Chapter 1-Last Finale Print

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Chapter 1

THE PROBLEM AND ITS SCOPE

Introduction

People nowadays are suffering from different diseases and illnesses in

which they need to look for a professional assistance to help them. They may

also choose to be admitted in hospitals if necessary. But due to economic crisis,

they prefer nearer health centers to save money as well as time.

Fortunately, health care assistance is founded by the health care team

wherein a nurse plays a significant part. The Department of Health launched the

Registered Nurses for Health Enhancement and Local Services known as RN

HEALS last January 2011 in which they are assigned in the Rural Health Unit in

the community; this is to deploy nurses to remote communities and to promote

good health and to help in the prevention of illnesses. They educate or give

health teachings to the public about various diseases particularly with epidemic

cases. They help in the treatment and rehabilitation of various diseases present

in the locality assigned. As health workers, RN HEALS used a considerable

judgment in providing a wide variety of services.

The most important aspect of nursing is caring. Caring sometimes

depends on the culture of an individual. It varies in terms of profession, rules,

expression of belief and patterns of living.


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One of the important measures in assessing the quality of care is

through the patients satisfaction. Patients dissatisfaction means that the goal of

RN HEALS has not been attained properly. The satisfaction of the patient will be

based on their evaluation and opinion regarding the care they receive from the

nurses. It is a measure with limitation when assessing the quality of nursing care.

Other patients do not have enough knowledge to appreciate the aspect of care

given to them. This reason reduces the ability to evaluate care. If the patients are

treated successfully, the state of their health will show a high satisfaction rating.

Expectations may relate to satisfaction.

But for some reasons, they fail to meet the expectations of the people.

Some complaints are made about them. Hence, this study has been conducted

in order to determine the quality of nursing care rendered by the RN HEALS

assigned at Ramain Rural Health Unit.

Theoretical Framework

This study was correlated to the Leningers Theory of Nursing Cultural

diversity and Universality (1978) which states That care is best described

nursing because of the patients unique cultural attributes and at the same time

assimilating it with the nursing individual process to surely render a culturally

congruent care. In her Culture Care Theory, Leninger stated that caring is the

essence of nursing and unique to nursing. She emphasizes also that nursing

practice is built on a single foundation, that care is applicable to all individuals of

the world.


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This theory also accentuates that cultural accommodation or negotiation

refers to creative actions that people of a particular culture adapt or negotiate

with others in the health care community in an effort to attain in the shared goals

of an optimum health outcome for clients of a delighted culture.

It was also associated with Hildegard Peplaus Interpersonal Relations in

nursing (1952) which emphasized the nurse-client relationship as the foundation

ofnursing practice. The essence of Peplau's theories is the creation of a shared

experience. Nurses, she thought, could facilitate this through observation,

description, formulation, interpretation, validation, and intervention.

For example, as the nurse listens to her client she or he develops a

general impression of the client's situation. The nurse then validates his or her

inferences by checking with the client for accuracy. The result may be

experiential learning, improved coping strategies, and personal growth for both

parties.

Conceptual Framework

The study on the Quality of Care Rendered by Registered Nurses for

Health Enhancement and Local Services or RN HEALS is based on the

Transcultural Nursing of Leninger which accentuates that the care and health are

influenced by the elements of social structure like technology, cultural beliefs and

values and philosophical factors, social interaction, educational and economic

factors.
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The researchers therefore conceptualized the respondents profile such as

age, gender, civil status, estimated family income, educational attainment,

employment are considered as the independent variables. On the other hand the

quality of care rendered by RN HEALS in terms of safe quality nursing care,

management of resources and environment, health education, legal

responsibility, ethico-moral and spiritual responsibilities, personal and

professional development, quality improvement research, record management,

communication and collaboration and team work are considered the dependent

variables.


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Figure 1

Independent Variables Dependent Variables

Figure 1

Schematic Diagram of the Study, Showing the Relationship of IndependentVariables and Dependent Variables

Respondents Profile

Age

Gender Civil Status Estimated Family

Income

EducationalAttainment

Employment

Quality of care rendered by RN HEALS in terms

of :

Safe Quality Nursing Care

Management of Resources andEnvironment

Health Education

Legal Responsibility

Ethico-moral and Spiritual Responsibility

Personal and Professional Development

Quality Improvement

Research

Record Management Communication

Collaboration and Team Work


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Statement of the Problem

This study aimed to determine the quality of care rendered by RN HEALS

in Ramain Rural Health Unit. Specifically, the study sought to answer the

following questions:

1. What is the profile of the respondents in terms of:

1.1Age;

1.2Gender;

1.3Civil Status;

1.4Educational Attainment;

1.5Estimated Family Monthly Income; and

1.6Employment?

2. What is the quality of care rendered by the RN HEALS in terms of:

2.1 Safe Quality Nursing Care;

2.2 Management of Resources and Environment;

2.3 Health Education;

2.4 Legal Responsibility;

2.5 Ethico-Moral and Spiritual Responsibility;

2.6 Personal and Professional Development;

2.7 Quality Improvement;

2.8 Research;

2.9 Records Management;

2.10 Communication;

2.11 Collaboration and Team Work;


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3. Is there any significant relationship between the respondents profile and

the quality of care rendered by the RN HEALS?

4. Is there any significant difference between the quality of care rendered by

RN HEALS when grouped according to their personal profile in terms of

age; gender; civil status; educational attainment, estimated family income

and employment?

Hypotheses

The following null hypotheses were tested at the 0.05 level of significance:

Ho1: There is no significant relationship between the respondents profile and the

quality of care rendered by RN HEALS.

Ho2: There is no significant difference between the ratings of the respondents on

the quality of care according to their personal profile.

Significance of the Study

The result of this study is deemed useful to the following individuals:

Department of Health. This will help in formulating their rules and regulations or

their policies for the improvement of their program in the Rural Health Unit.

Rural Health Unit Patients. This study will benefit them as the recipient of better

nursing care and they will look for remedy to their health problems.

Registered Nurses. This study will serve as a guideline is rendering quality

services in rural health unit without discrimination as to race, gender, and social

status in the community.


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Future Researchers. This study is useful to the future researchers as a

reference for conducting similar studies with a wide scope and for everyone to

have better understanding of the RN HEALS in Rural Health Unit care for their

patients.

Scope and Delimitation

This study was limited to 40 local patients of Ramain Rural Health

Unit in Marawi City with age range from 15-60 years old, regardless of gender,

civil status, educational attainment, estimated monthly income and employment

and reason for visit. This was conducted on the 2 nd week of October 2011.

Excluded from the study were those clients or patients who cannot read nor write

and those from other locality or barangay, as transient residents.

Definition of terms

For better understanding, the following key terms are operationally

defined.

Age. This refers to the number of years from birth which is usually marked by

certain degree of mental and physical development. The respondents age

bracket ranges from 15-60 years old.

Civil Status. This phrase indicates the classification of a persons status

whether single, married, or widowed.

Collaboration and Teamwork. It means working together to achieve a goal


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Communication. It refers to the process of interchanging the thoughts, opinion

or information by speech, writing and signs used by the RN HEALS.

Educational Attainment. This phrase pertains to the level of education attained

by the respondents.

Employment. This term refers to the respondent, being employed within the

government or private establishment or self-employed.

Ethico-Moral and Spiritual Responsibilities. This phrase denotes the RN

qualities on philosophic analyzing of human virtue, conduct, and respect for

religious beliefs and believing in the power of God and prayer.

Estimated Family Income. It refers to the monthly earning received by the

family of the respondents.

Gender. This means the classification that relates in part with the sex of the

respondents either male or female.

Health Education. This means the important aspect of the nursing care wherein

the RN HEALS is taking part in the health teaching or lectures regarding

exercise, diet, disease prevention to the respondents, etc.

Legal Responsibility. This phrase indicates the particular obligation of a nurse

to be accurate at all times and to keep things confidential.

Management of Resources and Environment. This phrase pertains to the act

of the RN HEALS in utilizing resources to ensure proper functioning and that of

maintaining the environment for safety.


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Personal and Professional Development. The most effective way to empower

ourselves, make ourselves better-off and enrich our cultures is by organising our

lives and our societies around self-improvement and learning.

Quality Improvement. Any evaluation of services provided and the results

achieved as compared with accepted standards. In one form ofquality

assurance, various attributes of health care, such as cost, place, accessibility,

treatment, and benefits, are scored in a two-part process.

Research. It is the systematic investigation into existing or new knowledge. It is

used to establish or confirm facts, reaffirm the results of previous works, solve

new or existing problems, support theorems, or develop new theories.

Record Management orRM. It is the practice of maintaining the records of an

organization from the time they are created up to their eventual disposal. This

may include classifying, storing, securing, and destruction (or in some cases,

archival preservation) of records.

RN HEALS. It refers to the health care team composed of registered nurses who

are deployed in remote communities to promote good health, help in the

prevention of illnesses, and educate the public about the treatment and

rehabilitation of various diseases in the locality assigned. In this study, the term

refers to the health workers assigned in the Rural Health Units (RHU) of the

municipality of Ditsaan- Ramain, Lanao del Sur.

Safe Quality Nursing Care. This pertains to the degree of excellence of nursing

care rendered by the RN HEALS.
http://medical-dictionary.thefreedictionary.com/quality+assurancehttp://medical-dictionary.thefreedictionary.com/quality+assurancehttp://en.wikipedia.org/wiki/Knowledgehttp://en.wikipedia.org/wiki/Theoremhttp://en.wikipedia.org/wiki/Theoryhttp://medical-dictionary.thefreedictionary.com/quality+assurancehttp://medical-dictionary.thefreedictionary.com/quality+assurancehttp://en.wikipedia.org/wiki/Knowledgehttp://en.wikipedia.org/wiki/Theoremhttp://en.wikipedia.org/wiki/Theory


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Chapter 2

REVIEW OF RELATED LITERATURE

This chapter presents the review of related literature and previous

research studies relevant to the present study.

Related Literature

Health worker is a profession for those with a strong desire to help

improve peoples lives. They help people function the best way they can with

their environment, deal with their relationships, and solve personal and family

problems. Social health workers often see clients who face life-threatening

diseases or social problems. They often provide health services in health-related

setting that are now governed and managed by organizations. At the local level,

they provide them with technical assistance and train them to monitor and

improve community health.

Nurses play an integral role in the health care system and we know that it

is important to maintain a positive and rewarding work environment for them and

all health care workers (Girard, 2004).

Erikson acknowledged that continued research in this area could be

helpful to determine career motivators and will provide best methods of

recruitment for nurses. He also asserted that nurses need to be advocates for

their own professions.

In support, Dr. Margaret Shetland stated that the Philosophy of

Community Health Nursing is based on the worth and dignity of man. The health


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care provides primary focus on the community health nursing practice more on

health promotion. Community health workers extend their nursing practice to give

benefits not only to single individual but the whole family and the community.

They also continue to interact with clients and or family in a long period of time

which include all ages and all types of health care (Shetland, 1981).

Moreover, Republic act No. 7305 of March 26, 1992 known as THE

MAGNA CARTA OF PUBLIC HEALTH WORKERS Section 2 states that the

state shall instill health consciousness among our people to effectively carry out

the health programs and projects of the government essential for the growth and

health programs and project of government essential for the growth and health of

the nation. Towards this end, this Act aims: (a) to promote and improve the social

and economic well-being of the health workers, their living and working,

conditions and terms of employment; (b) to develop their skill and capabilities in

order that they will be more responsive and better equipped to deliver health

projects and programs; and (c) to encourage those with proper qualifications and

excellent abilities to join and remain in the government service.

However, Section 4 of the same act postulates that recruitment policy and

minimum requirements with respect to the selection and appointment of the

public worker shall be developed and implemented by the appropriate

government agencies concerned in accordance with policies and standards of

the Civil Service Commission: Provided, that in the absence of appropriate

eligible and it becomes necessary in the public interest to fill a vacancy, a

temporary appointment shall be issued to the person who meet all the


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requirements for the position to which he/she is being appointed except the

appropriate civil service eligibility: Provided, further, that such temporary

appointment shall not exceed twelve (12) months nor be less than three (3)

months renewable, thereafter but that the appointee may be replaced sooner if

qualified civil service eligible become available, or (b) the appointee is found

wanting in performance or conduct befitting a government employee.

Thus, Community health workers are called by a variety of names;

including health auxiliaries, barefoot doctors, health agent, health promoters

family welfare educator, health volunteers, and village health workers. These

individuals can be enormously effective. They can perform preventive medical

services, monitor community, act as liaisons between the community and the

health system, interpret the social climate, as well as, provide basic curative

services. They are also often the only practical means of providing longevity as

bread to health program. They are currently providing the following type of

services: first aid, surgery assistance, treatment of minor illnesses, nutrition

correction, monitoring and feeding (Gardner, Cobb, and Jones, 1961).

Under general supervision, a Community Health Worker performs clinical

and limited outreach duties related to preventive and supportive health care

services in a variety of public health programs and performs related work as

assigned. Incumbent are responsible for performing outreach and client

counselling education services. Following an initial orientation, incumbent work

under close supervision and are expected to become increasingly knowledgeable

and carry out assignments with increasing independence. Community health


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workers duties are the following: A) Provide outreach, referrals, information, and

counselling to public mental or health program participants; B) Assist in

assessing specific conditions and in treatment planning with others public health

staff; C) Familiarized client with approved methods of preventive, supportive, and

rehabilitative health care; D) Perform related duties as assigned.

Related Studies

In the study that was done by UP Manila Institute of Health Policy and

Development on the Philippine Nursing Situation, results showed that while 85%

of the total demand for Filipino nurses comes from the international market, local

demand up for only 15.26% with government employment constituting major

local requirement with 17,547 jobs. These data on supply and demand for nurses

have not changed much through times as evidenced by the facts that alongside

the increased demand of nurses abroad, the number of schools and enrollees in

nursing correspondingly increase. The global arena has now expanded from the

USA to Europe, more specially UK and, what used to be known as nontraditional

countries such as Japan have also started to open its door to foreign nurses as

well (Silvera, 2002).

More likely, a study was conducted by Linda McGills Hall, Faculty of

nursing Toronto, USA (2003) about the Nursing Environment and Nurse staffing

Background; Changes to health care in Ontario over the latter part of the 1990s

have resulted in a number of new challenges for hospital nurse executives and

health care leaders. In response to fiscal constraints and funding reductions,


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Ontario health care settings have restructured and downsized in an effort to

reduce costs and improve the efficiency of services provided. Change has

occurred at all levels within the organization, as setting re-configured their

services and structures, redesigned patient care system and processes, and

introduced mixed staff mixes and model for providing patient care. These

changes, coupled with and impending nursing shortage, have prompted concern

in the nursing community regarding the quality of the work life environment for

nurses.

Furthermore, Thorsteinsson (2002) conducted a study entitled The

Quality Of Nursing Care As perceived by individuals with Chronic illnesses: The

Magical Touch of Nursing Providing high quality nursing care is the vision of

nursing. The literature has revealed gaps between the perspectives of patients

and nurses regarding the quality of nursing care. The purpose of the study was to

investigate how the individuals with chronic illnesses perceive the quality of

nursing care in order to enhance the quality of care. The participants were 11

Icelandic individuals, aged 39-80 years with various chronic illnesses.

Phenomenology was the research approach and in-depth dialogues were used.

Five themes emerged: nurses who provided high quality nursing care, the effects

of high quality nursing care, the lack of good quality nursing care and its effects,

ancillary factors, and the art of being a patient. Based on the findings, the

researcher concludes that professional caring is the most important part of

quality of care as perceived by individuals with chronic illness.


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CHAPTER 3

RESEARCH METHODOLOGY

This chapter presents the research design, research locale, respondents

and sampling technique, research instrument and its validity, data gathering

procedures and statistical tools used.

Research Design

This study makes used of the descriptive correlation method of research

where the profile of the respondents who were visited for check-up at Ramain

Rural Health Unit was described. And more importantly the quality of nursing

care rendered by the RN HEALS was rated by these respondents. Differences in

these rating were then compared with respect to the respondents profile.

Correlation method was used to determine the relationship between the two

variables, the independent variable which is the profile of the respondents and

the dependent variables which is the quality of care rendered by RN HEALS.

Research Locale

This study was conducted at Ramain Rural Health Unit located in Lanao

del Sur co-managed by Department of Labor and Employment. This health care

centre is committed to provide quality services through prevention of restoration

of health, prevention of illness. The Municipality of Ditsaan-Ramain is a 5th


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class city in the province ofLanao del Sur, Philippines . According to the

census in 2000 , it has a population of 19 157 people in 2682 households. The

town is divided into 34 villages.

It is known as the land of the Maranaos, people of the lake, among the

most devout of Muslim tribes as well as the most artistic. Nowhere is this more

evident than in the peoples most natural way of life and the lands most attractive

sites. This province has a cool and pleasant climate that falls dominantly under

type F, which is distinguished by an even distribution of rainfall throughout the

year. The Local Government Unit is spearheaded by Mayor Actar. A lot of

schools there offer free education. Mosque can be seen in all its barangays.

Respondents of the Study

The respondents of the study were the residents of Ramain who were

visited by the RHU for routine examination or check-up with age ranging from 15-

60 years old regardless of gender, civil status, educational attainment, estimated

monthly income and employment. A total of 40 respondents were selected

considering their availability and voluntarism or willingness to participate in the

study, conscious, able to read and write, and residents of the said locality for

about 6 months and above.

Sampling technique

Simple random technique was utilized in selecting the respondents. Each

member in the population has the equal chance of being selected as one of the
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respondents in the study. A simple random sample is meant to be an unbiased

representation of a group.

Research Instruments and Its Validity

This study utilized a questionnaire based from the eleven nursing

competencies prepared by Mindanao Sanitarium and Hospital College and

modified by the researchers to fit with the present study. It was used to gather

information about the perception and actual responses of local patients towards

quality of nursing care rendered by the RN HEALS (Registered Nurse for Health

Enhancement and Local Services). There were two parts in the questionnaire.

Part 1 dealt with the respondents demographic profile such as age, gender, civil

status, educational attainment, family monthly income and employment. The part

2 contained different indicators in the relation to the quality of care rendered by

RN HEALS.

Validity and reliability testing were implemented to 10 respondents from

other locality. A set of questionnaires were given to them to be answered. The

primary purpose of this was to determine whether the questionnaire was

acceptable and can be understood or it may need a modification or revision for

the final study. These 10 respondents were excluded from the final list of

respondents of the study.

Data Gathering Procedures


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A letter of request noted by the thesis adviser and research coordinator

was sent to the Barangay Captain and Midwife of Ramain RHU (Rural Health

Unit). With their approval, a list of patients was taken from the RHU midwife to

determine the total number of population for the study.

The researchers distributed the questionnaires to the qualified

respondents with a specified time given for them to answer the items. After that,

they were collected, tabulated and analyzed with the use of appropriate statistical

tools.

Statistical Tools

The following statistical tools were used in the analyses of the data of the

research.

1. Frequency and percentage distribution. This is used to describe the

respondents profile.

FORMULA: P=f/n (100)

Where: P-Percentage f- Frequency N-total

number of patient respondents

2. Weighted mean. This is used to describe the respondents perception on

the quality of care rendered by RN heals at Ramain RHU.

FORMULA: X=fiN

Where: X- Weighted mean

F-frequency


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I-weight given to each scaled response

N-number of respondents

3. Chi-square Test for Independence. This is used to determine the

relationship between respondents profile and the quality of care rendered

by the RN HEALS.

4. F-test and T-test Analysis. This is used to determine the differences on the

quality of care rendered by the RN HEALS.


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Chapter 4

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

This chapter presents the analysis, results and discussions of data

gathered by the researchers. The first part of this deals with respondents

profiles, the second part deals with the quality of care rendered by RN HEALS,

then the third part deals on the relationship between the respondents profile and

the quality of care rendered by RN HEALS and the last part deals with the

differences between the quality of care rendered by RN HEALS when grouped

according to profile.

Part I Respondents Profile

Table 1Distribution of the Respondents

in terms of Age

Age (in years) Frequency Percentage (%)

15-25 9 22.50

26-35 6 15.00

36-45 11 27.50

46-60 14 35.00Total 40 100.00

Table 1 shows that 14 or 35% of the respondents belong to age group 46-

60 years old, 11 or 27.50 % belong to 36.45 years old, then 9 or 22.50 % belong

to 15-25 years old and 6 or 15 % belong to 26-35 years old.

According to Kozier (2000), adult life ranging from ages 46 and above,

mostly acquire illness due to stresses on their activities of daily living, as well as

aging.


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in Terms of Gender

Gender Frequency Percentage (%)

Male 22 55.00

Female 18 45.00

Total 40 100.00

Table 2 shows the distribution of the respondents genders. There are 22

or 55% of male respondents, while 18 or 45% were female. This indicates that

both male and female residents visit the rural health unit for health concerns.

Male has high percentage than a female because male are more suppressive,

aggressive and more prone to some stressors. They are prone to sickness

because of their daily work, they have more responsibilities than female.


in Terms of Civil Status

Civil Status Frequency Percentage (%)Single 12 30.00Married 17 42.50

Widowed 11 27.50

Total 40 100.00

Table 3 shows the distribution of the respondents profile in terms of civil

status. About 17 or 42.5% of them were married, followed by the single

respondents at 12 or 30% and about 11 or 27.5% were widowed. This finding

implies that the majority of the respondents were married. They preferred to

have check-up at Rural Health Unit to save time, effort and money. Most of them

were there for their prenatal check-up or vaccination.


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Married couples, according to Gomez (2007), are more prone to diseases

due to anxiety, fatigue and family problems, especially in regards to financial

issues, such as anxiety of minimal wage to support the daily needs of each family

member and stress from works.

Table 4Distribution of the Respondents in Terms

of Educational Attainment

Educational Attainment Frequency Percentage (%)Elementary Level/Graduate 14 35.00

High School Level/Graduate 13 32.50College Level/Graduate 13 32.50

Total 40 100.00

Table 4 shows that 14 or 35% of the respondents were elementary level or

graduate. While high school level or graduate had the same number or

percentage with the college level or graduate, with 13 or 32.5 % each. It implies

that some of the respondents had not finished their education due to poverty and

distance from school and maybe they lack the initiative to pursue their studies.

They prefer to go to nearby health facilities and those that were managed by

Maranaos for easy communication.

According to Smith (2005), individuals who are not educated usually lack

knowledge on how to avoid and treat the disease. Moreover, they also lack

knowledge on how to identify signs and symptoms and the complications of the

disease, they are more likely to suffer from disorders or illness.


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in terms of Employment

Employment Frequency Percentage (%)

Government employee 6 15.00Private Employee 10 25.00

Unemployed 24 60.00

Total 40 100.00

Table 5 shows that majority of the respondents are unemployed (24 or

60%). About 10 or 25% of the respondents were private employees and only 6 or

15% of them were government employees.

The data implies that the respondents who were unemployed have not

reached higher education and they have a hard time finding for employment.

Based on the culture of Maranaos, once a family members get sick or having

problems, all family member will help or support. That is the spirit and culture of

pakiki-isa, a very strong trait in Maranao people.

According to Kozier (2004), occupational roles also predispose people to a

certain illness.

Table 6Distribution of the Respondents in Terms of

Estimated Family Income

Estimated FamilyIncome(Php)

Frequency Percentage (%)

Below-4,999 18 45.00

5,000-7,999 6 15.00

8,000-10,999 3 7.5011,000-above 13 32.50

Total 40 100.00

Table 6 displays that 18 or 45% of the respondents have an estimated

income of Php 4,999 and below, 13 or 32.5% of them have an estimated income


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of Php 11,000-above, 6 or 15% of them have Php 5,000-7,999 and lastly, 3 or

7.5% of them have Php 8,000-10,999 income per month.

It implies that some of the respondents belong to low socio economic

status, due to lack of education, and employment. So their income is not enough

to sustain their daily living much more to pay for hospital bills in private institution.

They were much prone to sickness because of the stresses that come along with

life, added with their economic condition.

According to Royeca (2008), Philippines has a low economic status due to

increase population, fewer industries to work, national debt and low wages. It is

worsened by corruption in which Filipinos suffer the most especially those who

belong to lower socio-economic level and because of that factor, it affects their

health status and they lack money to buy medicine to cure their disease/illness.

Part II Quality of Care Rendered by the RN HEALS

Table 7Distribution of the Quality of Care Renderedby the RN HEALS in Terms of

Safe Quality Nursing Care

Safe Quality Nursing Care Indicators WeightedMean (SD)

Rank Description

(SQ1) Reports to duty punctually,mentally and physically prepared toprovide safe and effective care.

4.15(0.68) 3rd Very Good

(SQ2) Assesses clients in a timelymanner. Performs case efficiently and

competently develops good decisionmaking skills.

4.23(0.80) 1.5th Excellent

(SQ3) Identifies clients priority problemand organizes work to meet thosepriorities with caring behavior.


Average 4.20(0.63) Excellent

Note: 4.20-5.00 Excellent 2.60-3.39 Good 1.00-1.79 Poor 3.40-4.19 Very Good 1.80-2.59 Fair


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Table 7 presents the distribution of the quality of care rendered by RN

HEALS in terms of safe quality nursing care. The perception statements 2 and 3:

assesses clients in timely manner, performs care efficiently and competently,

develops good decision making skills; Identifies clients priority problem and

organizes work to meet those priorities with caring behaviour, were rated as

excellent by the respondents. While the first perception statement: reports to

duty punctually, mentally, physically prepared to provide safe effective care was

rated very good. This suggests that the respondents have overall rating of

excellent in terms of the safety and quality care rendered to them by these

Registered nurses.

A definition for patient safety has emerged from the health care quality

movement that is equally abstract, with various approaches to the more concrete

essential components. Emphasis is placed on the system of care delivery that

prevents errors; learns from the errors that do occur; and is built on a culture of

safety that involves health care professionals, organizations, and patients. Jean

Watson accentuate the ideal and value of caring as a starting point, an attitude

which has to become an intention, a commitment, a will and a conscious

judgment that manifest itself in a concrete acts.


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Table 8Distribution of the Quality of Care Rendered by

the RN HEALS in Terms of Managementof Resources and Environment

Management of Resources andEnvironment Indicators WeightedMean (SD) Rank Description

(MR1) Maintains safe Environment byremoving hazardous equipment,materials.

4.05(0.90) 1.5th Very Good

(MR2) Utilizes resources and ensuresfunctioning of the resources to supportclient care


(MR3) Demonstrates flexibility inadapting to challenging situation

4.05(0.96) 1.5th Very Good

Average 4.00(0.82) Very Good

Note: 4.20-5.00 Excellent 2.60-3.39 Good 1.00-1.79 Poor

3.40-4.19 Very Good 1.80-2.59 Fair

Table 8 presents the quality of care rendered by RN HEALS in terms of

management of resources and environment, respondents rated very good to

the following indicators: Maintaining safe environment by removing hazardous

equipment and materials, also demonstrating flexibility in adapting to challenging

situation with a weighted mean of 4.05. Utilizing resources and ensuring the

functioning of the resources to support client care with a weighted mean of

3.90.This indicates that the RN HEALS have very good management of

resources and environment in rendering quality of care.

Perhaps the RN HEALS were oriented of the equipment materials and set

up in Ramain Health Center, thus they were able to manage it carefully.


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Table 9Distribution of the Quality of Care Rendered

by the RN HEALS in Termsof Health Education

Health Education Indicators WeightedMean (SD) Rank Description

(HE1) Provides relevant, accuratehealth care information.

4.10(0.90) 2nd Very Good

(HE2) Assesses clients learning needsas well as readiness for and barriersfor learning.


(HE3) Participates in client and familyseducational activities and evaluatesoutcomes of client and familyeducation

4.23(0.73) 1st Excellent



Table 9 reveals the quality of nursing care in terms of health education.

Perception 1 is rated excellent while the perception 2 and 3 were rated very

good. Overall rating for health education was very good. It implies that the RN

HEALS were conducting health teaching to the respondents and significant

others. Health education is the process by which people learn about their health

and more specifically, how to improve their health. It is critically important in

improving the health of communities and individuals. It also encompasses not

only the information on what behaviour was healthy, but also how to achieve

those behaviours with skills development and can sometimes include motivation

to change.

According to Brubaker (1983), health care should be directed towards high

level of wellness through processes that encourage alteration of personal habits

or the environment. It occurs after the health stability is present and assumes

disease prevention and health maintenance as prerequisites or by products.


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by the RN HEALS in Termsof Legal Responsibility

Legal Responsibility Indicators WeightedMean (SD) Rank Description

(LR1) Maintains accuracy andconfidentiality of clients record


(LR2) Adheres to practices inaccordance with nursing law and otherrelevant legislations.


(LR3) Identifies acts and reports riskpotential




Table 10 presents the quality of nursing care rendered by RN HEALS in

terms of legal responsibility. The respondents rated excellent in the indicator

about identification, acts, and report risk potential, and have very good

maintaining accuracy and confidentiality of clients record as well as adhering to

practices in accordance with nursing law and other relevant legislations with the

average rating of very good.

This shows that the respondents have a very good insight towards the RN

HEALS in Ramain in terms of legal responsibilities. The nurses were observing

confidentiality or privacy. Once have interdependent legal roles, each with rights

and associated responsibility provider of service, employer or contractor of

service and private citizen.

The nurses are expected to provide safe and competent care, so that

harm to the patient can be prevented. The nurses as a citizen are the same of

any of those individual under the legal system. It protects the patients from

danger or harm and ensures the right to privacy, confidentiality etc.


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According to Fenner (1980), the nurse has three, separate, independent,

legal roles, each with rights and also associated responsibility provider of service,

employer or contractor of service and private citizen.

Table 11Distribution of the Quality of Care Rendered by the

RN HEALS in Terms of Ethico-Moraland Spiritual Responsibility

Ethico-Moral and SpiritualResponsibility Indicators

WeightedMean (SD)

Rank Description

(EM1) Renders care consistent with theclients Bill of Rights.


(EM2) Respects the religious beliefs ofthe client and prays with the client

when needed.


(EM3) Treats all individuals with dignityand respect.




Table 11 demonstrates the quality of nursing care rendered by RN HEALS

in Ramain. They have an excellent rating in rendering care consistent with the

clients bill of rights, as well as in treating all individuals with dignity and respect.

They have very good performance in respecting religious beliefs of the clients

and pray with them when needed. The Ramain nurses respect the respondents

religion and culture and were able to render care regardless of their religion.


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Table 12Distribution of the Quality of Care Rendered by

the RN HEALS in Terms of Personaland Professional Development

Personal and Professional Indicators WeightedMean (SD) Rank Description

(PAP1)Prepares for clinicalresponsibilities.


(PAP2)Demonstrates appropriatebehaviors.

4.10(0.71) 2.5th Very Good

(PAP3)Takes initiative to obtain neededknowledge.

4.10(0.84) 2.5th Very Good

Average 4.14(0.61) Very GoodNote: 4.20-5.00 Excellent 2.60-3.39 Good 1.00-1.79 Poor

3.40-4.19 Very Good 1.80-2.59 Fair

Table 12 presents the distribution of perceived of quality care rendered

among the respondents in terms of personal and professional development.

Result shows that the nurses have excellent preparation for the clinical

responsibilities. They demonstrate very good appropriate behaviours and take

the initiative to obtain needed knowledge. On the average, the respondents have

a very good rating towards nurses in terms of personal and professional

development; they were able to perform their duty and responsibilities.

The result implicates that RN HEALS have attended several training like

Private Duty Nursing (PPN), intravenous therapy (IV training) prior to exposure in

Ramain Health Center.

\


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by the RN HEALS in Terms ofQuality Improvement

Quality Improvement Indicators WeightedMean (SD) Rank Description

(QI1)Recommends solutions toidentified problems


(QI2) Recognizes the purpose ofutilization review, continuous qualityimprovement, and balancing availableresources in health care management.


Average 4.24(0.64) ExcellentNote: 4.20-5.00 Excellent 2.60-3.39 Good 1.00-1.79 Poor

3.40-4.19 Very Good 1.80-2.59 Fair

Table 13 reveals that on the average, the respondents rated the nurses

excellently in terms of quality improvement. Nurses recommend solution to

identified problems. Nurses recognize the purpose of utilization review,

continuous quality improvement, and balancing available resources in health

care management very well.

The RN HEALS may have encountered the same problems or situation

related to health during student days, that is why they were able to manage it.

Table 14Distribution of the Quality of Care Rendered by the

RN HEALS in Terms of Research

Research Indicators WeightedMean (SD)

Rank Description

(R1)Identifies problems for research

purposes


(R2) Applies new findings in nursingpractice


(R3) Updates on the new trends andissues on emergency cases.





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Table 14 presents the quality of care in terms of research. Respondents

rated the nurses performance as very good on the average. They were excellent

in identifying problems for research purposes. Nurses were very good in applying

of new findings in nursing practice and in updating on the new trends and issues

on emergency cases.

RN HEALS nurses had undergone undergraduate thesis or research

studies as a requirement. They were able to widen their level of awareness on

the new trends and issues in the nursing practice thereby making them more

responsive and better equipped to deliver health projects and programs.


by the RN HEALS in Terms ofRecords Management

Records Management Indicators WeightedMean (SD)

Rank Description

(RM1) Documents complete, accurate,

pertinent information in a timely manner

4.10(0.78) 1st Very Good

(RM2) Uses appropriate terminology,spelling and grammar in writtencommunication.


(RM3) Maintains confidentialitypertaining to patients record andcondition.


Average 3.98(0.63) Very GoodNote: 4.20-5.00 Excellent 2.60-3.39 Good 1.00-1.79 Poor

3.40-4.19 Very Good 1.80-2.59 Fair

Table 15 displays the quality of care rendered by the nurses in terms of

records management. Respondents have a very good perception towards the

nurses in documenting complete, accurate, pertinent information in a timely

manner. Nurses were using appropriate terminology, spelling and grammar in


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written communication very well. They also maintain confidentiality pertaining to

clients record and the condition. They keep and organize the records of their

clients.

RN HEALS were trained to have complete, concise, and accurate

documentation in relation to patients care and maintain confidentiality on legal

purposes.

According to Hughes (2000), missing, incomplete or illegible

documentation can seriously impede patient care and the defense of malpractice

claim, even when the care was appropriate.


by the RN HEALS in Terms ofCommunication

Communication Indicators WeightedMean (SD)

Rank Description

(C1) Establishes rapport with the clientand members of the health care team.


(C2) Provides appropriate information

to clients and families. And able toconstruct nursing history and plan ofcare.


(C3) Uses therapeutic communicationof nurse when dealing with the clientand family.




Table 16 shows that the respondents rated the nurses in Ramain in terms

of communication very good. They were very good in establishing rapport with

the client and the members of the health care team, since Ramain is filled with

Maranaos, they often use Maranao as a primary language in communicating with


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each other. They provide appropriate information to the client and families, and

were able to construct nursing history and plan of care, by using of modifying

words that can be understood by the client easily. They use therapeutic

communication whenever they deal with the client and family members.

They were able to perform those things properly for the patients

confidence to elicit patients cooperation in the plan of care.

Furthermore, communication affects one another through exchange of

information ideas and feelings. Good communication is important so that they

can plan and organize comprehensive care plan for their patients (Udan, 2009).


by the RN HEALS in Termsof Collaboration and

Team Work

Collaboration and Team WorkIndicators

WeightedMean (SD)

Rank Description

(CT1) Utilizes channel ofcommunication and anticipate the

needs of the health care team inmeeting clients needs.


(CT2) Applies conflict resolution andproblem solving skills as appropriate.


(CT3) Facilitates continuity of carewithin and across health care setting.




Table 17 presents the result in terms of collaboration and team work,

where the respondents rated the performance of the nurses very good.

According to the perception of the respondents, the nurses in Ramain utilize

communication and anticipate the needs of the health care team in meeting the


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clients needs. Since, the Health unit is small; the respondents can see or

observe how the staff works with each other. Nurses apply conflict resolution and

problem solving skills as appropriate as possible. They were also very good in

facilitating continuity of care within and across health care setting. They

sometimes go to the houses of the respondents for further health care.

Part III Test of Relationships

Table 18Relationship between the Respondents Profile

and the Quality of Care Renderedby RN HEALS

Variables X2-value(df) p-value Remarks

Age 10.193*(3) 0.017 Significant

Gender 1.135ns(1) 0.460 Not significant

Civil Status 1.753ns (2) 0.416 Not significant

Educational Attainment 0.159ns (2) 0.924 Not significant

Employment 2.218ns (2) 0.330 Not significant

Estimated Family Income 3.876ns (3) 0.275 Not significantNote: Analysis is based on Likelihood Ratio Test *-significant (p0.05) ns-not

significant (p>.05)

Table 18 presents the relationship between the respondents profile and

the quality of care rendered by the RN HEALS. Result shows that there is a

significant relationship in terms of age, while there are no significant relationships

between the respondents gender, civil status, educational attainment,

employment and estimated family income since the corresponding p-values

exceeded the 0.05 level of significance.

This suggests that the quality of care rendered and the respondents age

showed a significant association. This suggests that the quality of care rendered

by the respondents are not associated with their gender, civil status, educational

attainment, employment, and estimated family income, but have significant


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association with their age. Thus, the null hypothesis which states that there is no

significant relationship between respondents gender, civil status, educational

attainment, employment and estimated family income and the quality of care

rendered was not rejected, but respondents age and quality of care rendered

was rejected.

Older people are much more prioritized than the lower age because they

are prone to any illness and that RN HEALS nurses treat them like their parents.

Older people are mostly prone to illness due to stresses on their activities of daily

living, as well as aging.

Part IV Test of Differences

Table 19Differences on the Quality of Care Rendered by

RN HEALS when Grouped According to Age

VariablesAge Group F-value/p-

valueRemarks

15-25 26-35 36-45 46-60

Safety quality nursingcare

4.51 4.22 4.15 4.02 1.169/0.335 Notsignificant

Management ofresources andenvironment

4.44 3.94 3.91 3.81 1.195/0.325 Notsignificant

Health education 4.44a 4.44a 3.58a 4.00a,b 4.234*/0.012 Significant

Legal responsibility 4.52 4.06 3.73 4.21 2.641/0.064 Notsignificant

Ethico-moral andSpiritual responsibility

4.30 4.06 3.88 4.26 1.392/0.261 Notsignificant

Personal andprofessionaldevelopment

4.44 4.28 3.94 4.05 1.404/0.258 Notsignificant

Quality improvement 4.39 4.08 4.14 4.29 0.382/0.766 Notsignificant

Research 4.44b 4.56b 3.76a 4.17a,b 4.174*/0.012 Significant

RecordsManagement

4.37b 4.44b 3.82a 3.67a 4.724**/0.007 Significant

Communication 4.22b 4.28b 3.64a 3.57a 4.220*/0.012 Significant

Collaboration andTeamwork

4.26 4.00 3.61 3.50 2.101/0.117 Notsignificant

Overall 4.40b 4.21a,b 3.83a 3.96a 3.438*/0.027 Significant


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Note: *-significant (p0.05) ns-not significant (p>.05)

Table 19 presents the differences on the perceived quality nursing care

rendered among the respondents in Ramain Rural Health Unit when grouped

according to their age. Result reflects that there are significant differences in the

perception of the respondents towards quality of care in terms of health

education, research and communication and record management since the p-

values did not exceed the 0.05 level of significance. Further, it shows that the

respondents have comparable perception on the safety quality nursing care,

management of resources and environment, legal responsibility, ethico-moral

and spiritual responsibility, personal and professional development, quality

improvement and collaboration and teamwork since the corresponding p-values

exceeded the 0.05 level of significance. On the average, there are differences on

the perception of the quality of care rendered to them by the RN HEALS. Thus,

the null hypothesis which states that there is no significant difference on the

quality of care rendered and the respondents profile when grouped to age was

rejected.

RN HEALS were thought and trained to provide health teaching to their

client when they were in college. As part of their curriculum, they had undergone

undergraduate research studies or thesis. They were thought to document

complete, accurate, pertinent information in a timely manner and maintain

confidentiality pertaining to patients record and condition. They were also

thought to establish rapport and proper communication technique for them to


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elicit patients cooperation in terms of care. They were trained to use therapeutic

communication when dealing with the client and family.

Table 20

Differences on the Quality of Care Renderedby RN HEALS when GroupedAccording to Gender

VariablesGender Group t-value/p-

valueRemarks

Male Female

Safety quality nursing care 4.41 3.94 2.464*/0.018 SignificantManagement of resources

and environment4.02 3.98 0.127/0.900 Not significant

Health education 4.14 3.94 0.873/0.388 Not significant

Legal responsibility 4.18 4.06 0.577/0.567 Not significantEthico-moral and Spiritual

responsibility

4.15 4.11 0.229/0.820 Not significant

Personal and professionaldevelopment

4.23 4.04 0.984/0.331 Not significant

Quality improvement 4.27 4.19 0.380/0.706 Not significant

Research 4.20 4.15 0.260/0.797 Not significantRecords Management 3.97 4.00 -0.150/0.881 Not significant

Communication 3.89 3.78 0.582/0.564 Not significant


3.82 3.72 0.370/0.714 Not significant

Overall 4.12 3.99 0.831/0.411 Not significant


Table 20 presents the quality of care rendered by the RN HEALS when

respondents are grouped to gender. Result shows that there is a significant

difference on the quality of care rendered in terms of safety quality nursing care

when respondents are grouped to gender since the p-value of 0.018 does not

exceed the 0.05 level of significance. On the other hand, the quality of care

rendered in terms of management of resources and environment, health

education, legal responsibility, ethico-moral and spiritual responsibility, personal

and professional development, research, record management, communication

and lastly, collaboration and team work shows no significant differences as the


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respondents are grouped to gender since the p-values exceeded the 0.05 level of

significance. On the average, the null hypothesis which states that there is no

significant difference on the quality of care rendered by RN HEALS when

respondents are grouped according to gender was not rejected. Hence, gender

does not affect the perception of the quality of nursing rendered by the nurses.

RN HEALS were required to report to duty punctually, mentally and physically

prepared to provide safe and effective care.

Table 21

Differences on the Quality of Care Renderedby RN HEALS when GroupedAccording to Civil Status

VariablesCivil Status Group F-value/p-

valueRemarks

Single Married WidowedSafety quality nursing

care4.44 4.16 4.00 1.535/0.229 Not significant

Management ofresources andenvironment

4.06 3.90 4.09 0.206/0.815 Not significant

Health education 4.42 3.76 4.09 3.587*/0.038 Significant

Legal responsibility 4.19 4.00 4.24 0.497/0.612 Not significantEthico-moral and

Spiritual responsibility4.14 4.06 4.24 0.363/0.698 Not significant


4.31 4.04 4.12 0.672/0.517 Not significant

Quality improvement 4.13 4.18 4.45 0.889/0.420 Not significant

Research 4.36 4.04 4.18 1.071/0.353 Not significant

Records Management 4.31 4.02 3.58 4.684*/0.015 Significant

Communication 4.14 3.76 3.64 2.229/0.122 Not significant


3.92 3.82 3.55 0.648/0.529 Not significant

Overall 4.22 3.98 4.02 1.017/0.372 Not significantNote: *-significant (p0.05) ns-not significant (p>.05)

Table 21 reflects the differences on the perceived quality of nursing care

rendered by RN HEALS among the respondents when grouped according to civil


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status. As shown in the table, there are significant differences on the quality of

care in terms of health education and record management when according

grouped to civil status. While the respondents have comparable perception on

the safety quality care, management of resources and environment, legal

responsibility, ethico-moral and spiritual responsibility, personal and professional

development, quality of improvement, research, communication and teamwork as

grouped to civil status.

On the average, the null hypothesis which states that there is no


grouped according to civil status was not rejected. Hence, this implies that being

single, married or widowed will not affect respondents perception regarding the

rendered nursing care.

RN HEALS were properly trained to provide proper Health teaching to

their clients when they were still students.


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Table 22

Differences on the Quality of Care Rendered by RN HEALSwhen Grouped According to Educational Attainment

VariablesEducational Attainment Group F-value/p-

valueRemarks

ElemLevel/Gra

d

HighSchool

Level/Grad

CollegeLevel/Gra

d

Safety quality nursingcare

4.14 4.08 4.38 0.856/0.433 Not significant

Management of

resources andenvironment

4.14 4.03 3.82 0.513/0.603 Not significant

Health education 4.00 4.08 4.08 0.054/0.948 Not significant

Legal responsibility 4.07 4.08 4.23 0.222/0.802 Not significant

Ethico-moral andSpiritual responsibility

4.14 4.18 4.08 0.112/0.895 Not significant


4.12 4.18 4.13 0.036/0.965 Not significant


Research 4.07 4.23 4.23 0.326/0.724 Not significant

Records Management 3.90 4.03 4.03 0.162/0.851 Not significantCommunication 3.86 3.87 3.79 0.054/0.948 Not significant


3.79 3.62 3.92 0.461/0.634 Not significant

Overall 4.05 4.04 4.09 0.032/0.968 Notsignificant


Table 22 presents the differences on the perceived quality nursing care

rendered among the respondent when grouped according to their educational

attainment. Result reveals that the respondents perceptions are comparable

towards the care rendered by the RN HEALS when grouped according to

educational attainment. Thus, the null hypothesis which states that there is no


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grouped according to educational attainment was not rejected. Hence, the study

suggests that being educated or not will not necessarily affect how the client

perceive the care rendered to them. Professional or not, everyone has their own

understanding of how things work around them.

Table 23Differences on the Quality of Care Rendered

by RN HEALS when GroupedAccording to Employment

VariablesEmployment Group F-value/p-

valueRemarks

GovernmentEmployee

PrivateEmployee

Unemployed

Safety quality nursing care 4.44 4.30 4.10 0.890/0.419 Not significant

Management of resourcesand environment

4.11 4.13 3.92 0.297/0.744 Not significant

Health education 4.22 4.07 4.00 0.243/0.785 Not significant

Legal responsibility 4.17 4.07 4.14 0.050/0.951 Not significant

Ethico-moral and Spiritualresponsibility

4.17 4.03 4.17 0.213/0.809 Not significant


4.39 4.07 4.11 0.590/0.560 Not significant


Research 4.50 4.23 4.07 1.396/0.260 Not significantRecords Management 4.22 3.90 3.96 0.530/0.593 Not significantCommunication 4.00 3.90 3.78 0.352/0.705 Not significant


3.89 3.97 3.67 0.545/0.585 Not significant

Overall 4.24 4.09 4.00 0.613/0.547 Notsignificant


Table 23 demonstrates that there is no significant difference on the

respondents perception of the quality of care when grouped according to

employment since the corresponding p-values exceeded the 0.05 level of

significance. Thus, the null hypothesis which states that, there is no significant

difference on the quality of care rendered by RN HEALS when grouped


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according to employment was not rejected. Hence, employment does not affect

the respondents perception regarding the quality of rendered care by the RN

HEALS.

Table 24Differences on the Quality of Care Rendered

by RN HEALS when Grouped Accordingto Estimated Family Income

VariablesEstimated Family Income Group F-value/p-

valueRemarks

4,999 5,000-7,999

8,000-10,999

11,000

Safety quality nursing care 3.98 4.28 4.11 4.49 1.768/0.171 Not significant

Management of resourcesand environment

3.96 4.11 4.00 4.00 0.045/0.987 Not significant

Health education 3.96 4.17 3.89 4.15 0.289/0.833 Not significantLegal responsibility 3.98 4.44 4.00 4.21 0.784/0.511 Not significant

Ethico-moral and Spiritualresponsibility

4.07 4.44 4.00 4.10 0.772/0.517 Not significant


4.06 4.11 4.00 4.31 0.483/0.696 Not significant

Quality improvement 4.25 4.33 3.83 4.27 0.436/0.728 Not significant

Research 4.06 4.56 4.00 4.21 1.219/0.317 Not significant

Records Management 3.81 4.11 4.00 4.15 0.827/0.488 Not significant

Communication 3.76 4.22 3.67 3.82 0.932/0.435 Not significant

Collaboration and Teamwork 3.54 4.00 3.44 4.08 1.507/0.229 Not significantOverall 3.95 4.25 3.90 4.16 1.008/0.401 Not significant


Table 24 depicts that there is no significant difference on the quality of

care rendered by the respondents when grouped according to the estimated

family income since the corresponding p-values exceeded the 0.05 level of

significance. Thus, the null hypothesis which states that, there is no significant

difference on the quality of care rendered by RN HEALS when grouped

according to estimated monthly income was not rejected. Hence, the income

does not affect the respondents perception regarding the quality of care

rendered by the RN HEALS.


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Chapter 5

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary, findings, conclusions and

recommendations of the study.

Summary

This study was conducted at Ramain Rural Health Unit, Lanao Del Sur

during the second semester of the academic year 2011-2012. The purpose of

this study was to determine the quality of care rendered by the RN HEALS in

Ramain Rural Health Unit. There were 40 respondents of the study who were

selected considering their willingness to participate in the study. Simple random

technique was utilized in selecting the respondents.

The instrument used in gathering data was a questionnaire adapted from

the core competency tool of MSH College and modified by the researchers. The

data were gathered by giving the respondents the questionnaires and requesting

them to answer the questions freely, based on their own experience and

observation. The questionnaires were collected, and the data were gathered and

tabulated with the use of appropriate statistical tools. The statistical tests used

were percentage, frequency and mean to determine the mean ratings.


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Findings

Based on the results presented in preceding chapter, the following major

findings are enumerated below:

1. There are 14 or 35% respondents whose age range from 46-60 years old,

22 or 55% are male, 17 or 42.50% are married, 14 or 35% are elementary

level or graduate, 24 or 60% are unemployed with estimated income of

below Php 4,999.

2. Results shows that on the quality of care rendered by RN HEALS , the

rating was excellent on some indicators, such as safe quality nursing care,

ethico-moral and spiritual responsibility and quality improvement, while

very good on the rest of indicators such as management of resources and

environment, health education, legal responsibility, personal and

professional development, research, record management, communication

and collaboration and teamwork.

3. It shows that there is a significant relationship between the respondents

profile in terms of age and the quality of care rendered by the RN HEALS.

4. It shows that there is a significant difference between the quality of care

rendered by RN HEALS when grouped according to respondents

personal profile.


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4.1According to age and health education, research, records

management and communication.

4.2According to gender and safe quality nursing care.

4.3According to civil status and health education and record

management.

Conclusion

Based on the findings of the data, the researchers concluded that;

Some of the respondents belong to elder adult, majority are male, married,

elementary level or graduates, unemployed with an estimated income of Php

4,999 and below.

Based on the findings, the quality of care rendered by RN HEALS in

Ramain Health Center is excellent in some indicators such as safe quality

nursing care, ethico-moral and spiritual responsibility and quality improvement.

While very good on the rest of indicators such as management of resources and

environment, health education, legal responsibility, personal and professional

development, research, record management, communication and collaboration

and teamwork.

Based on the findings, there is a significant relationship between the

respondents profile in terms of age and the quality of care rendered by RN

HEALS.


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Based on the findings, there is a significant difference between the quality

of care rendered by RN HEALS when grouped according to respondents profile

such as;

1. Age and health education, research, record management and

communication.

2. Gender and safe quality nursing care.

3. Civil status and health education and record management.


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Recommendations

Based on the findings and conclusions of the study, the following

recommendations are listed below:

1. Department of Health. It is recommended that the nursing personnel

will work in collaboration with other medical personnel to achieve the

efficient quality care. It will help the administration in formulating their rules

and regulations or their policies for the improvement of their program in

the Rural Health Unit.

2. Rural Health Unit Patients. It is recommended that health workers

consider the patients unique cultural attributes as the recipient of better

nursing care.

3. Registered Nurses. It will be used for the future study so as to prove

the quality of care rendered by the RN HEALS towards the clients in

Ramain Rural Health Unit. It will serve as guidelines in rendering quality

services in rural health unit without discrimination as to race, gender, and

social status in the community.


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4. Future Researchers. A similar study may be conducted considering

other factors in assessing the quality of care rendered by the RN HEALS

using a larger number of respondents.

BIBLIOGRAPHY

Books

Clarke, Sean P, Donaldson, and Nancy E. Chapter 25. Nurse Staffing and

Patient Care Quality and Safety.

Gerard, Taylors, Lillis, & Lemone. (2004). Fundamentals of Nursing: The Art and

Science of Nursing Care. 5th ed. Philadelpihia: Lippincott Williams and

Wilkins.

Hughes, R. (2000). Avoiding the Near Nurses, vol 104, no. 5, Washington DC

Kozier, Barbara, et al. (2004). Fundament of Nursing Concept , Process and

Practice. 7th ed. Philippines; Personal Education South Asia PTE Ltd.

Kozier, B. Erb G. Blais, k. and Wilkinson, J. (2002) Fundamentals of Nursing

Concepts, Processe and Practice. Singapore; Person Educational

Incorporated.

Margaret Shetland (1944). Statistical Reporting in Public Health Nursing,

National Organization for Public Health Nursing. Ang University of

Michigan.

Smith, P. (2005). Taylors clinical nursing skills: A Nursing Approach. New York:

Lippincott Williams and Wilkins.

Udan JQ. (2009). Fundamental f Nursing. Manila Philippines, Educational

Publishing House United Nations Avenue.

Watson, Jean. (2007). Ash well Nursing Care, Philadelphia P.A: W.B, Sounders.


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Watson, Jean (2001) Intentionally for Caring-Healing consciousness. A Practice

of Transpersonal Nursing. New York, W.W Norton

Journals

Thorsteinsson (2002) Visions, Bc mental Health and Addictions Journal. Vol. 3

no. 2

Ballard, K (2003) Patient Safety: A Shared Responsibility. Nursing Journals

Publishing

Joint Commission on the Accreditation of Healthcare Organization (2003)

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Perspective.


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APPENDIX A

Questionnaire

Dear Respondents,

We are third year Nursing Students of Mindanao Sanitarium & Hospital

College who are presently working on a study entitled Quality of Care Rendered

by Registered Nurses for Health Enhancement and Local Services in Ramain

Rural Health Unit as a requirement for the course Bachelor of Arts in Nursing.

We have chosen you as one of our respondents for we believe that you can give

us the needed information for our study. Please be assured that all the data will

be handled with utmost confidentiality.

Your cooperation will be greatly appreciated and treasured.

The Researchers

Part I. Demographic Data

Direction: Please indicate your answer by checking the option that applies

A. Age

( ) 15- 25 years old

( ) 25-35 years old

( ) 35-45 years old

( ) 45-60 years old


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B. Gender

( ) Mal e ( ) Female

C. Civil Status

( ) Single

( ) Married

( ) Widowed

D. Educational Attainment

( ) Elementary Level/

Graduate

( ) High School Level/

Graduate

( ) College Level/ Graduate


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E. Employment

( ) Government Employee

( ) Private Employee

( ) Unemployed

F. Estimated Family Income

( ) Php 2,000-4,000

( ) Php 5,000-7,000

( ) Php 8,000-10,000

( ) Php 11,000-above

Part II

Direction: Please put a check mark in the box that indicates your answer.

5-Excellent

4-Very Good

3-Good

2-Fair

1-Poor

1. SAFETY QUALITY NURSING CARE 5 4 3 2 1

a. Reports to duty punctually, mentally and physically prepared toprovide safe and effective care.

b. Assess client in a timely manner. Performs care efficiently andcompetently develops good decision making skills.

c. Identifies clients priority problem and organizes work to meet

those priorities with caring behavior.

2. MANAGEMENT OF RESOURCES AND ENVIRONMENT

a. Maintain safe Environment by removing hazardous equipment,materials.

b. Utilizes resources and ensures functioning of the resources tosupport client care

c. Demonstrate flexibility in adapting to challenging situation.


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3.HEALTH EDUCATION

a. Provide relevant, accurate health care information.

b. Assess clients learning needs as well as readiness for andbarriers for learning.

c. Participate in client and familys educational activities andevaluates outcomes of client and family education

4. LEGAL RESPONSIBILITY

a. Maintains accuracy and confidentiality of clients record

b. Adhere to practices in accordance with nursing law and otherrelevant legislations.

c. Identifies, acts, and reports risk potential

5. ETHICO-MORAL AND SPIRITUAL RESPONSIBILITY

a. Renders care consistent with the clients Bill of Rights.

b. Respects the religious belief of the client and prays with theclient when needed.

c. Treats all individuals with dignity and respect.

6. PERSONAL AND PROFESSIONAL DEVELOPMENT

a. Prepares for clinical responsibilities.

b. Demonstrates appropriate behaviors.

c. Takes initiative to obtain needed knowledge.

7.QUALITY IMPROVEMENT

a. Recommends solutions to identified problems

b. Recognizes the purpose of utilization review, continuous qualityimprovement, and balancing available resources in health caremanagement.

8. RESEARCH

a. Identifies problems for research purposes

b. Applies new findings in nursing practice

c. Updates on the new trends and issues on emergency cases.

9. RECORDS MANAGEMENT

a. Documents complete, accurate, pertinent information in a timelymanner

b. Uses appropriate terminology, spelling and grammar in writtencommunication.

c. Maintains confidentiality pertaining to patients record andcondition.

10. COMMUNICATION


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a. Establishes rapport with the client and members of the healthcare team.

b. Provides appropriate information to clients and families. Andable to construct nursing history and plan of care.

c. Uses therapeutic communication of nurse when dealing with the

client and family.

11. COLLABORATION AND TEAM WORK

a. Utilizes channel of communication and anticipate the needs ofthe health care team in meeting clients needs.

b. Applies conflict resolution and problem solving skills asappropriate.

c. Facilitates continuity of care within and across health caresetting.

APPENDIX B

December 20, 2011

Normallah Dimalotang Alonto, MD

Municipal Health Officer

Ramain Rural Health Unit

Dear Madam:


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Greetings of Peace!

We the researchers are nursing students of Mindanao Sanitarium and Hospital

College are presently working on a study entitled Quality Care Rendered by RN

HEALS in Ramain Rural Health Unit.

In connection with this, may we be allowed to distribute survey questionnaires

to the Maranao patients from December 20-21, 2011. This will be done with

utmost care and confidentiality.

Your approval to this request is highly appreciated.

Respectfully yours,

Nassar Macagaan

Namia Maulani

Hamida Menor

Noted by:

Armelyn Grace Maghanoy, MAN, RN Merlin M. Espinosa , DM,

MAN, RN

Thesis Adviser ResearchCoordinator

Roselyn S. Pacardo, MM, RN, RM

Dean of School of Nursing

Mindanao Sanitarium and Hospital College

Curriculum Vitae

Name: Nasar Limba Macagaan

Nickname: Nash

Gender: Male

Date of Birth: December 31, 1985

Place of Birth: Balindong Lanao del Sur


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Educational Background

Elementary Raya Elementary School

Secondary Dansalan College Foundation Inc.

College Centro Eskolar University Manila

Mindanao Sanitarium & Hospital College

Curriculum Vitae

Name: Sittie Namia A. Maulani

Nickname: Miot

Gender: Female

Date of Birth: December 2, 1991

Place of Birth: Marawi City


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Elementary Dansalan College Foundation Inc.


College MSU- IIT

Mindanao Sanitarium & Hospital College

Curriculum Vitae

Name: Hamida Decampong Menor

Nickname: Dida

Gender: Female

Date of Birth: September 10, 1990

Place of Birth: Iligan City Lanao Del Norte



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Elementary Dansalan College Foundation Inc.


College Mindanao Sanitarium & Hospital College

Chapter 1-Last Finale Print

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