Clinical Performance describes a competent level of behavior in the professional role,

including activities related to ethics, education, evidence-based practice and research,

quality of practice, communication, leadership, collaboration, professional practice
evaluation, resource utilization, and environmental health.

Purpose:

This study is designed to determine and evaluate the level clinical performance of staff
nurses in selected secondary hospitals in Manila. The findings of this study will not only
provide a baseline information on the level of professional practice, but will also generate
valuable insights and inputs in the development or strategies to provide support among
staff nurses during the transition of their professional practice.

Theoretical Framework

Figure 1. Shows Benners Theoretical Framework from Novice to Expert Skill

Acquisition. Using pyramid graph which is best used to organized hierarchical way to
indicate the level of clinical performance from bottom to top which is from novice to expert
stage.

Patricia Benner, nursing expertise closely follows the skill acquisition theory
developed by Dreyfus (1986). It proposes that the road from novice to expert nurse
encompasses five stages.

Stage 1 Novice: The bottom of the pyramid shows the first level of clinical performance,
Novice stage describes that the nurse has no background experience of the situation on
which he or she is involved. The novice also has difficulty in discriminating between
relevant and irrelevant aspects of the situation.

Stage 2 Advanced Beginner: the 2nd bottom line of the pyramid discuss advance
beginner as described by Benner, has a sufficient experience to easily understand
aspects of the situation. Clinical situations are viewed by nurses at the advanced beginner
stage as a challenge of their abilities and the demands of the situation place on them
instead of the patients needs.
Stage 3 Competent: the middle line of the pyramid shows the competent nurse considers
consistency, predictability, and time management as essential components. An increased
level of efficiency is evident. The competent nurse may display more responsibility for the
patient.
Stage 4 Proficient: the 4th line near the top of pyramid discuss the proficient level, In this
level, nurse identifies the most significant aspects and has a better understanding of the
situation based on background setting. They show an increase confidence in their
knowledge and skills.
Stage 5 Expert: The top of the pyramid, the last stage of clinical performance shows
expert nurses who are no longer relying on principles, rules, or guidelines to connect
situations and determine actions. They have much more background of experience. Has
intuitive grasp of clinical situations. Their performance is now fluid, flexible, and highly-
proficient

Research Paradigm

The upper box shows the theory that will be used in the study. The researcher will
use Skill Acquisition Theory of Patricia Benner which pertains to the, novice, advance
beginner, competent, proficient and expert nurses. The arrow going down to the next box
shows the second step which consists of the demographic profile and the 11 core
competencies from the PRC- BON (2009) written on the questionnaire to be use for
conducting the study. The arrows from the left and right boxes pertains to the significant
difference of the staff nurses self-evaluation and head nurses evaluation. From the
center, an arrow leading to the next box which contains the steps involving the
identification of strong and weak areas of core competencies. The lower box rules out a
proposal for a staff development based from the weak areas identified as a results of the
study. The feedback mechanism represented by the broken line in the figure connects
each process box counter validates the findings of the study.

The research paradigm discusses the flow of the study from the theory will be used
up to the outcome of the study. This study will identify the weakness and strength areas
to come up with the proposed nursing staff development based on the feedback of the
respondents.

Statement of the Problem

This study will assess the level of clinical performance of the staff nurses in selected
secondary hospitals in Manila. Specifically, this study aims to answer the following
questions:

1. What is the demographic profile of respondents in terms of;

1.1 Age;

1.2 Civil status;

1.3 Clinical area;

1.4 Educational Attainment;

1.5 Gender;
 1.6 Years of Clinical Experience?

2. What is the level of competency of the staff nurses based on their head nurses
evaluation in terms of the following;

2.1 Safety and Quality Care;

2.2 Management of Resources and Environment;

2.3 Health Education;

2.4 Legal Responsibility;

2.5 Ethico- Moral 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 Teamwork?

3. To what extent are the nursing core competencies performed efficiently by the staff
nurses as perceived by themselves and their head nurses?
4. Is there any significant difference in the staff nurses knowledge and their clinical
performance as perceived by themselves and their head nurses?
5. Is there a significant difference in the staff nurses clinical performance between
the two secondary hospitals?
6. Based on the results of evaluation, what are the areas of strength and weakness
of 11 core competencies according to staff nurses evaluation and their head
nurses evaluation?
7. Based on the findings, what staff nurses development progress can be
developed?

Research Hypothesis

Ho There is no significant difference in the staff nurses knowledge and their clinical
performance as perceived by themselves and their head nurse.
Ho - There is no significant difference in the staff nurses clinical performance between
the two secondary hospitals

Significance of the Study

This study is designed to evaluate the clinical performance of staff nurses. It also plays
an important role to all the staff nurses to help them to become aware of what they are
practicing and to know what will be the effects of this study to their competency. The result
of this study will be useful to the following:

Nursing Association. This study will provide an opportunity for professional nurses to
develop a bigger picture of nursing and health care overall.

Agency/Hospital. This study will provide performance evaluation of their staff nurses and
identifies their need for improvement.

Nursing School. This study will give benefits to the school and opportunities to the
student to choose their career.

Nursing Students. This study will give knowledge and background about the importance
of competency of staff nurses in the clinical setting.

Staff Nurses. This study will help the staff nurses determine their strength and
weaknesses to improve their clinical performance.

Patient. This study will help to provide quality patient care by the staff nurses evaluation
of their clinical performance.

Future Researcher. This study will provide additional information and new insight as well
as on such topics in, which hopefully, will be developed by future researchers to make it
more responsive and updated to the needs of others with similar situation.

Scope and Delimitation

The respondents of the study are 10 head nurses to evaluate the clinical performance
of 60 staff nurses. The nurses that will evaluate themselves and to be evaluated by their
head nurses are from Mary Chiles General Hospital, a secondary hospital with 100 bed
capacities and Mandaluyong City Medical Center, also a secondary hospital with 105 bed
capacities. The data gathering will be conducted on October to November 2017. The
qualified staff nurses to evaluate themselves and to be evaluated by their head nurses
are; male and female staff nurses presently employed in the selected secondary hospital,
registered nurses in the Philippines with or without experience in the nursing field, and
staff nurses who has the willingness to participate in the study. And the criteria for head
nurses who will evaluate the staff nurses are the following: Had a direct supervision to
the beginning staff nurses, with at least six (6) months of experience as a head nurse,
and has the willingness to participate in the study.
To those who did not fall to the category are; staff nurse that is not employed in the
selected secondary hospital, nurse supervisors, nursing aides, other medical staff, and to
those who are not willing to participate in the study.

Definition of Terms

Researchers used conceptual and operational definition.

Advance Beginner. Refers to the new graduates in their first jobs, have had more
experience that enable them to recognize recurrent, meaningful components of situations.

Age. Refers to the staff nurses age are 20 years old and above.

Civil Status. Refers the marital status of the staff nurse (e.g. single, married, and
widowed).

Collaboration and Teamwork. Refers to health care professionals assuming

complementary roles and cooperatively working together, sharing responsibility for
problem-solving and making decisions to formulate and carry out plans for patient care.

Communication. Refers to imperative in the health care environment and occurs

between various individuals on a daily basis by way of verbal, non-verbal and written
communication.

Competent. Refers to the nurses lack the speed and flexibility of proficient nurses, but
they have some mastery and can rely on advance planning and organizational skills.

Clinical Area. Refers where the staff nurse is assigned (e.g. ward, emergency room, and
operating room).

Clinical Performance. Refers to the level of the staff nurses performance in the clinical
field.

Educational Attainment. Refers to the education degree finished by the staff nurse (e.g.
BSN, Masteral, Doctoral etc.).

Ethico- Moral Responsibility. Refers to involve the nurses respect for the right of
individuals and groups; acceptance of the responsibility and accountability for own
decisions and actions; and adherence to international and national code of ethics for
nurses.

Evaluation. The process of determining the progress toward at- tainment of expected
outcomes, including the effectiveness of care.
Expert. Refers to the nurses who are no longer relies on principles, roles or regulations
to connect situation and determine actions, they are highly proficient and flexible.

Health Education. Refers to the ability of the nurse to assess the learning needs of the
patient; develop health education based on the assessed and anticipated needs; develop
learning materials to health education; implement health education plan; and evaluate the
outcomes of health education.

Legal Responsibilities. Refers to the nurses adherence to practices in accordance with

the nursing law and related legislation including contracts, informed consent, etc. and to
local and national organizational policies and procedures.

Management of Resources and Environment. Refers to the nurses ability to organize

work to facilitate patient care; utilize resources to support patient care, ensure functioning
of resources, check proper functioning of equipments, and maintain a safe environment.

Novice. Refers to the nursing student in his or her first year of clinical education, behavior
in the clinical setting is very limited and inflexible.

Personal and Professional Development. Refers to the nurses ability to identify his/her
own learning needs; pursue continuing education; get involved in professional
organization; project the professional image of a nurse; possess a positive attitude
towards change and criticisms; and perform functions according to professional standard.

Proficient. Refers to the nurses perceives and understands situations as whole parts,
learns from experiences what to expect in certain situations and how to modify plans.

Quality Improvement. Refers to the nurses capability to gather data for quality
improvement; participate in nursing audits and rounds; identify and report variances; and
recommend solutions to identified problems.

Record Management. Refers to the nurses ability to maintain accurate and updated
documentation of patient care; record outcome of patient care; and observe legal
imperatives in record keeping.

Research. Refers to the nurses skills in data gathering using different methodologies;
formulating recommendations for implementation; application of research findings in
nursing practice; and dissemination of results of research findings.

Safety and Quality Care. Refers to the nurses ability to demonstrate knowledge based
on the health or illness status of the client, provide sound decision-making, and promote
safety and comfort of clients, set priorities in care based on needs.

Staff Nurse. Refers to the nurse working regularly on a hospital.

Gender. Refers to the respondents of the study are male and female.

Secondary Hospitals. Refers to healthcare provided by the medical specialists and other
health problems who do not have direct contact with a patient like urologist, dermatologist,
and cardiologist; perform some surgeries and laboratory examinations. The following
selected hospitals are Mary Chiles General Hospital and Mandaluyong City Medical
Center

Years of Clinical Experience. Refers to the length of clinical exposure in the hospital.

Chapter 3

METHODOLOGY OF THE STUDY

This chapter discusses the methods and procedures implemented in conducting

the study. It includes the research design, population sampling, research instrument,
validation of questionnaire, data gathering procedures, ethical considerations and
statistical treatments.

Research Design
Research design refers to the overall strategy that the researchers will choose to
integrate the different components of the study. It provides maximum control over
extraneous variables and other phenomena that can influence the results of the study
and affect its validity. (Salustiano, 2009)
The researchers will use quantitative comparative research design in order to
obtain data about evaluation of the staff nurses in 11 areas of core competencies with
respect to the current status of their levels. This research is designed to obtain information
about the prevalence, distribution, and interrelations of variables within a population. This
research also compares the characteristics of groups according to some selected
variables as it is being evaluated also by head nurses, and its main purpose is to
determine the difference without determining the cause.
Population and sampling

Population refers to the largest body or totality of cases or individuals which

conforms to a set of specifications or designated criteria and is accessible as a pool of
subject for a study. Furthermore, research sampling is the process of selecting a portion
of the population to represent the research sample. (Salustiano, 2009)

Non-randomized purposive sampling will be used wherein respondents have

chosen based on predefined criteria to ensure accurate results. This type of sampling is
based on the assumptions that the researcher or the chosen expert has enough
knowledge about the population of interest to select specific subject of the study.
The criteria used in picking the sample of staff nurses are the following:
 1. Male and female registered nurses in the Philippines with or without experience in
the nursing field.
2. Presently employed in the selected secondary hospital.
3. Have the willingness to participate in the study.
For the head nurses who will evaluate the staff nurses, the following are the established
criteria:
1. Had a direct supervision to the beginning staff nurses.
2. At least had six (6) months experience as a head nurse.
3. Have the willingness to participate in the study.
Research Instrument
Research instruments are the formal tools, devices or means utilized to collect
needed data or information. (Salustiano, 2009)
The researcher will use a modified questionnaire as the instrument in gathering
data. The questionnaire consists of indicators from Nursing Core Competencies
formulated by PRC-BON National Core Competency Standards for Filipino Nurses. (Rev.
May 2009).

This questionnaire will be answered by putting a check on the respondents choice

according to the question being asked. The researcher had come up with the rating scale
in order to guide the respondents in answering the questionnaire. A 5 (five)-point Likert
scale is used as rating scale of the instrument. The respondents will be asked to indicate
the level of clinical performance expressed in the scale; and choose one numerical value
for each item. The ratings were describe as follows:

Rate of the Performance to determine the level of Clinical Performance of Staff Nurses
 Rate Description Interpretation

5 Outstanding Always perform it at all

times

4 Very Satisfactory Occasionally performs it 7-

8 times out of 10 occasions;
80%

3 Satisfactory Sometimes performs it 4-6

times out of 10 occasions;
50%

2 Unsatisfactory Seldom performs it 1-3

times out 10 occasions;
20%

1 Poor Never performs it all; 0%

Validation of Questionnaire
Measurement is an essential activity of medical science. In order to acquire data
about people, objects, and events proper data collection tools needs to be designed which
can measure things of scientific interest. Questionnaire is one of the most important
techniques to collect data. If a new questionnaire is to be developed, it should be pilot
tested and validation in order to evaluate if it is measuring what it supposed to measure
and is it doing it reliably. (Kazi & Khalid, 2012)

A letter of request will be addressed to the 3 (three) experts requesting for their
expertise to validate our questionnaire. It is further reviewed and revised in collaboration
with the experts so that the appropriate items will be included. After the questionnaire will
be validated by the experts, a pre-testing will be conducted in 10 sample of staff nurses
from the other hospital that is not included in our study. The tool will be presented in a
professional manner with a cover letter introducing the questionnaire to the respondents.
The questionnaire will be answered up to 15-30 minutes by each respondent.
Data Gathering Procedure
Prior to data gathering, a letter of request will be sent to the Dean of the
College of Nursing in Mary Chiles College and to the chief nurses of the selected
secondary hospital. Actual data gathering will begin right after the validation of
questionnaire. The validated research questionnaire will be distributed to the respondents
through facilitative effort of the Head Nurses of the secondary hospital. The respondents
will be given 7 days to answer the research questionnaire.
The research questionnaire will be answered by the 60 Staff Nurses, 30 from Mary
Chiles General, and 30 from Mandaluyong City Medical Center wherein they will evaluate
themselves, and the 10 Head Nurses, 5 of each selected secondary hospital will evaluate
their staff nurses by selecting the appropriate number point from the scale of 5-1 with the
corresponding descriptive value to show what extent a staff nurse is exhibiting an
acceptable behavior.
After the allotted time of answering the research questionnaires, researchers will
collect the data with strictly applying the confidentiality of the respondents.

Ethical Consideration
Most research in health care involves human subjects. To protect human subjects,
ethical guidelines and procedures need to be developed and the content of the study plan
meticulously reviewed to ensure that the research adheres to ethical principles and that
it protects the rights of subject. (Salustiano, 2009)
The respondents has the right to decide voluntarily, freely and without coercion to
participate or not and to refuse to give information without risking any penalty or threats
of penalty (Salustiano, 2009).
Informed consent along with the permit approved by the chief nurses' will be
attached to the research questionnaire to ensure that the participants are well informed
about the study before he or she consents to participate and before he signs the consent
form. (Salustiano, 2009)
After the data will be collected, privacy and confidentiality will be ensured. Every
participant have the right to expect that researchers will ensure that any information he
will provide, and his identity will be kept in the highest level of confidentiality. Furthermore,
confidentiality ensures that the identity of the participants will not be linked with the data
or information he provides and will not be publicly divulged.

Statistical Treatment
 To answer the hypothesis of this study, the results will be analyzed using the
following statistical treatment.
Frequency and percentage
A frequency and percentage distribution is a display of data that specifies the
percentage of observations that exist for each data point or grouping of data points.
(Lavrakas, 2008)
Frequency and percentage will be used in the statement of the problem number 1
(one) and number 2 (two). In the statement of the problem number 1 (one), researchers
will use frequency and percentage which is concerned of the respondent in terms of their
age, civil status, clinical area, educational attainment, gender, and years of experience.
In the statement of the problem number 2 (two) is concerned of the staff nurses level of
performance based on the 11 nursing core competency.
Formula:
% = (f/N x 100)
Where:
f = frequency of responses
N = total number of respondents
100 = the constant number in order to get percentage
Weighted Mean
According to Salustiano, 2009 weighted mean refers to the overall average of
responses or perceptions of the study subjects.
Weighted mean will be used in the statement of the problem number 2 (two), 3
(three), and 6 (six). Weighted mean is computed to determine the overall average of the
nursing core competencies performed efficiently by the staff nurses as perceived by
themselves and their head nurses.
The formula in computing the mean:
Z-test
In the statement of the problem number 4 (four) and 5 (five), the researcher will
use z-test. Z-test is used to determine the difference in the staff nurses knowledge and
their clinical performance as perceived by themselves and their head nurses. In the
statement of the problem number 4 (four), it will be used to determine the difference in
the staff nurses knowledge and their clinical performance as perceived by themselves
and their head nurses. In the statement of the problem number 5 (five), z-test will be used
to determine the difference between the two secondary hospitals in terms of their staff
nurses clinical performance.