MANILA DOCTORS COLLEGEEXTENT OF TRANSCULTURAL NURSING PRACTICES IN MANILA DOCTORS HOSPITAL

A Research Paper Presented to The Faculty of the College of Nursing MANILA DOCTORS COLLEGE Pasay City

In Partial Fulfilment Of the Requirements for the Degree BACHELOR OF SCIENCE IN NURSING

Christy Ann S. Camballa Joshua D. Flores Ronalyn S. Guevara Francis D. Ibase Nia Rose C. Maderazo Kristine Mae D. Mejia Yessa P. Ortega

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October 2009

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MANILA DOCTORS COLLEGEAPPROVAL SHEET

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In partial fulfillment of the requirements for the degree of BACHELOR OF SCIENCE IN NURSING, this research paper entitled EXTENT OF TRANSCULTURAL NURSING PRACTICES IN MANILA DOCTORS HOSPITAL has been prepared and submitted by CHRISTY ANNE S. CAMBALLA, JOSHUA ANDREW D. FLORES, RONALYN S. GUEVARRA, FRANCIS D. IBASE, NINA ROSE C. MADERAZO, KRISTINE MAE D. MEJIA, YESSA P. ORTEGA, who are hereby recommended for Oral Examination. _________________________________ ARMEL B. GONZALEZ, RN MHA Adviser

Approved by the Committee on Oral Examination with the grade of ______.

_______________________________ MICHAEL LEOCADIO, RN MAN Member

_______________________ NORA NARON, RN MAN Member

Accepted and approved in partial fulfillment of the requirements for the degree of BACHELOR OF SCIENCE IN NURSING.

_______________________________ EMILIE M. LOPEZ, RN MAN Officer-in-Charge, College of Nursing Date: October 2009

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MANILA DOCTORS COLLEGEACKNOWLEDGEMENT We would like to express our deepest gratitude to the following to help and support us to make this research possible: To Mrs. Armel Gonzalez our thesis adviser for her unselfish time, effort, encouragement that give us the strength to pursue this study and for sharing her knpwledge, for guiding us and being patient with us despite her busy schedule. To Ms. Emervic Gargoles, our statistician for her assistance in making this research possible To Ms. Rosie De Leon (Chief Nurse), Manila Doctors Hospital, for granting us the permission to counduct our study in the respective areas. To Mrs. Julita Fiesta, Mr. Demetrio Gamayon, Mr. Gregorio Mendoza III, for imparting their knowledge and expertise in the validation of our questionnaires. We would like to extent our warm thanks to our families and friends for giving us a hand in all our difficulities and for giving their all-out support. Above all, we would like to thank our Lord Almighty for his unconditional love and guidance and making everything possible.

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MANILA DOCTORS COLLEGEDedication We have conducted this study for eight (8) months. We went to different hardships, we exerted effort, and time to make this study feasible. This study is heartfully dedicated to all the people whose unwavering support, belief and guidance ensured that we would be able to graduate for this esteemed College. We would also like to dedicate this to our parents, guardians who never failed us to give financial support in conducting this study. This is also dedicated to the Lord Our God for his everyday blessing to us, and lastly, to our friends for their time and motivation.

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MANILA DOCTORS COLLEGERESEARCH ABSTRACT Research Title Researchers : : EXTENT OF TRANSCULTURAL NURSING PRACTICES IN MANILA DOCTORS HOSPITAL CAMBALLA, CHRISTY ANN S. FLORES, JOSHUA ANDREW D. GUEVARA, RONALYN S. IBASE, FRANCIS D. MADERAZO, NIA ROSE C. MEJIA, KRISTINE MAE D. ORTEGA, YESSA P. MRS. ARMEL GONZALEZ, RN MHN MAN MANILA DOCTORS COLLEGE BACHELOR OF SCIENCE IN NURSING October 2009 138 pages

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Adviser School Degree Conferred Date Completed No. of pages

: : : : :

This quantitative analytical research assessed the Extent of Transcultural Nursing Practice in Manila Doctors Hospital. The study was conducted last May 2009. A purposive sampling technique was used in distributing the questionnaire to a total of thirty (30) nurses from selected floors at Manila Doctors Hospital participated as respondents to this survey. The quantitative data obtained were tabulated and presented using frequency tables with the use of Statistical Packaged for Social Science (SPSS) software.

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MANILA DOCTORS COLLEGEThe demographic data gathered for respondents were the following: age, gender, and number of patients handled. To assess the extent of transcultural nursing practice of the staff nurses in Manila Doctors Hospital, researchers used chosen Sunrise Model (environmental, communication and space) from Madeleine Leininger. Majority of the nurses belongs to age 21-29 years old and have handled 1-2 foreign patients. As result, the study shows that there is no significant difference in the extent of transcultural nursing practice based on the given factors according to the profile. In the light of the findings and conclusions, the following recommendations are hereby offered. Firstly, for the staff nurses of Manila Doctors Hospital (MDH), to continue to develop the caring attitudes and provide the best quality nursing care as possible t their patient in spite of culture indifferences. Secondly, to the College of Nursing to suggest and encourage Commission on Higher Education to include Transcultural Nursing Practices patterned according to Leiningers Sunrise Model in the curriculum of Bachelor of Science in Nursing to help nurses prepare themselves as they have a greater chance and possibility of working abroad. Thirdly, to the students wherein they can read cultures of other country to update themselves regarding different cultures needed to consider before giving care.

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MANILA DOCTORS COLLEGEFourthly, to Nursing Service that they should monitor the knowledge of staff nurses not only in terms of different nursing procedures they can perform or intervention but also include in their training on providing care for foreign patients. Lastly, to the future researchers, we recommend that they explore other data gathering techniques for them to find the different result between the profiles of the respondents. And test other factors like religion, economic status and others; included in the umbrella of Sunrise Model of Leininger. Furthermore, they could increase the number of respondents, if possible, all the nurses in the said institution.

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MANILA DOCTORS COLLEGETABLE OF CONTENTS Approval Sheet Acknowledgment Dedication Research Abstract Table of Contents List of Tables List of Figures List of Appendices CHAPTER 1 THE PROBLEM AND ITS BACKGROUND Introduction Background of the Study Conceptual Framework Conceptual Paradigm Statement of the Problem Statement of Hypothesis Significance of the Study Scope and Delimitation of the Study Definition of Terms 2REVIEW OF RELATED LITERATURE AND STUDIES

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MANILA DOCTORS COLLEGELocal Literature Foreign Literature Local Studies Foreign Studies Relevance to the Present Study 3 METHOD AND PROCEDURE Research Method/Design Research Locale Sample and Sampling Technique Research Instrument Validation of the Instrument Test for Reliability of the Instrument Data Gathering Procedure Statistical Treatment of Data 43 43 43 43 45 46 46 47 17 19 37 38 40 ix

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PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA RESEARCH CENTER 51

MANILA DOCTORS COLLEGE5 SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS Summary of Findings Conclusions Recommendations REFERENCES APPENDICES 73 76 77 79 82

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MANILA DOCTORS COLLEGETABLE A 1 2 3 Four Point Likert Scale Frequency and Percentage Distribution of Staff Nurse According to Age Frequency and Percentage Distribution of Staff Nurses According to Gender Frequency and Percentage Distribution of Staff Nurses According to Number Patients Handle Extent of transcultural Nursing Practices in Manila Doctors Hospital Based on Communication Extent of transcultural Nursing Practices in Manila Doctors Hospital Based on Space Extent of transcultural Nursing Practices in Manila Doctors Hospital Based on Environment Summary of Categories Difference in the Extent of Transcultural Nursing Practices Grouped According to Age Difference in the Extent of Transculural Nursing Practices Grouped According to Gender Difference in the Extent of Transculural Nursing Practices Grouped According to Number of Foreign Patient Handled PAGE 49 51 53 54

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MANILA DOCTORS COLLEGELIST OF FIGURE FIGURE 1 Conceptual Paradigm PAGE 9

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MANILA DOCTORS COLLEGELIST OF APPENDICES Appendix A B C D E F G H Recommendations and Suggestions of the Panel Methods Statistical Analysis Communication Letters Certifications Gantt chart and Line Item Budget Photographic Documentations Curriculum Vitae PAGE 83 85 93 103 110 117 119 121

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MANILA DOCTORS COLLEGECHAPTER I THE PROBLEM AND ITS BACKGROUND Introduction "..I will serve mankind with love and compassion, recognizing their dignity and rights irrespective of color, caste, creed, religion and nationality. - Florence Nightingale. Pain is experienced by people of all cultures, communities and economic strata. It is the fifth vital signs that nurses included in assessing their patients every day. Nurse handles different people every day holding different beliefs, practices, values, religion, and cultures of clients, thus nurses have to face, accept, and must do their job in giving, providing, and fulfilling the needs of every client they have. It is like nurses wearing a mask in every time they are going to attend to the needs of their patients every day. No matter how kind or cruel the patient is, nurses should smile, show goodness, and understand the condition of their client. Different cultures of client is not a simple task for nurses, there are things to consider in providing an optimum care in each client. In year 2005, according to a senior Taiwanese Department of Health (DOH) official in Taipei said that there would be a self-payment ratio hike for out-patient and emergency patients. Increase in payment in medical services will be effective

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MANILA DOCTORS COLLEGEon 16th of July in the same year. Taiwanese as well as other nationalities come to the Philippines for medical professional help because aside from lower rates; they can avail wellness not mentioning the global competitiveness of medical practitioners and equipment available. Nurse prepares their selves in handling patients with different culture patterned to their clients culture, beliefs, values, practices, and even with their superstitious beliefs. Visiting one place from another dictates a big adjustment on the part of foreigners which, sometimes they cannot cope with changes around them affecting their health. There are a lot of factors that can affect the health of foreigners such as, weather, environment, food, water, hygiene, and presence of communicable disease like pulmonary tuberculosis. As nurses and future professional nurse, taking care not only the health of Filipinos but as well as foreigners is a major responsibility. Nurses profound knowledge and skills in giving care and practicing nursing skills will be used as a guide in assisting health needs of foreign clients. It will also support nurses duties in maintaining care and in preventing both local and foreign clients from acquiring any kind of diseases present in the environment. Each nationality deserves to have an adequate service and care that is patterned according to their cultural beliefs and practices that each professional nurses and future nurses should have knowledge of. Studying their culture and

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MANILA DOCTORS COLLEGEpractices, understanding their culture, and applying what the nurses learn will help nurses to be equipped and to be an effective nurse here and in abroad. To be globally competitive is the aim of each nurse who is planning to practice their profession outside the Philippines. As a response to these conditions, it is essential to study the extent of transcultural nursing practices of nurses in Manila Doctors Hospital. Background of the Study In the last four decades, understanding and acceptance of the need to prepare nurses and other practitioners to provide culturally competent care has grown around the world. In year 2005, a senior Taiwanese Department of Health (DOH) official in Taipei said that a self-payment ratio hike for out-patient and emergency patients will be announced. DOH Secretary-General Lai Chin-Hosing also said that hike is expected to be put into effect July 16, 2005. According to the fee hike plan envisaged by the Bureau of National Health Insurance (BNHI), the self-payment amount for outpatients as well as amount for emergency patients for district, regional and national hospitals will be raised. Based on the information, their fees are visibly higher than medical fees in our co untry. In relation to that,

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Taiwanese as well as other nationality come to our country for medical professional help because aside for lower rates; they can achieve wellness not mentioning the

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MANILA DOCTORS COLLEGEglobal competitiveness of our medical practitioners and the equipment available. Nurses should be prepared of handling patients according to their culture without violating anything from their beliefs, values, practices, or even to their superstitious beliefs. Nurses should respect their attitudes towards dealing with nurses, and

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nurses should understand that cultures should consider in giving care to foreign patients and know their limitations in giving care. In 2008, based on medical Tourism Monitoring Sheet of Manila Doctors Hospital (MDH), there were foreign patients coming from different countries who seek for medical assistance. With this record, it is evidently seen that nurses of Manila Doctors Hospital handled foreign clients who needs medical assistance. A student nurse experienced handling a Japanese patient in Manila Doctors Hospital and had a problem in communication. He needs an interpreter in order for him to understand the student nurse and vice versa. But unfortunately, there was no interpreter to relay and interpret the message to client. Action is the only means of communication similar to pantomime in order for client to understand different instructions, and answer questions given to client; and for client to ask questions as well. Even though actions were performed still there is a delay of understanding instructions and questions. On the brighter side, putting the words into actions is helpful compared to no total no means of communication.

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MANILA DOCTORS COLLEGEManila Doctors Hospital is the base hospital of students from Manila Doctors College. In relation to hospitals location, there is a hotel and game amusement near the area where a lot of foreigners visit and stay. In mentioning that situation, there is a high probability that Manila Doctors Hospital might have foreign patients who might ask and consult for medical services once they need medical assistance. Students from Manila Doctors College has a high probability of handling a foreign patients as well since the aforementioned hospital serve as their training hospital in developing their skills and molding students to a professional nurse some day. Handling different nationalities in the hospital is not an easy task. There are a lot of things to consider especially when culture comes in the process of giving care. Soon, student nurses will become professional nurse and will be facing different people not only coming from different provinces but from other country as well who have a different culture from Filipino nurses. Culture especially transcultural nursing is very important to nurses as nurses service will be evaluated and will be assessed by any patients as they leave the hospital. if nurses did not satisfied the standards of every culture in receiving care it will only reflect that nurses of Manila Doctors Hospital is short in terms of providing optimum care which is the primary goal of nursing profession as well as any hospital institution. In relation to this, this study was conceived in order to further assess the nursing practices of nurses of the said hospital in handling foreign clients. It is important to

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MANILA DOCTORS COLLEGEknow how wide is the practice of nurses in handling foreign clients in order to serve as a guide and a model for future nurses in Manila Doctors College. In addition, to gain knowledge of what is missing in terms of nursing practices in handling foreign client who has different culture to nurses in said hospital. This will be helpful for both registered nurses and future nurses. With this, the author would like to know the extent of transcultural nursing practices in Manila Doctors Hospital. Conceptual Framework Big responsibilities are on the shoulder of nurses since nurses serve as the front liner in facing different client every day. Interventions that every nurse employs are very important to help client improve and achieve optimum health as well. Thus, nursing practice should be considered in dealing with different client especially with foreign patients or clients. The study was based on Madeleine Leiningers theory patterned in her Sunrise Model of Transcultural Nursing, the author would like to investigate the factors suggested by Leininger namely, communication, space, and environmental control that can affect the extent of delivery of care for foreign patients. Transcultural nursing is a humanistic and scientific area of formal study and practice in nursing which focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the peoples cultural

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MANILA DOCTORS COLLEGEvalues, beliefs, and practices, and to use this knowledge to provide cultural specific or culturally congruent nursing to people. Leininger noted the main goal of

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transcultural nursing in her study is to discover and explain diverse and universal culturally based care factors influencing the health, well-being, illness or death of individuals or groups. Leininger theorized that every culture had access to some form of folk indigenous health care system and that some, but not all, had access to a professional health care system. According to Leininger, sunrise model provide a valuable guide to obtain data to gain cultural knowledge and understanding. Moreover, it can help

transcultural visitor like the author to discover data about specific individuals, groups, families, communities or institutions, and can be used in diverse settings (Leininger, 1997). The author focuses on communication, space and environmental control. The extent of transcultural nursing practices in Manila Doctors Hospital is based on Sunrise Model. Sunrise Model will help the author to assess the extent of

transcultural practices that every nurse performs in handling foreign patients. The factors chosen by the author are part of environmental context, language and ethnohistory. Under communication, language spoken, voice quality,

pronunciation, and nonverbal communication; while under space were the following: degree of confront observed (conservation), proximity to others, body

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MANILA DOCTORS COLLEGEmovement and perception of space; and lastly in environmental, cultural health practices efficacious neutral dysfunctional uncertain, values, and definition of health illness were part of the authors study. Communication is very important not only in transcultural nursing because communication is a way for people to express their selves and in order to maintain peace due to comprehending ideas, thoughts, instructions, and procedures to each and everyone especially between nurses and foreign patients. Leininger stated that to ensure a mutually respectful relationship between foreign patients and nurses, nurse should introduce her or himself and indicate to the foreign patients on how he or she wants to be address by his or her nurse, it can either be by name, last name, and or title. Nurse should elicit from the foreign client because this enables the nurse to address the foreign clients in a manner that is culturally appropriate. According to Leininger cited by Andrew and Boyle space is significant in cross-cultural communication. Space and distance from the client will help nurses to avoid conflict with foreign patients they handle. It is included in Leiningers Sunrise Model because there are culture that give values to space and distance like for instance those from Latin America, Japan, and Middle East which they need the least amount of space and feel comfortable standing close to others. Lastly, environmental control which has a significant influence upon clients healthcare practices (Leininger cited by McFarland, 2008). Different

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MANILA DOCTORS COLLEGEcultures might have different beliefs in relation to environment. Foreign patients belief and attitude towards his treatment and prognosis might be influenced by his or she believes which can control over events or whether he or she is more fatalistic and believes that chance and luck determine what will happen to him or her. Patients may cooperate with health regimens and can see the benefit of developing behavior that could improve his or her health. Some American Indians and Asian Americans believe in this category. With these factors to consider, it will help the author to assess the extent of transcultural nursing practices in Manila Doctors Hospital. Conceptual Paradigm Profile: Gender Age Number of Foreign Patients Handled Extent of Transcultural Nursing Practices: Communication Space Environmental Control

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Figure 1 Conceptual Paradigm Figure 1 shows the interplay of the variables chosen. The independent variable which is profile includes the age, gender, and the number of foreign patients handled of staff nurses in Manila Doctors Hospital while the extent of transcultural nursing practices is the dependent variable which refers to

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MANILA DOCTORS COLLEGEcommunication, environmental control, and space that could affect nursing practices in performing different interventions in giving care. Statement of the Problem This study aims to answer the following question: 1. What is the profile of the respondents in terms of: 1.1 Age, 1.2 Gender, 1.3 Number of foreign patients handled? 2. terms of: 2.1. Communication, 2.2. Space, 2.3. Environmental Control? 3. Is there a significant difference in the extent of transcultural nursing What is the extent of transcultural nursing practices of respondents in

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practices of Manila Doctors Hospital when grouped according to the profile?

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MANILA DOCTORS COLLEGEStatement of Hypothesis The hypothesis was tested at 0.05 level of significance. There is a no significant difference in the extent of transcultural nursing practices in Manila Doctors Hospital when grouped according to the profile. Significance of the Study The study was designed to overview the extent of transcultural nursing practices of staff nurses in providing care to foreign patients. The study will benefit to the following: For the Staff Nurses of MDH, The study will help the staff nurses in Manila Doctors Hospital to realize how important is considering their patients culture. They can foster also cooperation to achieve an effective nursing care. Expertise in their medical profession is not enough because having and maintaining a harmonious relationship with different patients is very important so that patients will trust the nurse who is attending and providing to their needs. It will train them on how to become more effective staff nurse in dealing with foreign patients. Knowing the extent of transcultural nursing will help staff nurses to identify what is missing and needs improvement of providing care to foreign patients. And for nurses to be globally competitive who has plan of and planning to go back abroad to practice their profession. So that nurses will be independent in rendering care

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MANILA DOCTORS COLLEGEand services to different patients of providing quality care. It can help nurses to have an effective care if they will consider different practices and cultures of each patient they encounter and handle regardless of their culture and country they come from. For the College of Nursing, since many staff nurses in Manila Doctors Hospital are products of the College, this study will help and guide the College of Nursing (CON) in Manila Doctors College to know how profound the knowledge of students regarding transcultural nursing. They will be aware that transcultural nursing practices should be given emphasis in their curriculum since there is an evidence of foreign patients comes to the Philippines to seek for medical help. There is a greater probability that students would handle foreign patients. Having the background of the extent of transcultural nursing practices of staff nurses will help the faculty to determine the focus of learning that faculty should focus on as well as to determine the other factors of transcultural nursing that students needs to know in order to develop their skills of providing care to different patients regardless of different cultures and country they come from. CON can lead their students to practice and become an effective student nurse and eventually professional nurse in providing an effective care to foreigners. For the Nursing Students, as this early stage, it is important for student nurses to value the importance of considering their patients culture before

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MANILA DOCTORS COLLEGEadministering care in order to encourage cooperation, and to have an effective care. It might be the source for students to have the knowledge regarding the appropriate knows approach or style to use in dealing with foreign patients. Handling foreign patients in different hospitals will train students from Manila Doctors College who have plans of practicing their profession as nurses, once they pass the nursing board examination, outside the country and be globally competitive. And lastly, to

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address the students of mentioned institution the importance of transcultural nursing practice to their future profession and to inform the students regarding the importance of learning different transcultural nursing practices that are necessary in giving care and dealing with different patients. Nursing Service, with this study, it will help the nursing service to determine if they have the need to further develop their staff nurses in handling foreign patients by giving seminars, trainings or even refreshment courses that can develop the skills of staff nurses in facing, handling, and improve nursing practices to facilitate cooperation and fast recovery of foreign client. Future Researchers, with this study, future researcher will help determine the coverage of their future study if they want to continue studying transcultural nursing practices here in the Philippines. This study only covers the extent of transcultural nursing practices. Future researchers can study the different indicators that can affect staff nurses of providing care to foreign patients. They can also

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MANILA DOCTORS COLLEGEstudy the different factors that can affect transcultural nursing practices like if politics, economics, and technological factors can affect staff nurses in giving and providing care to foreign patients. Scope and Delimitations of the Study The scope of the study was delimited to the extent of transcultural nursing practices of staff nurses in Manila Doctors Hospital (MDH). The research does not focus on the relationship among staff nurses and their employer rather on the extent of staff nurses of practicing transcultural nursing to their patients. This study focused only to staff nurses of Manila Doctors Hospital (MDH) who are working in different floors of the said hospital such as from 3rd up to 5th floor of the old building, and from 3rd up to 11th floor of the new building. Respondents are registered nurses who has experienced of handling foreign patients, and with at least 20 years of age. . The respondents of this research are representatives of the whole Manila Doctors Hospital (MDH). There are 11 floors in the new building and 5 floors in the old building but the researcher focused on 30 staff nurses of private wards of the said hospital due to limited time of the study. It would be difficult and impractical to give questionnaires with all nurses of all floors of both building. Thus, the findings may only hold true based on the results of interviews and

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MANILA DOCTORS COLLEGEquestionnaire given to staff nurses of private wards that would obtain from the respondents who was selected by convenience. The study was a non-experimental, quantitative, descriptive design on the extent of transcultural nursing practices in Manila Doctors Hospital (MDH). In addition, a purposive sample technique utilized in this study based on the authors criteria mentioned above. The author used a surveyed questionnaire with a format of closed-ended questions which was use to statically measure the extent of transcultural nursing practice in Manila Doctors Hospital (MDH). Lastly,

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questionnaires are answerable with adjectival ratings as follows: fullest extent (FlE), full extent (FE), moderate extent (ME), lesser extent (LE), and least extent (LtE); which was used as basis of the degree of extent transcultural nursing practices corresponding to each questions of each category. Definition of Terms The following terms are defined as used in this study in order to provide clarity of term used. Communication it refers to exchange of information and instructions between client and nurse that includes use of verbal and nonverbal communication.

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MANILA DOCTORS COLLEGEEnvironmental Control refers to the totality of an event, situation, or particular experience that gives meaning to peoples expression, interpretations, and social interactions, and technologic factors in specific cultural settings. Extent it is the measurement or the degree of nursing practices render by nurses to their foreign patients. Foreign Patient A person who is from other country or a non Filipino or alien to the Philippines who seek help regarding their health problems. Space refers to the distance between individuals (client and nurse), body movement, degree of confront observed or conservation when they (client and nurse) interact. Staff Nurses in this study, refers to a registered nurses employed at Manila Doctors Hospital. Transcultural Nursing Practices different nursing practices that nurses implements and practice in facing, dealing, and handling foreign patients. Nursing practices like certain distance they implement when caring for patients which is included in the factors of space in transcultural nursing.

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MANILA DOCTORS COLLEGECHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES This chapter presents information from articles and studies conducted by local and foreign researchers, which gave the researchers a wider grasp and full understand of the study. This summarizes the literature and studies that have significant bearings on the study. Local Literature Culture is not genetically inherited, it is acquired but once learned and internalize, cultural ways became forms of rationality. Culture provides the individual and the group to which he belongs with common point and reference for behavior, enhancing the sharing values, norms, believes and practices. When held in common the mention elements of behavior becomes establish into pattern that form the basis of peoples ways of listening, feeling and acting as emphasized by Linda Jocano(1999). However Sociological perspective in clinical pastoral care underscores the sociocultutral context that qualifies a person life, consequently, the context or the climate when it stifles human life will demand a qualitative change for authentic human development to happen. It takes the whole social reality economic, politic,

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MANILA DOCTORS COLLEGEreligion-cultural in order to humanize this for it to sustain peoples total human development efforts and objective. (Dulnalagan 1997) According to Mercado, (2002), she said that the purpose of nursing is to assist in people attaining a level of health and well being which enable them to live socially and economically productive life. To achieve this breadth of nursing is wide from curative to palliative to preventive to promotive. It also function, not in a vacuum, but increasingly in a socioeconomic political environment, through which nursing must find its way but do so in maturing independent way. In the special report of Fabon, Julia. M., (2006) he stated, in this area of practice the nurse uses her knowledge of the dynamic of human behavior. He is called upon to make for purposeful use of the self. Relationship between the nurse and the patient is established through therapeutic communication and interpersonal processes. Communication between two human beings can be difficult and challenging. The nurse can be guided by the human behavior the patient exhibits. She need to be sensitive not only to the verbal messages of the patient but to the nonverbal expression of his abstract thought and feeling that means he or she must know how to read the body language and hear the nuances of speech and voice infection.

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MANILA DOCTORS COLLEGEForeign Literature The ever-increasing multicultural population in the Unite States poses a significant challenge to nurses providing individualized and holistic care to their patients (Lorentz, 2008). It requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent

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nursing care helps ensure patient satisfaction and positive outcomes. From the transcultural point of view, healthcare providers must deliver a service that is culturally sensitive and appropriate. However, for a variety of reasons, there is growing concern that the cultural healthcare needs of minority ethnic group are not met adequately (Narayanasamy, 2003). The extent of transcultural nursing has many determinants or it can cause by many factors. These determinants can either be verbal or nonverbal factors. The profile of staff nurses can affect the extent of transcultural nursing practices in rendering quality care to foreign patients. According to Leininger, transcultural is defined as the beliefs and definitions in which cultural groups are compared and contrasted. The theoretical principle of transcultural nursing guides nurses in providing meaningful and appropriate care to people of diverse and similar cultures. Transcultural nurses are academically prepared to serve many cultures by respecting the worth, dignity

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MANILA DOCTORS COLLEGEand rights of individuals, families, groups and communities. Most important, transcultural nurse are prepared to assess the cultural care needs of people and to skillfully integrate the values, beliefs and lifeways of cultures for the health and well-being of those served as human rights imperative. Moreover, transcultural nurse shows compassion and humanistic caring to alleviate cultural conflicts, cultural imposition, and cultural pain to people of diverse cultures. Knowledge of nurses of transcultural nursing provides creative ways to maintain, accommodate, and/or restructure care in meaningful and beneficial ways for people of the world. Transcultural nursing society believes that nurses and other health care practitioners should provide and maintain humanistic care for people worldwide. Focus of care of nurses is on preserving and maintaining the human right of all people. Theses human rights should not be denied neglected or violated and deserve protection from acts of injustice. Healthcare practitioners especially

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transcultural healthcare practitioner should influence healthcare policy and practices by individuals and institutions to enhance the care for people worldwide. Regardless of race, ethnicity, national origin, religious and philosophical beliefs, gender, sexual orientation, cultural values, age, and other diversities, people have the following universal human rights. Transcultural nursing society named name human rights that every person must achieve in providing a holistic care, this were the following: Access to quality care including qualified healthcare professionals, organizations and resources; Access to culturally and linguistically competent

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MANILA DOCTORS COLLEGEhealthcare providers; Respectful care with recognition for personal dignity, privacy and confidentiality; inform participation in ones own healthcare; Involvement of family members and significant others in healthcare delivery and decision making if desired by the care recipient; Accept or refuse care and negotiate with healthcare providers to achieve culturally congruent care; Freedom form healthcare treatments that involve coercion, bribery, and illicit activities that place ones well being at risk; Receive care in an environment in which physical, psychological, spiritual and cultural safety is assured for the person and his or her family, and significant others; and Receive care without putting ones self or loved ones in jeopardy or harms way. In relation to this, foreign patients receive appropriate care even if they seek medical help outside their country. We as Filipino nurses, is responsible to provide care that they deserve in order to achieve optimum health. Care is the heart of nursing; care is essential to healing or well being; care is curing; care is or should be the central and dominant focus of nursing and transcultural nursing decisions and actions. Transcultural nursing promotes and upholds these ideas because human beings are born, live, work and die within a culture care context and viewpoint. To neglect cultural factors such as ones religion, family ties, and economical, political, educational and technological factors can lead to non-caring and cultural negligence with often non-beneficial outcome (Leininger, 1998).

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MANILA DOCTORS COLLEGECulture has a powerful influence on ones interpretation of and responses to health and everyone has the right to be respected for his or her uniqueness and cultural heritage. Caregivers need both general and specific cultural information to provide sensitive and culturally competent care. Cultural awareness improves the caregivers self-awareness (Purnell, 2002). To provide culturally congruent care is to provide care that is meaningful and fits with cultural beliefs and life ways of the client. It refers to the use of (local cultural knowledge and life ways) in meaningful and tailored ways that fits with ethic (largely professional outsiders knowledge) to help specific cultures, whether ill, disabled, facing death or other human conditions (Leininger, 1999). Currently, there are inadequate numbers of health care providers worldwide who are prepared to provide culturally congruent care. Many providers neither recognize nor acknowledge the existence of variety of healing and caring paradigms that are widely valued and used. In addition, health providers are frequently unwilling or unable to accommodate ways of knowing and healing that do not fit into their own cultural frameworks of knowledge and experience. Instead, they impose practices of care on people that are ineffective or harmful, rather than working collaboratively across paradigms and care systems. Actions related to ethnocentrism, lack of awareness and moral blindness perpetuate and exacerbation healthcare inequities (Lauderdale, 2005). Moreover, the inequities,

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MANILA DOCTORS COLLEGEdiscriminations and sufferings must not continue given available resources, healthcare providers throughout the world have the ability to address and redress the inequities. Nurses in particular, have the potential to bridge gaps in cultural knowledge about health and caring that will significantly reduce the impact of intolerance, in full access, and decrease health inequities locally and globally. Most of all, collective political action is needed to channel resources into education and preparation of nurses and other health care provides in order to systematically address crisis (Lauderdale, 2005). Culturally competent care is care that is sensitive to the differences individuals may have in their experiences and responses due to their heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background. It is care that is based on understanding how those differences may inform the responses of people and the processes of caring for them (Meleis, 1999). There are seven components of nursing that were identified as the essence of Native American Nursing Practice at a Summit of Native American Nurses in 1997. The essence was described as being synonymous with nature, core, gist, substance, spirit, heart, or principle. The following themes were identified as an essence of Native American Nursing is the following: caring, traditions, respect, connection, holism or holistic, trust, and spirituality. There is a need to leg go of the rational mind to bring transformation energy into all aspects of work of nurses.

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MANILA DOCTORS COLLEGEHowever, the literature suggests that Native American Nursing Practice might view cultural competence on a continuum which is described unconscious incompetence meaning no awareness that one is lacking cultural knowledge; conscious incompetence means there is knowledge but still not know how to use it; conscious competence meaning intentional act of learning about a patients culture and providing culturally responsive nursing interventions; and lastly, unconscious competence meaning the ability to spontaneously provide culturally responsive care to individuals from divers cultural backgrounds. The literature suggests that in order for nurses to become culturally competent, they must identify their personal values, clarify values of self and client and integrate those values into their own professional practice. The nurses competence can be the basis on the extent of transcultural nursing practices they perform and provide to their patients. Purnell model for cultural competence is really built on Leiningers model with minor exceptions. Purnell states that a culturally competent healthcare

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provider develops the following: an awareness of his or her existence, sensation, thoughts, and environment; those does not let these factors have an undue effect on those for whom care is provided. While the major assumptions of the model were the following: all healthcare providers needs similar information about cultural diversity; all share the mataparadigm concepts of global society, community, family, person and health; one culture is not better than another culture; all cultures

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MANILA DOCTORS COLLEGEshare core similarities; differences exist among, between and within cultures; and cultures change slowly over time in a stable society. Transcultural nursing theory is incorporated in the Sunrise Model of Culture Care of Madeleine Leininger. Nurses who use this theory in nursing care often referred to us providing culturally competent care, although this term is gaining popularity outside this framework as well. According to sunrise model, culture care and similarities between patients and nurses exist in all human cultures worldwide. Culturally congruent nursing care occur when individual, group,

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family, community, or institutional care values, expressions or patterns are known and use explicitly in appropriate and meaningful ways. The model avoids focus on medical problems, and fragmenting client and looking at many important variables affecting client. Giving care is the essence of nursing and distinct, central, and unifying force. In addition, Sunrise Model provides a valuable guide to obtain data on culture to gain cultural knowledge and understanding. In relation, sunrise model can help a transcultural visitor to discover data about specific individuals, groups, families, communities or institutions, and can be used in diverse settings (Larson, 2004). It provide an ideal format for building trust in a transcultural context and offered this observer a comprehensive and holistic view of health through the examination of cultural and social structures, and care expressions. Each

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MANILA DOCTORS COLLEGEdimension of Sunrise Model can readily observe in terms of the present and ancient culture. Theory of Culture Care and Sunrise Model were the conceptual and theoretical guides used to discover the worldview, lifeways, and cultural values. The Sunrise Model depicts the components of a culture which include worldview, cultural and environment context, and seven social structure factors (Lee, 1996). This social factor emphasizes social structure dimensions that include: Technological Factors, Religious and Philosophical Factors, Kinship and Social Factors, Cultural Values and Lifeways, Political and Legal Factors, Economic Factors and Educational Factors (Larson, 2004). Based on the Sunrise Model, the seven social factors mentioned in under the influences care expression, patterns and practices. The researcher chose communication, environmental control, and space that can affect transcultural nursing. Among the three, communication is the most important since communication is a medium for other people to understand each other; followed by environmental control and space that could affect the culture of foreigner whenever they seek medical assistance in the Philippines which nurses should consider before rendering care. Establishing an environment where cultural differences are respected begins with effective communication. Communication is the means by which culture is transmitted and preserved. In addition, communication can be language spoken;

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MANILA DOCTORS COLLEGEvoice quality, pronunciation, and use of nonverbal communication not purely rely on spoken language. Both verbal and nonverbal communications are learned in ones culture (Davidhizar and Giger, 1994). Verbal and nonverbal patterns of communication vary across cultures, and if nurses do not understand the patients cultural rules in communication, the patients acceptance of treatment regimen may be jeopardized (Davidhizar and Giger, 1994). This occurs not just from speaking the same language, but also through body language and other cues, such as voice, tone, and loudness. According to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) they require facilities to have interpreters available. At times nurses will be on their own interacting with patients and families who do not speak English tips were provided in order to avoid barriers of communication. To name a few were greet the patient using his or her last name or complete name; avoid being to casual or familiar; point to yourself (nurse) say your name and smile; nurses should proceed in an unhurried manner and pay attention to any effort the patient or his or her family makes to communicate; speak in a low, moderate voice and avoid talking loudly because there is a tendency to raise the volume and pitch of our voice when a listener appears not to understand. In result patient may think that nurse is angry and shouting. Use short, simple sentences and speak in the active voice. Use simple words, such as pain rather than discomfort. Avoid medical jargon, idioms, and slang. Give instruction in the proper sequence like for instance, rather than saying, Before you take the medicine, get into bed, you

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MANILA DOCTORS COLLEGEshould say, Get into your bed, then take your medicine. And lastly, the nurse should check and see if the patient has another language in common. For instance, many Indo-Chinese people speak French, and many Europeans know three or four languages. language. To ensure that a mutually respectful relationship is established, nurse should introduce her self or his self and indicate to the client how they prefer to be called either by first name, last name, and or title. Nurse should elicit the same formation from the client because this enables the nurse to address in a manner that is culturally appropriate (Andrew and Boyle, 2007). Nonverbal communication pattern vary widely across cultures, nurses must be alert for cues that convey cultural differences in the use of silence, eye contact, touch and space distance and facial expression. Wide cultural variation exists in interpretation of silence. Some individuals find silence extremely uncomfortable and make every effort to fill conversational lags with words. In contrast, many native North American consider silence essential to understanding and respecting the other person (Andrew and Boyle, 2007). Accurate diagnosis and treatment is impossible if the healthcare professional cannot understand the patient. When the provider is not understood, he or she often avoids verbal communication and does not realize the effect of Try Latin words or phases that if the nurse is familiar with the

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MANILA DOCTORS COLLEGEnonverbal communication, which is all too often the painful isolation of patients who do not speak the dominant language and who are in an unfamiliar environment. Consequently, the patient experiences cultural shock and may react by withdrawing, becoming hostile or belligerent, or being uncooperative (Spector, 2000). Culture not only determines the appropriateness of the message but also influences all the components of communication. The concept of space and distance are significant in cross-cultural communication. Such behavior by theses clients is probably an attempt to bring nurses close into the space that is comfortable with close physical proximity to theses client, they are perplexed by nurses distancing behavior and may perceive nurses as aloof and unfriendly. Space refers to the distance between individuals when they interact. All communication occurs in the context of space (Giger and Davidhizar, 2002). Space includes degree of confront observed (conservation), proximity to others, body movement, and perception of space. According to Spector, there are four distinct zones of interpersonal space: inmate zone (extends up to 1 feet), personal distance (extends from 1 to 4 feet), social distance (extends from 4 to 12 feet), and public distance (extends 12 feet or more). In relation, rules concerning

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personal distance vary from culture to culture. The extreme modesty practiced by members of some cultural groups may prevent members from seeking preventive

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MANILA DOCTORS COLLEGEhealth care (Spector, 2000). For instance, some Afghans prefer closeness in space with others and particularly with the same sex. When comfortable with others, these individuals prefer to be in close proximity to build trusting relationships (Giger and Davidhizar, 2002). Giger and Davidhizar stated that comfort level is related to personal space like comfort in conversation, proximity to others, body movement, perception of space. Eye contact, space, and touch practices may be very different from ones sphere of reference. People tend to regard the space immediately around them as an extension of themselves. The amount of space they prefer between themselves and others to feel comfortable are a culturally determined phenomenon. Most people aren't conscious of their personal space requirements - it's just a feeling about what's comfortable for them - and you may be unaware of what people from another culture expect. For example, one patient may perceive your sitting close to him as an expression of warmth and caring; another may feel that you're invading his personal space. Research reveals that people from the United States, Canada, and Great Britain require the most personal space between themselves and others. Those from Latin America, Japan, and the Middle East need the least amount of space and feel comfortable standing close to others. Keep these general trends in mind if a patient tends to position himself unusually close or far from you and be sensitive to his preference when giving nursing care.

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MANILA DOCTORS COLLEGETouch is a body movement that is culturally determined to a great degree. For instance, in Hispanic and Arab cultures, male health care providers may be prohibited from touching or examining certain parts of the female body; similarly, females may be prohibited from caring for males. While among many Asian Americans, touching a person's head may be impolite because that's where they believe the spirit resides. Before assessing an Asian American patient's head or evaluating a head injury, you may need to clearly explain what you're doing and why. As nurses, always consider a patient's culturally defined sense of modesty when giving nursing care. For example, some Jewish and Islamic women believe that modesty requires covering their head, arms, and legs with clothing. Respect their tradition and help them remain covered while in your care. Various cultural groups have wide-ranging beliefs about mans relationship with the environment. A patients attitude toward his treatment and prognosis is influenced by whether he generally believes that man has some control over events or whether he is more fatalistic and believes that chance and luck determine what will happen. If your patient holds the former view, you are likely to see good cooperation with health care regiments; he will see the benefit of developing behavior that could improve his health. Some American Indians and Asian In contrast, Hispanic and

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Americans are likely to fall into this category.

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MANILA DOCTORS COLLEGEAppalachian patients tend to be more fatalistic about nature, health, and death, feeling that they cannot control these things. Patients who believe that they cannot do much to improve their health through their actions may need more teaching and reinforcement about how diet and medications can affect their health. Provide information in a nonjudgmental way and respect their fatalistic beliefs. Environmental control refers to the ability of the person to control and to plan and direct factors in the environment. It includes cultural health practices efficacious neutral dysfunctional uncertain, values, and definition of health and illness. Some groups perceive man as having mastery over nature; others perceive humans to be dominated by nature, while others see harmonious relationships between humans and nature (Giger and Davidhizar, 2002). This particular cultural phenomenon plays an important role in the way patients respond to health-related experiences, including the ways in which they define an illness and seek and use health-care resources and social supports. For instance, Asians and Native Americans may perceive that illness is a disharmony with other forces and that medicine is only capable of relieving the symptoms rather that curing the disease. Theses groups are likely to look for naturalistic solutions, such as herbs and hot and cold treatments to resolve or cure a cancerous condition (Degazon, 1996). In addition, environmental context also has significant influence upon the clients healthcare practices. Environmental context refers to the totality of an event,

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MANILA DOCTORS COLLEGEsituation, or particular experience that gives meaning to peoples expression, interpretations, and social interactions, and technologic factors in specific settings (Leininger, 2006). In relation, that statement holds significance for nurses

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practitioners in primary care contexts. For instance, the setting of the office such as are, literature, ambience or decor, client flow design or user friendliness, type or content of magazines and teaching literature; languaging of forms, staff composition or posture or language or tone, and means of meeting and greeting all lend to the totality of the primary care experience of the client. The nurses practitioners body language, listening skills, approach to assessment and sharing of information, flexibility towards modifying professional practices advised, and attention to privacy and confidentiality during the encounter contribute to the particular experiences of the patient within the environmental context of the primary care settings. These contributing factors in interactive totality influence the clients perspective of the nurse practitioner, the healthcare encounter, and indeed, the healthcare system, and significantly affect the individuals willingness and ability to use the modalities of care mutually chosen as the plan of care (McFarland and Eipperie, 2008). According to Leininger, man is a social being within a culture. Needs are holistic, and include needs for both care and cure. Health equates to caring and harmony within culture. It is state of well-being that culturally defined. World views, social structures, and cultural beliefs cannot be separated from the concepts

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MANILA DOCTORS COLLEGEof health, wellness and illness. The environment in which an individual participates is key in maintaining optimal health. Moreover, Leiningers broad view of the environment includes technological, religious, philosophical, kinship, cultural, political, legal, economical, and educational systems. The disharmony between each area is causing further stress to optimum level of functioning. According to Rasmussen (2009), the nurse must place patient in best possible condition for healing to occur. The environment is all external conditions and influences affecting the life and development of organisms and capable of preventing, suppressing, or contributing to disease or death. Florence Nightingale stated that the art of nursing is to provide an environment in which the patient is in the best position for nature to act upon, and Martha Rogers, in turn, emphasized that one part in nursing is to pattern the environment into a place where healing conditions are optimal. Caring is the essence of nursing. Nursing care that is not congruent with the beliefs and values of a patients culture will lead to noncompliance and stress. The healthcare professional therefore has to take into consideration all of the factors that pertain to each domain. The overall goal is to maintain equilibrium between the individuals external stimuli as well as balancing the internal stimuli. The review of related literature indicates the facts on how culture influences nursing care. We nurses need to recognize, appreciate and respect cultural

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MANILA DOCTORS COLLEGEdifferences in healthcare values, beliefs, and customs. The study helps us understand aspects of cultural differences and extent of transcultural nursing practices that have been studied by different person who studied transcultural nursing. Also it leads nurses to render appropriate care for certain individuals and their beliefs for the client's maximum satisfaction. Leininger (1991) notes the main goal of transcultural nursing is to discover and explain diverse and universal culturally based care factors influencing the health, well-being, illness or death of individuals as groups. But before transcultural nursing can be adequately understood, there must be a basic knowledge of key terminology such as culture, cultural values, culturally diverse nursing care, ethnocentrism, race, and ethnography. To be able to attain these goals, we need to treat each client as a unique individual with unique beliefs and traditions and this promotes nurse-client interaction, which is the best way to find out his cultural preferences.

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This study gives knowledge to the healthcare providers on how to react and deal when confronted by a situation which deals with the client's cultural preferences. This is important because some cultures have rigid codes of behavior that need to be strictly followed whatever the reason may be.

It is said that the main goal of transcultural nursing is to provide culturally specific care. The relevance of that statement reverberates more in our society more than in any other period in the past. As the world increasingly becomes more

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MANILA DOCTORS COLLEGEglobalized labor and services consequently become more and more flexible in terms of location. Economically speaking, countries now ascribe to the more for less maxim; they are now more open and more aggressive in terms of sourcing out the cheapest labor and services, from any other country, just so long as they could maintain a competitive advantage. This is very much apparent in the field of nursing, since nurses can work anywhere and everywheretheir labor and service is not location-bound. In the Philippines, most nursing graduates aim to land a job in other countries for the promised higher wages; and the countries that hire them, in turn, see nurses as better investments as compared to those who trained locally, for they demand higher salaries. As nurses, it is the conscientious route to take into account the cultural differences in the country that they work in. It is ideal to have knowledge of what specific nursing approaches one should employ in a certain situation, in a certain culture, for them to be able to deliver the most efficient and effective healthcare possible, one that is in line with the culture that is in place. A nurse who intends to pursue a job overseas should be aware of the ideas embedded in the study of transcultural nursing, as this will help him or her acclimatize better to the work environment of a new culture, and to better provide quality healthcare services for patients. A good grasp of extent of transcultural nursing practice and what transcultural nursing entails will go a long the way in terms of nurses being more capable of providing better services, and in the long run, in fostering a more comprehensive idea of how certain nursing approaches, applied to the right

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MANILA DOCTORS COLLEGEscenarios, can improve the atmosphere in the workplace and the overall satisfaction with the work done. Local Study According to the study of Chit Estella, (2004), the national institute of health warns that because of migrating nurse are usually the one with training experiencing and skill, patient in hospital and other health institution in the Philippines can expect a higher incidence of cross-infection. With the best among nursing student often leaving as soon as they graduated, the less skilled are taking the place of senior or relatively more experienced nurses who have also left for other shores. In a year or two they too would be gone the void could be filled once more by fresh graduates who would repeat the same cycle: get a few experienced in a local hospital, apply for work abroad and then leave. In the relevance to the study of Chit Estella, Soon student nurses will become professional nurse and will be facing different people not only coming from different provinces but from other country as well who have a different culture from Filipino nurses. And for nurses to be globally competitive who has plan of and planning to go back abroad to practice their profession. The study of Gadut, Ma. Carmelita et.Al (2006), in every institution there are values in providing nursing care for their patient, in pursuing the Course of Bachelor of Science. There are factors that may posses for better understanding

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MANILA DOCTORS COLLEGEwhat nursing is all about, most student took nursing because of other countries demand for competitive advantage, creative, caring, cultural adapted, competent and committed nurses. Foreign Study According to Youqing Peng, et.al., in recent years, with the deepening of Chinas reform and opening as well as the increasing of international exchanges the number of foreign patients in Pudong New District in Shanghai is growing persistently. Nurses face more and more patients from different countries, nations, with different languages, complexion and cultural background, whose transcultural needs are obviously upgrading. Because of different social environment and cultural background, foreign patients knowledge, beliefs, values, customs and habits are also different, it is a tendency to understand comprehension of transcultural and provide transcultural nursing .The purpose of this study is to understand the transcultural nursing needs of the foreign patients in Pudong New District to provide a basis for the implementation of transcultural nursing. Under the conditions of modern society, transcultural nursing is the inevitable trend of nursing development. It means that, according to different patients world outlook, value. Religion belief, living habits, nurse should take different nursing measures to satisfy health care demands with different cultural background. Madeleine Leininger pointed out that the culture care needs of people

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MANILA DOCTORS COLLEGEin the world will be met by nurses prepared in transcultural nursing. She considered that the culture care is the essence and the central idea of nursing, the motivity of cultural activities and it is the basic on which nurses provide patients nursing in line with their cultural background. Researcher documented an investigation and analysis of transcultural nursing needs of the foreign patients. It shows there is a lot needs of the nursing service (the nurses English translating service, privacy protection and so on). Researchers data suggest that health care providers and nursing managers should be improved in the nurses spoken English, transcultural nursing theory. And the training of transcultural nursing application capacity for nurses needs to be strengthened. The implementation plans need to be formulated and carried out including the policy of privacy protection and aspect of customs and taboos, optimized nursing service flow, so as to improve the quality of transcultural nursing service. The development of the above-mentioned scheme, regulations and process needs patient's participation. During the implementation, nurses should

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continuously listen to the foreign patients feedback, so as to make transcultural nursing measures to satisfy patients needs and improve the service quality of transcultural nursing. According to Synder (2004), although most nurses are women, there is no biological reason to assume that women are the only gender suited to the nursing

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MANILA DOCTORS COLLEGEprofession. Rather, women are nurses because nursing has been socially constructed and institutionalized as a feminine occupation. In fact, historically nursing was a male-dominated occupation in many cultures. Nursing, which until the late nineteenth century was a strictly male occupation, was opened up, albeit reluctantly, to females largely as a result of Florence Nightingale and her work during the Crimean War. Men let Florence do her thing, thus turning over to women hospital dirty work to make it womens work. Regarded at that time to be a radical departure from the accepted norm, nursing as a feminine role has acquired an historical weight. The role of the nurse has been accepted as being especially congruent with the traditional role of the female in western culture (Etkowitz 1971: 432). Today, nursing is considered to be a nurturing and caring profession attributes associated more with women than men. In relevance to the study of Synder (2004), the researcher wanted to prove that there is no significant difference in extent of transcultural nursing practices in Manila Doctors Hospital when grouped according to gender. In fact, historically nursing is male dominated, in contrast to the population at Manila Doctors Hospital that the dominated staff nurses are female. Relevance to the Present Study From the related literature gathered, the authors were able to derive variables influencing extent of transcultural nursing practices in Manila Doctors

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MANILA DOCTORS COLLEGEHospital such as communication, space and environmental control. The variables mentioned will serve as a tool for measuring the extent of transcultural nursing practices of these staff nurses. The related literature and studies are arranged in such a way that given the subject matter, this will support authors study based on evidence collected from the related literature. These variables will also serve as a comparison to the authors study. Therefore, there is a reason to conduct this study having cited literature as proof that there is existence of problems related to extent of trancultural nursing practices. The studies can be closely related to the topic under investigation. Local studies will be focused on the demographical data of the population being studied. The facts gathered clarified the extent of transcultural nursing practices of staff nurses regarding transcultural nursing. The said studies had an associate significance with the current study since it gives support to the extent of transcultural nursing practices. Lastly, with the help of Madeleine Leiningers Transcultural Nursing Theory, the author can relate the extent of transcultural nursing practices in terms of staff nurses communication, space and environmental control with their foreign patients. Then, the extent of transcultural nursing practices determines individuals adaptation towards existing problems like proper handling of caring for a foreign

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MANILA DOCTORS COLLEGEpatient. Through this the author can determine measure of significance of their study.

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MANILA DOCTORS COLLEGECHAPTER III METHOD AND P ROCEDURE This chapter discussed the methodologies and procedures used by the researchers in answering the specific problems stated. It also tackled the research design, the subject of the study, the instruments used in gathering the data, and the statistical method used to check relevance of the data gathered. Research Method/ Design The research study is a non-experimental, quantitative, descriptive design. It was aimed to determine the extent of transcultural nursing practices perform by staff nurses in providing and giving care to foreign patients. The reasons for extent of transcultural nursing practice has been described, analyzed, and summarized. Research Locale Staff nurses from private floors of Manila Doctors Hospital (MDH) are the locale of study. Thirty (30) registered staff nurses from different private floors of old and new building was the area of study. Entry in this hospital is possible because Manila Doctors Hospital is the base hospital of Manila Doctors College. Sample and Sampling Technique A purposive sample technique utilized in this study based on the authors criteria. Registered staff nurses selected based on the following criteria: nurses

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MANILA DOCTORS COLLEGEshould be a registered nurse, should have experienced handling foreign patients, and at least 20 years of age. Thirty (30) registered staff nurses respondent of Manila Doctors Hospital (MDH) were the target population, since it was the permitted number of respondents given by the chief nurse. Thirty registered staff nurses working in private wards of both old and new building of the hospital was selected in different floors namely, 3rd up to 5th floor of the old building, and from 3rd up to 11th floor of the new building. Using a survey in a form of questionnaire was distributed to thirty registered staff nurses covering all morning and afternoon shift nurses on duty during the day. Questionnaire was divided into three categories namely communication, space, and environmental control. The sample questionnaire is included in our appendix (appendix B). Research Instrument The author made use of survey questionnaire. The survey questionnaire used a closed-ended question format, which was use to statistically measure the extent of transcultural nursing practice in Manila Doctors Hospital (MDH). The survey questionnaire is composed of two (2) parts, one, profile of respondents; and second, survey proper with three (3) categories to cover. The profile part is composed of name which is optional, age, gender, and number of patient handled by a nurse. The first category of the second part is Communication which

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MANILA DOCTORS COLLEGEcomprises of language spoken, voice quality, pronunciation, and use of nonverbal communication. Followed by space which comprises of degree of confront

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observed (conservation), proximity to others, body movement, and perception of space. Lastly, environmental control which comprises of cultural health practices efficacious neutral dysfunctional uncertain, values, and definition of health and illness. Questions from the survey are written in English since a registered nurse is capable of comprehending different questions ask written in universal language. Questions are answerable with adjectival ratings based on the degree of extent of transcultural nursing practices corresponding to each questions of each category. Adjectival rating is the following: fullest extent (FlE), full extent (FE), moderate extent (ME), lesser extent (LE), and least extent (LtE). Validation of the instrument In preparation of the research questionnaire, the researchers submitted the first draft to the thesis adviser and lecturer for comments and suggestions. The researchers considered the comments and suggestions to improve the

questionnaires. The final draft was prepared with the suggestions integrated. The final draft was then under validation from experts of the chosen field of study.

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MANILA DOCTORS COLLEGEThese experts are those who have a mastered degree in arts of nursing (MAN), a registered nurse who became supervisor in other country, and a professor who has a profound knowledge in transcultural nursing. Those experts have The

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examined whether each item of question falls in appropriate category. questions had modified incorporating the experts comments. Test for Reliability of Instrument

The instrument had subject to a pilot study in a sample population (n-30) of registered nurse in mentioned hospital use for the stability reliability analyses. Results have been computed and interpret by the experts using a Crobachs Alpha which gave us a result of .958 with a total pilot population of 30 respondents. With this result, it supported a high reliability test using the survey questionnaire presented during pilot study. Respondent from the pilot study have the same criteria of respondents involved in the actual giving of survey questionnaire. Same questionnaire had been given to respondents in pilot study but they will not be included in the respondents of proper implementation of the study to avoid duplication of answer. Data Gathering Procedure A letter of request together with a copy of questionnaire has been sent to the Nursing Service Office of Manila Doctors Hospital (MDH). Topic and objective of the study are all stated in the letter. The Nursing Service of the said hospital gave

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MANILA DOCTORS COLLEGEan approval for research to conduct the study. A face-to-face contact between the registered staff nurses and researchers was done in explaining the purpose of the study and shown permit to head nurse of approved area to certain floors to conduct survey questionnaire coming from their superior in Nursing Service. questionnaire have The

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randomly distributed to those staff nurses on duty during

morning and afternoon shift that pass the criteria set by the author to all private floors of the hospital. Each respondent asked to self administer the questionnaire. Nurses answered the questionnaire by themselves. The author gathered and

collected the data after 24 hours or less. The data immediately collated and entered into statistical software for analysis. Statistical Treatment of Data This study has determined the extent of transcultural nursing practices in Manila Doctors Hospital (MDH) in which it had been resolute by the survey questionnaire. In seeking answers to the specific problems, the author used the following statistical tools with the use of Statistical Package for Social Science (SPSS) software which validated the findings of the study:

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MANILA DOCTORS COLLEGEFrequency and Percentage is the statistical treatment applied to answer the statement of the problem number one (1) which is about the general profile in terms of age, gender, and number of foreign patients handled by nurses at Manila Doctors n x 100 Hospital (MDH). P = was the formula used to answer the N statement problem number one where in P represents the percentage, n represents the number of responses falling under a particular category and lastly, N corresponds to the total number of respondents. On the other hand, to answer the problem statement number two (2) which is the extent of transcultural nursing practices of respondents in terms of communication, space and environmental control weighted mean is applied. The author used this statistical treatment to present the answers of the respondent based on the questionnaire. Simple

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tabulation is easy to interpret by the readers, and it is simple to crack down codes. The weighted mean of the response was computed using the formula X = Efx/N.

Wherein X corresponds to arithmetic mean, f represents the frequency and N is the total respondents. The result of respondents answer to the questionnaire has been analyzed based on the adjectival rating which is fullest extent (FlE), full extent (FE), moderate extent (ME), lesser extent (LE), and least extent (LtE). Each adjectival

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MANILA DOCTORS COLLEGErating has corresponding mean score, range, and interpretation which are presented on the next page. Table A 5 Point Likert ScaleScale 5 4 3 2 1 Range 5 and above 4.0 to 4.99 3.0 to 3.99 2.0 to 2.99 1.0 and below Interpretation Always Often Sometimes Rarely Never Adjectival Rating Fullest Extent (FlE) Full Extent (FE) Moderate Extent (ME) Lesser Extent (LE) Least Extent (LtE)

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However t-test is the statistical tool employed to answer the statement of the problem number three (3) which was to compare the significant differences in the extent of transcultural nursing practices when they are grouped according to profile such as age, gender, and number of foreign patients handled. The formula was presented below wherein X1= the Mean of sample, X2= Mean of the 2nd sample, S1= Standard deviation of the 1st sample, S2 = Standard deviation of the 2nd sample, N1 = Number of items in the 1st sample, and N2 = Number of items in the 2nd sample; was used to answer statement number three (3).

t=

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MANILA DOCTORS COLLEGEFurther more, analysis of variance or ANOVA which refers to a comparison test determined the difference of two or more groups. This study, ANOVA was used to determine the significant difference in extent of transcultural nursing practices when respondents are grouped according to number of patients handled based on communication, space, and environmental control. The equation for ANOVA test isF = MSb MSw

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where F is the Fishers ratio; MS b is mean of squared

variation between groups; and MSw is square variation within group. The decision criteria of the study were based on the 0.05 level of significant. If the result of the study is close or lesser than 0.05 level of significant the study can be rejected. While if the result is greater than 0.05 level of significant, the study can be accepted by the author.

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MANILA DOCTORS COLLEGECHAPTER IV PRESENTATION, ANALYSIS, INTERPRETATION OF DATA This chapter answers the query in the statement of the problem by classifying and tabulating the data gathered and analyzing the results. The findings of the study was presented figuratively in manner of numerical values and rated adjectively as well. 1. Profile of the Respondents 1.1 Age Table 1 shows the frequency distribution and percentage distribution of staff nurses in Manila Doctors Hospital (MDH) in matters of age. This table was the initial profiling of the respondents. This table merely represents the age

background of the respondents simplified into two which are the 20-29 and the 3039. Table 1 Frequency and Percentage Distribution of Staff Nurses According to AgeAge 21-29 30-39 Total Frequency (f) 25 5 30 Percentage (%) 83 17 100

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MANILA DOCTORS COLLEGETable 1 shows that based on the thirty (30) total number of respondents, there were five (5) respondents who belongs to age of 30-39 years old while there were twenty-five (25) respondents belongs to 21-29 years old. Table 1 shows the profile of the respondents based on age. Majority (83%) of the respondents belongs to the nurses with the age of 21-29 years of age, while minority (17%) of the respondents belongs to the 30-39 years of age. Based on findings from the 2004 National Sample Survey of Registered (NSSR) nurses (RN) in U.S. Department of Health and Human Services particularly Health Resources and Service Administration (HRSA), the average age of the RN continuous to climb, increasing to years of age in 2004, compared to 45.2 years in 2000, and 44.3 years in 1996. In relation to the result of the study, the average age of nurses in Manila Doctors Hospital (MDH) was not under the age of 44.4 rather, it belongs to the younger age which is 21-29 years old. According to the study, only nine percent (9%) of all registered nurses were under the age of 30 in 2000, while, the percent of nurses over fifty-four (54) years of age increased to 25.4 percent in 2004 which if it is going to compare with the result of nurse respondent according to profile of age nurses from Manila Doctors hospital were younger. Only seventeen percent (17%) from the 30 nurse respondents represent the age of 30-39 years old who is working as staff nurses in the said

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RESEARCH CENTER

MANILA DOCTORS COLLEGEhospital.Therefore, majority of staff nurses in Manila Doctors Hospital are age 2129 years old 1.2 Gender Table 2 shows the frequency distribution and percentage distribution of staff nurses in Manila Doctors Hospital (MDH) in terms of gender. This was the second profiling of the respondents. Table 2 Frequency and Percentage Distribution of Staff Nurses According to GenderGender Male Female Total Frequency 12 18 30 Percentage 40 60 100

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Table 2 shows that out of thirty (30) respondents there were eighteen (18) female respondents, while there were twelve (12) male respondents. Table 2 shows the profile of the respondents based on gender. Majority (60%) of the respondents belong to the female group, while minority (40%) of the respondents belongs to male group. Same with the study done by Health Resources and Services Administration (HRSA), male still comprise a very small percentage of total number of registered nurses working in their hospital, although according to HRSA number of male registered nurse is continuously growing.

RESEARCH CENTER

MANILA DOCTORS COLLEGETherefore, majority of staff nurses in Manila Doctors Hospital are female. 1.3 Number of Patients Handled Table 3 shows the frequency distribution and percentage distribution of staff nurses in Manila Doctors Hospital (MDH) in terms of number of foreign patients handled. This was the third profiling of the respondents. Table 3 Frequency and Percentage Distribution of Staff Nurses According to Number of Foreign Patients HandledNumber of patient 1-2 3-4 5 and above Total Frequency 11 10 9 30 Percentage 37 33 30 100

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Table 3 shows that out of thirty (30) respondents there were nine (9) respondents who handled 5 and above foreign patients; ten (10) respondents who have handled 3-4 foreign patients, and eleven (11) respondents who have handled 1-2 foreign patients. Table 3 shows the profile of the respondents based on number of patients handled. Majority (37%) of the respondents handled 1-2 foreign patients, while minority (30%) of the respondents belongs to 5 and above handled foreign patients. Based on Leiningers Transcultural theory, number of patients is not important in handling foreign patients. Nurses develop their skills in handling patients with different cultures or even foreign patients as nurses each day deals RESEARCH CENTER

MANILA DOCTORS COLLEGEand faces different patients. They are equipped and well-versed on proper handling in caring of patients different to their cultures. With the nature of work of nurses which they are the one who is with the patient most of the time, they are used to with dealing and facing different patients while their wok as nurses in providing and giving optimum care is not at risk but instead, they can still do their job regardless of number of foreign patients they have handled. Their experiences in handling local patients which are different with their culture help them to manage and provide a care that deserves and rightfully should be given to both local and foreign patients.2.

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The Extent of Transcultural Nursing Practices: 2.1 Communication Table 4 shows the Extent of Transcultural Nursing Practices in terms of

Communication wherein the following 10 items of queries implemented in the instrument.

RESEARCH CENTER

MANILA DOCTORS COLLEGETable 4 Extent of Transcultural Nursing Practices in Manila Doctors Hospital Based on CommunicationCommunication 1. I greet my foreign patient and his/her family before doing any procedure. 2. I establish rapport to my foreign patient 3. If my foreign patient could not speak nor understand English I performed simple action while verbalizing the instructions. 4. I speak softly and clearly when talking to my foreign patient. 5. I speak softly and clearly when talking to my foreign patient. 6. I perform simple action like sign languages or pantomime whenever my foreign patient could not understand my instructions. 7. I use simple words rather than complicated words when talking to my foreign patient. 8. I courteously listen to concerns of my foreign patient. 9. I courteously listen to concerns of my foreign patient. 10. I use terminating words upon leaving the room of my foreign patient. Composite Mean Mean 4.59 4.50 4.60 4.73 4.67 4.27 4.57 4.53 4.53 4.13 4.51 Interpretatio n Often Often Often Often Often Often Often Often Often Often Often Adjectival Description FE FE FE FE FE FE FE FE FE FE FE

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Legend: 5 and above Fullest Extent (FlE); 4.0-4.99 Full Extent (FE); 3.0-3.99 Moderate Extent (ME); 2.0-2.99 Lesser Extent (LE); 1.0 and below Least Extent (LtE)

Table 4 shows that question number ten has a mean of almost four and quarter (4.13) followed by question number six with a mean above four and quarter (4.27), question number two with four and half (4.50), same mean of more than four and half (4.53) in questions number eight and nine, question number five with 4.57, question number one with 4.59, question number three with 4.60, question number 5 with 4.67, and last but not the least, question number four with 4.73; with the overall mean of 4.51in which all have the values above four and half.

RESEARCH CENTER

MANILA DOCTORS COLLEGEIn their rating and interpretation, all questions were in category of full extent and often respectively including the overall mean or composite mean. Table 4 shows out of 10 questions in communication 10th question got the lowest mean of less than four and quarters (4.13) on the contrary, 4th question got the highest mean of higher than four and half (4.73) with the overall mean of four and half (4.51). The above data shows that the staff nurses at Manila Doctors Hospital always speak softly and clearly to their foreign patients in relation according to Commission on Accreditation of Healthcare Organization (JCAHO), it is necessary for the nurses to speak in a low, moderate and avoid talking loudly because there is tendency to raise the volume and pitch of their voice when a listener appears not to understand in re