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EVALUATING THE NEED FOR A STRUCTURED CLIENT
EDUCATION FOR PATIENTS IN THE SURGERY WARD OF
HOSPITAL X
An Undergraduate Thesis Presented to the Faculty of the College of Nursing
Pamantasan ng Lungsod ng Pasig
Kapasigan, Pasig City
In Partial Fulfillment of the Requirements for the Degree
Bachelor of Science in Nursing
GROUP J: JI JOE
Bunao, Regina Grace C.
Coronado, Abiegale G.
Picar, Vanjeff G.
Reyes, Angela L.
Robles, Jean Rovy M.
San Jose, Nina Christine G.
BSN- III SOTEJO
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February 2010
Chapter I
INTRODUCTION
This chapter discusses the background of the study, the statement of the problem,
the hypothesis, the significance of the study and the scope and delimitations.
Background of the Study
Researchers have found wide variations in re-hospitalization and prolonged
hospitalization rates in the country. Most of those results from conditions other than those
for which they originally hospitalized. According to a US Health Society 75 percent of
patients who were initially in the hospital for surgery were readmitted for complications
of their original illness.
Recognizing patients as experts with a unique knowledge of their own health and
their preferences is a significant part of the health care being provided to them. Increased
patient involvement is an important part of quality improvement since it has been
associated with improved health outcomes likewise the needs of a patient should be
assessed in order to plan for an intervention intended to suffice the assessed needs. Care
is done by providing the needs of the patients which is not purely physical but also giving
due importance to other needs such as psychological, emotional and spiritual needs.
According to Kozier (2004) all people have the same basic needs; however each
persons needs the ways in which they react to those needs are influenced by the culture
with which the person identifies. It is essential that these needs be met in order to achieve
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Evaluating the Need for a Structured Client Education for Patients in the Surgery Ward of Hospital X 3
the highest level of clients well being. It has been overlooked for years the other aspect
of a clients need other than the physiologic needs.
These results are attributed to loss of focus on client education which is mainly an
essential part of the comprehensive health care. This problem has been alarming that
there is a need to further improve the assessment of the clients need and its relation for
a need to likewise improve client education on health institutions/facilities.
Knowledge of the theoretical basis of human needs assists nurses in responding
therapeutically to client behaviors and in understanding themselves and their own
responses to needs (Kozier, 2004). Roys Adaptation theory focuses on the responses of
the human adaptive system, which can be an individual or a group, to a constantly
changing environment. This is subdivided into Physiologic Mode, Self-Concept Role
Functioning, and Interdependence. With careful evaluation of the clients needs, better
client health education will be rendered to patients and improvement in health outcomes
is expected.
Statement of the Problem
This study aims to evaluate the need for a structured client education for patients
in the Surgery Ward of Hospital X.
Specifically it aims to yield answers to the following questions:
1.What is the demographic characteristic of the patient respondents in terms of:
1.1 . Age;
1.2 . Sex;
1.3 . Educational Assessment;
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Evaluating the Need for a Structured Client Education for Patients in the Surgery Ward of Hospital X 4
1.4 . Length of Hospitalization; and
1.5 . Diagnosis?
2. What is the demographic characteristic of the nurses respondents in terms of:
2.1. Age;
2.2. Sex;
2.3. Educational Attainment; and
2.4. Length of Practice?
3. What are the reported needs of the clients in terms of the following subsystems of
Roys Adaptation Theory:
3.1. Physiologic Mode;
3.2. Self concept;
3.3. Role Functioning; and
3.4. Interdependence?
4. What are the clients needs assessed by the nurse in terms of the following
subsystems of Roys Adaptation Theory:
4.1. Physiologic Mode;
4.2. Self Concept;
4.3. Role Functioning; and
4.4. Interdependence?
5.Is there a significant difference in the assessment of two groups of respondents with
regards to the following subsystems of Roys Adaptation Theory?
6. Is there a need for a structured client education for patients in the Surgery Ward of
Hospital X?
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Hypothesis
This study of evaluating the need for a structured client education for patients in the
Surgery Ward of Hospital X sets forth the null hypothesis at 0.05 alpha level of
significance:
There is no significant difference in the assessment of the patients and nurses
with regards to the following subsystems of Roys Adaptation Theory.
Significance of the Study
This study is designed to evaluate the needs of the client based on the four (4)
subsystems according to Roys Adaption Theory.
The findings of this study could be beneficial to the following:
Clients in the hospital setting, this study could help them to establish their health-
seeking behaviors. Upon reading the interview tool, they could have the awareness of
their need and the care that they could expect to receive from the nurses.
Staff nurses, this study could help them identify the clients reported needs,
thereby employing nursing interventions in the context of the clients expectation of
nursing care that they should receive.
Hospital Administration, this study could make them aware of the reported
needs of the clients and the nurses assessed needs of the client. Being aware of such, this
study could help them as an additional reference, should they wish to improve the
hospitals facilities in terms of the client education.
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Future Researchers, this study could be used as a reference in literature review
of their research, as the information provided herein extends the body of knowledge of
nursing, specifically client education.
Scope and Delimitation
This study will be conducted to evaluate the need for a structured client education
for patients on Hospital X. The data will come from a population sample of 50
respondents composing of patients in the surgery ward with different age, sex, and
diagnosis and registered nurses employed in Hospital X. The researchers will conduct the
data gathering from April 1-3, 2010.
The researchers will focus only on assessing needs according to the four (4)
subsystems of Roys Adaptation Theory. The 28 questions that will be used in the tool
will assess the clients needs and perceptions of nurses on the needs of the client. The
availability of the respondents depends on their current health status or condition. The
emotional condition of the respondents is beyond the limitations of the researchers.
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Chapter II
THEORETICAL FRAMEWORK
This chapter takes the account of related literature and other studies in relevance
to this research. It will offer complementary information about client education, assessing
and evaluating the clients needs in the context of the four (4) subsystems in Roys
Adaptation Theory. Furthermore, the definition of terms is included in the last part of this
chapter which will facilitate better understanding of the study.
Review of Related Literature and Studies
Surgery Patients
Surgery encompasses all elements in the scientific care of surgical patients
(Brookside Press, 2007). The operation is the focal point for these patients. It is
imperative that the patient comes to the operating room (OR) optimally prepared
physically and emotionally before performance of an operative procedure. The persons
concerned with and/or contributing to surgical patient care are many. The nurse shares a
special experience with the patient at this time of great stress and need in his life. Their
relationship encompasses feelings, attitudes, and behavior approaches. The nurse's first
objective is to promote and establish a meaningful, therapeutic relationship, enabling the
provision of individualized care. The nurse, then, is to provide the perioperative nursing
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care that is required for the safest possible care of the patient and production of a
favorable surgical outcome (Brookside Press, 2007).
A large number of patients express moderate to severe anxiety and fear related to
undergoing surgery. Perioperative nurses are in a unique position to assess and intervene
to help patients and their family members cope with the fear of surgery. Preoperative
teaching is an effective nursing intervention that can help reduce stress. When patients
and their family members cope with surgery positively, they resume normal functioning
more quickly (Garbee, et. al., 2001).
Patients have many fears regarding surgery, including fear of death, anesthesia,
and pain. Also, past personal experiences or stories told by family members and friends
have the potential to increase fear. Financial worries create the fear about how to pay for
medical bills and how long to remain off work. Older adults often fear the hospital in
general, as it is perceived as a place where people die. Many older adults have had
experiences with friends and family members not regaining full function after surgery
and being placed in a nursing home (Garbee, et. al., 2001).
Clients Needs
There are different needs that clients have. Anticipating and meeting these needs
can develop trust thus helping to promote clients well-being.
Sister Callista Roy (1976) developed the Adaptation Model, which sees that the
person needs to adapt on the constant changing environment. She believes that adaptation
occurs in four different modes: (1) Physiologic, the maintenance of physical integrity
which includes the basic human needs such as nutrition, oxygen, fluids, and temperature
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regulation; (2) Self-concept, the maintenance of psychic integrity which includes
perceptions of ones physical and personal self; (3) Role Function, the maintenance social
integrity by adaptation to role changes that occur through out lifetime; and (4)
Interdependence, also the need for social integrity which involves maintaining the
balance between independence and dependence in ones relationships with others.
Client education plays a significant role in meeting clients needs. The importance
of education and teaching as vital components of the nursing process has been recognized
since the early days of the profession (Kovner &Jones, 2002). It provides a method for
individualizing patient care and education for each patient and event. The first step in this
process is a nursing assessment: the process of collecting data to identify the needs and
problems of an individual patient and family. In the assessment process, the nurse
collects information from various sources, validates this information, sorts and
categorizes data, and summarizes or interprets it. The end product--a nursing diagnosis of
educational need--is a judgment based on sound data and information (Rankin &
Stallings, 2001).
Client Health Education
Traditionally, client education has been done in a behavioral and, routine way.
Content has been chosen based on a clients specific diagnosis, or some other
distinguishing feature. Education of any kind, including client education, should attend to
the whole person and ....recognize that learning is subjective, contextual, dialogic and
values-driven, (Watson, 1988). Client education is shifting from a received knowledge
paradigm to a facilitative partnership between the nurse and the client. Nurses are
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becoming enablers, helping clients to practice self care and autonomy. Enabling includes
coaching, informing and explaining, helping the client to generate alternatives, guiding
them to think issues through and validating the clients reality. Traditionally, prevention
teaching has often been presented in a behavioral self-disciplined context, which often
led to clients ignoring the advice of the nurse or resenting any proposed lifestyle changes.
Patient education is a vital component of the nurse-to-patient relationship that
requires time and attention. Research conducted by the Agency for Healthcare Research
and Quality (AHRQ) has identified a number of factors that lead to medical errors; one
being the lack of appropriate patient education (2004). Nurses provide the majority of
patient education in healthcare settings. With that said, in order to provide comprehensive
education RNs need staffing conditions that allow them to meet the needs of each and
every patient they encounter. Patient care assignments should be formulated with the
educational needs of patients in sight.
Nurses can improve patients physical and mental health, improve their quality of
life, decrease personal and environmental risk factors, and prevent disease, illness and
disability through patient education (ANA, Scope and Standards of Practice, 2004). But
still, the success of patient education is dependent on a well-designed plan that includes a
clear statement of the goals and objectives of the educational process. Goals are the
desired outcomes of learning, while objectives detail the behaviors that will be performed
to achieve the goal (Rankin & Duffy, 1996; Redman, 2004).
Nurses Perspective
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Most nurses inherently value the concept of partnership, of complementary
expertise, of collaboration. This stems from the service orientation and the holistic view
of situations and solutions. Nurses also value the recognition that bring unique skills and
characteristics, termed as the nursing lens: an ability to view patients holistically in the
context of their environment and daily experiences; to establish therapeutic relationships
with a wide variety of individuals; to think in terms of systems and the big picture; to
have a scientific basis for practice and a pragmatic view of what works (Disch 2009).
Assessment
The nursing process is a process by which nurses deliver care to patients,
supported by nursing models or philosophies. The nursing process was originally an
adapted form of problem-solving and is classified as a deductive theory.
Nursing process is a patient centered, goal oriented method of caring that provides
a framework to nursing care. It involves five major steps of assessment, nursing
diagnosis, planning, implementation/intervention and evaluating.
Assessing is the systematic and continuous collection, organization, validation,
and documentation of data (information). In effect, assessing is a continuous process
carried out during all phases of the nursing process. All phases of the nursing process
depend on the accurate and complete collection of data. There are four different types of
assessments: initial assessment, problem-focused assessment, emergency assessment, and
time-lapsed assessment. Assessments vary according to their purpose, timing, time
available and client status.
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Nursing assessment focus on a clients responses to a health problem. A nursing
assessment should include the clients perceived needs, health problems, related
experience, health practices, values, and lifestyle. To be most useful, the data collected
should be relevant to a particular health problem. Therefore, nurses should think
critically what to assess. (Kozier, 2004).
Assessment is the first stage of the nursing process in which the nurse should
carry out a complete and holistic nursing assessment of every patient's needs, regardless
of the reason for the encounter. Usually, an assessment framework, based on a nursing
model is used.
The purpose of this stage is to identify the patient's nursing problems. These
problems are expressed as either actual or potential. For example, a patient who has been
rendered immobile by a road traffic accident may be assessed as having the "potential for
impaired skin integrity related to immobility". A nursing assessment includes a physical
examination: the observation or measurement of signs, which can be observed or
measured, or symptoms such as nausea or vertigo, which can be felt by the patient. The
techniques used may include Inspection, Palpation, Auscultation and Percussion in
addition to the "vital signs" of temperature, blood pressure, pulse and respiratory rate, and
further examination of the body systems such as the cardiovascular or musculoskeletal
systems. The assessment is documented in the patient's medical or nursing records, which
may be on paper or as part of the electronic medical record which can be accessed by all
members of the healthcare team. The nursing process, as defined in Roys Adaptation
Model consists of six steps: First level assessment, Second level assessment, Problem
Identification, Goal Setting, Intervention, and Evaluation (Roy, 1976).
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First level assessment - the assessment of client behaviors -is the evaluation of the
persons behavior in each of the four adaptive modes: physiologic, self-concept, role
function, and interdependence. The nurse then selects areas of concern, either
maladaptive behaviors or adaptive behaviors requiring reinforcement. These areas of
concern are then taken into Second level assessment (Roy, 1976).
In Second level assessment - the assessment of influencing factors - the nurse
takes the behaviors of concern and further evaluates the determining the focal, contextual,
and residual stimuli contributing to them. The focal stimuli are the extent or degree of
change immediately confronting the person. The contextual stimuli are all other stimuli
affecting the person presently. Residual stimuli consist of the beliefs, attitudes, and
experiences that color his reactions to the focal stimuli. Assessment of the focal,
contextual, and residual stimuli will allow for an individualized nursing diagnosis,
behavioral goals, and nursing actions for the person (Roy, 1976).
Evaluation
Evaluation is the final step in the nursing process (Kozier, 2004). The
effectiveness of the nursing action is determined by the assessment of the persons'
outcome behaviors. In here we will evaluate if the client needs to have a structured client
education or not. We will analyze the success (or failure) of the current goals and
interventions, but examining the need for adjustments and changes as well.
If the outcome behaviors are the same as the stated goals, then the intervention
has been successful. If the outcome behaviors are still maladaptive, further evaluation of
the nursing action needs to take place for consideration of a different approach. Once
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adaptive behaviors are developed, the nursing process is started over to evaluate any new
or on-going problems. As a result, the nursing process is cyclical in nature (Roy, 1976). It
involves judging the effectiveness of the nursing intervention in relation to the behavior
after the nursing intervention in comparison with the goal established.
Physiologic Mode
Roys Adaptation theory focuses on the responses of the human adaptive system,
which can be an individual or a group, to a constantly changing environment. Adaptation
is the central feature of the model. Problems in adaptation arise when the adaptive system
is unable to cope with or respond to constantly changing stimuli from the internal and
external environments in a manner that maintains the integrity of the system.
Environmental stimuli are categorized as: focalthe stimuli most immediately
confronting the person, contextualthe contributing factors in the situation and residual
other unknown factors that may influence the situation. When the factors making up
residual stimuli become known, they are considered focal or contextual stimuli. Each
persons adaptation level is unique and constantly changing. Individuals respond to needs
(stimuli) in one of four modes: Physiological/physical mode, Self-concept/group identity
mode, Role function mode and Interdependence mode.
Physiological/physical mode: physiological modefor individuals; concerned
with basic needs requisite to maintaining the physical and physiological integrity of the
individual human system. It encompasses oxygenation; nutrition; elimination; activity
and rest; protection; senses; fluid, electrolyte, and acid-base balance; neurologic function;
and endocrine function. The basic underlying need is physiologic integrity, physical
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modefor groups; pertains to the manner in which the collective human adaptive system
manifests adaptation relative to basic operating resources, that is, participants, physical
facilities, and fiscal resources. The basic underlying need is resource adequacy, or
wholeness achieved by adapting to change in physical resource needs.
Physiologic-Physical Mode, pertain to physical and chemical processes involved
in the function and activities of living organisms; the underlying need is physiologic
integrity as seen in the degree of wholeness achieved through adaptation to change in
needs. Roy believes that an individuals adaptation occurs in four different modes. This
also holds true for families (Hanson, 1984). These include the physiologic mode, the self-
concept mode, the role function mode, and the interdependence mode (Roy, 1980).
The individuals regulator mechanism is involved primarily with the physiologic
mode, whereas the cognator mechanism is involved in all four modes (Roy and Roberts,
1981). The family goals correspond to the models modes of adaptation: survival =
physiologic mode; growth = self-concept mode; continuity = role function mode.
Transactional patterns fall into the interdependence mode (Clements and Roberts, 1983).
In the physiologic mode, adaptation involves the maintenance of physical integrity. Basic
human needs such as nutrition, oxygen, fluids, and temperature regulation are identified
with this mode (Fawcett, 1984). In assessing a family, the nurse would ask how the
family provides for the physical and survival needs of the family members.
Young (491, 492) has summarized the work on appetite in its relation to body
needs. If the body lacks some chemical, the individual will tend (in an imperfect way) to
develop a specific appetite or partial hunger for that missing food element. Physiologic
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modes are sometimes referred to as basic needs. Physiological needs must be met at least
minimally for life to continue.
Self- Concept
A commonly quoted definition of self-concept, is "the sum total of all that a
person feels about himself/herself". These needs may therefore be classified into two
subsidiary sets. These are, first, the desire for strength, for achievement, for adequacy, for
mastery and competence, for confidence in the face of the world, and for independence
and freedom. Second, we have what we may call the desire for reputation or prestige
(defining it as respect or esteem from other people), status, fame and glory, dominance,
recognition, attention, importance, dignity, or appreciation. These needs have been
relatively stressed by Alfred Adler and his followers, and have been relatively neglected
by Freud. More and more today there is appearing widespread appreciation of their
central importance, among psychoanalysts as well as among clinical psychologists.
However because these subdivisions have proved to be useful in practice, Curbow has
suggested that 'The self concept is best viewed as a collection of self representations'
some of which will be core conceptions and some will be more peripheral, and that self-
concept is dynamic: active, forceful and capable of change. The affective component of
the self-concept is self-esteem, which has been described as 'the disposition to experience
oneself as competent to cope with the basic challenges of life and as worthy of happiness.
(Mac Pherson, et. al., 2003). Self-esteem has two interrelated components: self-efficacy
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and self-respect. Humans have a need for a stable, firmly based, high level of self-
respect, and respect from others.
Satisfaction of the self-concept leads to feelings of self-confidence, worth,
strength, capability, and adequacy, of being useful and necessary in the world. But
thwarting of these needs produces feelings of inferiority, of weakness, and of
helplessness.
The most stable and therefore most healthy self-concept is based on
deserved respect from others rather than on external fame or celebrity and unwarranted
adulation. Even here it is helpful to distinguish the actual competence and achievement
that is based on sheer will power, determination and responsibility, from that which
comes naturally and easily out of one's own true inner nature, one's constitution, one's
biological fate or destiny, or as Horney puts it, out of one's Real Self rather than out of
the idealized pseudo-self.
Role Function
The role function mode refers specifically to the place that a person holds in
society and how the person acts in that role according to society's expectations. Roy and
Andrews (1999) suggest that patients adaptive problems in the role function mode may
lead to role distancing or role failure, which may then interfere with the patient's adaptive
processes and expected involvement in his treatment plan. It describes the roles assumed
by the family members. It also describe to what extent are the family roles supportive, in
conflict, reflective of role overload and last how are family decisions reached.
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Set of expectations about how a person occupying one position behaves toward a
occupying one position behaves toward a person occupying another position person
occupying another position. Need is role clarity, understanding and committing to fulfill
expected tasks so group can achieve common goals; process of integrating roles in
managing different roles and their expectations; complementary roles are regulated.
Interdependence
The interdependence mode applies to adaptive behaviour for both individuals and
groups. Judging the effectiveness of the nursing intervention in relation to the behavior
after the nursing implementation in comparison with the goal established is evaluating the
education given to the client. Interdependence in the adaptive modes is the need to
achieve relational integrity using process of affection adequacy, i.e., the giving and
receiving of love, respect, and value through effective relations and communication in
individual and the need is to achieve relational integrity using processes of developmental
and resource adequacy, i.e., learning and maturing in relationships and achieving needs
for food, shelter, health, and security through independence with others. Interdependence
mode is a behavior pertaining to interdependent relationships of individuals and groups,
(Roy, 1984). Focus on the close relationships of people and their purpose. Each
relationship exists for some reason. Involves the willingness and ability to give to others
and accept from others. Balance results in feelings of being valued and supported by
others. Basic need - feeling of security in relationships
Dyadic adaptation, representing the individual-significant other relationship;
social support, representing the nurturing behavior within the relationships; and
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loneliness, as an inverse measure of interdependence, were designated as manifestations
of the interdependence adaptive mode for the investigation, (Roy & Roberts, 1981).
The interdependence mode focuses on the close relationships of people as
individuals versus one's role in society. A basic underlying need within this mode is for
relational integrity or feeling of security and satisfying relationship with significant other
(person with whom meaning of most importance is given) and with support systems
(others with which one associates) especially during hospitalization (Roy & Andrews,
1991, 1999). Roy and Andrews (1999) cite an older study by Cohen (1985) which
supports those poor personal relationships may negatively influence quality and length of
life for the patient on long-term maintenance dialysis. An assessment of the effect of
sexual dysfunction on the interdependence mode may therefore be essential to promotion
of positive adaptation and quality of life for the patient on dialysis.
Synthesis
The individual and the environment are sources of stimuli that require
modification to promote adaptation which is an ongoing purposive response. Adaptive
responses contribute to health which is defined as the process of being and becoming
integrated. The goal of Sister Callista Roys model is to enhance life processes through
adaptation in the four subsystems of an individual (Kozier, 2004). This theory of
evaluating the need for a structured client education aims to assess the needs of patient in
the Surgery ward in the four subsystems namely physiological, self-concept, role
functioning and interdependence in order to validate the need for a structured client
education.
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Kitson (1990) said that to be able to give quality care, the nurse must set in mind
that caring is more than just a task. Whatever care rendered to patients must be given to
the best of the nurse knowledge and skills.
According to Schorr (1993), emphasis should be given on the refinement of the
nurses skill of listening to patients problems to provide quality health care services.
Patients expectations to the care that they want to receive are similarly important for the
nurse to consider listening.
This study is related to the study of Judith Ann Speckhart (1984) entitled A
descriptive Study of Student Nurses Perception of Clients Suffering. It aims to identify
the difference between the student nurses class standing and his/her perception of the
degree of suffering experienced by clients, as related to the clients sex, age, illness or
injury, and pain type. Conclusion for this study were the students perception of clients
suffering was significantly related to class standing, type of illness or injury and type of
pain, Sophomore student nurses perceived clients suffering as greatest followed by
Seniors and then Juniors.
This research is similar to an article by Messner (1993) which stated a list of
nursing interventions that are valued highly by patients. Messner (1993) focused on
clients wants while this research focuses on both the clients needs and the perception of
the nurses on clients needs.
This work is related to Perucci (2001) which showed the clients satisfaction that
represents their expectations of nursing care and the care they actually receive from the
nurse. Five common clients expectations including attitude, responsiveness, sensitivity,
privacy and appearance were stated in the article.
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As for local studies, this study is similar to the concept of Cora A. Anonuevo on
her study on The Filipino Perspectives on Caring and Caring Society which is a
descriptive and explanatory study designed to establish the claim that Filipinos possess an
important social orientation of being caring; that is the identity of the Filipinos is oriented
towards a caring society (Anonuevo, 2005). It is similar since assessing the clients needs
will direct the nurse to identify the appropriate care to be provided to the client.
It is also similar to the study of Anonuevo (2004) entitled Realities, Perception
and Health care Needs of Filipino Menopausal Women. Anonuevos study described
how Filipino women felt about themselves, their relationship with others and the events
in their lives during the menopausal period. The study also looked into their reasons for
consulting a clinic and their health care practices during this phase of their lives. Health
professional ought to be sensitive health care providers as they validate the experiences
and explore with clients the ways they are coping with the realities of their lives. Surgery
patients may have needs different from what any other client usually needs and the health
care provider should be challenged to assess these needs in order to design appropriate
interventions individualized for the client.
This study is similar to the study of Barcelo and Perez (1997) entitled Womens
health Training Project: Distance Education Needs Assessment. This study is done
primarily to ensure that health care providers who are implementors of the Womens
health and safe motherhood program of the DOH are adequately trained and retrained and
the need for distance education is being looked at as a possible strategy to be used in
training the hundreds of barangay Health workers and public health midwives who are
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out in the provinces. Assessment of needs was done in order to ensure that the DOH
program stated above is being well implemented.
Lastly, this study is similar to the concept of Rita Cui Ramos (1999) on her study
on Effects of Nurse Presence on Perception of Feeling of security Among Adult
Patients which was conducted to determine the effects of nurse presence as an
intervention on the perception of feeling of security among adult patients and to
determine the relationship between the perception of feeling of security with nurse and
patient factors. Every patient have needs that when provided, will satisfy the four
subsystems of an individual as explained by Sister Callista Roy in her theory. Once these
needs are satisfied by the nurse and all health care providers, improvement in clients
health status will be visible.
Conceptual Framework
Sister Callista Roys Theory on Adaptation is the theory that will guide the
researchers throughout this study. The theory is primarily adopted since in this model,
human beings are biopsychosocial adaptive systems who cope with the environmental
change though the process of adaptation. Polit and Beck (2006) said that within the
human system, there are four subsystems or response modes: physiologic needs, self-
concept, role function and interdependence. These subsystems constitute adaptive modes
that provide mechanisms for coping with environmental stimuli and change (Polit and
Beck, 2006, p.157). Promotion of patient adaptation during health and illness is the goal
of nursing according to this model.
Individuals respond to needs or stimuli in one of four modes. The physiologic
mode involves the bodys basic physiologic needs and ways of adapting with regard to
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fluid and electrolytes, activity and rest, circulation and oxygen, nutrition and elimination,
protection, the senses, and neurologic and endocrine function (Kozier, 2004, p.42). The
individuals regulator mechanism is involved primarily with the physiologic mode,
whereas the cognator mechanism is involved in all four modes (Roy and Roberts, 1981).
The self concept mode includes two components: physical self, which involves
sensation and body image, and the personal self, which involves self-ideal, self
consistency, and the moral-ethical self. A commonly quoted definition of self-concept, is
"the sum total of all that a person feels about himself/herself". These needs may therefore
be classified into two subsidiary sets. These are, first, the desire for strength, for
achievement, for adequacy, for mastery and competence, for confidence in the face of the
world, and for independence and freedom. Second, we have what we may call the desire
for reputation or prestige (defining it as respect or esteem from other people), status, fame
and glory, dominance, recognition, attention, importance, dignity, or appreciation. (Mac
Pherson, et. al., 2003)
The role function mode is determined by the need for social integrity and refers to
the performance of duties based on given positions within society (Kozier, 2004, p. 42).
The role function mode refers specifically to the place that a person holds in society and
how the person acts in that role according to society's expectations. Roy and Andrews
(1999) suggest that patients adaptive problems in the role function mode may lead to role
distancing or role failure, which may then interfere with the patient's adaptive processes
and expected involvement in his treatment plan.
Lastly, the interdependence mode according to Kozier, 2004 involves ones
relations with significant others and support systems that provide help, affection and
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attention. Interdependence mode is a behavior pertaining to interdependent relationships
of individuals and groups, (Roy, 1984). Focus on the close relationships of people and
their purpose. Each relationship exists for some reason involves the willingness and
ability to give to others and accept from others. Balance results in feelings of being
valued and supported by others.
Application of the theory to selected variables: age, gender, educational
attainment, and length of hospitalization for patient respondents and age, gender,
educational attainment and length of practice for nurse respondents are significant to
explain the framework of the study. Age is one of the significant factors that may affect
the needs of each individual since each individual require needs appropriate to the
developmental stage they are in. Also, gender may have an effect on the perceived needs
of an individual. For example, female individuals are more emotional than male
individuals and so the need for a support system is increased in them. More so,
Educational Attainment is important since it may affect the adaptive capability of
individuals. Another variable, length of Hospitalization for patients is similarly important
since increase in it may require more needs than those who have stayed shortly in the
hospital. Lastly, length of practice for nurse respondents is also significant in assessing
the needs of patients.
This conceptual paradigm illustrates the relationship between selected variables
such as age, gender, educational attainment and length of hospitalization among patients,
and age, gender, educational attainment and length of practice among nurses, and the
analysis of assessment data from patients and nurses with regards to the following
subsystems of Roys Adaptation Theory namely: Physiologic, Self-Concept, Role
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Functioning and Interdependence. The figure above shows the relationship of the
following demographic variables mentioned above to the analysis of assessment data
from patients and nurses as specified.
Figure 1.The Conceptual Paradigm for the thesis entitled Evaluating the Need for a
Structured Client Education for Patients in the Surgery Ward of Hospital X.
Demographic Profile of:
Patients:
Age
Gender
Educational
Attainment
Length of
Hospitalization
Nurses:
Age
Gender
Educational
Attainment
Length of
practice
Analysis of Assessment
data from patients and
nurses
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Definition of Terms
For better understanding of this study, the operational definitions of the
important words were provided as follows:
Client: Thisrefers to a person or individual who undergone operation and whom nurses
rendered care. In this study, this is the person who is currently admitted in Pasig
City General Hospital at the Surgery Ward specifically.
Client Health Education. Thisrefers to the nurse-client interaction which comprised of
a set of learning objectives that aims to improve the clients condition after
recovering from illness, prevent disease, and decrease the risk factors.
Clients needs. This refer to wants, desire or request of patient; it can be physiologic
need, safety and security or love and belongingness. In this study, wants, desire or
request of the client are being assessed.
Length of Hospitalization. This refers to the span of time patient Admitted in the
hospital until its recovery. In this study, longer length of hospitalization is being
prevented.
Reported needs. This refer to specific wants, desire or request of patient. In this study,
this specific needs are being assessed and use it to evaluate the need for structured
client education.
Structured client education. This refers to a center or area. In the study, this is where
interactions between nurse-patient are being held.
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CHAPTER III
METHODOLOGY
This chapter presents the research design, research locale, samples and sampling
technique used, instrumentation, data gathering procedure and statistical analysis.
Research Design
In this study, the researcher will use the descriptive correlation method.
According to Key (1997), descriptive research is use to obtain information concerning the
current status of the phenomena to describe what exist with respect to variables or
conditions in a situation. The method involves range from the survey which describes the
relationship between variables, developmental studies which seek to determine changes
overtime. This method includes giving of questionnaires and conducting interviews. This
will be used to evaluate the need for a structured client education for patients in the
surgery ward of Hospital X. This method will be used to identify the relationship between
the assessed needs of the client, the perception on the clients needs of nurses and the
need for a structured health education.
Research Locale
The researchers will conduct the data gathering procedure in Pasig City General
Hospital which located at F.Legaspi St. Maybunga, Pasig City, funded by the Local
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Government of Pasig City. Its vision is to continuously improve the delivery of health
care services by providing fair, friendly service, training, research and practices. Its
mission is to provide the best quality comprehensive and compassionate health care
services to all.
Pasig City General Hospital was established in 1995 through the help of our
beloved Former Mayor Vicente P. Eusebio. His vision is that No man shall be denied
access to hospitalization by reason of poverty and also to provide quality and
affordable medical health services to the people of Pasig City.
In addition to this the said institution continue to develop and expand in terms of
bed capacity, state of the art equipment and human resources and at present, it does not
only serve the bonafide Pasigueos but also the nearby cities, municipalities and
provinces.
Samples and Sampling Technique
The focus of this study will be clients of different ages and gender in the Surgery
Ward of Hospital X regardless of the length of hospitalization and their educational
attainment, and registered nurses in the Surgery Ward of Hospital X regardless of their
length of practice. The researchers will make use of convenient sampling technique.
According to the internet citation (Sampling, Wikipedia 2006) Convenience Sampling is
sometimes called grab or opportunity sampling, this is the method of choosing items
arbitrarily and in an unstructured manner from the frame. Though almost impossible to
treat rigorously, it is the method most commonly employed in many practical situations.
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In social science research, snowball sampling is a similar technique, where existing
studies subjects are used to recruit more subjects into the sample.
This technique would be suitable for the respondents in order for them to be fully focus
on answering the research questionnaire and so that they will have enough time to think
and express their view points.
Instrumentation
The researchers will be using a questionnaire as an instrument for the study. The
questionnaire is composed of two parts and both questionnaires will be given to both
nurses and clients. Both questions have the same content except for the Personal
Information sheet. The first part is the personal information sheet which includes the
respondents name, age, sex, educational attainment, civil status, previous occupation,
length of stay in the hospital and the diagnosis; however, the diagnosis will be filled up
by the researchers and the length of practice for the nurses.
The second part consists of 25 close ended questions arranged according to its
classification on the four (4) subsystems under Roys Adaptation Theory. It will be
composed of questions on the levels namely Physiologic, Self-concept, Role Functioning
and Interdependence. Four possible answers will be provided as choices to be checked
according to the respondents answers. The researchers will adapt the Likert-type
response scale. The scale interpretation ranges from a score of four (4) which is
interpreted as Strongly Agree to a score of one (1) which is interpreted as Strongly
Disagree. Each item of the questionnaire will require rating of the frequency that the
respondents think.
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Two (2) open-ended questions were included which will be helpful in further
assessing the needs of the clients.
The tool will be translated to Filipino and will be validated by a Filipino
professor. The questions will be based on the Caring and Behavior Assessment
instrument that was used by Cronin and Harrison (2000) in their study. The researchers
lifted some questions that would the level of under four (4) subsystems under Roys
Adaptation Theory.
This questionnaire will aid the researchers in determining and assessing the
education needs of the client and the perception of nurses in the Surgery Ward of
Hospital X, and will answer the rest of the research problem.
Data Gathering Procedure
Prior to data gathering, letters will promptly and personally be given to proper
authorities asking permission to conduct a study in the area. Upon approval, ocular
survey of the area will take place and the researchers will explain the objectives of the
study and procedures that will transpire in the data gathering.
Interview tools and consent form will be prepared one week before the actual data
gathering. The researchers will personally administer the questionnaires to 30
respondents, both male and female and of no particular age group and 20 registered
nurses from the surgery ward of hospital X. Proper instructions will be given to
respondents on how the tool will be answered.
The researchers will read each questions and choices to the respondents in order
to minimize measurement problems. On the other hand, the respondents will answer the
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open-ended questions independently. On the other hand the questionnaire will be given to
nurses on their most convenient time. The data gathering procedure will last for 3 days
from April 1-3, 2010.
The questionnaires will be personally prepared by the researchers and will
undergo careful study and validation of proper authorities to ensure its reliability and
validity.
Statistical Treatment of Data
The researchers will make use of the following statistical procedure to draw
meaningful inferences from the data:
a. To answer question number one regarding the demographic characteristics of the
client respondents in terms of age, gender, educational assessment, length of the
present hospitalization of the respondents, and diagnosis and question number two
regarding the demographic characteristics of the nurse respondents in terms of
age, gender, educational attainment and length of practice, the percentage formula
will be used.
Percentage Formula:
Were P = percentage
f = frequency
n = total number of respondents
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b. To answer question number three and four regarding the assessed needs of the
clients and the perception of nurses on clients needs in terms of the four
subsystems of Roys Adaptation Theory, the researchers will utilize the mean
formula:
Mean Formula:
= the computed mean
X = the score of each subsystem in Roys Adaptation Theory
n = refers to the total number of
respondents
c. To answer question number five regarding the relationship between the assessed
needs of the client and the need for a structured client education, question number
six regarding the relationship between the perceptions of the nurse on clients
need and the need for a structured client education, and question number seven
regarding relationship between the clients diagnosis and the need for a structured
client education, the Chi-square was used.
2
=
where: O is the observed frequency
E is the expected frequency
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K is the number of categories