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Critical Care Competency of Nurses in selected Tertiary Hospital in Batangas

The study aims to determine the competencies of critical care nurses in selected tertiary

hospital in Batangas

It will seek the following criteria

1. What is the profile of the respondent1.1age

1.2gender

1.3Civil status

1.4Length of experience as a critical nurse

2. What is the level of competency of critical care nurses in terms of,

2.1Professional Competence

2.2Cognitive competence

2.3Interpersonal skills

3. What is the significant relationship between profile and level of competency of critical

care nurses

4. What is the best predictor of the competency of critical care nurses

5. What program maybe proposed to enhance the competency of Critical care nurses


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CHAPTER 1: INTRODUCTION

In this chapter, presentation of the problem, existence of satisfactory condition,

rationale of the study, historical background of the study, and the desire to have a clean

and deeper understanding of the situation, circumstances and phenomenon.

Presentation of the problem

Nurses in this field care for patients of all ages who are acutely ill or in critical

condition. These nurses often must use sophisticated equipment, and are also

responsible for the emotional welfare of patients and their families. Critical-care nurses

practice in settings where patients require complex assessment, high intensity therapies

and interventions, and continuous nursing vigilance. Critical-care nurses rely upon a

specialized body of knowledge, skills, and experience to provide care to patients and

families and create environments that are healing, humane, and caring.

Foremost, the critical-care nurse is a patient advocate. Critical care nurse is a

nurse requires specialization of area, knowledge and skills. It consists of all nursing

care, whole care of patients delivered. There are thousands of nursing graduate yearly

and the population continuously arise. Those who are trained going in other place like

other country so the main problem is the lack of skilled nurse in special area.

Competence is the ability to perform a specific task, action or function

successfully. Incompetence is its opposite.


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Critical competency of nurses here in Batangas in selected hospital is the study

of ability of the nurse in a special area like ICU,PICU,NICU,OR,DR,and RR. This means

a skills, knowledge and confidence in doing their profession successfully.

The study aims to determine the competencies of critical care nurses in selected

tertiary hospital in Batangas

It will seek the following criteria

6. What is the profile of the respondent

6.1 age

6.2 gender

6.3 Civil status

6.4 Length of experience as a critical nurse

7. What is the level of competency of critical care nurses in terms of,

7.1 Professional Competence

7.2 Cognitive competence

7.3 Interpersonal skills

8. What is the significant relationship between profile and level of competency of

critical care nurses


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9. What is the best predictor of the competency of critical care nurses

10. What program maybe proposed to enhance the competency of Critical care

nurses

Existence of an unsatisfactory condition

At this time the problem encircling at competencies among the nurses of the

different hospital in Batangas. Critical care nurse must have a qualification, their training

attended, seminars and length of experience in an area. Critical-care nurses must have

education and training beyond their basic preparation as a registered nurse (RN) to

meet the needs of patients and families who are experiencing critical illness.

Most critical-care nurses will complete a critical-care training course or

orientation that includes essential information on the care of the critically ill patient.

Although certification is not mandatory for practice in a specialty like critical care,

many nurses choose to become certified. Some employers prefer to hire certified

nurses, as they tend to demonstrate a higher level of knowledge in their specialty and

often have more specialty practice experience.

Certified critical-care nurses (CCRNs) validate their knowledge by passing a

rigorous test and by meeting extensive continuing education and clinical experience

requirements.


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The problem is most of nurse in critical care area are not qualified for their

position they just got entered in that area because of politics and their contacts inside

the hospital. Continuous education is important tool for updating the new practice or for

improving.

Rationale of the study

The study conduct to seek what are the things need to improve in selecting a

critical nurse in special area and to know what are the most effective way of improving

the staff competence in doing their profession smoothly. In many hospitals they just get

their improving skills in conducting seminars and continuous education of their staff. The

purpose of the research work is to identify or to find ways on how the nurse can be

competence on their work.

The study is expected to answer such questions as; (1) What is the level of

competency of critical care nurses in terms of Professional Competence Cognitive

competence Interpersonal skills, (2) What is the significant relationship between profile

and level of competency of critical care nurses, (3) What is the best predictor of the

competency of critical care nurses, (4) What program maybe proposed to enhance the

competency of Critical care nurses.

The purpose of the study is to construct a description and develop in terms of

practice.


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Historical background of the Problem

Although nurse have been providing care with their knowledge and skills into

their patient also having a long term experience is important tool to gain confidence and

familiarization of the routine of their workplace. Critical-care nursing is that specialty

within nursing that deals specifically with human responses to life-threatening problems.

A critical-care nurse is a licensed professional nurse who is responsible for

ensuring that all critically ill patients and their families receive optimal care.

Although very sick and complex patients have always existed, the concept of

critical care is relatively modern. As advances have been made in medicine and

technology, patient care has become much more complex. To provide appropriate care,

nurses needed specialized knowledge and skills, while care delivery mechanisms also

needed to evolve to support patients needs for continuous monitoring and treatment.

The first intensive care units emerged in the 195

0s as a means to provide care to very

sick patients who needed one-to-one care from a nurse. It was from this environment

that the specialty of critical-care nursing emerged.

According to the March 1996 report, The Registered Nurse Population, by the

U.S. Department of Health and Human Services (DHHS), there are 273,850 nurses in

the U.S. who care for critically ill patients in the hospital setting. Critical-care nurses

account for an estimated 24 percent of the total number of nurses working in the

hospital setting.


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CONCEPTUAL FRAMEWORK

This study focused on the relationship between respondents in level of

competency in critical care which will act as dependent variable and profile of

respondents as independent variable.

Likewise the relationship between respondents profile, professional competence,

cognitive competence and interpersonal skill was assessed. Respondent profile include

age, sex, civil status and length of experience

Figure 1 Conceptual Framework of the Study

Age

Gender

Length of experience

Occupation

Professional Competence

Cognitive Competence

Interpersonal Skills

Critical Care Nurse

Competency


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STATEMENT OF THE PROBLEM

The purpose of this study is to develop a program to enhance a capability of a

nurse in giving care which can be used lifetime. Increase the level of skills and

knowledge of the reader and increase confident to do the job said.

The purpose of the study is to answer the following questions:

1. What is the level of competency of critical care nurses?

2. What is the best predictor of the competency of Critical Care Nurse?

3. What program may be proposed to enhance the competency of critical Care

Nurse?

HYPOTHESIS

There is a significance difference between the profile and level of competency of

critical care nurse


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SCOPE AND DELIMITATION OF THE STUDY

The area of the study is the selected tertiary hospital in Batangas. The main

reason or the purpose of the study is to increase the number of competent nurse and

promote continuous education for them to enhance their skills and gained self

confidence to do their profession.

The primary objective of the study is to develop a skills and knowledge about the

area of responsibility according to their title. A being competency in the place is better to

improve quality care and to support and help people peace of mind.

The respondent selected is the nurse in the tertiary hospital inside the area of

responsibility of Batangas. The paper period of study is within 1 to 2 months from the

start of making the study to finish.

However, the study shows many limitation and weaknesses, it only study the

tertiary hospital nurses, study the special care area not included the ward and any other

facilities in hospital and it only study the hospital inside Batangas.

SIGNIFICANCE OF THE STUDY

The study of the research paper enhances the c competencies of all nursing

personnel to deliver a quality of care to their patients. The study aims to increase the

number of competence nurse nationwide. The goal of the researcher is to deliver a


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quality care to the patient and gained skills and knowledge and confidence trough

continuous study and experience in the area.

Through this study the researcher also and the reader was able to conduct a self

analysis for their competency.

DEFINITION OF TERMS

Critical-a state of crisis or emergency

Care-the work of caring for or attending to someone or something

Nursing- the work of caring for the sick or injured or infirm

Nurse- one skilled in caring for young children or the sick

Competency- the quality of being adequately or well qualified physically and

intellectually

Tertiary hospital- a major hospital that usually has a full complement of services


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6. Counsel patients and families in a supportive manner so they can understand

their/their childs illness or injury and its treatment, share in decision-making, and give

informed consent.

7. Provide effective preventive health care and anticipatory guidance to patients and

families as indicated in the ICU setting.

COMPETENCY Medical Knowledge. Understands the scope of established and

evolving biomedical, clinical, epidemiological and social-behavior knowledge needed by

a paediatrician; demonstrates the ability to acquire, critically interpret and apply this

Knowledge in patient care.

1. Demonstrate efficient access to the knowledge base needed for effective care of

critically ill children (e.g., information on the web, in the literature, text books, or PDAs).

2. Recognize the limits of ones knowledge and expertise by seeking information

needed to answer clinical questions and using consultants and referrals appropriately.

Use this process to guide life-long learning plans.

3. Know oxygen delivery systems, indications for/types of artificial airways.

4. Define respiratory failure/potential failure; demonstrates how to adjust ventilator

parameters and know extubation criteria; noninvasive interventions (BiPaP, heliox and

NO)

5. Know indications for/demonstrates expertise of parenteral/enteral nutrition,

transfusion of blood products, renal replacement therapies.


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6. Manage respiratory compromise (positioning, oral/nasal/ airways, oxygen,

bronchodilators, when/how to intubate), increased intracranial pressure, status

epilepticus/seizures, circulatory insufficiency.

7. Know evaluation/differential of altered mental status; appropriate

assessment/interventions; indications for pain/sedative/paralytic; different classes of

analgesics/ sedative risk/benefits

8. Recognize cardiovascular insufficiency by evaluating pulses, refill, dysrhythmia, blood

pressure; knows interventions and methods of monitoring

9. Is familiar with ethical and medical-legal considerations: futility, withdrawal and

withholding of care, brain death, organ donation, ethics consultation.

COMPETENCY Interpersonal Skills and Communication Skills. Demonstrate

interpersonal and communication skills that result in information exchange and

partnering with patients, their families and professional associates

1. Communicate effectively in a developmentally appropriate manner with critically ill

patients and their families to create and sustain a professional and therapeutic

relationship across the broad range of socioeconomic, religious and cultural

backgrounds

2. In cases of serious and life-threatening disease, counsel the patients family with

sensitivity to their beliefs related to advanced life support or withholding of care

considering quality of life issues.


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3. Communicate effectively with physicians, other health care professionals, and health

related agencies about patients in the ICU setting.

4. Develop effective approaches for teaching students, colleagues, other professionals,

and lay groups about critically ill children and potential outcomes.

5. Provide effective consultation to other physicians (surgeons, subspecialists) and

health professionals involved in the care of the ICU patient

6. Maintain comprehensive, timely, and legible medical records with clear management

Plan

COMPETENCY Practice-based Learning and Improvement. Demonstrate

knowledge, skills and attitudes needed for continuous self-assessment, using scientific

methods and evidence to investigate, evaluate, and improve ones patient care practice.

1. Identify and use resources, including the application of technology to obtain up-to

date information that alters ones practice in the care of pediatric ICU patients.

2. Locate, appraise, and assimilate evidence from scientific studies related to health

problems of ones patients in the ICU.

3. Analyze ones practice experience to recognize ones strengths, deficiencies and

limits in knowledge and expertise in the care of critically ill or injured paitents.


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COMPETENCY Professionalism. Demonstrate a commitment to carrying out

professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

1. Demonstrate respect for confidentiality, commitment, responsibility, accountability for

patient care, including continuity of care

2. Demonstrate honesty and integrity in ones professional duties in the ICU.

3. Consistently use compassion and empathy in ones role as a physician. Maintain

professional boundaries in ones dealings with patients, family, staff and professional

colleagues in the ICU setting.

4. Work collaboratively, as a member of a healthcare team, including nurses, dietitians,

social service workers, and other personnel in providing pediatric critical care services.

5. Advocate the interests of patients over personal interests while developing an

appropriate balance between personal and professional beliefs and obligations during a

rotation in the ICU.

6. Recognize the limits of ones knowledge, skills, and tolerance for fatigue and stress

by asking for help as needed.

COMPETENCY 6. Systems-Based Practice. Understand how to practice quality

health care and advocate for patients within the context of the health care system.

1.Practice cost-effective health care and resource allocation in the ICU setting that does

not compromise quality of care


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2. Interface appropriately with established plans of care for chronically ill children in the

ICU

3. Coordinate plans with the multiple consultants involved in the care of the critically ill

or injured patient

4. Advocate for promotion of health and disease/injury prevention by involving social

workers/ DCFS, educators, dietians and child life

5. Demonstrate ability to work with health care, managers/discharge planners, nurse

specialists, rehabilitation specialists (OT, PT, speech) in the ICU to assess, coordinate,

and improve patient care


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CHAPTER 3

METHODS OF RESEARCH AND PROCEDURE

This chapter of a thesis commences a brief statement and enumerating the main

topics that are to be covered in it; namely; 1) Research Design; 2) Sources of Data

(Locale of the Study and Population/Sampling); 3) Instrumentation and Data Collection;

and 4) Tools for Data Analysis.

Introduction to Grounded Theory

Grounded theory is a qualitative, exploratory method used to develop mid-range,

substantive theory. The focus of a grounded theory is most often on a social process

including not only human actions/interactions but the consequences of those actions

and the conditions under which they occur (Strauss & Corbin, 1998). Grounded theory

uses an inductive and systematic method to develop a theory that interprets, explains,

and predicts human actions and behaviour (Chenitz & Swanson, 1986a). Because

process (i.e., evolving sequences of events) is most often the focal point of grounded

theory research, many experts advocate the use of interviews for data collection

(Chenitz, 1986; Morse & Field, 1995; Schreiber, 2001; Hutchinson & Wilson, 2001). The

most valuable information relevant to the phenomena of interest often comes from the

description of the events, experiences, and thoughts of the participants (Morse, 2001).

Participants of a grounded theory study are encouraged to describe the events,


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thoughts, and actions of the process as they were experienced. The data are collected

and carefully examined for recurring concepts.

The emerging concepts are labeled and abstracted to categories with identifiable

properties and dimensions. This analytic process involves methodical comparison of all

data to identify and validate patterns in behavior and context that emerge consistently in

the events described. Categories and relational statements are similarly developed

using constant comparison and abstraction until a theory takes shape. The concepts,

categories, and hypotheses thus earn their way into the theory, and the theory is indeed

grounded in the data. Built from the actual experiences, thoughts, and actions of the

participants, grounded theory can provide an excellent representation of reality (Morse,

2001). Grounded theory illuminates complex social processes and the contexts in which

they occur, and therefore it is an ideal method to study phenomena in their natural

settings (e.g., nursing practice). A theoretical explanation generated from grounded

theory contributes new understanding to the substantive area of interest (Hutchinson &

Wilson, 2001). This new understanding can be used to inform nursing practice,

education, and research. In nursing, grounded theory studies have resulted in (a) new

nursing knowledge (e.g., Brady-Fryer, 1994), (b) new ways of viewing old knowledge

(Sandelowski, 1993), (c) the development of new nursing interventions (e.g., Morse &

Johnson, 1991; Rempusheski & Phillips, 1988), (d) advances in nursing education (e.g.,

Hutchinson, 1992), and (e) the development of formal theory (Sandelowski, 1995;

Kearney, 2001). The primary focus of this study is to generate new knowledge, i.e., a

theoretical explanation of the TpN process that can inform practice, education, and

research in this specialty practice.


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Grounded theory method can provide an explanatory theory of this complex

nurse/caller interaction, its context and consequences, and therefore is the logical

choice for initial studies of this phenomenon. Grounded theories, because they are

drawn from data, are likely to offer insight, enhance understanding, and provide a

meaningful guide to action (Strauss & Corbin, 1998, p. 12).

SAMPLING DESIGN AND SAMPLE

Research Design

This study is engaged Qualitative research design of research in which it

employed survey questionnaires as the main gathering instrument .the overall amount

of staff in selected hospital presents as a sample.

A researcher selects purposely subjects who are judge to be typical of the

population or particularly knowledgeable about the issue under study. The target

subjects of the study are those who are in the critical care facilities such as ICU, PICU

and other area that requires critical monitoring.

The study held inside Batangas region at selected tertiary Hospital namely

Batangas Provincial Hospital, our lady Of Caysasay Hospital, and Medical Center

Western Batangas.


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SAMPLING DESIGNED

The total number of critical care nurses from Batangas Provincial Hospital are 14,

from our Lady of Caysasay hospital are 16 and & from Medical Center Western

Batangas are 20. The target samples are the nurse in the field of study, those who are

duty.

The total population of this study was the average staff nurse of the selected

hospital with the total of50 records last October 2010

In that population the researcher only took half of the participants in each hospital

like 7 from BPH, 8 from our Lady of Caysasay, 10 from MCWB

Research Strategies

This study used the descriptive survey method. The survey method was a form of

questionnaires. The questionnaires have guide and provided the respondents with

questions that will help the researcher picture out how SEDP Inc, Ligao Branch helps it

beneficiaries in their socioeconomic conditions.


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Research Instrument

The instrument used in this research was divided into five parts. The first part

answers the profile of the sample includes name, age, civil status, length of experience

On the other hand, the second part of the instrument answered the second

question in the problem, the level of competency of critical care nurses in terms of

Professional Competence, Cognitive competence, Interpersonal skills

The next part was the significant relationship between profile and level of

competency of critical care nurses. The fourth part of the questionnaire the best

predictor of the competency of critical care nurses.

Lastly, what program maybe proposed to enhance the competency of Critical

care nurses.

Data Gathering Procedure

In gathering data, the researchers took the following steps:

1. The researchers made a letter to the list of hospitals to ask permission to conduct the

study undersigned by their officials.

2. The researchers request the needed information in conducting of the study such as

the number of samples.

3. To look for related literatures and studies the researchers went to different libraries

and surf to the internet for additional information.

4. The researchers combined all information gathered.


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STATISTICAL TREATMENT OF DATA

The data were subjected to analyzed using the SPSS or the Statistical Packages

for Social Science

The following statistical tools were used

1, frequencies and Percentages. This was used to determine the profile of the

respondents in the hospital

Formula:p= freq x 10 X100

N

N= total number of respondents

2. Mean. This was used to determine the level of Critical care delivered to their patientsin terms of competency, job satisfaction and level of care rendered

Formula; X=x

N

Where x = the sum of the response

N=total number of respondents


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QUESTIONNAIRES

A. Management and Staff

Name (optional): ____________________________________

Age: 21 below 21-25 25-30 31-35 36-40 above 40(specify): ________

Gender: Male Female

Assigned Area:

Emergency Room OB Ward Gyne Ward Pediatric Ward Medical-Surgical Ward General Ward Dialysis Ward Delivery Room Operating Room Intensive Care Unit Others:

_______________________________________________________Position in the hospital:

Years of Experience: 1-5 6-10 10-20 21-onwards

Professional Attainment: BSN MAN MSN PhD Others: _____________________

Trainings and Seminars Attended:_______________________________________

Affiliation with (Accredited Professional Organization of Nurses):______________


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General Information

A. Hospital

Hospital Name: _______________________________________________

Location: ____________________________________________________

TypeLevel: Primary Secondary Tertiary

Classification: Public Private Semi-Private

Specialty (if applicable): General SpecializedSpecify: _____________________________________

Years of Operation or Existence: 1-5 6-10 10-20 21-onwardsSpecify: ____________

Accreditation: ________________________________________________

Departments: Emergency Room OB Ward Gyne Ward Pediatric Ward Medical-Surgical Ward General Ward Dialysis Ward Delivery Room Operating Room Intensive Care Unit Others: ___________________________________________________


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Patients and Relatives Satisfactory Survey

Name :( Optioanal) _____________________________________________________

Age: _________________Gender____________Status_________________________

Length of Stay in Hospital________________________________________________

Hospital Name_________________________________________________________

Check () yes if yes, Check () no if no

Critical Care nurse

1. Proper Uniform while On duty yes____ No_____

2. Able to operate machine inside the area yes____ No_____

3. Hand hygiene before and after contact yes____ No_____

4. Aware of the condition of the patients yes____ No_____

5. Routine care applied yes____ No_____

6. Do health teaching to the patients and/ or relatives yes____ No_____

7. Always greet the Patients and relatives yes____ No_____

8. Explained the importance of the procedure yes____ No_____

9. Inform the patient of the procedure yes____ No_____


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Critical Care Competency of Nurses in selected Tertiary Hospital

in Batangas

By

Hernani John Bautista Marasigan.Rn

In partial fulfilment of requirements for the Masteral Of arts in

Nursing

Saint Jude College

October 2010

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