i

ASSESSMENT OF NURSES PROFESSIONAL PRACTICE: A BASIS FOR AN ACTION PLAN FRAMEWORK FOR THE NURSING SERVICE

A Masters Thesis Presented to The Faculty of the Graduate School of University of Perpetual Help System DALTA Las Pias City

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

MA. BERNARDITA V. VILLARUEL, RN March 2012

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APPROVAL SHEET

This dissertation entitled ASSESSMENT OF NURSES PROFESSIONAL PRACTICE: A BASIS FOR AN ACTION PLAN FRAMEWORK FOR THE NURSING SERVICE prepared and submitted by MA. BERNARDITA V. VILLARUEL in partial fulfilment for the degree of Master of Arts in Nursing Major in Nursing Administration has been examined and recommended for acceptance and approval for Final Oral Examination.

HAZEL N. VILLAGRACIA, EdD Adviser

ORAL EXAMINATION COMMITTEE Approved by the Committee on Oral Examination with a grade of _____________________.

YOLANDA T. CANARIA, PhD Member

AMELIA M. MENDOZA, RN, MAN Member

NAOMI M. DE ARO, EdD Chairman

Accepted and approved in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Major in Nursing Administration.

ATTY. IRINEO F. MARTINEZ, JR., PhD Dean, Graduate School of Education

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ACKNOWLEDGEMENT The author expresses her gratitude to a number of people who made this research possible. She extends her thanks and appreciation to all of them for sharing their time and effort finishing this work. To the researchers parents, Mr Daniel I. Villaruel and Mrs. Herminia V. Villaruel; to her sister, Ma.Margarita Villaruel-Banzon and her family; to her brother, Francis Anthony V. Villaruel, and to her, best friend, Ma. Theresa R. David, for the untiring help and immeasurable moral support in accomplishing this study. To Dr. Antonio L. Tamayo and family, for the scholarship that was given to the researcher. Atty. Irineo Martinez, the Dean of the Graduate School of Education, UPHSD, who gave his genuine support during the final phase of the study. Dr. Hazel Villagracia, the writers teacher and adviser, for her great concern, patience, and assistance for the realization of this study. Dr. Kathryn Floro-Cruz, a physician at UPHDMC, for her motivation, invaluable insights, and advice that help to improve her study. and for their prayers in

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Ms. Elenita Javier, the Chief Nurse of the research locale of the study, who gave all the support needed and for allowing the researcher to fulfil the research work in their institution. Dr. Florencia Marfil, Dean of the College of Education, UPHSD, for her motherly advice and a supportive professor during the initial phase of research work. Dean Naomi De Aro, Dean of College of Nursing, DLSU Dasmarinas, Cavite, the panel chairman, for her suggestions, and recommendations for the improvement of the study. Ms. Amelia Mendoza, Dr. Yolanda Canaria, and Dean Francisco Sosa, who gave their time as defense panel members during the researchers challenging stages of the research work. Dr. Jesus Gollayan, statistician of UPHSD, who has shared his part in statistical treatment. Mr. Francisco Rivas, editor of UPHSD, who gave his time in editing this study. And above all, to God Almighty, for endowing the researcher the wisdom, patience and determination to overcome the trials to succeed in this undertaking.

ABSTRACT Name of Institution: Address: Title: University of Perpetual Help DALTA Pamplona, Las Pinas City Assessment of Nurses Professional Practice: A Basis For An Action Plan Framework for the Nursing Service Author: Degree: Major: Date of Completion: Ma. Bernardita V. Villaruel Master of Arts in Nursing Nursing Administration March 2012

STATEMENT OF THE PROBLEM: This study sought to ascertain the assessment findings of nurses and their implications to professional practice. The answers to the following specific questions were attained: 1. What is the demographic profile of nurses according to gender, age, civil status, length of service and position? 2. What are the assessment findings of the nurses professional practice in terms of three elements of practice: Facilitation; Nurturance; and Unconditional Acceptance?

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3. Is there a significant difference between the assessment findings of nurses professional practice in terms of facilitation, nurturance and unconditional acceptance when grouped according to gender, age, civil status, length of service and position? 4. Based in the findings of the study, what action plan framework can be proposed?

METHODOLOGY The study made use of Descriptive Quantitative Research Design Survey questionnaires serves as the instrument. A data interpretation scale, which summarizes the coding rules established for analysis, together with corresponding statistical limits, were utilized to facilitate data analysis. A total of 92 respondents consisting of 6 nursesupervisors, 9 head nurses, and 77 staff nurses participated in the study. Respondents in the quantitative strand were selected by Purposive Sampling. The descriptive measures used in the treatment of data gathered from the study included Frequency Counts, Percentage Distribution and Weighted mean. To test the hypothesis, ANOVA or analysis of variance F-test was utilized.

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HYPOTHESIS: There is no significant difference between the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance when grouped according to Gender, Age, Civil Status, Length of Service and Position.

FINDINGS: 1. The demographic profile of the nurse-respondents

1.1 Gender As to gender of the respondents, only 32 percent are male respondents, while 68 percent are female nurses. It shows that females outnumbered the males in the field of nursing. 1.2 Age As far as age is concerned, majority of them or 39 percent, are young and belong to the less than 25 years old age group, while very few or 1-2 percent, belong to more the than 42 years old age group. 1.3 Civil Status As to civil status of the respondents, only 17 percent of the respondents are married and 78 percent are single nurses. It means that single nurses outnumbered the married nurses.

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1.4 Length of Service As to length of service, majority of the respondents or 40 percent are new in their posts with less than 3 years of experience followed by 35 years of experience or 45 percent. However, there were only 15 percent who has 6-10 years of experience of work as nurses. 1.5 Position As to position, 84 percent of the population are staff nurses. This was followed by the head nurses constituting 10 percent of the respondents. Only 6 percent are nurse supervisors.

2.

What are the assessment findings of the nurses professional

practice in terms of: Facilitation, Nurturance and Unconditional Acceptance? 2.1 Facilitation. The respondents from the group of the nurse-supervisors and head nurses assessed practice of Facilitation on nurses as Highly Practiced in this hospital, while staff nurses assessed Facilitation as Moderately Practiced. It could be noted in Item 3 that all of the respondents agreed to support the institution has the and managers support towards nurses and was thus rated as Highly Practiced. However, nurses rated Item 6 to

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be Moderately Practiced with regard to the availability of clinical nurse specialists in every area of practice. 2.3 Nurturance The majority of the nurses from the group of nurse-supervisors and head nurses assessed practice of Nurturance on nurses as Highly Practiced in this hospital, while nurses in the staff nurse position assessed nurturance as Moderately Practiced. Item number 5 tells us that all nurses rated it as Highly Practiced regarding chief nurses availability and being compassionate to nurses when needed. However, Items 1,2,3,4,6,8,9, and 10, staff nurses rated these indicators as Moderately Practice, such concerns recognition, acknowledging, and acceptance of contributions of nurses to the institution. 2.3 Unconditional Acceptance Under the practice of Unconditional Acceptance, all of the respondents, from the position of nurse supervisors, head nurse, and staff nurse position assessed this element of practice as Highly Practiced. A majority of the items were positively rated as Highly Practiced except for one item in Numbers 2, 6, and 8 wherein staff nurses rated it as Moderately Practiced. These data showed that all

nurses have common assessment findings concerning Unconditional Acceptance in this hospital.

3.

Is there a significant difference between the assessment

findings of nurses professional practice in terms of facilitation, nurturance and unconditional acceptance when grouped according to profile variables: 3.1 Gender The critical F value of 3.947 at five percent level of significance is above the F computed value of facilitation which is 0.062, with Nurturance at is 0.666, and Unconditional Acceptance at is 0.314. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to gender was not rejected. There are no differences in the assessment findings of nurses professional practice when grouped according to

gender. Male and female nurses face common assessment findings in their professional practice. 3.2 Age The critical F value of 2.321 at five percent level of significance is above the F computed value of facilitation which is 1.411; Nurturance was at 2.042 and Unconditional Acceptance yielded is 2.0032. The Null

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Hypothesis that there are no significant differences in the assessment findings of nurse respondents when grouped according to age was thus not rejected. Indeed, there are no differences in the assessment findings of nurses professional practice when grouped according to age. The young and older nurses illustrate a common assessment finding of their professional practice. 3.3 Civil Status The critical F value of 3.099 at five percent level of significance is above the F-computed value of Facilitation which is 2.527, Nurturance was at 0.994 and Unconditional Acceptance at 0.705. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to civil status was therefore not rejected. There are no differences in the assessment findings of nurses professional practice when grouped according to c ivil status. The married, single, and separated nurses show a general assessment finding in their professional practice. 3.4 Length of service The critical F value of 3.099 at five percent level of significance is above the F-computed value of Facilitation which is 1.221: Nurturance was at 0.488 and Unconditional Acceptance at 0.670. The Null Hypothesis that there are no significant differences in the assessment

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findings of nurse respondents when grouped according to length of service was thus not rejected. There are no differences in the assessment findings of nurses professional practice when grouped

according to length of experience. All nurses have shown no variance of assessment finding in relation to their professional practice. 3.5 Position The critical F value of 3.099 at five percent level of significance is below the F computed value of facilitation which is 6.669; Nurturance was at 5.867 and Unconditional Acceptance which is 4.691. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to position was thus rejected. Consequently, there are differences in the findings of nurses professional practice when grouped assessment according to

position. All nurses face varying assessment findings in professional practice. 4. Based on the findings of the study, an action plan framework

is proposed. This addresses the guidance of the nursing service toward positive patient outcome in maintaining and enhancing elements of practice; namely: Facilitation, Nurturance and Unconditional Acceptance.

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CONCLUSIONS 1. Majority of the nurse-respondents belonged to the level of staff nurse - 83.70 percent of the respondent population. While head nurses only constituted 9.78 percent of the population; the lowest percent at 6.52 belonged to nurse-supervisors. Data also showed that most of the nurses are females and a few of them were males; majority of them are in the staff nurse level. In terms of nurses age, it was noticed that it was a population dominated by young nurses. It is a fact that most of them belong to the age group of 21 to 25 years. There seems to be a fewer number of older nurses, and a majority of the nurses are single. In terms of their experience, majority of the nurses who are head nurses and staff nurses have been working for less than 5 years. Only very few of them have 6 to 10 years of work experience, belonging, of to the position of nurse supervisors. 2. In assessing nurses professional practice along the three elements of practice, namely: Facilitation; Nurturance; and Unconditional

Acceptance, the highest degree of assessment findings was in the practice of Unconditional Acceptance, while the least was in Nurturance. The nurse respondents have given a favorable response, obtaining Moderately Practice in relation to the assessment findings in their professional practice.

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3. There are no significant differences in the assessment findings of nurses professional practice when grouped according to gender, age, civil status, and length of service. All nurses have demonstrated common assessments insofar as the elements of practice in their profession. However, when grouped according to position, nurses faced varied assessment findings of their professional practice which signifies that there are differences in assessment findings. 4. Based on the assessment findings of the nurses professional practice in this study, in terms of the following elements: the administrations practice of Facilitation, Nurturance and Unconditional Acceptance towards the nurses, though the Analysis of Variance test showed that there is difference in the assessment of professional practice among nurses, it is not prudent at the moment to formulate an action plan for the nursing service because the results showed favorable outcome which signified good management and staff relationship leading to better policy and procedure implementation and quality patient care. As stated by Butts (2010), every organization has its own culture, beliefs, attitudes, values, customs and practices from the chief executive officer or to the managers down to their employees. Ethically, the researcher feels that it would be inappropriate to interfere with what this hospital is already implementing and practicing

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which is considered of good quality. However, the findings of this study may suggest ways on reinforcing and enhancing the existing practice in this hospital. Specifically in terms of Facilitation and Nurturance of staff nurses, nurses felt that they were less nurtured by the moderate practice of giving recognition and acknowledging staff nurses performance by the administration. Hence, a proposed action plan framework in nurses professional practice based on the results of the study can be seen in the last part of Chapter 4.

RECOMMENDATIONS A) For the Management / Nursing Administration 1. Continue the positive practice of Facilitation, Nurturance and Unconditional Acceptance to employees under the nursing service; 2. Find more ways, strategies, and techniques for strengthening ties and support in relation to Nurse-Supervisors, head nurses, staff nurses, as well as other member of the health team; 3. Maintain open-communication styles among members of Multidisciplinary teams, communicating effectively, which is considered important if teams are to function optimally and ensure patient safety and quality of care.

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4. Maintain open channels for communication, transparency, trust, assertiveness, and strong leadership that are considered important factors in facilitating the effective flow of high-quality information and the sharing of knowledge; 5. Reward and recognize nurses who provide excellence in direct patient care; and 6. Have provisions for feedback among teams to assist in continuous improvement. Feedback is information provided for the purpose of improving team performance and should be focused on behaviours, not personal attributes, and should be constructive and timely. B) For the Nurse Supervisors and the Head Nurses. 1. Continue collaboration, open communication with staff nurses, and supporting nurses with daily duties in the institution. 2. Engage in more training and support mechanisms to assist other nurses fulfill patient care; and 3. Nurture and promote positive working relationships by acting as a mentor to staff nurses by passing and sharing knowledge and skills to other nurses to ease transition which young nurses undergo in the workplace.

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C) For Staff Nurses 1. Staff nurses should maintain rapport with managers, supervisors, and head nurses in creating a positive working relationship. 2. Continue working with other members of the health team who are part of the planning and implementation of nursing policies for the benefit of patients; and 3. Attend seminars and in-house trainings as self enhancement of practice, skills, and knowledge in professional practice.

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TABLE OF CONTENTS

PAGE TITLE PAGE APPROVAL SHEET ACKNOWLEDGEMENT ABSTRACT TABLE OF CONTENTS LIST OF APPENDICES LIST OF TABLES LIST OF FIGURES CHAPTER 1 THE PROBLEM AND ITS SETTING Introduction Theoretical/Conceptual Framework Statement of the Problem Hypothesis Scope and Limitation Significance of the Study Definition of Terms 1 6 12 13 13 14 15 i ii iii v xviii xx xxi xxiii

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THE REVIEW OF RELATED LITERATURE AND STUDIES Related Literature Related Studies Synthesis 19 60 75

RESEARCH METHODOLOGY Research Design Population and Sampling Respondents of the Study Research Instruments Validation of Instruments Test of Reliability Data Gathering Procedure Statistical Treatment of Data 78 79 79 80 81 82 82 83

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA 85

SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS Summary Findings Conclusions 113 114 120

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Recommendations REFERENCES APPENDICES A B C D Questionnaires for the Nurse Letter of Request to Respondents Letter of Approval to Conduct Study Letter of Approval of Locale to Conduct the Study E F Letter of Approval for Pilot Test Letter of Request for Evaluator A Letter of Request for Evaluator B Letter of Request for Evaluator C G H I J K L Picture Image of Locale Study Philippine Nursing Act of 9173 Split-Half Method Analysis of Variance F-Test Certification of Editing Certification of Statistical Treatment

123 125 134 134 137 138

139 140 141 142 143 144 145 156 157 158 159 160

Curriculum Vitae

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LIST OF TABLES TABLE 1 2 3 4 5 Respondents of the Study Profile of Respondents According to Gender Profile of Respondents According to Age Profile of Respondents According to Civil Status Profile of Respondents According to Length of Service Profile of Respondents According to Position Assessment Findings of Nurses Professional Practice in terms of Facilitation Assessment Findings of Nurses Professional Practice in terms of Nurturance Assessment Findings of Nurses Professional Practice in terms of Unconditional Acceptance Significant Difference Between Assessment Findings Among Nurse-Respondents when Grouped According to Gender Significant Difference Between Assessment Findings Among Nurse-Respondents when Grouped According to Age Significant Difference Between Assessment Findings Among Nurse-Respondents when Grouped According to Civil Status Significant Difference Between Assessment Findings Among Nurse-Respondents when Grouped According to Length of Service PAGE 80 85 86 88 88

6 7

89 90

95

98

10

100

11

102

12

103

13

105

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14

Significant Difference Between Assessment Findings Among Nurse-Respondents When Grouped According to Position

106

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LIST OF FIGURES FIGURES 1 2 3 Theoretical Paradigm of the Study Conceptual Paradigm of the Study Action Plan Framework PAGE 9 10 109

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CHAPTER 1 THE PROBLEM AND ITS SETTING

Introduction A professional is someone who is a member of an established and learned profession. To be considered truly professional, a person must live a life of one, before his brethren and the public. Indeed the word Professional has been used-and is overused in the workplace. However, due to its vast usage, one cannot avoid meeting such concept in the workplace. Professionalism defines the high standard that is

expected from a person who is well-trained in a particular job. It encompasses the conduct, goal, commitments, and responsibilitiesqualities that characterize a profession. A significant part of ones educational preparation for entry into a profession is the development of qualities, behavior, and even appearances that comprise

professionalism. Professionalism is often seen in the extent to which professionals develop a sense of calling to the profession, (Olesen & Whittaker, 1968). This is commonly seen in the profession that defines a type of job that needs special training or skill, especially one that needs a high level of education like in the field of nursing.

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Professional nursing practice is simultaneously an art and a science. What makes a nurses job of enhancing people's health, whic h is both continual and exciting, and sometimes elusively frustrating, is this fusion of art and science. If a nurses goal is to assist and teach clients in their growth as a person, the nurse needs to cultivate both scientific foundations for action and artful performance, (Kelly, 2010). Truly,

nurses practice in a wide range of settings, from hospitals, to visiting people in their homes, and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings, also called industrial health settings, like companies, school clinics, and physicians offices. They also work in cruise ships and in military

service. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as a part-time nurse or a private duty nurse. Nurses also work as agents in call centers and drug companies as medical representatives. They have also been linked to the world of informatics, acting as consultants in the creation of computerized charting programs and other software. Nurses work in a large variety of specializations wherein they work

independently or as part of a team to assess, plan, implement, and evaluate care.

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In the nursing practice, since nurses have been working in diverse fields of their careers, very few people have been inquisitive and interested in understanding perceptions or assessments of nurses in relation to the practice of their profession. Based on the elements/

practice of Facilitation, Nurturance and Unconditional Acceptance, modelled after the nursing Theory of Modelling and Role Modelling, the researcher, who is a nurse by profession, was stimulated to apply it in assessing and understanding nurses practice. It is fact a nurses

assessments of professional practice may differ from one another brought about by the different positions they handled. There are

possibilities that a Nurse Supervisors assessment may be dissimilar to the Head nurses or to the staff nurses assessment. Based on the

researchers experience, some common factors observed in the working environment that give rise to different assessments or perceptions of nurses may be classified on aspects dealing with how nurses are being facilitated, nurtured, and unconditionally accepted by the nursing administration. Under Facilitation, the nursing service helps the nurse take steps toward positive health, including providing necessary resources and information. To nurture nurses touches on how the

nursing service provides care and comfort of such medical professionals in the practice-setting. How the nursing service accepts each nurse

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pertains to embracing his/her person without conditions. To understand the nurses world better, the nursing service may gather key information from the nurse and have appropriate assessment findings. It is in the light of the foregoing that this researcher considered the concepts of Facilitation, Nurturance and Unconditional Acceptance from the Modelling and Role-Modelling Theory as indicators to analyze the assessment findings of the nurses professional practice. Truly, nursing roles provide an insight as to how nurses are facilitated, nurtured, and unconditionally accepted. The assessment findings made this author

further understand and determine if there are differences of assessments among the nurses according to their position in the nursing service. Consequently, this work hopefully, be one of the vehicles in determining what implications can be made in their professional practice to promote positive patient outcomes. According to Roussel (2010), a healthy work environment is a practice setting that maximizes the health and wellbeing of nurses, quality patients, or client-outcomes, organizational performance, and societal outcomes. In this study, HOSPITAL-A, which has a 250 tertiary bed capacity, and a slogan of "Dedicated to Total Quality Healthcare," situated in Cavite, was assessed. It has a mission and vision that is committed to the formation of a tertiary hospital providing a wide range of medical

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services

and

composed of

compassionate,

morally-upright,

and

intellectually mature men and women motivated by their insatiable quest for excellence in their respective duties and areas of responsibility. This institution aims to instill in the minds of the general public a deep sense of trust and confidence, faith in the integrity and competence of hospital personnel, and be looked upon as a friendly medical institution that truly cares for the welfare of the people. This institution is dedicated to the services of humanity and for the greater glory of God. The credentialed medical teams are supported by efficient and nurturing staff, reliable services, and highly-specialized centers that are fully-capable of addressing nearly every medical concern faced by patients of different classification. The institution offers quality service and considers it the ultimate mission to provide patients with compassionate, competent, and holistic care. Moreover, the HOSPITAL-A Nursing Service, as one of the major departments of the hospital, functions in line with the goal of primarily promoting quality health care. The respondents from the Nursing

Service provides nursing care to patients by utilizing nursing processes and conduct training activities to improve its main quest of becoming effective and efficient. Based on the results of this study, such will be a useful tool in creating future plans, guidelines, or frameworks for nurses

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as part of enhancement skills, professional development, and the improvement of the quality of care nurses provide.

Theoretical / Conceptual Framework This study is supported by the Theory of Modeling and RoleModeling (MRM) of Erickson, Tomlin & Swain. The theory is based on philosophical beliefs and assumptions about people, environments, health, and nursing. MRM was both inductively and deductively derived from practice experiences, empirical studies, and several foundational theories. Foundational theories upon which MRM are based include

those of Maslows, Eriksons, Piagets, Bowlbys, Winnicotts, Engels, Lindemanns, Seyles, Lazarus, and Seligmans. The difference

between those basic theories and the derived theory (MRM) is the synthesis of the foundational theories in MRM, (Irwin, 2007). In MRM, Modeling is the process by which the nurse seeks to know and understand the clients personal model of his or her world and learns to appreciate its value and significance. It recognizes that each person has a unique perspective model of his or her world. The nurse uses this process to develop an image and understanding of the clients world from the clients perspective. Modeling is a useful tool and

beneficial for the nurse administration and subordinates. It provides the

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foundation

and

atmosphere

for

good,

open

communication.

Alternatively, Role-Modeling is based on the assumption that all humans want to interact with others; they want to carry out selected roles in society. Role-Modeling is using the clients model of the world to plan interventions that meet his or her perceived needs, grow, develop and heal. This requires that we aim to build trust, promote a positive

orientation and a sense of control, affirm strengths, and set specific mutual goals. In this study the goal is to help nurses achieve quality and wholistic health. Furthermore, said processes deals with how nurses facilitate and nurture the individual in attaining, maintaining, and promoting health. Role-Modeling accepts the client unconditionally and allows planning of unique interventions. However, in support of this

work, the same recognizes that the nurse is the expert in providing care and knows best how they are to be helped. In other words, this concept provides a strong and stable foundation for learning and teaching. It is a popular and very effective tool that allows new nurses remember information and helps information stick better. Furthermore, according to the MRM theory, the roles of nursing are Facilitation, Nurturance, and Unconditional Acceptance. Facilitation is a role of the mentor in which the mentor moves the mentee towards the desired outcomes, (Schultz, 2006). In giving bearing for this study,

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for example, nurse administration may facilitate the nurse in getting experience by making contacts or networking on behalf of the nursementee. Nurturance requires that the mentor has the ability to understand and support the mentees values, (Schultz, 2006). Through Nurturance, the mentor moves the mentee towards desired outcomes. In relation to this work, with the nurse administration gaining a clear understanding of the nurses values and desires, the administration can then nurtur e or feed the nurses needs and cares for those needs, much as a parent nurtures children. Verily, Unconditional Acceptance is acceptance with empathetic communication, no strings attached, and non-judgmental respect of the other person, (Schultz, 2006). This kind of acceptance is in contrast to the traditional role of nurse administration which involves critical judgments, grading, and evaluating a nurses behaviors or performance. To capture the essence of the MRM Theory, its Theoretical Paradigm, for purposes of this study, is shown in Figure 1 in the next page; thus:

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Figure 1: Theoretical Paradigm of the Study The figure above illustrates how the core represents nurses professional practice as surrounded by the three components of practice; namely: Facilitation, Nurturance, and Unconditional Acceptance.

Conceptual Framework The IPO Model, a process viewed as a series of boxes or processing elements connected by inputs and outputs, considers information or material objects that flow through a series of tasks or

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activities based on a set of rules and/ or decision points, (Harris and Taylor, 1997). The variables that goes in is the Input, while what causes the change is the Process. After which, what comes out from the Process, is the Output or outcome, (Harris and Taylor, 1997). Indeed, IPO model provided the structure and gave direction for the study; hence, the same may be seen in Figure 2 below. INPUT The demographic profile of nurses according to: 1.1 Gender 1.2 Age 1.3 Civil status 1.4 Length of service 1.5 Position PROCESS Data-gathering based on analysis of data through assessments of the Nurses Professional Practice in terms of: 1) Facilitation; 2) Nurturance; and 3) Unconditional Acceptance OUTCOME Implications to the Nurses Professional Practice (Basis for Action Plan Framework in the Nursing Service Department / Office)

Figure 2: Conceptual Paradigm of the Study Hence, the Input was the data profile of nurses at HOSPITAL-A and the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance. The process

involved an analysis of the assessment of the respondents regarding

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their practice considering Facilitation, Nurturance, and Unconditional Acceptance. After data gathering, the outcome of the study produced implications in the professional practice of nurses which was then used in having a Basis for an Action Plan Framework in the nursing service. Local studies view the IPO model as a conceptual paradigm concerning assessment processes, such as in the study of Montano (2007) on Assessment of Leadership and Behavior of Selected College Deans; A Definition of Phenomenological Existence. His study

assessed the leadership behavior of selected college deans on the basis of the perception of leadership by others who have worked with them. The leadership behavior was ascertained by examining the relationship between behavior and perception from the respondents. Wherein the IPO model was illustrated, was the one undertaken by Salonga (2011) entitled An Assessment of the State of Sports Development Program in the UPHSD Schools: Basis for Proposed Individualized Models. This study explored the state of sports development program, specifically in the areas of governance, athletes development, coaching, faci lities and equipment in the tertiary schools of Las Pias, Molino and Bian of the UPHSD, with the end view of formulating individualized program on sports development for the three campuses.

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Statement of the Problem This study sought to ascertain the assessment findings of nurses and their implications to professional practice. Specifically, this study answered the following questions: 5. What is the demographic profile of nurses according to: 5.1 Gender; 5.2 Age; 5.3 Civil status; 5.4 Length of service; and 5.5 Position? 6. What are the assessment findings of the nurses professional practice in terms of : 2.1 Facilitation; 2.4 Nurturance; and 2.3 Unconditional Acceptance? 7. Is there a significant difference between the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance when grouped according to the following profile variables: 7.1 Gender; 7.2 Age;

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7.3 Civil status; 7.4 Length of service; and 7.5 Position? 8. Based on the findings of the study, what action plan framework can be proposed?

Hypothesis There is no significant difference between the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance when grouped according to Gender, Age, Civil Status, Length of Service and Position.

Scope and Limitation of the Study The study was confined to all nurses in a selected hospital somewhere in Bacoor, Cavite. Such included all the nurses; therein; namely: nurse supervisors, head nurses, and staff nurses from different departments under the nursing service. To be sure, this researcher

confined herself to study on the nurses assessments in relation to the practice of their profession as basis to propose an action plan framework.

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Significance of the Study This study is of importance to the following groups: Nurses. The results of the study may help staff nurses to take more control over themselves, their jobs, working relationships and the working environment to enhance properly the contributions they give as professional nurses and members of health teams, empower themselves to be realistic about the quality of effort and commitment expected of them; it may help the nursing department provide effective and efficient service, as fervently as they wished for by them. Nurse Administrators. It is hoped that the findings of this study will enhance understanding and assessment skills of nurse-managers, nurse-supervisors, and head nurses with nurses practice concerns. Indeed, the results of the study may be used as guides in designing action plan framework and programs that will enhance quality care rendered by each department. Other Professionals. The results from this study hopes to be beneficial to other professionals insofar as gaining knowledge and beliefs related to their practice are concerned. Other Researchers. The information this study provides will be useful to them if they wish to venture into or undertake a similar study.

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Definition of Terms To facilitate a better understanding of this study on the assessment findings of nurses professional practice, the following terms are hereby defined within the context they were used for this study: Assessment Findings of the Nurses Professional Practice. This refers to assessment parameters such as Facilitation, Nurturance and Unconditional Acceptance. Demographic Profile. This refers to the variables of the respondents such as Gender, Age, Civil Status, Length of Years and Position in Service. Facilitation. This pertains to how the nursing service helps the nurse take steps toward health, including providing necessary resources and information. Under Facilitation, this deals with workload or work schedules given by the administration, the support of the institution or the managers towards their nurses. This also includes resources such as a pleasant working facility that helps promote a positive working environment. Nurses. This refers to the respondents who will be assessed in their practice of profession. It refers to the respondents who are the Supervisors, Head Nurses and Staff nurses of UPHDMC Las Pinas.

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Nursing Professionalism. A process achieved by the nurse to reach professional status. Nursing Professional Practice. This refers by general

description, to an act of providing care to the patients. In providing care to patients, nurses implement a nursing care plan which is based on the initial condition of the patient. Professional nursing practice is a set of guidelines followed by professional nurses to promote high-quality nursing standards. While no formal set of rules is outlined by any Nursing practices

organization, these practices are widely-followed.

include maintaining a safe environment and sticking to basic nursing ethics. Nurses work for not just the patients, but also their families Nurses in professional settings should be eligible for advancement if they have taken steps to educate themselves, satisfied patients, shown improvements in their clinicals, and act as a mentor to others. In a

professional setting, nurses should have resources and opportunities to enhance their knowledge, such as continuing education classes, mentorships, and internships. Nurses should be encouraged to grow professionally. In this study, this refers to an act of providing care to the nurses by the nursing service. In providing care to nurses, the nursing service implements a framework of action plan which is based on the

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assessment of the nurses. Assessment findings of the nurse will be measured using a Five Point Likert Scale that is based on the nursing roles of Facilitation, Nurturance and Unconditional Acceptance from the MRM theory. Truly, such nursing roles play a part in nursing services approach in assessing nurses practice. To facilitate means helping

nurses identify, mobilize, and develop personal strengths in moving toward health. To nurture is gently supporting and encouraging nurse to integrate all biophysical, cognitive and affective processes in movement toward health. To accept unconditionally is using empathy to fully accept nurses as being worthy, with no strings attached. Nurturance. This refers how the nursing service provides care and comfort to the nurse that includes how nurses are rewarded and acknowledged, for every performance nurses make. Encouragement

and enhancing the character of the nurse from the nursing service is part of nurturing a nurse. Positive patient outcomes. This refers to the outcomes resulting from care of patients by nurses or an interdisciplinary care team. Such include realizing patient satisfaction and optimal health status. Any of the activities related to patient outcomes are directed toward improving organizational performance.

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Unconditional Acceptance. This refers to how the nursing brethren, accepts each nurse as he or she is without any conditions. This term means feeling into a description that aptly conveys the way an administration conveys the nurse's feelings. Through the same, the administration or nursing services can relate better to the nurse's perspective and provide care that is more understanding and compassionate.

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Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES

This Chapter presents the related literature and studies about Facilitation, Nurturance and Unconditional Acceptance and nurses assessment of their professional practice. RELATED LITERATURE Defining Nursing Professionalism The struggle to define Nursing Professionalism expands beyond critical care environments. For many years, there has been an ongoing dialogue about whether nursing is a true profession. Kelly (2010)

emphasizes that the status of nursing as a profession is important because it reflects the value society places on the work of nurses. However, some think that nursing is, at best, an emerging profession because entry into the nursing profession does not require a baccalaureate degree. Still, others believe that the nursing profession has made adequate progress to meet full-fledged professional status. One of the first definitions of professionalism came from Abraham Flexner, who wrote the classic Flexner report in the early 1900s to reform medical education. It defines professionalism as a process by which an occupation achieves professional status. Although other

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professions have developed their own criteria, Flexners work remains the benchmark and foundation for many. Kelly (1981) was the first to expand his work for the nursing profession. Kellys criteria give a

theoretical framework from which professional nursing characteristics are defined today. According to Rutledge (2007), the short definition for

professionalism is that of behaving in an ethical manner while assuming and fulfilling your rightful responsibilities in every situation, every time, without fail. To get a bit more granular, one can say that it means, in part, conducting ones affairs in such a way as to engender trust and confidence in every aspect of work. It means having the requisite ability to be worthy of the confidence of others. It means having already made the right choices so that one attracts the right sort of client and work under good circumstances rather than having to continually make the best of bad circumstances and take whatever is tossed ones way, regardless of its quality. As stated by Zeldman (2007), perhaps most importantly, professionalism means, in every situation, willfully gathering

responsibility rather than avoiding it. Doing so is important because if one does not acknowledge and assume the onus of responsibility in every aspect of work, one will seldom, if ever, make the right choice to

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do what is necessary to achieve consistent success for his/her employer, ones employees, clients, or oneself. Quite simply, if the buck does not stop for an individual, he/she is not a professional. Definition of Practice of Nursing. Under Article 139 of the Nursing Education Act, it is defined for the purpose of practicing as a registered professional nurse, that of diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this law and in accordance with the commissioner's regulations. A nursing regimen shall be consistent with, and shall not vary, any existing medical regimen. licensed practical nurse is defined The practice of nursing as a as performing tasks and

responsibilities within the framework of case finding, health teaching, health counseling, and provision of supportive and restorative care under the direction of a registered professional nurse or licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner's regulations.

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The practice of registered professional nursing by a nurse practitioner, certified under section six thousand nine hundred ten of this article, may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures within a specialty area of practice, in collaboration with a licensed physician qualified to collaborate in the specialty involved, provided such services are performed in accordance with a written practice agreement and written practice protocols. The written practice agreement shall include explicit provisions for the resolution of any disagreement between the collaborating physician and the nurse practitioner regarding a matter of diagnosis or treatment that is within the scope of practice of both. To the extent the practice agreement does not so provide, then the collaborating physician's diagnosis or treatment shall prevail, (Retrieved February 20, 2011 from

http://www.op.nysed.gov/prof/nurse/nurselaw.htm Professional Practice Environment An article in the journal of the Detroit Receiving Hospital (DRH) in 2005, discussed the components of the professional practice model at DRH; these components provide a purposeful and strategic direction for professional nursing practice and a roadmap for all care delivery at DRH. Through its eleven interconnecting components, focused on the patient,

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the model depicts a care delivery system that promotes interdisciplinary, patient-centered care within a collaborative practice environment. As one of its interactive components, the shared decision-making element enables autonomy and control over practice that is the hallmark of professional nursing as noted in the ANA Standards of Professional Practice and Performance. The components of the DRH Professional Practice Model are as follows: (1) Patient: The patient is at the center of everything done at DRH. The patient is the recipient of all care and is the focus of the contract of trust that every professional nurse has with the consumer public. Patients are cared for and DRH considers it to be a privilege to serve; (2) Swansons Caring Model: The Caring Model provides a theoretical framework for nursing practice at DRH. Nurses incorporate the five dimensions of caring into their daily interactions with patients and families. The theory defines caring as a nurturing way of relating to a valued other intrinsic to all human interactions because of inter-connectedness. Knowing is accomplished through ongoing, annual competency updates to ensure quality care. Nurses demonstrate Being With by being emotionally and physically present and enduring with patients throughout the care process. Nurses practice Doing For by comforting and anticipating patient needs while protecting and preserving human dignity. Enabling involves encouraging patients and

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families to participate in planning their care, informing/explaining care delivery and protocols, as well as providing support and care alternatives and giving feedback. Nurses provide care with empathy and

compassion while Maintaining Belief in healing; (3) Michigan Public Health Code: The public health code defines the practice and education of nurses in the state of Michigan; (4) Code of Ethics: nurses practice according to the American Nurses Association Code of Ethics for Nurses, practicing with compassion, respect for inherent dignity worth and uniqueness of each individual; (5) Professional Standards of Practice: The ANA standards of professional practice and performance and the ANA principles of staffing are the basis of system-wide policies for the provision of patient care. These professional standards exist as authoritative statements to ensure that the highest quality of care is maintained regardless of the number, experience and competency level of staff and specialty areas. These policies also drive practice on a daily basis; (6) Mission, Vision, and Values: The practice of nursing at DRH overwhelmingly supports the hospitals mission, values, and vision statement. A large part of the mission of DRH has been access to care regardless of the patient circumstance, belief, or social strata; (7) Shared Governance: Shared decision-making is an expected behavior of all nursing staff and as each nurse enacts this professional accountability,

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the professional practice environment is stronger and more alive; (8) Evidence-Based Practice: Exemplary practice entails the consistent application of knowledge and evidence. The vision for DRH is that

patient care services would become an evidence-based and practicedriven environment where nurses have access to, and constantly utilize, available science to promote achievement of superior clinical outcomes; (9) Care Delivery Models: The care delivery models at DRH are determined by the needs of the patient and the competence of the staff. These methods of providing care include total patient care and team models and are tailored to meet the unique needs of the patients in the care environment; (10) Autonomy: Professional nurse autonomy is defined as belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, which reflect advocacy for the client. Nurses are appropriately credentialed, permitted, and expected to practice autonomously consistent with the nurse practice act and professional standards; (11) Professional Development Professional development of nurses at all levels is facilitated and supported by the organization. We believe that

professional development is critical in advancing the career and image of nurses; (12) Collaboration-excellence in patient care can only be

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achieved in an environment of collaboration, and, as nurses, accept responsibility for coordinating the efforts of the patient care team. The Standards of Professional Performance for Nursing According to Kimmel (2007), all professions have, as their cornerstone and creed, a code of ethics and/ or professional performance standards. The nursing profession is no different. As the field of nursing grows and changes in defining the role of a nurse, the central theme will always be that of caring. It can be said that all other duties and responsibilities of nurses have centered around "caring." Caring has been described by many nursing theorists as the innate nature of a human being to be able to give unconditional help in the form of doing for, therapeutic communication, therapeutic touch, compassion, a gentleness of spirit, and humbleness of knowing ones self. Watson (1985) believed that caring was central to the profession of nursing as well as being the unifying principle of practice. The two major assumptions that she made are as follows: 1. Care and love constitute the primal and universal psychic energy; and; 2. Care and love are requisites for our survival and the nourishment of humanity.

Nursing theorist Leininger (2007), a nurse and anthropologist proposed a theory of caring based on culture that deals with how one society defines caring is not always the same as another society. For instance, in Asia, looking directly into another's eyes is not a sign of respect but a sign of disrespect. Therefore, a western nurse unaware of the Asian culture of caring would be seen as an uncaring and disrespectful person. Leininger termed this knowledge of cultural caring as "transcultural nursing." That beliefs are that culture is the broadest and the most holistic way to conceptualize, understand, and be effective with people. With the emergence of the "caring" theorists also came the emergence of "Standards of Profession Performance." The two terms are entwined in their definitions. There cannot be one without the other. The American Nursing Association set forth the following requisites for standards of professional performance. It is within these standards that the unifying theme of caring can be seen. Standard 1. Quality of Care. The nurse systematically evaluates the effectiveness of nursing practice. The nurse does this by participating in peer review committees and in consistently evaluating his/her own performance and how her performance has enhanced clients health and emotional wellness.

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Standard II. Performance Appraisal The nurse evaluates his/her own nursing practice in relation to the national and state statutes set forth defining the role of a nurse. Standard III. Education The nurse acquires and maintains current knowledge in nursing practice. Many states now require continuing educational credits to be earned by a nurse. The number of credits vary from state to state.

However, nurses cannot renew their licenses without proof of these continuing educational credits. These credits help to keep the nurse current with new medical/nursing advancements related to patient care. Standard IV. Collegiality The nurse interacts with, and contributes to, the nursing profession by meeting with other professionals in the medical field, such as Physicians, Physical Therapists, Respiratory Therapists, and Home Care Coordinators, to exchange ideas and gain a mutual respect while stimulating a learning environment from which all will benefit. Standard V. Ethics The nurse's decisions and actions in helping and caring for individuals are based on principles of ethics and institutional guidelines. Standard VI. Collaboration

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The nurse collaborates with other medical professionals in creating an environment for the clients that facilitate an increasing continuum of mental and physical wellness. Standard VII. Research The nurse will not cease to expand his/her educational horizons and continue to seek out and explore new areas of research and statistics. Standard VIII. Resource Utilization The nurse will participate in committees within the organization to evaluate and increase the effectiveness of safety, costs in planning, and delivering patient care. It can be seen that, within the guidelines of professional performance, the center theme is the caring for the client in every aspect. It is within these guidelines that the nurse can better define his/her role as an individual who has the ability to enhance the clients mental and physical wellness by coordinating, educating, and working with others to promote a caring and supportive environment. Theory of Modeling and Role Modeling: Integrating Nursing Theory into Practice As explained by Walsh (2009) in the Journal of Advanced Nursing, the central concept of Modeling & Role-Modeling is that the

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nurse must understand a client's world. The nurse models his world as it exists for him. Modeling contains both the art and science of nursing. It combines scientific aggregation and analysis of data with the image and understanding of the world from the client's view. When one sees the world as the client does, then one can role-model. Role modeling is the facilitation of the individual in attaining, maintaining, or promoting health through purposeful interventions. Role Modeling is a science because it draws on the theoretical bases of nursing practice. It is an art because the nurse plans and intervenes within the person's own unique model. The bedrock of the nurse's action is Unconditional Acceptance, Positive Regard, Facilitation, and Nurturance of the individual. These attitudes permeate the nurse's approach if the relationship is successful. The nursing process, as visualized by M & RM, is defined by the relationship to the client. The nurse brings his or her whole self into an intensive, interpersonal relationship with client. The nursing process

which results is continual and therapeutic, as opposed to a rigid sequence of steps. From the first moment of contact, a nurse is

intervening, simply by listening and analyzing data. The nurse evaluates what she perceives in this give-and-take dialogue and responds further. This dynamic process continues throughout the relationship. The more formal aspect of the nursing process is reflected in the theory and

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knowledge she uses in her actions, her analysis, and responses in the nurse-client relationship and her documentation of what is occurring. One important implication of this theory is focusing on the client's perception. The client's concerns pre-empt the nurse-identified

concerns. If the need most central to the individual is addressed, one knows that their holistic response will also impact needs the nurse has identified which the client may not have been aware of / focused on. Establishing trust and then positively impacting a client is only possible if what is important to that individual receives attention. To model the

client's world, the nurse gathers key information from the client and appropriate significant others. Areas the nurse addresses include how the individual views their situation, their current and future expectations, their strengths and support systems, and finally their goals, (Campbell et al. 1985). As the interpersonal relationship continues to develop, the client will share those issues important for them. The art of nursing is listening and discovering those issues. The science of nursing is being able to understand those issues within the framework of the theory. Saxby (2010) also cited that MRM covers a broad range of phenomena and has a wide range of applicability. It can be applied to a variety of settings not limited to healthcare. MRM would be of interest to

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any helping profession.

Research on this theory centers around the

applicability of one or a few concepts, rather than applying the theory as a whole. For example, instead of tackling each of the theory's aims and propositions, Sappington (2005) wrote about the concept of Facilitation, Nurturance, and Unconditional Acceptance regarding how it can be applied to assessing and meeting a patient's needs. If MRM is

understood as a grand theory from which more prescriptive mid-range theories may spring, then Sappington's method may make the most sense for research purposes. Concept of Facilitation According to Mowers (2010) on the Concept of Facilitation, the concept of facilitating learning is not new, rather it has gained additional prominence with its emphasis on not only the dispensation of information, but the role it plays in developing critical thinking, problemsolving, and decision-making skills, (Banning, 2005). Facilitation works best when staff members are self-directed. This does not mean selflearning activities are done on an individual basis, or that staff members develop objectives, learning strategies, and outcomes on their own. Highly motivated and mature staff members may be able to develop and implement their own learning plan; here typically, the educator develops

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objectives and determines a way to measure and meet the outcomes based on pre-determined standards. The educators role is to encourage staff members to engage in opportunities to learn, using different skills in ways that are comfortable to them and consistent with their own learning styles, (Bylund, et al, 2008). Indeed, the staffs responsibility is to provide the internal

motivation to learn. According to Cur (2006), this refers to a mutual involvement/ interaction between the nurse manager and the nurse with the purpose of mobilizing their resources, knowledge, skills, collaboration, support, attitudes and values in order to promote a caring environment and to restore the element of caring in nursing. It is a dynamic process aimed at aiding or facilitating the internalization of professional values among nurses. As mentioned by Weis and Schank (2005), a value frequently arises from a person's background, tradition, and philosophy. The inner meaning of an action or an attitude refers to a person's values. Weis and Schank (2005) define professional values as "standards for action, accepted, and identified by registered nurses." These values could

provide a framework for evaluating decisions and beliefs that influence the behavior of the registered nurses, as these individuals have

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capabilities to choose what they regard as worthy and important for making decisions. Indeed, Facilitation can be viewed as support provided by the institution and managers. In the study of Reiling (2007) entitled The Impact of Facility Design on Patient Safety, Cognitive psychologists have identified the physical environment as having a significant impact on safety and human performance. Understanding the interrelationships

between humans, the tools they use, and the environment in which they live and work is basic to any study of the design of a health care facility and its effect on the performance of the nurses and other caregivers who interface with the facility and its fixed equipment e.g., oxygen and suctioning ports on the wall of a patient room and moveables, e.g., patient bed equipment and technology. Humans do not always behave clumsily and humans do not always err, but they are more likely to do so when they work in a badly-conceived and designed health care setting. The design of a facility/structure with its fixed and moveable components can have a significant impact on human performance, especially on the health and safety of employees, patients, and families. In a review of more than 600 articles, researchers found that there was a link between the physical environment (i.e., single-bed or multiple-bed patient rooms) and patient (e.g., fewer adverse events and better health

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care quality) and staff outcomes (e.g., reduced stress and fatigue and increased effectiveness in delivering care). Efforts to improve patient and staff outcomes can target latent conditions for clinicians by using evidence-based designs to decrease distractions, standardize locations of equipment and supplies, and ensure adequate space for

documentation and work areas.

The research done by Reason and

Leape describes the value of practices based on principles designed to compensate for human cognitive failings. Thus, when applied to the

health care field, human factors research, i.e., an area of research that includes human performance, technology design, and human-computer interaction (Henriksen, et al. 2007), has emphasized the need for standardization, simplification, and use of protocols and checklists that can be used to improve health care outcomes. In the work of Kramer and Schmalenberg (2009) on Nurse Manager Support: How do staff nurses define it? they commented on the support given by staff as either a highly regarded function of the nurse manager or as seemingly ignored, as evidenced by the lack of specific supportive role behaviors. Staff nurses in magnet hospitals, the American Association of Critical-Care Nurses, and the American Organization of Nurse Executives identify nurse manager support as essential to a healthy work environment. Nurse-manager support is one

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of the eight essentials of a healthy work environment identified by staff nurses in magnet hospitals; the behaviors specific to the nurse-manager role in designating this support were primarily leadership functions. Nurse manager support is one of the role functions of nurses in leadership positions identified by the American Association of CriticalCare Nurses under their authentic leadership standard for establishing and sustaining healthy work environments; here, specific role behaviors were not listed. Nurse manager support of staff is cited 3 times in the American Organization of Nurse Executives list of 179 competencies common to nurses in executive practice regardless of job title; supportive role-behavior were not provided. In contrast, the American Nurses

Associations standards for nurses in administrative practice make no reference to nurse-managers support of staff, the supportive role function, or to supportive role behaviors. In an article by Hall (2007) in the Nursing Administration Quarterly Journal entitled The Relationship Between Supervisor Support and Registered Nurse Outcomes in Nursing Care Units it stated that Workplace social support is a major characteristic related to the Job Demand-Control model of job stress. Organizational and managerial The

support have an effect on nurse satisfaction and burnout.

relationships between perceived supervisor support and measures of

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nurse occupation-related outcomes were investigated in 3 nursing units within an academic medical center. Nurses with greater levels of perceived supervisor support experienced more positive job outcomes and less negative outcomes, including less occupational stress, than nurses with less perceived supervisor support. Facilitation of a Positive Working Environment Aiken (2007), in the International Journal for Quality in Health Care regarding provision of adequate number of personnel maintains that adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout, and, ultimately, to improving the nurse retention problem in hospital settings. Larson (2012) mentioned in an article in Nursezone.com entitled Flexible Scheduling Boosts Nurse Morale, Retention, that studies have shown that scheduling accommodations such as flextime, non-traditional shifts, and self-scheduling can help nurses with family obligations, continuing education and work-life balance. Dana Dye, RN, MPH, and chief nursing officer at Baptist Memorial Hospital-Memphis observed that hospital allows nurses to choose between eight-hour shifts or 12hour shifts and a weekend option program exists for nurses who are willing to work 24 hours on the weekend but still receive full-time pay.

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Meanwhile, the PRN category does not provide any benefits, such as time off or insurance, to the nurses in this pool. There are also different levels within the category; some nurses work only few shifts per month and very few holidays or weekends, while the nurses who are the most flexible and work the most shifts get paid more. But they can pick and choose when they work, Dye said. Its very attractive to some people. It also helps the hospital because it allows for more nurses at times when more of them are needed. Baptist-Memphis tends to rely on this group the most in the winter months, when patient volumes go up. But having an array of flexible scheduling options has helped Baptist not only serve its patients but also its staff. Its really helped us not only with recruitment, but with the retention of the staff that we have, Dye said. In an article entitled Clinical Housewide Policy: Staffing Plan for Nursing Services Policy Statement by the Salem Hospital (November 2006) it was noted that the Staffing Plan for Nursing Services reflects specific service needs to meet patient care and organizational needs. Evaluation of the department specific needs and staffing requirements is a component of the annual budgetary process. Nurse Managers,

Nursing Directors, and Senior Management include input from continuous improvement projects, patients, families, employees, and the

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medical staff when reviewing and updating department specific service needs to provide patient care and manager resources. According to Kimmel (2007), in the article "Standards of Profession Performance" Standard VIII. Resource Utilization, it has

been observed that the nurse will participate in committees within the organization to evaluate and increase the effectiveness of safety, costs in planning, and delivering patient care. It is within these guidelines that the nurse can better define his/ her role as a/ the one individual who has the ability to enhance the clients mental and physical wellness by coordinating, educating, and working with others to promote a caring and supportive environment. Facilitation through Availability of a Clinical Nurse Specialist Cedars-Sinai Medical Center Journal (2012) sees a Clinical Nurse Specialist (CNS) is an expert in clinical nursing who is familiar with the theory and research related to a nursing specialty area. Clinical Nurse Specialists are registered nurses, who have graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating, and managing the health concerns of patients and populations. As an advanced practice registered nurse, the CNS continues to perform many of the same actions used in basic nursing practice. The difference

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in this practice relates to a greater depth and breadth of knowledge, a greater analysis of data, and complexity of skills and actions. Traditionally, the CNS provides direct clinical care to patients as well as education, research, consultation and leadership/management. The

CNS influences care outcomes by providing expert consultation, and implementing improvements in the healthcare delivery system. He/she often functions as a program coordinator, a leader in implementing change strategies to improve patient outcomes, an educator, and/or manager of complex patient populations. The CNS provides direct

patient care, including assessing, diagnosing, planning, and treatment of health problems, health promotion, and preventive care within this specialized area of practice. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. (Retrieved on February 20, 2012 at http://www.cedars-sinai.edu/index.aspx) Wade (2009) stated in an article on Perceived Effects of Specialty Nurse Certification: a review of literature, that recent evidence suggests that specialty nurse education and certification may improve the quality of patient care. Specialty nurse certification may also improve nurses' job satisfaction and sense of empowerment, as well as positively affect collaboration with other health care team members. Despite the

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evidence that there are intrinsic rewards for specialty certification, the lack of extrinsic value to nurses makes it unlikely that greater numbers of nurses will be attracted to certification unless health care administrators increase opportunities for recognition and greater compensation. Facilitation through Open Communication and Collaboration An article in the Journal of Department of Health in Melbourne, Australia (July 2010) entitled Promoting Effective Communication among Healthcare Professionals to Improve Patient and Quality Care states that, in healthcare, effective communication involves arriving at a shared understanding of a situation and, in some instances, a shared course of action. This requires a wide range of generic communication skills, from negotiation and listening, to goal setting and assertiveness, and being able to apply these generic skills in a variety of contexts and situations. Effective communication also requires individuals and teams having access to adequate and timely information necessary to perform their role effectively and appropriately. The use of technical terms and jargon, acronyms, abbreviations, and diagrams to communicate can influence how well information is shared and the effectiveness of communication as well as in business, adhering to the five standards of effective communication in healthcare is likely to facilitate improvements

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in the exchange of information between healthcare professionals; thus, information should be: (1) complete - It answers all questions asked to a level that is satisfactory to those involved in the exchange of information, (2) concise wordy expressions are shortened or omitted. It includes only relevant statements and avoids unnecessary repetition, (3) concrete The words used mean what they say; they are specific and considered. Accurate facts and figures are given, (4) clear short, familiar, and conversational words are used to construct effective and understandable messages (5) accurate - The level of language is apt for the occasion; ambiguous jargon is avoided, as are discriminatory or patronizing expressions. The Joint Commission reports that investing to improve communication within the healthcare setting can lead to: (1) Improved safety, (2) improved quality of care and patient outcomes, (3) decreased length of patient stay, (4) improved patient and family satisfaction, (5) enhanced staff morale and job satisfaction, (Joint Commission on the Accreditation of Health Care Organizations, 2005). Freisen wrote in the MSN Journal, (December 2007) an article entitled Communication: Patient Safety and the Nursing Work Environment that there is a need to improve collaboration and communication among health care providers that have implications for the education of future nurses, physicians, and other healthcare

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providers. Educational strategies must be developed to better prepare students to collaborate effectively in the future, not only to build bridges rather than silos, but to rethink what and how students are taught to better meet the needs of the future. Indeed, inter-professional

communication and collaboration are key to improving patient care delivery and effective care. Barriers to interdisciplinary education exist but these barriers can be managed and overcome. According to Roussel (2010), in his Concepts and Theories Guiding Professional Practice it was emphasized that facilitations twin is collaboration, a term which encourages the nurse who has been in a predominantly perioperative role to share knowledge, skills, and expertise with other hospital departments, health care facilities, and the public. Roussel (2010) said that interdisciplinary practice or collaboration is described as a joint decision-making and communication process among health care providers that is patient-centered, focusing on the unique needs of the patient and the specialized abilities of those providing care. Characteristics of interdisciplinary collaboration include mutual respect, trust, good communication, cooperation, coordination, shared responsibility, and knowledge. Professional nursing practice

must be supported by an environment of professionalism with exemplars

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of recognition, preceptorship, and interdisciplinary collaboration providing evidence that such an environment makes a difference. Using this as a backdrop, the ANA outlines components of a professional nursing practice environment; namely: (1) manifests a philosophy of clinical care emphasizing quality, interdisciplinary collaboration, continuity of care and professional accountability in that nursing staff responsibility and accountability for their own practice and nursing staff patterns have an adequate number of qualified nurses to meet patients needs, considering patient care complexity; (2) demonstrates professional development support for nurses, in that professional continuing education opportunities are available and supported long term career support programs targets specific populations of nurses, such as older individuals, home care, or nurses from diverse ethnic backgrounds; (3) creates collaborative relationship among members of the health care provider team, in that professional nurses, physicians, and other health care professionals practice collaboratively and participate in standing organizational processes. Provision of Training Program In the Philippines, the Training Division of the Nursing Department of the Lung Center of the Philippines offers quality education, training, committees, the governing structure, and review

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and research to registered nurses and allied health professionals, enabling them to meet the challenges facing their profession in todays complex environment. The Lung Center of the Philippines offers

mentoring programs for new nurses and a strong orientation program for newly-employed nurses. The programs offered by the Training

Department include IV Therapy Training, Clinical Instructor Training Program, Private-Duty Nursing Program, and Skills Enhancement Training for Nursing Attendants, and Ward-Clerk Training Program. Objectives of programs such as The Basis IV Training Program, primarily designed to comply with Professional Regulation Commission, Board of Nursing Resolution No. 08 series of 1994, the Philippine Nursing Act of 1991, RA 7164 (Article V, Section 30), and to ensure safe practice in Intravenous Therapy. This program aims to enhance the nurse's

knowledge and skill in the delivery of their expanded role as intravenous nurse therapists. Another program, The Basic Skills Enhancement

Training Program, aims to develop nurses' knowledge, skills, and attitude in the performance of techniques and procedures with an understanding of the principles involved. (Retrieved September 14, 2011 from

http://www.lcp.gov.ph/nursing_training.html) Concept of Nurturance

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According to Sapphington (2006), in the Journal of Holistic Nursing, the word nurture was first used in the 14th century, but the term nurturance did not appear until 1976 in the supplement to the Oxford English Dictionary. Websters New World Dictionary identified two uses of the root word nurture. The meaning of the word, as it is used in biology, was stated as all the environmental factors, collectively, to which one is subjected from conception onward, as distinguished from ones nature or heredity. This use of the word nurture is often

discussed in literature as part of an ongoing debate about what determines human behavior. Some scientists believe genetics play a larger role in controlling behaviors, whereas others think nurture, or environmental influence, is the dominating factor. Nurturing in nursing is far more than providing nourishment in the form of food and nutriments. The act of nurturing a patient is a process. The processes of nurturing care is founded on training, educating, and fostering the recovery development of the patient while also keeping in mind the well-being of the caregiver. McMahon (2010), in an article in Nurseweek.com believes that altruism in nursing comes with age. She says in nurseweek.com that older nurses grumble that young ones are disloyal, spoiled, and hooked on excitement, technology, and money instead of nurturing. Younger

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nurses see their older colleagues as out of touch and stuck in a work model that disappeared years ago. She also believes that nurses can respect and learn from each other about the good attitudes and behavior between young and old nurses. Nurturing the Nurse thru Recognition and Rewards In an article in Positive Influence.com (2010), it was stated that positive reinforcement is provided by giving a person attention and positive feedback. For nurses, recognizing accomplishments is a

positive reinforcer that motivates the nurses to do their job well. If this motivating factor is lacking, expect a less-efficient job performance from the employees. Weikal (2011) wrote in the Liberty Tibune a piece Nurturing from the Nurses Office stated, Sometimes cookies can be healthy. The

author noted that two William Jewell College nursing students watched a School nurse delicately take a frosted cookie from a stack shared by a kindergartener celebrating her sixth birthday. The school nurse said

thanks and setting the cookie aside as the smiling youngster and her best friend turned to visit the teachers lounge and students greeted the nurse happy birthday. These two students are among 18 students jobshadowing Liberty Public Schools nurses in January and February as part of the colleges nursing program. The point is to give the nascent

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nurses a taste of what they might do in the work world, according to this school nurse; that cookie is a great example of the wide range of skills they will have to use. That cookie may not seem very important, but to the school nurse it is You may not be hungry, you may not even like cookies, but its an opportunity to nurture the children in your community. Weikal adds, helping people with that combination of hard science and soft skills is what drew the two nursing students to nursing in the first place. Nursing merges the arts and sciences so well; one has to be wellrounded and know how to interact with people. According to Roussel (2010) one of the components of a professional nursing practice environment is the recognition of contributions of nurses knowledge and expertise to clinical care qualit y an patients outcomes, in that an organization has a comprehensive reward system that recognizes role-distinction among staff nurses and other expert nurses based on clinical expertise, reflective practice, education, or advanced credentialing. According to Taunton (2007), the role of the chief nurse in acute care settings has undergone several dramatic changes in the past 3 decades, evolving from that of supervisor, head nurse, or clinical expert, to that of department head, to that of nurse-manager and leader. The role continues to be a major focus of discussion and research today.

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The leadership of the nurse manager is key to effective functioning of the unit, to high-quality patient care, and to retention of nurses. In one

study, 3 84% of nurses left or considered leaving their jobs as a result of their relationships with their nurse manager. Taunton, et al., (2007)

reported that 40% of the 124 nurses who were separated from their unit during the 6-month period of the study left their nurse-manager (transferring to another unit within the same hospital). Effective

performance in the nurse-manager role is key to the empowerment of staff that is essential to work effectiveness, to the strong need for nurses to function autonomously for patient safety and quality care; and to the promotion of collaborative/ collegial relationships between physicians and nurses that are essential to good outcomes for patients. In the work of Cathcart (2008), entitled The role of the chief nursing officer in leading the practice: lessons from the Benner tradition, there is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare

organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the

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practice to be fully-lived out if he or she is to be successful as the leader of the discipline. (Retrieved February 20, 2012 at www.pubmed.com) Nurturance from Nursing Service in Enhancing Nurses Character Herlihy (2008), in Reward nurses for excellence, staid that nurses who demonstrate competence in any observed area should be rewarded for it. Thus, hand-out prizes such as gift certificates to local businesses are given which the nurse can use on his/her day off. One must offer paid company lunches each month for nurses who demonstrate consistent excellence. During lunch, one must give personal tributes and toasts to celebrate each nurse's accomplishments in front of his peers. (Retrieved February 20, 2012 from

http://www.ehow.com/how_6853114_regcognize-existing-skills) Nurturance through Counseling Program A study by Arranz (2005) entitled Evaluation of a counseling training program for nursing staff, in which the main aim was to evaluate the effects of a counseling training program and assess the evolution of difficulties that professionals perceived in their work in three different periods: before the training, after the training, and at follow-up stage, 2 months after the program was delivered. According to the results, one can maintain the hypothesis that the counseling training program

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reduces perceived interaction difficulties in nursing staff. Consequently, one can expect a further improvement in the interaction performance with patients and their families after the training. The findings suggest that counseling training has to be taken into account to improve quality of care in health care providers; it may also help to prevent professional burnout by increasing competence level at minimum personal cost. A study by Price (2008) entitled Enhancing skills to develop practice, noted that nurses are skilful healthcare professionals, but the ability to develop skills depends on readiness to evaluate what one does. This article describes a three-stage process which helps nurses analyze a particular skill and to decide what to do next. (Retrieved February 20, 2012 from www.pubmed.gov) Nurturance Nurses being Comforted in Difficult Situation Aiken and Sloane (2007) noted that two empirical studies report that greater nurse autonomy leads to better patient outcomes. It was observed that, after control was done for a variety of organizational and patient characteristics, the intra-organizational status of nursing leads to greater autonomy allowing nurses to act on behalf of their patients thereby reducing mortality rates. They argue that specialized AIDS units represent a form of unit specialization whereby nurses knowledge of patients increases thereby enhancing clinical autonomy. In these

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articles, autonomy was measured by 3 items: nursings control of its ow n practice, freedom to make important decisions about care, and not being placed in a position of having to do things that are against nursing judgment. Professional environment of nursing practice must be supported of by an

professionalism

with

exemplars

recognition,

preceptorship, and interdisciplinary collaboration providing evidence that such an environment makes a difference. Using this as a backdrop, ANA outlines components of a professional nursing practice

environment; thus: (1) recognizes contributions of nurses knowledge and expertise to clinical care quality and patient outcomes, in that the organization has a reward system that recognizes role distinctions among staff nurses and other expert nurses based on clinical expertise. Nurses are encouraged to be mentors to less experienced colleagues and to share their enthusiasm about professional nursing within the organization, and (2) maintains clinical advancement based on education, certification, and advanced preparation; here, peer review, patient, collegial and managerial input, are available for performance evaluation on an annual or routine basis, aside from financial rewards being available for clinical advancement.

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According to Duffys (2008) article in EzineArticles.com on Nurturing the Nurse: Beating Burnout In Helping Professionals, there are Organizational Steps For Prevention of Burnout. The system itself is often not conducive to self-care. Administrators and supervisors do not always recognize or concern themselves with the level of stress experienced by nurses. They are often under tremendous pressure

themselves. If one is lucky enough to have a supervisor/ administrator who is concerned with the needs of the nursing staff, cited were some suggestions that one might consider adopting to support the staff; thus: (1) Rotate staff as much as possible in order to distribute difficult patients and assignments; (2) Include staff in discussions of rotations, and stress reliever suggestions; (3) Build group cohesiveness by regular trainings, discussions, and in-services; (4) (5) (6) (7) (8) Let staff suggest topics; Encourage peer support; Offer recognition for success and excellence; Vary professional responsibilities; A monthly newsletter with updates and kudos is always appreciated;

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(9) (10)

Let the staff know it is all right to ask for a "stress break" ; and Watch for signs of significant stress in staff, and offer them help. Asking for, and accepting help, must be part of the culture within

the organization. Admitting to being stressed must be accepted and not viewed as a sign of weakness. It takes time to build the attitude required for this level of openness to occur. Although administrators at first might see these suggestions as daunting, they will soon see their efforts rewarded with lower staff turnover, fewer days of absenteeism, a more productive and satisfied staff, and improved patient care. Concept of Unconditional Acceptance Unconditional Acceptance is acceptance with empathetic

communication, no strings attached, and non-judgmental respect of the other person (Schultz, 2006). This kind of acceptance is in contrast to the traditional role of nurse administration which involves critical judgments, grading, and evaluating a nurses behaviors or performance. Walker (2010) cites that accepting unconditionally with empathy is an integral part of nursing and a theory borrowed from Kohut's SelfPsychology Model. It has been defined as the capacity to experience the feelings of another as one's own, Empathy enables the practicing nurse to experience what her patient is experiencing-thus understanding his pain, his fear, his malaise, and his distress. The term "empathy"

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comes from the German word Einfuhlung, whose literal me aning is "feeling into," a description that aptly conveys the way a nurse senses the patient's feelings and responds to nurse. Through empathy, the

nurse can relate better to the patient's perspective and provide care that is more understanding and compassionate. 2012 from www.Empathy in Nursing.html) Respect and Team Work Ulrich (2005) maintains that respect is important in the nursing profession. Beginning in the 1980s, both the American Nurses (Retrieved February 20,

Association and the American Association of Colleges of Nursing included respect in their conduct codes for nurses. The first provision of the ANA Code of Ethics provides that a The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Efforts in discussing respect in nursing were directed mostly at respect for patients and respect for cultures and ethnicity. While these efforts were important in addressing how nurses could show respect to their patients, they did not address how medical professionals share respect among each other.

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Amos (2005) believes that, in terms of the impact of team building on communication and job satisfaction of nursing staff, team-building strategies assisted the nurse leader/manager to build an effective work team by strengthening communication and interpersonal relationships so that the staff could function as a more cohesive group. Staff development consultants can help nurse-managers become more effective team leaders by identifying the necessary resources and by helping to plan and coordinate team-building strategies. (Retrieved

February 20, 2012 from www.ncbi.nlm.nih.gov/pubmed/20214789) Osterman (2010), in a pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation, states the team-building process consists of didactic instruction and training in problem-solving, team-building, and constructive conflict resolution. It was found that the team building

process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self-Realization, Life Satisfaction,

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and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. This concluded strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care. (Retrieved February 20, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/20214789) Values and Autonomy In an article in the Detroit Receiving Hospital Journal (2009), it was observed that Professional nurse autonomy is defined as a belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, which reflect advocacy for the client. Nurses are appropriately credentialed, permitted and expected to practice autonomously consistent with the nurse practice act and professional standards. This component provides a

purposeful and strategic direction for professional nursing practice and a road-map for all care delivery at DRH. This depicts a care delivery

system that promotes interdisciplinary and patient-centered care within a collaborative practice environment.

(www.ProfessionalPracticeEnvironment.com) In the ANA (2010) Code of Ethics for Nurses, values in nursing encompass an appreciation of what is important for the nurse personally. The ANA emphasized the magnitudes of moral respect for all human

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beings, including respect of nurses for themselves. Self respect can be thought of as personal regard. Personal regard involves nurses

extending attention and care to their own requisite needs. Mentoring other Nurses According to Bartels (2007) in an article in the NursingCenter.com entitled, preparing Nursing Faculty for baccalaureate-level and

graduate-level nursing programs: role, one strategy recommended to support mentoring programs is to create reward models for developing excellence in new educators. The responsibilities that mentors assume are both time-intensive and challenging. Staff nurses who act as

preceptors to new staff nurses in the clinical setting are often rewarded with a differential in pay. The expectations to assist in developing a novice educator should be viewed as additional responsibility and rewarded accordingly. Here, mentors go "above and beyond" when

providing advice, counseling, and coaching activities with a new faculty member. A reward system established for this type of activity could (Retrieved February 20, 2012 from

improve morale and retention.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=997576) Caine (2006) in Pubmed.com stated that through authenticity and treating staff with dignity and respect, nurse leaders provide frontline support of mentoring through inspiration, motivation, developing trust,

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empowering, and collaborating with staff. Nurse leaders are the frontline supporters of the "mentoring culture." It is important that nurse leaders be perceptive to staff needs; acknowledge, value, and recognize their achievements; and verbalize thankfulness and gratitude for individual contributions, suggestions, and input. Through these simple actions,

nurse leaders have the opportunity to make their staff feel valued. Caine also stated that mentoring is an active process that is currently receiving wide-spread attention in education, in the corporate world, and, increasingly, in health care. Job satisfaction of the critical care nurse may be related to the fulfillment of personal needs and goals. The attainment of these needs and goals ultimately will lead to increased job productivity, which in turn will promote cost-effectiveness, an outcome cherished by management. Therefore, recognizing the worth of job satisfaction to the institution and the possibility that mentoring may have an effect on it among the professional staff may be a key to the future of improved health care and cost reduction in an increasingly specialized and technologic health care environment. Certainly, the

nursing shortage is no longer news to the lay public or those of us engaged in the practice of nursing. In critical care, that shortage is

acutely apparent. Attrition of qualified critical care nurses is increasing and various solutions to the shortage have been proposed, some being

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met with more enthusiasm than others. A more basic solution might be to answer the question, "How can we maintain a high quality of patient care while promoting job satisfaction and instilling a sense of self-worth within the critical care nurse?" Critical care nurses need to play a pivotal role in nurturing and developing other critical care nurses as a means to retain those individuals. How can they do that effectively? Mentoring is one answer. (Retrieved February 20, 2012 from www.ncbi.nlm.nih.gov)

RELATED STUDIES Facilitation In a study done by Kramer (2007) entitled Nurse Manager Support: what is it? Structures and practices that promote it,

professional nursing organizations identify nurse manager (NM) support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be

identified by staff nurses. In this mixed-method study, supportive role behaviors were identified by 2,382 staff nurses who completed the investigator-developed Nurse Manager Support Scale. In addition, semistructured interviews were conducted with 446 staff nurses, managers, and physicians from 101 clinical units in 8 magnet hospitals in which staff nurses had previously confirmed excellent nurse manager support.

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Through individual and focus group interviews with NM and chief nurse executives in the 8 participating hospitals, the organizational structures and practices that enabled NM to be supportive to staff were determined. The 9 most supportive role behaviors cited by interviewees were as follows: is approachable and safe, cares, "walks the talk," motivates development of self-confidence, gives genuine feedback, provides adequate and competent staffing, "watches our back," promotes group cohesion and teamwork, and resolves conflicts constructively.

Supporting structures and programs identified by managers and leaders include the following: "support from the top," peer group support, educational programs and training sessions, a "lived" culture, secretarial or administrative assistant support, private office space, and computer classes and seminars. A study done by Erenstein (2006) entitled How Healthcare Work Environments influence nurse retention. he determined the effect of healthcare work environments on nurse retention. The studies

comprising this review describe factors that contribute to unhealthy work environments and implicate them as significant factors influencing nurse retention. The themes identified by nurses for purposes of retention

included a desire for autonomy, empowerment, and decision-making opportunities in the environments in which they work.

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In a study by Lekalakala & du Rand (2007) entitled A Model for facilitation in nursing education, it was noted that a key step in the development of a model for learning is to identify the needs of both the facilitators and the learners. The purpose of this study was to develop a model for facilitation in nursing education based on the identified needs of facilitators and learners and a confirmation by the literature. A

Qualitative Research Design was used and the population of the study was the facilitators and the learners of departments/schools of nursing in four universities in South Africa. Focus group interviews were conducted with facilitators and learners. The sample was purposively selected.

The results underline the needs as well as the perceptions of both facilitators and learners with regard to facilitation. Concepts were

identified and analyzed from the identified needs which led to the development of the model for facilitation. The complete visual model was described and presented to experts for evaluation. Feedback from the evaluators was used to adapt and finalize the model, after which the model was again presented to evaluators who approved and accepted it. The model is a unique contribution to nursing education as it sets guidelines for a new field of learning in nursing education. Koh (2008), in his study entitled A study of leadership training program demands of first-line nurse managers in university hospitals.

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Maintains that there is an important concern regarding the First-line Nurse-Manager's leadership because of the recognition that

effectiveness of leadership in this position results in benefits for the whole health care organization. So knowledge and practice of effective leadership behavior are now more essential to nursing than ever before. First-line Nurse Managers must be effective leaders to meet today's challenge because staff nurses and patients are affected by them. Thus, the purpose of this study was to identify and to analyze the need for a Leadership Program of First Line nurse managers in university hospitals. There were three major purposes of this study; First, identify First-line nurse-managers general characteristic; second, identify their experience of leadership training; and third, identify and analyze their demands for leadership training programs. The subjects for this study were 167 Firstline nurse managers randomly selected from 18 university hospitals in Korea. Data were collected through questionnaires from Oct. 13 to Nov. 20, 1997; data was analyzed using frequencies and percentages. The steps of analysis of descriptions were as follows: Initial analysis centered on the identification of the demands of first-line nurse managers. Later analysis collapsed the demands into broad categories. From the collect data, 283 demands of first-line nurse managers were identified. These demands were then sorted into 3 broad categories that included: Self

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development as first-line nurse managers, relationship with others, and practice. The result of the study were as follows: (1) most of nurse managers (79.6%) had leadership training courses and had good experience to improve self leadership; (2) their demands for leadership training course are as follows: First, for self as first-line nurse managers, they want to learn leadership theory, identify their leadership style, and then develop their leadership skill. Second, for others as first-line nurse managers, they want to improve their communication skills, empowering others, and ones relationship with others. Third, for patients as first-line nurse-managers, to improve their knowledge of practice. From the

above finding, this study can be suggested the following: (1) Develop a leadership training course to improve first-line nurse manager's leadership skill according to their demands, so they will be better able to lead staff nurses for organization purposes; (2) when develop leadership training program, it must contain the factors which first-line nurse managers want to learn. A study by Lacey, et al (2008) entitled Enhancing the work environment of staff nurses using targeted interventions of support, it was observed that nurse executives continue to search for ways to support their staff nurses through enhancing their work environment to promote professional practice environments. Given that not all hospitals

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have the intensive resources necessary to pursue Magnet Recognition certification or the Texas Nurses Association's Texas Nurse-Friendly Hospital program designation, this does not prohibit them from pursuing specific components adapted for their own institution. The authors

discuss 3 programs to enhance the work environment through increased professional practice. The rationale for these programs, pre

implementation and post implementation are explained. Ritters (2011) study entitled The Relationship between Healthy Work Environments and Retention of Nurses in a hospital setting, sought to determine the effect a healthy work environment has on the retention of nurses in a hospital setting. There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this

issue is the impact the nursing shortage will have on healthcare organizations and patients. The paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work

environments, and the impact of the work environments on retention. Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work

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environments and the manager's role in creating and sustaining a healthy work environment. The work provided evidence on the link

between healthy work environments and the retention of nurses in a hospital setting. The implications for management are to implement

changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future. Hinshaw (2006), in the study Keeping Patients Safe: a collaboration among nurse administrators and researchers, translated the recommendations from the Institute of Medicine's landmark report, Keeping Patients Safe: Transforming the Work Environment of Nurses, into practice and healthcare policy which require an extensive collaboration among nurse administrators and nurse researchers. The insights and skills of both groups are critical for evaluating the recommendations and their implications for practice, for filling gaps in research, and for influencing significant health system change. Hewison (2007) in Policy analysis: a framework for Nurse Managers, stated that the lack of involvement of nurses in the policy process is an issue of concern which has resulted in calls for nurses to become more active in this area of activity. However, what is often less clear is precisely how this can be done. This paper presents a template for policy analysis which can be used by nurse managers. The nature of

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policy and policy analysis is explored to provide a broad context for the discussion, and the need for managers and nurse managers in particular to be 'policy competent' is established, as a pre-requisite for effective management. There is also an examination of policy analysis in nursing which demonstrates why a range of approaches to the analysis of policy is needed. Based on this, a particular framework for policy analysis which can be used by nurse managers is presented. The overall

purpose of the paper is to encourage debate in this area and contribute to the development of a specific tool for policy analysis that may help ensure a nursing management perspective informs policy formation and implementation. In the study of Vahey (2008) entitled Nurse Burn Out and Patient Satisfaction, it has noted that, amid a national nurse shortage, there is a growing concern that high levels of nurse burnout could adversely affect patient outcomes. This study examines the effect of the nurse work

environment on nurse burnout and the effects of the nurse work environment and nurse burnout on patients satisfaction with their nursing care. This conducted cross-sectional surveys of nurses and

patients from 40 units in 20 urban hospitals across the United States. Nurse surveys included measures of nurses practice environments derived from the revised Nursing Work Index (NWI-R) and nurse

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outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica Oberst Patient Satisfaction Scale (LOPSS). The results were patients cared for on units that nurses

characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. This concluded improvements in nurses work environments in hospitals have the potential to simultaneously reduce nurses high levels of job burnout and risk of turnover and increase patients satisfaction with their care. Aiken et al, (2007) in Hospital staffing, organization, and quality of care: cross-national findings examined the effects of nurse staffing and organizational support for nursing care on nurses dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. The design used in this study was the multisite cross-sectional survey. Settings were in adult acutecare hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. Participants were 10, 319

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nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. The main outcomes were Nurse job dissatisfaction, burnout, and nurse-rated quality of care. The results were

dissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/

managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurseassessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. This conclude that adequate nurse staffing and organizational/ managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings. Brunetto, et al., (2009), in the study entitled Supervisor subordinate communication relationships, role ambiguity, autonomy and affective commitment for nurses, examined nurses' levels of satisfaction with their supervisor-subordinate communication relationships on their level of role ambiguity (in relation to their supervisors) and their resultant perceptions of autonomy and, in turn, affective commitment. The

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method used was a survey of 900 nurses working in private sector hospitals in Australia. The results were the combined effects of

supervisor - nurse communication relationships and nurses' role ambiguity in relation to their supervisors plus nurses' resultant perceptions of autonomy that definitely influenced nurses' level of affective commitment. Also, nurses were somewhat dissatisfied with

their communication relationships with their supervisors, experienced role ambiguity, reported being only a little autonomous, and were subsequently only somewhat committed to their hospitals. The findings contribute to addressing nurse retention challenges by identifying factors affecting nurses' organisational commitment. Not only will nurses be

more productive (with less supervisor ambiguity), but high quality Nurse Unit Manager-nurse communication relationships are also likely to enhance perceptions of autonomy and thereby encourage nurses' commitment to their organisation and intention to remain. The

implication of these results raise the question as to whether the present management practices are ideal for retaining nurses who are in short supply in many Organisation for Economic Co-operation and

Development countries. As stated by Sorrentino, et al., (2007), in The Effect of Head Nurse behaviors on Nurse job satisfaction and performance, many

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nursing executives ponder the repeated problems at the unit level and occasionally surmise that effective supervision at that level holds the key to quality patient care. These pragmatic concerns, while commonplace, have yet to be explored empirically. The relationship of head nurse

direction and support on subordinate job satisfaction and performance is not clearly understood. This study examined these relationships in the context of three moderating factors--role clarity, job anxiety, and unit size. Additionally, head nurse support is examined as a moderator of relationships between head nurse direction and subordinate satisfaction and job performance. Using a sample of 103 registered nurses in a medium-capacity metropolitan general hospital, the results showed some significant correlations between head nurse behavior and job satisfaction and performance, and in moderating the effects of job anxiety, unit size, and support. settings. The study highlights the need for replication in other

Additionally, other variables relevant to job satisfaction and

performance such as life stressors (death or illness in the family) require investigation. The findings of this study reveal implications for

management at the unit level and the importance of understanding subordinate behaviors in the context of head nurse support and direction.

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Nurturance Arranz et al., (2005) wrote in Evaluation of a counseling training program for nursing staff, that one of the essential issues in nurses' daily work is interaction with patients, patients' families, and co-workers. However, in the Spanish academic programs for Nursing Schools, social interaction skills do not receive adequate attention and nurses often report communication problems. In order to diminish these difficulties and to train nursing staff to better manage interaction, an intensive counselling training program was designed and implemented in a General University Hospital. The main aim of this study was to evaluate the effects of a counselling training program and assessing the evolution of difficulties that professionals perceived in their work in three different periods: before the training, after the training, and at follow-up, 2 months after the program was delivered. According to the results, one can

maintain the hypothesis that the counseling training program reduces perceived interaction difficulties in nursing staff. Consequently, one can expect a further improvement in the interaction performance with patients and their families after the training. These findings suggest that counseling training has to be taken into account to improve quality of care in health care providers, and it may also help to prevent

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professional burnout by increasing competence level at minimum personal cost. Bgat (2006), in a study on Reflection on how clinical nursing supervision enhances nurses' experiences of well-being, related to their psychosocial work environment, the findings suggest that clinical nursing supervision influence nurses' experiences of well-being in relation to their psychosocial work environment. Nurses attending clinical nursing

supervision reported increased satisfaction with their psychosocial work environment. This concluded the significance of caring and nursing

becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well-being. The value of work becomes clear when nurses reflect on themselves as professionals and authentic human beings in clinical nursing supervision. This will lead to the emergence of self-recognition. (Retrieved February 20, 2012 from www.pubmed.com) Ernst, et al., (2011) in their study entitled Work, Job Satisfaction, Stress and Recognition in a Pediatric Setting, Purpose of determined the factors predicting nursing job satisfaction and examine relationships among nursing job/work satisfaction, job stress, and recognition. It noted that older nurses with more experience and more years at MCH had less job stress and were less concerned with pay than younger nurses. Pay

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correlated significantly and inversely with age, years nurse, on unit and years at MCH. Older nurses received more recognition for job well done and were less concerned about task requirements than younger nurses. Although nurses are recognized at nurses week, they want more one -toone mentoring, private feedback and written acknowledgement. It

concluded that future research should measure anticipated job turnover to actual turnover with job satisfaction and retention and investigate the effect of receiving ANCC Magnet Recognition. In a study by Frankel (2008) entitled Applying theory to practice through clinical supervision, It was stated that effective mentorship is critical in delivering high quality care, ensuring patient safety, and facilitating positive development of health care support workers. This study aimed to demonstrate that professional development is a partnership between the support worker and the mentor. A self-selecting sample of support workers completed a questionnaire and a stratified sample was selected to take part in structured interviews. Focus group discussions were facilitated with senior managers and directors of the organization. One of the main findings of the research was that structured mentorship through supervision was important for developing the role of

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support workers. Better mentorship and supervision will help support worker to implement theory into their practice. According to Tezak and Cahn (2005) in Nurturing the seeds of learning: a professional development initiative for hospital-based nurse educators, described therein was the collaborative initiative between two healthcare organizations to promote professional development of nurse educators from hospitals in neighboring regions. Information

collected from a needs survey and a pre-registration questionnaire was used to develop didactic and interactive sessions of a 1-day conference. Several brainstorming sessions were utilized to engage participants and to facilitate networking. Participants responded positively to this

professional development conference in meeting their learning needs.

SYNTHESIS Studies define professionalism as a process by which an occupation achieves professional status. Under the Nursing Education Act, Article 139, of June 18 2010, it states that the practice of the profession of nursing as a registered professional nurse is one of diagnosing and treating human responses to actual or potential health problems through such services as case-finding, health teaching, health counseling, and provision of care supportive to, or restorative of life, and

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well-being, and executing medical regimens prescribed by a licensed physician, dentist, or other licensed health care provider legally authorized under said law. With regard to integrating the nursing Theory of MRM, Walsh (2009) submits that the central concept of M & RM states the nurse must understand a client's world. The nurse models his world as it exists for him. Modeling contains both the art and science of nursing. It combines scientific aggregation and analysis of data with the image and understanding of the world from the client's view. Meanwhile, Saxby

(2010) mentioned that MRM covers a broad range of phenomena and has a wide range of applicability. settings not limited to healthcare. helping profession. It can be applied to a variety of MRM would be of interest to any

Sappington (2005) wrote about the concept of

Facilitation, Nurturance, and Unconditional Acceptance, and how it can be applied to assessing and meeting a patient's needs. Mower (2010) believes that facilitation works best when staff members are self-directed. This does not mean self-learning activities that are done on an individual basis, or that staff members develop objectives, learning strategies, and outcomes on their own. As per Cur (2006), Facilitation refers to a mutual involvement/ interaction between the nurse manager and the nurse with the purpose

of mobilizing their resources, knowledge, skills, collaboration, support, attitudes and values in order to promote a caring environment and to restore caring in nursing. It is a dynamic process aimed at aiding or facilitating the internalization of professional values among nurses. According to Sapphington (2006), the act of nurturing a patient is a process. The processes of nurturing care is founded on training, educating, and fostering the recovery development of the patient while also keeping in mind the well-being of the caregiver. McMahon (2010) believes that altruism in nursing comes with age. She said that older nurses grumble in that young ones are disloyal, spoiled, and hooked on excitement, technology, and money, instead of nurturing. Younger nurses see their older colleagues as out of touch and stuck in a work model that disappeared years ago, McMahon believes that nurses can respect and learn from each other about the good attitudes and behavior between young and old nurses. Accepting

unconditionally with empathy is an integral part of nursing and a theory borrowed from Kohut's Self-Psychology Model. Defined as the capacity to experience the feelings of another as one's own, empathy enables the practicing nurse to experience what her patient is experiencing, thus understanding his pain, his fear, his malaise, and his distress. Indeed,

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empathy, the nurse can relate better to the client's perspective and provide care that is more understanding and compassionate.

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Chapter 3 METHODOLOGY

This chapter deals with the research methodology and the procedures that were employed in the study. The presentation includes the Research Method used, Population and Sampling, Respondents of the Study, Research Instrument, Data Gathering Procedure, and the Statistical Treatment of Data.

Research Design The Descriptive-Quantitative Research Design was used by the researcher used in this study. The method was believed to be the most appropriate in obtaining information from nurses regarding their assessment towards their practice of their profession. This is a type of research which allows the marketer to gain a greater understanding of something that he does not know. It is used principally to gain a deeper understanding of something. It involves description, recording, analysis and interpretation of the present nature, composition, or processes of phenomena. The focus is on prevailing conditions or how a person, group or thing behaves in the present. A Quantitative Research lends itself to investigating phenomena that require precise measurement and

ciii

quantification often involving a rigorous and controlled design (Polit and Beck, 2006).

Population and Sampling There were 92 nurses as respondents from HOSPITAL-A which is situated in Cavite, Region 4, Philippines and its geographical coordinates are 14 25' 34" North, 120 56' 46" East. Its original name with diacritics of the place is Bacoor. HOSPITAL-A is a 250 tertiary bed capacity with slogan of "Dedicated to Total Quality Healthcare." There were 6 nurse supervisors, 9 head nurses and 77 staff nurses. The population of

nurses belonging to different positions under the nursing service was taken so that all nurses were involved as direct respondents. Purposive Sampling Technique was utilized in the study. It is a technique in which the researcher selects and studies a specific number of a special group that represents the target population with regard to certain

characteristics (Burns & Grove, 2007).

Respondents of the Study The respondents of the study were all nurses from HOSPITAL-A. It covered nurses under the supervisor position, head nurse position and staff nurse position.

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Table 1 Respondents of the Study Position Nurse Supervisors Head Nurses Staff Nurses Total Number of Respondents 6 9 77 92 These

This table presents the number of nurse respondents.

respondents were composed of 6 Nurse-Supervisors, 9-head Nurses and 77 staff nurses under the nursing service of Hospital-A.

Research Instrument The study made use of the Descriptive-Normative Survey questionnaire to gather needed data. The questionnaire was divided into two parts; thus: Part 1 of the questionnaire included the demographic profile of the respondents in terms of gender, age, status, position, and number of years in service as health workers. Part 2 was designed to obtain respondents assessment of the respondents toward their practice of their profession. The Five (5) Point Likert Scale Instrument was used for interpretation of the survey results. The adjectival equivalent was designed in accordance with the required

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responses in the survey questionnaires, but using only the same scale. The researcher consulted a statistician for interpretation. follows: The scale

SCALE

LIMIT

ADJECTIVAL EQUIVALENT Very Highly Practiced Highly Practiced Moderately Practiced Fairly Practiced Not All Practiced

DESCRIPTION

4.50-5.00

Manifested / Practiced at all Times Manifested / Practiced 4 out of 5 encounters Manifested / Practiced 3 out of 5 encounters Manifested / Practiced 2 out of 5 encounters Manifested / Practiced none out of 5 encounters

3.50-4.49

2.50-3.49

1.50-2.49

1.00-1.49

Validation of Instruments The questionnaire was presented to a group of three members of the committee chosen by the Dean of the Graduate School In UPHSD Las Pias to perform content validation. The revised questionnaires

containing the suggestions and comments, such as the adding statement as supervisor, head nurse, staff nurse in this hospital before the indicators, were accepted and floated to a group of nurses in a selected

cvi

hospital in the south of Las Pias to test whether these were easily understood. The final form of the questionnaire was then distributed.

Test of Reliability of the Instrument To test the reliability of the instrument, a pilot study was conducted and the set of data gathered was analyzed using the SPLITHALF METHOD for reliability coefficient with the application of Pearson Product Moment of Coefficient of Correlation. Based on the data obtained from odd-even items, the computed r- value of 0.924 being higher than the critical r-value of 0.878 at five percent level of significance, revealed a significantly high reliability of the instrument.

Data-Gathering Procedure Before the distribution of the final and approved copies of the questionnaire to the respondents, a permission to conduct the survey was secured from the Nursing Director of the HOSPITAL-A. (A letter for the same appears as one of the appendices). Copies of the questionnaires were given out personally by the researcher in HOSPITAL-A through the permission of their Nursing Director. After seven days, copies of the accomplished questionnaires

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were retrieved through the help of the Nurse Supervisors of HOSPITALA.

Statistical Treatment of Data The following statistical tools were employed in analyzing and interpreting the data gathered in order to answer the specific problems of the study, thus: Frequency and Percentage Distribution. This refers to a

description of the subjects of the study according to their personal variables: age, gender, years of experience in the field. This determined the frequency and percentage of the respondents in a particular question in the questionnaire. This was utilized to answer sub problem number 1 that relates to the demographic profile of the nurse-respondents. Weighted Mean. This refers to the average derived when a set of numbers are multiplied by their relative importance. The Weighted Mean was utilized in the summation of the survey. It was utilized to answer sub problem number 2 that determined the degree of practice by the nurse respondents towards the elements of professionalism. Every element contains 10 items or situations that the principal respondents ranked accordingly to practice encountered in the workplace from a Highly Practiced degree to a Not Practiced at All degree. The degrees of

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assessments were defined by the mean ratings arranged from highest to lowest and translated to their equivalent degrees. ANOVA (Analysis of Variance). This is a collection of statistical models and their associated procedures, in which the observed variance in a particular variable is partitioned into components attributable to different sources of variation. In its simplest form, ANOVA provides a statistical test of whether or not the means of several groups are all equal, and, therefore, generalizes the t-test to more than two groups. This was utilized to answer the significant differences in the degree of practice in the assessments of nurses professional practice.

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CHAPTER 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the primary purpose of this study-to provide answers to specific problems on assessment of nurses professional practice. Problem 1. What is the demographic profile of the nurse-

respondents according to: 1.1 1.2 1.3 1.4 1.5 Gender; Age; Civil Status; Length of Service; and Profile?

Table 2 Profile of Respondents According to Gender Gender Male Female Total Frequency N=92 29 63 92 Percent (%) 32 68 100

Table 2 reveals that, for the respondents of the study, female nurses outnumbered the male nurses. There were only 29 male nurses,

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or 32 percent of the population that served as respondents, compared to the 63 female nurses or 68 percent, that served in a similar capacity. According to Grover (2008), there are substantially more female nurses than there are male nurses. As of 2010, 5.4 percent of nurses were men, meaning 94.6 percent of nurses were women. While the perception of nursing as a female-only profession is changing, it is still female-dominated. Men do not suffer from discrimination in general, but there have been instances of patients feeling uncomfortable with male nurse midwives and male nurses in obstetrics. This means that a male staff nurse can have a harder time getting into these fields than a female nurse. Table 3 Profile of Nurse Respondents According to Age Age 21 - 25 y/o 26 - 30 y/o 31 - 35 y/o 36 - 40 y/o 41 - 45 y/o 46 - 50 y/o Total Frequency N=92 36 32 11 10 2 1 92 Percent (%) 39 35 12 11 2 1 100

As shown in Table 3, there were 92 respondents. The highest percentage belonged to the 21-25 age group with 36 or 39 percent. This is followed by 32 or 35 percent belonging to the 26-30 age groups and

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11 or 12 percent belonged to the 31-35 age group. The data reveals that majority of the nurse-respondents, 86 percent, are young in age and are 30 years and below presumably just in their training stages as nurses. About 14 percent of them are matured nurses. As opined by Tan (2008), one of the reasons that the population of older nurses working in the Philippines is getting smaller compared to those of younger nurses due to the fact older nurses leave their workplace or the country for better-paying jobs abroad. The annual

outflow of Filipino nurses is now three times greater than the annual production of licensed nurses. It has been explained that developed countries are experiencing a longer lifespan and the graying of their population. But their youth population is not interested in the nursing profession because of difficult and risky work. More options are also available to them to take on other professions that offer better pay and working conditions. The solution for these countries: hire foreign nurses to do the job. Based on statements made by their respective

governments, the US would need around 10,000 nurses a year, while in the UK, Ireland, the Netherlands, and other European countries, they would need another 10,000 nurses a year.

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Table 4 Profile of Respondents According to Civil Status Frequency N=92 72 16 4 92 Percent (%) 78 17 4 100

Civil Status Single Married Separated Total

As may be seen, majority of the nurses are single, 72 of them are such, or 78 percent; 16, or 17 percent, are married; and only 4 percent are separated. Table 5 Profile of Respondents According to Length of Service Length of Service Less Than 3 yrs 3 -5 yrs 6 - 10 yrs Total Frequency N=92 37 41 14 92 Percent (%) 40 45 15 100

As may be gleaned from the table above, majority of the respondents, 37, or 40 percent, have only less than 3 years of experience as nurses. This information shows that they are somehow new in their posts. This is followed by 41 or 45 percent with 3-5 years of experience. It is, however, worthy to note that there are 14, or 15 percent, who have been serving patients for 6-10 years as nurses.

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Although they are relatively young in their position, they were able to accumulate enough knowledge and skills in dealing with subordinates. Table 6 Profile of Respondents According to Position Position Nurse Supervisor Head Nurses Staff Nurses Total Frequency N=92 6 9 77 92 Percent (%) 6 10 84 100

As shown in Table 6, out of the 92 respondents, the highest percentage belonged to the 77 staff nurses at 84 percent. This was followed by the 10 percent belonging to the 9 head nurses and the 6 percent pertaining to the 6 nurse supervisors. Data revealed that majority of the nurse-respondents were working as staff nurses. This is based on the number of required staffing position in Hospital-A.

Problem 2. What are the Assessment Findings of the Nurses Professional Practice in Terms of? 2.1 Facilitation; 2.2 Nurturance; and 2.3 Unconditional Acceptance?

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Table 7 Assessment Findings of Nurses Professional Practice in Terms of Facilitation

NURSE SUPERVISOR Interpretation Highly practiced HEAD NURSE Interpretation Highly Practiced STAFF NURSE Interpretation Highly practiced Overall Mean

Mean

Mean 3.78

Mean 4

This hospital has.... 1) Adequate support services by the institution in allowing to spend time with patients 2) Are supportive managers every shift 3) working facility that is pleasant and comfortable 4) A flexible work schedule given by the Nursing Service Office 5)A contingency plan if increase in the number of patients to be cared by staff nurse 6) Available advance clinical nurse specialist in every specialty area 7) A Nursing Service Training Department allow the nurses to participate in annual development plans 8) Nursing Administration promoting an open communication among the personnel 9) Nursing Administration collaborating with the medical department in terms of patient care 10) a comprehensive training program for newly hired nurses that articulates a standard policies and procedures of the Nursing Service Overall Mean

3.83

Highly Practiced

4.17

Highly practiced Highly practiced Highly practiced

4.00

Highly Practiced Moderately Practiced Highly Practiced

Highly practiced Moderately Practiced Moderately Practiced

Highly Practiced Moderately Practiced Highly Practiced

3.50

3.33

4.17

3.89

4.17

Highly practiced

3.67

Highly Practiced

Moderately Practiced

Highly Practiced

3.33

Moderately Practiced

3.33

Moderately Practiced

Moderately Practiced

Moderately Practiced

4.67

Very Highly Practiced

4.00

Highly Practiced

Moderately Practiced

Highly Practiced

4.67

Very Highly Practiced

4.00

Highly Practiced

Moderately Practiced

Highly Practiced

4.33

Highly practiced

3.67

Highly Practiced

Moderately Practiced

Highly Practiced

3.83

Highly practiced

3.56

Highly Practiced

Moderately Practiced

Highly Practiced

4.07

Highly Practiced

3.72

Highly Practiced

Moderately Practiced

Highly Practiced

Legend: Scale 5 4 3 2 1

Limit: 4.50 5.00 3.50 4.49 2.50 3.49 1.50 --2.49 1.00 --1.49

Adjectival Equivalent: Very Highly Practiced Highly Practiced Moderately Practiced Fairly Practiced Not all Practiced

Description: Manifested / Practiced at all times Manifested / Practiced 4 out of 5 encounters Manifested / Practiced 3 out of 5 encounters Manifested / Practiced 2 out of 5 encounters Manifested / Practiced none out of 5 encounters

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As shown in Table 7, majority of the nurse supervisors perceived facilitation in Hospital-A as Highly Practiced. Such is evident, as may seen from their answers, which all indicators, except for Item 6 on the availability of a clinical nurse specialist which had a weighted mean of 3.33, or is Moderately Practiced in every specialty area. Meanwhile, on the head nurses perception of facilitation practice, data show that head nurses perceived it also as Highly Practiced; nevertheless, certain items, such as in item 3, with a weighted mean of 3.33, or interpreted as Moderately Practiced; indicate the pleasant and comfortable environment of a working facility. In the area of practice, as mentioned by Reiling (2008), there are many factors in the workplace that impact care delivery and work satisfaction, and they should be incorporated into designs. Recent

attention in facilitation of health care has been on the actual architectural design of a hospital facility, including its technology and equipment, and its effect on patient safety. To address the problems of errors in health care and serious safety issues, fundamental changes of health care processes, culture, and the physical environment are necessary and need to be aligned, so that the caregivers and the resources that support them are set up for enabling safe care. Another work of Gurses and Carayon (2008), they stated that processes of care will need to be

cxvi

modified to address any inefficiencies caused by distractions like by family members, overly busy working conditions and delays in getting access to required resources like medications, patient medical records, supplies, and medical equipment, delays in seeing new medical orders, and misplaced equipment. However, the advantage of having a clinical nurse specialist or CNS in the area of practice, according to the Journal of Cedar Sinai (2010), is that a clinical nurse specialist influences care outcomes by providing expert consultation and implementing improvements in the healthcare delivery system. The clinical nurse specialist often functions as a program coordinator, a leader in implementing change strategies to improve patient outcomes, an educator, and/or manager of complex patient populations. The CNS provides direct patient care, including

assessing, diagnosing, planning, and treatment of health problems, health promotion, and preventive care within this specialized area of practice. On the other hand, Table 7 also tells how staff nurses perceived practice of facilitation as Moderately Practiced in Hospital-A, except for item 1 and 2 regarding support of managers and the institution which they see as Highly Practiced in Hospital-A.

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According

to

Kramer

(2007)

that

Professional

nursing

organizations identify nurse-manager or NM support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be identified by staff nurses. In terms of nursing administration promoting an open

communication with the staff nurses, in the study done by Oandasan (2009), it is stated therein that organizational culture plays an important role in facilitating and supporting effective communication across the organization. For example, open channels for communication,

transparency, trust, assertiveness, and strong leadership are considered important factors facilitating the effective flow of high-quality information and the sharing of knowledge. An understanding of the workplace

culture allows opportunities for targeted improvement such as enhancing communication among multi-disciplinary teams. Furthermore, by allowing participation of staff nurses in annual development plans by the administration, staff nurses presumably have felt less important compared to nurse supervisors and head nurses as the table above shows the same to be Moderately Practiced. This supports the view of Roussel (2010) regarding the Concept and Theories Guiding Professional Practice in the framework for the standard of nursing practice Standard 4 (As Planning in the The Standards of

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practice); it was stated therein that it considers development, maintenance and evaluation of organizational systems as that which facilitate planning for care delivery. Definitely, there is collaboration amongst advocation for staff involvement in decision-making.

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Table 8 Assessment Findings of the Nurses Professional Practice in Terms of Nurturance

NURSE SUPERVISOR Interpretation
Highly Practiced

Mean This hospital has....

1) Giving recognition for every nurses accomplishments, e.g. (pat on the back or giving remarks such as very good or job well done!) 2) The contributions of the nurses to the institution are being recognized 3) Positivism of the nurses is constantly encouraged 4) Each nurse is mentored on a regular basis 5) A Chief Nursing Officer is available, accommodating and compassionate to all staff 6) An enrichment of nurses character from the nursing service 7) The nurse is acknowledged and rewarded when there is improvement of job performance 8) A counselling program is available for all nurses 9) The skills in every nurse are being appraised by the nurse managers 10) The nurse is being comforted whenever a difficult situation in the clinical area arises Overall Mean 4.00

Mean
3.56

HEAD NURSE Interpretation

Highly Practiced

Mean
3.35

STAFF NURSE Interpretation

Moderately Practiced

Overall Mean

Highly Practiced

4.00

Highly Practiced

3.11

Moderately Practiced

3.22

Moderately Practiced

Moderately Practiced

4.67

Very Highly Practiced

3.56

Highly Practiced

3.44

Moderately Practiced

Highly Practiced

4.17

Highly Practiced

3.67

Highly Practiced

3.39

Moderately Practiced

Highly Practiced

4.00

Highly Practiced

4.22

Highly Practiced

3.94

Highly Practiced

Highly Practiced

4.17

Highly Practiced

3.56

Highly Practiced

3.42

Moderately Practiced

Highly Practiced

4.50

Very Highly Practiced

3.33

Moderately Practiced

3.30

Moderately Practiced

Highly Practiced

4.50

Very Highly Practiced Highly Practiced

3.56

Highly Practiced Highly Practiced

3.27

Moderately Practiced Moderately Practiced

Highly Practiced Highly Practiced

4.33

4.00

3.35

4.33

Highly Practiced

3.56

Highly Practiced

3.25

Moderately Practiced

Highly Practiced

4.27

Highly Practiced

3.61

Highly Practiced

3.39

Moderately Practiced

Highly Practiced

Legend: Scale 5 4 3 2 1

Limit: 4.50 5.00 3.50 4.49 2.50 3.49 1.50 --2.49 1.00 --1.49

Adjectival Equivalent: Very Highly Practiced Highly Practiced Moderately Practiced Fairly Practiced Not all Practiced

Description: Manifested / Practiced at all times Manifested / Practiced 4 out of 5 encounters Manifested / Practiced 3 out of 5 encounters Manifested / Practiced 2 out of 5 encounters Manifested / Practiced none out of 5 encounters

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Table 8 presents the data that majority of the nurse supervisors and head nurses perceptions of nurturance in Hospital-A are Highly Practiced. In Item number 5 on the chief nurses accommodation and being compassionate to nurses, staff nurses perceived it as Highly Practiced. But the practice of nurturance, as seen by staff nurses,

insofar as majority of its indicators, were rated as Moderately Practiced. To support - such practice of acknowledging nurses contributions and in giving recognition for every nurses accomplishments, like a pat on the back or giving remarks such as very good or job well done, Ernst (2011) states that there are findings that, more senior in position, or older nurses, receive more recognition for a job well done and were less concerned about task requirements compared to younger nurses. Although nurses are recognized at nurses week, they want more one-toone mentoring, private feedback, and written acknowledgement. Roussel (2010) stated that one of the components of professional nursing practice environment is to recognize contributions of nurses knowledge and expertise in clinical care and quality patients outcomes, in that an organization has a comprehensive reward system that recognizes role- distinction among staff nurses and other expert nurses based on clinical expertise, reflective practice, education, or advanced credentialing.

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Moreover, in enriching nurses character in the nursing service, suggested that clinical nursing supervision has an influence on nurses' experiences of well-being and in relation to their psycho-social work environment. Aiken (2007), stated that two empirical studies report that greater nurse autonomy leads to better patient outcomes; That autonomy is measured by 3 items: nursings control of its own practice, freedom to make important decisions about care, and not being placed in a position of having to do things that are against nursing judgment.

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Table 9 Assessment Findings of Nurses Professional Practice in Terms of Unconditional Acceptance

NURSE SUPERVISOR Interpretation Very Highly Practiced Highly Practiced Highly Practiced HEAD NURSE Interpretation Highly Practiced Highly Practiced Highly Practiced STAFF NURSE Interpretation Highly Practiced Moderately Practiced Highly Practiced Overall Mean

This Hospital demonstrates...... 1) Respect in every manager-subordinate relationship 2) Team building actively available in every unit 3)There is observance of obedience (e.g. (respecting/complying decisions of superiors.) 4) The individuality of the nurse is taken into consideration 5) The nurse has been given the freedom to decide clinically 6) The core values of nurses are respected by the administration 7) Each nurse is being accepted as an individual in the institution 8) A sense of fulfilment by sharing skills and sharing wisdom to others 9) Acceptance of creativity when mentoring new nurses 10)Satisfaction that come from the nurse by passing insights on to others which is valued more than the work compensation

Mean 4.67

Mean 4.00

Mean 3.66

Highly Practiced Highly Practiced Highly Practiced

4.17

3.78

3.38

4.17

3.89

3.62

4.50

Very Highly Practiced Highly Practiced

3.89

Highly Practiced Highly Practiced

3.53

Highly Practiced Highly Practiced

Highly Practiced Highly Practiced

4.00

3.78

3.49

4.33

Highly Practiced

3.33

Moderately Practiced

3.44

Moderately Practiced

Moderately Practiced

4.33

Highly Practiced

3.78

Highly Practiced

3.51

Highly Practiced

Highly Practiced

4.33

Highly Practiced

3.67

Highly Practiced

3.44

Moderately Practiced

Highly practiced

4.50

Very Highly Practiced

3.67

Highly Practiced

3.58

Highly Practiced

Highly Practiced

4.50

Very Highly Practiced

3.56

Highly Practiced

3.52

Highly Practiced

Highly Practiced

Overall Mean

4.35

Highly Practiced

3.73

Highly Practiced

3.52

Highly Practiced

Highly Practiced

Legend: Scale 5 4 3 2 1

Limit 4.50 5.00 3.50 4.49 2.50 3.49 1.50 --2.49 1.00 --1.49

Adjectival Equivalent Very Highly Practiced Highly Practiced Moderately Practiced Fairly Practiced Not all Practiced

Description Manifested / Practiced at all times Manifested / Practiced 4 out of 5 encounters Manifested / Practiced 3 out of 5 encounters Manifested / Practiced 2 out of 5 encounters Manifested / Practiced none out of 5 encounters

Table 9 shows that the practice of Unconditional Acceptance was positively answered by all the nurses holding different positions and were

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rated as Highly Practiced. Here there is respect and obedience in every managersubordinate relationship. Nurses individuality and skills were given importance. However, Item 2 and 8 were perceived by the staff nurses as Moderately Practice. To support the practice of Unconditional Acceptance in the area of nurses professional practice in terms of team-building, Amos (2005) stated that Team-building strategies assisted the nurse leader/manager to build an effective work team by strengthening communication and interpersonal relationships so that the staff could function as a more cohesive group. Staff development consultants can help nurse-

managers become more effective team leaders by identifying the necessary resources and by helping plan and coordinate team-building strategies. Furthermore, nurses have felt freedom to decide clinically in the area of practice. To be sure, the Detroit Receiving Hospital Journal (2009) states that Professional Nurse Autonomy is defined as a belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, which reflect advocacy for the client. Nurses are appropriately credentialed, permitted and expected to practice autonomously, consistent with the Nurse Practice Act and professional standards.

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Problem 3. Is there a significant difference between the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance when grouped

according to the following profile variables: 3.1 Gender; 3.2 Age; 3.3 Civil status; 3.4 Length of service; and 3.5 Position?

Table 10 Significant Difference Between Assessment Findings Among NurseRespondents when Grouped According to Gender
Mean Rating PRACTICE FACILITATION NURTURANCE UNCONDITIONAL ACCEPTANCE Male 3.38 3.5 3.53 Female 3.41 3.46 3.62 F-computed value* 0.062 0.667 0.314 Significance NS NS NS Decision** Ho:A Ho:A Ho:A

*F critical value (5% level of significance, 1 & 90 df)= 3.947 **Ho: A - Null Hypothesis is not rejected. Legend: NS Not Significant

The mean assessment findings of male nurses did not differ from the findings of the female nurses. However, analysis revealed that the differences in the mean assessments in their practices were found Not Significant since the computed F-values went below the critical F-value

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of 3.947 at five percent level of significance. Hence, the null hypothesis that there are no significant differences in the assessment findings of nurse respondents when grouped according to gender was not rejected. According to Davenport and Yurich (2010), gender issues between males and females in other countries, such as in the United States, gender role socialization, and cultural experiences, shape identities of women and men, define their behavior, and set up expectations for how they interact in the world. Gender role behaviors change between various cultural groups; however, significant themes reflect commonalities across culture as stated by Gilligan (2010). For example, among many cultural groups, female roles typically reflect caretaking responsibilities while male roles focus on status at work, in relationships and in society. Gender role behaviors may be influenced by spiritual/religious experiences. Spirituality/ religion contributes to

womens development and mens identity. How men and women view themselves in relationship to the world around them is critical information for counselors to examine. (McGoldrick, 1998) In contrast to issues of gender among nurses in this study, issues around gender differences in communication styles, values, and expectations are common in all workplace situations. In the health care industry, where most physicians are male and most nurses are female,

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communication problems are further accentuated by gender difference. (Rosenstein and ODaniel, 2005) Table 11 Significant Difference Between Assessment Findings Among NurseRespondents when Grouped According to Age
Mean Rating PRACTICE
FACILITATION NURTURANCE UNCONDITIONAL ACCEPTANCE

1
3.4 3.47 3.57

2
3.45 3.44 3.6

3
2.99 2.99 3

4
3.47 3.62 3.77

5
4.15 3.95 4.05

6
3.5 4.8 4.7

F-value* 1.411 2.042 2.032

Significance

Decision**

NS NS NS

Ho: A Ho: A Ho: A

*F critical value (5% level of significance, 5 & 86 df)= 2.321 Legend: 1: 21 - 25 yrs old 2: 26 - 30 yrs old 3: 31 - 35 yrs old 4: 36 - 40 yrs old 5: 41 - 45 yrs old 6: 46 - 50 yrs old **Ho: A - Null hypothesis is not rejected.

The nurses from the 41-45 age group gave the highest rating to assessing Facilitation Practice at 4.15, while Unconditional Acceptance had 4.05. For the 46-50 age group, mean assessments produced a 4.8 rating. To justify the mean assessments, analysis revealed that the

differences in the mean assessments, in their practices, were found to be Not Significant since the computed F-values went below the critical Fvalue of 2.321 at five percent level of significance. Hence, the Null

Hypothesis that there are no significant differences in the assessment

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findings among nurse respondents when grouped according to age was not rejected. The practice of nurturance in Hospital-A can be supported by Ernsts (2011) Work, Job Satisfaction, Stress and Recognition in a Pediatric Setting, wherein most of the older nurses received more recognition for a job well-done and were less concerned about task requirements compared to younger nurses. Table 12 Significant Difference Between Assessment Findings Among NurseRespondents when Grouped According to Civil Status
Mean Rating PRACTICE FACILITATION NURTURANCE UNCONDITIONAL ACCEPTANCE S 3.35 3.44 3.59 M 3.66 3.68 3.74 SEP 3.75 3.6 3.9 F-value* 2.527 0.994 0.705 Significance NS NS NS Decision** Ho: A Ho: A Ho: A

*F critical value (5% level of significance, 2 & 89 df)= 3.099 Legend: S Single M- Married Sep Separated

NS - Not Significant **Ho: A - Null hypothesis is not rejected.

Here the mean rating of single nurses were lower than those of nurses who are married and separated. Analysis revealed that the

differences in the mean assessments in their practices were found Not Significant since the computed F-values went below the critical F-value of 3.099 at five percent level of significance. Hence, the Null Hypothesis

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that there are no significant differences in the assessment findings of nurse respondents when grouped according to civil status was not rejected. This study shows that nurses civil status does not affect or make a difference at all in relation to their perception of professional practice. However, Quinn and Stines (2007) found that 38% of men and 43% of women who were married and who had jobs and children reported that job and family life conflicted somewhat or a lot in relation to the aforesaid perception of professional practice. Workplace

characteristics can also contribute to higher levels of work - family conflict. Researchers have found that the number of hours worked per week, the amount and frequency of overtime required, an inflexible work schedule, unsupportive supervisor, and an in hospitable organizational culture for balancing work and family all increase the likelihood that women employees will experience conflict between their work and family role (Frone, et al., 2007). Furthermore, Baruch and Barnett (2005), found that women who had multiple life roles such as being a mother, a wife, and an employee, were less depressed and had higher self-esteem than women who were more satisfied in their marriages and jobs compared to women and men who were not married, unemployed, or childless.

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Table13 Significant Difference Between Assessment Findings Among NurseRespondents when Grouped According to Length of Service
Mean Rating Less than 3 yrs 3.51 3.56 3.71 3-5 yrs 3.3 3.41 3.56 6 - 10 yrs 3.47 3.49 3.48 Fvalue* 1.221 0.488 0.0670

PRACTICE FACILITATION NURTURANCE UNCONDITIONAL ACCEPTANCE

Significance NS NS NS

Decision** Ho: A Ho: A Ho: A

*F critical value (5% level of significance, 2 & 89 df)= 3.099 **Ho; A - Null hypothesis is not rejected. Legend: NS Not Significant

The mean rating of assessments under the group of nurses with less than 3 years experience are a little bit higher than those nurses with more than 3 years of experience. Analysis revealed that the differences in the mean assessments in their practices were found Not Significant since the computed F-values went below the critical F-value of 3.099 at five percent level of significance. Hence, the null hypothesis that there are no significant differences in the assessment findings among nurse respondents when grouped according to length of service was not rejected. This study shows that the length of years of service among nurses did not make any difference in the perception of assessment findings of

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practice. The element of nurses with different years of service have no effect on how they see elements of practice in Hospital-A. In support of the foregoing, Noe (2009), stated that, the more the number or years of experience can mentor new nurses in the professional area. Mentors in nursing are nurses who have more experience one has, he/she and knowledge and they guide, support, and nurture the less experienced nurses. A wise mentor makes sure that newer nurses are getting job assignments that challenge them, test their limits, and make sure they have opportunities for learning. Mentoring instills self-confidence and build self-esteem. This is one of the top strategies for retaining nursing staff. Table 14 Significant Difference Between Assessment Findings among NurseRespondents When Grouped According to Position
MEAN ASSESSMENT*
PRACTICE FACILITATION NURTURANCE UNCONDITIONAL ACCEPTANCE NURSE SUPERVISOR 4.07 4.27 4.35 HEAD NURSE 3.72 3.61 3.73 STAFF NURSE 3.31 3.39 3.52 F-computed value* 6.669 5.867 4.691 Significance Significant Significant Significant Decision** Ho: rejected Ho: rejected Ho: rejected

Assessments obtained from descriptions presented in problem F-critical value (5% level of significance, 2 & 89 df) = 3.099 Ho refers to the Null Hypothesis stated earlier.

The mean assessment in terms of Facilitation of Nurse Supervisors was 4.07, higher than the Head Nurses assessment at

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3.72, and the staff nurses assessment at 3.31. In terms of Nurturance, the Supervisors assessment was higher compared to that of the Head nurses assessment at 3.61 and the staff nurses assessment of 3.39. In terms of Unconditional Acceptance, Nurse Supervisors finding in terms of Facilitation was 4.35, still higher that the Head Nurses findings of 3.73 and the Staff Nurses findings of 3.52. Analysis revealed that the differences in the mean assessments in their practices were found Significant since the computed F-values exceeded the critical F-value of 3.099 at five percent level of significance. Hence, the Null Hypothesis that there are no significant differences in the assessment findings of nurse respondents when grouped according to position was rejected. Indeed, Roussel (2010) stated that the nurses ability to communicate and to promote effective communication and interpersonal relationships among nursing staff. Ernst (2011) noted that older nurses received more recognition for a job-well done and were less-concerned about task requirements than younger nurses. Also, Hall (2007), stated that organizational and managerial support have an effect on nurse satisfaction and burnout. The relationships between perceived

supervisor support and measures of nurse occupation-related outcomes were investigated in 3 nursing units within an academic medical center.

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Such work concluded that nurses with greater levels of perceived supervisor support experienced more positive job outcomes and less negative outcomes, including less occupational stress, than nurses with less perceived supervisor support.

Problem 4. Based professional proposed?

on

the

assessment plan

findings

of

nurses can be

practice,

what action

framework

An Action Plan Framework refers to the proposal that will guide one in the step by step activities of the nursing service. It is the process of planning of what needs to be done, when it needs to be done, by whom it needs to be done, and what resources or inputs are needed to do it. Thus:

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Figure 3: Proposed Action Plan Framework for the Nursing Service

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CHAPTER 5 SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

This Chapter briefly presents the Summary of Findings, the Conclusions drawn from the analysis of data gathered and

Recommendations of the researcher. Summary The study sought to find out assessments of nurses professional practice. Specifically, the study answered the following questions: 1. What is the demographic profile of nurses according to: 1.1 Gender; 1.2 Age; 1.3 Civil status; 1.4 Length of service; and 1.5 Position? 2. What are the assessment findings of the nurses professional practice in terms of : 2.1 Facilitation; 2.5 Nurturance; and

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2.3 Unconditional Acceptance? 3. Is there a significant difference between the assessment findings of nurses professional practice in terms of Facilitation, Nurturance and Unconditional Acceptance when grouped according to the following profile variables: 3.1 Gender; 3.2 Age; 3.3 Civil status; 3.4 Length of service; and 3.5 Position? 4. Based on the findings of the study, what action plan framework can be proposed?

Findings The following are the summary of findings: 5. The demographic profile of the nurse-respondents 5.1 Gender As to gender of the respondents, only 32 percent are male respondents, while 68 percent are female nurses. It shows that females outnumbered the males in the field of nursing.

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5.2 Age As far as age is concerned, majority of them or 39 percent, are young and belong to the less than 25 years old age group, while very few or 1-2 percent, belong to more the than 42 years old age group. 5.3 Civil Status As to civil status of the respondents, only 17 percent of the respondents are married and 78 percent are single nurses. It means that single nurses outnumbered the married nurses. 5.4 Length of Service As to length of service, majority of the respondents or 40 percent are new in their posts with less than 3 years of experience followed by 35 years of experience or 45 percent. However, there were only 15 percent who has 6-10 years of experience of work as nurses. 5.5 Position As to position, 84 percent of the population are staff nurses. This was followed by the head nurses constituting 10 percent of the respondents. Only 6 percent are nurse supervisors.

6. What are the assessment findings of the nurses professional practice in terms of: Facilitation, Nurturance and Unconditional Acceptance?

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2.1 Facilitation. The respondents from the group of the nurse-supervisors and head nurses assessed practice of facilitation on nurses as Highly Practiced in this hospital, while staff nurses assessed facilitation as Moderately Practiced. It could be noted in Item 3 that all of the respondents agreed to support the institution has the and managers support towards nurses and was thus rated as Highly Practiced. However, nurses rated Item 6 to be Moderately Practiced with regard to the availability of clinical nurse specialists in every area of practice. 2.2 Nurturance The majority of the nurses from the group of nurse-supervisors and head nurses assessed practice of Nurturance on nurses as Highly Practiced in this hospital, while nurses in the staff nurse position assessed nurturance as Moderately Practiced. Item number 5 tells us that all nurses rated it as Highly Practiced regarding chief nurses availability and being compassionate to nurses when needed. However, Items 1,2,3,4,6,8,9, and 10, staff nurses rated these indicators as Moderately Practice, such concerns recognition, acknowledging, and acceptance of contributions of nurses to the institution.

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2.4 Unconditional Acceptance Under the practice of Unconditional Acceptance, all of the respondents, from the position of nurse supervisors, head nurse, and staff nurse position assessed this element of practice as Highly Practiced. A majority of the items were positively rated as Highly Practiced except for one item in Numbers 2, 6, and 8 wherein staff nurses rated it as Moderately Practiced. These data showed that all nurses have common assessment findings concerning Unconditional Acceptance in this hospital.

7. Is there a significant difference between the assessment findings of nurses professional practice in terms of facilitation, nurturance and unconditional acceptance when grouped according to profile variables: 7.1 Gender The critical F value of 3.947 at five percent level of significance is above the F computed value of facilitation which is 0.062, with Nurturance at is 0.666, and Unconditional Acceptance at is 0.314. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to gender was not rejected. There are no differences in the assessment

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findings of nurses professional

practice when grouped according to

gender. Male and female nurses face common assessment findings in their professional practice. 7.2 Age The critical F value of 2.321 at five percent level of significance is above the F computed value of facilitation which is 1.411; Nurturance was at 2.042 and Unconditional Acceptance yielded is 2.0032. The Null Hypothesis that there are no significant differences in the assessment findings of nurse respondents when grouped according to age was thus not rejected. Indeed, there are no differences in the assessment findings of nurses professional practice when grouped according to age. The young and older nurses illustrate a common assessment finding of their professional practice. 7.3 Civil Status The critical F value of 3.099 at five percent level of significance is above the F-computed value of Facilitation which is 2.527, Nurturance was at 0.994 and Unconditional Acceptance at 0.705. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to civil status was therefore not rejected. There are no differences in the assessment findings of nurses professional practice when grouped according to civil

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status. The married, single, and separated nurses show a general assessment finding in their professional practice. 7.4 Length of service The critical F value of 3.099 at five percent level of significance is above the F-computed value of Facilitation which is 1.221: Nurturance was at 0.488 and Unconditional Acceptance at 0.670. The Null Hypothesis that there are no significant differences in the assessment findings of nurse respondents when grouped according to length of service was thus not rejected. There are no differences in the assessment findings of nurses professional practice when grouped

according to length of experience. All nurses have shown no variance of assessment finding in relation to their professional practice. 7.5 Position The critical F value of 3.099 at five percent level of significance is below the F computed value of facilitation which is 6.669; Nurturance was at 5.867 and Unconditional Acceptance which is 4.691. The Null Hypothesis that there are no significant differences in the assessment findings of nurse-respondents when grouped according to position was thus rejected. Consequently, there are differences in the findings of nurses professional practice when grouped assessment according to

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position. All nurses face varying assessment findings in professional practice.

8.

Based on the findings of the study, an action plan framework

is proposed. This addresses the guidance of the nursing service toward positive patient outcome in maintaining and enhancing elements of practice; namely: Facilitation, Nurturance and Unconditional Acceptance.

Conclusions The following conclusions were drawn based on the findings: 1. Majority of the nurse-respondents belonged to the level of staff nurse - 83.70 percent of the respondent population. While head nurses only constituted 9.78 percent of the population; the lowest percent at 6.52 belonged to nurse-supervisors. Data also showed that most of the nurses are females and a few of them were males; majority of them are in the staff nurse level. In terms of nurses age, it was noticed that it was a population dominated by young nurses. It is a fact that most of them belong to the age group of 21 to 25 years. There seems to be a fewer number of older nurses, and a majority of the nurses are single. In terms of their experience, majority of the nurses who are head nurses and staff nurses have been working for

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less than 5 years. Only very few of them have 6 to 10 years of work experience, belonging, of to the position of nurse supervisors. 2. In assessing nurses professional practice along the three elements of practice, namely: Facilitation; Nurturance; and Unconditional Acceptance, the highest degree of assessment findings was in the practice of Unconditional Acceptance, while the least was in Nurturance. The nurse respondents have given a favorable response, obtaining Moderately Practice in relation to the assessment findings in their professional practice. 3. There are no significant differences in the assessment findings of nurses professional practice when grouped according to gender, age, civil status, and length of service. All nurses have demonstrated common assessments insofar as the elements of practice in their profession. However, when grouped according to position, nurses faced varied assessment findings of their professional practice which signifies that there are differences in assessment findings. 4. Based on the assessment findings of the nurses professional practice in this study, in terms of the following elements: the administrations practice of Facilitation, Nurturance and Unconditional Acceptance towards the nurses, though the Analysis of Variance test showed that there is difference in the assessment of professional

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practice among nurses, it is not prudent at the moment to formulate an action plan for the nursing service because the results showed favorable outcome which signified good management and staff relationship leading to better policy and procedure implementation and quality patient care. As stated by Butts (2010), every organization has its own culture, beliefs, attitudes, values, customs and practices from the chief executive officer or to the managers down to their employees. Ethically, the researcher feels that it would be inappropriate to interfere with what this hospital is already implementing and practicing which is considered of good quality. However, the findings of this study may suggest ways on reinforcing and enhancing the existing practice in this hospital. Specifically in terms of Facilitation and Nurturance of staff nurses, nurses felt that they were less nurtured by the moderate practice of giving recognition and acknowledging staff nurses performance by the administration. Hence, a proposed action plan framework in nurses professional practice based on the results of the study can be seen in the last part of Chapter 4.

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Recommendations D) For the Management / Nursing Administration 7. Continue the positive practice of Facilitation, Nurturance and Unconditional Acceptance to employees under the nursing service; 8. To find more ways, strategies, and techniques for strengthening ties and support in relation to Nurse-Supervisors, head nurses, staff nurses, as well as other member of the health team; 9. To maintain open-communication styles among members of Multidisciplinary teams, communicating effectively, which is considered important if teams are to function optimally and ensure patient safety and quality of care. 10. Maintain open channels for communication, transparency, trust, assertiveness, and strong leadership that are considered important factors in facilitating the effective flow of high-quality information and the sharing of knowledge; 11. Reward and recognize nurses who provide excellence in direct patient care; and 12. Have provisions for feedback among teams to assist in continuous improvement. Feedback is information provided for the purpose of improving team performance and should be focused on behaviors, not personal attributes, and should be constructive and timely.

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E) For the Nurse Supervisors and the Head Nurses. 4. To continue collaboration, open communication with staff nurses, and supporting nurses with daily duties in the institution. 5. Engage in more training and support mechanisms to assist other nurses fulfill patient care; and 6. To nurture and promote positive working relationships by acting as a mentor to staff nurses by passing and sharing knowledge and skills to other nurses to ease transition which young nurses undergo in the workplace. F) For Staff Nurses 4. Staff nurses should maintain rapport with managers, supervisors, and head nurses in creating a positive working relationship. 5. To continue working with other members of the health team who are part of the planning and implementation of nursing policies for the benefit of patients; and 6. To attend seminars and in-house trainings as self enhancement of practice, skills, and knowledge in professional practice.

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APPENDIX - A Questionnaires for Nurse Supervisors / Head Nurses / Staff Nurses:

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Part 1: Background Profile (Please check appropriate response) Name: __________________________________________ (OPTIONAL) Position: ___Nurse Supervisor (NS) ___Head Nurse (HN) ___Staff Nurse (SN) 1. Gender: ___Male ___Female ___21 to 25 years old ___26 to 30 years old ___31 to 35 years old ___36 to 40 years old ___41 to 45 years old ___46 to 50 years old ___51 to 55 years old ___56 to 60 years old

2. Age:

3. Civil Status: ___ Single ___Married ___Separated ___Widow 4. How long have you been employed as an RN on that unit / department? ___less than 3 years ___3 to 5 years ___6 to 10 years ___11 to 15 years ___16 to 20 years ___21 to 25 years ___ more than 25 years

Part 2: The following questions relate to your current nursing practice environment. For each item in this section, please indicate the extent to

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which you agree that the following conditions are present in your current job. Indicate your practice by checking ( / ) the appropriate number. 5 Very Highly Practiced 4 Highly Practiced 3 Moderately Practiced 2 Fairly Practiced 1 Not Practiced Assessment towards practice of profession: A. FACILITATION (This refers how the nursing service helps the nurse take steps toward health, including providing necessary resources and information.)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. As a supervisor/ head nurse/ staff nurse, this hospital there is/are...... an adequate support services by the institution in allowing to spend time with patients. supportive managers every shift. a working facility that is pleasant and comfortable. a flexible work schedule given by the Nursing Service Office. a contingency plan if increase in the number of patients to be cared by staff nurse. an available advance clinical nurse specialist in every specialty area. a Nursing Service Training Department allow the nurses to participate in annual development plans. a Nursing Administration promoting an open communication among the personnel. a Nursing Administration collaborating with the medical department in terms of patient care. a comprehensive training program for newly hired nurses that articulates a standard policies and procedures of the Nursing Service. 5 4 3 2 1

B. NURTURANCE (This refers how the nursing service provides care and comfort to the nurse.)
As a supervisor/ head nurse/ staff nurse in this hospital is/are...... 5 4 3 2 1

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1. Giving recognition for every nurses accomplishments, e.g. (pat on the back or giving remarks such as very good or job well done!) The contributions of the nurses to the institution are being recognized. Positivism of the nurses is constantly encouraged. Each nurse is mentored in a regular basis. A Chief Nursing Officer is available, accommodating and compassionate to all staff. An enrichment of nurses character from the nursing service. The nurse is acknowledged and rewarded when there is improvement of job performance. A counselling program is available for all nurses. The skills in every nurse are being appraised by the nurse managers. The nurse is being comforted whenever a difficult situation in the clinical area arises.

2. 3. 4. 5. 6. 7. 8. 9. 10.

C. UNCONDITIONAL ACCEPTANCE (This refers how the nursing service accepts each nurse just as he or she is without any conditions.)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. As a supervisor/ head nurse/ staff nurse, in this hospital there is/are ...... respect in every manager-subordinate relationship. team building actively available in every unit. There is observance of obedience (e.g. (respecting/complying decisions of superiors.) the individuality of the nurse is taken into consideration. the nurse has been given the freedom to decide clinically. the core values of nurses are respected by the administration. each nurse is being accepted as an individual in the institution. a sense of fulfilment by sharing skills and sharing wisdom to others. acceptance of creativity when mentoring new nurses. satisfaction that come from the nurse by passing insights on to others which is valued more than the working compensation. 5 4 3 2 1

Thank you for taking the time to share your experiences and your opinion. Your contributions will be valued to this research project.
APPENDIX - B INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY

clxi Study Title: ASSESSMENT OF THE NURSES PROFESSIONAL PRACTICE: A BASIS FOR AN ACTION PLAN FRAMEWORK FOR THE NURSING SERVICE. Dear Respondent, I am inviting you participate in a research project to study Assessment of Nurses Professional Practice. Along with this letter is a short questionnaire that asks a variety of questions about your personal profile, your professional practice in terms of facilitation, nurturance and unconditional acceptance. I am asking you to look over the questionnaire and, if you choose to do so, complete it and send it back to me. It should take you about 5 minutes to complete. The results of this project will be an analysis and understanding of the assessment of nurses practice that will be the basis for an action plan framework for the nursing service. I do not know of any risks to you if you decide to participate in this survey and I guarantee that your responses will not be identified with you personally. I promise not to share any information that identifies you with anyone outside my research group which consists of me only. You should not put your name on the questionnaire. If you do not feel comfortable handing in your survey to me, you may also drop it off at nursing office] I hope you will take the time to complete this questionnaire and return it. Your participation is voluntary and there is no penalty if you do not participate. If you have any questions or concerns about completing the questionnaire or about being in this study, you may contact me at 09192757424. You do not have to place your name on the survey. Sincerely, (Sgd) Ma. Bernardita V. Villaruel, RN MAN, Candidate

APPENDIX - C LETTER OF APPROVAL FROM DEAN TO CONDUCT STUDY

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APPENDIX - D LETTER OF APPROVAL OF LOCALE TO CONDUCT THE STUDY

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APPENDIX - E LETTER FOR APPROVAL FOR PILOT TEST

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APPENDIX - F LETTER OF REQUEST FOR THE EVALUATOR A

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LETTER OF REQUEST FOR THE EVALUATOR B

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LETTER FOR THE EVALUATOR C

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APPENDIX G

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PICTURE IMAGE OF LOCALE OF THE STUDY (HOSPITAL A)

APPENDIX H PHILIPPINE NURSING ACT OF 1991

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Republic of the Philippines Congress of the Philippines Metro Manila Eighth Congress Republic Act No. 7164 November 21, 1991

AN ACT REGULATING THE PRACTICE OF NURSING IN THE PHILIPPINES Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:: ARTICLE I TITLE Section 1. Title. This Act shall be known as the "Philippine Nursing Act of 1991." ARTICLE II DECLARATION OF POLICY Section 2. Declaration of Policy. It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, and in humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantee the delivery of basic health services through an adequate nursing personnel throughout the country. ARTICLE III ORGANIZATION OF THE BOARD OF NURSING Section 3. Name and Composition of the Board. There shall be created a Board of Nursing to be composed of a Chairman and four (4) members who shall be appointed by the President from a list of twelve (12) nominees who are registered nurses of recognized standing in the Philippines and who possess the qualifications prescribed in Section 5 of this Act as certified by the accredited national nurses association to the Professional Regulation Commission. Section 4. Power and Duties of the Board. The Board shall have following powers, duties and functions: (a) Supervise and regulate the practice of the nursing profession; (b) Describe the subjects in the licensure examination, determine the syllabi of the subjects, and their relative weight, construct the test questions, in the licensure examination, and score and rate the examination paper. The Board shall within one hundred twenty (120) days after the examination, submit a report of the examination result which shall contain the weighted average

clxx
rating of each examinee to the Office of the President for release and publication; (c) Issue, suspend, or revoke certificates of registration for the practice of nursing; (d) Study the condition affecting the nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical, technical, moral and professional standards in the practice of nursing, taking into account the health needs of the nation; (e) Examine the prescribed facilities of universities or colleges seeking permission to open colleges of nursing or departments of nursing education in order to ensure that standards and essential requirements for a qualified dean and faculty and adequate budget are property complied with and maintained at all times. The authorization to open colleges of nursing shall be based upon the favorable written recommendation of both the Board and the Department of Education, Culture and Sports; (f) Require nurses who graduate from state colleges and universities to render, after being issued the necessary board licenses, at least one (1) year of nursing service in the Philippines before they are allowed to leave for overseas jobs; (g) Investigate violations of this Act. For this purpose it may through its Chairman, with the approval of the Board, issue summons, subpoena or subpoena duces tecum to violators of this Act and witnesses thereof and to compel their attendance by the power of contempt; and (h) Promulgate decisions or adopt measures as may be necessary for the improvement of the nursing practice, for the advancement of the profession, and for the proper and full enforcement of this Act. Section 5. Qualifications of Board Members. A member of the Board shall: (a) Be a citizen and resident of the Philippines; (b) Be a member in good standing of the accredited national nurses association; (c) Be a registered nurse and holder of a masters degree in nursing conferred by a college or university duly recognized by the Government; (d) Have at least ten (10) years of continuous practice of the profession prior to appointment; (e) Not be a holder of a green card or its equivalent; and

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(f) Not have been convicted of any offense involving moral turpitude even if previously extended pardon by the President of the Philippines. Section 6. Requirements Upon Qualification as Member of the Board of Nursing. Any person who qualifies as Chairman or member of the Board shall automatically resign from any teaching position in any school, college or university and/or review program for the local nursing board examinations or in any office or employment in the Government or any subdivision, agency or instrumentality thereof, including government-owned or controlled corporations or their subsidiaries. He shall not have any pecuniary interest in or administrative supervision over any institution offering basic nursing education programs, including review classes. Section 7. Term of Office. The Chairman and the members of the Board shall hold office for a term of three (3) years and until their successors shall have qualified: Provided, That a member of the Board may be reappointed for another term not exceeding three (3) years: Provided, further, That, in the event that only one (1) member of the Board is reappointed, he or she, by virtue of seniority, shall automatically become the Chairman of the new Board. However, in case two (2) or more members are reappointed, the best qualified among them, to be determined by all the members of the new Board, shall become the new Chairman of the Board: Provided, finally, That, in case all members of the old Board are reappointed or all members are new, all the members of the new Board shall determine the best qualified from among themselves who shall be recommended to the President of the Philippines to be the Chairman of the Board. Any vacancy in the Board occurring within the term of a member shall be filled for the unexpired portion of the term only. Each member of the Board shall take the proper oath of office prior to the performance of his or her duties. Section 8. Compensation of Board Members. The Chairman and members of the Board shall receive as compensation an amount equal to that given the Chairman and members of other government boards situated under analogous circumstances. Section 9. Removal of Board Members. The President may remove any member of the Board on the following grounds after giving the member concerned an opportunity to defend himself or herself in a proper administrative investigation to be conducted under the supervision and control of the Department of Justice, upon instruction of the President: (a) Continued neglect of duty or incompetence; (b) Commission or toleration of irregularities in the examination conducted by the Board; and (c) Unprofessional or dishonorable conduct. Section 10. Rules and Regulations. The Board shall promulgate such rules and regulations as may be necessary to carry out the provisions of this Act. Section 11. Records. All records of the Board of Nursing, including examination papers, minutes of deliberations, records of administrative cases and investigations, and examination results shall be kept by the Professional Regulation Commission under the direct custody of the

clxxii
person designated by the Chairman of the Commission. No record shall be removed, altered or examined without the prior authorization of the Board. Section 12. Examination Required. All applicants for license to practice nursing shall be required to pass written examination by the Board of Nursing. Section 13. Qualifications of Applicants. In order to be admitted to the examination for nurses, an applicant must, at the time of filing his or her application, establish to the satisfaction of the Board of Nursing that: (a) He or she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country: Provided, That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act; (b) He or she is at least eighteen (18) years of age: Provided, That any underage applicant who successfully passes the examination shall not be permitted or licensed to practice nursing until he or she shall have reached the age of majority; (c) He or she is in good health and is of good moral character; and (d) He or she is a holder of bachelors degree in nursing from a college or university duly recognized by the proper government agency. Section 14. Licensure Examination. The licensure examination for the practice of nursing in the Philippines shall by given by the Board not earlier than one (1) month but not later than two (2) months after the closing of the semester prescribed by the Department of Education, Culture and Sports. The examination shall be held in the City of Manila or in such places as may be decided by the Board subject to the approval of the Professional Regulation Commission. Section 15. Scope of Examination. The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board. The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and competencies in determining the subjects of examinations. Section 16. Rating in the examination. In order to pass the examination, an examinee must obtain a general average rating of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average rating of seventy-five percent (75%) or higher but gets a rating below sixty percent (60%) in any given subject must take the examination again, but only in the subject or subjects where he or she rated below sixty percent (60%). In order to pass the succeeding examination an examinee must obtain a rating of at lest seventyfive percent (75%) in the subject or subjects repeated. An examinee who despite the third examination fails to obtain at least seventy-five percent (75%) in the subject or subjects repeated shall no longer be allowed to take the examination,

clxxiii
unless he proves to the satisfaction of the Board that he/she has undergone a refresher course consisting in enrollment and passing in the regular fourth year subjects in a recognized nursing school. Section 17. Issuance of Certificates. A certificate of registration as nurse shall be issued to any applicant who passes the examination upon payment of the prescribed fees. Every certificate of registration shall show the full name of the registrant, the serial number, the signature of the members of the Board, and the official seal of the Board. Section 18. Fees of Examination and Registration. Applicants for licensure examination and for registration shall pay the prescribed fees set by the Professional Regulation Commission. Section 19. Registration by Reciprocity. Certificates of registration may be issued without examination to nurses registered under the laws of any foreign state or country: Provided, That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That the laws of such state or country grant the same privileges to registered nurses of the Philippines on the same basis as the subjects or citizens of such foreign state or country. Section 20. Non-issuance of Certificates in Certain Cases. No person convicted by final judgment of any criminal offense involving moral turpitude or any person guilty of immoral or dishonorable conduct shall be issued a certificate of registration. The Board shall furnish the applicant a written statement setting forth the reasons for its action which shall be incorporated in the records of the Board. Section 21. Revocation and Suspension of Certificates. The Board shall have the power to revoke or suspend the certificate of registration of a nurse upon any of the following grounds: (a) For any of the causes mentioned in the preceding section (b) For unprofessional and unethical conduct; (c) For gross incompetence and serious ignorance; (d) For malpractice or negligence in the practice of nursing; and (e) For the use of fraud, deceit, or false statements in obtaining a certificate of registration. Section 22. Reissuance of Revoked Certificates and Replacement of Lost Certificates. The Board may, for reasons of equity and justice or when the cause for revocation has disappeared or has been cured and corrected, upon proper application therefor and the payment of the required fees, issue another copy of the certificate of registration. ARTICLE IV NURSING EDUCATION

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Section 23. General Entrance Requirements. Applicants desiring to enroll in a nursing course must belong to the upper forty percent (40%) of the graduating class of the general secondary course, as certified by the school. Section 24. Nursing Education Program. The nursing education program shall provide sound academic and professional foundation for the practice of nursing. Section 25. Learning Experiences. The learning experiences required in a classroom, hospital, home, community or other health/welfare agency shall adhere strictly to specific requirements embodied in the prescribed curriculum for the nursing course and in the rules, policies, and standards of nursing education. Such learning experience shall not be less than six (6) units or its equivalent. Section 26. Qualifications of the Faculty. A member of the faculty in a college or school of nursing must: (a) Be a Filipino citizen; (b) Be a registered nurse in the Philippines; (c) Have at least three (3) years of clinical practice in a field of specialization; (d) Be a member of good standing in the accredited national nurses association; and (e) Be a holder of a masters degree in nursing or other related fields conferred by a college or university duly recognized by the Government of the Republic of the Philippines; Provided, however, That nothing in this Act shall be construed to disqualify those who have already been considered qualified and actually occupying the position before the effectivity of this Act: Provided, further, That those occupying such position before the effectivity of this Act shall be given a period of five (5) years from the date of effectivity of this Act within which to qualify under the provisions hereof: Provided, finally, That, by the year 2000, all colleges of nursing shall only employ faculty members with a masters degree in nursing or in other related fields. In addition to the aforementioned qualifications, the dean of a college or school of nursing must have had at least there (3) years of experience in teaching and supervision in nursing education, and preferably must have a masters degree in administration and supervision of nursing education programs.

ARTICLE V NURSING PRACTICE

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Section 27. Scope of Nursing. A person shall be deemed to be practicing nursing within the meaning of this Act when he, for a fee, salary or other reward or compensation, singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in various stages of development towards the promotion of health, prevention of illness, restoration of health, and alleviation of suffering through: (a) Utilization of the nursing process, including assessment, planning, implementation and evaluation of nursing care. Nursing care includes, but not limited to, traditional and innovative approaches in self-executing nursing techniques and procedures, comfort measures, health teaching and administration of legal and written prescription for treatment therapies, medication and hypodermic intramuscular or intravenous injections: Provided, however, That, in the administration of intravenous injections, special training shall be required according to protocol established; (b) Establishment of linkages with community resources and coordination of the health team; (c) Motivation of individuals, families and communities; resources and coordination of services with other members of the health team; (d) Participation in teaching, guidance and supervision of student in nursing education programs, including administering nursing services in varied settings such as hospitals, homes, communities and the like; undertaking consultation services; and engaging in such other activities that require the utilization of knowledge and decision-making skill of a registered nurse; and (e) Undertaking nursing and health manpower development training and research and soliciting finances therefor, in cooperation with the appropriate government or private agency: Provided, however, That this provision shall not apply to nursing students who perform nursing functions under the direct supervision of qualified faculty. Section 28. Qualifications of Nursing Service Administrator. A person occupying supervisory or managerial positions requiring knowledge of nursing must: (a) Be a Filipino citizen or a former Filipino citizen who was has officially declared his/her intention to reacquire Filipino citizenship; (b) Be a registered nurse in the Philippines; (c) Be a member in good standing of the accredited national organization of nurses; (d) Have at least two (2) years experience in general nursing service administration; and (e) Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in management courses at the graduate level.

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Provided, That a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, possess: (a) At least five (5) years of experience in a supervisory or managerial position in nursing; and (b) A masters degree major in nursing service administrati on or its equivalent: Provided however, That those occupying such position before the effectivity of this Act shall be given a period of five (5) years from the date of effectivity of this Act within which to qualify: Provided, further, That, by the year 2000, only holders of a masters degree major in nursing administration shall be appointed to such position: Provided finally, That, for hospitals with bed capacity of fifty (50) and below, the minimum academic qualifications and experiences for a chief nurse shall be as specified under subsections (c), (d) and (e) of this section. ARTICLE VI HEALTH HUMAN RESOURCE DEVELOPMENT, PRODUCTION AND UTILIZATION Section 29. Studies for Nursing Manpower Needs, Production, Utilization and Development. The Nursing Board shall undertake studies and initiate and/or cooperate with appropriate government or private agencies in the conduct of studies for health human resource production, utilization and development. ARTICLE VII PENAL AND MISCELLANEOUS PROVISIONS Section 30. Prohibitions in the Practice of Nursing. A fine of not less than Ten thousand pesos (P10,000.00) nor more than Forty thousand pesos (P40,000.00) or imprisonment of not less than one (1) year nor more than six (6) years, or both, in the discretion of the court, shall be imposed upon: (a) Any person practicing nursing in the Philippines within the meaning of this Act: (1) Without a certificate of registration or without having been declared exempt from examination in accordance with the provisions of this Act; (2) Who uses as his/her own the certificate or registration of another; (3) Who uses an expired, suspended or revoked certificate of registration; (4) Who gives any false evidence to the Board of Nursing in order to obtain a certificate of registration;

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(5) Who falsely poses or advertises as a registered nurse or uses any other means that tend to convey the impression that he or she is a registered nurse; or (6) Who appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered Nurse) to his/her name without having been conferred said degree or registration; (b) Any person who undertakes in-service educational programs or who conducts review classes for both local and foreign examinations without permit/clearance from the Philippine Nursing Association, the Board of Nursing and the appropriate office or officer of the Department of Labor and Employment; and (c) Any person violating any provision of this Act. Section 31. Standard Basic Pay. Based on current National Economic and Development Authority (NEDA) figures, the proper government office or agency shall fix a standard pay for all nurses working in either public or private health agencies. The same standard basic pay shall be increased periodically to cope with the increase in cost of living. Section 32. Enforcement of this Act. It shall be the duty of all duly constituted lawenforcement agencies and officers of national, provincial, city or municipal governments to enforce the provisions of this Act and to prosecute any person violating the same. Section 33. Repealing Clause. All laws, decrees, orders, circulars, rules and regulations, and other issuances which are inconsistent with this Act are hereby repealed, amended or modified accordingly. Section 34. Separability Clause. If any part of this Act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational. Section 35. Effectivity. This Act shall take effect one (1) month after its publication in any newspaper of general circulation in the Philippines. Approved: November 21, 1991

APPENDIX I SPLIT-HALF METHOD

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Raw data pilot test result used the SPLIT-HALF METHOD for reliability coefficient with the application of Pearson Product Moment of Coefficient of Correlation RELIABILITY TEST MEAN ODD 3.73 3.00 3.47 3.67 3.40 3.67 3.67 3.53 3.60 2.67 3.67 3.67 3.20 3.53 3.53 3.40 MEAN EVEN 3.70 3.20 3.53 3.67 3.40 3.87 3.68 3.52 3.65 2.68 3.40 3.83 3.33 3.63 3.57 3.42

r = 0.924

APPENDIX J

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ANALYSIS OF VARIANCE F-Test

Anova: Single Factor FACILITATION SUMMARY Groups NURSE SUPERVISOR HEAD NURSE STAFF NURSE ANOVA Source of Variation Between Groups Within Groups Total Anova: Single Factor NURTURANCE SUMMARY Groups NURSE SUPERVISOR HEAD NURSE STAFF NURSE ANOVA Source of Variation Between Groups Within Groups Total Total Anova: Single Factor UNCONDITIONAL ACCEPTANCE SUMMARY Groups NURSE SUPERVISOR HEAD NURSE STAFF NURSE ANOVA Source of Variation Between Groups Within Groups Total SS 4.046541502 38.38954545 42.43608696 df 2 89 91 MS 2.023271 0.431343 F 4.690628522 P-value 0.011567911 F crit 3.098869718 Count 6 9 77 Sum 26.1 33.6 270.9 Average 4.35 3.733333 3.518182 Variance 0.191 0.585 0.430980861 SS 4.453213972 33.7775469 38.23076087 38.23076087 df 2 89 91 91 MS 2.226607 0.379523 F 5.866856535 P-value 0.0040418 F crit 3.098869718 Count 6 9 77 Sum 25.6 32.5 261.2 Average 4.266667 3.611111 3.392208 Variance 0.390666667 0.541111111 0.361780588 SS 4.183663341 27.91590188 32.09956522 df 2 89 91 MS 2.091832 0.313662 F 6.669066954 P-value 0.002000722 F crit 3.098869718 Count 6 9 77 Sum 24.4 33.5 255.1 Average 4.066667 3.722222 3.312987 Variance 0.214666667 0.346944444 0.316671224

APPENDIX K Certification of Editing

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APPENDIX N Certification of Statistical Treatment

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This is to certify that the Thesis entitled, Assessment of Nurses Professional Practice: A Basis for An Action Plan Framework for the Nursing Service, of Ms. Ma. Bernardita V. Villaruel was statistically analyzed using appropriate statistical tools by the undersigned.

Sgd. DR. JESUS B. GOLLAYAN Statistician Noted:

Sgd. Atty. IRINEO F. MARTINEZ, JR., Ph.D. Dean, Graduate School

CURRICULUM VITAE

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Name Born Civil Status Gender Address

: : : : :

MA. BERNARDITA V. VILLARUEL, RN. December 9, 1969 Single Female 34 Arabejo St. Phase 2 Gatchalian Subd. Manuyo 2, Las Pinas City 1745 Email add: berdvil@yahoo.com

EDUCATION: Graduate Studies : Master of Arts in Nursing, Major in Nursing Administration University of Perpetual Help System DALTA - LAS PINAS 2008-2012 Emilio Aguinaldo College Manila Bachelor `of Science In Nursing 1986 - 1990 St. Paul College of Paranaque High School 1982 - 1986

Tertiary School

Secondary School :

EMPLOYMENT EXPERIENCE:

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Registered Nurse - UNIVERSITY OF PERPETUAL HELP DALTA MEDICAL CENTER - LAS PINAS Alabang - Zapote Rd., Las Pinas City, Philippines January 1997 to Present EXAMINATIONS TAKEN: 1. Philippine Nursing Board Examination Date Taken : June 12, 1992 Remarks : Passed Commission on Graduates of Foreign Nursing Schools (CGFNS) Date Taken : November 10, 2004 Remarks : Passed International English Language Testing System (IELTSAcademic) Date Taken : September 18, 2008 (Speaking -7 ; Band Score 7) Remarks : Passed NCLEX (California Board of Nursing) Date Taken : July 29, 2006 Remarks : Passed

2.

3.

4.

SOCIETY MEMBERSHIP: Philippine Nurses Association

SKILLS: Knowledge in Nursing Skills I.V. Therapy

CONTINUING EDUCATION PROGRAMS ATTENDED: Basic First Aid G2010, CPR/AED G2010, CPR Pro G2010, ACLS G2010 Golden Success (GSTEII) - Bright Center 5F G5 Bldg 840 MF Jhocson St Sampaloc Manila 1008 November 18-21, 2011 1ST ANNUAL POST-GRADUATE COURSE-ANATOMY OF AN EMERGENCY

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Ernesto Palanca Crisostomo Hall Auditorium University of Perpetual Help System Dalta Alabang-Zapote rd. Las Pinas City August 27, 2011 Medical Urgencies: The Brain Focus University of Perpetual Help Dalta Medical Center Alabang-Zapote Road, Las Pias City, Philippines September 8-9, 2010 Beyond E.R Dusit Thai Hotel, Ayala Center, Makati City April 15-16, 2010 Care for those with Chronic and Life Threatening Illnesses Asian Hospital Medical Center - Alabang, Muntinlupa City March 25, 2010 Blood and Blood Component Therapy ANSAP Accredited Reg. No. 036 University of Perpetual Help Dalta Medical Center Alabang-Zapote Road, Las Pias City, Philippines February 22, 2010 Advanced Cardiac Life Support Lecture University of Perpetual Help Dalta Medical Center Alabang-Zapote Road, Las Pias City, Philippines May 26, 2008 Basic Life Support Lecture University of Perpetual Help Dalta Medical Center Alabang-Zapote Road, Las Pias City, Philippines February 22, 2008 The Good Samaritan Hospital-Los Angeles, CA. (Internship Nursing Program) California State Board of Nursing Approved Asian Institute of Management, Makati, Philippines October 11-20, 2006