QUALITY OF NURSING CARE PRACTICES AMONG SELECT

HOSPITALS IN BATAAN: BASIS OF NURSE MANAGERS

ON QUALITY OF NURSING CARE PROGRAM

______________________

A Thesis
Presented to the
Faculty of the Graduate School
BATAAN PENINSULA STATE UNIVERSITY
Main Campus, Balanga City, Bataan

_______________________

In Partial Fulfillment
Of the Requirements for the Degree
Master of Arts in Nursing

______________________

BY

YOLANDA V. ESCONDE
2018
 CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Introduction

In the advent of the coming of the 21st century, advances in medical science emergence of

new technologies and equipment, redesigning of building facilities, more focus in addressing

problems of errors in health care and serious safety issues, leveling up of health care processes and

health insurances were realigned so that the medical workers specially the doctors, nurses and

caregivers and the resource that supports them are set up for enabling more safe care.

The health care quality continuously to be a subject of intense criticism and

debate, since quality nursing care is vital to patient outcomes and safety. Nurses play

a vital role in improving the quality and safety of patients’ care not only in the

hospital or ambulatory treatment facility but also of community- based care and the

care performed by family members. Nurses need to know what proven techniques

and interventions they can use to enhance patients’ outcomes According to to

American Nurses Association (ANA) for over 100 years they have worked to

improve the quality of patients’ safety by promoting quality in nursing care and

nurses work lives.

In the Philippines, health care system can be considered to be of good

standard, despite the fact that the facilities may not be impressive as those found in

high end US or European hospitals. We have the nursing standards that regulate the
nursing policies and procedures as mentioned in Republic Act 9173 of 2002. As

Filipinos, caring aspect of the nurses is one of the most important aspect in dealing

with clients and patients as well.

Good quality nursing care therefore means a good experience for patient and

was identified as how and not a what with the core elements of holistic approach on

physical, mental, emotional needs, patient-centered and continuous care. Another is

efficiency and effectiveness combined with humanity and compassion. Professional

high quality evidenced-based practice. Safe, effective and prompt nursing

interventions. Patient empowerment support and advocacy. The last one is the

seamless care through effective teamwork with other profession.

Quality nursing care practices is a combined effort of nurses, patients and

significant others They should work hand in hand for the treatment and recovery of

the patients. It also deals with the patients’ satisfaction, outcomes and perceptions

and the context of care to attain an excellent quality of nursing care.

It is with this context that the researcher wants to pursue this study to have a

pulse of the quality of nursing care to patients and to delve deeper on the nursing

care to determine if this study will be a basis of Nurse Managers on quality of

Nursing Care Program.

Statement of the Problem

The main problem of the study is: what is the quality of nursing care practices

among select hospitals in Bataan that would possibly be the basis in the development

of Nurse Managers in the Quality of Nursing Care Program.

Specifically, the study seeks to answer the following questions:

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

1.1 Patient

1.1.1 age;

1.1.2 gender;

1.1.3 educational attainment;

1.1.4 family income, and

1.1.5 religion ?

1.2 Staff nurses

1.2.1 age;

1.2.2 gender;

1.2.3 civil status;

1.2.4 educational attainment;

1.2.5 area of assignment, and

1.2.6 years in service?

2. How does the nursing staff assess the quality of nursing care practices in

terms of:

2.1 safe and quality nursing 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 record management;

2.9 research;

2.10 communication, and

2.11 collaboration and teamwork?

3. How may the significant difference in quality of nursing care practices among

select hospitals in Bataan be described when grouped according to to the profile

of the patients?

4. How may the significant differences in quality of nursing care practices

among select hospitals in Bataan be described be when grouped according to the

profile of the staff nurses?

5. Based on the findings, how may the select hospitals improve the quality of

nursing care practices?

Significance of the Study

The findings of this study will be important primarily to all medical

practitioners both in public and private hospitals in Bataan, particularly to nurses

and caregivers and the patients for which this study will be conducted. hence the

following will be all benefited:

Nurses. This study may strengthen the quality of the nursing care practices

that are based from standards. This study may also assess the knowledge,

attitudes, and skills of nurses in rendering patient care. Nurses play a vital role

in the early recovery of a patient, therefore, this study will certainly improve

nurses’ care practices

Patient/ Client. These are the direct beneficiaries of this study. All the

patients have the right to receive the best quality of nursing care practices, this

will be a contributory factor to patients’ early recovery.

standards that will guide each nurse , from novice to advance beginners up to

Hospitals. This study will benefit the nursing services in terms of quality of

nursing care practices of hospitals select in Bataan. Their Nursing Program will

focus more on patients’ outcome and satisfaction.

 Nursing Education. This study provides a directive on how the stockholders

will learn from the Program. Nursing students will be benefited by this study

that may be applicable with their future endeavor.

Future Researchers .Findings and recommendations of the study may tend

to give further points of study in conducting a similar research by future

researchers similar the present nursing study.

Scope and Delimitation

This study aims to identify and assess the quality of nursing care practices

among nurses in hospitals select in Bataan as perceived by patients, that will help

the nurse manage in the creation and development of quality of nursing care

program.

This study involves seven (7) private hospitals in Bataan with ____ staff

nurses ____are male while there are _____female. This research will also

include 5% of the patients or clients of the seven hospitals are select who

currently recuperating and ready for discharge at the time of the conduct of this

study. This will also include the profile of the staff nurse in terms of age, gender,

civil status, educational attainment, area of assignment and years of service.

Moreover, the quality of nursing care practices will be assessed in terms of safety

and efficiency of nursing care, management of resources and environment,

health education, legal responsibility, quality improvement, research, record

management, communication and collaboration and teamwork; while the

patients profile will include age, gender, educational attainment, family income

and religion.

This study will be quantitative descriptive and cross-sectional in nature, in the

sense that patients will also be surveyed and interviewed. It will also use

universal and sampling for the nurses and simple random sampling for the

patients.
Notes in Chapter I
 Chapter II

THEORETICAL FRAMEWORK

This chapter presents the relevant theories, related literature and studies,

conceptual paradigm, the hypothesis of the study and the definition of terms.

This study on the Quality of Nursing Care Practices among Select Hospitals

in Bataan. Basis of Nurse Manager in Quality of Nursing Care Program is

premised on the most significant and commonly applied theories in the different

field of studies. Erik Erikson’s (1950) Theory of Psychosocial Development of

Man, Abraham Maslow’s (1943) Theory of Hierarchy of Needs and carl Jung’s

(1920) Theory of Introvert and Extrovert Personalities.

Eriksons Theory of Psychosocial Development of Man is a Comprehensive

Psychoanalytic Theory that identifies a series of eight stages, in which a healthy

developing individual should pass through from infancy to late adulthood be

emphasized that the ego makes positive contributions to development by

mastering attitudes, ideas and skills at each stage of development.

The practice of nursing care is situated within a nursing work environment

embedded in the socio-cultural context of the health care organization. As

providers of care nurses are expected to allocate their time to establish and

maintain therapeutic nurse-patient relationships and implement the nursing

process to maximize patients outcome.

 The emphasis is on individualized patient-centered care and time. Nurses and

patients want more time devoted to patient care.

On the other hand, Maslow’s Theory of Hierarchy of Needs describes that

man has physiologic needs like breathing, food, water, sex, sleep and excretion.

Safety needs of a man include security of body, employment, resources,

morality, family, health, family, health and property.

Another need of man is Love and Belonging needs, this deal with friendship,

sexual intimacy and family. Esteem needs cover self-esteem, confidence and

achievement and the last need is Self-Actualization needs which include

morality, creativity, spontaneity, problem-solving, lack of prejudice and

accepting of facts.

Maslow’s Theory of Hierarchy of Needs posits that humans are motivated by

the intrinsic need for self-actualization. Needs must be met in hierarchical

structure where meeting one need propels the individual to seek meeting

“higher” needs. Nurses can apply Maslow’s Theory to their practice of patient

care. Each person’s need must be met individually in order for them to feel

satisfied, cared for and they can feel the sense of cooperation.

The nurse can identify the level of care required for the patient. Nurses

working is a clinical setting will not need to attend to the need for food and water
 but do need to protect the safety and privacy for their patients. Nurses must adjust

their behavior towards their patients needs.

Research Studies

A major national health insurer is conducting a pilot program in New Jersey,

Delaware USA to evaluate the success of transitional care. As Dr. Mayor states,

nurses will play a pivotal role in addressing the health care needs of people through

out the 21st century. The cutting edge led by nurses and design to advance knowledge

related to promoting healthy lifestyle and caring for the chronically ill, will position

nurses and other health team members to make a major difference in the lives of

these people.

Transitional Care Improves Outcomes for Elders After Leaving the Hospital.

According to Tang, Soong & Lim, patient satisfaction has been viewed as a valid

outcome measure of a health care delivery system. Satisfaction evaluations reflect

the expectations from the patients point of view and compare with the realities of the

care received. Hence, the purpose of the study was to assess patients satisfaction

with nursing care using Patients Satisfaction with Nursing Care Scale. The findings

revealed that the patients rated their satisfaction of nursing care as being at moderate

level of satisfaction. Hence, determining the level of patient satisfaction and the

contributing factors can assist nurses in improving nursing care.

 Quality nursing care is a concept that attracted the interest of nurse

professionals around the world. Despite the different understanding between nurses

and patients two aspects of the care were found common, that is being care for by

competent nurses and addressing the patient needs.

Quality nursing care is a context specific term, meaning that many variables

deriving from contextual factors influence the way that patients and nurses view

quality.

According to the Hellenic Journal of Nursing (2010) reviews quality nursing

care is desired by patients and promised by nurses. However, the complexity and

ambiguity of the term which has been highlighted in the literature obstructs nurses

moving beyond asserting to assuring that the care they provide is excellent.

Researchers have explored the issue of quality mainly from the patients

perspectives. The clinical question which this review attempted to address was

whether a consensus understanding in relation to quality nursing care exists between

patient and nurses.

According to Raya (2011), quality nursing care should be based on the views

of the patients, who are the immediate evaluator of the provided care. Patients and

nurses are those who define and assess quality. Here lies perhaps the reason why

their opinions on what constitutes high quality care or what makes their care

inadequate should be taken into consideration. However, according to Gunthes and

Aligood (2010), impeded the nursing profession to articulate clearly what comprises

high quality nursing care because we have been defining it as a product viewed from

the patients perspective rather than a service offered by the profession.

Raftopoulos & Theodosapoalou (2011) performed a historic review on quality

in the health sector. They assert that even if quality has different meanings to

different people, there are some common elements in the various definitions which

allow its evaluation and assessment. They emphasize that quality is the result of two

dependent variables, the relationship between nurses and patients. Hence, the patient

and the nurse view quality from different perspectives. Quality of care is the degree

to which the health care services provided to the people and populations increase the

likelihood of achieving the desired outcomes based on the current knowledge.

On the other hand, Astedt Kurki haggman-Latila (2010) claim that high

quality nursing care involves an understanding and utilization of principles from the

social sciences. However, the simple possession of knowledge is not enough to

provide quality care. The nurse needs to apply in relation to the patients life.

Fitzpatrish et.al (2011) being provided for by the nurses who are up to date,

well-informed and willing to communicate information about both the health

problem and the necessary care forms the care of patients definition. Patients require

from nurses to hold certain dispositions in order to provide quality care such as
emphaty, reliability, responsiveness and care. Moreover, nurses need to be friendly

kind, objective and possessing a compassionate attitude.

Oermann et.al (2010), acknowledge the fact that the perceptions of quality

nursing care also differ among patients. In-patients have different views of quality

care than do consumers in ambulatory facilities, while hospitalized patients decribed

quality care as hospital staff respecting patients values and needs, coordination of

care, communication and education, physical comfort, emotional support, family

involvement and continuity in the transition to home.

Edgeman-Lewton and Cleary (2012) stated that even ambulatory patients are

also concerned with issues such as access to care, waiting time, assistance from

office staff and follow-up care and information.

Thornstemsson (2012) performed a phenomenological study in order to

investigate how individuals with chronic illness perceive the quality of nursing care.

Eleven Icelandic patients aged 38-80 years with various chronic illnesses were

interviewed and data analyzed through the coding and categorization method. The

analysis revealed that there is not a simple definition of the phenomenon quality of

nursing care. The findings emphasize that the quality of nursing care.

In the study Al-Kuntari & Ogundeyin (2010) and Clemes et.al (2010) appear

to support the estimation that nurses and patients in relation to quality of care while

other studies seem to support otherwise.

 Busset (2012) explored in his research the nurses perceptions of quality care.

He suggested that there are differences between patients and nurses perceive to be

good care. Nurses appeared to values the interpersonal elements.

A research by Erwin et.al (2010) found that patients and staff commonly

disagreed on the nature of the health problems, treatments and outcomes. On the

other hand, Irurita and Altree(2010), reported that patients identified different levels

of quality depended on contextual and intervening conditions worked in the

environment, organization and the personal characteristics of both staff and patients.

Williams(2012) in his study carried out a grounded theory study of the nursing

care. Ten registered nurse purposively selected from four surgical specialty wards

of an acute-care public hospital located in Perth Australia were interviewed.

Additionally, transcripts of 12 additional interviews were made available for

comparison and clarification of categories towards the end of the analysis. Data were

analyzed with use of constant comparative method of analysis, whereby collection,

coding, and analysis occurred simultaneously.

 Chapter III

METHODS OF RESEARCH

This chapter presents the methods and techniques of the study, population of

the study, data collection, data processing, statistical treatment to be used, validation

and administration of the instrument to be used in the present study,

Methodology

This study aims to assess the quality of nursing care practices among select

hospitals in Bataan as possible would-be basis for nurse managers on the quality of

nursing care program.

The method to be used in this study will be qualitative descriptive. Descriptive

research is also known as Statistical research, since it describes data and the

characteristics about the population or phenomenon being studied. This type of study

answers the questions who, what, where, when and how. It is not used in looking for

caused relationship , where one variable affects another. In other words, the goal.

Furthermore, Burns and Groove added that the objective of descriptive

research are the accurate observation and assessment which arise from the data that

ascertain in the nature and influence of prevailing conditions and practices in

description of objects, processes and persons.

Population of the Study

The respondents of the study are the-------- staff nurse and ------ patients from

the different hospitals select in Bataan. The criteria for the population are: patients

should be 18 years old or older, they are patients who will be discharged from the

medical wards or patients who have spent two to three nigh wards in the medical

ward; able to speak Filipino or English with stable vital signs and mentally alert.

Frequency Distribution of Respondents and Their Gender

Gender

Hospitals Number of Nurse Male Female Percentage

Total

Frequency Distribution of Respondents and Their Gender

Gender

Hospitals Number of Patients Male Female Percentage

Total
Sampling Technique

In this study, the combination of universal and random sampling technique will

be employed in this study in the sense that only 10 percent of the total nurses in

private hospitals in Bataan will be involved while 25-30 patients will be engaged in

this study, equivalent to 5 % of the persons involved.

Research Instrument

The questionnaire checklist and unstructured interview questions are the main

instruments to be used in gathering the needed data. This survey instruments appear

to be the most appropriate materials of gathering the responses needed to determine

the quality of nursing care practices among hospitals select in Bataan that would

possibly be a basis of Nurse Managers on quality of Nursing Care Program.

The instrument will be comprised of 2 parts: Part 1 is for the profile of the

respondents, who are the nurses and the patients. This part of the questionnaire will

focus on the demographic profile of the respondents, intended for the nurses and the

patients. For the nurses it includes their age, civil status, gender, highest educational

attainment, area of assignment and years in service; while the patients, their profile

religion.

Part II includes the nursing care practices being undertaken along with the

following dimensions safe and quality nursing care, management of resources and
environment health education, legal responsibility, ethico-moral responsibility,

personal and professional development, quality improvement, records management,

Research, communication and collaboration and teamwork. An unstructured

interview will be also utilized to support the needed data gathered through the

questionnaire.

Preparation and Validation of the Instrument

With regards to content validity, analysis, a panel of experts from public an

private hospitals will be engaged to review the validity of the questionnaire. In case

some corrections, modifications will be recommended the researcher will comply

with the recommendations; but if the members of the panel of experts will approve

the validity, said questionnaire will be administered.

In addition, a pilot study will be conducted using respondents coming from

another hospital to determine the reliability of the questionnaire.

Administration of the Instruments

The researcher will secure a written permission from the Hospital Director

through the Chief Nurse to be able to distribute questionnaires to the respondents

which is called the Nursing Care Practices Scale (NCPS). For the patients consists

of 20 items on a 4-point Likert scale format. The questionnaire was developed in

English language used subsequently translated into Tagalog or Filipino language.

 An unstructured interview will be conducted to supplement the data gathered

from the respondents.

Data Processing and Statistical Treatment

In order to obtain answer stipulated in the Statement of the Problem in Chapter

I, the data gathered will be tallied, tabulated and treated statistically.

Percentage will be employed to answers of the questions in Chapter I. The

formula will be

P= f/N x 100

Where: P= percentage

f= frequency

N= total number of respondents

Weighted Average Mean will be used to arrive at a verbal description of each of the

items in all dimensions. Formula will be:

WM= (TWF)/N

Where: TWF= Total Weighted Frequency

N = Number of Respondents

WM= Weighted Mean

A 4-point Likert Scale will be used in treating the nursing care practices in 20 items

Scale Description

4 Strongly Agree
3 agree

2 disagree

1 strongly disagree

T-test statistical procedure will be employed to test if there is a significant difference

between the ursing care practices for each demographic variable. The formula will

be:

T computes = M1-M2
SEd

Where: M1= mean of the 1st group

M2= mean of the 2nd group

SEd= standard error of deviation

Formula: SEd =√( SD1)2+ (SD2)2

N1 n2

Where: SD=standard deviation

N1= number of cases of the 1st group

N2= number of cases of the 2nd group

If the computed T values is less than the tabular t-value, the null hypothesis will be

accepted.
Notes in Chapter III