CHAPTER I

Level III Far Eastern University Institute of Nursing students Clinical Exposure to private and government hospitals

A Research Study Submitted In Partial Fulfillment of the Requirements For the degree of Bachelor of Science in Nursing To Institute of Nursing Far Eastern University

Proponents: Aldrin Ian O. Alpe Jericho D. Arago Kris M. Arcenio Jessica L. Cabbuag Krisslene H. Cuevas Kristine Jane G. Garcia Janine S. Gonzaga Regie S. Gonzaga Evalyn A. Lacsamana Chiberie H. Orgino (BSN 137 Group145)

Barbara Michelle De Guzman RN, MSN

Research Adviser

Submitted to:

INTRODUCTON

I.

The Problem and its Background Exposure of nursing students to hospitals are said to be of great help in nurturing the

students potential in providing a holistic and quality care to patients especially in these times wherein different issues arise questioning or concerning health care services (Srinivasan, 1997). Hospitals in the Philippines are divided in two categories; these two major groups are the government and the private hospitals. These serve as the primary health care setting for everyone in the country. Public and private hospitals are similar in a number of ways. A comparison of the types of diagnoses most frequently treated by public and private hospitals indicates that the two sectors offer many of the same hospital services, particularly chemotherapy, renal dialysis and medical obstetrics. More broadly, a number of large metropolitan private hospitals offer a range of services on par with large government hospitals including, in some instances, accident and emergency treatment and clinical training. Differences between public and private hospitals in terms of hospital size, location and services are, in part, a function of their business models, government requirements and community expectations. The government hospital sector handles the majority of acute care separations and accounts for most regional and remote hospitals, while private hospitals are more concentrated in metropolitan areas and are more likely to treat patients of higher socioeconomic advantage. The government sectors activity is concentrated on medical cases (including those typically admitted through emergency departments) while the private sectors activity is more concentrated on surgical (typically elective) procedures. (Philippine Centre for Health Research, 2007) Hospitals in and around Manila often offer high-quality medical care. However, other hospitals may not meet the standards of medical care, sanitation, and comfort provided by private

hospitals in the Philippines. Many hospitals outside major urban areas may offer only basic medical care in rudimentary conditions. (Marquez, 2009). In government hospitals, there is a deficiency of certain medical equipments and other infrastructures. These equipments are needed for the clients procedures and nursing students practices. Government hospitals health practitioners, as well as the students, should come up with alternatives if any equipment or material is unavailable. A public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. (Wright J, et al, 2002). The students develop the sense of resourcefulness and creativity from what they had learned from their studies. In terms of the privilege of nursing students, the midwives, doctors, and registered nurses allow the student nurses to perform the procedures hands-on, such as handling the delivery of a newborn baby. This allows the students to practice certain procedures effectively. On the other hand, private hospitals with more sophisticated equipment and a more extensive service range are more attractive not only to patients, but also to medical practitioners. This is likely to partially explain the notable decline in the number of privately insured patients receiving treatment in public hospitals. (Victoria, 1994). This provides a quality healthcare for the patients, and mastery of students to the equipments and modern technology. In private hospitals, they perform once of the procedures by availability of resources are more indeed. Furthermore, most of the private hospitals do not allow the students to perform certain hands-on procedures, and they only allow the students to observe on how the procedures have been done. The students can not apply in practices what they had learned from studies (Mikkeal, 2005). The healthcare services of the nation offered by the government hospitals, such as Valenzuela Medical Center (VMC), Taguig Pateros District Hospital (TPDH) and Jose Reyes M.

Medical Center (JRMMC) are with good quality of care, despite the fact that the facilities may not be as impressive as those found in private hospitals like the FEU-NRMF, Castro Maternity and General Hospital and Medical City. These are some hospitals that the level III nursing students of Far Eastern University are having their duties. Studying nursing practices in both government and private hospitals is a way to help nursing students in the advancement of learning so that they can apply these into a real setting. As for the fact that nursing practice is the actual provision of nursing care, it is also based around a specific nursing theory which will be selected as appropriate for the care setting. Expertise in nursing practice will bring a unique function of the nurse to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge. Nursing practice is a complex and varied field that requires precision, dedication, care, and expertise. Clinicians must have both the skills and the tools to attend to changes in patients' responses, recognize trends, and understand the nature of their patients' conditions over time. Expertise in the plan of care of every nurse can have a positive result if she/he has been exposed in every clinical setting either private or government hospitals. Exposure of nursing students in a Government or Private hospitals will determine the effectiveness in developing their knowledge, skills and attitude. This could help to evaluate the capacity of hospitals in educating nursing students thus building a better foundation of learning for nursing students that may help them acquire the qualities and values that a knowledgeable, skilled & humanistic nurse must possess. Furthermore, this can also contribute in the enhancement and development of health services the hospitals can provide, as well as to the quality of care and effectiveness and appropriateness of nursing interventions that our nurses render to their clients.

Exposure of nursing students in the different clinical area is essential to every nursing students, because from the different clinical exposure from private and government hospitals will enable the nursing students to acquire knowledge from the natural, social, medical, and nursing sciences; develop critical thinking and professional decision-making abilities; utilize current research in the application of the nursing process; develop leadership potential and accountability in professional practice; become aware of the emerging roles of the professional nurse and of the social forces and trends affecting health and health care systems; and to learn to balance professional and personal growth and values. Knowledge is also enhanced as when the students have learned new information, which then they must be guided in relating the new knowledge to what they already know, organizing that information, and then making it a part of their long-term memory. Students acquire knowledge when performing meaningful tasks. A skill of every nursing student in exposing in the different clinical area is an important part of nursing education. The challenge within universities is to expose and provide a clinical skills program that is cost effective and adequately prepares students to practice within an increasingly complex health care system. The adoption of programs that are based on principles of self-direction would appear to meet the challenge (Purdy, 2003). Skills is developed when students are acquiring new skills and processes, they must learn a model (or set of steps), then shape the skill to make it appropriate for them, and finally, internalize ad practice the skill so they can perform it easily, efficiently and effectively. On the other hand, attitude is also a very important part of nursing profession because attitudes and perceptions affect students' ability to learn; also it is a key element of effective instruction, then, is to help establish positive attitudes and perceptions about learning. If students have negative attitudes and perceptions about learning, then they will likely learn little. If they

have positive attitudes and perceptions, they will learn more and learning will be easier. (Olive, 2007)

II. Statement of the Problem The researchers were motivated to undertake this study to differentiate the exposure between private and government hospital of level III nursing student in terms of acquiring knowledge, skills and attitude. The research study aims to compare the knowledge, skills and attitude that every nursing student could acquire from their exposure to a government or private hospital. Knowledge can be in terms of the nursing theories, principles and rationales for every procedure, and how they apply these to practices. Skills can be in terms of the nursing practices such as maintaining sterile technique. Attitude can be in terms of morality of the nursing students such as honesty, obedience, confidence and more which are needed for effective nursing care and learning. There are many differences between the government and private hospitals in terms of providing the three aspects of learning needed by the students. In general, this study aimed to differentiate the level and amount of clinical exposure of level III nursing students of FEU in acquiring knowledge, skills and attitude. Specifically, the study sought to answer the following questions:
1. What is the status of clinical exposure of Student Nurses in Private Hospital in term

of the following: a. Knowledge

b. Skills c. Attitude
2. What is the status of clinical exposure of Student Nurses in Government Hospital in

term of the following: a. Knowledge b. Skills c. Attitude 3. Is there a significant difference between the clinical exposure in Private Hospital and Government Hospital?
4.

Is there a relationship between hospital status and clinical experience?

III. Significant of the studies Nursing Practice Nursing practice can help in the primary caring relationship between the nurse and the person in their care. Exposure in a private and government hospital will let the students perform different kinds of skills; these skills may vary according to what the hospital setting has. Students may be limited or have freewill to do variations of procedure depending on the hospital protocol that will train the students to be expert in their field. Some hospital setting restrict students to

perform some medical procedure these hospitals are more of the private ones but they also has advantage due to advance technologies.

Nursing Administration Studying nursing administration can contribute to the skill of every nursing student. Nursing administration is an instrument for the nurses work and to increase the quality of assistance, as well as for the development of the nursing staff and, the administrative functions as a role which has to be developed in the nursing professional practice. Studying nursing administration can help in developing nursing leaders, empowering people through education/mentoring, in advocating the benefits in every member and the communities that the nurse serve, in promoting the significance of the role of nursing administrators, in anticipating and acting in response to a changing environment, in partnering with other entities for the benefit of our organization, by being guided by integrity in all the nurses actions, in promoting/providing opportunities for networking within our organization, and lastly by sharing/promoting best practices that promote/ensure the highest quality of care and quality of life. One way to strengthen critical thinking skills of nursing students is through adequate training. Student nurses should participate in training to improve their competency and communication skills. Their goal should be to determine when you can exercise critical thinking skills and hands on skills. Also consider online programs designed for nurses, such as "Sharpening Critical Thinking Skills". Training should expose nursing students to various scenarios or hypothetical situations so they can practice reflecting about possible options and get feedback, particularly about critical thinking errors and practices.

Nursing Education This knowledge will help educators evaluate the capacity of Hospitals in educating nursing students thus building a better foundation of learning for nursing students that may help them acquire the qualities and values that a knowledgeable, skilled & humanistic nurse must possess. This study will give certain understanding on what really affect the learning of the nursing students during their related learning experiences especially in terms of their exposure in different hospitals. This study will also serve as a discussion point and even reference for clinical instructors and administration especially those who are involve in RLE. With this, interventions can be made by probably doing rotations in terms of the areas where the students will be exposed, so each can equally experience exposure from both government and private hospitals. Clinical Instructors can also take part by utilizing and maximizing the resources and equipments available and that the affiliating hospital can offer to students thus making the exposure more educational and fruitful.

Nursing Research The future researchers who plan to conduct a study on the same plane may use the study result as a framework for further studies. This could put interest and a new knowledge that can improve the field of nursing. It can also serve as a related literature for the future study. The result of the study may also be used as a foundation and as a supplemental reference. This study can also be done to different level of Institute of Nursing and compare their results to be able to come up with a more complex and systematized body of knowledge. Furthermore, this research can also give a background for other related researches in the future.

IV. Scope and limitation The focus of the study was to find out if there is a significant difference between clinical exposure to government and private hospitals and acquiring knowledge, skills and attitudes among level III IN students of Far Eastern University. The researchers include participants, both males and females from the institute of Nursing level III students enrolled at FEU, in the school year of 2010-2011, ranging from 17-20 years old. Scope of the study includes the level and amount of exposure of level III IN student in both private and government hospital in acquiring knowledge, skills and attitude. The limitation of the study includes the population of FEU students in the Institute of Nursing, the availability of the students and the short span of time in conducting this research. The results and the sample is only limited to those students of FEU especially the nursing students.

CHAPTER II REVIEW OF RELATED LITERATURE

This chapter includes a review of related literature and studies both foreign and local which are related to the variables under study. Each study offers a specific and valuable contribution in

the exposure of nursing student in both private and government hospitals in acquiring knowledge, skills and attitudes. V. Literature Review Government versus Private Several studies investigated show the differences of private and public hospitals with regards to their facilities and equipments that they use. It is about the government hospitals having more advance equipments provided by the government versus the private hospitals owned by a company. Darden, WR, Perrault, WD. (1975) conducted a study comparing the quality of services provided by public and private hospitals in Bangladesh. A total of 207 surveys were analyzed with respondents indicated visiting 57 hospitals and clinics in the area. Combination of multiple analysis of variance (MANOVA) and two-group discriminant analysis (DA) were used for data analysis because if the overall test of group differences using MANOVA is significant, DA can help determine the direction and intensity of each criterion variables impact on the overall group differences Of the 207 responses, 191 cases were used in the MANOVA and discriminant analysis procedures. Of these, 91 respondents reported using a public hospital, while the remaining 100 used a private hospital or clinic. On responsiveness, the results indicate that private hospitals are perceived as more responsive than public hospitals. Similarly, on communication and discipline, private hospitals obtained a significantly higher rating than public hospitals. This contention was reasonably supported: private hospitals were evaluated better on responsiveness, communication, and discipline. By responding to these needs, hospitals in Bangladesh can improve their image and

be perceived more favourably. Market, competitive, social, internal and regulatory incentives are to be considered to promote higher quality in hospitals.

Andaleeb, (2000) conducted a study about the quality of services provided by the hospitals is contingent on market incentives because private hospitals are not subsidized and depend on income from clients, they will be more inclined than public hospitals to provide quality services and to meet patients needs better. The researcher conducted the study through survey and questionnaires By doing so, they will not only be able to build satisfied and loyal clients who will revisit the same facility for future needs; the clients will also serve as a source of referrals to recommend the private establishments to friends and family, thereby sustaining the long-term viability of private hospitals. In public hospitals, on the other hand, there is little or no market incentive to motivate the staff to take extra initiative or effort to improve the condition of patients and ameliorate their suffering. Tax subsidies and other sources assure these organizations of their survival. Harsh as this may sound, evidence of their lack of responsiveness, dedication, or quality assurance in media reports is often stark. This suggests that their service quality will be rated lower than private hospitals.

Daniele Guisti, Bart Criel and Xavier De Bethune conducted a study in sub-Saharan Africa to determine the difference between private and public health care delivery. Through a group discussion or debate, they determine the service offered by the private and public in terms of health care delivery. There are different frame of classification between private and public health care proposed: one is based on the purpose of the health service pursues and on the outputs it yields. It was concluded that the distinction between private and public based on the institutional set-up of a given service is not always adequate in defining the very nature of the service offered, the latter

being of paramount importance to the health planner at any level of the health system. For example, many private hospitals and health centers in developing countries operate according to a rationale which could be defined as public; at the same time, lucrative goals are being introduced into public health services which, eventually, endanger their adequacy, relevancy and accessibility.

Clinical Exposure

Several studies investigated shows that clinical exposure affects the learning of every nursing student and greatly affects the improvement of their knowledge skills, and attitude.

Henderson S., Happell B. and Martin T. (2007) conducted a study about the Impact of theory and clinical placement on undergraduate students' mental health nursing knowledge, skills, and attitudes. 192 students from the University of Victoria averaged 84%, decreasing to 71% at the second date collection point and to 65% at the final data collection point. Questionnaires were distributed in class time with an envelope so that respondents could pass sealed envelopes to the front of the classroom on completion.. Findings shows that both the theoretical and clinical segments of the mental health component did increase nursing students self-reported knowledge, skills, attitudes in nursing people experiencing mental health problems. In terms of clinical experience, all students, regardless of duration of the theoretical component, reported higher knowledge, skills, attitudes compared with baseline and made the greatest improvement in specialist mental health knowledge and skills, such as mental status assessment and risk assessment. This supports the available literature in suggesting that clinical experience is highly influential on the extent to which students are able to acquire the desired knowledge, skills, and attitudes.

Needham and De Sousa, (2002) conducted a study about Student nurses' attitudes towards adolescents and their care in hospital. Using a self-administered questionnaire comprising a series of open-ended questions among a sample of 14 child branch degree level students in their second, third or fourth year at a West Midlands university, this study found that the students had a good knowledge of young people and of their needs while in hospital. They did not report strong negative attitudes towards adolescents but suggested that a number of factors affected their attitudes towards nursing young people, including media reports and the attitudes of mentors. Most of the students expressed a preference for working with younger children, partly because the students lacked experience and confidence, and partly because of a lack of age appropriate resources in ward areas, which made caring for adolescents more challenging. It was concluded that more could be done to improve student exposure to adolescent patients and that inadequate inpatient facilities, rather than staff attitudes and knowledge, may prevent some young people receiving good quality care in hospital.

Sharif & Masoumi (2005) conducted a study with 90 baccalaureate nursing students from Shiraz University of Medical Sciences in order to investigate the nursing student's views and experiences about their clinical practice. The researchers use focus group discussion in collecting data among the participants which determine that nursing students were not satisfied with the clinical component of their education. It had come up with a four themes that arisen from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap", clinical supervision"," professional role", was considered as important factors in clinical experience. All in all students felt unsatisfied and incompetent due to lack of nursing skills and knowledge to practice care to patients, therefore, experiencing anxiety.

Clinical Exposure and Government vs. Private

Edwards, Smith, Courtney, Finlayson and Chapman (2004) conducted a study using a quasi-experimental design using a pre-test post-test survey aimed to determine the relationship between the location of clinical placements and competence and preparedness for practice from the perspective of the nursing students. The population consisted of all final year Bachelor of Nursing students at Queensland University of Technology, who undertook their clinical placement in either a rural or metropolitan location. They have to undertake a four week clinical placement. The pre and post survey contains 3 sections which are the demographic information, questions related to the students preparedness for the clinical experience and issues that were important for them during the clinical experience and lastly is the questions related to the students satisfaction with their clinical placements and factors likely to influence their future career plans. It had also high lightened the importance of both rural and metropolitan clinical environments in developing not only student competency but also students satisfaction with their clinical experience.

Libbin J., Linnea S. and Millikan W., (2001) conducted a study about Student Experience and performance in a surgical clerkship. Phase I of this study compared students' experiences regarding patient demographics, surgical content, and clinical skill practice in three different hospital settings: university, community, and public. Phase II examines the aspects of clerkship performance that contribute to students' final grades. An instrument to track the experiences of students on their surgical clerkship was developed and piloted. Eighty medical students successfully completed the tasks required for participation in the second phase of this study during academic year 2000-2001. The purpose of this phase of the study was to identify the extent to which performance factors affected the students' final clerkship grades. Data were analyzed to

compare the frequency of common surgical tasks performed and exposure to various surgical topics and patient demographics as well as to identify factors that explain variance on student grades. Students performed an average of 33 clinical tasks per week and were exposed to a broad range of surgical topics. Analysis of variance results demonstrated no significant differences between public, private, or university settings with respect to students' clinical practice opportunities or content exposure. Clinical evaluations and National Board of Medical Examiners scores account for 75.5 per cent of the variance in students' final grades. There was no significant correlation between patient load and clinical task load with final clerkship grades. The common clinical and didactic components of a surgical clerkship can balance a student's experience with surgical topics and tasks performed. It is important to utilize this information in program review of multisite clerkships to ascertain and enhance the validity of student performance measures. It is important to utilize this information in program review of multisite clerkships to ascertain and enhance the validity of student performance measures.

Berntsen K. and

Bjrk IT. (2010) conducted a study about the Nursing students'

perceptions of the clinical learning environment in nursing homes. They have conducted a study through a cross-sectional survey design in which nursing students in clinical placements at eight nursing homes completed a questionnaire on one occasion. A cohort of first-year nursing students in a bachelor degree nursing program were invited to participate in the study (N = 92). The final sample comprised 74 students (80%). Forty-one students (55%) were younger than age 25, 16 students (22%) were between ages 25 and 35, and 17 students (23%) were older than age 35. Approximately half of the students (54%) had experience from working in nursing institutions before entering nursing studies, and 13 students (18%) confirmed former higher education. Clinical studies for the target group were organized in a 4- week module, with a 30-hour workload per

week. During placement, students were supervised and guided by both teachers and nurses. Each student was allocated an RN as a preceptor. Both the preceptor and the teacher supervised each student twice during morning care. The teacher also organized and facilitated reflection in groups at each nursing home two times during placement. Findings show that the students total mean score on the instrument indicated that students perceived their learning environment in nursing homes as moderately positive. One reason for this may be the supervisory system that included supervision and guidance from both nurses and clinical teachers. The supervisory system may emphasize the ward as a context for both learning and performance by Saarikoski et al. (2002) in which Finnish students positive evaluation of the learning environment was partly explained by good supervision. A limitation of this study is the small number of respondents, although the sample included nearly the total population of first-year nursing students at the university college. Using only the scale exploring students perceptions of their actual learning environment, and not the scales for preferred clinical learning environment, may also be viewed as a limitation. This study assessed only the students perspectives of the clinical learning environment. Including perceptions from the perspectives of clinicians and clinical teachers would provide a broader perspective to complete the picture.

Stark P. (2007) conducted a study about the clinical learning teaching and learning in the clinical setting. They have conducted a qualitative study using focus groups with undergraduate medical students and semi structured interviews with hospital consultant clinical teachers. The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK, in which Fourth year medical students and consultant clinical teachers were studied. Two focus groups were convened with 10 students in each.11 Each group met once. The participants were purposefully selected for certain variables (gender and ethnicity), and not for their representativeness.

Purposeful sampling was considered important as ethnicity and gender12 may affect perceptions and expectations of clinical teaching and relationships with senior staff. Finding shows that Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be teaching by students. While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills. The methodology of this research had a number of strengths. Most importantly, the researchers access to, and knowledge of the respondents and the organizations enabled purposeful sampling to encompass the selected variables. No consultant refused to be interviewed. It is not clear whether an unknown researcher would have gained such easy access to the consultant participants.

Synthesis: The mentioned studies and literatures help the researchers to understand the study and gave a clear view of the phenomenon that the researchers were discussing. The study on government vs private hospitals stated that there is a difference when it comes to learning in nursing student with regards their knowledge, skills and attitudes.

II.

Research Paradigm Level III IN Students

PRIVATE HOSPITAL

KNOWLEDGE SKILLS ATTITUDE

Figure 1.1 Figure 1.1 Paradigm of the dependent and independent variable in correlation with the exposure of Level III IN Students to Private and Public Hospitals

III. Conceptual Framework Nursing students are always exposed to different areas in the hospital either private hospital or government hospital. The students clinical exposure is always accompanied by learning which will help the students develop and enhance their knowledge, skills, and attitude as a nurse.

EXPOSURE GOVERNMEN T HOSPITAL KNOWLEDGE SKILLS ATTITUDE

In every hospital exposure there is always a difference in government hospital exposure and private hospital exposure regarding their learning and the enhancement of their knowledge skills and attitude. IV. Research Hypotheses There are significant differences that exist between the treatments that may affect the enhancement of skills of every nursing student that being exposed in different areas. There are significant difference between private and government hospital exposure among level III nursing students. There are significant differences between private and government hospital among level III nursing student in acquiring their knowledge, skills and attitude. V. Variables

The Independent variable: The independent variable of this study is the exposure of level 3 FEU nursing students in private and government hospitals. This variable could give an affirmative or negative relation with the dependent variable of the study. This is considered as the independent variable because the researchers can not modify this variable, which could be exposure in private hospitals alone, public hospitals alone, both hospitals, and even neither of the two. Private hospitals have different advantages and disadvantages from the government hospitals. Both hospitals have different strategies in developing the knowledge, skills and attitude of the students. The Dependent variable:

The development of knowledge, skills and attitude is the dependent variable of this study. Acquiring knowledge, skills and attitude of level 3 FEU nursing students depends on their exposure to different kinds of hospitals because private and government hospitals offer different kinds of learning. VI. Definition of terms Private Hospital The conceptual definition of private hospital according to Webster Dictionary is a hospital which is owned by a company which caters services which is funded through payment by the patients. The operational definition of private hospital a non-government owned hospital where students are assigned to have their clinical exposure. Government Hospital The conceptual definition of government hospital according to Webster Dictionary is a hospital which is owned by the government which caters services for patients for free and is funded by the government. The operational definition of government hospital is a government owned hospital where students are assigned to have their clinical exposure. Clinical Exposure The conceptual definition of clinical exposure according to Webster Dictionary is engaging on different areas in the hospital to gain or acquire experience.

The operational definition of clinical exposure is the time wherein nursing students are having their related learning experience to acquire experience and knowledge. Knowledge The conceptual definition of knowledge according to Webster Dictionary is a confident understanding of a subject which is acquired through experience and education with the ability to use it for a specific purpose if appropriate. The operational definition of knowledge is persons ability to answer or react to a situation or to something thats been ask. Skills The conceptual definition of skill according to Webster Dictionary is the technique and expertise of an ability to do something or to get something well. The operational definition of skill is a particular ability to do something well in the exposure.

Attitude The conceptual definition of attitude according to Webster dictionary is a persons way of expressing himself which greatly affects the way she talks, move and act. The operational definition of attitude is a persons perspective in doing or saying things.

Chapter III Research Methodology Research Design A correlational design was selected as the research design for this study which is a nonexperimental design. This will assess the relationship between the exposure of the level III Far Eastern University Institute of Nursing (FEU-IN) students in government and private hospitals, and the development of their knowledge, skills and attitude.

Population and Sample The participants in this study will be all the students from the FEU - Institute of Nursing who are in the fourth level. The researchers will choose them as the participants since they have been exposed to different private and government hospitals. With this, they can share their experiences upon having their Related Learning Experiences (RLE) in the said hospitals during the implementation. The population will be consisting of male and female students regardless of their age. The researchers will use a purposive sampling technique wherein 44 sections will be clustered into four (4). Among these four clusters, the researchers will choose the sections which had have their RLE in government and private hospitals. The Slovins formula will be used to determine the ideal sample size with a margin of error from the population size, as shown below. n = N/(1 + Ne)

where, n = sample size N = population size e = margin of error

The researchers will need sections, where each are composed of four (4) RLE groups which are composed of one (1) leader, and a minimum and maximum of seven (7) and eleven (11) members each group, respectively. Considering the possible maximum number of participants which is there will be 44 sections composing 4 groups each section with 12 members each group, therefore, the population size will be 2112. Using the formula with 5% margin of error, the ideal sample size will be 336 participants, or 7 sections. Given, N = 2112 e = 5% = 0.05

n = 2112 / (1 + 2112 0.05) n = 2112 / (1 + 18000 0.0025) n = 2112 / (1 + 5.28) n = 2112 / 6.28 n = 336 students or 7 sections, since the maximum number of students each section will be 48.

Research Locale The study will be conducted inside the campus of Far Eastern University located at Nicanor Reyes St., Sampaloc, Manila, within the University Belt. It is a private non-sectarian institute of learning in the Philippines. It has nine institutes that include the Institute of Nursing that offers the Bachelor of Science in Nursing. The Institute of Nursing has level one to level four students and are holding classes in the Law building, the Science building and the Nursing building.

Research Instruments The instruments which will be used in this study are the following: the samples RLE grades from their first semester in their third level, which will be used to measure the knowledge and skills; and a modified questionnaire, provided by the researchers, which will be used to measure the attitude. The research instrument that will be used to measure the attitude will be a modified research questionnaire from Rebols (1996), which is a Likert-type questionnaire. The questionnaire contains 6 parts. Part I, informed consent, contains the details regarding the informed consent and profile of the participant. It includes name (optional), age, sex and section of the participants. Part II-A contains questions regarding quality of experience. Part II-B of the tool contains questions regarding professional attributes of the clinical instructors who supervise the students in RLE. Part II-C contains questions regarding variety of practices. Part II-D of the tool contains regarding professional socialization. The participants will be asked to rate their experiences toward clinical exposures by indicating whether they strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree with the given statements presented. This instrument was found out to be adequate and useful from a previous study, and was ensured the validity of the content using the following validation techniques:

1. Consultation with the Research Specialists. The questionnaire was given to a statistician

and qualified nursing professor. They were asked if all the items are clear and unequivocal and suited the level of comprehension of the participants. Additionally, they were consulted whether

the instrument used answered the problems presented in the statement of the problem. The comments and suggestions elicited where incorporated to the final questionnaire.

2. Reliability. In determining the level of accuracy of how the contents of the questionnaire

measures the quality of experiences, characteristics of clinical instructors, variety of practices and professional socialization, a set of questions from a portion dissertation of Rebolos, M.D. (1996) was used with little modifications. This ensured that the contents of the questionnaire where sufficient in addressing of the objectives of the study thus making the questionnaire valid in content wise.
On the flip side, reliability of the questionnaire ensures the consistency of results over time. Fifteen randomly selected 3rd year students were used in the reliability analysis. The randomly chosen respondents were not included in the actual data gathering. Moreover, Coefficient of Internal Consistency was used to determine whether the questionnaire is reliable or not. Coefficient of Internal Consistency is the coefficient obtained when two equivalent halves of the same test where correlated. A formula was used to estimate the reliability of the test. Items in the questionnaire were divided according to their assigned numbers, either odd or even. The scores of add numbered responses were correlated with the total scores of the responses to even numbered responses. The reliability of one half of the questionnaire was computed by using the Pearson R. Further more, the spearman-brown split half reliability coefficient was also computed and this indicates the reliability of the questionnaire. With the entire spearman-brown split half reliability coefficient of the four categories greater than 0.90, we can conclude that the questionnaire and scales is reliably good.

Category

Number of

Pearson Rho

Split-half coefficient

statements Quality of experience Characteristics of CI Variety of Pac Professional 8 7 11 10 0.87 0.822 0.965 0.871 0.930 0.902 0.982 0.931

Table1. Summary of Reliability Analysis. The researches then personally distributed the copies of the questionnaire to the participants, and approximately collected it after 10 minutes.

Data Collection The letter for permission will be submitted to Dean Glenda Arquiza of Institute of Nursing for validation and approval. Prior to data collection, the researchers will be divided into two groups so that the implementation will be done faster. The first group will be asked for the permission of the professor, will give the introduction, and will explain the purposes of the study. The second group will be distributing the questionnaires. Both groups will be then scouting for participants around the FEU campus for possible sections to be interviewed. In addition, the questionnaires will be strictly given for level four nursing students only. The researchers will focus on the Law building, Nursing building and Science Building since level four nursing students mostly have their classes in these buildings. After finding the sections, the researchers will introduce themselves and the purpose of the study to the professor. After gaining the consent of the professor, researchers then will make an introduction to the respondents. Then, the purpose of the study is to explore the difference between clinical exposure to government and private hospitals in acquiring knowledge, skills and attitudes. Participants were assured of anonymity and confidentiality.

They will be given a choice to participate or refuse in the study. Along with handing out the questionnaires, the consents will be also given. They will be then instructed to answer the questionnaires according to their own perspective and not from others answers. No time limit will be given, so that the respondents could answer the questions about the different clinical exposure of nursing student in both private and government hospital without pressure. After all of the respondents are finished, the questionnaires were collected. The researchers will then check if there were any missing or incomplete data, and some incomplete data will be brought back to the respondent who answered it through communicating with their class mayor. A statistician was then hired to compute for the demographic profile of the respondents by the use of a percentage calculation. Next, the effects of networking sites on academic performance of students were also calculated and tabulated. Lastly, the computation for Pearson scale was done to determine the relationship between the variables and verify or invalidate our hypothesis.

Statistical Treatment of Data The data gathered from the actual RLE grades and the questionnaires will be presented in charts, tabulated, classified, and tallied in tables using frequency and percentage. To answer the research questions: Is there significant difference between the status of government hospital and private hospital?; Is there a significant difference between the clinical exposure in Private Hospital and Government Hospital?; and Is there a difference between hospital status and clinical experience?, the statistical test which will be used is the independent group t-test or also known as the pooled t-test.

Independent group t-test (Pooled t-test)

A statistical test used to compare the means of two independent groups (e.g., 1 and 2, where 1 and 2 are population 1 mean and population 2 mean, respectively). The assumptions will be the following: 1 and 2 are unknown but assumed to be equal; the samples are selected randomly; the samples are selected independently; and the samples are from normally distributed populations, where 1 and 2 are the population variances of groups 1 and 2, respectively. First, select the level of significance, , where 0.05 is commonly used. Then define 1 and 2 in the context of the problem. The 1 for this study will be the exposure of nursing students in government hospitals, and 2 will be the exposure of nursing students in private hospitals, where both are in relation to the acquirement of the students knowledge, skills and attitude. Then, the null hypothesis (Ho) will be stated as follows: Ho: 1 = 2 (means of the two groups are equal) And then, an alternative hypothesis will be chosen from the following: a. Ha: 1 2 (means of the two group are not equal) b. Ha: 1 < 2 (mean of group 1 is less than the mean of group 2) c. Ha: 1 > 2 (mean of group 1 is greater than the mean of group 2)

The test statistic for this is the t (t statistic), with n1 + n2 - 2 degrees of freedom, where n1 and n2 are the sample sizes for groups 1 and 2. A low p-value for this test (e.g., less than 0.05) means that there is evidence to reject the null hypothesis in favor of the alternative hypothesis, or there is evidence that the difference in the two means is statistically significant.

The test statistic can be calculated by first computing for the pooled standard deviation using the formula:

sp =

( n1 1) s12 + ( n2 1) s 22
n1 + n 2 2

, where s1 and s2 are sample 1 and sample 2 standard

deviations, then calculate the test statistic using the formula:

t0 =

( x1 x2 )
1 1 , where x1 and x2 are the sample means of group 1 and 2. sp + n n 1 2

Finally, find the P-value (observed significance level) using a t distribution with n1 + n2 2 degrees of freedom (df ):

Each case corresponds to the alternative hypotheses listed above. a.) P = P( t > t 0 ) b.) P = P( t < t 0 ) c.) P = 2 P( t >| t 0 |)

t0

t0

| t0 |

| t0 |

The conclusion would be: Reject H0 if the P-value is less than the level of significance; otherwise, do not reject H0. When H0 is rejected the result is statistically significant.

Ethical Consideration The researchers emphasized the need for major ethical considerations in performing the study to make sure that confidentiality, safety privacy, and right of the objects are protected. Ethical principles used are the principle of justice, beneficence, and of human dignity.

a. Principle of Justice
In this research we will treat every participant the right to receive fair treatment and the right to privacy. The Privacy is maintained by which individuals will be informed of uses and disclosures of their confidentiality information for research purposes, and their rights to access information about them held by covered entities. Where research is concerned, the Privacy protects the privacy of individually identifiable health information, while at the same time ensuring that researchers continue to have access to information necessary to conduct vital research. Fair treatment will be provided by giving each and everyone the same questionnaire with the same instructions in it.

The researchers have treated each respondent equally and fairly, same treatments and procedures were done to all other respondents. The researchers made it sure that all the information about the subjects will be kept confidential by disclosing the information between the researchers and the respondent only.

b. Principle of Beneficence The researchers aims to provide this principle as doing no harm and actively contribute to the health and well being of their participants, wherein all participants in this study will be free from harm both physically and psychologically. The researchers wont induce stress and fear

psychologically through proper explanation, providing comfort and entertained questions and answering it appropriately and completely in every person who will participate in the study. Every participant has the free will to drop out if they feel too.

c. Principle of respect for Human Dignity and Autonomy In this research the participants is communicated a decision based on their understanding. Informed consent is a vital part of the research process, and as such entails more than obtaining a signature on a form. Inform consent will give the participants the capacity to intentionally understand and have no control influences that will initiate a free and voluntary act and can withdraw the research any time they wish too. The researchers will give informed consent depends on: 1) adequate disclosure of information; 2) patient freedom of choice; 3) patient comprehension of information; and 4) patient capacity for decision-making. The researchers aim to achieve three necessary conditions: 1) that the individuals decision is voluntary; 2) that this decision is made with an appropriate understanding of the circumstances; and 3) that the patients choice is deliberate insofar as the patient has carefully considered all of the expected benefits, burdens, risks and reasonable alternatives.