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Transcript of Thesis Kath- With Feedback
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Chapter 1
THE PROBLEM AND ITS BACKGROUND
Introduction
The Philippine government is working hard to offer a solution to the
burning issue of oversupply and unemployment of Filipino nursing graduates.
The large number of nursing graduates can be blamed by the mushrooming of
nursing schools that tried to accommodate students who want to enroll in the
nursing program.
In an attempt to solve this problem, the Philippine government first offered
the Nurses Assigned in Rural Service (NARS) program which deployed
registered nurses to provinces and barrios where their services are very much
needed. This year, the Department of Health (DOH) and the Department of
Labor and Employment (DOLE) introduced a new program that is similar to
NARS. The new program is called Registered Nurses for Health Enhancement
and Local Service (RN-Heals).
The new government program said to offer hope to almost 200,000
unemployed nurses in the country. This fact is said to be ironic because many
Filipinos die of preventable diseases just because they were not given an
opportunity to be treated by medical workers. This means that there is a great
demand for nurses in the country. What are lacking are the employment
opportunities for them.
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The healthcare needs of Filipino people especially those living in far flung
areas and the need of nursing graduates for hospital experience and exposure
will both be dealt with through the RN-Heals program.
RN Heals hires licensed qualified nurses for one year —as ―contractuals.‖
The nurses are made to perform regular nursing tasks and augment the nursing
manpower in many understaffed hospitals; yet, they are considered ―trainees‖
with an allowance of not more than P8,000 a month. Meager as it is, the release
of the allowance in many cases is even delayed for 2-3 months. Meantime,
trainees spend for their daily needs (meals and transportation) and other
incidental expenses like scrub suits, gloves or even medicines for job-related
health problems like allergy, etc.
A more serious concern: RN Heals nurses have little or no protection at all
from possible work-related liabilities or accountabilities that may arise from the
performance of their duties.
The country has a huge pool of nurses. But severe unemployment
remains the core problem in the nursing front. Ironically, nursing service is
gravely needed in underserved and poor communities, and in public hospitals
that are generally ill-equipped and seriously understaffed. Indeed, there is
scarcity amidst plenty.
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The government has neither observed nor implemented the standards that
itself has set especially the nurse-patient ratio of 1:12 for bedside nursing care,
and 1:20,000 for public health. In many government hospitals, a nurse usually
handles more than 20 patients—often even more, like in the National Mental
Health Center where a ward nurse is made to take charge of an average of 80-
100 psychiatric patients. Moreover, public health nurses should have been
receiving a starting monthly salary of P24,887, as per the Philippine Nursing Law
of 2002, but the government has not allotted any budget for the enforcement of
this law.
RN Heals neither ―heals‖ nor dignifies nurses because it is a form of
exploitation. The public health system can be made stronger by creating plantilla
positions for more nurses to meet the growing needs of the population. Health is
a major responsibility of the state, so the government should allot adequate
budget for health services and human resource. (Provide sources for your
discussions)
NARS sees nursing as a service profession and not merely a job; it is a
moral duty and commitment to care for the well and the sick. We can truly live up
to our commitment only with the government’s full support.
Provide a paragraph discussing on the purpose of the RN Heal program;
maybe you can find it from the program of activities.
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Realizing how significant nurses in helping people in the community, this
study will be conducted to assess the competencies acquired on the Registered
Nurses for Health Enhancement and Local Service (RN-HEALS) program in
PJGMMRC hospital.
Conceptual Framework
The conceptual framework of the study which is presented in Figure 1
utilized the systems approach which consists of the input, the process, the
output, (and the outcome.)
The input consists of the demographic profile of the respondents, extent of
competencies acquired in the registered nurse heals program in PJGMRMC
hospital, and degree of the problems met in the registered nurse heals program
in PJGMRMC hospital
The process includes normative survey with the use of questionnaire
checklists, statistical treatment and analysis of data, personal interviews from
among the target respondents, actual observations in the research locale of the
study, and textual and tabular presentation of results.
The output deals with the improve the competencies acquired of the
registered nurse heals program in PJGMRMC hospital.
The outcome deals with the program may be formulated towards
registered nurse heals program in PJGMRMC hospital.
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Figure 1.
Demographic profile of the respondents
Extent of competenciesacquired in theregistered nurse healsprogram in PJGMRMChospital
Degree of theproblems met in theregistered nurse healsprogram in PJGMRMC
hospital
Normative surveywith the use of
questionnairechecklists, statisticaltreatment andanalysis of data,personal interviewsfrom among thetarget respondents,actual observationsin the researchlocale of the study,and textual and
tabular presentation
Improve thecompetencies acquired of the registered nurseheals program inPJGMRMC hospital
Program may beformulated towardsregistered nurse healsprogram in PJGMRMC
hospital
INPUT
PROCESS
OUTPUT
OUTCOME
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Statement of the Problem
This study will try to evaluate the extent of competencies acquired by the
Registered Nurses involved on the Registered Nurses for Health Enhancement
and Local Service (RN-HEALS) program in PJGMRMC hospital, as basis for
program enhancement. Specifically, it will seek to answer the following problems:
1. What is the demographic profile of the respondents in terms of:
1.1. Age;
1.2. Gender;
1.3. Educational Attainment; and
1.4. Years of Experience?
2. What is the extent of competencies acquired in the registered nurse
heals program in PJGMMRC hospital as described in terms of:
1.1. Cognitive;
1.2. Psychomotor; and
1.3. Affective?
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3. Is there a significant difference in the assessment of respondents on the
extent of competencies acquired as a registered nurse in the heals program in
PJGMRMC hospital? As to what variables?
4. What is the degree of the problems met in the registered nurse heals
program in PJGMRMC hospital be described in terms of the above mentioned
variables?
5. Is there a significant different in the assessment of respondents on the
degree of the problems met in the registered nurse heals program in PJGMRMC
hospital? As to what variables?
6. What program may be formulated towards registered nurse heals
program in PJGMRMC hospital?
Hypotheses
The researcher will test the following hypothesis:
1. There is no significant difference in the assessment of respondents on the
extent of competencies acquired in the Registered Nurses for Health
Enhancement and Local Service (RN-HEALS) program in PJGMRMC hospital.
2. There is no significant different in the assessment of respondents on the
degree of the problems met in the Registered Nurses for Health Enhancement
and Local Service (RN-HEALS) program in PJGMRMC hospital.
Significance of the Study
This research study will be significant to the following:
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Hospital administrators. Being the ones who receive applicants to work
in the operating room, they have to be consistent with policies set by their
institution with regard to the qualifications of their employees because this will be
the major basis for the assessment of their competencies. Also, always have
activities or have them attend seminars that will update their knowledge and skills
for better administration of care given to clients. The directors of the hospitals
can have better plans that will improve the services they are rendering to the
patients. The chief nurses, assistant chief nurses and supervisors can monitor
and guide the practice of nursing by their staff nurses and trainees in order to
ensure the competency and efficiency of care they are delivering to every patient
in the hospital.
RN HEALS. The study will greatly benefit them since they are the main
focus of the study. They will be able to reflect on their practices as nurses. They
will realize their strengths and weaknesses in dealing with clients in the hospitals,
and so, maintaining the good practice and improving the weak ones. By realizing
and doing such, they will be able to lift the names of nurses by being competitive
and leaders in promoting health for people.
Patients/clients. Strengthening the skills and competencies of operating
room nurses will make them feel they are always in good hand whenever they
will be entering the operating room for surgery. They can be assured of the
quality of nursing care given by the nurses and as well as by the doctors. The
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thought of being with competent health workers will ease and lessen their fears
and worries/ or their anxieties.
Researcher. The findings of the study will give him important information
on how to become competent in the field of nursing he had chosen. Being an
nurse means that the life of the client depends on how he performs during the
hospitals procedure; therefore, he must think and act as a professional nurse
ready to follow all the orders of the doctors, and he must develop competence
and anticipating skills.
Significant others of the clients. Improved nursing competency may
make them trustful with nurses and doctors with whom they entrust their loved
one’s health condition.
(Just discuss what could be the possible benefits that can be
obtained from the findings of the study by the different stake holders)
Scope and Delimitation
The study will is conducted only in the Cabanatuan City. It will focused on
the competencies acquired by the Registered Nurses involved on the Registered
Nurses for Health Enhancement and Local Service (RN-HEALS) program in
PJGMRMC hospital.
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The respondents of the study will be the nurse (Is it the nurses involve in
the RN Heals Program or the regular nurses in PJG they worked with?), doctor,
and patient in PJGMRMC hospital.
The study will cover a period of one (1) semester, and that is from
November 20012 to March 2013, and is delimited only to the items and specific
problem statements in the questionnaire, giving emphasis on the following: 1)
extent of competencies acquired in the Registered Nurses for Health
Enhancement and Local Service (RN-HEALS) program in PJGMRMC hospital; 2)
degree of the problems met in the Registered Nurses for Health Enhancement
and Local Service (RN-HEALS) program in PJGMRMC hospital.
Definition of TermsThe following terms are defined operationally for better understanding of
the readers.
NURSERN-HEALS PROGRAMSExtent of CompetenciesDegree of Problems
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Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter presents the related literature and studies that helped the
researcher identify the knowledge gap and strengthen his conviction on the area
under investigation.
Foreign LiteratureThe Nevada State Board of Nursing-NSBN (2008) stressed that registered
nurses should always maintain accountability for the overall provision of nursing
practice following the accepted standard of care. The NSBN recognized that
these nurses need to work effectively with assistive personnel, underscoring the
Formatted: Left
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critical competencies or their abilities to assign and supervise. The RNs are
assigned tasks based on the needs and condition of the patients, potential for
harm, stability of the patients’ condition, complexity of the task, predictability of
the outcomes, abilities of the staff to whom the task is assigned, and the context
of other patient needs.
They perform intubation, postmortem enucleation, remove, clean and
reinsert a "donut" type pessary upon successful completion of formal education
and training which includes demonstration of competence in the use of this
device. Documentation of annual updates of education and demonstration of
competency are required, remove mediastinal drainage tubes, remove a
respirator when a patient has been determined to be brain dead and pronounced
dead by a physician. The nurse may refuse to remove the respirator for medical,
ethical, or moral reasons and perform epicardial pacing wire removal, provided
the following guidelines are followed:
1. The nurse is competent to perform the procedure and has the
documented and demonstrated knowledge, skill, and ability to perform the
procedure. Continued competency shall be documented annually and include
clinical review with successful return demonstration.
2. There are facility policies and procedures and any required
protocols in place for the nurse to perform the procedure. Protocols shall include
specific guidelines for patient monitoring after epicardial pacing wire removal.
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3. The nurse maintains accountability and responsibility for nursing
care related to the procedure and follows the accepted standard of care.
4. The procedure is performed interdependently. It must be based on
an order by a physician, be performed under indirect supervision of a physician
and per protocol. It is performed only in a licensed medical facility where a
physician who has documented and demonstrated knowledge in the area of
cardiovascular surgery is present within the facility and available for one hour
following the procedure should complications arise. Replace a gastrostomy tube
or suprapubic catheter that is not sutured in a patient, has been in place for an
extended time, and there is a clearly established passageway, advance or
withdraw endoscope and colonoscope. The procedure is performed when the RN
is visualizing the lumen. The RN is permitted to advance or withdraw a flexible
sigmoidscope without direct visualization. The procedure is carried out under the
direct supervision of a licensed physician. Written policy and procedure are in
place, administer intrahepatic arterial chemotherapy (provided procedure is
approved by chief nurses and included in facility policies and procedures), and
administer medications for the purpose of induction of sedation for short-term
therapeutic, diagnostic, or surgical procedures (procedural sedation). There are
multiple sedation and anesthetic agents that cause profound changes in
respiratory status even at low doses. Some of these medications do not have
reversal agents and require the support of competent clinicians in advanced
airway management. Licensed professional nurses (RNs) who administer these
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agents should be qualified to rescue patients whose level of sedation is deeper
than intended or those who enter the state of general anesthesia.
RNs may administer medications for the purpose of induction of sedation
for short-term therapeutic, diagnostic or surgical procedures (procedural
sedation). Authority for RNs to administer medications is derived from NRS
632.220. This places no limits on the type of medication or route of medication;
there is only the requirement that the drug be ordered by one lawfully authorized
to prescribe.
The registered nurse must be competent to perform the function, and the
function must be performed in a manner consistent with the standard of practice.
In administering medications to induce procedural sedation, the RN is required to
have the same knowledge and skills as for any other medication the nurse
administers. This knowledge base includes but is not limited to potential side
effects of the medication, contra-indications for the administration of the
medication, and amount of the medication to be administered.
The requisite skills include the ability to competently and safely administer the
medication by the specified route, anticipate and recognize the potential
complications of the medication, recognize emergency situations, and institute
emergency procedures.
Thus the RN shall be held accountable for knowledge of the medication
and for ensuring that the proper safety measures are followed. The institution
shall have in place a process for evaluating and documenting the RN’s
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demonstration of the knowledge, skills and abilities for the management of
patients receiving agents to render procedural sedation. Evaluation and
documentation of competency shall occur on an annual basis.
The safety considerations for procedural sedation include: continuous
monitoring of oxygen saturation, cardiac rate and rhythm, blood pressure,
respiratory rate and level of consciousness. The RN shall ensure the immediate,
on-site availability of back-up personnel for airway management, resuscitative
and emergency intubation and of emergency equipment which contains
resuscitative and antagonistic medications, airway and ventilatory adjunct
equipment, defibrillator, suction and a source for administration of 100% oxygen.
The RN administering agents to render procedural sedation shall conduct a
nursing assessment to determine that administration of the drug is in the patient’s
best interest. The RN shall ensure that all safety measures are in force.
The RN is held accountable for any act of nursing provided to a patient.
The RN managing the care of the patient receiving procedural sedation shall not
leave the patient unattended or engage in tasks that would compromise
continuous monitoring of the patient by the registered nurse. The RN has the
right and obligation to act as the patient’s advocate by refusing to administer or
continue to administer any medication not in the patient’s best interest.
If the RN is a Registered Nurse First Assist (RNFA), preparation of
saphenous vein for coronary artery bypass grafting is within his/her scope of
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nursing and of the Certified Nurse First Assistant (CRNFA) provided the following
guidelines are followed.
1. The nurse must have successfully completed an RN First Assistant
program that meets the Association of Operating Room Nurse (AORN) Education
Standards for RN First Assistant Programs and a clinical preceptorship devoted
to the application of knowledge and clinical skills associated with the process of
harvesting a coronary conduit/saphenous vein. The nurse must maintain
documentation of competency and maintain current CNOR certification.
2. The nurse will use surgical instruments to perform dissection or
manipulate tissue as directed by the surgeon to accomplish preparation/harvest
of a saphenous vein.
3. As part of informed consent, the patient or responsible party is
informed that a nurse will be performing the procedure.
4. The nurse is competent to perform the procedure and has the
documented and demonstrated knowledge, skill, and ability to perform the
procedure pursuant to NAC 632.071, 632.224, and 632.225.
5. There are agency policies and procedures, a provision for
privileging, and any required protocols in place for the nurse to perform the
procedure.
6. The nurse maintains accountability and responsibility for nursing
care related to post-operative follow-up for the procedure and follows the
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accepted standard of care which would be provided by a reasonable and prudent
nurse.
7. The procedure is performed interdependently by the surgeon and
the nurse. The surgeon must be in attendance while the nurse performs this
procedure.
Hospital admissions are creating vast challenges for nurses because of
increased patient longevity, multiple organ system problems, greater survival
from critical states, and obesity. Due to these conditions, nursing success rate
for peripheral intravenous placement (PIVs) is becoming increasingly more
difficult. Using ultrasound for PIV placement, similar to nurses using ultrasound
for Peripherally Inserted Central Catheters (PICCs) can increase nursing success
rates. By increasing success rate at PIVs through ultrasound guidance, nurses
should see the following results:
1. Increased patient satisfaction from fewer access failed attempts,
2. Less damage to peripheral vasculature from fewer access attempts,
3. Intravenous treatment delay is prevented, and
4. Preventing delay of intravenous treatment fosters decreasing the length
of hospital stays and cost containment.
These procedures are within the scope of practice for a registered nurse
provided the following guidelines are followed:
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1. The nurse is competent to perform the procedure and has the
documented and demonstrated knowledge, skill, and ability to perform the
procedure pursuant to NAC 632.071, 632.224, and 632.225.
2. There are agency policies and procedures and any required
protocols in place for the nurse to perform the procedure.
3. The nurse maintains accountability and responsibility for nursing care
related to the procedure and follows the accepted standard of care, be
authorized to perform the task of removing an epidural catheter. The Nevada
State Board of Nursing has determined that a registered nurse, who has
completed the appropriate training and follows all applicable competency
regulations under NAC 632, may be authorized to perform the task of removing
an epidural catheter, as defined, post-surgery/procedure, with a physician or
CRNA order.
The following epidural catheters may not be removed by a registered nurse:
1. Metal or spring epidural catheters,
2. Any tunneled epidural catheter, and
3. Spinal cord stimulators placed in the epidural space.
Safety is assured by undergoing a specific training program a registered
nurse removes an epidural catheter that has been placed by an Anesthesiologist
or a Certified Registered Nurse Anesthetist (CRNA). This practice would be
comparable to removal of femoral sheath catheters, removal of arterial line
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catheters and removal of PICC lines which is currently within the scope of
practice of a registered Nurse.
Removal of an epidural catheter will be the responsibility of the qualified
registered nurse only after appropriate training and documentation of catheter
integrity and site integrity. Consumer safety may be documented through Quality
Assurance/Infection Control monitors.
For consumer safety, the qualified Registered Nurse may remove
percutaneously inserted epidural catheters.
Intervention and documentation with a patient should include site care and
cleanliness, removal of protective barriers, hygiene, indications of infection and
fluid leakage.
The removal of an epidural catheter by a Registered Nurse allows the
patient to have a broader option for elective epidural pain management while
maintaining a safe environment for the patient. Continued or additional epidural
pain management is not always a choice when a physician is responsible for
removing the catheter at the completion of a case or procedure.
Only registered nurses with the appropriate didactic and clinical return
demonstration skills training, in collaboration with the facility policies and
procedural support, may participate in the removal of epidural catheters. The
didactic portion of the education program should include but is not limited to,
anatomy, physiology, related pharmacology, assessment, contraindications,
exceptions, emergency preparedness and intervention.
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A specified number of return demonstrations must be completed at the
end of the initial training. Annual skills validation must be demonstrated and
documented as part of each facilities education program. Each nurse must meet
all the competency requirements as set forth in NAC 632.
Removal of an epidural catheter may be considered within the scope of
practice of the registered nurse and only performed following the completion of
didactic and clinical training. A policy and procedure should be developed
specifically for the practice, and implemented in each facility following the nursing
process.
This procedure can be performed in any relevant department of each
facility by a qualified registered nurse. The areas impacted by this practice
change would include obstetrical and surgical services, post anesthesia recovery
units, out-patient services, ambulatory surgical centers, critical care and medical-
surgical units.
Annual documentation of competency and skills will be monitored by the
chief nurse in accordance with NAC 632.224 and 632.225. Infection control
monitors may be employed to measure infection rates.
Included in the literature search is a position statement from the American
Nurses’ Association. This position statement was written in collaboration with
Delaware Board of Nursing (6/90), Louisiana Board of Nursing (1/90); Ohio board
of Nursing (3/92); Oklahoma Board of Nursing (Fall/92); Wyoming Board of
Nursing (Spring/1993); and, South Carolina Board of Nursing.
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Removal of epidural catheters by qualified registered nurses will decrease
cost to the patient by eliminating the additional visit by the physician or CRNA.
The impact on manpower will increase the continuity of patient nursing
care. The registered nurse will have the ability to assess the patient’s pain levels
prior to the removal of the epidural catheter, and with specific physician orders,
administer additional pain management medications through the epidural
catheter in a more timely manner, if necessary.
The qualified registered nurse will work as a team member with the
attending physician, consulting Anesthesiologist, or CRNA.
Currently, qualified nurses in the state of Nevada may:
remove mediastinal drainage tubes, insert and remove PICC lines, remove
arterial lines, remove femoral sheaths, and instill reversible opioid agonists via an
epidural catheter.
These procedures are within the scope of practice for a registered nurse
provided the following guidelines are followed:
1. The nurse is competent to perform the procedure and has the
documented and demonstrated knowledge, skill, and ability to perform the
procedure pursuant to NAC 632.
2. Prior to incorporating the practice of inserting EJ PIVs, the nurse
must have a minimum of two years of experience in infusion therapy. To
incorporate the insertion of EJ PICCs, the nurse must have a minimum of two
years of experience in infusion therapy and certification in PICC insertion. The
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nurse must have successfully completed an external jugular educational program
that included theoretical content and clinical instruction to add insertion of either
EJ PIVs and/or EJ PICCs to his practice.
3. There are agency policies and procedures and any required
protocols in place for the nurse to perform the procedure.
The nurse maintains accountability and responsibility for nursing care related
to the procedure and follows the accepted standard of care.
The Board has determined that registered nurses and licensed practical
nurses may not perform intrauterine insemination, administer epidural
anesthetics. This procedure is reserved for CRNAs and physicians. Licensed
nurses must not be solely responsible for management of the patient under the
effects of epidural anesthesia, but may assist the physician in the patient's care,
accept employment as a nursing assistant, unless they hold a CNA certificate;
activity must be limited to the scope of practice for which the nurse is employed,
remove medications in the event of death of a home care client. A nurse
removing drugs is acting unprofessionally and may be subject to disciplinary
action for violating NAC 632.890, ss 15, 16, and/or 18.
A person who practices nursing or delivers patient care in relation to patients
who are located within the State of Nevada must be licensed by the Nevada
State Board of Nursing. The following activities include, but are not limited to,
conduct that is considered to be delivering patient care:
1. Any intent to enter into a therapeutic relationship with the patient.
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2. Any notation or documentation in an individual patient’s medical
records.
3. Designation or acting as chief nurse.
4. Accepting an assignment for patient care.
5. Patient education.
6. Any nursing education that involves direct patient contact.
7. Designation as or acting as an RN who supervises care provided by
another RN, LPN or CNA.
Along the same perspective, the Australian Nursing Council Incorporate
(ANCI) clearly defines the principles to achieve culturally competent nursing care,
and require nurses to respect the values, customs, spiritual beliefs and practices
of all individuals and groups; however, they are not sufficiently explained or
developed to guide nursing practice. What the standards need to make clear is
that the constituents of competence are found not in the nurse alone but in the
relationship that exists between the nurse, their colleagues, patients, and
families, and with the situation itself.
The RN specializing in Perioperative Nursing practice performs nursing
activities in the preoperative, intraoperative and post-operative phases of their
patients’ surgical experience. Registered nurses enter perioperative nursing
practice at a beginning level depending on their expertise and competency to
practice. As they gain knowledge and skill, they progress on a continuum to an
advanced level of practice.
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Based on the Standards and Recommended Practice for Perioperative
Nursing, the operating room nurse provides a continuity of care throughout the
perioperative period, using scientific and behavioral practices with the eventual
goal of meeting the individual needs of the patient undergoing surgical
intervention. This process is dynamic and continuous, and requires constant
reevaluation of individual nursing practice in the operating room.
The perioperative nurse is responsible and accountable for the major
nursing activities occurring in the surgical suite. These include, but are not
limited to the following:
Assessing the patient’s physiological and psychological status before,
during and after surgery;
Identifying priorities and implementing care based on sound judgment and
individual patient need;
Functioning as a role model of a professional perioperative nurse for
students and colleagues;
Functioning as a patient advocate by protecting the patient from
incompetent, unethical or illegal practices during the perioperative period;
Coordinating all activities associated with the implementation of nursing
care by other members of the health care team;
Demonstrating a thorough knowledge of aseptic principles and techniques
to maintain a safe and therapeutic surgical environment;
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Directing or assisting with the care and handling of all supplies, equipment
and instruments to ensure their economic and efficient function for the
patient and personnel under both normal and hazardous conditions;
Performing as a scrub or circulating nurse as needed, based on
knowledge and expertise for a specific procedure;
Participating in continuing education programs directed toward personal
and professional growth and development; and
Participating in professional organization and research activities that
support and enhance perioperative nursing practice (Mc Murray, 2004).
Foreign Studies
According to Leeper (2005), competency standards for operating theater
practice were used in some countries to guide clinical and professional
behaviors. The need for competence assessment has been enshrined, but the
conceptualization and agreement about what signifies competence in Operating
Theatre has been lacking.
Three focus groups were conducted with 27 operating theatre nurses in
three major metropolitan hospitals in Queensland, Australia. Interviews were
audio taped and field notes were taken. Data were collected during 2008.
Thematic analysis was performed.
From the analysis of the textual data, three themes were identified:
coalescence of theoretical, practical, situational and aesthetic knowledge within a
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technocratic environment; the importance of highly developed communication
skills among teams of divergent personalities and situations; and managing and
coordinating the flow of the list.
These findings identified that competence in respect to components of
knowledge, teamwork and communication, and the ability to coordinate and
manage were important and should be incorporated in operating theatre
Competency Standards. Additionally, findings may assist in the development of
an instrument to measure operating nurses' perceived competence.
According to Pateraki (2003), medical students must be competent in
basic aseptic technique (BAT) to function effectively in the operating room.
However, a comprehensive literature review revealed a deficit of research in
standardized BAT training for the operating room in medical school curricula.
A modified reactive Delphi technique was used to survey an expert panel
of 100 surgical educators. A focus group provided initial responses to key
questions, and the panel completed two surveys. In the first survey, the panel
identified elements for a BAT curriculum for the operating room. In the second
survey, the panel received feedback from the first survey and was asked to
respond in light of those results.
An 81% response rate was obtained from the first survey. A 74%
response rate was obtained from the second survey. Seven of the 18 essential
entry-level competencies (EELCs) identified were ranked as the most important.
The top five instructional strategies and the top three methods for evaluation
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were also selected. The panel identified the third-year curriculum as the preferred
time of training and a nurse preceptor/educator as the preferred instructor.
These results provided a minimum set of educational objectives that could
be used to develop a standardized curriculum in BAT for the operating room for
medical students.
According to Howery DI (2000), there are indications of lack of
cooperation, lack of special O.R. training, as well as incompetence in hospital
management. Given that most subordinates considered their superior as hard-
working and responsible, the reasons why hospital management was unable to
appoint head nurses capable of managing the operating room in a conscientious
manner should be studied since good-will alone is not enough to create
competent leaders. Ways must be found to improve surgical team cohesion and
increase the team’s efficiency so that all of its members could enjoy job
satisfaction, which they deserved anyway.
On the other hand, the Australian Nursing Council-ANC (2002) provided a
guidance as to how assessment of competence might occur and identified six
principles for the assessment of competency: accountability, performance-based
assessment, contextual relevance, evidenced-based assessment, participation
and collaboration.
A study of 831 Australian health professionals including nurses revealed
that all health professionals involved in the study rated the ANCI competencies
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as important and that the nurses identified 19 out of 65 competencies as unique
to the nursing profession.
From the regulatory perspective, although the ANMC competency
standards were already endorsed by all state and territory regulatory authorities,
the National Review of Nursing Education (2002) initiated by the Department of
Education, Science and Training took a more formalized and national approach
and recommended that nationally agreed principles be developed to underpin
State and Territory nursing legislation that should include requirements for
assessment against ANCI competencies for initial regulation of registered and
enrolled nurses.
From an academic perspective, the competencies were used as the basis
for all undergraduate programs and all nursing undergraduate curricula were
designed to meet the desired competency standards. However, the
competencies were not sufficiently culturally sensitive for contemporary
Australian society.
Brazen’ study (2003) revealed that most competencies in the human and
leadership categories were rated higher than the competencies in the financial
management, conceptual, and technical categories. These scores were
consistent on both subscale one (ie, knowledge and understanding) and
subscale two (ability to implement and/or use). Seven of the 10 lowest-rated
competencies were from the conceptual and technical categories; however, two
technical competencies (ie, nursing practice standards and infection control
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practices) were rated among the top five competencies on subscales one and
two.
Local Literature
In response to the call of the World Health Assembly, the Philippines
reinforced and institutionalized the implementation of quality assurance where
patient safety was regarded as one of the key dimensions of quality care. It was
critical in the development of systems to improve health outcomes in the
Fourmula One for Health. The country however needed to consolidate the gains
of these efforts, strengthen a nationwide reporting system of adverse events, and
institute a mechanism that would encourage disclosures about said events.
Likewise, there was a dire need to encourage research in patient safety,
epidemiological studies of risk factors, effective and protective interventions,
assessment of associated cost of damage and protection. To secure more,
better and sustained financing for health; assure the quality and affordability of
health, goods and services; ensure access to and availability of essential and
basic health packages and improve performance of the health system, the
Department of Health and the Philippine Health Insurance Corporation (PHIC)
affirmed their commitment to patient safety policies and objectives thru the DOH
mandate, the Fourmula One(F1) for Health, and thru the Philippine Health
Insurance Corporation (PHIC) Benchbook to adopt the Fifty-fifth World Health
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Assembly’s resolution in the formulating guidelines for the implementation of
Patient Safety Program.
According to maintaining technical competency includes providing clinical
expertise and implementing intra-operative care planning and general nursing
guidelines. Operating room nurse-managers maintain technical competence and
apply humanistic competency when teaching novice operating room staff
members. The potential operating room nurse managers of the future gain the
trust and respect of both staff members and physicians. Conceptual competency
refers to the ability to visualize the entire scope of a specific procedure.
Competent operating room nurse- managers understand that the operating room
is one unit within the total health care facility. They process competing demands
and address multiple tasks simultaneously, including financial management (eg,
budgeting, productivity, cost/benefit analysis). Maintaining financial goals must
be accomplished within a humanistic frame of reference. Furthermore, as leaders
of their units, operating room nurse managers guide, mentor, and delegate to
empower coworkers and direct problem-solving efforts.
Local Studies
In 1999, the qualitative study conducted by revealed that operating room
nurse-managers needed technical skills in clinical and managerial areas, in
addition to the human and conceptual skills.
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In 2003, a researcher named explored on the professional preparation
required of operating room administrators. Although he did not identify specific
competencies, he did identify the need for in-service education because most
operating nurse managers were promoted from clinical positions and lacked
administrative backgrounds. He also examined hospital-based nurse-managers’
competencies and determined which competencies were most necessary for
them to be effective.
Synthesis of the Reviewed Literature and Studies
The related literature and studies—both foreign and local reviewed in the
conduct of the present study were similarly related with each other, this is owing
to the fact that they all deal with the present status of competencies of nurse,
here in the local setting and in abroad.
The related literature and studies cited in this study gave the researchers
an idea on the concept, mechanics and designs on how to conduct the present
study. The related literature and studies consulted in the conduct of the present
study only differs in terms of respondents, setting, period covered, and most
obviously the way how the present study will be conducted, including the
research design and statistical treatment of data.
Despite of the some few indifference encountered, the related literature
and studies earlier presented, all of them gave impetus and direction to the
researcher to effectively interpret relevant data, purposely to have clear
discussion on competencies of nurse, and other considerations relatively with the
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conduct of the present study. Hence, in this particular instance the reviewed
literature and studies, both foreign and local are considered relevance in the
conduct of the present study.
Just get the main idea in every literature that you have reviewed, there is no
need for you to actually copy paragraphs from each literature. If you can get
literature that will follow this logical sequence: RN competencies, practice after
passing the board like residency or internship program that further enhance their
competencies, government aided programs for RN to improve their training,
government program on employment of professionals.
Formatted: Normal, Justified, Line sDouble
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CHAPTER 3
RESEARCH METHODS AND PROCEDURES
This chapter presents the following: research methods, population of the
study, sampling designs, instrument used, reliability and validity of instrument,
procedures in data gathering, and statistical treatment of data.
Research Methods
This research study will used the descriptive method of research. Soriano
(2010) defines descriptive type of research as a study that finds answer to the
questions who, what, when, where and how. This type of research describes a
situation or given state of affairs in terms of special aspects or factors. This study
will be conducted through the normative survey with the use of questionnaire
checklist and interview schedule, actual observations within the research locale
of the study, and focal group discussion with the different sectors of the society in
the locality.
Population of the Study
The respondents involved in the conduct of this research study will be the
nurse, doctors, and selected patients within the PJGMRMC hospital. Table 1
presents the population and samples of the study.
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Table 1 Population of the Study
Respondents F %
Nurse 20 33.33%
Doctors 10 16.66%
Selected Patients 30 50.00%Total 60 100%
How did you get the numbers and the percentages of respondents?
Sampling Design
The samples were selected through purposive sampling of the actual number
of the nurse, doctors, and selected patients within the jurisdiction of the research
locale of the study. This sampling design was adopted based on the rationale
that a true picture on the extent of competencies acquired in the registered nurse
heals program in PJGMRMC hospital, using as subjects the above stated
respondents. If it is purposive you have to provide criteria to follow in the
selection of your respondents.
Procedures in Data Gathering
The researchers will first seek permission from the Director of the
PJGMRMC hospital for allowing him to float the questionnaire checklist, conduct
personal interviews from among the target respondents, and undergo actual
observations in the research locale of the study. The researcher will personally
administer ed and explained the mechanics and concepts in answering the
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questionnaire checklist for a period of one month to the target respondents to
facilitate the early retrieval of the instrument.
The data that will come from the conduct of personal interviews and actual
observations were used to supplement and contribute in assessing the 1) extent
of competencies acquired in the Registered Nurses for Health Enhancement and
Local Service (RN-HEALS) program in PJGMRMC hospital; 2) degree of the
problems met in the Registered Nurses for Health Enhancement and Local
Service (RN-HEALS) program in PJGMMRC hospital.
Research Instrument
This study will use a questionnaire that will be devised with the help and
guidance of adviser. It will be divided in four parts, as follows:
Part I of the instrument will be composed of 5-item checklist under six (or
three) headings, and that is: cognitive, affective, and psychomotor, which are all
designed to draw information on the extent of competencies acquired in the
Registered Nurses for Health Enhancement and Local Service (RN-HEALS)
program in PJGMRMC hospital.
The responses to each item will be evaluated according to the five-point
bipolar scale below:
Ranges Scale Verbal Description
4.21 - 5.00 5 Very Competent (VC)
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3.41 - 4.20 4 Competent (C)
2.61 - 3.40 3 Moderately Competent (MC)
1.81 - 2.60 2 Slightly Competent (SC)
1.00 - 1.80 1 Not Competent (NC)
Part II of the instrument will be composed of 5-item checklist under six
headings, and that is: cognitive, affective, psychomotor, which are all designed to
draw information on degree of the problems met in the Registered Nurses for
Health Enhancement and Local Service (RN-HEALS) program in PJGMRMC
hospital..
The responses to each item will be evaluated according to the five-point
bipolar scale below:
Ranges Scale Verbal Description
4.21 - 5.00 5 Very Serious (VS)
3.41 - 4.20 4 Serious (S)
2.61 - 3.40 3 Moderately Serious (MS)
1.81 - 2.60 2 Slightly Serious (SR)
1.00 - 1.80 1 Not Serious (NS)
The researcher thru the help of adviser will also formulate an interview
guide schedule with blank spaces provided in each of the item relatively with the
statement of the problem, purposely to gather qualitative information from among
the different groups of respondents, purposely to complement the quantitative
data collected thru the questionnaire checklist.
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The reliability and validity of the instrument will be established through the
following, i.e., the reliability which refers to the consistency of measuring
instrument, often used to describe a test was determined through the conduct of
test-retest.; and the validity, which refers to the degree to which a study supports
the intended conclusions drawn from the results will be establish examining each
item to know whether the instrument in question does in fact measure what it has
been designated to measure.
Statistical Treatment of Data
For Sub-Problem 1. The demographic profile of respondents will be
studied from the responses derived in Part I of the instrument. The frequency and
percentage distribution will be computed to evaluate the responses (Concepcion,
et. al., 2007).
Formula:
% = n x 100N
Where:% = Percentagen = ResponsesN = Population
For Sub-Problems 2,& 4. The extent of competencies acquired, and degree
of the problems met in the registered nurse heals program in PJGMRMC hospital
will be both studied from the responses derived in Part II, and Part III of the
instrument. The total weighted frequency and grand weighted mean will be
computed to evaluate the responses (Ybanez, 1997).
Formula: _
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x = WMN
Where: _ x = Group Mean
= SummationWM = Weighted MeanN = Number of Cases
For Sub-Problems 3 and 5. The significant different in the assessment of
respondents on the extent of competencies acquired in the registered nurse
heals program , and the significant different in the assessment of respondents on
the degree of the problems met in the registered nurse heals program and, will
be both tested by using the f-ratio test. The level of significance will be
established at 0.05 level (Downie and Heath, 1997).
Formula:
f = Between-Groups Variance
Within-Group Variance
F = Mean Square Between (MSB)Mean Square Within (MSW)
F = MSBMSW
Where:
MSB = Sum of Squares Between = SSBDegrees of Freedom Between dfb
MSW = Sum of Squares Within = SSWDegrees of Freedom Between dfb
To find SSB and SSW:Formula:
SSB = (XC)2 - (X)2 = SST – SSB
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N N
SST = X2 – X)2N
F = MSBMSW
Where:
MSB = Sum of Squares Between = SSBDegrees of Freedom Between dfb
SST = Total Sum of Squares
X = Item Values Per Column
N = Total Sample Size
SSB = Sum of Square Between
XC = Sum of the Value per Column
n = Sample Size
SSW = Sum of Squares Within
Note:
Find the SSB and SSW to solve the MSB and MSW, and then finally the f-
ratio.
Rule:
If after the computation, the result of the computed f-ratio is larger than
critical value of F05, reject Ho., or otherwise accept it.
This study will also use the qualitative and quantitative researches. In
quantitative research concepts are assigned numerical value, whereas in
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qualitative research concepts are viewed as sensitizing ideas or terms that
enhances understanding of a given phenomenon (Hagan, 2003). The above
research methodology will be used based on the rationale that the true picture on
the extent of competencies acquired and degree of the problems met in the
Registered Nurses for Health Enhancement and Local Service (RN-HEALS)
program in PJGMRMC hospital will be determined.