42

CHAPTER II

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the statistical analysis and

interpretation of the data gathered for the study. This study

determined the profile of the staff nurses, their level of compliance

on the Philhealth Benchbook in terms of three performance areas.

I. Profile of the Staff Nurses

Table 1 presents the profile of staff nurses. In terms of age,

49 0r 81.67% belonged to the age group of 19-40 years old, 11 or

18.33% belonged to age group of 41 to 65. Most of the

respondents belonged to the young adulthood stage of

development. Young adulthood is typically vibrant, active and

healthy, and is focused on friendships, romance, child bearing and

careers.

Young adults are able to assimilate and synthesize complex

and contradictory situations and arguments, and unlike

adolescents, aren't set on finding absolute truths. They are focused

on developing their careers and achieving independence from their

families - a crucial requirement for balanced, well functioning

adults. The young adult according to Erikson's Theory of

 43

personality should be progressing through the psychosocial crisis of

intimacy versus isolation. The task for this stage of life consist of

courting and selecting a “mate”, marriage and associated choices,

career choices and lifestyle changes and furthering intellectual

abilities to accommodate choices.(Turner & Helms, 1987.). Some

of the personal abilities that the young adult must employ include

decision making, career planning, understanding nature of

increased responsibility and being able to accommodate greater

demands of self (http://www.digitaltermpapers.com/a684.htm).

Majority of the healthcare worker in the study are young

nurses. The number of young people becoming full-time registered

nurses has increased dramatically over the past decade, according

to a new study published by Health Affairs. In the Philippines fast

turnover of nurses is the trend in the hospital setting; most of the

older nurses who have gained more experience and have greater

qualification abroad are employed on the foreign country for they

have hired for much high salary, thus younger nurses are the front

lines in the nursing service department now a days.

The study, published in Health Affairs, revealed a drastic

increase in the number of full-time registered nurses ages 23-26

entering the workforce. 165,000 of these young nurses joined the

 44

workforce in 2009. The number is 62 percent greater than the

102,000 young nurses who entered the workforce in 2002

(www.hpnonline.com).

As for the gender of staff nurses, 16 or 26.67% are

male and 44 or 73.33 % are female. 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

In today’s career boards, nursing are still greatly occupied by

female professionals, the result of a century’s worth of this field

being cemented as a “feminine” career option. This is the mindset

which still prevails today, nursing as female dominated profession.

In our society, the values mostly associated with this career,

nurturing, intimate care and dependency relationships are still

closely associated with female gender stereotypes, while men are

seen to fit in more aggressive, dominant roles, hard to reconcile

 45

with this sort of medical assistance. However, the increasing

flexibility brought by an increasing comfort with personal choices

not encumbered by social gender molds has made it possible for

many men to consider this career, greatly aided by the increasing

reputation of nursing, and the higher pay offered for a job in great

demand( http://www.malenursingscholarships.com) .

Most of these respondents are single which is consisting of

39 or 65 %, followed by 19 or 31.67% who are married and those

who are widowed is 2 or 3.33 %.

According to Robert Havighurst, this is the stage where

individuals are achieving new and more mature relations with age

mates of both sexes, achieving a masculine or feminine social role,

accepting one’s physique and using the body effectively, achieving

emotional independence of parents and other adults ,preparing for

marriage and family life, acquiring a set of values and an ethical

system as a guide to behaviour and desiring and achieving socially

responsible behaviour and lastly selecting an occupation

(http://nongae.gsnu.ac.kr/~bkkim/won/won_117.html).

As to the highest educational attainment, majority (46 or

76.67 %) of the staff nurses have only finished the BS Nursing

 46

degree while 7 or 11.67 % have already taken some masteral units

and 7 or 11.67 % have finished their master’s degree.

Republic Act No. 9173 known as the “Philippine Nursing act

of 2002”, Article IV (Examination and Registration) section 12:

stated that all applicants for license to practice nursing shall be

required to pass a written examination. And a minimum

requirement for applicants for license must be a holder of a

Bachelor’s Degree in Nursing from a college or university that

complies with the standards of nursing education duly recognized

by the proper government agency (www.nurseslabs.com).

Continuing education provides the opportunity for working

professionals to continue their learning and remain abreast of

developments within their field. While this practice is important in

all disciplines, it is particularly important within the health industry

where a lack of information can lead to patient mismanagement, or

even death. To ensure proper patient care and optimum outcomes,

hospitals and medical facilities should promote professional

development among their nurses. Because of the current

competitive healthcare job market worldwide, more and more

nursing students and current professionals are pursuing after their

 47

bachelors’ degrees with master’s programs for nursing to become

more attractive to prospective employers. The strategy of course is

that after they completed these courses of study, these nursing

professionals can become qualified for high-paying positions.

As for the area of assignment, most respondents are

assigned to Ward which consist of 26 or 43.33%, 19 or 31.67% are

from Special Areas (Emergency Department ,Operating Room,

Delivery Room and ICU unit ) and Ward and Special Area was

consist of 15 or 25 % respectively.

As to the length of service, 14 or 23.33% have less than 1

year clinical experience, 39 or 65 % have 1 to 10 years of length of

service, 5 or 8.33 % have 11 to 20 years of length of service while

2 or 3.33% have rendered its service for 21 and above years.

Young nurses dominate the health care facility in the country.

Foreign hospitals usually hire skilled nurses, leaving Filipino

patients in the care of inexperienced ones. Nurses are enticed to

leave their home countries by promises of better pay and working

conditions; improved learning and practice opportunities; and free

travel, licensure, and room and board. Primarily female, nurses

often have opportunities for wages unequalled in their own

 48

countries and thus become the means for substantial remittances.

Some national governments and government agencies, such as in

the Philippines, are attempting to encourage outflow of health workers

from their country. This may have a financial imperative (to encourage

the generation of remittance income), it may be a response to labour

market over-supply, or it may be an attempt to develop a long-term

improvement in the skills base of the workforce by encouraging short-

term outflow to other countries where training is available.

Another good reason why Registered Nurses are pushed out of the

country is the salary received compared to the salary offered by

developed countries. In the Philippines, a nurse can earn an average of

U.S.$170 monthly (U.S.$ 2,040 per annum).If compared to the salary

that developed countries offer which is U.S. $ 3000 to $4000 (U.S.

$36,000 to $48,000 per annum), the incomparable amount that most

nurses see as a reason to leave the country. What they can earn in a

year outside their homeland is comparable to twenty years of work in

their homeland (www.ukessays.com).

The number of Filipino nurses who sought employment

abroad has grown because of factors and conditions that drove or

pushed the nurses away from their country while pulling them into

the United States, a more superior and affluent nation that offered
 49

a better quality of life. Lorenzo et al. (2007) reported the following

“push and pull” factors that led to migration.

Push Factors. (1) Economic: low salary at home, no

overtime or hazard pay, poor health insurance coverage.(2) Job

related: work overload or stressful working environment, slow

promotion.(3) Socio-political and economic environment: limited

opportunities for employment, decreased health budget, socio-

political and economic instability in the Philippines.

Pull Factors. (1)Economic: higher income, better benefits,

and compensation package. (2) Job related: lower nurse to patient

ratio, more options in working hours, chance to upgrade nursing

skills (3) Personal/family related: offers opportunity for family to

migrate, opportunity to travel and learn other cultures, influence

from peers and relatives. (4) Socio-political and economic

environment: advanced technology, better socio-political and

economic stability. Based on the “push and pull” factors mentioned

above, the situation in the Philippines made immigration not a

choice but a necessity (http://repository.tamu.edu).

The Philippines has dominated the nurse migration pipeline to

the United States and to other recruiting countries. Indeed, until

 50

the mid-1980s Filipino nurses represented 75 percent of all foreign

nurses in the U.S. nurse workforce. Their representation dropped

to 43 percent by 2000 as more countries began sending nurses

abroad.

According to party-list Rep. Arnel Ty, Filipino nurses may

have difficulty entering the US labour market until 2020. "Right

now, they have ample supply of US-educated nurses,” said Ty. In a

statement, Ty cited statistics from America's National Council of

State Boards of Nursing which show that the US produced close to

a million nurses from 2006 to 2011.Ty said the US demand for

Filipino and other foreign nurses may start to recover in 8 years

when thousands of US-based nurses would have retired. The US

first encountered a shortage of nurses in 1998. This created a

surge in number of Filipino nursing graduates hoping to get a

career in the US (www.filipinosabroad.com).

An official from the Philippine Nurses Association of America

(PNAA) stated that retrogression continues to be the reason why

no visas for competent nurses applying for work in the US are

available, thus resulting to delay in their employment overseas , but

this doesn’t stop nurses to work to seek greener pasture. Middle

 51

East is the second destination for Nurses travel from many

countries especially from Asian country such as Philippines. High of

Nurses interest to go to Middle East like Kuwait, Qatar, Bahrain,

Arab Saudi, Dubai, United Arab Emirate caused Middle East is

country which offering high paying Nurses Salary with free tax ,

free accommodation, free housing, free transport to many nurses

surrounding Asian countries and Gulf Countries. In other hand

Nurses recruitment in Middle East is not complicated with at least

Nurses who qualified with their job and skill experiences 2 years

up, Spoken and written English, Arabic Language (not preferable,

but better if have capability Arabic language)

(www.filipinosabroad.com)
 52

Table 1
Profile of the Respondents
n = 60

Profile Frequency Percentage

Age
19 – 40 49 81.67
41 – 65 11 18.33
Gender
Male 16 26.67
Female 44 73.33
Civil Status
Single 39 65.00
Married 19 31.67
Widow 2 3.33
Highest Educational
Attainment
BSN Graduate 46 76.67
w/ Masteral Units 7 11.67
w/ Masteral Degree 7 11.67
Area of Assignment
Ward 26 43.33
Special Areas 19 31.67
Ward and Special 15 25.00
Area
Length of Service
Less than 1 year 14 23.33
1 – 10 years 39 65.00
11 – 20 years 5 8.33
21 years and above 2 3.33
 53

II. A. Level of Compliance of Staff Nurses on Philhealth

Benchbook in Aisah Medical Hospital

Table. 2.1 presents the Aisah Medical Hospital staff nurses

level of compliance on Philhealth Benchbook in terms of Patients

Rights and Organizational Ethics, Patient Care and Safe Practice

and Environment.

The data shows that the staff nurses have a very high level

of compliance to Philhealth Benchbook with a general mean of

3.44.

The staff nurses have very high compliance on Patients

Rights and Organizational Ethics with an average mean of 3.54.

Obtaining consent prior to initiation of care acquire a very high

response with a mean of 4 while providing patients with written

statements of patient’s right and responsibilities elicited least

agreement of the respondents with a mean of 2.8 which is

interpreted as high in compliance.

In view of staff nurses compliance to Patient care, the

respondents are considered very high in compliance with an

average mean of 3.58. Staff nurse has very high compliance in

identifying all patients correctly by their patients chart and all

prescriptions and orders are verified with the attending physicians,

 54

more over they are compliant with the standards that all patients

are identified before administration of medications and elicit a

mean of 4.

Among the criterion of patient care, documentation and

implementation of policies and procedure and the provision of

resources that promote interactive, appropriate and educational

programs for patients elicited less agreement with the respondents

with a mean of 3.2 which is still interpreted as high in compliance.

Along with this, are the awareness of patient’s roles and

responsibilities in their health care, only qualified personnel order,

prescribe, prepare, dispense and administer drugs.

Telephone orders are countersigned by the ordering

physicians not later than standards set by the organization and

based on statutory requirements and results of evaluation of care

are fed back to the health care provider’s concerned elicited also

least agreement from the respondents with a mean of 3.2

interpreted as high compliance.

For the compliance of safe practice and environment, staff

nurses are highly compliant with a mean of 3.2. Having a

management plans for the safe and efficient use of medical

equipment according to specifications and personnel understand

 55

and fulfils their role in safe practice elicited a largest number of

agreement from the respondents with a mean of 3.5 that is

interpreted as having a very high compliance. While programs for

treatment of needle stick injuries, and policies and procedures for

the safe disposal of used needles are documented and monitored

elicited the least agreement from the respondents with a mean of

2.8.

Based on the results, staff nurse follows the hospital policy to

secure consent prior to initiation of care to all patients and

informed consent must be signed either by the patient or any

member of the family or the guardian if the patient is a minor.

They also felt the needs to improve patient’s education on their

rights and responsibility by providing those leaflets aside from the

tarpaulin and a nurse educator to explain further their rights and

responsibilities as well as their role on their healthcare.

WHO reports in the World Health Report 2002, that of the 35

million health-care workers, 2 million experience percutaneous

exposure to infectious diseases each year. It further notes that

37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of HIV/AIDS in

Health-Care Workers around the world are due to needlestick

injuries (www.who.int).
 56

Nurses felt the need to improve the programs on needlestick

that occur in the institution and to document and monitored it

occurrence as tom protect the healthcare worker.

The results of the survey is in consonance with the National

Health Insurance Act 7875, to implement a Quality Assurance

Program applicable to all health care providers which ensures

provision of quality health services to achieve desired outcomes to

all its members. The Benchbook is a yardstick against which the

quality of health care rendered by accredited health care providers

can be measured. It also contains accreditation standards that

evaluate processes and outcomes of health care and presents a

significant change from the current standards that govern only

inputs to health care.

Table 2.1 Level of Compliance of Staff Nurses in Aisah

Medical Hospital
Indicators Average Mean Interpretation
Patient’s Rights and 3.54 Very High
Organizational Ethics
Patient Care 3.58 Very High
Safe Practice and Environment 3.2 High
Grand Mean 3.44 Very High
Legend:
3.26 – 4.00 Very High
2.51 - 3.25 High
1.76 – 2.50 Low
1.0 - 1.75 Very Low
 57

II. B. Level of Compliance of Staff Nurses on Philhealth

Benchbook in Borbon General Hospital Inc.

Table. 2.2 presents the Borbon General Hospital Inc. staff

nurses level of compliance on Philhealth Benchbook in terms of

Patients Rights and Organizational Ethics, Patient Care and Safe

Practice and Environment.

The data shows a general mean of 3.74 which indicate that

the staffs’ nurses have very high compliance on the Philhealth

Benchbook.

Considering the staff nurses compliance on Patients Rights

and Organizational Ethics, the nurses have a very high compliance

with an average mean of 3.84. Securing consent prior to initiation

of care elicited a very high response with a mean of 4, interpreted

as very high while identifying and monitoring of personnel

compliance with the code of ethics relevant to respective discipline

elicited the least agreement from respondents with a mean of 3.6

which is still interpreted as very high.

In the Performance area of Patient care, the respondents are

having very high compliance with the mean of 3.79. Patients,

visitors and staff can efficiently and safely move within the confines

of the organization, staff nurses identified patient correctly by their

 58

chart, the order of assessment is determined by the patients

prioritized needs and the right to refuse treatment is always

respected that elicited a higher agreement with a mean of 4 that is

interpreted as very high. In the contrary, documentations and

implementations of policies and procedures and provision of

resources to promote interactive, appropriate and relevant

educational programs for patients elicited the least agreement

among the respondents with a mean of 3.1 which is interpreted as

high.

For the third performance area which is the safe practice and

environment, the respondents are having very high compliance

with a mean of 3.61. All personnel understand and fulfil their role

in safe practice obtained largest number of agreement from the

respondents with a mean of 3.74, while policies and procedures

that address safety, security, control of hazardous materials and

biological waste, emergency and disaster preparedness, fire safety,

radiation safety and utility system are documented and

implemented obtained the lowest agreement from the respondents

with a mean of 3.4.

Formalized in 1948, the Universal Declaration of Human

Rights recognizes “the inherent dignity” and the “equal and

 59

unalienable rights of all members of the human family”. And it is

on the basis of this concept of the person, and the fundamental

dignity and equality of all human beings, that the notion of patient

rights was developed. In other words, what is owed to the patient

as a human being, by physicians and by the state, took shape in

large part thanks to this understanding of the basic rights of the

person (www.who.int).

In Over the last 100 years, nursing has evolved into a very

complex professional field. Nurses are now faced with life and

death decisions, sometimes on an hourly basis. Medical care has

advanced to the point that new technology with its potential benefit

or harm to a patient changes constantly. Although the private

conduct of a nurse is no longer controlled by the employer, the

effects of that lifestyle on the nurse's ability to think and respond

to patients while on duty falls under the code of ethics

(www.enotes.com).

The goal of the patient rights and organization ethics function

is to help improve patient outcomes by respecting each patient's

rights and conducting business relationships with patients and the

public in an ethical manner. The results obtained are consistent

with the standards of Philhealth Benchbook where organizational

 60

policies and procedures respect and support patient quality care

and their responsibilities in that care and the personnel discharge

function according to codes of ethical behaviour and other relevant

profession and statutory standards.

Table 2.2 Level of Compliance of Staff Nurses in

Borbon General Hospital

Indicators Average Mean Interpretation

Patient’s Rights and
Organizational Ethics 3.84 Very High
Patient Care 3.79 Very High
Safe Practice and Environment 3.61 Very High
Grand Mean 3.74 Very High

Legend:
3.26 – 4.00 Very High
2.51 – 3.25 High
1.76 – 2.50 Low
1.0 – 1.75 Very Low

II. C. Level of Compliance of Staff Nurses on Philhealth

Benchbook in Hofilena Hospital

Table. 2.3 presents the Hofilena Hospital staff nurses level of

compliance on Philhealth Benchbook in terms of Patients Rights

and Organizational Ethics, Patient Care and Safe Practice and

Environment.
 61

The general mean for the level of compliance of staff nurses

on Philhealth Benchbook is 3.69, which means that the

respondents have very high compliance.

The staff nurses are having very high compliance on the on

Patients Rights and Organizational Ethics with a mean of 3.72.

Involving patients and their families in making care decision with

ethical issues, such as withholding resuscitation, foregoing life-

sustaining treatment, end-of-life care, etc, elicited the largest

number of agreement from the respondents with a mean of 3.9,

which is interpreted as very high compliance. In the other hand,

the provision of written statements of patients right and

responsibilities and the hospital staff awareness of and following

policies and procedure in addressing patient’s needs for

confidentiality, privacy, security, counselling and communication

elicited the least agreement from the respondents with a mean of

3.6 which is still interpreted as very high.

For the second performance area which is the Patient care,

the respondents are having very high compliance with the mean of

3.75.Staff nurses ascertain that patients, family and visitors can

efficiently and safely move within the confines of the organization.

Those patients are identified accurately by their charts and patients

 62

refusal for test or treatment is respected, furthermore, they show

higher compliance to ensuring orders are verified and patients are

identified prior to execution of treatment procedures, this criterion

obtained largest number of agreement from the respondents with a

mean of 4 which is very high. On the other hand, having

alternative passageway for patients with special need, prominently

marked and free of obstruction elicited lowest response and

criterion where only qualified personnel order, plan, perform and

assist in performing procedures obtained the lowest agreement

from the respondents with a mean of 3.4 still interpreted as very

high.

For the third performance area which is the safe practice and

environment, the respondents are having very high compliance

with a mean of 3.60. All personnel understand and fulfil their role in

safe practice obtained largest number of agreement from the

respondents with a mean of 3.9, while the policies and procedures

that address safety, security, control of hazardous materials and

biological waste, emergency and disaster preparedness, fire safety,

radiation safety and utility system are documented and

implemented and the organization takes steps to prevent and

 63

control outbreaks of nosocomial infections obtained the lowest

agreement from the respondents with a mean of 3.4.

In accordance with the standards of Philhealth Benchbook,

high compliance to the three performance area implies that the

hospital meet the minimum requirements to be awarded as center

of safety.

Table 2.3 Level of Compliance of Staff Nurses in

Hofilena Hospital

Indicators Average Interpretation

Mean
Patient’s Rights and
Organizational Ethics 3.72 Very High
Patient Care 3.7 Very High
Safe Practice and Environment 3.60 Very High
Grand Mean 3.69 Very High

Legend:
3.26 – 4.00 Very High
2.51 – 3.25 High
1.76 – 2.50 Low
1.0 – 1.75 Very Low

II. D. Level of Compliance of Staff Nurses on Philhealth

Benchbook in Metro Pagadian Specialist Hospital

Table. 2.4 presents the Metro Pagadian Specialist Hospital

staff nurses level of compliance on Philhealth Benchbook in terms

 64

of Patients Rights and Organizational Ethics, Patient Care and Safe

Practice and Environment.

The general mean for the level of compliance of staff nurses

on Philhealth Benchbook is 3.87, which means that the

respondents have very high compliance.

The data indicates that the staff nurses are having very high

compliance on Patients Rights and Organizational Ethics with a

mean of 3.84. For this performance area, it is evident that

informed consent is obtained from patients prior to initiation of

care. Hospital staff is aware of and follows policies and procedure

in addressing patient’s needs for confidentiality, privacy, security,

counselling and communication and the organizations identify and

monitor personnel compliance with the code of ethics relevant to

their respective disciplines elicited the largest number of

agreement from the respondents with a mean of 3.9, while having

patients receive written statements of their rights and

responsibilities elicited the least agreement from the respondents

with a mean of 3.7 but still fall in the interpretation of very high.

In the Performance area of Patient care, the respondents are

having very high compliance with the mean of 3.92. In this

classification, it has been noted that the entrance and exits are
 65

clearly and prominently marked, free of any obstruction and readily

accessible and directional signs are prominently posted to help

locate service areas within the organization. The staff also

documents, follows policies and procedures, and provides

resources for safe and efficient direction of patients, their families

and visitor and nurses traffic it elicited a mean of 4 which is

interpreted as very high.

Very high compliance with a mean of 4 has also been

perceive by staff nurses in the patient care as to correctly

identifying patient by their chart; prior to admission patients and

their family are appropriately informed by authorized qualified

personnel of their disease, conditions or disability, its severity,

likely prognosis, benefits and possible adverse effects of various

treatments options, an d the likely cost of treatment; patient and

their family are informed of the need for and availability of

resources to continue care after discharge and the care of

planning is documented in the patient chart.

Respondents are also compliance with the standards where,

patients receive explanation on the nature of a test or treatment,

the need for it prior to administration, it’s likely effects and side

effects and what patients can do to cope with them; patient wish to
 66

decline test or treatment is respected; Only qualified personnel

order, prescribe, prepare, dispense and administer drugs; and

Prescription or orders are verified and patients are identified before

medications are administered elicited a mean of 4 interpreted as

very high.

As for the treatment and procedures, staff nurses performed

it in a timely, safe, appropriate and controlled manner. Having

qualified personnel to order, plan, perform and assist in performing

procedures and the orders are verified and positive patient

identification prior to performance of treatment and procedures. It

addition , treatment procedures are legibly and accurately

documented in the patient chart by qualified personnel obtained

largest number of agreement from the respondents with a mean of

4 interpreted as very high in compliance.

In contrast with the above mentioned criterion being rated

very high in compliance, the organization documentation and

implementation of policies and procedures and provision of

resources to promote interactive, appropriate and relevant

educational programs for patients obtained the lowest agreement

from the respondents with a mean of 3.6 but it is still interpreted

as very high.
 67

For the compliance of safe practice and environment, staff

nurses have very high compliance with a mean of 3.87 .The design

of patient areas provides sufficient space for safety, comfort and

privacy of the patient and emergency care elicited the largest

number of agreement from the respondents with a mean of 4 while

an incident reporting system that identifies potential harms,

evaluates causal and contributing factors for the necessary

corrective and preventive action elicited the least agreement from

the respondents with a mean of 3.6.

Patient care is one of the performance areas that include a

number of criterions. The second performance area goals are to

ensure that the organization is accessible to the community that it

aims to serve and care is delivered to ensure the best possible

outcomes for the patient. All criterions are directed in delivering

care to patient in a timely, efficient and systematic matter.

Table 2.4 Level of Compliance of Staff Nurses

in Metro Pagadian Specialist Hospital

Indicators Average Mean Interpretation

Patient’s Rights and
Organizational Ethics 3.84 Very High

Patient Care 3.92 Very High

Safe Practice and Environment 3.87 Very High

Grand Mean 3.87 Very High

 68

Legend:
3.26 – 4.00 Very High
2.51 – 3.25 High
1.76 – 2.50 Low
1.0 – 1.75 Very Low

II. E. Level of Compliance of Staff Nurses on Philhealth

Benchbook in Pagadian Doctors Hospital

Table. 2.5 presents the Pagadian Doctor’s Hospital staff

nurses level of compliance on Philhealth Benchbook in terms of

Patients Rights and Organizational Ethics, Patient Care and Safe

Practice and Environment.

The general mean for the level of compliance of staff nurses

on Philhealth Benchbook is 3.94, which means that the

respondents have very high compliance.

The staff nurses are having very high compliance on Patients

Rights and Organizational Ethics with an average mean of 4. All

Category elicited large number of agreement from the respondents

with a mean of 4 which includes the compliance in obtaining

informed consent prior to initiation of care. Patients receive written

statement of their patient’s right and responsibilities. Patients and

their families are involved in making care decisions with ethical

issues, such as withholding resuscitation, foregoing life-sustaining

treatment, end-of-life care, etc. Hospital staff is aware of and

 69

follows policies and procedure in addressing patient’s needs for

confidentiality, privacy, security, counselling and communication

and the organizations identification and monitoring of the

personnel compliance with the code of ethics relevant to their

respective disciplines.

In the Performance area of Patient care, the respondents

have very highly compliant with an average mean of 3.91. Out of

26 indictors, 15 of it elicited largest number of agreement from the

respondents with a mean of 4 which is interpreted as very high.

Included in this area, are the entrance and exits are clearly and

prominently marked, free of any obstruction and readily accessible;

directional signs are prominently posted to help locate service

areas within the organization; alternative passageways for patients

with special needs are available, clearly and prominently marked

and free of any obstruction; the organization documents, follows

policies and procedures, and provides resources for the safe and

efficient direction of patients, their families and visitors and staff

traffic and ; patients, their visitors and staff can efficiently and

safely move within the confines of the organizations.

All patients are correctly identified by their patient charts;

the patient chart contain identifiers unique to each other; patient

 70

chart are appropriately indexed to facilitate retrieval and storage to

avoid duplication or loss; patient and their family are informed of

the need for and availability of resources to continue care after

discharge; the order of assessment is determined by the patients

prioritized needs and; care of planning is documented in the

patient chart correspond to a very high compliance of the

respondents which obtained a mean of 4.

Still in line with the Patient care, the indictors where only

qualified personnel order, prescribe, prepare, dispense and

administer drugs; prescription or orders are verified and patients

are identified before medications are administered; treatment and

procedures are performed in a timely, safe, appropriate and

controlled manner and orders are verified and patients are

identified before treatment procedures are performed obtained

also a largest number of agreement from the respondents with a

mean of 4, interpreted as very high, while the indicators where

patients receive explanation on the nature of a test or treatment,

the need for it prior to administration, it’s likely effects and side

effects and what patients can do to cope with them obtained the

lowest agreement from the respondents with a mean of 3.7, but

still interpreted as very high.

 71

For the third performance area which is the safe practice and

environment, the respondents are having very high compliance

with an average mean of 3.89. The compliance of management

plans for the safe and efficient use of medical equipment according

to specifications; an incident reporting system identifies potential

harms, evaluates causal and contributing factors for the necessary

corrective and preventive action and programs for treatment of

needle stick injuries, and policies and procedures for the safe

disposal of used needles are documented and monitored obtained

largest number of agreement from the respondents with a mean of

4, while personnel understanding and fulfilment of their role in

safe practice obtained the lowest agreement from the respondents

with a mean of 3.6 still interpreted as very high.

Modern health care is highly complex, high risk and error

prone. Not surprisingly, health care errors and consequent adverse

events are a leading cause of death and injury, even though well-

documented methods to prevent the occurrence of many of these

errors are available. The recent heightened attention that has been

focused on medical errors has sparked interest in the use of health

care practices that reduce the risk of harm resulting from the
 72

processes, systems, or environments of care, i.e., Safe Practices

(www.ncbi.nlm.nih.gov).

Safe practice and environment are directed to patient, staff

and other individual within the organization are provided a safe,

functional and effective environment of care. Furthermore, the risk

of acquisition and transmission of infection among patient,

employee and other personnel, visitor and trainee are identified

and reduced.

The level of compliance of nurses which is very high in

indicate that quality has become a major focus within health care,

especially in the areas of regulatory quality, quality assurance,

quality improvement and patient safety.

Nurses today have many roles. In addition to meeting the

needs of patients and serving as part of the health care team,

nurses also play a key role in meeting the Joint Commission's

National Patient Safety Goals in such areas as medication safety,

communication and patient safety. This role allows nurse to

contribute to quality improvements.

According to Hall and co-authors, nurses feel valued when

asked for their expert opinions, especially when making

contributions to innovations and improvements for patients. When

 73

nurses serve as patient advocates and participate on

interdisciplinary quality improvement teams, they can add value to

their work (www.medicalnewstoday.com).

Table 2.5 Level of Compliance of Staff Nurses in

Pagadian Doctors Hospital

Indicators Average Mean Interpretation

Patient’s Rights and
Organizational Ethics 4.0 Very High
Patient Care 3.94 Very High
Safe Practice and 3.89 Very High
Environment
Grand Mean 3.94 Very High

Legend:
3.26 – 4.00 Very High
2.51 – 3.25 High
1.76 – 2.50 Low
1.0 – 1.75 Very Low

II. F.Level of Compliance of Staff Nurses on Philhealth

Benchbook in Zamboanga del Sur Medical Center

Table. 2.6 presents the Zamboanga Del Sur Medical Center

staff nurses level of compliance on Philhealth Benchbook in terms

of Patients Rights and Organizational Ethics, Patient Care and Safe

Practice and Environment.

 74

The general mean for the level of compliance of staff nurses

on Philhealth Benchbook is 3.90, which means that the

respondents have very high compliance.

The data illustrate that the staff nurses have very high

compliance on Patients Rights and Organizational Ethics with an

average mean of 3.86. For this performance area, obtaining

informed consent from patients prior to initiation of care elicited

the largest number of agreement from the respondents with a

mean of 4 interpreted as very high, while the indicator where

hospital staff is aware of and follows policies and procedure in

addressing patient’s needs for confidentiality, privacy, security,

counselling and communication elicited the least agreement from

the respondents with a mean of 3.4 but still interpreted as very

high in compliance.

In the Performance area of Patient care, the respondents

have compliance of very high, with an average mean of 3.92. In

this classification, 14 indictors obtained largest number of

agreement from the respondents with a mean of 4, interpreted as

very high in compliance. To wit: the organization documents,

follows policies and procedures, and provides resources for the safe

and efficient direction of patients, their families and visitors and

 75

staff traffic; all patients are correctly identified by their patient

charts; patient chart are appropriately indexed to facilitate retrieval

and storage to avoid duplication or loss; patient and their family

are informed of the need for and availability of resources to

continue care after discharge and ; the order of assessment is

determined by the patients prioritized needs.

Patients receiving explanation on the nature of a test or

treatment, the need for it prior to administration, it’s likely effects

and side effects and what patients can do to cope with them; the

organization documents and implements policies and procedures

and provides resources to promote interactive, appropriate and

relevant educational programs for patients; patient is aware of

their roles and responsibilities in their health care; only qualified

personnel order, prescribe, prepare, dispense and administer drugs

and; prescription or orders are verified and patients are identified

before medications are administered are indicators of patient care

that also elicited a largest number of agreement from the

respondents with a mean of 4.

Other indicators that obtained a very high compliance among

the respondent still under the performance area of patient care are

the indicator where treatment and procedures are performed in a

 76

timely, safe, appropriate and controlled manner; only qualified

personnel order, plan, perform and assist in performing

procedures; orders are verified and patients are identified before

treatment procedures are performed and; treatment procedures

are legibly and accurately documented in the patient chart by

qualified personnel with a mean of 4, while the entrance and exits

are clearly and prominently marked, free of any obstruction and

readily accessible obtained the lowest agreement from the

respondents with a mean of 3.5.

For the third performance area which is the safe practice and

environment, the respondents has very high compliance with an

average mean of 3.93. The management plans for the safe and

efficient use of medical equipment according to specifications; an

incident reporting system identifies potential harms, evaluates

causal and contributing factors for the necessary corrective and

preventive action; the organization takes steps to prevent and

control outbreaks of nosocomial infections and; there are programs

for treatment of needle stick injuries, and policies and procedures

for the safe disposal of used needles are documented and

monitored obtained largest number of agreement from the

respondents with a mean of 4 interpreted as very high, while the

 77

indicator that risk are identified, assessed and appropriately

controlled. Where elimination or substitution is not possible,

adequate warning and protection devices are used obtained the

lowest agreement from the respondents with a mean of 3.8

although it has the least agreement, it was still interpreted as very

high.

Table 2.6 Level of Compliance of Staff Nurses in

Zamboanga del Sur Medical Center

Indicators Average Mean Interpretation

Patient’s Rights and
Organizational Ethics 3.86 Very High
Patient Care 3.92 Very High
Safe Practice and 3.93 Very High
Environment
Grand Mean 3.90 Very High

Legend:
3.26 – 4.00 Very High
2.51 – 3.25 High
1.76 – 2.50 Low
1.0 – 1.75 Very Low

III. Relationship Between Profile and Level of Compliance

on the PHILHEALTH Benchbook

Presented in table 3 is the relationship between the profile of

the staff nurses and their level of compliance on PHILHEALTH

 78

Benchbook. For age and level of compliance on Philhealth

Benchbook, the chi value is 0.10 with p value of 3.84 denoting no

correlation thus the null hypothesis is accepted .For gender and

level of compliance, the obtained chi value is 0.22 with p value of

3.84 which denotes no correlation and the acceptance of null

hypothesis. Furthermore, for civil status and level of compliance,

the chi value is 0.41with the p value of 5.99 which again denotes

no correlation and the acceptance of the null hypothesis. For

highest educational attainment and level of compliance, the chi

value is 0.16 with p value of 5.99 which denotes no correlation and

the acceptance of null hypothesis.

For area of assignment and level of compliance, the chi-

value is 0.56 with p value of 5.99 which denotes no correlation and

failed to reject the null hypothesis. As for the length of service and

level of compliance, the chi value is 0.73 with the p value of 7.82

which denotes no correlation thus it failed to reject the null

hypothesis. Therefore, it is concluded that the profile of staff

nurses doesn’t affect the compliance of Philhealth Benchbook.

The results implied that the compliance of the staff nurses

has no correlation with their profile. Worker variables such as

personality variables, mood, and job attitudes were expected to

 79

predict safety compliance, but this relation was expected to be

moderated by role definitions (DeJoy et al.’s 1998). Role definition

is the employee’s subjective assessment of the broadness of the

category of behaviours that he or she is required to perform by his

or her employing organization (Bachrach & Jex, 2000).

Table 3. Relationship between Profile and Level of Compliance on the

Implementation of the PHILHEALTH Benchbook

Variables Computed Critical Decision Interpretation

Correlated Chi-Value Chi-Value on Ho
Age and Level of 0.10 3.84 Failed to No Correlation
Compliance Reject
Gender and Level of 0.22 3.84 Failed to No Correlation
Compliance Reject
Civil Status and 0.41 5.99 Failed to No Correlation
Level of Compliance Reject
Highest Educational 0.16 5.99 Failed to No Correlation
Attainment and Reject
Level of Compliance
Area of Assignment 0.56 5.99 Failed to No Correlation
and Level of Reject
Compliance
Length of Service 0.73 7.82 Failed to No Correlation
and Level of Reject
Compliance

IV. Facilitating Factors that Influence the Compliance of

Staff Nurses on the PHILHEALTH Benchbook

As to the compliance of staff nurses on the Philhealth

BENCHBOOK there are factors that influence them to achieve the

said standards that are expected from them. The following

 80

presents the common themes based on the interview conducted

and in order to provide confidentiality of the persons involved, the

researcher used faux name using names of famous the Hollywood

celebrities namely: Tom, Brad, Channing, Scarlet, Angelina and

Kate.

The researcher asks (6) key informants from the different

hospital where study is conducted to identify factors that

contribute their compliance. Based on the findings of the interview

conducted’ the following themes revealed: Trainings and

development, Leadership, Compensation and Feedback.

Themes Key Informant

1. Training and Development Tom, Brad, Channing, Scarlet,

Angelina, Kate

2. Leadership Kate, Brad, Channing

3. Feedback and Brad, Scarlet, Channing

Performance Evaluation
4. Remuneration and Tom, Kate, Brad
Incentives

“Trainings and Development”

Learning doesn’t end up in college; it’s a continuous process

throughout the life’s span. Nursing, a growing profession needs to

 81

harness its skills and knowledge all over to be competent in

rendering care. Training often is considered for new employees

only. This is a mistake because ongoing training for current

employees helps them adjust to rapidly changing job

requirements.

Tom: “In our institution, trainings and updates is conducted quarterly”.

Brad: “The hospital sends participants in seminars and trainings, after the seminar,
he/she will recapitulate what has been thought to the seminars to the entire department”.

Scarlet: “Each committee in our hospital conduct lectures and updates on the new
standards of practice, like the infection control committee, they organized lectures on
proper waste disposal since we are informed regarding what need to be done, then we are
putting it to practice”.

Angelina: “Meeting is set every 15th day of the month, in the meetings, problems and
needs for improvement is being discussed and from there lectures and trainings will be
scheduled and who will be the participants”.

Kate: “When the nursing department conducts trainings and lecture, they make sure that
every participant got the right idea thus nurse supervisor monitor the compliance of staff
nurses and return demonstration are conducted”.

Channing:” I have all the knowledge, then there’s no reasons why I can’t comply”.

Trainings and development help ensure that organization and

members have the knowledge and skills needed to perform job

effectively, take on new responsibilities and adapt to changing

conditions. Training primarily focuses on teaching organizational

members how to perform their current jobs and helping them

acquire the knowledge and skills they need to be effective

 82

performer. Development focuses on building the knowledge and

skills of organizational member so that they are prepared to take

on new responsibilities and challenges.

In-service trainings are about facilitating learning and

development of an employee while rendering a service to an

organization. Some of the in-service training that is provided in

the hospital are hand hygiene practices, proper use of Personal

Protective Equipments, Emergency Management, Cardiopulmonary

Resuscitation and Basic Intravenous Therapy Training.

The opportunity for all staff to learn and develop is a crucial

factor in achieving new ways of patient-centred working to take

forward the modernisation and delivery of education and

continuing professional development beyond registration, ensuring

this supports the needs of patients and carers, health-care teams

and individuals and related service and organisational priorities.

Continuous education program in organization are aimed at

updating employees knowledge and competency in order to

increase their capacity to analyze complex health problems, deliver

service and sustain professional interpersonal relationship.

 83

Continuous education is usually part of the self- development

responsibility of the employee; however organization may need to

accept this responsibility to ensure that their staffs is kept up to

date with new development . This may take the form of workshop,

conference or individual studies (Booyens, 1993).

Investing in employees, through staff education, continuing

education courses, and providing (or sending personnel to outside)

courses for national certifications, works to the benefit of the

organization in several ways. Having a strong education

department is a good recruitment tool, as well as a factor in

attaining magnet status. Retention also increases when nurses feel

valued, and invested in. These costs are offset by lower turnover,

not having to recruit and orient new staff as frequently, and

increased competency among the existing staff. Not only does

increased competency lead to increased confidence, it provides

better patient care and outcomes. Empowerment of the educators

themselves also leads to better retention and decreased stress in

their own departments; putting control of the monies and

resources used in investing in employees to the employees

 84

themselves shows a high level of trust and cooperation (www.

allnurses.com).

“Leadership”

Leadership is a dynamic relationship (based on mutual

influence and common purpose) between leaders and

collaborators which leads both parties to higher levels of

motivation and moral development as they evoke “real” change.

Kate: “How nurse managers deal with their subordinates influences our compliance to
Philhealth Benchbook”

Brad: “Leaders should be the first to obey to show good example”.

Channing: “What leadership style our nurse supervisor used affects our compliance”.

Leadership is the process by which people exerts influence

over other people and inspire, motivate and direct their activities

to help achieve group or organizational goals. The persons who

exert such influences are a leader. When leaders are effective,

they influence, they exert over others help a group or organization

achieve its performance goals. When leaders are ineffective, their

influences does not contribute to and often detracts from goals

attainment. Beyond facilitating the attainment of performance

 85

goals, effective leadership increases an organizational ability to

meet all the contemporary challenges.

A clinical nursing leader is one who is involved in direct

patient care and who continuously improves care by influencing

others (Cook, 2001). Leadership is not merely a series of skills or

tasks; rather, it is an attitude that informs behaviour (Cook,

2001). Several important functions of a nurse leader are: acting

as a role model, collaboration to provide optimum care, provision

of information and support, providing care based on theory and

research, and being an advocate for patients and the health care

organization (Mahoney, 2001). In addition, nurse leaders should

have knowledge of management, communication, and teamwork

skills, as well as some background in health economics, finance,

and evidence-based outcomes (Mahoney, 2001). Personal

qualities desirable in a nurse leader include competence,

confidence, courage, collaboration, and creativity. Nurse leaders

should be aware of the changing environment and make changes

proactively. Leaders who show concern for the needs and

objectives of staff members and are cognizant of the conditions

affecting the work environment will encourage productivity

 86

(Moiden, 2003). In doing this, it is important that a philosophy of

productivity is established.

Leader’s acts as a role model and mentors for their staff.

Behaviour displayed by leader will affect, in some way or other,

the follower in regard to commitment and confidence to achieve

work outcomes, inspiration to set and strive for higher goals,

intrinsic reward, increased effort, improved satisfaction and

performance.

According to Jooste (2004), three things that are essential to

leadership are authority, power, and influence. Effective leaders

of today should use more influence and less authority and power.

It is more important to be able to motivate, persuade, appreciate,

and negotiate than to merely wield power. The author cites three

categories of influence for nurse leaders to use in creating a

supportive care environment. These include modelling by

example, building caring relationships, and mentoring by

instruction (Jooste, 2004). In addition, Jooste lists five practices

fundamental to good leadership including inspiring a shared vision,

enabling others to act, challenging processes, modelling, and

encouraging. Team leadership moves the focus away from the

leader towards the team as a whole (www.ukessays.com).

 87

“Feedback and Performance Evaluation”

Performance feedback is information provided to employees

about how well they are performing in their work role. The nursing

profession has a long history of providing formal, written

performance reviews, traditionally from a manager to subordinate,

with less formal feedback sources including peers, clients and

multidisciplinary team members. Effective and timely feedback is

essential. Feedback works well when it relates to a specific

standards or indicator. It should be given as soon as the behaviour

has taken place and should be provided in a way that will

contribute to improvement of performance.

Brad: “Consolidations of patient feedback at the end of the month give as the idea on our
performance and the overall performance as well. It aids us to develop new strategies to
correct our lapses in rendering service based on the patient feedback”.

Scarlet: “I am open to constructive criticism, it helps me know my mistakes and correct

it”.
Channing: “Monthly performance evaluation is a predictor to my compliance, since I
am aware of my ratings; I’m motivated to strive better to improve my performance”.

Hospitals that actively communicate with and provide timely

and useful feedback to staff reportedly are more likely to foster

quality improvement than those that do not. As one hospital CNO

noted, “We have tried to be as transparent as we can and share as

much information as we can with our nursing staff. They get a lot
 88

of information and that helps them stay motivated and engaged in

the process.”

According to Trooskie (1993) and Torrington and Hall (1998)

performance appraisal is about ascertaining the value of persons

work performance by assessing an employees’ strength and

development need using different measures and evaluation

methods. The key in performance analysis is the identification of

the desired actual performance. They will provide clarity on the

expected performance (goals) and the current situation (baseline)

to enable monitoring of progress (Winch et al, 2003).

According to Armstrong (1994) “feedback transmits

information on performance from one part of a system in order to

generate corrective action to initiate new action. This implies that

performance management provides an opportunity for feedback to

be presented to employee concerning their performance (how well

they does and how effective their behavior has been) and to take

corrective measures if performance was below expectation as to

reinforce and strengthen positive or good performance. The

importance of feedback on both success and failures has been

highlighted for reinforcement of behavior.

 89

“Remuneration and Incentives”

Payment and incentives are seen as having a profound effect

on performance. According to the WHO (2003), raising wages in

developing countries where workers are paid less than in

developed countries will increase productivity. Nonetheless,

increasing wages and other non- financial benefits such as

accommodation, transport, on –the-job training and opportunities

for promotion and rotation has been shown to increase

productivity.

Tom: “I am paid for my work so I do my part”.

Kate: “being rewarded for a good performance keeps me doing what the right things to
be followed and done”.

Brad: “I abide with the policy and procedures, for I know I’ll get a reward eventually”.

Hicks and Adams (2003) defines remuneration as “the total

income of an individual and may comprise a rage of separation

payment determined according to different rules”. The WHO

(2000) defines incentives as “all reward and payments the

providers face as a consequence of the organization in which they

work, the institution under which they operated and specific

intervention they provide.

 90

Financial incentives consist of pays, other direct financial

benefit (such as pensions, health insurance, dependents

allowance, clothing/housing allowance) and indirect financial

benefits. Non-financial incentives include flexible working hours,

study leave, planned career break, occupational health and

counselling, access to support for training and education.

A system of flexible working hours gives employees some

choice over the actual times they work their contracted hours.

Such a system can be a good way of recruiting and retaining staff

- since it provides an opportunity for employees to work hours

consistent with their other commitments (www.tutor2u.net).

The study leave is a time-off from work not exceeding six (6)

months with pay for the purpose of assisting the qualified officials

and employees to prepare for their bar or board examinations or

to complete their masteral degree. The leave shall be covered by a

contract between the beneficiary and the agency head or his

representative (www.excell.csc.gov.ph).

According to the CHSRF (2001), there is a relation between

nurses satisfaction with their salaries and job satisfaction; however

the salary become the issue of concern usually in the absence of

 91

the factors of satisfaction such as recognition, appreciation for

personal development and growth.

V. Inhibiting Factors that Influence Compliance of Staff

Nurses on the PHILHEALTH Benchbook

There are factors that contribute to non- compliance with

Philhealth Benchbook. These factors are lack of resources,

understaffing and personnel attitude.

Themes Key Informant

1. Lack of Resources Brad, Kate, Angelina

2. Understaffing Kate, Brad, Angelina

3. Attitude Kate, Scarlet, Tom

“Lack of Resources”

Insufficient resources, infrastructures, equipment,

consumables, money for recurring expenses and staff make it

possible for output of a certain quality to be turned out under the

prevailing circumstances.

Brad: “During duty time, we provide our own Personal Protective Equipment (PPE), such
as mask “.
Kate:” Many times we want to use PPE, but we cannot because it’s not available”

Angelina: “We have requested supply for the nurse station, but sometimes it’s not readily
available for use to use”.
 92

Availability of resources is an important factor in the

compliance of nurse to quality of care. The access of it indicate that

in the healthcare setting its once of the means in delivering a safe

and efficient care. However, in some of the institution many nurses

suffer not only the shortage of staff but as well as the inability of

the needed materials and equipment such as availability of

Personal Protective Equipment.

Nurses are the front lines health care worker that is in

constant interaction with the patient. They perceive that

sometimes resources are there but it is scarce. They felt the need

to have these resources to respond to the different call in patient

care and to specifically practice within the standards set in the

nursing practice.

In some private hospital, staff nurses are the one who

provides protective equipment for themselves such as (mask). The

participant stated that they often come across situations where

they must use protective equipment, but this is not possible due to

the lack of availability of such equipment. A different aspect of non

availability of equipment is the storage of such equipment in places

far from where nursing care is provided. Another parameter is the

 93

fact that this equipment may be available, but not in sizes or types

that are necessary (www.biomedcentral.com).

“Understaffing”

Appropriate nurse staffing is critical to patient safety and well

being. In adequate patient staffing levels are known to influence

the rate of heart attack, falls, medication error and respiratory

infection as well as overall mortality.

Kate: “I have 13 to 14 patients load daily, and sometimes I don’t have enough time to
attend to my patient need”

Brad: “I felt that the number of personnel greatly affects our compliance”.

Angelina: “I am too busy during my duty time; there are times where I’m the only nurse
on duty and manned the station alone with a census of 11-15 patients”.

Nurses also find themselves spending less time caring for a

patient, and more time with interruptions and performing other

tasks to save money on hiring or maintaining other employees to

perform these tasks. They are inundated with documenting care,

due to rising fears of medical-related litigation that have resulted in

almost obsessive requirements for care documentation (i.e.,

charting). Twelve-hour shifts have turned into 14-hour workdays

due to the charting requirements, with management frowning upon

recording of this extra time. Documentation as well as other

responsibilities of the nurse has increased in equal proportions to

 94

the acuity and number of patients cared for as a result of errors

and other risk factors due to the understaffing models of

institutions. Mandatory overtime is another administrative answer

to the problem. Bathroom and meal breaks for nurses have been

reduced to stolen seconds. Self health care of nurses is replaced

with physical injuries, stress and exhaustion related ailments as

well as medications or therapy in order to maintain employment.

A recent survey of nurses staffing trend by the American

Nurse Association ( ANA) found that 54 percent of nurses in adult

medical and emergency unit report spending insufficient time with

patient and 43 percent of nurses work extra hours due to short –

staffing or excessively busy units. In 20 percent of the cases

examines, low staffing had a negative impact on unit admission,

transfer and discharge. Understaffing also deplete morale leading

to higher level of absenteeism and staff turnover.

As many recent reports and studies have illustrated, nurse

staffing is insufficient in many healthcare organizations today,

resulting in preventable complications and, in some instances,

patient deaths. Insufficient nurse staffing also increases nurse

burnout, fuelling an exodus from the profession, and thereby

further exacerbating the escalating nurse shortage.

 95

As nurse workloads increase, nurse burnout and job dissatisfaction

become greater factors in the voluntary turnover that leads to

understaffing of hospitals. Healthcare consumers rank this

understaffing as a major threat to patient safety.

As hypothesized, workload was found to negatively affect

perceived quality and safety of care. This is consistent with

previous research (Institute of Medicine 2004); however, it should

be noted that we conceptualized and measured nursing workload

differently than previous studies. Several mechanisms can explain

this finding (Carayon and Gurses 2008). One is that nurses who

had a high workload over a shift would be pressured for time.

Consequently, they would focus mainly on major patient issues and

would not be able to attend to minor issues such as giving bath to

patient or brushing patient's teeth. Another one is based on

Reason's (1997) argument about the traditional inclination of

industries to focus on production at the expense of safety. For

example, a nurse who had a high workload during a shift would

probably use her time to complete major patient care tasks at the

expense of complying with hand-washing guidelines (Pittet et al.

2000).
 96

As many recent reports and studies have illustrated, nurse

staffing is insufficient in many healthcare organizations today,

resulting in preventable complications and, in some instances,

patient deaths. Insufficient nurse staffing also increases nurse

burnout, fueling an exodus from the profession, and thereby

further exacerbating the escalating nurse shortage (www.rwjf.org).

The international standard for the ideal ratio of nurses to

patients in hospitals is 1:4. But even at the premier state hospital

in the country, the Philippine General Hospital (PGH), said Dr.

Jaime Galvez Tan, former Vice Chancellor for Research of the

University of the Philippines-Manila and executive director of the

National Institutes of Health-Philippines, the ratio of nurses to

patients averages from 1:15 up to 1:25. In Davao del Sur and in

most other hospitals, the ratio would even reach 1:50 up to 1:100

(www.bulatlat.com).

In private hospital, understaffing also happen, as stated by

the participants they have more than patients load than the ideal.

A staff nurse usually has an average patient load of 7 to 8 and

sometimes assumed different role per shift. They are not only
 97

attending to in-patients but as well as to out-patients, sometimes

nurses are overload and do multi-tasking.

“Attitude “

Individuals and the work environment are known to affect each

other mutually. Positive interaction contributes to both the individual's

health and the success of the institution (Tekarslan, Sencan, Kilinc, &

Baysal, 2000). Individuals demonstrate common or personal attitudes

towards their profession, managers and institutions, which varies

according to the interaction experienced in the work place (Baysal,

1980).

Kate: “It’s difficult to change things that you are used to, that’s why sometimes I’m
indifferent”

Scarlet: “Resistance to change is one factor that leads to attitude problem”

Tom: “Nurses are so exhausted, one rest day per week is not enough thus sometimes we
cannot comply with the standard”

Nursing esthetics is the way in which nursing knowledge is

expressed (Kozier, et. al. 2001, p.15). It involves feelings that

are gained through subjective experience. It is said to be the

“art” and “science” of Nursing (Ibid. p. 15). And it is through the

art of nursing that nurses primarily express caring; thus, esthetics

includes attitudes, beliefs, and values. Sensitivity and empathy

 98

are important facets of Nursing Esthetics. They enable nurses to

be aware of the clients’ perspectives and to be attentive to cues of

the clients’ physiological state. A nurse who is highly skilled in

empathizing with clients has a wider range of interventions for

providing effective and satisfying nursing care (Carper 1978, p.17)

On the other hand, personal knowledge is concerned with knowing

one’s self. It involves the knowing of self in relation to another

and interacting on a person-to-person rather than a role-to-role.

Attitude is defined as a predisposition or potential behavioral

intention to respond in a favorable or unfavorable way to any

concrete- abstract, animate-inanimate objects in the environment,

which is shaped over time in relation to the upbringing of the

individual and lifelong experiences (Eren, 2001; Tekarslan et al.,

2000). In addition, it could prompt the individuals to distinguish

themselves from others; however, it might change or gain strength

or completely disappear in time, while it cannot be observed

directly, it can be interpreted from the individuals' statements and

behaviors (Schermerhorn, Hunt, & Osborn, 2005; Simsek,

Akgemci, & Celik, 2001).

 99

The attitude of employees towards a profession manifests

itself in the way they respond to work related factors. Given the

relationship between the individual's attitude and behaviors

towards an object, many authors have expressed that identifying

the attitudes of employees towards their profession would provide

significant data for managers in predicting employees' job

satisfaction, performances and productivity (Hulin & Judge, 2003;

Nahavandi & Malekzadeh, 1999; Ramamoorthy & Flood, 2002;

Schermerhorn et al., 2005; Tekarslan et al., 2000).

The 2006 report of the International Council of Nursing (ICN)

emphasizes the fact that healthcare professionals working in

healthy and secure settings produce positive outcomes in patient

care, and suggests that national nursing organizations and

associations should pioneer and/or support research into safety

and compliance of the working environments of nurses, as well as

the studies on nurse-related risk behaviors, attitudes, procedures

and activities in their countries (www.icn.ch).

However, studies have so far demonstrated that nurses

exhibit negative attitudes towards their profession, such as

frequently complaining about the difficulties of the professional and

 100

working conditions, finding the profession very stressful, practicing

unwillingly, seriously considering to leave the profession, and

showing a tendency to absenteeism and job dissatisfaction (Baykal

& Serezli, 1999; Gunduz & Beydagi, 2007; Kovner, Brewer, Wu,

Cheng, & Suzuki, 2006; Kücükyilmaz, Ozer, & Tasci, 2006).

Nurses unsatisfied with their jobs experience emotional

problems, including high stress, tension and anxiety, which could

result in a failure to concentrate on their tasks, which in turn leads

them to demonstrate behaviors that disrupt the quality and the

continuity of nursing services, such as complaining about their

work, the facility and their coworkers, neglecting duties,

absenteeism or quitting work. In addition, more frequent

supervision is required for nurses who have these types of negative

attitudes, and managers have to spare additional time to find

solutions to their complaints and problems. As a consequence of

this additional workload of nurse managers, more undesired events

such as reduced organizational effectiveness, increased costs and

decreased quality are experienced in such settings (Eren, 2001;

Türköz, 1999).
 101

Within nursing, Derlmn and Takacs (1990), focused on how

individuals cope with change and work through the changes that

affect them. Although individual must devote personal resources

and energy to accomplish change, organization tends to overlook

the human emotion associated with an organizational change.

According to Workman and Kenney (1998), change occurs on

a continuum from haphazard drift to structural planned change.

Change can occur by drift. Things and people unilaterally change in

an uncontrolled fashion. At the end of continuum, change can be

deliberate and planned such as occurs when an organization

identifies a plan to adapt and important total quality management.

Change has been described as inevitable, constant, universal and

powerful. Change is a persuasive element of society, of today’s

healthcare environment and of life (Huber, 1996).

Resistance to Change is natural because any change whether

beneficial or not, requires adjustment by the change target and

represents a threat to the employee’s role, job security, economic

welfare, self esteem and social support structure. The strength of

an employee’s resistance to proposed change is proportional to her

emotional and economic investments in the status quo. If she was

 102

attracted to the existing structures been it appealed to her habit,

preference, vested interest and personal goals. She will strongly

resist effort to alter those circumstances that are of particular

significance to her (Gillies, 1989).

 103

Proposed Intervention Plan for Compliance of Philhealth

Benchbook among Staff Nurses

 104

Rationale:

In recent years, emphasis on improving the quality of care

provided by the nation’s hospitals has increased significantly and

continues to gain momentum. Because nurses are integral to

hospitalized patients’ care, nurses also are pivotal in hospital

efforts to improve quality. As hospitals face increasing demands to

participate in a wide range of quality improvement activities, they

are reliant on nurses to help address these demands.

Gaining a more in-depth understanding of the role that

nurses play in quality improvement and the challenges nurses face

can provide important insights about how hospitals can optimize

resources to improve patient care quality.

General Objectives:

The Proposed Intervention Plan will improve the level of

compliance among staff nurses working in the health care facility

and will take appropriate actions to maintain consistency on their

level of compliance.
 105

Proposed Intervention Plan

Area of Concern Specific Strategy People Involve Expected

Objectives Outcome
Review the Patient Provision of Patient Staff Nurses Staff will
right and Rights and knowledgeable with
Responsibilities responsibilities copy to the patient right and
all staff and orientation responsibility
and re orientation of
staff
Facilitate compliance Regular staff nurse Staff Nurses Very good rating in
Patient’s Right and
with the code of evaluation on code of the staff nurse
Organizational Ethics
ethics ethics compliance
evaluation
Review guidelines in Conduct in-house Staff Nurses Awareness on the
ethical issues in conference on commonly ethical issues that
making care decision ethical issues that are arise in rendering
encounter in the patient care
healthcare

Facilitate accurate Conduct seminar on Staff Nurses Nurses will be able

documentation in accurate documentation to document
nursing care accurately
Patient Care Review policy and Orientation and re- Staff Nurses Staff nurses will
procedures on orientation of staff in perform duties in
nursing standards relations to nursing accordance with
service standards of nursing standards
practice
 106

Provide solutions for Evaluate the applicable Nurse Managers There will be
understaffing modalities of care in the enough staff to
healthcare setting attend patient needs

Review guidelines on  Orientation on the Staff Nurses Awareness on the

management plans safe and efficient guidelines how to
for safe and efficient use of medical use medical
use of medical equipment equipment safely
equipments  Provide each and effectively
department with
operation manual Able to operate
on how to use machine with
medical minimal supervision
equipments and can perform
Safe Practice and Environment simple
troubleshooting of
machine
Facilitate safe and Conduct annual fire drill Staff Nurses Able to respond to
effective an emergency in a
environment of care coordinated, timely
and effective
manner
Review policy and Orientation and re- Staff Nurses Fulfill their role in
procedures on orientation of the policy safe practice
personnel role in and procedures
safe practice
Provide job description to
each staff with
conformed
Review guidelines on Hold a seminar on Staff Nurses Learn and practice
infection control Infection Control infection control
procedures procedures
 107

Practice proper hand Demonstration and Staff nurses Application of

washing technique Return demonstration on proper hand
and proper waste proper hand washing washing technique
disposal technique and proper and proper waste
waste disposal disposal
Review policy on Seminar on sharps Staff nurses Learn and practice
safety technique in safety safe handling of
handling sharps sharps
Provision of Provide each area with Staff nurses Proper disposal of
equipment that for punctured proof sharps
safe disposal of container
sharps
Facilitate compliance Regular evaluation of Staff nurses Obtain a very good
with safe practice in safe practice in handling rating in the
handling sharps sharps evaluation