Chapter 1
THE PROBLEM AND ITS SETTING

Background of the Study

Learning in clinical environment involves what Jarvis (2006) defines as action learning, which involves “learning by doing... within a specified social context” (in nursing it is the clinical area). It also involves much more complex learning such as learning of concepts, problem solving, decision making, rule learning, critical thinking.

The nursing educators and institutions have an ethical obligation to ensure admission criteria and academic standards that are reasonable and fare, yet effective indicators of students’ success. When an educational institution issues a diploma to one of its students, it is, in effect certifying the society that the student possesses all the knowledge and skills that are required in his chosen discipline. To remain competitive and accountable, it is imperative for nursing programmes to have efficient and reliable admission criteria. Quantitative data and research- base facts are essential for the development, revision and modification of the admission criteria to guide nursing educators to identify and select those students who will successfully complete the nursing programme. It also helps in minimizing the wastage of human and material resources that occur due to student failure and attrition (Dr. Romana Idrees, 2008).

Furthermore, the students are exposed to a wide variety of clinical settings—including hospitals, outpatient, community clinics, treatment centers, and long-term care facilities—as well as patient populations diverse in age, gender, health status, socioeconomic background, and geographic distribution.

According to Robles and Dionisio (2002), clinical experience requirements in every college, institute and school of nursing should endeavor to provide an integrated program of instruction and experience and where required courses are to be integrated with other courses, the outline of the integrated course should show where possible settings, like the hospitals’ outpatient department, community agencies, and the family should be used to supplement and coordinate ward experience and classroom instruction.

However, the earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practice the skills that they will be expected to perform as new graduate nurses (Löfmark And Wikblad, 2005). In addition, the most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualized mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship. These conditions raise both capacity and professional competence issues regarding the possibilities of creating a positive atmosphere for nursing students’ educational purposes. Capacity issues will affect the integration of the students into the professional nursing community. This study is focused in determining the level of academic performance and clinical exposure of nursing students of John Paul II College of Davao.
Statement of the Problem

The main purpose of the study is to determine the clinical exposure and academic performance of 3rd year nursing students of John Paul II College of Davao. Specifically, the study will aim to answer the following question;

1. What is the level of academic performance of 3rd year and 4th year nursing students of John Paul II College of Davao? 2. What is the level of clinical exposure of 3rd year and 4th year nursing students of John Paul II College of Davao? 3. Is there a significant relationship between academic performance and clinical exposure of 3rd year and 4th year nursing students of John Paul II College of Davao?
Hypothesis
There is no significant relationship between academic performance and clinical exposure of 3rd year and 4th year nursing students of John Paul II College of Davao.
REVIEW OF RELATED LITERATURE Shown in this portion are the related literatures that will provide additional insight in the development of the study whose sources come from books, journals, newspapers and reliable websites.
Academic Performance

Academic performance generally refers to how well a student is accomplishing his or her tasks and studies, but there are quite a number of factors that determine the level and quality of students' academic performance (Shock, 2012).

As cited by Geiser and Santelices (2007), academic performance is affected by a number of factors including admission points, social economic status and school background.

According to Graetz (1995), one’s educational success depends very strongly on social economic status of the parents. Considine and Zappala (2002), argue that families where the parents are advantaged socially, educationally and economically foster a high level of achievement in their children.

Considine and Zappala (2002) agreed in their citation that students from high social economic backgrounds are well exposed to scholastic materials, which aid their intelligence.

Sentamu (2003) and Kwesiga (2002), as cited in Considine and Zappala (2002) all argue that the type of school a child attends influences academic achievement.

On the other hand, academic performance according to Durden & Ellis (2003), is frequently defined in terms of examination performance. In this study academic performance was characterized by performance in tests, in course work and performance in examinations of undergraduate students. In educational institutions, success is measured by academic performance, or how well a student meets standards set out by local government and the institution itself. As career competition grows even fiercer in the working world, the importance of students doing well in school has caught the attention of parents, legislators and government education department’s alike (Bell, 2011).

Durden & Ellis (as cited in Staffolani and Bratti, 2002) observed that measures of prior educational performance are the most important determinants of student performance. This implies that the higher the previous performance, the better the students will perform academically.

However, academic performance is strongly associated with the latent variable labeled “cognitive ability” which captures most of the variation in the individual specific cognitive outcome measures. Working memory, visual spatial skills, and learning together stood out as the best combination to predict academic performance (Bangirana, John CC, Idro R, Opoka RO, Byarugaba J, et al. (2009).

On the other hand, one effective tactic involves cultivating a supportive school climate that emphasizes personalization and high expectations. Building supportive ties at school can ameliorate potential risks at home and in the clinical area (Thalhofer, 2009). As cited by Conard, 2006, Jansen & Bruinsma, 2005), positive attitude toward learning along with work ethic and discipline were identified in some studies as a predictor of academic achievement. Another important strategy is building teacher’s capacity to foster healthy skills development. Additionally teaching resiliency skills with targeted curricular materials can enhance students’ knowledge and lead to improved academic performance (Thalhofer, 2009). Accordingly, much psychological research has focused on identifying predictors of academic performance, with intelligence and effort emerging as core determinants. In this article, we propose expanding on the traditional set of predictors by adding a third agency: intellectual curiosity. (Von Stumm, Sophie; Hell, Benedikt; Chamorro-Premuzic, Tomas 2011).

As a result, the interactions that nursing students tend to have with advisors are more frequent than students enrolled in other majors (Harrison, 2009) and more focus on support with academic challenges and career advisement than discussions about course scheduling (Gasper, 2009). Additionally, students’ confidence in themselves academically and their perceived control over learning affect not only the strategies they employ in studying but also their overall academic achievement (Ferla, Valcke, & Schuyten, 2009; Richardson, 2011; Yip, 2009). Previous research found that close, positive student-teacher relationships are positively related to a wide range of child social and academic outcomes in school (Hughes, Gleason, & Zhang, 2005).

However, what students believe about learning and their purpose in gaining a higher education has an effect on their level of achievement (Entwistle & Peterson, 2004).

In addition, students who are attending college for strictly vocational outcomes will have a different approach to their classes than students attending for personal development and the acquisition of knowledge. This overall belief in the purpose of education and motivation will significantly affect their approach to learning, goal setting, and academic achievement (Durik, Lovejoy, & Johnson, 2009).

Durik et al. (2009) suggest that evaluating achievement motivation and use of goals could assist professionals in determining students who may need more assistance and advising throughout their college experience.

In order to assist with the nursing shortage, it is critical that the educators focus on developing strategies for academic success and retention for students who are enrolled in undergraduate nursing programs (Jeffreys, 2007).

Clinical Exposure Nursing is an art, an art of caring. Nurses are much involved in lots of health teachings and interventions; and are expected to portray a variety of roles. Be it as an educator, communicator, caregiver, counselor, advocate or as a leader, a nurse should possess a well- defined body of knowledge and expertise in the field especially on actual scenarios (Kozier et.al., 2008). Student nurses may be perceived as trainees, yet it is far apart from that thought. It is incorporating oneself to and embracing the vocation of helping and providing care in order forastery and dedication to be more likely. According to Robles and Dionisio (2002), cinical experience requirements in every college, institute and school of nursing should endeavor to provide an integrated program of instruction and experience and where required courses are to be integrated with other courses, the outline of the integrated course should show where possible, the hospital outpatient department, community agencies, and the family should be used to supplement and coordinate ward experience and classroom instruction. For a college student, clinical experience typically refers to exposure to a setting where medical services are provided. For example, some students shadow a physician or other health professional providing patient care or observe a medical procedure. You are not expected to provide a clinical service. In some cases, you may have additional training or skills that may allow you to provide services.

“Philippine Nursing Act of 2002 Republic Act 9173 Order no. 30, Article IV, Sec. 2, was issued to give emphasis on the clinical exposure of the nursing student during their Related Learning Experiences (RLE). Student nurses perform nursing functions under the direct supervision of the clinical instructor, who is capable of providing continuous learning in such activities where the students engaged.

According to Elliot & Naphtine (2002), the quality of nurse education depends largely on the quality of the clinical experience. Therefore, the learning depends on the hospitals and Professors. Then, how can students experience a method of care if the hospitals and professors don’t allow the students to do it. Strategies like encouraging students to be involved in every aspect of their patients’ care. This means adjusting their role as their scope of practice allows. For example, a student may not be allowed to perform the laying of a skin graft. However, they can be involved in setting up the trolley and environment, positioning and comforting the patient, reviewing the order and policy or opening sterile packets to assist in the process. Added by Elliot, students require effective clinical placements to allow the application of theory to practice.

Moreover, these experiences are central to the student’s preparation for entering the workforce as a competent and independent practitioner (Penman and White, 2005; Papp et al, 2003).

As stated by Landers, 2004, clinical placement provides the opportunity for students to observe role models, practice, develop their skills and problem-solving abilities, and reflect on what they see, hear and do.

According to Cope et al, 2005, as they practice in the clinical environment, it is essential that the nursing student integrates theoretical content provided by the educational institutions with the realities of nursing practice.

In the essay of Adah Chung (2009), clinical performance of nursing students is measured through observation and feedback during clinical rotations. They also assessed using simulated clinical practice exams, in which nursing student’s complete simulated scenarios with patients in a fair and objective way.

There are a variety of influences in the clinical learning environment according to Clarke et al, 2003, that can significantly limit and hinder the development of the learner.

On the other hand, clinical education occurs in an environment that can be unstructured, unpredictable and overwhelming (Papp et al, 2003). This has the potential to generating feelings of vulnerability and anxiety in nursing students (Elliot, 2002). There are many facets that make up the clinical learning environment and it is the interactions of the nursing student with and within these elements that determine both the experience and the quality of their learning outcomes.

Students identify that the skills and attributes of nurse teachers, their attitude towards them (Goopey et al, 2004) and access to relevant learning opportunities, is paramount in the achievement of positive learning outcomes (Pearcey and Elliot, 2004).

According to Sharif and Masoumi, 2005, nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education.

The major categories of learning were classified as nursing skills, time management, and professional socialization. The quality of learning was reportedly affected by the quality of the student's preparation, characteristics of the instructor, and the variety of clinical opportunities to which students were exposed. The data also reflected a pattern of student development which was separated into three stages. The first stage was permeated with anxiety and obsession with the rules of task performance (The Journal of nursing education, January, 2009).

According to Informa, 2004, early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can also influence their career choices.

Moreover, one of the more critical experiences for nursing students is exposure to patients in a clinical setting. This type of experience will allow them to ensure that they enjoy working with patients.

According to Elsevier, 2005, clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these ‘remote’ settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment. One of the more difficult aspects of clinical experience as an undergraduate student is that in most cases you are not yet trained to do clinical work. Often, this means that you are restricted in what you can do in a health care setting. However, there are a variety of options for meaningful clinical experiences as an undergraduate.

The students considered clinical practice as an essential component of their learning process. Clinical practice allowed the participants to have direct experience with the real world of nursing, to practice the clinical skills required for the job, to learn about general nursing routines and to learn about the responsibility of the nurse. Participants also considered that clinical practice allowed them to develop interpersonal relationships with others and what is more, to become aware of the political aspects of health care.

Clinical practice also assisted students in consolidating their knowledge by getting their hands on experience and practicing what they were taught in the laboratory. All participants expressed they 'loved' being on clinical practice. However, this experience often conveyed mixed feelings regarding clinical practice. While on some occasions they discussed feeling scared, nervous, stressed, intimidated, and awkward. On other occasions, students found clinical practice to be exciting, interesting, important and enjoyable (Aejne, 2004).

In clinical placements nursing students enter new settings for learning purposes. In order to learn the students depend upon a supportive atmosphere based on psychological and pedagogical aspects (Chan, 2004).

First timers in clinical rotation engage themselves in the initial stage of familiarizing and accustoming one’s self to the practice becomes crucial. This is the point when printed theories in books and hand outs are recalled and reshuffled in the mind in order to carry out the best intervention suited for a particular situation. It was never easy for a novice student nurse to be assigned in the OB ward or in the emergency room without sufficient knowledge about postpartum care or familiarity with the basic instrument used in minor surgeries. Also, inadequate and ineffective education influences the manner that one gains necessary principles and skills needed in actual and assisted delivery cases. This has affected the coping strategies of the trainees to different problems arising in the clinical settings. In reality, some just performed as assistants instead of handling actual deliveries, this is also dependent to the hospital protocols, and some were just given free cases (Penman and White, 2005).

Preparation for supporting and supervising nursing students will make nurses more confident with their role in facilitating learning in clinical placements (Landmark et al., 2003) and contribute to nursing students’ experiences of the clinical learning environment (Clarke et al. 2003).

As emphasized by Abaravar et.al. 2006, the performance of students in the clinical area is greatly affected by difficulties they encounter especially in their first clinical duty. Factors include relationship with clinical instructors, misunderstandings arising from group works, hospital policies and requirements, alterations in contingencies when handling patients and so on. As new members of the healthcare team, adjustment to different stressors seems to be crucial.

Many factors impact on how the learning environment is perceived. Supportive relationships are important, as is how the students experience the learning situations that they are exposed to in terms of meaning and content. Nursing students undergoing clinical practice in nursing homes must be helped and supported in viewing gerontological nursing as not being unchallenging, repetitious or boring (cf. Happel 2002, Brown et al. 2008); this may allow them to perceive nursing homes as good learning environments.

Understanding students‟ experiences and the challenges they are faced with in clinical settings is essential in identifying the kind of support they require in order to cope well and to be able to learn. I believe that the way students are coping with stress will influence their self efficacy, development of a professional self concept, their perception of autonomy, and subsequently their learning ( Mlek, 2011 ).

Nurse educators are finding it increasingly more challenging to prepare undergraduate students for the ever-changing and more acute clinical environment. As an answer to this dilemma, the human patient simulator can provide students with the opportunity to enhance knowledge, to facilitate skill acquisition, to decrease anxiety, and to promote clinical judgment in a safe environment. These experiences assist the novice nursing student to progress to the advanced beginner stage of practice. This article describes how faculty used the human patient simulator in creating a case scenario that enhanced critical thinking in senior nursing students (© 2005 Lippincott Williams & Wilkins, Inc.).
Theoretical Framework of the Study

Independent Variable Dependent Variable

Figure 1. Research Paradigm

This study was anchored to the theory of Interpersonal Relationship by Hildegard Peplau. She described nursing as a significant, therapeutic interpersonal process. It functions cooperatively with human processes that present health as a possible goal for individuals. When nurses, together with the health care team offer health services, they project health holistically taking while considering the socio- economic, spiritual, emotional and physical aspect of every person. When interacting with patients or clients in every setting available, the nurse uses the interpersonal model as a way to explore and to identify the needs of the person seeking professional help.

Another theory that will be anchored in the study will be the Cognitive- Experiential Self- Theory by Seymour Epstein. He proposes the idea that people operate using two separate systems for information processing: analytical-rational and intuitive-experiential. The analytical-rational system is deliberate, slow, and logical. The intuitive-experiential system is fast, automatic, and emotionally driven. These are independent systems that operate in parallel and interact to produce behavior and conscious thought. Epstein argues that within the context of day to day life, a constant interaction occurs between the two systems. Because the experiential system is fast, guided by emotion and past experience, and requires little in terms of cognitive resources, it is especially equipped to handle the majority of information processing on a daily basis, all of which occurs outside of conscious awareness. This, in turn, allows us to focus the limited capacity of our rational system on whatever requires our conscious attention at the time.

Significance of the Study
The findings of the study would benefit the following; Dean of the College of Nursing- the study would benefit the Dean of the Nursing department and as well as the coordinators to plan more ways on how to improve academic teaching strategies of her clinical instructors. Clinical Instructors- the study would benefit the clinical instructors for them to come up with an effective means to find more ways on how to make their students do equal performance in the clinical area and in school. Nursing Students- the study would benefit nursing students by having more experiences on every area of exposure. Patients- the study would benefit the patients in the clinical area by receiving quality care and service from the nurses/ student nurses. Future Researchers- the study would benefit the future researchers to serve as their basis to future researches.
Definition of Terms: Academic Performance. This refers to the lecture grades of the 3rd year and 4th year nursing students in their major nursing subjects. Clinical Exposure. This refers to the Related Learning Experience grades of 3rd year and 4th year nursing students. Nursing Students. This refers to the 3rd year and 4th year nursing students enrolled during the 1st and 2nd semester of the school year 2013- 2014.

Chapter 2
METHODOLOGY
Presented in this chapter would be the research design, research subjects, research instruments, data gathering procedure and statistical treatment of data.

Research Design The researchers used the descriptive-correlation design. Descriptive-correlation is used when the objective of the study is to seek specific picture of the population under investigation in terms of their social and economic characteristics, opinions and their knowledge about, or behavior towards a certain phenomena as well as the relationship between the two variables involved in the study, specifically the relationship between the independent variable academic performance and dependent variable clinical exposure (Salmorin, 2005). This will be used by the researchers in determining the level of nursing knowledge of nursing students and their confidence level. Moreover, the study will try to investigate whether a significant relationship will exist between the two variables understudied.

Research Subjects The respondents of the study would be the 3rd year and 4th year nursing students of John Paul II College of Davao who were officially enrolled during the 1st and 2nd semester of academic year 2013- 2014. Universal sampling technique will be utilized in the study.
Research Instrument The researchers used the final grade in their major nursing subject to determine the academic performance and the final RLE (Related Learning Literature) grade for the clinical performance. The variables of the study would be interpreted and analyzed using the scale below (See Table 1).

Table 1. Scaling for Academic Performance and Clinical Exposure
|Range of Grades |Range of Mean |Interpretation |
|91-100 |4.1 – 5.0 |Very Good |
|86-90 |3.6 – 4.0 |Good |
|80-85 |3.0 – 3.5 |Fair |
|75-79 |2.0 – 2.9 |Poor |
|Below 75 |1.0 – 1.9 |Very Poor |

Data Gathering Procedure The researchers used the following steps in the conduct of the study: 1. A permit to conduct a study will be forwarded to the School Directress, Ms. April Evangelista to seek approval to conduct a study in John Paul II College of Davao. 2. Upon approval, the researchers then will go to the Office of the College of Nursing to request to make a record review on the RLE grades and lecture grades of nursing students understudied. 3. As soon as the request will be granted, the researchers will collate the RLE grades and lecture grades and will record them accordingly. 4. The collated data will then be tallied and will be subjected to statistical analysis. Results of computation will then be interpreted and analyzed.

Statistical Treatment of the Data In analyzing the data, the researchers will use Mean and Pearson-r. Mean. This will be used to determine the level of clinical exposure and academic performance of 3rd year nursing students of John Paul II College of Davao. Pearson-r. This will be used to determine the significant relationship between the clinical exposure and academic performance of 3rd year nursing students of John Paul II College of Davao.

Chapter 3

DATA PRESENTATION, INTERPRETATION AND ANALYSIS OF FINDINGS

This chapter presents the results of the conduct of study, the interpretation of findings as well as the data analysis.

Table 2. Academic Performance
|Interval of Grades |Scaling |Percentage |Interpretation |
|91 - 100 |5 |0 |Excellent |
|86 – 90 |4 |0 |Very Good |
|80 – 85 |3 |19.11 % |Good |
|75 – 79 |2 |48.52 % |Fair |
|Below 75 |1 |32.35 % |Poor |
|Level of Academic Performance: | 99.98 % |

The data illustrated in table 2 depicted the computed data deriving from the Final Lecture grades that denotes the academic performance of 3rd year and 4th year nursing students. Data revealed that the 3rd year and 4th year nursing students obtained a mean grade ranging from 58.13 to 85.48 with an overall mean rating of with a descriptive equivalent of . This means that the level of academic performance of 3rd year and 4th year nursing students is .

Findings of the study revealed majority 48.52% of the respondents had a grade within the interval of 75 to 79 which is considered a low performance level, while the other 32.35% obtained a grade below 75 which is a very low level. About 19.11% of the respondents had a grade within the interval of 80 to 85 which is considered a moderate level of academic performance.

Table 3. Clinical Exposure

Table 3 shows the clinical exposure grades of NCM 103, 104, 105 and 106 nursing students with mean grade ranging from 60.03 to 85.55 with an overall mean grade of described as . This means that the clinical performance of nursing students is .

The findings further disclosed that majority 48.53% of students obtained a grade within the interval of 75 to 79 which is relatively low and 27.94% of the collated grades got 80 to 85 which is relatively moderate level. There were 23.58% who gained a grade below 75 which is considered a very low clinical performance.

Table 3: Clinical Performance
|Interval of Grades |Frequency |Percentage |Interpretation |
|91 - 100 |0 |0 |Very High |
|86 – 90 |0 |0 |High |
|80 – 85 |19 |27.94 % |Moderate |
|75 – 79 |33 |48.52 % |Low |
|Below 75 |16 |23.58 % |Very Low |
| N = 68 | 99.98 % |

ACADEMIC PERFORMANCE AND CLINICAL EXPOSURE OF NURSING

STUDENTS OF JOHN PAUL II COLLEGE OF DAVAO

[pic]

A Thesis Proposal Presented to the Faculty of the College of Nursing

John Paul II College of Davao

Matina, Davao City

In Partial Fulfillment of the Requirements for the Degree of

Bachelor of Science in Nursing

By:

Parcasio, Maria Nimpha A.

Ibanez, Diana Rose C.

2013- 2014

TABLE OF CONTENTS

Page

Title Page i

Approval Sheet ii

Abstract iii

Acknowledgement iv

Table of Contents v

List of Tables vi

List of Figure vii

Chapter 1 THE PROBLEM AND ITS SETTING

Background of the study 1

Statement of the Problem 3

Hypothesis 3

Review of Related Literature 4

Theoretical and Conceptual Framework 14

Significance of the Study 15

Definition of Terms 16

Chapter 2 METHODOLOGY

Research Design 17

Research Subjects 17

Research Instruments 18

Data Gathering Procedures 18

Statistical Treatment of the Data 19

Chapter 3 PRESENTATION, INTERPRETATION &

ANALYSIS OF FINDINGS

Academic Performance of 3rd and 4th year Nursing Students of John Paul II College of Davao

Clinical Exposure of 3rd and 4th year Nursing Students of John Paul II College of Davao

Chapter 4 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary

Conclusions

Recommendations

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ACADEMIC PERFORMANCE

CLINICAL EXPOSURE