CLINICAL PERFORMANCE AND PATIENT SATISFACTION

ON THE CARE RENDERED BY NURSING

STUDENTS

An Undergraduate Thesis Presented to the

Faculty of Institute of Nursing, Far Eastern University

By
Fajayan, April Rose A., Ferrer, Jasmine Joie T., Gonzaga, Shela Mae C., Guno,
Cindee V., Malabi, Nadia J., Marfil, Ezrah Mae P., Mateo, Catherine A., Mirano,
Joyce Karen C., Montalbo, John Joseph M., Peñafiel, Toni Marziet M., Pineda,
Jaffar C., Rillera, Ramon S.

In Partial Fulfillment of the

Course Requirement in Nursing Research

October 2009

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 Acknowledgment

The researchers would like to thank first and foremost, Mr. Jesson V. Butcon, RN

MA, PhD, their research adviser, who profoundly encouraged them to have firm hold

onto their research endeavor.

To Ms. Geraldine Cañete, RN, MAN, for her guidance in the critical initial steps

in learning the language of research.

To the dear institute coordinators, the researchers are of much gratitude for their

kind consideration in handing the vital data which served as one of the keys for the study.

The researchers are indeed grateful to beloved Dean Glenda S. Arquiza, RN,

MAN, PhD, for the utmost support a mentor can ever share to her young and ambitious

students.

To Mr. Adrian Joseph Luansing, RN, MAN, and family, most especially to Mrs.

Ma. Emelita Luansing, RN, MAN, a parcel of thanks is addressed to them for the always

generous help they have done in making this work a study.

To Sir Manolito Aban, RN, a deep gratitude from the researchers for the statistical

aid and pieces of advice.

A multitude of thanks to Professor Emma Santaren, PhD, for the approval of the

Filipino translation of the patient satisfaction scale.

The researchers’ deepest gratitude goes to Dr. Fe Del Mundo Medical Center staff

for their hospitable accommodation in allowing the researchers to conduct their research

study.

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 To the most essential characters that took the greatest part in this study, the

patients and students who humbly participated in the research, a parcel of gratitude.

To the family and friends of the researchers, the debt of gratitude they owe and

could never repay.

Above all, to the Almighty; in Him lies a person’s strength.

BSN001 – Group003

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 ABSTRACT

Clinical Performance and Patient Satisfaction are two components that are both

vital in quality nursing care. The study was aimed at determining the relationship

between clinical performance and patient satisfaction on the care rendered by nursing

students.

Using descriptive research design, the clinical performance of twenty three (23)

level IV nursing students were obtained using purposive-convenience sampling. Consents

were obtained for disclosure of grades in a particular rotation. Meanwhile, patient

respondents completed the Satisfaction Survey tool matched with the sample clinical

performance rating of students. Then, the researchers retrieved the grades for comparison

and analysis. Data showed that results were negligible on the relationship between the

two variables yielding a Spearman Coefficient of 0.18. Thus, it is recommended to

conduct the study in a bigger sample size using time-series design.

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 TABLEOF CONTENTS

CHAPTER I – Introduction………………………………………………………..1
Statement of the Problem …………………………………………………. 3
Significance of the Study ………………………………………………….. 3
Scope and Limitations of the Study ……………………………………….. 5

CHAPTER II - Review of Related Literature …………………………………… 7

Nursing students and Clinical Performance Evaluation…… 7
Patient and Patient Satisfaction …………………………… 10
Patient Satisfaction and Nursing Care ……………………...13
Patients and Nursing students ………………………………15
Synthesis ……………………………………………………15
Research Paradigm………………………………………………………….16
Hypotheses……………………………………………………………….… 21
Definition of Terms…………………………………………………………21

CHAPTER III - Method………………………………………………………… 23

Research Design…………………………………………………………… 23
Population and Sample…………………………………………………….. 23
Research Locale …………………………………………………………… 25
Research Instruments………………………………………………………. 26
Data Collection Procedure…………………………………………………. 27
Statistical Treatment ………………………………………………………. 29

CHAPTER IV - Results and Discussion………………………………………… 31

Part I. Clinical Performance ……………………………………………….. 31
Part II. Patient Satisfaction …………………………………………………34
Part III. Relationship between Clinical Performance
and Patient Satisfaction…………………………….. 37

CHAPTER V - Summary of Findings, Conclusions and Recommendations ……. 39

Conclusions………………………………………………………… ………41
Recommendations …………………………………………………………. 41

Bibliography………………………………………………………………………. xi
Appendix A……………………………………………………………………… xii
Appendix B………………………………………………………………………... xiii
Appendix C……………………………………………………… ………………xiv
Appendix D……………………………………………………………………….. xv
Curriculum Vitae……………………………………………………………….... xvi

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 LIST OF FIGURES AND TABLES
FIGURE
Figures 1 Conceptual Paradigm …………………………………………………… 20

TABLES
Table 1- Demographic Characteristics of the Patient Respondents…………………25

Table 2 - Clinical Performance of Nursing Students

Based on the Four Areas of Competencies………………………… 34

Table 3 - Patient Satisfaction on the Care Rendered by Nursing Students………… 35

Table 4 - Mean Difference in Patient Satisfaction

according to Demographic Characteristics …………………………37

Table 5 - Relationship between the Clinical Performance Rating

and Patient Satisfaction Rating…………………………………….. 38

Table 6 - Clinical Performance of Nursing Students

Based on the Four Areas of Competencies………………… Appendix B

Table 7 - Relationship between Clinical Performance and Patient Satisfaction

and The Spearman’s Rho Coefficient Result………………. Appendix D

Table 8 - Relationship between Patient Care Competencies

and Nursing Care Domains………………………………… Appendix D

Table 9 - Relationship between Enabling Competencies

and Nursing Care Domains …………………………………Appendix D

Table 10 - Relationship between Enhancing Competencies

and the Nursing Care Domains ……………………………. Appendix D

Table 11 - Relationship between Empowering Competencies

and Nursing Care Domains …………………………………Appendix D

Table 12 – Test of Significant Difference between Clinical Performance

and Patient Satisfaction ……………………………………. Appendix D

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 CHAPTER I

Introduction

Quality care of nurses is considered the hallmark of nursing responsibility.

Different studies have proven the basis of quality nursing: some described patient

satisfaction as the sole determinant of quality nursing care while others connote

competence of nurses in terms of knowledge and skills as the source of this quality

nursing care. Hence, nurses are expected to render quality care since patient satisfaction

varies according to the perception of the patient and how the care is rendered by a nurse.

Concomitantly, a nursing student who is as well exposed to the clinical setting is

anticipated to give quality care. However, no studies have been made yet to prove if

there exists a correlation between the clinical performance of a nursing student and

patient satisfaction.

Patient satisfaction with nursing services gains even more importance, since

owing to the nature of nursing, patients may judge the overall quality of hospital services

on the basis of their perceptions of the nursing care received (Scardina, 1994; Yellen et

al., 2002); it establishes that patient satisfaction is subjective in nature and relies heavily

on what the client perceives as a “good nursing care”. Aside from the patient’s perception

of the care received, patient related factors like age and gender affects the patient’s

satisfaction towards the care performed (Thiedke, 2007).

Patient satisfaction with regards to nursing care are determined by these factors: a.

when internal needs are met such as the need for interpersonal relations, recognition and

participation in decision-making (Bond and Thomas, 1992); b. when adequate

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information/ health teachings are provided (Elder et al., 2005) and; c. when the nurses

display good temperament, approachability and politeness (Cuevas, 2008).

In fulfilling the goal of preparing nursing students as competent healthcare

professionals, clinical preceptors have the responsibility of seeing to their performance in

accordance to the standards of the profession. The Clinical Performance Evaluation Tool

as a competency-based framework enables the institution and the nursing students to have

a clear understanding of expectations in relation to their role performance which would in

turn provide a basis for developing continuing educational improvement specifically

training needs analysis that would meet the needs of the institution and the nursing

students as future health care professionals.

Based on the researchers’ own experiences in the clinical area and accounts from

other nursing students, there have been instances wherein patients have expressed

satisfaction with the care delivered with a poor outcome on the clinical performance

grade. As a result, these sparked an interest in discovering whether patients are satisfied

with the nursing care rendered and whether it affects the evaluation of the clinical

performance of the nursing students.

In this study, nursing care rendered by nursing students during their clinical

exposure in a certain ward will be evaluated by the clinical performance and by the

patient satisfaction. The researchers will build a bridge that will connect the existence of

the correlation between clinical performance and patient satisfaction thus; the study is

geared towards finding if a high clinical grade reflects a high rating of patient satisfaction

or vice versa.

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 These inquiries motivate the researchers to pursue the study so that improvement

in certain aspect of nursing care such as nurse-patient-interaction will be attained.

Statement of the Problem

The study sought to determine the relationship between clinical performance and

patient satisfaction on the care rendered by Level IV FEU-IN students. Specifically, it

aims to answer the following questions:

1. What are the demographic characteristics of the patients in Dr. Fe del Mundo

Medical Center?

2. What is the average clinical performance of students rotating in Dr. Fe del Mundo

Medical Center when grouped according to four areas of nursing core competencies?

3. What is the patient satisfaction rating when grouped according to three domains

of nursing care?

4. What is the patient satisfaction rating when grouped according to age and gender?

5. What is the relationship between clinical performance and patient satisfaction of

clients cared by the nursing students?

Significance of the Study

The study was of particular importance to the nursing profession and society for

reasons that it sought to understand the relationship between clinical performance of the

students and patient’s satisfaction. It also sought to determine if the patients’

9
demographic characteristics influenced their satisfaction. Specifically, the study was

essential for reasons that it:

Patient. Since the researchers valued patient satisfaction, this study was geared

towards optimal patient-centered health promotion that would endeavor to uphold patient

satisfaction and to the care rendered by the nursing students.

Nursing Practice. Through this study, nursing students were made aware of their

contribution to their patients by means of measures undertaken to aid their recovery.

Nursing Administration. The study aimed to provide significant contributions

toward improvement of the overall health care delivery system in carrying out nursing

care for hospitalized patients. In the long run, this would be beneficial to the entire health

institution, for the patient’s trust and satisfaction in the capabilities of the care service

would be improved.

Nursing Education. In clinical education, assessment of students in clinical

practice was imperative in order to ensure that those who become registered nurses are

safe and competent practitioners. The study could contribute to the improvement of the

way nursing students deliver care thus contributing to the development of nursing

education and enrichment of nursing research pertinent in patient’s satisfaction. A

significant relationship between the clinical performance of nursing students and patient

satisfaction would provide another dimension by which the nursing students’ clinical

performance would be evaluated.

Nursing Research. The study could supplement and support the previous

research study done by Cuevas (2004) and could be used in correlation with other studies

and reviews like that of Thiedke (2007) about the effects of profile variables on patient

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satisfaction, so that the researchers would be able to have comprehensive reviews

reevaluation. It could also be used as a framework or basis for the establishment of future

studies for those who wish to pursue the research study.

Scope and Limitations of the Study

The researchers allotted 2 months for the whole study. The first month was used

for data gathering while the remaining month was spent for data analysis and finalization

of the study.

The study was conducted in the medical ward of Dr. Fe del Mundo Medical

Center. Inclusion criteria were patients who are (1) either male or female; (2) 18 years old

and above; (3) was under the care of same assigned nursing student/s for at least 3

consecutive days; (4) conscious and coherent.

Characteristics of the participants that deterred the subjects from participating in

the study included those who were: (1) not under the care of senior nursing students; (2)

under the care of more than one assigned nursing student; (3) under the care of nursing

students from 11 P.M. to 6 A.M.; (4) who suffered from mental or cognitive disorders;

(5) unable to read and write.

On the other hand, the nursing students who were subjected to the study were (1)

Level IV FEU-IN students, (2) who have had their duty in Dr. Fe del Mundo Medical

Center, (3) who solely rendered care to the patient (4) and who willingly gave his/ her

consent for the grade.

Students who did not meet the above inclusion criteria did not qualify as a subject

for the study.

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 The researchers selected the respondents from both sexes for the purpose of non-

selectivity and to avoid bias. Age was based on the patient’s ability to answer questions

competently and independently. Extraneous variable like (1) the number of students

assigned to the patient and (2) patients who received care from the staff nurses and not

solely from the nursing students were controlled so that they would not contaminate the

relationship of patient satisfaction and nursing students’ clinical performance.

The evaluation time for nursing students included in the study was controlled to

those with shifts that extended from 6 in the morning until 11 in the evening for reasons

that, beyond this shift, patients were usually asleep, thereby preventing evaluation of

satisfaction on their part.

The study was restricted to FEU senior nursing students because the clinical

performance tool utilized was available only for use of this institution and senior nursing

students were more adept when it comes to knowledge and skills in the clinical area.

Measuring student nursing care depended on the values of the patient making the

assessment and reflected in what the patient believed as good nursing care, in this case,

patient’s profile would take place. In the study, patient’s profile variables were factors

inherent to the patient and could be limited but could not be controlled in a descriptive

study.

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 CHAPTER II

Review of Related Literature

Nursing students and Clinical Performance Evaluation

Patients provided data from the product consumer viewpoint. Patient satisfaction

was considered an important marker in quality health care and can be considered as part

of student evaluation. Judgment about nursing students’ performance was made from

patient’s personal experiences and data should be weighted for its value. Patients often

have positive comments to make about their students which can be positive for the

students to hear.

The goal of evaluation was an objective report about the quality of the clinical

performance. Faculty needs to be aware of the potential for evaluation of student’s

clinical performance to be subjective and inconsistent. Even with objective instruments

based on measurable and observable behavior, subjectivity can still be introduced into a

tool that is viewed as objective. Billings and Halstead encouraged faculty to be sensitive

to the forces that contribute to the subjective side of evaluation as faculty strives for

fairness and consistency (as cited by Reilly and Oerman, 1992). However, clinical

evaluations based on direct observation are inherently biased, and subjective evaluations

lack generalized reliability (Vannata et al., 1996). Billings and Halstead argued also that

educators cannot ignore the social connotations of grading including the impact

evaluation has on the learning process and motivation (as cited by Wiles and Bishop,

2001).

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 Literature also suggests that nursing education is often far removed from the

realities in which students experience during clinical practice. This study suggests that

students have difficulty in transferring the principles of 'good' communication from the

classroom into their own interactions with patients (Duffy et al., 2007).

Fair and reasonable evaluation of students in clinical settings requires use of

appropriate evaluation tools that are effective and ideally efficient for faculty to use.

Instrument content can vary according to the academic level of a student and can also

relate to the teaching institution’s purpose and philosophy. Any evaluation instrument

used to measure clinical learning and performance should have criteria that are consistent

to the course objectives. A faculty group’s decisions about the tools to be used for the

data collection are typically indicated. Many clinical evaluation tools have been

developed and implemented within clinical settings. Faculty must make decisions about

using these instruments according to their purpose for clinical evaluation.

Primary strategies for the evaluation of clinical practice include (1) observation,

(2) written communication, (3) oral communication, (4) simulation, and (5) self-

evaluation. Because clinical practice is complex, a combination of method is indicated

and helps support a fair reasonable evaluation (Billings & Halstead, 2004).

According to the theory proposed by Patricia Benner (1984) students nurses still

belong to the novice level with limited background experiences and will only acquire

skills such as management of resources, increase level of efficiency, clinical grasp and

resource based practice by reaching a higher level of expertise such as advance beginner,

competent, proficient and expert levels. However according to Bramble (1994) nursing

students plays a pivotal role in the care of patients though difficulty is inevitable.

14
Nursing students' synthesis of didactic information and abilities to apply knowledge in

the clinical setting can be compromised.

Competence is the knowledge, skills, abilities and behaviors that a nurse needs to

perform their work to a professional standard, and is key lever for achieving results that

will enable the organization to achieve its health care objectives (Ryan, 2001). The

competencies needed to undertake a given role in nursing and health care should prepare

practitioners who are fit for purpose and fit to practice. Competencies are needed to

provide recognition of learning, wherever it takes place, and provide links between

individual and organizational requirements, which should enable cost effective education

and training programs to be delivered.

Competencies of nurse practitioners are dependent upon development and

application of a strong fund of knowledge in the specialty area and demonstration of

technical, interpersonal, and critical thinking skills, attitudes, and ethics. Contexts

change, new knowledge emerges, and practice develops therefore competence to practice

needs to be redefined on a regular basis if the practitioner is to ensure that they are

meeting the needs of their patients and the organization.

The Clinical Performance Evaluation Tool as a competency-based framework

enables the institution and the nursing students to have a clear understanding of

expectations in relation to their role performance which would in turn provide a basis for

developing continuing educational improvement specifically training needs analysis that

would meet the needs of the institution and the nursing students as future health care

professionals.

15
 Evaluations conducted by clinical preceptors and direct observation by faculty

are the most frequent methods used for the evaluation of nursing students in the clinical

area.

Patient and Patient Satisfaction

Patient satisfaction has become an established outcome indicator of the quality

and the efficiency of the health care systems (Johansson et al., 2002; Mahon, 1996;

O’Connell et al., 1999). According to Merkouris et al. (1999a), patient satisfaction

measurement can also be seen as a therapeutic intervention, an important criterion for

making and evaluating organizational and administrative decisions, a tool for patient-

client marketing or as an ethical obligation which has the potential to humanize care by

bringing forth patients’ views. Patient satisfaction with nursing services gains even more

importance, since owing to the nature of nursing, patients may judge the overall quality

of hospital services on the basis of their perceptions of the nursing care received

(Scardina, 1994; Yellen et al., 2002).

Patient related factors like age, gender, and economic status affects the patient’s

satisfaction towards the care performed. In terms of the patient’s age, Woods (1990) has

classified the population into: (a) Veterans; (b) Baby boomers; (c) Generation X and; (d)

Generation Net. The Veterans include those who are 65 years old and above. Next are

Baby Boomers which are composed of people who belong to the 45-64 age range. The

Generation X are those whose ages are 30-44 years old. Last is the Generation Net whose

age range is from 18-29 years old. It is difficult to keep up with generational labels these

days – Veterans, Baby Boomers, Generation X and Generation Y.

16
But regardless of what they are called, generation designations have one thing in

common: they assume that people in different age groups have certain characteristic

values, perceptions, and expectations that set them apart from those who came before and

after (Blizzard 2004). However, in the study made by Blizzard (2004), inpatient

satisfaction rating is higher among patients between the ages of 18-35 years old.

Studies on the effect of gender are contradictory. In the study made by Blizzard

(2002), he found out that males were also less satisfied than females. Staff members

should be sensitive to the fact that males tended to be more impatient and concerned with

the speed of the process. On the other hand, some studies showed that women tend to be

less satisfied and other studies showing the opposite (Thiedke, 2007).

According Risser (1975), patient satisfaction with nursing care is the degree of

convergence between the expectations patients have of ideal care and their perception of

the care they really get. A consensus on a common conceptual definition of patient

satisfaction is still lacking (Bond and Thomas, 1992; Fitzpatrick, 1991; Williams et al.,

1998). Satisfaction with care is a composite and subjective concept with still undefined

boundaries and multiple interacting variables (Walsh and Walsh, 1999). These, coupled

with the knowledge and information they receive, enable them to define the situation and

their needs. Thus, a set of expectations about care is formed and it provides a subjective

standard against which the quality of care received is measured up.

Many researchers have focused on the relationship between patients’ expectations

and satisfaction (Staniszewska and Ahmed, 1999) but there is no concurrence, as to the

17
degree and the way in which unmet expectations affect overall satisfaction (Williams et

al., 1998).

Patient satisfaction is a person’s feeling of pleasure or disappointment resulting

for comparing product/service’s perceived performance or outcome in relation to his or

her expectations. As this definition makes clear, satisfaction is a function of perceived

performance and expectations. If the performance falls short of expectations, the patient

is dissatisfied. If the performance matches the expectations, the customer is satisfied. If

the performance exceeds expectations, the customer is highly satisfied or delighted.

Recently, providers of medical and nursing services have awakened to consumer

challenges, competition, quality, and the realities of marketing. With these changes, a

related and equally important issue has emerged, the patient-provider relationship on the

overall medical and nursing services quality evaluation. Patients are increasingly

frustrated with the commercialization of medical and nursing service, proliferated

bureaucratic health care system and weakened client-provider relationship (Sinay, 2002).

To achieve patient satisfaction, medical and nursing service providers should realize the

importance of healthcare marketing. Therefore, hospitals, clinics and medical service

providers should make effort to develop therapeutic relationships with their patients,

determining their needs, and tailoring their services to meet those needs (Habbal, 2006).

Vuori (1987) investigated the reasons that have led to a questioning of the validity

of the measurements of patient satisfaction and concluded that: (a) patients do not have

the scientific or technical knowledge to assess the quality of care, (b) patients can be in

such a physical and psychological state that they are unable to express objective opinions,

(c) the most rapid succession of interventions, diagnostic tests and measuring does not

18
allow the patients to have a complete and objective picture of what is happening, (d )the

professionals and the patients can have different goals, and (e) the notion of quality

depends on the cultural habits and varies from country to country. It also depends on the

patient’s characteristics such as their age, educational background, social class and their

state of health.

Hospital nurses need to take into consideration the way nursing is defined and

organized in our days so that these instruments can be used to evaluate the needs of their

patients and their interventions to meet these needs. Evaluating care provision in this

regard involves both patients and nurses (Merkouris, et al. 1999).

Patient Satisfaction and Nursing Care

Nurses are not limited as a caregiver; they can also be counselor and teacher when

the need arise. Studies also showed that providing patients with information increase their

satisfaction with the health institution. Marchal, et al. (2005) found out that information

provided by the nurse was rated a mean of 9.33 (with 10 as the most satisfied) in a study

about post-operative care and patient satisfaction after ambulatory surgery for breast

cancer patients. Another study by Elder et al. (2005), found out that the more information

provided for the patient the more the satisfaction. The study concludes that patient

satisfaction is an important health outcome and is necessary to improve the overall

quality of patient care.

The nurse patient relationship, according to research by Press Ganey Associates

Inc., sets the tone of the care experience and has a powerful impact on patient

satisfaction. Nurses spend the most time with patients. Patients see nurses’ interactions

19
with others on the care team and draw conclusions about the hospital based on their

observations. Also, nurses’ attitudes toward their work, their coworkers and the

organization affect patient and family judgments of all the things they don’t see behind

the scenes.

Without a positive nurse patient relationship, there cannot be patient and family

satisfaction. And there cannot be an environment that supports anxiety reduction and

healing (Leebov, 2009).

Patient satisfaction with nursing services gains even more importance because

nursing staff comprises the majority of the health staff (McDonnel and Nash, 1990) and

are constantly found at the side of the patient to satisfy their needs comprising the main

component in the maintenance and rehabilitation of the patient’s health. There seems to

be a concurrence among researchers regarding the importance of nursing interventions in

the molding of over-all patient satisfaction with hospital services (Abramowitz, Cote &

Berry 1987). Bond and Thomas (1992) explain patient satisfaction with nursing services,

contended that patients are satisfied when internal needs, such as the need for

interpersonal relations, recognition and participation in decision-making, while they

become dissatisfied when the environmental factors and amenities which are provided are

not the right ones.

Risser Scale (1975) identified a dissatisfaction factor and drew the conclusion that

satisfaction and dissatisfaction are not the exact opposites of the same straight line. La

Monica and associates (1986), making a factor analysis with one of the classic patient

satisfaction instruments.

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 Recent studies suggest that triangulation provides a fairly accurate description of

patient satisfaction (Hyrkas et al, 2000), an effective design and method of data synthesis

remains to be determined.

Patients and Nursing students

The study entitled “The Patients' Satisfaction with AU Nursing Students'

Performance” of Jittakoat, Y. revealed that most patients were very satisfied with AU

nursing students' performance in providing health-care services. There was no statistical

correlation between socio-demographic factors and satisfaction with AU nursing students'

performance in all categories, except for the quality of nursing care and age which have

statistically significant correlation.

An evaluation of the performance of the nursing students in the Philippines is

essential both for the national and foreign health institutions and for the nursing students

themselves. Filipino nurses still rule when it comes to patient satisfaction as compared to

their other foreign co workers (Katigbak, 2008).

Synthesis

Patient satisfaction is considered as an important measure of quality care services.

It is influenced by the different internal and external needs of the patient. These include

the socio-demographic factors such as age, gender, economic status and educational

attainment. Other than these, environmental factors and expected outcomes are also taken

into consideration in assessing and evaluating the nursing care received.

Nurses, comprising majority of the health care team, are considered as the best

21
determinants in patient satisfaction since they are often at the patient’s side to render

care. Their professional skills, technical knowledge, interpersonal capabilities are viewed

as the basis of evaluation of care from patient to patient.

Today, nursing students also play a great role in patient care. With this in mind,

nursing students are able to put into practice their knowledge instilled from the academe.

To effectively evaluate their skills and abilities, the clinical performance evaluation tool

is designed as a guide for clinical preceptors and serves as the basis for nursing students’

grades. The clinical performance tool aims to grade nursing students in an objective

manner however it is still subject to the perception of the faculty assigned. Clinical

instructors’ perceptions for evaluating nursing students differ from patients’ perception

because of the former’s professional competencies. Some studies such as those conducted

by, French Meterko and Merkouris pointed out that evaluation of care provision involves

both patients and nurses, whereas Vuori questions the ability of patients in evaluating the

quality of nursing care rendered. In addition there was no relationship established

between patient satisfaction and clinical performance of the nursing students in all of the

studies reviewed thus the study aims to evaluate clinical performance grades through a

qualitative-quantitative combination of the subjective perceptions of the patient and the

objective use of the clinical performance tool.

Research Paradigm

The theory involved in the study is Duffy and Hoskins’ Quality-Caring Model.

Caring relationship is its core concept. While caring exists in a generic sense in all

cultures and between relatives and friends, the caring that exists in nursing practice is

22
integrated in the daily work of nursing and has as its aim of health and healing

(Leininger, 1988; Duffy & Hoskins, 2003). In 1971, Mayerhoff wrote that knowledge is

required for caring to occur. Gordon (2002) agreed with Mayerhoff and labeled caring

that is embedded in nursing practice as “educated caring”.

This theory is guided by the following assumptions: (1) caring must be done in

relationship; (2) caring is submerged in the daily work of nursing; (3) caring relationships

are tangible and can be measured; (4) knowledge of caring is a significant issue for

nursing education, nursing practice, and nursing administration and; (5) increased use and

study of nurse caring will determine nursing contribution to health care.

The first major component of this theory is "Structure". Originally, structure was

defined by Donabedian (Donabedian, 1988) and relates to components of a system such

as the resources, equipment, and providers. Dr. Duffy's definition of structure blends the

causal past of the participants and takes into account characteristics of the provider and

the system. Within each of the participants (provider and patient), there are unique

attributes and knowledge that characterizes their previous life's experiences,

demographics, physiological, psycho-socio-cultural, biomedical, and spiritual factors.

Structural characteristics influence the processes and outcomes of health care.

Within the structure component, Person is defined as a multidimensional

interdependent participant who is connected to the larger diverse world. Participants

include the provider and patient. Each participant has a phenomenal field that has a

unique frame of meaning. Unique experiences, demographics, attitudes, and behaviors

comprise the participant's phenomenal field.

23
 The second major component is "Process" which is located in the center column.

Processes, according to Duffy, are the real focus of the model since the caring practices

of nursing professionals assist patients and other health care providers to meet health

outcomes. Necessary human connection is created by Clinical Caring Processes

(Watson, 1979; 1985). The roles of the nurse are "initiating, cultivating and sustaining

caring relationships." (Duffy & Hoskins, 2003, p 79-80)

Donabedian defined "Outcomes" as the consequences or the end point of a

process (Donabedian, 1988). These are high priority indicators for quality. Intermediate

outcomes are the end results of the individual and collaborative relationships that

produced feelings of being "cared-for," necessary to the attainment of terminal

outcomes. Terminal outcomes are depicted not only for the patient, but for providers and

the health care system. Examples of terminal outcomes include quality of life, costs,

disease-specific outcomes, and satisfaction with care. The Quality-Caring Model

provides a continuous, dynamic framework to practice professional nursing and

assess health care outcomes. Evaluating care provision in this regard involves both

patients and nurses (Merkouris, et al. 1999).

The theory above supports this study in terms of delineating the variables and

components involved. Structure, which includes the provider and patients (Person), was

reflected in the study by the nursing students and patients respectively. Moreover, the

Person also encompasses the socio-demographics of both the provider and patients;

however, in this study, only the patients’ demographics were considered. Furthermore,

attributes and knowledge of the provider influenced the quality of nursing care given. The

second component, Process, as it was applied to the study, was the nursing care rendered

24
by the nursing students. Nursing care is governed by four competencies namely: Patient

Care, Enabling, Enhancing, and Empowering competencies. The “produced feelings” of

patient satisfaction illustrated the end-point termed as the Outcome. Therefore, the three

components of the theory discussed represented the variables adequately in this study.

The theory shows that the “Person” is composed of the provider and patient. In

this study, the student nurse acts as the provider wherein his/her clinical performance

grade is the independent variable. In addition, patients’ attributes such as age and gender

are the moderating variables which could influence the patient satisfaction rating. The

“Outcome” or the end point of the process yields the feeling of being “cared for” as

manifested by the patient satisfaction (DV). Patient satisfaction encompasses three

domains of nursing care namely: Technical – Professional, Interpersonal – Educational

and Interpersonal – Trusting. Furthermore, the center of the relationship termed as the

“Process” was reflected in the study as the “Nursing Care” rendered by the students.

Below is the schematic diagram that shows the interrelationship between the variables.

25
 Patient’s
demographic
variables

Student Nurse:
Patient
Clinical Nursing Care Satisfaction
performance
(CPET grade)

Conceptual Paradigm

Figure 1

26
Hypotheses

1. Differences in patient satisfaction are influenced by the patients’ demographic

characteristics.

2. Patient satisfaction is associated with the clinical performance of nursing students.

3. Patient satisfaction decreases with age.

4. Female patients are more satisfied than male patients in terms of overall care

rendered by the nursing students.

Definition of Terms

Clinical Performance (CPET Grade) – It is the rating given by the clinical instructor

based on the student nurse’s performance on bedside care measured by the Clinical

Performance Evaluation Tool. In this study, clinical performance will be evaluated using

the following nursing care areas:

(i) Patient Care Competencies includes Safe and Quality Nursing Care,

Health Education, Communication and Collaboration and Teamwork.

(ii) Enabling Competencies includes Management of Resources and

Environment and Records Management.

(iii) Enhancing Competencies includes Quality Improvement and Research

(iv) Empowering Competencies includes Legal Responsibility and Personal

and Professional Development

27
Patient Satisfaction – it is the degree of congruency between a patient’s expectations of

ideal nursing care and his perception of the real nursing care that he receives. In this

study, patient satisfaction is measured using the following domains:

(i) Technical- professional behavior - includes nurse’s knowledge, physical care

for the patient and expertise in implementing medical care.

(ii) Interpersonal- educational- it deals with the social aspects of nursing care as

well as the information exchange between patient and nurse which includes

answering questions, explaining and demonstrating.

(iii) Interpersonal- trusting- this includes sensitivity to people and their feelings,

and listening t/o patient problems.

Nursing student – Students under the nursing curriculum and exposed with the clinical

situations in their related learning experiences. In the study, this will be composed of

FEU Institute of Nursing students at 4th year level that are exposed to any wards. This

term is synonymous to “student nurse.”

Nursing Care – Actions of the nursing student concerned with or involved in providing

physical and mental services, preventive medicine, and treatment to individuals or the

public. In this study, it is the one that affects the satisfaction of the patients. Care

rendered is geared towards improving the health status of the client measured in terms of

satisfaction as perceived by the patient in the context of caring, continuity of care,

competence of nurses, and education of patient and significant others.

28
 CHAPTER III

Method

Research Design

The researchers used the descriptive correlational design as it is a more useful tool

in finding out the relationship between clinical performance and patient satisfaction on

the nursing care rendered by nursing students. No interventions were introduced &

performed during the course of this study. In addition, causal relationship between

clinical performance & patient satisfaction was not established. Consequently, data

gathering efforts were aimed at grouping & ranking patient satisfaction ratings as well as

clinical performance grades. Determining the relationship between the two variables is

possible only with the use of Spearman’s rho, specific for comparison of non-parametric

measures (ordinal system).

Population and Sample

The study was conducted in Dr. Fe del Mundo Medical Center. Inclusion criteria

for the patient respondents were (1) either male or female; (2) 18 years old and above; (3)

under the care of the same assigned nursing student for at least two consecutive days; (4)

conscious and coherent; (5) willed to participate; (6) and were able to answer questions

indicated; (7) able to read and write.

Characteristics of the study participants that deterred the respondents from

participating in the study included: (1) were those not under the care of FEU-IN senior

nursing students; (2) were under the care of more than one assigned nursing students; (3)

29
were under the care of nursing students from 11 P.M. to 6 A.M.; (4) suffered from severe

mental or cognitive disorders; (5)were unable to read and write.

On the other hand, the nursing students that were subjected to the study were (1)

Level IV FEU-IN students, (2) had their duty in the said affiliated hospital,(3) solely

rendered care to the client, (4) were under the same clinical instructor as with the other

nursing students that were involved in the study, (5) and willed to give his/ her consent

for the CPET grade released by the clinical instructor that handles the said students on

the said hospital. Students who did not meet the above inclusion criteria were not

qualified as subjects for the study.

The researchers used non-probability purposive sampling design in sample

selection. In this design, the researchers decided who will be included in the study. The

researchers hand-picked the sample because they knew who among the population was

qualified and also this type of sampling design was the most applicable to the study.

After the implementation, the researchers had consented 23 nursing students

assigned in Dr. Fe del Mundo Medical Center that participated in the study. A total of 23

patient satisfaction tools were accomplished and 23 CPET tools were collected from their

respective clinical instructor.

Table1 showed the demographic characteristics of the patient respondents.

Majority of the respondents belonged to Baby Boomers or those who were 45-64 years

old which comprised 48% of the respondents. 30% of the respondents were from

Generation Net or those that are 18-29 y/o while the remaining 22% of them were from

Generation X or those 30-44 y/o. It also showed that 74% of the respondents were

females while the remaining 26% were males.

30
 TABLE 1

Demographic Characteristics of the Patient Respondents

Demographic Profile N= 23 Percentage

Age (Mean: 36.78)

Generation net 7 30%

Generation X 5 22%

Baby Boomers 11 48%

Sex

Male 6 26%

Female 17 74%

Research Locale

The study was conducted in Dr. Fe del Mundo Medical Center, a private and

tertiary hospital found in Quezon City, wherein nursing students had their RLE (related

learning experience) exposure.

The researchers selected the said hospital for the following reasons: (1) to assure

that there are FEU nursing student affiliates; (2) it was easier to gain entry to a private

hospital compared with the public hospitals; (3) the researchers was permitted to conduct

the study before or after the duty hours of the student subjects.

31
Research Instruments

The instrument used by the researchers measures the patient’s satisfaction and the

clinical performance of the students. Data on patient satisfaction was gathered through a

checklist. The study developed by Risser, consisted a 28- item statements which

evaluated the effectiveness of nursing care provided in a hospital ward. The three

domains used to evaluate student nursing care were: Technical – Professional,

Interpersonal – Educational and Interpersonal – Trusting. Content validity and test –

retest reliability had been established. The instrument’s original Cronbach α score is

0.912; while on the pilot study done among 5 patients under FEU-IN level IV student on

Dr. Fe del Mundo Medical Center, the Cronbach α score is 0.54. Patients found a specific

item as inapplicable (i.e. The nurse gives good advice over the telephone) and were

confused on items having similar thought (i.e. The nurse gives directions at just the right

speed and The nurse gives direction too fast wherein the former was retained and the

latter was omitted). After revising the tool, the researcher came up with the 26 item

checklist from which the contents were approved by the head of the training office in Dr.

Fe del Mundo Medical Center. Retesting was done on the same hospital and it came up

with the Cronbach α score of 0.81. The instrument that was developed by the researchers

was modified; the term nurse was replaced to nursing student. Demographic data such as

name (optional), age and sex were asked in the instrument. In order to measure the

patient satisfaction and the domain of nursing care, Likert 5 point scale wherein 1-

“Strongly agree”, and 5- “Strongly disagree” was used as the basis. The study

participants chose the most appropriate rating for each query by putting a check on the

box corresponding to the degree of satisfaction felt and nursing care performed.

32
 Prior to dissemination, the instrument was translated into Filipino language to

break the language barrier among the study participants. The translation done by the

researchers was approved by a Filipino professor with a Doctorate degree in Filipino

language that ensured the reliability of the content of the translation. The applicability of

the statements to student nursing care was assured because the researchers sought the

approval of one of the staff nurses and clinical preceptor in an affiliating hospital of FEU,

in this case, FEU-NRMF. Prior to answering the questionnaire, instructions were given to

the patients. Entries such as name, age and gender were filled-up. Also, Likert scale was

clarified to the patients: 5 strongly agree and 1 as strongly disagree.

In terms of measuring the clinical performance of the nursing students, the

researchers relied on the Clinical Performance Evaluation Tool (CPET) used by the

clinical instructors to grade the students including the four domains (Patient Care

Competencies, Enabling Competencies, Enhancing Competencies and Empowering

Competencies). The grading system also utilized the Likert scale: 4 – Competent and 1 –

Progress Unacceptable. Validity of this tool had been established since it is being used by

the Institute of Nursing in the RLE exposure of the nursing students.

Data Collection Procedure

Beforehand, the researchers wrote a letter of request to the Dean of FEU-IN

asking for permission for data collection on Dr. Fe Del Mundo Medical Center. The

researchers also asked the level IV FEU-IN coordinators about the RLE rotation plan, so

that the researchers will be able to locate the group of FEU- IN Level IV assigned to the

said hospital. Also, a letter was made to the hospital administrator through the training

33
officer to inform them of the purpose of the study and be able to gain entry to the health

institution and to make the data gathering possible, ensuring mutual agreement and

understanding on both the researchers and the hospital administrator. The researchers also

requested the hospital administrator that for a particular period of time, only FEU Level

IV nursing students will be assigned to handle patients in a particular ward. After the

approval, the researchers obtained the names of nursing students and their clinical

instructor. The researchers coordinated with the clinical instructor regarding patient

assignment to satisfy the inclusion criteria. The schedule of activities of the nursing

students was also communicated.

In relation to the clinical grades, the researchers sought the consent of level IV

FEU-IN on the disclosure of their CPET grades for a particular rotation. Then the

researchers wrote a letter of request to the Dean of FEU-IN asking for permission for

gaining access to the grades of the students. Explanation about the purpose of the study

was given and assurance of the confidentiality of their grades was made. Afterwards, the

researchers coordinated with the Level IV FEU-IN coordinators for the RLE grades.

Clinical performance grades were obtained from the clinical instructor after the students’

clinical rotation for processing and analysis purposes.

The researcher collected data after gaining entry. Purposive, non-probability

design to obtain subjects was used, of which there was no randomization done;

homogeneity in terms of the availability of patients whom the nursing student rendering

bedside care was utilized by the researchers to control confounding/ extraneous variables.

This design was utilized to confirm specific targets that qualified in the inclusion criteria.

The primary data gathering was done once for each client. The researchers conducted the

34
survey guided by the checklist they have on hand. Introduction with the client about the

purpose of the survey was made. Clients were not forced to participate because they

were consented verbally. Then, the researcher proceeded with explaining the instruction

in answering each question. Terms that the client understands was used; the researcher

assured the client about the confidentiality of the results at the end of the interaction.

Statistical Treatment

1. The clinical performance of nursing students in relation to their instructor’s

evaluation of care rendered to the patient respondent was grouped into four

domains (Patient Care Competencies, Enabling Competencies, Enhancing

Competencies and Empowering Competencies). The mean of clinical

performance were assigned according to the four domains. The total mean for

each domain of clinical performance was used to derive the general average of

patient satisfaction. Mean was used to identify the average of clinical

performance from 23 nursing students.

2. The satisfaction ratings of patient respondents were grouped into three

domains (Technical Professional, Interpersonal Educational, Interpersonal-

Trusting). The mean of the satisfaction rating were assigned according to the

three domains. The total mean for each domain of patient satisfaction was

used to derive the general average of patient satisfaction. Mean was used to

identify the average of the patient satisfaction from the 23 patient respondents.

3. The profile variable of the patient respondents were age and sex. Age was

grouped into Baby Boomers, Generation X, and Generation Net. The sex was

35
 grouped into Male and Female. The mean score of patient satisfaction were

grouped according to what was stated above.

4. The relation between each of the four domains of clinical performance and the

three domains of patient satisfaction were treated using the Spearman’s Rho to

indicate the magnitude of the relationship between the patient satisfaction and

clinical performance.

5. The relation between the general average of clinical performance and the

general average of patient satisfaction were treated using Spearman’s Rho to

identify the degree of the relationship between patient satisfaction and clinical

performance. Spearman’s rho is a non-parametric test that was used because

ordinal and nominal numbers were utilized in the study.

6. The relation between the general average of clinical performance and the

general average of patient satisfaction was treated using t-test to determine the

level of significance between the two variables. In addition, it was used to

validate the statistical difference between clinical performance and patient

satisfaction.

36
 CHAPTER IV

Results and Discussion

This chapter presented the findings of the study, their analyses and interpretations.

For better understanding, the results were presented in three parts. Part I focused on the

Clinical Performance of the nursing students. Part II focused on the Patient Satisfaction

rating and its score according to age and gender. Part III discussed the relationship

between clinical performance score and patient satisfaction rating.

Part I. Clinical Performance

The clinical performance of nursing students in relation to their instructor’s

evaluation of the care rendered to the patient respondent was analyzed by obtaining the

general average of the mean for each domains of the Clinical Performance Evaluation

Tool.

Table 2 showed the mean clinical performance rating of the nursing students on

the four areas of competencies. As shown, the empowering competencies obtained the

highest mean (x= 3.93) which indicated that the students were “Competent” in the said

area. This implied that nursing students performed well when it came to legal, ethico-

moral responsibilities and personal and professional competencies. This finding signified

that students were proficient in skills such as: documenting and recording accurately,

providing privacy to the patients, demonstrating punctuality in reporting for duty with

complete paraphernalia and showing respect to authority at all times. Students were also

skilled in assisting other health team members (doctors, nurses and physical therapist and

37
the like), applying and integrating knowledge and theories, wearing complete and proper

uniform and well-groomed at all times, exhibiting proper decorum at all times and

punctuality in submission of requirements and reports. Their ability on the said

competency may indicate that the students were well trained on these different nursing

actions as these were inculcated and emphasized to them by the institution.

Ranked second to empowering competencies was the patient care competencies

with the mean score of x=3.58 which also meant that they were “Competent”. This

indicated that the students were competent in nursing actions such as collecting

comprehensive nursing health history, performing comprehensive physical assessment,

identifying patients’ needs and problems, explaining rationale in procedures, drug and

IVF administration in safe and quality nursing care, giving comprehensive and accurate

health teachings, therapeutic communication skills and correct and timely endorsements.

Discussion of actions which promote patient well-being, assisting and observing

treatments and other diagnostic procedures, referring to other health team members,

providing for continuity of care and establishing rapport with patients, relatives and other

health team members. This finding held true since the students were still on training and

improving their skills during their RLE duty.

Ranked third was the enabling competencies with the mean of 3.11 followed by

enhancing competencies which acquired the lowest mean of x=3.00. This meant that the

students’ performances in these two areas were considered “Progress acceptable”. This

finding indicated that the students were not competent enough but has the capacity for

improvement. The nursing actions involved in these nursing competencies are as follows:

performing nursing interventions competently and efficiently, carrying out of doctors’

38
orders with efficiency, confidence and competence, prioritizing patient needs and

problems.

This implied that the nursing students were mostly competent in practicing legal

responsibilities as well as personal and professional as indicated in the clinical evaluation

tool. The nursing students were as well considerably competent in the practice of safe and

quality nursing care, health education, communication, collaboration and teamwork.

However, they have an acceptable progress in managing resources and environment as

well as in quality improvement and research which is true to the theory proposed by

Patricia Benner (1984), which aver that students nurses still belong to the novice level

with limited background experiences and will only acquire skills such as management of

resources, increase level of efficiency, clinical grasp and resource based practice by

reaching a higher level of expertise such as advance beginner, competent, proficient and

expert levels.

When summed up, the level of competence of nursing students has an acceptable

progress (x=3.41).

Competencies of nursing students are dependent upon development and

application of a strong fund of knowledge in specialty area and demonstration of

technical interpersonal and critical thinking skills, attitude and ethics as stated by

McGivern Billings and D. Halstead J.

39
 TABLE 2

Clinical Performance of Nursing Students Based on the Four Areas of Competencies

Areas of Competency Mean Interpretation*

I. Patient care competencies 3.58 Competent

II. Enabling Competencies 3.11 Progress Acceptable

III. Enhancing competencies 3.00 Progress Acceptable

IV. Empowering Competencies 3.93 Competent

Mean Clinical Performance Rating: 3.41 Progress Acceptable

*Reference Value:

3.51-4.00=Competent 1.51-2.50=Needs improvement

2.51-3.50=Progress Acceptable 1.00-1.50= Progress unacceptable

Part II. Patient Satisfaction

The satisfaction ratings of patient respondent in relation to the care rendered by

nursing students were analyzed by acquiring the general average of the mean for each

domains of patient satisfaction.

Table 3 showed the mean satisfaction rating of respondents in relation to the care

rendered by nursing students. The highest domain that contributed to the patient

satisfaction is the interpersonal-educational domain with an average mean of 3.85which

meant that the patients were “satisfied” with the performance of the student in the said

domain. This was followed by the technical-professional domain which had the mean of

3.62 that meant that they were also “satisfied” with the student’s performance in this

domain. Lastly the interpersonal trusting domain obtained the mean of 3.32 which meant

40
that they were “Neutral” about the performance. Overall the patients are “Satisfied” with

the nursing students’ performance (x=3.60).

This implied that the patients were most satisfied when nursing students

performed well in practicing health education such as in answering questions, explaining

conditions and demonstrating client teachings. Whereas the nursing students’

knowledge, physical care and expertise in implementing care also greatly influenced the

level of satisfaction among patients next to the aforementioned parameter; the least

considered by clients to contribute to their level of satisfaction is the nurses’ sensitivity

and feelings towards patients as well as listening to patients’ problem.

As what studies show conducted by Marchal, et al. (2005) and Elder et. al. (2005),

providing patients with information increase their satisfaction with the health institution;

the more the information provided the more the satisfaction.

TABLE 3

Patient Satisfaction on the Care Rendered by Nursing Students

Domains of Nursing Care Mean Interpretation*

Technical performance (TP) 3.62 Satisfied

Interpersonal education (IE) 3.85 Satisfied

Interpersonal trusting (IT) 3.32 Neutral

Mean Patient Satisfaction Rating: 3.60 Satisfied

*Reference Value:

4.51-5.00=Strongly Satisfied 1.51-2.50=Unsatisfied

3.51-4.50=Satisfied 1.00-1.50=Strongly Unsatisfied

2.51-3.50=Neutral

41
 Table 4 showed the patient satisfaction rating when grouped according to the

demographic characteristics of the patients. It discussed the patient satisfaction in terms

of the age and gender. Those who belonged to generation net had the highest satisfaction

rating (x=3.95), followed by baby boomers (x=3.49) and lastly, Generation X (x=3.33).

These indicated that over all, the Generation Net were “Satisfied” and the Baby Boomer

and Generation X were “Neutral” in their rating.

The table also showed that females had higher satisfaction rating (x=3.63)

compared to males (x=3.48). With these domains, females have higher satisfaction rating

in terms of technical-professional and interpersonal education on the other hand there is

an equal satisfaction rating between males and females in the domain interpersonal-

trusting. Overall the females’ rating was “Satisfied” while the males’ rating was

“Neutral”. The study made by Blizzard showed that patients between the ages of 18-35

years old were most satisfied in terms of healthcare services particularly in inpatient

basis; this held true with the result of the study which showed that Generation Net (18-29

years old) were most satisfied, in all the domains of nursing care. The results augmented

the statement of Thiedke (2007) that “various studies showed varying result of patient

satisfaction between men and women” and that of Blizzard that a patient’s gender has no

discernible impact on his/ her ratings of overall patient satisfaction. Males were also less

satisfied than females. Staff members should be sensitive to the fact that males tended to

be more impatient and concerned with the speed of the process (Blizzard 2002).

42
 TABLE 4

Mean Difference in Patient Satisfaction according to Demographic Characteristics

Domains of AGE GENDER

Nursing Care Generation Generation Baby Male Female

net x boomers

TP 4.09* 3.18* 3.52* 3.35* 3.71*

IE 4.20* 3.57* 3.75* 3.76* 3.87*

IT 3.57* 3.24* 3.20* 3.32* 3.32*

TOTAL 3.95* 3.33* 3.49* 3.48* 3.63*

*Reference Value:

4.51-5.00=Strongly Satisfied 1.51-2.50=Unsatisfied

3.51-4.50=Satisfied 1.00-1.50=Strongly Unsatisfied

2.51-3.50=Neutral

Part III. Relationship between Clinical Performance and Patient Satisfaction

Table 5 showed the relationship between Clinical Performance and Patient

Satisfaction. The results revealed that there was a positive correlation between the two

variables which indicated that clinical performance might have directly influenced patient

satisfaction. However, the result (ρ=0.18) proved to be negligible since it did not reach

the desired table value of 0.41.

The result was applicable to the present circumstances as well as the experiences

perceived by the students and the researchers since there were two different evaluators of

the students – the clinical preceptor and patient. Clinical preceptor focuses on the nursing

43
core competencies in concordance with the standards of the nursing profession while the

patients focus on the students’ fulfillment of their expectations.

TABLE 5

Relationship between the Clinical Performance Rating and Patient Satisfaction

Rating

Clinical Performance Patient Satisfaction Spearman’s Rho Result/

Interpretation

x=3.41 x=3.60 P=0.18*/

Positive Correlation

*0.05 Level of Significance: Table Value = 0.41

44
 CHAPTER V

Summary of Findings, Conclusions and Recommendations

The purpose of this study was to determine if there existed a correlation between

the clinical performance and patient satisfaction. At the same time, it sought to establish

the average clinical performance of students rotating in Dr. Fe del Mundo Medical

Center. Furthermore, it aimed to determine the patient satisfaction rating of students

rendering care on patients according to patients’ demographic characteristics particularly

their age and gender.

The study utilized the quantitative research specifically descriptive correlational

design that yielded statistical results in which the analyses and interpretations of the

relationship were based from. It involved the patient respondents who met the following

criteria: (1) either male or female; (2) 18 years old and above; (3) who were under the

care of same assigned nursing student/s for at least 2 consecutive days; (4) conscious and

coherent; (5) willed to participate; (6) and were able to comprehend questions indicated.

The study used the adapted and modified Risser Patient Satisfaction Scale as a

tool that determined the satisfaction rating of the patients handled by the FEU-IN Level

IV students. Moreover, the FEU-IN Clinical Performance Evaluation Tool was utilized

by a faculty which rated the nursing students’ clinical performance in rendering care to

their patients.

On the first problem, age was grouped according to Woods’ Generation Age

Group namely: Veterans (age 65 and above), Baby Boomers (45 to 64 years old),

Generation X (30 to 44 years old) and Generation Net (18 to 29 years old). Baby

45
Boomers comprised the majority of the respondents while Generation X was the least

among the age groups. Furthermore, there were respondents that belong to the Veterans.

Females had more number of respondents than the males.

On the second problem, students have an overall rating of “Progress Acceptable”

for their clinical performance. “Empowering Competencies” obtained the highest rating

while “Enhancing Competencies” ranked the lowest.

With regards to the third problem which discussed the patient satisfaction rating

of students rendering care according to the three nursing domains, the data showed that

the patient satisfaction rating of students obtained the highest rating in the “Interpersonal

Education” domain while “Interpersonal Trusting” ranked the lowest. Overall the patients

have a rating of “Satisfied” in the care rendered by the nursing students.

For the fourth problem which was aimed at determining the patient satisfaction

rating according to the patients’ demographic characteristics, data showed that all age

brackets of patients were highly satisfied on the “Interpersonal Education” domain.

“Generation net” (18-29 years old) had the highest rating among all age brackets while

“Generation X” ranked the lowest. Average patient satisfaction according to the patient

respondents’ gender revealed that females had a higher mean rating compared to males.

On the fifth problem which discussed the relationship between the clinical

performance and patient satisfaction of clients cared by the students, the data indicated a

positive but negligible relationship between clinical performance of nursing students and

patient satisfaction.

46
Conclusions

Based on the findings of the study, the following conclusions are hereby made:

1. Majority of the respondents belonged to the Baby Boomers. Females also

comprised the majority of the respondents.

2. The average clinical performance of the nursing students is “Progress

Acceptable”.

3. The patients are “Satisfied” on the “Interpersonal – Educational” domain.

4. Generation Net was the most “Satisfied” among the groups. Females were more

“Satisfied” compared to males.

5. There is a positive but negligible correlation between Clinical Performance and

Patient Satisfaction Ratings.

Out of 2,300 FEU Level- IV IN students, 23 were taken as sample in the study.

Recommendations

From the above findings and conclusions, the researchers recommend to replicate

this study so as to improve the generalizability and significance of the results. To attain

this, the following are suggested:

1. Since there was limited number of subjects among the nursing students and

patients, the study recommends that there would be higher number of respondents

in future studies.

47
 2. Since socio-demographic variables are determinant factors of patient satisfaction,

it is imperative to take into consideration other variables such as educational,

economic status, ethnicity and religion of the respondents.

3. The study was confined to one hospital in a certain ward. Because of this, it

recommends that future studies be conducted in various hospitals may it be public

or private institutions so as to determine if there is significant difference of the

rating of the patient satisfaction .

4. The study suggests use of time series methodology in obtaining data that would

yield a more accurate comparison of results in each time frame.

5. The study recommends the participation of more clinical instructors so as to

lessen the bias of the results since clinical performance evaluation has a tendency

to be subjective.

6. Since the results of the study showed that no relationship between the Clinical

Performance and Patient Satisfaction exists, then it is recommended that the

nursing students try to excel in their Clinical Performance and at the same time,

provide a better care for their patients. They should do their best in both variables

since these two are important factors of being a great nurse.

In recent years, nursing has been popular and in-demand here and abroad. Nursing

schools boom and continue to grow in number to facilitate and cater countless aspiring

students. As these nursing students have the opportunity to be exposed to different

clinical settings, they are able to render care to their patients as they put into practice

what they have learned in their respective schools. Patients, on the other hand, are able to

48
evaluate the nursing students as well as the care they receive. Patient satisfaction, being

an important evaluation of quality care, has a great role in determining the quality care

status the hospital is offering and providing. In relation to this, nurses, being the major

work force in the hospital, serve as a relevant indicator of quality care. Therefore,

students becoming future professional nurses must continue to uphold and emphasize the

integrity of nursing profession. Armed with technical knowledge, professional skills and

interpersonal abilities, nursing students will be able to perform quality and high standard

nursing care that will not only bring pride to their schools but will uphold the integrity of

the nursing profession as well. Nursing students can make a difference!

49