Chapter 1

Introduction
For the past 20 years, the National Council of State Boards Nursing (NCSBN) has asserted its focus on continued competence, although only within the past 11 years have formally defined competence as the application of knowledge and the interpersonal, decision-making and psychomotor skills expected for the practice role, within the context of public health, safety and welfare. Theorists hold that understanding the process of ethical competency acquisition and applying its result is to be used to develop a profession, to modify job description and employment, and to promote effective education. The researchers prompted to conduct the study to assess the competency of nursing students in the implementation of ethical guidelines for nursing practice. Since nursing is a unique health care profession that is composed of a unique body of knowledge, standard clinical practices, and healthy attitude towards caring, it is important to appreciate the importance of these attributes in understanding the many concepts related to the nursing profession. One should understand that the things nurses perform on, to, and for their patients are anchored on well-established facts and principles. It means that, in order for nurses to fully functional well, they should be well-equipped with all the knowledge with which they can rationalize their nursing actions in the clinical area. Health care ethics is concerned with the rights, responsibilities, and obligations of health care professionals, institutions of care, and clients. Upon entering the profession of nursing, nurses accept the responsibilities and trust that have accrued to nursing over the years and also the obligation to adhere to the professions's code for ethics. The Code for Nurses, published by the American Nurses Association, is the standard by which ethical conduct is guided and evaluated by the profession. It provides a framework within which nurses can make ethical decisions and discharge their professional responsibilities to the public, to other members of the health team, and to the profession. 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. Indeed, the concern about code of ethics is very important for it will give an assurance of competency for nursing students. The code covers nurses' responsibilities toward clients' rights and to work toward improving the practice of nursing. It requires protection for clients and the public where ethical, practical and legal matters are concerned. This study will help the student nurses to further their knowledge regarding nursing practice for them to be a competent and qualified, execute good judgment and improve the standards of quality nursing care.

Theoretical Framework
According to Benner (Competency of Nursing Students, 2011), clinical nursing requires theoretical knowledge and practical knowledge. Theoretical knowledge can be acquired in an abstract fashion through reading; observing and discussing. On the other hand, the development of practical knowledge requires actual experience in a situation because it is contextual and transactional. Benner stated that, Knowledge development in a practice discipline consist of extending practical knowledge know-how through theory-based scientific investigation and know-how develop through clinical experience in practice of that discipline. Clinical embodies the notion of excellence by studying practice, nurses can uncover new knowledge. Benners Dreyfus model of skill acquisition and skill developments are novice, advanced beginner, competent, proficient and expert. Stage 1: Novice Beginners have had no experience of the situational in which are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no life experience in the application of rules.

Stage 2: Advanced Beginner Advanced beginner is those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, is to have pointed out to them by a mentor, the recurring meaning situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience. Stage 3: Competent Competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in term of long-range goals or plans of which he or she is consciously aware. For the competent nurse, a plan establishes a perspective, a the plan is based on considerable conscious, abstract, analytic, contemplation of the problem, The conscious, deliberate planning that is characteristics of this skills levels help achieve efficiency and organization. The competent nurse lacks speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The competent person does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most silent, most important. Stage 4: Proficient The proficient performer perceives situations as whole rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long term goals. The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The proficient nurse can now recognize when the expected normal picture does not materialize. The holistic understanding improve the proficient nurses decision-making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones. Stage 5: The Expert The expert performer no longer relies on an analytic principle (rule, guideline, and maxim) to connect her or his understanding of the situation to

an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnosis and solutions. The expert operates from a deep understanding of the situation.

Conceptual Framework
Figure 1 illustrates the conceptual framework of the study. The input is composed of the profile of the students and clinical instructors and the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice which will be rated using the Likert scale from excellent, very good, good, fair, and poor. The output are the proposed measures to improve the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice. Input Process Output I. Likert scale 5 - Excellent 4 - Very good 3 - Good 2 - Fair 1 - Poor Proposed measures to improve the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice.

I. Profile of nursing students a. Age b. Gender c. Civil status d. Religion e. Year level f. Ethnic background g. Socio-economic status II. Profile of nursing instructors a. Age b. Gender c. Civil status d. Religion e. Highest degree earned f. Ethnic background g. Number of years in professional practice III. Degree of competency of nursing students in the implementation of ethical guidelines for nursing ptactice

Statement of the Problem

The study aims to determine the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice. The study also aims to propose measures to improve the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice. The study seeks to answer the following queries: 1. How are the nursing student respondents characterized as follows: a. Age b. Gender c. Civil status d. Religion e. Year level f. Ethnic background g. Socio-economic status 2. What is the profile of the clinical instructor respondents in terms of: a. Age b. Gender c. Civil status d. Religion e. Highest degree earned f. Ethnic background g. Number of years in professional practice 3. What is the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice? 4. What measures can be proposed to improve the degree of competency of nursing students in the implementation of ethical guidelines for nursing practice?

Assumption
This study is premised on the following assumptions: 1. The possibility of miscommunication increases when the nurse and patient speak different languages. 2. All patients need support toward health. 3. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. 4. Religious belief contribute substantially to the formation of medical practices of every individual.

Scope and Delimitations of the Study

The respondents of this study were 800 selected nursing students and clinical instructors at Dagupan City, Pangasinan who were chosen by purposive sampling. The researchers have chosen Colegio de Dagupan, Lyceum Northwestern University, Panpacific University North Philippines, University of Luzon, University of Pangasinan, Virgin Milagrosa University, The emphasis of this study was placed on the Degree of competency of nursing students in the implementation of ethical guidelines for nursing practice. The actual study on the respondents will be conducted from June to October 2013 and was based on primary data sources which are information coming directly from the respondents through the questionnaires; and from the secondary data sources which came from the published and unpublished materials such as books, journals, websites, theses and dissertations.

Significance of the Study

To the Researchers: This study will enable the researchers to apply the theories learned in nursing research thus helping them to hone their skills. To the Nursing Students: They will be given more knowledge on the different ethical guidelines for nursing practice. They will be able to learn some alternative techniques or actions on how to at least improve their competencies. Nursing students will somehow be ready in handling ethics.

They will be competent and be effective nurses someday. To the Clinical Instructor: This study will give them knowledge on what is the current degree of competency of nursing students regarding the implementation of ethical guidelines for nursing practice. Clinical instructors must display the knowledge and skills required to enhance nursing student competency, which will optimize the high standards of patient care. To the Future Researchers: This study will provide additional information and new insight as well as on such topics in Student Nurse Competency, which hopefully, will be developed by future researchers to make it more responsive and updated to the needs of others with similar situation. This study will also serve as guide and source of information to the future researchers thus make them finish their paper easier and faster.

Definition of Terms
The following are terms defined by the researchers to ensure clearer understanding and appreciation of the study: Degree of competency. Means the measure of the relative degree or extent of that competency of nursing students for nursing practice using ethics. Teamwork and cooperation. This indicator of competency includes cooperation with others to accomplish common goals; treats others with dignity and respect and maintains a friendly demeanor; values the contribution of others. Accountability. This indicator of competency includes acceptance of full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; presents oneself as a credible representative of the Agency to maintain the public's trust. Judgment and decision-making. This indicator of competency includes the analyzation of problems by evaluating available information; develops effective, viable solutions to problems which can help drive the effectiveness of care. Communication. This indicator of competency includes listening respectfully to others to gain a full understanding; comprehends written material; presents information in a clear and concise manner orally and in writing to ensure others understand his/her ideas; appropriately adapts his/her message, style, and tone to accommodate a variety of people. Conflict management. This indicator of competency includes the addressing of

conflicts by focusing on the problems at hand to develop effective solutions when disputes or disagreements occur; helps others resolve conflicts by providing impartial mediation when needed. Cultural awareness. This indicator of competency includes demonstration of open-minded approach to understanding people regardless of their gender, age, race, national, origin, religion, ethnicity, disability status, or other characteristics; treats all people fairly and consistently; effectively works with people from diverse backgrounds by treating them with dignity and respect. Flexibility. This indicator of competency includes adaptation to change and different ways of doing things quickly and positively; appropriately adapts ones thinking or approach as the situation changes. Professional development. This indicator of competency includes demonstration of commitment to professional development by proactively learning to develop new capabilities, skills, and knowledge. Ethics. This term refers to the principles that guide an individual, group, or profession in conduct. The study of ethics has led to the identification of basic concepts including rights, autonomy, beneficence, nonmaleficence, justice, and fidelity. Understanding these concepts assists the nursing students with making decisions during difficult situations. Rights. This term refers tosomething to which one has a just claim or the power or priviledge to which one is justly entitled. Autonomy. the concept of autonomy gives them the right to make those decisions unless they are mentally impaired. Beneficence. It means to do good, not harm, to other people. Nonmaleficence. This term refers to the concept of preventing intentional harm. Justice. This term is closely tied with the legal system. However, the word refers to the obligation to be fair to all people. Fidelity. This term refers to the concept of keeping a commitment. Although the word is more closely used to describe a marital relationship, fidelity is the concept of accountability. Privacy and confidentiality are concepts that could be challenged under the concept of fidelity. Nursing students. The term refers to those individuals enrolled in a school of nursing or a formal educational program leading to a degree in nursing regardless of age, gender, and civil status. Nursing Practice. This term refers to the provision, at various levels of preparation, of services essential to or helpful in the promotion, maintenance,

and restoration of health and well-being or in prevention of illness, as of infants, of sick and injured, or of others for any reason unable to provide such services for themselves.

Lyceum Northwestern University Dagupan City

DEGREE OF COMPETENCY OF NURSING STUDENTS IN THE IMPLEMENTATION OF ETHICAL GUIDELINES FOR NURSING PRACTICE

A Thesis Presented to Mrs. Marjorie Joy Fernandez, RN, MAN

In Partial Fulfillment Of the Requirements for Nursing Research 1

By: Group 6 Balberan, Saro D. (Leader) Balbin, Lea Marie Reyes, Christine N.

December, 2012