1) either male or female; (2) 18 years old and above; (3) under the care of the same assigned nursing

student for at least two consecutive days; (4)conscious and coherent; (5) willed to participate; (6) and were able to answer questions indicated; (7) able to read and write. Characteristics of the study participants that deterred the respondents from participating in the study included: (1) were those not under the care of SACR nursing students; (2) were under the care of more than two assigned nursing students; (3) were under the care of nursing students from 2:00pm to 10pm; (4) suffered from severe mental or cognitive disorders; (5)were unable to read and write. On the other hand, the nursing students that were subjected to the study were (1) SACR students, (2) had their duty in the hospital, (3) solely rendered care to the client, (4) were under the same clinical instructor as with the other nursing students that were involved in the study. Students who did not meet the above inclusion criteria were not qualified as subjects for the study. The researchers used probability simple random sampling design, fishbowl method in sample selection. In this design, the researchers decided to use pieces of paper on which the names or symbol of each of the elements of the population is written, is placed in a container and mixed. Then the desired number of elements is drawn, either with replacement or without replacement. After the implementation, the researchers had consented 600 nursing students assigned in St. Anthony College Hospital that participated in the study. A total of 600 patient satisfaction tools were accomplished.

Table1 showed the demographic characteristics of the patient respondents. Majority of the respondents belonged to Group A or those who were 45-64 years old which comprised 48% of the respondents. 30% of the respondents were from Group B or those that are 18-29 y/o while the remaining 22% of them were from Group C or those 30-44 y/o. It also showed that 74% of the respondents were females while the remaining 26% were males. TABLE 1 Demographic Characteristics of the Patient Respondents

Demographic Profile Age (Mean 36.78) Generation net Generation X Baby Boomers Sex Male Female

N= 100 (23)

Percentage

7 5 11 6 17

30% 22 % 48% 26% 74&

Research Instruments The instrument used by the researchers measures the patients satisfaction and the clinical performance of the students. Data on patient satisfaction was gathered through a checklist. The study developed by Risser, consisted a 30- item statements which evaluated the effectiveness of nursing care provided in a hospital ward. The three domains used to evaluate student nursing care were: Technical Professional, Interpersonal Knowledge and Interpersonal Rapport. Content validity and test

retest reliability had been established. Patients found a specific item as inapplicable (i.e. The nurse gives good advice over the telephone) and were confused on items having similar thought (i.e. The nurse gives directions at just the right speed and The nurse gives direction too fast wherein the former was retained and the latter was omitted). After revising the tool, the researcher came up with the 25 item checklist from which the contents were approved by the Level IV Clinical Coordinator. The instrument that was developed by the researchers was modified; the term nurse was replaced to nursing student. Demographic data such as name (optional), age, gender, level of awareness and economic status were asked in the instrument. In order to measure the patient satisfaction and the domain of nursing care, Likert 5 point scale wherein 1-Strongly agree, and 5- Strongly disagree was used as the basis. The study participants chose the most appropriate rating for each query by putting a check on the box corresponding to the degree of satisfaction felt and nursing care performed. The applicability of the statements to student nursing care was assured because the researchers sought the approval of one of the staff nurses and clinical preceptor in St. Anthony College Hospital. Prior to answering the questionnaire, instructions were given to the patients. Entries such as name, age and gender were filled-up. Also, Likert scale was clarified to the patients: 5 strongly agree and 1 as strongly disagree. Validity of the Questionnaire The questionnaire was subjected to face validation zeroing on its content. The validators were members of the faculty at St. Anthony College of Roxas City, Inc. who were considered experts in this line of discipline.

Reliability of the Questionnaire To test the reliability of the questionnaire, it was subjected to a pilot test. It was administered to 30 health care providers at St. Anthony College Hospital through the staff nurses, patients and probationary student nurses who were chosen by convenience and did not participate in the actual survey. Only 25 pretest respondents were used in the reliability testing because according to Garrett, this number is adequate enough.

Dat Gathering Procedures Having established the validity and reliability of the questionnaire, the instrument was reproduced according to the number of respondents, namely 100 regular level IV student nurses, 20 regular staff nurses and 100 admitted patients. The researchers obtained permit to administer the questionnaire from heads of the units covered. With permit granted, they personally distributed the questionnaires to the respondents. The researchers were able to get a hundred percent return rate of all questionnaires they distributed. Observations and interviews were done in some instances while collecting the data needed. The researchers personally marked immediately the observation table based on the medical-surgical teams reaction during the use of music therapy while on operation. Data Collection Procedure Beforehand, the researchers wrote a letter of request to the Dean of St. Anthony College of Roxas City asking for permission for data collection on St. Anthony College

Hospital. There searchers also asked the Level IV coordinators about the RLE rotation plan, so that the researchers will be able to locate the group of St. Anthony College of Roxas City Level IV assigned to the said hospital. Also, a letter was made to the hospital administrator through the training 20 officers to inform them of the purpose of the study and be able to gain entry to the health institution and to make the data gathering possible, ensuring mutual agreement and understanding on both the researchers and the hospital administrator. The researchers also requested the hospital administrator that for a particular period of time, only St. Anthony College of Roxas City Level IV nursing students will be assigned to handle patients in a particular ward. After the approval, the researchers obtained the names of nursing students and their clinical instructor. The researchers coordinated with the clinical instructor regarding patient assignment to satisfy the inclusion criteria. The schedule of activities of the nursing students was also communicated. Clinical performance grades were obtained from the clinical instructor after the students clinical rotation for processing and analysis purposes. The researcher collected data after gaining entry. Purposive, non-probability design to obtain subjects was used, of which there was no randomization done; homogeneity in terms of the availability of patients whom the nursing student rendering bedside care was utilized by the researchers to control confounding/ extraneous variables. This design was utilized to confirm specific targets that qualified in the inclusion criteria. The primary data gathering was done once for each client. The researchers conducted the 25 survey guided by the checklist they have on hand. Introduction with the client about the purpose of the survey was made. Clients were not forced to

participate because they were consented verbally. Then, the researcher proceeded with explaining the instruction in answering each question. Terms that the client understands was used; the researcher assured the client about the confidentiality of the results at the end of the interaction.

Statistical Treatment 1. The clinical performance of nursing students in relation to their instructors evaluation of care rendered to the patient respondent was grouped into four domains (Patient Care Competencies, Enabling Competencies, Enhancing Competencies and Empowering Competencies). The mean of clinical performance were assigned according to the four domains. The total mean for each domain of clinical performance was used to derive the general average of patient satisfaction. Mean was used to identify the average of clinical performance from 108 nursing students. 2. The satisfaction ratings of patient respondents were grouped into three domains (Technical Professional, Interpersonal Knowledge, Interpersonal- Rapport). The mean of the satisfaction rating were assigned according to the three domains. The total mean for each domain of patient satisfaction was used to derive the general average of patient satisfaction. Mean was used to identify the average of the patient satisfaction from the 100 patient respondents. 3. The profile variable of the patient respondents were age and sex. Age was grouped into Group A, Group B, and Group C. The sex was (SKIP-MEAN) grouped into Male and Female. The mean score of patient satisfaction were grouped according to what was stated above.

4. The relation between each of the four domains of clinical performance and the three domains of patient satisfaction were treated using the Spearmans Rho to indicate the magnitude of the relationship between the patient satisfaction and clinical performance. 5. The relation between the general average of clinical performance and the general average of patient satisfaction were treated using Spearmans Rho to identify the degree of the relationship between patient satisfaction and clinical performance. Spearmans rho is a non-parametric test that was used because ordinal and nominal numbers were utilized in the study. 6. The relation between the general average of clinical performance and the general average of patient satisfaction was treated using t-test to determine the level of significance between the two variables. In addition, it was used to validate the statistical difference between clinical performance and patient satisfaction.