PERFORMANCE OF NURSING STUDENTS IN AFFILIATING HOSPITALS

Introduction
In this present age of science and technology when so much emphasis is being placed on professionalism, one profession that has gained the admiration of the recipients of its expertise is that of nursing. Nursing bears the dignity not only of a high skilled profession, but also the sacredness that brings with it the healing power of touch and presence. The student nurse who is dedicated in his/her chosen profession is one who really cares, who educate and also who listens. His/her calling is akin to one who ministers hand in hand with the Divine Physician going about doing good.

Two driving forces have emerged lately that have impact on the nursing practices which are emphasis on quality and emphasis on cost containment. Student nurses, like all health care providers are responding to consumer demand for quality service. Student nurses are continually seeking ways to improve their practices and the satisfaction of the client they serve. If nursing is to survive the competitive challenges of the time, it must contain to provide a quality of service that clients desire and value.

RESULT OF THIS STUDY MAY SERVE AS A MOTIVATION TOWARDS IMPROVEMENT OF PATIENT CARE. THE FACTORS IDENTIFIED RELEVANT TO THE NURSING PROFESSION AND TO THE PROVISION OF QUALITY NURSING CARE COULD BE READILY AVAILABLE FOR STUDENT AND PROFESSIONAL NURSES TO EITHER ENHANCE OR ELIMINATE, AS IT IS DEEMED NECESSARY TO IMPROVE THEIR PRACTICE AND THE SATISFACTION OF THE CLIENTS THEY SERVE. IT COULD ALSO BENEFIT THE PATIENTS BECAUSE THERE WILL BE AN IMPROVED NURSING QUALITY SERVICE.

For the health professionals, the findings of this study could be made available for them to have always sought to measure, maintain and improve quality of patient care. This study could provide them a better understanding of the care they measure and help them identify several conditions existing in their institution that affects the provision of care through nursing process.

By knowing the results of this study, Nursing Institutions could consider improving the working conditions of student nurses in the hospital, giving them wide knowledge, proper motivation and incentives to inspire them in their work. To the nursing educators, the work acknowledges the role of nursing education in providing inputs about nursing process and its application into a learning experience. Through this study, educators could be able to determine the inadequacy and appropriateness of these inputs and learning experiences they provide to their students.

The nursing process is the essence of professional nursing practice. Its the underlying scheme that provides order and direction in nursing practice. It is a problem-solving framework in delivering nursing care to patients and their families. Its goal is to identify a clients health status, actual or potential health care problems, establish plan to meet the needs and deliver specific nursing interventions. It requires the use of this process day in and day out. The process is based on theories and practices taught in nursing school that must be well learned by the student nurses. While the goal of the student nurse is to meet the needs of patients and render a health quality care, he/she must be aware that a tool should be used to attain this. Such tool is the nursing process which is defined as the application of the scientific method of problem solving in a progressive of purposeful thought actions which the nurse employs in order to help her patient/client cope with his problem arising from health-illness situation. It has been observed that one of the weaknesses of the student nurse today is their ineffectiveness in the implementation of the nursing process in their practice. This brings a considerable concern to any nursing institution for the matter. This gave the researchers a concern to undertake this study concerning nursing process because it can be a blessing and a misfortune in the nursing process.

The researchers would also be benefited from this study as their insights and knowledge about the performance of student nurses in delivering nursing services would be broadened as they become nurses in the future. Hopefully, results of the study would serve as an eye opener for the school administrators as to the preparation of the students to assume a greater role. Likewise, it would serve as a basis for formulating policies and strategies to better prepare the students as they become professional nurses in the future. To the clinical instructors this study could enable them to know the amount of supervision they would be giving to students.

SCOPE AND DELIMITATION

This study was conducted to determine the level of performance of nursing students in affiliating hospitals during the school year 2012-2013. It also looked into the significant relationship between the performance of nursing students in affiliating hospitals and their personal and hospitalrelated profile.
The dependent variable is the performance of the nursing students along the phases of the nursing process such as assessment, nursing diagnosis, planning, implementation and evaluation. The dependent variables are the respondents socio-demographic profile which include age, sex, civil status and seminars attended and hospital-related profile such as type of hospital, category of hospital, classification and studentnurse patient ratio.

Statement of the Problem This study aimed to determine the performance of nursing students in four affiliating hospitals during aimed school year 2012 2013. Specifically, it sought answers to the following questions: What is the profile of the respondents in terms of the following: A. Personal Factors a) age, b) sex, c) civil status, d) seminars attended on Nursing process? B. Hospital Related Factors a) type of hospital, b) category of hospital, c) classification of patients and d) student nurses patient ratio?

2. Is there a significant relationship between the level of performance and the personal and hospital related profile of the respondents?

3. What is the level of performance of the respondents along the following phases of the nursing process:
A) Assessment, B) Nursing Diagnosis, C) Planning, D) Implementation, E) Evaluation?

The respondents of this study were the fifty three (53) third year students in the college of nursing, University of northern Philippines assigned in the medical and surgical wards in Gabriela Silang General Hospital private rooms and wards (2nd floor) in Metro Vigan Cooperative hospital, Private rooms and wards in Ilocos Sur Cooperative Hospital and all the wards in Corpuz Clinic and Hospital. The operating and delivery rooms in the affiliating hospitals where excluded in the study such as Gabriela Silang General Hospital, Abra Provincial Hospital, Metro Vigan Cooperative Hospital and St. James Hospital. In Addition five (5) clinical instructors who supervised the respondents were requested to validate their responses. The study employed the descriptive-correlational method of research with a questionnaire- checklist as the main instrument which was adopted from the study of Ramos (2011) Entitled: Performance of Nurses in Tertiary Level Hospital in Ilocos Sur. To treat and interpret the data gathering the study made used of the frequency and percentage, mean and simple correlational analysis.

THEORETICAL FRAMEWORK
This framework presents the researchers readings on related literature and studies, both foreign and local which provides the researchers with a wide understanding of the research on hand. The review efforts are concentrated on readings on nursing process including such variables upon which this study is based. It is similarly based on the assumption of student nurses undertaking this four-year nursing degree in which they seize the competency and sufficiency in the performance of their respected functions as they are exposed in different affiliating hospitals around the first district of Ilocos Sur.

The Nursing Process Nurse leaders, nurse teachers and nurse theorists suggest that the nursing process is the most effective and humane way of organizing and delivering nursing care (Bowman and Parson, 2003:40). Nurse practitioners in several specialties have described how to use the nursing process in practice. But there are many interpretations of it, and nurses are often unsure whether they are doing the nursing process. The nursing process theory contains both method and beliefs. It includes description of methods of organizing and delivering nurse care. Yura and Walsh (2000:50) succinctly describe nursing process method as: Thus, the nursing process is the application of the scientific method of problem solving in a progression of purposeful thoughts and actions which the nurse employs in order to help her patient or client cope with his problems arising from health-illness situations. According to Wolff et al. (1999:29), it is a set of acts that are directed toward the goal of helping a patient achieve or maintain well-being: its parts (assessment, planning, implementation and evaluation ).

Assessment
Bautista (1999:31) pointed out that assessment is the first phase in the nursing process. The nurse judges the patients health -illness status. It has two sub-phases: data collection relating to patients and their problems and data analysis or synthesis. Assessment consists of the systematic and continuous collection, validation and communication of client data. Insufficient or incorrect assessment could lead to incorrect nursing diagnosis, which could mean inappropriate planning, implementation and evaluation. Therefore, the importance of accurate assessment cannot be overemphasized. It is vital to the process and is basis for all other phases. Although assessment is the first phase, it also occurs as reassessment during any other phase of process when new data are obtained. It has been found out that the systematic and orderly collection of data is essential for the nurse to know if sufficient data have been collected. It also provides a method of quick retrieval of information about the client/patient for auditing professional practice and for doing nursing research. In addition, it serves as a means for communicating information to other health care providers. Several authors have included guidelines for the systematic collection of data. The Standards of Nursing Practice (ANA, 1993) also provides information to aid in the collection and organization of data. A holistic view during the assessment phase ensures the biological, psychological, social, cultural and spiritual spheres of the client are considered.

A process is series of planned actions or operations directed toward a particular result. The nursing process is a cyclical process with interdependent steps. The process starts with the initial nurse-patient interaction as the patient enters the health care system and continues as long as the patient needs nursing assistance in coping with the healthillness problems. The nursing process is not a new thing. Some limited evidence of the term appeared during the fifties. When the term was first introduced, the reactions of some nurses varied. Some have affirmed the use of the process ever since while a number of nurse educators probably are left with questions in their minds regarding graduating quality nurses; teaching the correct usage of nursing process; and how the nursing student develop the knowledge and skills necessary in all phases of the nursing process. The answer to all of these questions is certainly undisputed. The contents as well as the methods of practice are seemingly more common than their variations. The Department of Education, Culture and Sports (DECS) prescribed the curriculum which provides directions in the students learning with emphasis on the use of nursing process as a basis of health care delivery.

Nursing Diagnosis The diagnostic statements are derived from the nurses inferences, which are based on the assessment and validated data coupled with nursing, scientific, humanistic concepts and theories. As one proceed the analysis of data, a diagnostic may deal with an actual (present-oriented) or a potential (future-oriented) health problems that may be symptoms of psychological disorder or behavioral, psychological or spiritual problems. It is based on the conclusions reached in the assessment phase. Diagnosis it is a second phase of the nursing process. In this phase, nurses use critical thinking skills to interpret assessment data and identifying client strength and problems. Diagnosis is a pivotal step in the nursing process (Kozier 2008:196).

Implementation

After planning, implementation is the next, or third phase of the nursing process. Implementation refers to the actions initiated to accomplish the defined goals and objectives. It is simply the carrying out of the plan of care. It is the actual giving of nursing care and putting the plan in action. Implementation is an ongoing process through which the nurse is reassessing, reviewing and modifying the plan of care, and if necessary seeking assistance in meeting the clients health and care needs. Implementation includes all actions performed by the nurses to promote wellness, prevent disease/illness, restore health and facilitate coping with altered functioning. Implementation phase begins when the nurse considers various alternative actions and select those most suitable to achieve the planned goals and objectives. Nursing action may be carried out by the nurse who developed the nursing care plan or by others who developed the nursing care plan. Nursing action may be carried out by client or family. Campbell (2003:95) gave seven categories of nursing actions. These are assertive, hygienic, rehabilitative, supportive, preventive, observational and educative. The implementation phase is completed when the nursing actions are finished and the results are recorded against each diagnosis.

Evaluation Evaluation is the fifth and the final phase of the nursing process. Morgan (2003:314) defines it as the appraisal of the clients behavior changes that are a result of the action of the nurse. Although it is considered as the final phase, it frequently does not end the nursing process. It may lead to reassessment, which in turn, may result in the nursing process beginning all over again. The key to appropriate nurse-client actions lies in the planning phase of the nursing process. When objectives are described in behavioral terms, it is easy to determine whether or not the nurse-client actions were successful. It is important for the nurse and the client to mutually establish objectives. Evaluation consists of the following five steps: 1. Review the goals/predicted outcomes, 2. Collect the data about the clients responses in nursing actions, 3. Compare actual outcomes to predicted outcomes and decide if the goals have been met, 4. Record the conclusion, and 5. Relate the nursing plan to the client outcomes. When the predicted outcomes are not reached, reassessment should occur, and the process begins again. If the evaluation shows that the nurse-client objectives have been met, the nursing process is complete.

Planning
Planning is the third phase of nursing process. The plan for providing nursing care can be described as the determination of what can be done to assist the client. Planning involves the mutual setting of goals and objectives by the nurse with the clients, judging priorities and designing methods to resolve the actual or potential problems. The first sub-phase of planning is setting the goals and objectives, which are derived from the nursing diagnoses and are established for each nursing diagnosis listed. The plan is written document for nursing action designed to help the caregiver and give quality client care. The plan contains relevant nursing diagnoses, expected outcomes, nursing interventions and evaluation information. In addition, it becomes a permanent part of the clients health record. In preparing to write the plan, the client and his or her family should be consulted before formulating the goals and objectives, which should be realistic and attainable, supportive of clients needs and mutually acceptable. It is important to consider the need for objectives that can be defined and stated concisely in an act -of-being phase. This phase should contain the performer (the client), a mover (action) and a change of behavior to be accomplished (objective) should be stated in a manner that everyone will understand without seeking clarification. Time is another consideration when specifying desired outcomes. The time limits should be precise for evaluation purposes but should not be so rigid that chances cannot readily be made. Changes in time limits are based on reassessment of priorities and necessary outcomes in terms of the clients behavior rather than the nurses behavior, in keeping with the standards of nursing practice developed.

CONCEPTUAL FRAMEWORK
This study looked into the relationship between the dependent variables, which includes the level of performance along the phases of nursing process namely: assessment, nursing diagnosis, planning, implementation, evaluation, and the independent variables which includes personal factors and hospital-related factors.

Independent variables

Dependent variables

Personal Factors Age Sex Civil Status Seminars attended on Nursing Process Hospital-Related factors Type of Hospital Level of Performance along the Phases of the Nursing Process Assessment Nursing Diagnosis Planning Implementation evaluation

Category of Hospital
Area of Assignment Student-Patient Ratio

Figure 2 .Research Paradigm

The study revolved on the paradigm shown in Figure 2. The paradigm shows that the performance of the student nurse along the phase of the nursing process namely; assessment, diagnosis, planning, implementation and evaluation could be related to the personal and hospital-related factors.

ASSUMPTIONS:
1. This study was anchored on the following assumptions:

2. The level of performance of student nurses toward the phases of the nursing process in selected government and private affiliating hospitals/clinics can be measured.
3. The instrument used as the primary tool in this study is valid. 4. The responses of the respondents are objective, valid and reliable.

HYPOTHESIS:
The following hypothesis was considered in this study: 1. There is a significant relationship between the level of performance of nursing students along the phases of the nursing process in terms of: 2. Personal Factors 3. Hospital-Related Factors In Chapter II, the abovementioned hypothesis was converted into its null form and was tested at 0.5 probability level.

METHODOLOGY
This portion described the research design, sampling technique, data gathering procedures and statistical treatment of data that was used in the conduct of the study. Research Design. To ascertain the performance of third year nursing students of the University of Northern Philippines along the nursing process, a descriptive research design was utilized. Population. The respondents of this study were the fifty three (53) third year students in the college of nursing, University of northern Philippines assigned in the medical and surgical wards in Gabriela Silang General Hospital private rooms and wards (2nd floor) in Metro Vigan Cooperative hospital, Private rooms and wards in Ilocos Sur Cooperative Hospital and all the wards in Corpuz Clinic and Hospital. The operating and delivery rooms in the affiliating hospitals where excluded in the study such as Gabriela Silang General Hospital, Abra Provincial Hospital, Metro Vigan Cooperative Hospital and St. James Hospital. In Addition five (5) clinical instructors who supervised the respondents were requested to validate their responses

Data Gathering Instruments. The researchers made use of a questionnaire checklist as the main instrument of this study which was adapted from the study of Ramos (2011) entitled: Performance of Nurses in Tertiary Level Hospitals in Ilocos Sur. The questionnaire is divided into two parts. The first part elicited information on the profile of the respondents, such as the socio-demographic and hospital related factors. While, the second part of the questionnaire obtained information on the performance of the student nurses in affiliating hospitals along the phases of the nursing process which include assessment, nursing diagnosis, planning, implementation and evaluation. Data Gathering Procedure. The researchers asked permission from the President of the University of Northern Philippines and the Dean of the College of Nursing to float the questionnaires to the respondents. One hundred percent (100%) were retrieved.

TABLE 1 DISTRIBUTION OF THE RESPONDENTS

Statistical Treatment of Data. The statistical tools used in the interpretation of the data gathered are the following:
1. Frequency and percentage to describe the personal and hospital-related factors of the respondents 2. Mean was used to determine the level of performance of the respondents along the phases of the nursing process 3. Simple Correlational Analysis to establish relationship between personal and hospital-related factors and the performance of the respondents along the phases of the nursing process in the affiliating hospitals.

CHAPTER II PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Problem 1:
Problem 2. What is the level of performance of the respondents along the following phases of the nursing process: A) Assessment, B) Nursing Diagnosis, C) Planning,

D) Implementation,
E) Evaluation?

Level of Performance of the Respondents along the Phases of the Nursing Process The level of performance of the student-nurses on the utilization of the nursing process was measured in terms of assessment, nursing diagnosis, planning for patients care, implementation of nursing care plan, and evaluation of the nursing intervention. The grand mean rating 3.73 indicates a very high level of performance along the phases of nursing process. On Assessment. The table 4 shows the level of performance of the respondents along the assessment phase of the nursing process. The overall performance of the respondents along assessment is high as back -up by the mean rating of 3.69. This is supported by the response of the respondents wherein they always assess client and family and capability to participate in the patients care (x= 4.83) and often analyses and interprets the collected data. The overall performance of the respondents along the assessment phase connotes that they are excelling efforts and cleverness in obtaining necessary information for the wellness of their patients. This also signifies that respondents are prepared to take care in establishing the foundation of treatment by implementing the different method in gaining pertinent data about their patients. Furthermore, the data also imply that the respondents embrace health assessment as central to effective planning, implementation and evaluation of nursing care for which respondents are accountable for. The care they provide should accurately determine on order to plan and deliver evidence -based care.

Table 4 Mean Rating Showing the Level of Performance of the Respondents along the Assessment Phase of the Nursing Process
Items 1. 1. Establishes rapport with the patient/family Utilizes various assessment techniques to determine patients condition, problems and needs. a) Completes and uses nursing health history and assessment worksheet on . b) Performs simple physical examination c) Involves patient, family and significant others in obtaining Mean 4.08 3.51 3.62 3.86 4.07 3.66 3.29 3.58 3.52 4.08 3.69 DR A O O O O O SM O O O H

accurate information.

d) Assesses client and familys capability to participate in the patient care 1. 1. 1. 1. Reviews past and present medical records to identify patterns of illness and coping abilities. Synthesizes significant laboratory findings. Validates and organizes collected data, focusing functions needing assistance/support. Analyzes and interprets collected data. TOTAL

Norm: Range of Scores 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60
1.00 1.80

Item Descriptive Rating Always ( A) Often ( O) Sometimes (SM)

Seldom (SL) Never (N)

Overall Descriptive Rating Very High ( VH) High (H) Moderate (M)
Low (L) Very Low (VL)

On Diagnosis. The table 5 shows the level of performance of the respondents along the diagnosis phase of the nursing process. The mean rating of 3.69 suggests a high overall level of performance of the respondents along the diagnosis phase of the nursing process. The respondents often identify the nursing problems of the patient with the highest mean rating of (x= 3.90) and often state nursing diagnosis/ diagnoses concisely and precisely and often identify the potential problems or complications that require collaborative interventions with the lowest mean rating of (x= 3.61) of both items. The overall performance of the respondents along the diagnosis phase suggests that the students are competent in coming up with a nursing diagnosis appropriate for the case of their patients. This can be attributed to the adequate trainings undergone by the respondents during their exposure to the different clinical areas which includes community diagnosis, nursing care plan, family case study, oral case presentations and patients case analysis. Hence there is still a need to further improve the respondents critical thinking skills in order to interpret assessment data and analyze problems being presented by the client in order to identify client strengths and problems. It further implies that the respondents still needs the supervision in the formulation of nursing diagnosis.

TABLE 5 MEAN RATING SHOWING THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE DIAGNOSIS PHASE OF THE NURSING PROCESS
Items
1. 1. 1. Identifying nursing problems of the patient. Identifying the defining characteristics of the nursing problem. Identifying the etiology of the nursing problem

Mean
3.90 3.72 3.62

DR
O O O

1.

Stating nursing diagnosis/ diagnoses concisely and precisely

COLLABORATIVE

3.61

1.

Identifying the potential problems or complications that require collaborative interventions.

3.61

1.

Identifying health team members with whom collaboration is essential.

3.70

TOTAL
Norm:
Range of Scores Item Descriptive Rating 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60 Always ( A) Often ( O) Sometimes (SM) Seldom (SL) Moderate (M) Low (L) Overall Descriptive Rating Very High ( VH) High (H)

3.69

1.00 1.80

Never (N)

Very Low (VL )

On Planning. The table 5 shows the level of performance of the respondents along the planning phase of the nursing process.

The overall performance of the respondents long planning phase is HIGH as evidenced by the mean rating of 3.68. This is supported by the response of the respondents wherein they Often Selects appropriate nursing interventions/strategies/actions (x=3.86) and updates and modifies the plan as needed (x=3.57). The High overall performance of the respondents along the planning phase is one of the signs that a student nurse utilizes her foundations, theories and communication skills while working with his or her own client. As stated in the study of Manaoang (1998), as a measure of performance, effectiveness reflects application of theories, concepts and principles of nursing care.

TABLE 6 MEAN RATING SHOWING THE PERFORMANCE OF THE RESPONDENTS ALONG THE PLANNING PHASE OF THE NURSING PROCESS
Items 1. 1. Establishes priorities of nursing diagnoses. Mutually formulates goals and expected outcomes with patient, family, significant others. Mean 3.69 3.63 DR O O

1.

Collaborates/ coordinates with health team members in planning for patient care.

3.67

1. 1. 1. 1. 1.

Correlates nursing care plan with medical plan of care. Selects appropriate nursing interventions/strategies/actions. Develops alternative in plan of care. Writes the nursing care plan. Updates and modifies the plan as needed. TOTAL

3.76 3.86 3.55 3.70 3.57 3.68

O O O O O H

NORM: RANGE OF SCORES 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60 1.00 1.80

ITEM DESCRIPTIVE RATING ALWAYS ( A) OFTEN ( O) SOMETIMES (SM) SELDOM (SL) NEVER (N)

OVERALL DESCRIPTIVE RATING VERY HIGH ( VH) HIGH (H) MODERATE (M) LOW (L) VERY LOW (VL)

The High overall performance of the respondents along the planning phase is one of the signs that a student nurse utilizes her foundations, theories and communication skills while working with his or her own client. As stated in the study of Manaoang (1998), as a measure of performance, effectiveness reflects application of theories, concepts and principles of nursing care.

On Implementation. The table 5 shows the level of performance of the respondents along the Implementation phase of the nursing process.
A High overall performance of the respondent along the implementation phase was obtained as evidenced by a mean rating of 3.82. This is backed up by the response of respondents wherein they Often maintains confidentiality of records (x=4.04), acts as patients advocate whenever needed (x=4.04) and modifies nursing care plan as needed (x=3.60). Generally, the capacity of the respondents to implement the plan of care is effective. This observation tends to imply that the respondents are good in carrying out instructions of doctors and implementing independent nursing actions. The rigid training that the respondents is experiencing during their exposure to different areas can be attributed to it. During the respondents practicum, it was found out that they were trained to implement orders or instructions of doctors and superiors for the welfare of their patients under their care. As simple error or deviation from the doctors order or when proper procedures are done inaccurately could be fatal to the patients This may also give the idea that student nurses can perform nursing interventions that are necessary in achieving the goals and outcomes of the nursing care. It is astonishing to note that all of the items in this area have a descriptive rating of Often.

TABLE 7 MEAN RATING SHOWING THE PERFORMANCE OF THE RESPONDENTS ALONG THE IMPLEMENTATION PHASE OF THE NURSING PROCESS
Items 1. Performs nursing procedures accurately, completely and safely. a) Observes the 7 rights in administering medicines. b) Provides/ assists in performance of activities of daily living whenever needed. c) Prepares patient for special procedures and assists wherever needed. d) Uses precautionary and preventive measures in providing care. e) Assists patients in meeting emotional and spiritual needs. 1. Provides and maintains therapeutic environment. b) Adjusts care in accordance with patients need. c) Orients patient/family/significant others to hospital. 1. 1. 1. 1. 1. Reassesses patients to determine whether a re-modification of care plan is needed. Modifies the Nursing Care Plan as Needed. Provides health teaching to patient/family and/or significant others Conducts discharge planning with patient/family, significant others, and members of the health team. Coordinates/collaborates with various members of the health team, divisions of the hospital for smooth functioning of units and harmonious relationships. Documents nursing interventions completely, accurately and on time. Maintains confidentiality of records. Acts as patients advocate whenever needed. TOTAL
Norm: Range of Scores Item 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60 1.00 1.80 Descriptive Rating Always ( A) Often ( O) Sometimes (SM) Seldom (SL) Never (N) Overall Descriptive Rating Very High ( VH) High (H) Moderate (M) Low (L) Very Low (VL)

Mean 3.94 3.85 3.90 3.92 3.70 3.80 3.70 3.74 3.63 3.60 3.75 3.70 3.82 3.92 4.04

DR O O O O O O O O O O O O O O O

a) Motivates patient to adhere to treatment regimen.

1. 1. 1.

4.04 3.94 3.85 3.81

O O O H

On Evaluation. The table 5 shows the level of performance of the respondents along the Evaluation phase of the nursing process.
The data show that the respondents overall performance along the evaluation phase is high as indicated by the overall mean of 3.78. This observation tends to imply that the respondents are highly when it comes to evaluating the nursing action implemented and the outcome of such to the patient This is supported by item number 2 (x=3.87), Resets priority of care according to patients condition and needs obtaining the highest overall mean of 3.87 which tends to imply that among the aspects of evaluation the respondents possesses the highest level of performance in terms of resetting priority of care according to patients condition and needs. This is so because the respondents were already exposed to cases in the hospital and community requiring modification and evaluation in patients condition and needs thus, they were able to develop the skills along this aspect. Moreover, this could also be attributed to the interest of the respondents in providing individualized quality care and in doing the right action on what the patient needs. In such way it can help them build their trust and confident to their self on what action brought about.

TABLE 8 MEAN RATING SHOWING THE PERFORMANCE OF THE RESPONDENTS ALONG EVALUATION PHASE OF THE NURSING PROCESS
Items Mean 3.84 3.87 DR O O

1.
1.

Monitors patients clinical status throughout tour of duty.

Resets priority of care according to patients condition and needs.

3.74 1. Evaluates the efficiency and effectiveness of nursing interventions rendered. 3.79 1. Adjusts plan of care according to changing health needs of the patient. 3.67 3.78

1.

Participates in quality assurance programs unit. TOTAL

O H

Norm: Range of Scores Item 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60 1.00 1.80 Descriptive Rating Always (A) Often (O) Sometimes (SM) Seldom (SL) Never (N) Overall Descriptive Rating Very High (VH) High (H) Moderate (M) Low (L) Very Low (VL)

AS A WHOLE, THE PERFORMANCE OF THE STUDENT NURSES IN THE UTILIZATION OF THE NURSING PROCESS IS ON THE HIGH (X=3.78) LEVEL. THEY HAVE A HIGH PERFORMANCE OF ALL THE DIMENSIONS OF THE NURSING PROCESS NAMELY, ASSESSMENT, NURSING DIAGNOSIS, PLANNING, INTERVENTION AND EVALUATION. FINDINGS INDICATE THAT THE STUDENT NURSES ARE UTILIZING THE NURSING PROCESS IN THE DISCHARGED OF THEIR DUTY. IT MEANS THAT THEY BELIEVED THAT THE NURSING PROCESS HELPSS THEM IN ORGANIZING AND PRIORITIZING PATIENT CARE, AND FROM THINKING THAT IT WILL HELP THEM GAIN CONFIDENCE AND SKILLS NEEDED TO THINK CRITICALLY IN THEIR EXPOSURE IN THE CLINICAL AREA.

TABLE 9 MEAN RATING SHOWING THE PERFORMANCE OF THE RESPONDENTS ALONG THE 5 PHASES OF THE NURSING PROCESS
Phases of the Nursing Process Assessment Nursing Diagnosis Planning Implementation Evaluation Mean 3.69 3.69 3.68 3.81 3.87 DR H H H H H

Overall

3.75

Problem 3: Is there a significant relationship between the level of performance and the socio-demographic and hospital related profile of the respondents? The Relationship between the Level of Performance and Socio- Profile of the Respondents. The correlation coefficients showing the relationship between the level of performance of the respondents along the phases of the nursing process and their socio demographic profile is presented in Table 10.

TABLE 10 CORRELATION COEFFICIENTS SHOWING THE RELATIONSHIP BETWEEN THE LE VEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE PHASES OF THE NURSING PROCESS AND THEIR SOCIO-DEMOGRAPHIC PROFILE
Phases of the Nursing Process
Assessment .235 -.020 -.097 Nursing Diagnosis -.443** -.039 -.076 Planning -.417** -0.49 -.189 Implementing -.493** .049 -.194 Evaluation -.376** .044 -.204 .362* Seminars attended on NursingProcess .056 .322* .558** .418**

SocioDemographic Factors Age Sex Civil Status

Legend: **. Correlation is significant at the 0.01 level (2-tailed) *. Correlation is significant at 0.05 level (2-tailed) a .Cannot be computed because at least one of the variable is constant

ON ASSESSMENT AND SOCIO-DEMOGRAPHIC PROFILE. AS REFLECTED IN TABLE 10, THERE IS NO SIGNIFICANT RELATIONSHIP SHOWN BETWEEN THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE ASSESSMENT PHASE OF THE NURSING PROCESS AND THEIR SOCIO DEMOGRAPHIC PROFILE THIS MEANS THAT THE LEVEL OF PERFORMANCE OF THE STUDENT NURSES ALONG THE ASSESSMENT PHASE OF THE NURSING PROCESS IS MORE OR LESS THE SAME WHETHER THEY ARE MALE OR FEMALE, SINGLE OR MARRIED, YOUNG OR OLD, OR REGARDLESS THE NUMBER OF SEMINARS ON NURSING PROCESS THAT THEY HAVE ATTENDED. THIS CONTRADICTS THE STUDY CONDUCTED BY DAVID (2009) WHICH REVEALED THAT AGE HAS SIGNIFICANT RELATIONSHIP ON THE PERFORMANCE OF STUDENT NURSES. FURTHERMORE, IT WAS STATED THAT YOUNGER STUDENT NURSES TEND TO HAVE A BIGGER LEVEL OF PERFORMANCE OF NURSING PROCESS ALONG ASSESSMENT THAN THE OLDER STUDENT NURSES.

ON NURSING DIAGNOSIS AND SOCIO-DEMOGRAPHIC PROFILE. AS GLEANED FROM TABLE, THE LEVEL OF PERFORMANCE ALONG THE NURSING DIAGNOSIS PHASE OF THE NURSING PROCESS IS SIGNIFICANTLY RELATED WITH THE RESPONDENTS A GE (R =.443) AND SEMINARS ATTENDED ON NURSING PROCESS (R =.322).THIS PROMPTED THE RESEARCHER TO REJECT THE NULL HYPOTHESIS WHICH STATES THAT THERE IS NO SIGNIFICANT RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE OF THE STUDENT NURSES ALONG THE ASSESSMENT PHASE OF THE NURSING PROCESS AND AFOREMENTIONED VARIABLES. YOUNGER STUDENTS TEND TO HAVE A HIGHER LEVEL OF PERFORMANCE ON THE NURSING PROCESS ALONG THE NURSING DIAGNOSIS THAN THE OLDER STUDE NTNURSES. THIS MEANS THAT THE YOUNGER THE STUDENT THE MORE ENERGET IC, CONVERSANT AND CURIOUS SO THAT HE/SHE WILL BE ABLE TO ELICIT INFORMATION ABOUT THE PATIENT AND COME OUT WITH A NURSING DIAGNOSIS APPROPRIATE FOR THE PATIENTS CASE. FURTHERMORE, IT ALSO IMPLIED THAT AS THE STUDENT NURSES ATTEND MORE SEMINARS ON NURSING PROCESS, THE MORE THEIR SKILLS IN FORMULATION OF NURSING DIAGNOSIS IS ENHANCED. ACCORDING TO GUINID (2006), A NURSE WHO ATTENDS MORE SEMINARS NATURALLY HAVE MORE KNOWLEDGE AND EXPERIENCE THAT WOULD COME HANDY WHEN CONFRONTING CERTAIN PROBLEMS RELATED TO NURSING SERVICE. THE OTHER SOCIO-DEMOGRAPHIC FACTORS LIKE SEX (R = -.039) AND CIVIL STATUS (R = -.072) FAILED TO ATTAIN A SIGNIFICANT RELATIONSHIP WITH THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE NURSING DIAGNOSIS PHASE OF THE NURSING PROCESS.

ON PLANNING AND SOCIO-DEMOGRAPHIC PROFILE. TABLE 10 SHOWS THAT THERE IS A SIGNIFICANT RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE ALONG THE PLANNING PHASE OF THE NURSING AND THE RESPONDENTS AGE (R =.417) AND SEMINARS ATTENDED ON NURSING PROCESS (R =.558). THIS MEANS THAT THE YOUNGER THE STUDENT NURSE THE MORE FLEXIBLE THEY ARE IN MAKING A PLAN OF CARE THAT WILL ADHERE TO THE PATIENTS NEED. ATTENDING SEMINARS ON NURSING PROCESS WILL CREATE AVENUES FOR THE STUDENT NURSE TO ENHANCE THEIR SKILLS IN PLANNING OF CARE FOR THEIR PATIENT. THE ABOVE FINDINGS IS ON CONTRARY WITH THE STUDY OF DAVID (2009) WERE SOCIO- DEMOGRAPHIC PROFILE FAILED TO ATTAINS SIGNIFICANT WITH THE PERFORMANCE OF THE STUDENT NURSE RESPONDENTS IN THE UTILIZATION OF NURSING PROCESS ALONG PLANNING.

ON IMPLEMENTATION AND SOCIO-DEMOGRAPHIC PROFILE. IT CAN BE SEEN ON THE TABLE THAT THERE IS A SIGNIFICANT RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE IMPLEMENTATION PHASE OF THE NURSING PROCESS AND THEIR AGE (R = -.493) AND SEMINARS ATTENDED ON NURSING PROCESS ARE (R =.558). YOUNGER STUDENT NURSES HAVE A HIGHER LEVEL OF PERFORMANCE ALONG THE IMPLEMENTATION PHASE OF THE NURSING PROCESS COMPARED TO THE OLDER STUDENTS. THIS IS BECAUSE YOUNGER STUDENT NURSES ARE MORE ENERGETIC AND MORE ENTHUSIASTIC IN CARRYING OUT THE PLAN OF CARE. FURTHERMORE, THIS MEANS THAT WHEN THE RESPONDENTS FREQUENTLY ATTEND SEMINARS ON NURSING PROCESS THEY TEND TO HAVE HIGHER LEVEL OF PERFORMANCE ALONG THE IMPLEMENTATION PHASE OF THE NURSING PROCESS. THE MAIN PURPOSE OF SEMINARS BEING CONDUCTED IS TO UPDATE AND REFRESH THE STUDENT NURSES ON THE CURRENT STRATEGIES TO DELIVER QUALITY NURSING CARE. IN THIS REGARD, AS THE STUDENT NURSES ATTEND MORE SEMINARS AND TRAININGS THEY BECOME MORE EFFICIENT IN THE PERFORMANCE OF THEIR NURSING FUNCTIONS AND RESPONSIBILITIES. OTHER SOCIO DEMOGRAPHIC FACTORS OF THE RESPONDENTS WHICH INCLUDES SEX (R = .049) AND CIVIL STATUS (R= -.194) FAILED TO ATTAIN SIGNIFICANCE. MEANING THESE FACTORS DID NOT HAVE ANY BEARING ON THE LEVEL OF PERFORMANCE OF STUDENT NURSES ALONG THE IMPLEMENTATION PHASE OF THE NURSING PROCESS.

ON EVALUATION AND SOCIO-DEMOGRAPHIC PROFILE. THE TABLE SHOWS THAT AGE (R =-.375) AND SEMINARS ATTENDED ON NURSING PROCESS (R = .362) ARE SIGNIFICANTLY CORRELATED WITH THE LEVEL PERFORMANCE OF STUDENTS- NURSES ALONG THE EVALUATION PHASE OF NURSING PROCESS. MEANING THE YOUNGER THE STUDENT NURSE THE MORE OBSERVANT THEY ARE ON THE EFFECTIVENESS OF A NURSING CARE RENDERED. IN ADDITION, SEMINARS ATTENDED ON NURSING PROCESS AFFECTS THE LEVEL OF PERFORMANCE OF THE STUDENT NURSES ALONG THE EVALUATION PHASE OF THE NURSING PROCESS IT CAN BE INFERRED THAT IF THE STUDENT NURSE ATTENDED SEMINARS, HE/SHE CAN BECOME MORE ANALYTICAL/CRITICAL IN SETTING SOME CRITERIA FOR EVALUATION OF NURSING CARE. FURTHER ANALYSIS OF THE DATA SHOWS THAT THE OTHER PARAMETERS OF THE SOCIO- DEMOGRAPHIC FACTORS FAILED TO ATTAINED SIGNIFICANT RELATIONSHIP ON THE LEVEL OF PERFORMANCE OF THE STUDENT- NURSES IN NURSING PROCESS ALONG EVALUATION OF NURSING INTERVENTION.

THE RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE AND HOSPITAL-RELATED PROFILE OF THE RESPONDENTS THE CORRELATION COEFFICIENTS SHOWING THE RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE PHASES OF THE NURSING PROCESS AND THEIR HOSPITAL- RELATED PROFILE IS SHOWN IN TABLE 11.

TABLE 11 CORRELATION COEFFICIENTS SHOWING THE RELATIONSHIP BETWEEN THE LE VEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE PHASES OF THE NURSING PROCESS AND THEIR HOSPITAL-RELATED PROFILE Phases of the Nursing Process Hospital- Related Factor
Nursing Diagnosis

Assessment

Planning

Implementing

Evaluating

Type of Hospital Category of Hospital Area of Assignment Student NursePatient Ratio

-.129

-.318*

-.204

-.031

.090

-.031

.015

.093

.030

.025

.030

.124

.200

.081

.106

Legend: **. Correlation is significant at the 0.01 level (2-tailed) *. Correlation is significant at 0.05 level (2-tailed) a .Cannot be computed because at least one of the variable is constant

ON ASSESSMENT AND HOSPITAL-RELATED PROFILE. THE TABLE SHOWS THAT NONE OF THE HOSPITAL-RELATED FACTOR SUCH AS TYPE OF HOSPITAL, CLASSIFICATION OF HOSPITAL, AREA OF ASSIGNMENT AND STUDENT NURSE- PATIENT RATIO, IS SIGNIFICANTLY RELATED TO THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE ASSESSMENT PHASE OF THE NURSING PROCESS. THIS IMPLIED THAT THE AFOREMENTIONED HOSPITAL-RELATED FACTORS DO NOT INFLUENCE THE PERFORMANCE OF THE STUDENT NURSES IN THE UTILIZATION OF THE NURSING PROCESS PARTICULARLY IN ASSESSMENT PHASE. ON NURSING DIAGNOSIS AND HOSPITAL-RELATED PROFILE. THE TABLE REVEALS THAT THERE IS A SIGNIFICANT RELATIONSHIP BETWEEN THE LEVEL OF PERFORMANCE OF THE RESPONDENTS ALONG THE NURSING DIAGNOSIS PHASE OF THE NURSING PROCESS AND TYPE OF HOSPITAL.

On Planning and Hospital-Related Profile. It can be deduced from the table that the hospitalrelated factor such as type of hospital, classification of hospital, area of assignment and student nurse-patient ratio failed to attain significance with the level of performance of the respondents along the planning phase of the nursing process. This tends to imply that the above mentioned variables do not influence the level of performance of the student nurses along the planning phase of the nursing process. On Implementing and Hospital-Related Profile. The table shows that none of the hospital-related factor such as type of hospital, classification of hospital, area of assignment and student nurse patient ratio, is significantly related to the level of performance of the respondents along the implementing phase of the nursing process. This implied that the aforementioned hospital -related factors do not influence the performance of the student nurses in the utilization of the nursing process particularly in implementing phase. On Evaluation and Hospital-Related Profile. The table reveals that none of the hospital-related factors yielded significance to the level of performance of the respondents along the evaluation phase of the nursing process. This implied that the hospital-related factors do not influence the performance of the student nurses in the utilization of the nursing process particularly in evaluation phase.

CHAPTER III SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of the findings, conclusion drawn and the recommendations advanced by the researchers.

SUMMARY The level of performance of student nurses on affiliating hospitals was the focus of the research study. This study aimed to determine the level of performance of the 3 rd year nursing students of the University of Northern Philippines along the utilization of the nursing process namely; Assessment, Nursing Diagnosis, Planning, Implementation and Evaluation. It similarly looked into the relationship between the respondents level of performance and their personal and hospital-related factor. The subject of this study were the fifty three (53) third year students in the college of nursing, University of Northern Philippines assigned in the medical and surgical wards in Gabriela Silang General Hospital, private rooms and wards (2nd floor) in Metro Vigan Cooperative hospital, Private rooms and wards in Ilocos Sur Cooperative Medical Mission Group and Hospital and all the wards in Corpuz Clinic and Hospital. The operating and delivery rooms in the affiliating hospitals where excluded in the study such as Gabriela Silang General Hospital, Abra Provincial Hospital, Metro Vigan Cooperative Hospital and St. James Hospital. Total enumeration was employed and with the researchers effort all (53) the data gathering instrument were retrieved. The descriptive correlational research design was employed in the study. The descriptive method determined the level of performance of the respondents. On the other hand, the establishment of relationship between the independent and dependent variable made use of the correlational approach.

The main tool used in gathering the data needed was a questionnaire checklist. The said tool was adopted from the book of Ramos (2010), entitled Level of Performance among the Staff Nurses in Tertiary Hospitals of Vigan City. The student nurse respondents were asked to answer the said tool, on the other hand, respective clinical instructors on the said areas were asked to evaluate the student nurses using the same tool for check and balance purposes. In order to seek answers to the problems raised in the study and to test the researchers hypothesis, the data gathered were analyzed through the use of different statistical tools. Frequency and percentage were used to describe the personal and hospital -related factors of the respondents, weighted mean was used to determine the level of performance of the respondents along the phases of the nursing process and a simple Correlational Analysis to find out the relationship between personal and hospital -related factors and the performance of the respondents along the phases of the nursing process in the affiliating hospitals.

FINDINGS The salient findings of the study are summarized as follows: Profile of the respondents

Socio - demographic Factor

a.1 Age Most (51 or 96.2%) of the respondents are within the age bracket of 16 20 years old. a.2 Sex Almost all of the respondents (43 or 81.1 %) are female. a.3 Civil Status Majority (51 or 96.2%) of the respondents are single. a.4 Seminars Attended on Nursing Process Most (43 or 81.1%) of the respondents participated in at least three seminars and below. Hospital-related factor b.1 Type of hospital- Most of the respondents (32 or 60.4%) are assigned in private hospitals. b.2 Category of Hospital- Almost all of the respondents (42 or79.2%) are assigned in a secondary level of hospitals. b.2 Area of assignment- Almost all of the respondents (42 or 79.2%) are assigned in medical wards b.3 Patient- student Nurse Ratio- Almost all of the respondents (42 or 79.2%) are assigned on one patient per student nurse.

Level of Performance of Students Nurses in affiliating hospitals Assessment The student nurses earned an overall mean rating of 3.69 that suggests a High level of performance along the assessment phase of the nursing process. In respondents evaluation when taken singly, item number 3 in this dimension suggest that the respondents sometimes review past and present medical records to identify patterns of illness and coping abilities, with 3.29 as the lowest mean rating. Nursing Diagnosis In terms of the level of performance in nursing diagnosis, the respondents obtained a High level (3.69) rating. Planning As a whole, there is a High level (3.68) of performance of the respondents on the planning phase of the nursing process. Implementation The level of performance of the respondents along this aspect is High level with 3.82 rating Evaluation A High rating (3.78) was also garnered by the respondents in evaluation

CHAPTER III SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of the findings, conclusion drawn and the recommendations advanced by the researchers.

SUMMARY The level of performance of student nurses on affiliating hospitals was the focus of the research study. This study aimed to determine the level of performance of the 3rd year nursing students of the University of Northern Philippines along the utilization of the nursing process namely; Assessment, Nursing Diagnosis, Planning, Implementation and Evaluation. It similarly looked into the relationship between the respondents level of performance and their personal and hospital-related factor. The subject of this study were the fifty three (53) third year students in the college of nursing, University of northern Philippines assigned in the medical and surgical wards in Gabriela Silang General Hospital, private rooms and wards (2nd floor) in Metro Vigan Cooperative hospital, Private rooms and wards in Ilocos Sur Cooperative Hospital and all the wards in Corpuz Clinic and Hospital. The operating and delivery rooms in the affiliating hospitals where excluded in the study such as Gabriela Silang General Hospital, Abra Provincial Hospital, Metro Vigan Cooperative Hospital and St. James Hospital. Total enumeration was employed and with the researchers effort all (56) the data gathering instrument were retrieved. The descriptive correlational research design was employed in the study. The descriptive method determined the level of performance of the respondents. On the other hand, the establishment of relationship between the independent and dependent variable made use of the correlational approach.

FINDINGS The salient findings of the study are summarized as follows: 1. Profile of the respondents a) Personal Factor b) Hospital-related factor 2. Level of Performance of Students Nurses in affiliating hospitals a) Assessment The student nurses earned an overall mean rating of 3.69 that suggests a High level of performance along the assessment phase of the nursing process. In respondents evaluation when taken singly, item number 3 in this dimension suggest that the respondents sometimes review past and present medical records to identify patterns of illness and coping abilities, with 3.29 as the lowest mean rating.

BY:
MARIUS CLIFFORD R. BILLEDO CHARISSE KAY M. GALAMGAM MARIELLE BABYLYN B. CORPUZ LEHLIE JESSE R. REDULLO LAURENCE T. AQUINO