Final Chapter 123 1st Defense

8/14/2019 Final Chapter 123 1st Defense

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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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Evaluating the Need for a Structured Client Education for Patients in the Surgery Ward of Hospital X 2

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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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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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

Final Chapter 123 1st Defense

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Transcript of Final Chapter 123 1st Defense