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"Factors Affecting the Quality of Health Care Services Redered by Nurses in Mandaue City Hospital"



Nursing care is the basic need of every client who seeks medical attention from health care professionals. Nursing as it is practiced today and as it will be practice tomorrow requires an understanding of some of the current social forces currently influencing this profession. These forces usually affect the entire health care system. Nursing as a major component of that system cannot avoid the effects on services rendered to the clients.
   Basic nursing skills, knowledge and attitude or psychosocial characteristics varies in every nurse as well as compensation, benefits, job descriptions which vary in every institution/agency and client demands are some of the factors which may affect one’s performance that will result to either positive or negative outcome to both client and the nurse.
   To be effective with a dynamic, complex health care system and to help clients achieve their best potential, nurses need to be knowledgeable, resourceful and able to work well with other health care practitioners.  The nurse is a key participant within interdisciplinary teams whose members share expertise, establish collaborative strategies, and use information technology to achieve, sustain and uphold quality care (Kozier, B., 2002).
   An increasing number of nurses migrating to other countries somehow affects the quality of health care services in the sense that highly skilled, specialized and more experienced nurses were already leaving the country while fresh graduates starts their journey of the nursing profession by having their clinical experience in local hospitals and eventually they too will leave the country.
   The Department of Health reported that the continuing exodus of Filipino nurses abroad is already threatening the country’s health care system, since a large number of public health care workers have been leaving the country to seek greener pasture abroad (The Philippine Star, 2008).
   These factors affecting quality nursing care needs to be identified to promote awareness, good communication among health care practitioners and other institutions and better nursing relationship with the clients. Moreover, as these factors are identified, measures will be implemented to improve quality healthcare services.
   Recently, nursing around the world has evolved and is striving to give quality nursing care through evidenced based-practice, as such thousands of nursing researches were conducted every year (Polit, D., 2004).
   The purpose of this study is to provide direction, improve and maintain the integrity of health care professionals particularly the nurses. This study will show evidence to support how clients can receive a satisfaction and guaranteed health care services from nurses.
   With these observations, the researchers were motivated and inspired to conduct a study on “Factors Affecting the Quality of Healthcare Services Rendered by Nurses in Mandaue City Hospital”.


Discussion of the Theoretical Framework

Sister Callista Roy's model offers a classification for stressors that may affect adaptation. Her system concentrates on adaptive behaviors and the set of processes by which an individual adapts to environmental stressors. It is composed of philosophic assumptions, classes of stimuli and coping mechanisms.
A person is a biopsychosocial being creating a united system that searches for balance. Health is defined as a state of adaptation due to successful coping with stressors, and ?a process of being able to respond positively to environmental changes. Whereas, illness is the ineffective coping on a continuum from death toward adaptation. Environment is defined as external surroundings and influences that affect a person's development. Nursing will foster successful coping through manipulation of stimuli. It can help man adapt to changes in his physiological needs, self-concept, role function, and interdependent relations during health and illness. 
There are two philosophical assumptions in Roy’s Adaptation theory: First, is Humanism.  It is believed that the individual shares in creative power, behaves with determination, not in an order of cause and effect. It holds intrinsic holism as well as aims to uphold integrity and to recognize the need for relationship.
Second, Veritivity, believed that the individual in society is seen in the perspective of purposefulness of human existence, unity of humankind purpose, activity and creativity for humankind, value and meaning of existence (George, J.B.,2002).
Adaptation is the process and result where thinking and feeling persons use conscious awareness and choice to produce human and environmental integration. Roy's Adaptation Model is composed of modes of behavior, classes of stimuli, and two subsystems.
Four adaptive modes of behavior resulting from coping: physiologic, self-concept, role function, & interdependent relationships. Classes of stimuli are the combined effect of these stimuli that will show the person's adaptation level. A person's adaptation level determines the zone that shows the range of stimulation that will have an adaptive response. If additional stimuli land outside the zone, the person is unable to respond positively, and thus, ineffective coping occurs.  The Classes of stimuli are: focal - directly confronting the person, contextual - other stimuli present and residual -Non-specific stimuli. Regulator subsystem is made up of mostly automatic neural, endocrine, and chemical activity. Cognator subsystem, includes cognitive-emotive pathways and presents perceptual/information processing, learning, judgment, and emotion.
The desired outcome of the Adaptation Model is a position in which conditions promote the person's goals. The goal has been reached when any positive response from the recipient to the stimuli present releases energy for responses to other stimuli. The goal of adaptation is advanced through nursing assessment and intervention, including the client as an active participant (Leddy, S. & Pepper, J.M., 1998).


Discussion of the Conceptual Framework
   The above illustration shows that the quality of health care services rendered by nurses are affected by the following factors: basic skills, psychosocial characteristics, nurse profile and professional background.
   In this study, the researchers would like to determine if the following factors: Demographic Profile of the Nurses, the Basic Nursing skills as well as the psychosocial characteristics will affect the quality of health care rendered by the nurses to the clients of Mandaue City Hospital.  The first factor, demographic profile of the nurses refers to the age, sex, civil status and salary. The second factor, basic nursing skills refer to the basic nursing procedures and the ability to give medication and charting. The psychosocial characteristics are the work-related factors that refer to the following antecedent variables: position, length of services; job satisfaction, and leadership behavior.




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