CHAPTER 1

INTRODUCTION

This chapter involves selecting the defining area of research that provides opportunity

in advancing nursing science. The purpose of this chapter is to introduce, define important

variables and, show the gaps in nursing knowledge. This includes the background of the

study, statement of the problem, significance of the study to the nursing field, scope and

delimitation and definition of terms. The researcher’s task in this chapter is to get the reader’s

attention and let him have interest in the result of the study.

Background of the Study

The background of the study explains what the study is about and why the study

should be conducted. The first paragraph of the study should explain “what” the research is,

the aim and focus. It starts with a topic sentence. It could be the main problem or the main

concept of the study. The Background of the Study has to set the reader’s mind regarding

included participants and specific setting of the study. It also shows the reason why there is a

need to conduct the research. Remember to use third person throughout the manuscript.

In the introduction the variables should be clearly defined. The constructs used in the

study should be clearly explained. What is the existing literature in the topic of the study?

How serious is the problem that it needs to be researched? What is the magnitude of the

problem? Does it really need to be researched as a trend? If it is a health research present

the existing weakness of the study population or nursing practice. What are their strengths

that can be used in solving such problem. Illustrate the possible opportunities and possible

threat in the participants and in clinical or nursing practice. Is your research, after getting the
 2

result creates a great impact in the nursing practice? Or in the community? Or to

stakeholders?

Going back to definition of variables, it is extremely useful in laying the background.

However it must be an operational definition. Avoid dictionary definitions, if variables in the

study are described according to dictionary or universal meaning, the concept need not be

defined.

According to Polit and Beck (2007) the introduction acquaints readers with the

research problem and its context. This section usually describes the following: (1) the central

phenomena, concepts, or variables under study. The problem area under investigation is

identified; (2) the statement of purpose, and research questions or hypotheses to be tested.

The reader is told what the researcher set out to accomplish in the study; (3) a review of the

related literature. Current knowledge relating to the study problem is briefly described so

readers can understand how the study fits in with previous findings and can assess the

contribution of the new study. (4) the theoretical framework. If it is theoretically driven

study, the framework is usually presented in the introduction; (5) the significance of and

need for the study. The introduction to most research reports includes an explanation of why

the study is important to nursing. Thus, the introduction sets the stage for a description of

what the researcher did and what was learned.

Example of introductory paragraph of Vicente and Habaradas in their study

Accessibility of Essential Medicine among Selected Ecotourism Sites in Puerto Princesa City

“Essential medicines”, according to the World Health Organization (WHO), are those that
“satisfy the priority health care needs of the population‖ and are intended to be available within
the context of functioning health systems at all times in adequate amounts, in the appropriate
dosage forms, with assured quality, and at a price the individual and the community can afford.”
The United Nations Development Group defines “access” in this context as having medicines
 3

continuously available and affordable at public or private health facilities or medicine outlets that
are within one hour‘s walk from the homes of the population.

As a component of the right to health, the right to essential medicines depends not only
on the production, distribution, and pricing of medicines, but also on the incentives for research
and development of drugs needed to treat diseases in developing countries, on functioning health
systems, so that drugs are part of a rational system of quality treatment and care, as well as on
infrastructure, so that they can be delivered to all areas where they are needed .”
(Jane Fatima Vicente & Mary Joy Habaradas, Accessibility of Essential Medicine among
Selected Ecotourism Sites in Puerto Princesa City, 2010, p.1)

In the above example the first paragraph is a definition of concepts. In this case it is

extremely useful that it served the purpose of the researchers’ own meaning. The description of

essential medicine and accessibility are not the conventional uses but from an organization with

great authority in health, essential as basic need and accessibility is used according to the existing

ideal delivery of health care, availability and affordability.

The second paragraph pointed out the significance of accessibility of essential medicine

to people’s right. Here the researchers positioned their major argument in the study.

This Background of the Study is an excerpt from unpublished work of Liao et al

(2013),

“In the Philippines, disparities exist in health care attendants’ maternal and newborn
care practices. The country’s Millennium Development Goal (MDG) target may not be
achieved because of slowing of decrease of maternal and neonatal mortality rate. Every year
there is an average of 550 per 100,000 Filipino women die because of child birth. According
to statistics it is one of the major causes of women’s death. Also every year approximately
40,000 Filipino neonates die, the majority die within the first two days in their first week of
life. Several studies revealed that infant mortality and morbidity are results of inadequate or
inappropriate care during pregnancy, childbirth, or the first critical hours after birth. (Basics
II, 2004) There are harmful newborn care practices that are discouraged because the
mortality and morbidity rates are directly related to inappropriate hospital and community
practices however it is still practiced today.

Several studies conducted in urban health facilities (Liao, et al, 2011, Sobel et al,
2011; WHO 2008; UNICEF, 2004) revealed that the practice of skilled birth attendants on
newborn care is below the Department of Health (DOH) and World Health Organization
(WHO) standards. The immediate clamping of the cord, early bathing, routine suctioning,
immediate dressing of the baby and separation from the mother contradict the basic
recommended interventions of WHO and DOH. There is also a misplaced perception that the
 4

care of the newborn improves by complex technology. (Basics II, 2004) Birth attendants
believed that if they do not have the modern facility they cannot render standard care
expected from them.

In 2009 the DOH issued an Administrative Order 2009-0025, it is about proper

guideline on how to manage newborns. In response to the order a new neonatal protocol and
program was launched on December 30, 2009. A year after its launching the intrapatum care
was integrated in the protocol from Essential Newborn Care (ENC) it became Essential
Intrapartum Newborn Care (EINC). Their campaign slogan is Unang Yakap (The First
Embrace). Government health agencies, Health Professional organizations and the academe
were trained on new protocol and campaigned on its use afterwards. Health care providers
were updated through conventions, seminars, workshops and formal trainings.

In 2011 survey among Clinical Instructors (CI) of Midwifery schools who attended
the midwifery training on Essential Intarapartum Newborn Care (EINC) conducted by the
Association of Philippines Schools of Midwifery (APSOM) in Metro Manila, all of the Basic
Emergency Obstetric Neonatal Care facilities (BeMONC) (where the CI’s were affiliated)
has the highest compliance in the Essential Newborn Care (ENC). It turned out that the
private hospitals has the lowest compliance to the said directive followed by private birthing
homes and provincial hospitals.

In focused study conducted in Puerto Princesa City health facilities, some health
workers have awareness in Unang Yakap but they can not fully grasp its protocol. If the
health practitioners can not fully understand the program it would also affect its practice. The
extent of the EINC campaign and level of awareness of the health care providers on EINC is
yet to be discovered. Knowledge and awareness of mothers on Unang Yakap who gave birth
from middle of 2010 to this period is yet to know. Is there any campaign and training done to
private practitioners such as midwives and nurses? Awareness follows knowledge and
knowledge is followed by change of behavior that will then result into action.

The course Diploma in Midwifery in Palawan State University was first established
in 1985. Since then...”

(April Grace O. Liao, Rhodora C. Manalon, and Jojie C. Martal, The Essential Intrapartum
Newborn Care Practice in Private Birthing Homes in Puerto Princesa City: A Training
Manual Development for Birth Attendants in Private Practice: A Research Proposal for
Manual Development for Midwifery and Nursing Students and Professionals by the Faculty
of College of Nursing and Health Sciences, Palawan State University, 2013, p 5)

Another example:

“Metro Manila is the largest and most populous city in the Philippines, with a
population that is projected to reach about 170 million by the year 2000. Census and
registration statistics have shown that fertility has been declining in Manila since the middle
of the 1960s; the total fertility rate dropped from 6.2 children per woman in 1960 to 3.5 in
1986.2 The largest declines between 1980 and 1984 occurred in the Central East region (a 25
 5

percent drop) and in the Northeast (20 percent). Because poorer women make up the major
part of the population of these two regions, the data suggest that they are reducing their
childbearing substantially. (Phillip, 1989) In addition, a number of surveys have
demonstrated increases in contraceptive practice among Filipino women. These changes have
occurred in the absence of an effective government- sponsored family planning program,
although since 1983... and the Ministry of Social Security (Instituto Nacional de Assistência
Médica e Previdência Social—INAMPS) began a similar program in 1985.” (Sarah Hawker
Costa, Ignez Ramos Martin, Sylvia Regina da Silva Freitas and Cristiane Schuch Pinto,
Family Planning from Low-Income Women in Metro Manila: 1984-1985, International
Family Planning Perspective, 1989 p.8)

Statement of the Problem

Determine the overall purpose of the problem. The main problem can be expressed in

declarative form and specific problems in interrogative form. See the example below:

“This study aimed to determine the accessibility of essential medicine among

households in selected eco-tourism sites of Puerto Princesa City.”

“The main purpose of the study is to develop an educational manual for birth

attendants and health care students that can be used during EINC training. It is necessary to

test and observe the respondents basic knowledge and skills to determine the effectiveness of

the manual.”

“This study is designed to measure patterns of contraceptive practice in seven slum

communities of Metro Manila in late 1984 and early 1985.”

Significance of the Study

In this part the rationale why the study needs to be conducted is explained. It must

state the contribution it will make in the society (government), to nursing practice

(profession), institution and readers. It has to describe the contribution of the study to the

existing knowledge. State in this part the direct beneficiaries of the research. The

enumeration of rationale must be arranged in order of importance, the most important first.
 6

Write the significance in paragraph form not bullet. The importance of the study to the

welfare of the beneficiaries must be arranged according to the degree of importance to them.

The study on utilization of Essential Newborn Care (ENC) of selected birthing home
in Puerto Princesa City as stipulated in DOH AO 2009-0025 is significant to the following:

Department of Health. The result of this study will render awareness to the present
practice. Moreover, it provides a glimpse on the sustainability of this program to Puerto
Princesa City. Further recommendations can be made to strengthen the implementation of
the said program.

Local Government. This study serves as basis in the creation of realistic policy and
rules that assures strict adherence to the EINC procedures.

Birth attendants. It will objectively illustrate how EINC is practiced by different

birth attendants in varied birthing centers. Through review of their actions and reinforcement
this will allow the birth attendants to enhance their capability in doing the EINC procedures.
Thus, the standard practice of intrapartum and newborn care will be strictly followed.

Researchers. The result of this study can be a helpful data for future studies.
Scope and Delimitation

In scope and delimitation briefly state what the study about, who are the respondents,

where the research will be conducted and duration of the study. When it will commence and

when it will end. Explain the variables those that are in the study and explain why some

variables are not included.