COMPETENCY OF THE FOURTH YEAR NURSING STUDENTS

INSIDE THE OPERATING ROOM AND ITS RELATIONSHIP TO BOARD EXAM

RATINGS AMONG BIG
UNIVERSITIES IN ANGELES CITY
_____________

A Thesis
Presented to the
Faculty of the College of Nursing
Philippine Rehabilitation Institute

____________

In Partial Fulfillment of the

Requirement for the Degree
Bachelors of Science in Nursing
____________

By:
David, Camille Z.
Jingco, Ramquielle D.
Odiaman, Liza Vanessa Farhana O.
Sarmiento, Kreinzy Ann B.
Tableza, Alvin S.
November, 2015

Chapter I
THE PROBLEM AND ITS BACKGROUND

Being a nurse is to go above and beyond the call of dutyThe first to

work and the last to leave. They are the heart and soul of caring.
~Anonymous

The nurse competence of graduating nursing students is an important

issue in health care as it is related to professional standards, patient safety
and the quality of nursing care (World Health Organization 2010). When
approaching graduation, nursing students are expected to have adequate
nurse competence to fulfill their duties safely and effectively, as an
adequate supply of competent RNs is necessary to provide high-quality,
safe and patient-centered care. Benner (1982) has proposed that nurse
competence develops along a continuum from novice to expert. Novices
are nurses who have no experience in the situation they are practicing in.
Through being an advanced beginner, competent and proficient, a nurse
will finally become an expert. However, according to Benner, competent
nurses have usually been in the same job or situation for two to three

years. (Benner 1982). The RN4CAST study has reported that the
educational level of nurses is crucial as higher competence level among
nurses in hospital wards leads to reduced incidence of mortality, morbidity
and adverse events. The purpose of this empirical study is to improve the
level of competency of Filipino nursing graduates, potentially increasing the
passing rate in the Nursing Licensure Exam (NLE), and to produce nurses
that are highly qualified and globally competent in the health care field.
In the global setting, a problem faced by health care institutions is the
shortage of nurses (American Association of Colleges of Nursing). Filipino
nurses had been the preference of foreign employers especially in the
United States. Employers not only seek Filipino nurses for their caring
nature, but also because of the quality education Filipino nurses have.
However, with technology evolving together with health practices, the local
curriculum must keep up with the current innovations if we want our nurses
to meet the global demand.
In the local setting, the problem identified by CHED is the low passing
rate in the NLE .Only about half of the total examinees pass the local board
exam. The Professional Regulation Commission (PRC) announces that
9,707 out of 17,891 (54.26%) passed the Nurse Licensure Examination

(NLE) given by the Board of Nursing last May 30 and 31, 2015 (Philippine
Board Exam Results).
The solution of CHED to ensure a better passing rate is the Ched
Memorandum Order No.14 which is the curriculum being implemented now.
One particular interest of the researchers is how this can help in the
competency of students in the operating room or Perioperative Nursing.
To assess the effectiveness of the curriculum, the researchers will
investigate the performance of nursing students inside the operating room.
This is because Article V, section 7.2 of Ched Memorandum Order No.14
states that:
At the end of the school year, the student shall have acquired the
holistic understanding of the human person as a bio-psycho cultural being
focusing on the concept of health and illness as it is related to Perioperative
Nursing in varied settings. The student shall be able to demonstrate the
competencies in the following key areas of responsibility such as safe and
quality nursing care, communication, collaboration and teamwork, health
education, legal responsibility, ethico-moral responsibility, personal and
professional development, quality improvement, research, management of
resources and environment, and record management.
The Core Competency Standards, developed by the Board of Nursing
(BON) with the Technical Committee on Nursing Education (TCNE) of the
Commission on Higher Education (CHED), served as a basis in the

curriculum reform. By focusing on the Eleven (11) Core Competencies, the

new curriculum will ensure quality education for nursing students if it is
implemented well (Tamse, July-Dec 2012).
Using the Core Competency Standards as an evaluation tool, this
study will determine if the new curriculum Ched Memorandum Order No.14
2009

is

effective

in

improving

the

level

of

competency

of

(_________________) nursing students in Perioperative Nursing.

Statement of the Problem
This study aims to evaluate the competency of level 4 students of
(________________) in the operating room.
It seeks to answer the following questions:
1. What is the profile of the respondents in terms of the following:
a. Age and
b. Gender
c. University (present)

2. What is the level/rating of the competency of the 4 th year students

in terms of the following:
a. Safety and quality nursing care
b. Management of resources and environment
c. Health education
d. Legal responsibility
e. Ethico-moral responsibility
f. Personal and professional development
g. Quality improvement
h. Research
i. Record management

j. Communication
k. Collaboration and Teamwork
3. Is there a difference between the competency level of male and
female level IV student nurses?
4. Is there a difference between the competency level of students age
18 and below, and 19 and above?
5. What is the implication of this research in the field of nursing?

SIGNIFICANCE OF THE STUDY

Nursing Practice. To the nursing profession, the study will test the
students competency in the operating room. This is to ensure that
the students competency level will be identified and efforts will be
made to help the students reach the highest level of competence
so that the school will be able to produce nurses capable of
delivering quality nursing services.
Nursing Education. To the students, instructors and the school,
this study will be beneficial in identifying the students weak points
in the 11 Core Competencies. Students and instructors can focus
on these weak points and strengthen learning in these aspects.

The core competencies are also the basis of the Nursing

Licensure Exam. By enhancing learning in the core competencies,
the students can improve their chances in passing the board
exam.
Nursing Research. To future researchers, this study will provide
information on the strengths and weaknesses of students in the
operating room in terms of the core competencies. Researchers
can use this information to examine other subjects and contribute
suggestions to improve the implementation of the new curriculum.
Scope and Limitation
The study aims to evaluate the competence of the level IV student
nurses in the operating room by using questionnaires based on the Eleven
(11) Core Competencies.
The respondents of the study will be all level IV student nurses of
(__________). Survey questionnaires will be used for data gathering. The
questions will cover concepts in Perioperative Nursing and will be based on
the Eleven Core Competencies. There will be 30 questions to be answered
by level IV students. Students will be given 1 hour to answer the questions.
The topic covered will only be about Perioperative nursing whileother
subject areas are not included in this study. The respondents of the study
will be limited to level IV student nurses of (___________) whoenrolled in
summer 2015. Other year levels will not be part of the study.

Definition of Terms:
Board of Nursing (BON). This is the regulatory body of the nursing
profession in the Philippines.
Commission on Higher Education (CHED). CHED is the governing body
covering both public and private higher education institutions as well as
degree-granting programs in all tertiary educational institutions in the
Philippines.
Competency. It is a combination of attributes enabling performance of a
range of professional tasks to the appropriate standards.
Competent. This is used to describe a nurse who uses analysis and
conscious deliberate planning that helps achieve efficiency and
organization.
Core Competency Standards. This represents the minimum knowledge,
skills and attitudes necessary to provide nursing care (Tamse, 2004).
Curriculum. It is an educational plan that spells out which goals and
objectives should be achieved, which topics should be covered and
which methods are to be used for learning, teaching and evaluation.
Expert. This is a nurse described as one who no longer relies on rules,
guidelines or maxims to link their understanding of the situation with
the correct action.
Perioperative nursing. It is a nursing specialty that works with patients
who are having operative or other invasive procedures.
Proficient. This is a term used to describe a nurse who has well-developed
decision making skills and is able to discriminate quickly where the
problem exists.

Chapter 2

REVIEW OF LITERATURE
Foreign Literature
Global Standards in Nursing and Midwifery Education
One of the reasons for the nursing curricular reform is to incorporate
global standards in the Philippines nursing curriculum. Implementation of the
standards will facilitate progress towards the highest level of education
attainable in a country or region, assure equitable and appropriate placement
of nurses in health-care roles and, potentially, simplify recruitment practices
throughout the world (WHO, 2009).
The goal of the global standards is to establish educational criteria and
assure outcomes that:
a. are based on evidence and competency
b. promote the progressive nature of education and lifelong learning; and

c. ensure the employment of practitioners who are competent and who,

by providing quality care, promote positive health outcomes in the
populations they serve.
The global standards in the nursing curriculum are divided into four
areas.

These

are

Curriculum

Design,

Core

Curriculum,

Curriculum

partnership, and Assessment of Students. Each has its own criteria as stated
below:
1. Curriculum Design
Take into account workforce planning flows
Meet national and international education criteria
Delivers the knowledge and skills required to meet the needs of

their respective populations.

Demonstrate balance between the theory and practice components

of the curriculum.
Use of recognized approaches to teaching and learning
Provide classroom and clinical learning based on established

competencies
Enable the development of clinical reasoning, problem solving and

critical thinking
Conduct regular evaluations of curricula and clinical learning
Offer opportunities for multidisciplinary content and learning
experiences

2. Core Curriculum

provide core content that will enable their graduates to meet the

established competencies
provide core content in nursing theory
provide core through the primary health-care approach
provide supervised clinical learning experiences

3. Curriculum Partnership
develop partnerships with other healthcare disciplines
use inter-professional teamwork approaches
have access to, and arrangements for, the clinical learning sites
4. Assessment of Students
assess student learning using reliable evaluation methodologies
use a variety of methods to assess the subject matter
have student retention systems in place
The
curriculum.

new
The

curriculum
global

adopted

the

standards

was

global

standards

adopted

to

in

enhance

nursing
global

competitiveness. The Core Competencies also have the same goal to improve
global competitiveness. Under the criteria of the core competencies, the
researchers will evaluate if the new nursing curriculum will or will not be able
to meet the goals of international standards.
Local Literature
The New Curriculum
CHED Memorandum Order No. 14, series of 2009 (CMO No.14, s. 2009)
contains provisions on the BSN course, including the course specification,
standard curriculum, competency standards, and other requirements. It is the
basis of implementation of the new nursing curriculum in the Philippines
which took effect on the academic year 2009-2010.

Core Competency Standards

Core Competency Standards, as defined by Tamse (July-Dec 2004),
represent the minimum knowledge, skills and attitudes necessary to provide
nursing care. It reflects complex nature of nursing activities and determines
the level of accountability. Graduate of the BSN program must be able to apply
analytical and critical thinking in the nursing practice. The nurse must be
competent in the eleven (11) core competency areas for nursing practice that
were identified as follows (CMO No.14, s.2009):
1. Safe and quality nursing care. The nurse must be able to
demonstrate knowledge base and provide safety and sound
decisions in the care of the client. The nurse must also utilize the
nursing process and prioritization in the care of the client.
2. Management of resources and environment. The nurse must
maintain a safe environment for the client and utilize resources
properly.
3. Health education. The nurse must be able to assess the clients
learning needs and develop an educational plan for the client.
4. Legal responsibility. The nurse must adhere to practices in
accordance to the law.
5. Ethico-moral responsibility. The nurse must respect the rights of
the client and take responsibility for ones decisions and actions.
6. Personal and professional development. The nurse must be able to
assess ones own learning needs and pursue growth and

development in the field. The nurse must also project of

professional image of the nurse.
7. Quality improvement. The nurse must be able to identify variances
and recommend solutions to the identified problems.
8. Research. The nurse must participate in research studies and
utilize the research findings.
9. Record management. The nurse must maintain accurate and
updated documentation of client care.
10.
Communication. The nurse must be able to establish rapport
with the client, clients family, and members of the health team
and respond to their needs.
11.
Collaboration and Teamwork. The nurse must establish
collaborative relationship with members of the health team and
plan a collaborative care for the client.
The Need for a Curriculum Reform
What prompted CHED to revise the nursing curriculum is the low
passing rate of graduates in the Nursing Licensure Examination (NLE). The
passing rate in December 2007 was 42.71%. There were only 28,924 passers
out of 67,728 total examinees. According to CHED acting chairman Romulo
Neri, international standards are adopted into the local curriculum. This is to
ensure better performance of nursing graduates in the NLE (GMANews.TV,
April 30, 2008).

Although the new curriculum is met with objections, UST College of

Nursing Dean Glenda Vargas points out needed changes in the old curriculum
in favor of the new. Patient assessment needs to be a stand-alone subject
rather than just be integrated in nursing professional subjects. In abroad,
nurses are expected to do a thorough health assessment and students need to
be trained more in this area (The Varsitarian Vol. LXXIX, No. 12 ; June 10,
2008).
In a press release by the Philippine Nurses Association (PNA), they
supported the new curriculum stating that

nursing leaders and educators

firmly believe that this curricular reform will improve the quality of current
Philippine nursing education products by honing critical competencies to
provide safe and high quality health care for their patients here and abroad.
Core competencies for 11 key areas of responsibilities that are important in
nursing are spelled out in the various nursing professional courses together
with their indicators. (PNA, July 8, 2008)
The Board of Nursing (BON) also supports the implementation of CMO
No.14. Strengths of the new curriculum enumerated by the BON are as follow
(BON, April 6, 2009):

The Core Competencies with their indicators are spelled out in

various professional courses.

the

Common core values identified by the Board of Nursing and the various
professional organizations during the workshop on good governance were

also included in the curriculum.

Total General Education Courses is 90 Units
Total Professional Courses is 115 Units
The following professional courses included in CMO NO. 5 were retained.
(CMO No. 5 was the prototype of CMO No. 14)
> Theoretical Foundations in Nursing
> Health Assessment
> Pharmacology
> Nutrition and Diet Therapy
> Nursing Research
> Competency Appraisal

> IV Therapy is introduced in NCM 106

Two Nursing Electives are included (6 Suggested Nursing Electives are

included for the third year and senior year level)

Intensive Nursing Practicum both for community-based and hospital-

based experience are included

Guide for RLE are incorporated
The Intraoperative, Intrapartal and Immediate Care of the Newborn are

spelled out as part of the curriculum

More Specific Admission policies are encouraged
Guide for Hospital Affiliation are more specific
Proper Implementation of Nursing Education Standards is encouraged.
However, sanctions for schools who are not performing well are spelled
out.

One of the changes in the curriculum is the rearrangements of topics in

the Nursing Care Management (NCM) course. In the old curriculum based on
CMO No.30, NCM 101, 102 and 104 is an integration of Medical-Surgical
Nursing, Psychiatric Nursing, and Maternal and Child Health Nursing(MCN). It
means that in NCM 101, there are three subjects altogether. However, in the
new curriculum CMO No.14, Nursing Care Management Courses were
separated according to nursing specialties. For example, NCM 101 and 102
deals with only Maternal and Child Health Nursing.
Since CMO No. 14 was implemented only lately, the first batch under the
new curriculum is currently in the second year level. Article V, section 7.2 of
CMO No. 14 states that:
At the end of the fourth year, the student shall have acquired the holistic
understanding of the human person as a bio-psycho cultural being focusing on
the concept of health and illness as it is related to Perioperative nursing in
varied settings. The student shall be able to demonstrate the competencies in
the following key areas of responsibility such as safe and quality nursing care,
communication,
responsibility,

collaboration
ethico-moral

and

teamwork,

responsibility,

health

personal

education,
and

legal

professional

development, quality improvement, research, management of resources and

environment, and record management.
Specifically, the student shall:

a. describe the health care delivery system and the nurses role in it;
b. demonstrate ethico-moral, legal responsibilities in the care of individual
family and community;
c. demonstrate the beginning skills in the provision of independent and
collaborative nursing function;
d. relate the stages of growth and development in the care of clients;
e. demonstrate beginning skills in the preparation of healthy and
therapeutic diets in varied client cases;
f. explain the dynamics of the disease process caused by microbes and
parasites and the environment;
g. imbibe the core values cherished by the nursing profession such as love
of God, country and people, and caring;
h. design a plan that will focus on health promotion and risk reduction to
clients; and
i. utilize the nursing process in the care of the high risk mother and child
in the family.
Statements from several sources, such as CHED, PNA, and BON, suggest
that they support the implementation of the new curriculum. These sources
have enumerated the strengths of the new curriculum and emphasized the
relevance of incorporating the Core Competencies in the new curriculum.
According to Tamse (July-Dec 2004), the Core Competency Standards serve as
a framework for program development and also serve as a tool for performance
evaluation. With this information, the researchers will use the same Core
Competency Standards to evaluate the effectiveness of the new curriculum

with regards to Perioperative Nursing. The result of this study may either
support or refute the statements of the said sources.
Foreign Studies
A study by Richard W. Redman, et al. Deals with competency assessment
in nursing education.
Competency Assessment: Methods for Development and Implementation in
Nursing Education
Competent performance by health care professionals is expected
throughout society. However, defining what it is and teaching students how to
perform competently faces many challenges. This article provides a brief
overview of the contemporary focus on competency assessment in nursing
education. The redesigned nursing curriculum at the University of Colorado is
presented as an exemplar of a practice-oriented model that requires competent
performance among students. Methods for implementing a competency-based
curriculum and lessons learned during the process are discussed.
Competency assessment is always outcome oriented; the goal is to
evaluate performance for the effective application of knowledge and skill in the
practice setting. Competency assessment techniques address psychomotor,
cognitive, and affective domains. Competencies can be generic to clinical
practice in any setting, specific to a clinical specialty, basic or advanced.
Competency-based education has been found to be equally effective in
both didactic and self-learning approaches presents hallmarks of competencybased education that make them applicable both in practice and in educational

settings. These include competencies based on validation of what performance

by competent practitioners actually comprises. In addition, competency
assessment is based on criterion-referenced evaluation methods where the
learners performance is evaluated against a set of criteria provided to the
learner so that both the learner and the assessor are clear on what
performance is required. Finally, competency-based education is learnercentered in that outcomes are specified and describe what the learner must do
to demonstrate competency.
The experience in converting to a competency-based curriculum has
been both successful and challenging. Faculty and student experiences to date
have been positive. The redesigned curriculum is viewed as responsive to the
competency-oriented environment and employers believe the transition of
graduates into practice settings will be more effective, efficient, and successful.
This competency-based approach to education can serve as a model which
offers a wide variety of applications to education and service environments.
The researchers adopted the criterion-referenced evaluation methods.
Competency is evaluated against a set of criteria. In this study, the criteria to
be used is the Eleven Core Competency Standards.

Local Study

A similar study of evaluating a curriculum was conducted by Helen

Villarico-Correa, RN, MN, EdD published in The Philippine Journal of Nursing
Volume 73 No.2.
The Associate in Health Science Education Curriculum: An Evaluation
This paper presents the result of a survey conducted in Region VI as to
the implementation of the Associate in Health Science Education (AHSE)
Curriculum. The survey was conducted among all the higher education
institutions in the region that offers the health-related professions and the
associate in health science education curriculum. The respondents were 35
deans of the health-related professions in the region which include Bachelor of
science in Nursing, Bachelor of Science in Medical Technology, Bachelor of
Science in Physical Therapy, Bachelor of Science in Pharmacy, Bachelor of
Science in Nutrition and Dietetics, Bachelor of Science in Radio Technology,
and the two-year Midwifery Program. In addition, this paper also provides an
overview of the AHSE curriculum including the views and experiences of the
deans who actually implemented the said programs since the academic year,
1998-1999.
Specifically, this study aimed to determine:

whether the objectives of the AHSE curriculum were met

the strengths and the weaknesses of the curriculum;
the problems encountered in implementing the program
the facilitating factors that help in the implementation of the
program; and

the preferred curriculum of the respondents

The results of the study show that majority of the respondents replied
that the objectives of the AHSE curriculum has not been met. Several
advantages and disadvantages of the AHSE curriculum were mentioned. And
according to the study, 85.71% of the respondents preferred the generic
curriculum over the AHSE curriculum.

Synthesis
CMO No. 14 mandates the implementation of the new nursing
curriculum. It contains the standard curriculum and syllabi of the nursing
subjects. This memorandum was developed to improve the competency of
Filipino nurses and produce highly qualified nurses.
From the literatures collected, the researchers are able to extract the
information that fourth year nursing students are expected to be
knowledgeable in Perioperative nursing and be able to develop competencies in
the 11 Core Competency areas. With this, the researchers will utilize the Core
Competencies to test the students knowledge in Perioperative nursing that it
can also be used as an evaluation tool.

PRC results
-----------------NOTHING FOLLOWS----------------------

The Performance of Schools in the May 2015 Nursing Licensure Examination in alphabetical order as per R.A. 8981 otherwise known as
PRC Modernization Act of 2000 Section 7(m) To monitor the performance of schools in licensure examinations and publish the results thereof
in a newspaper of national circulation is as follows: (Any discrepancy in the report is not intentional on the part of the Commission, but rather
due to miscoding of school codes by the examinees themselves. Concerned schools may write the Commission for correction.)
HAU passing rate = 69.09%
Angeles University Foundation = 96.00 %

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