Chapter 1

The Problem and Its Scope

Introduction

Emergency care is one of the most sensitive areas of health care. This sensitivity

is commonly based on a combination of factors such as urgency and crowding. Urgency

of care results from a combination of physical and psychological distress, which

appears in all emergency situations in which a sudden, unexpected, agonizing and at

times life threatening condition leads a patient to the emergency department (ED).

In an ER, patients’ circumstances vary in their demands of direct nursing care.

However, each nursing activity should meet standard time requirements. Unfortunately,

the actual condition in an ER is that when the number of ER patients increases, or

patients with severer conditions are admitted to an ER, their individual demands for

direct nursing care will increase; thus, their needs often cannot be met by the standard

direct nursing services provided by fixed nursing staffing. Therefore, nursing staffs may

be forced to reduce the nursing care available or the time provided for each patient.

When the supply of direct nursing care is less than the demand at the time, it may pose

a threat to the health of patients.

It has been estimated that approximately 45%-70% of the total number of

hospitalized patients are emergency room (ER) patients, so that the ER is also called as

the frontline of hospitals (Chou, 2008). An ER takes charge of the quality of medical

services expected by patients during an emergency. When sent to ER, ER patients

easily tend to feel anxious due to their various conations of discomfort or illness, and

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hope that medical staff can deal with their problems as soon as possible (Chen, et al.,

2009).

As focus has shifted from the healthcare providers to the healthcare consumers;

patient satisfaction is being increasingly used worldwide for the assessment of quality of

services provided by healthcare institutions. To understand patient satisfaction,

“patient’s perception” of care must first be understood. Of all the healthcare workers

nurses spend maximum time with the patients. Therefore, the nurse is in a unique

position to influence and promote effective consumer relationships. Though patient

satisfaction surveys with nursing care are routinely conducted in the developed world to

monitor and improve the quality of care, the same is not true for the developing country

like the Philippines.

Nurses’ self-recognition of own level of competence is essential in maintaining

high standards of care. The demands for nurse competence may vary between work

environments like in emergency room environment. Nurse competence profiles differed

in both the level of and in frequency of using competencies between work

environments. Context-specific knowledge of nurse competence from real work life

situations provides direction on how to structure work environments and staff

development interventions to provide qualified care (Meretoja, Leino-Kilpi & Kaira,

2009).

According to Muntlin, Gunningberg & Carlsson (2009), patients are not always

satisfied with the care received at emergency departments. More attention needs to be

paid to the specific needs and expectations of the non-urgent group of patients, who

make up the majority of attenders at many emergency departments. Nurses’ and

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physicians’ perceptions about good quality of care do not always agree with patients’

perceptions. Instruments measuring patient satisfaction have often been focused on

inpatient treatment. Thus, the importance of nursing care in the emergency department

should be highlighted to nurses and physicians and they also need to be more attentive

to the need of the individual patient (Muntlin, Gunningberg & Carlsson, 2009).

Rationale of the Study

Healthcare as an industry has changed and grown with quality care being

recognized as a right rather than a privilege. Quality of care is the degree to which

health services for individuals and populations increase the likelihood of desired health

outcomes and are consistent with current professional knowledge.

The researcher is currently a civilian head nurse of Cavite Naval Hospital in

Cavite City. After 12 years of working with a military hospital, the researcher has come

to terms with the reality that nursing is not merely a routine work and a source of

livelihood. Certainly, there are more challenges that must be overcome in being a nurse

than what meets the eye.

To further his career path, the researcher is now a trainee of VLGH, the study

hospital, specializing in trauma nursing in the Emergency Department under the Nurse

Corps Specialty Training Course (NCSTC) and endorsed by Cavite Naval Hospital. One

of the requisites of the training course is the preparation of a thesis. Since, the

researcher has already been lecturing on emergency room operations among Philippine

Navy enlisted men, he considered it prudent to pursue a study which topic is congruent

with this field of specialization, specifically on the level of competency of ER nurses.

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Statement of the Problem

The study sought to analyze the level of competency of Emergency Room

Nurses of Victoriano Luna General Hospital (VLGH) to be used as the basis for an

enhanced competency plan.

Toward the resolution of the main problem, answers to the following specific

questions were addressed:

1. What is the profile of the ER staff nurse-respondents in terms of the

following demographic variables:

1.1 Age
1.2 Gender,
1.3 Highest Educational Attainment,
1.4 Nursing Specialization,
1.5 Length of Service with VLGH,
1.6 Hospital Employment Classification,
1.7 Length of Experience in VLGH Emergency Department,
1.8 Number of Seminars, Training Programs and Related Events on

Hospital Emergency Room Operations Attended?

2. What is the level of competency of the ER staff nurses in the performance

of skills, knowledge and attitudes of trauma nurses as prescribed by

Emergency Nurses Association (2007)?

3. Is there a significant difference in the level of competency of ER staff

nurses when they are grouped according to their demographic profile?

4. Is there a significant difference in the level of competency of ER staff

nurses as perceived by themselves, their immediate supervisor and a

doctor?

Null Hypotheses

The study tested for acceptance or rejection the following null hypotheses:

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 1. There is no significant difference in the level of competency of ER staff

nurses when they are grouped according to their demographic profile.

2. There is no significant difference in the level of competency of ER staff

nurses as perceived by themselves, their immediate supervisor and a

doctor.

Significance of the Study

When individuals are admitted to the Emergency Room of a hospital for whatever

emergency reason, they cannot choose the healthcare providers who will attend to him

or her. Notwithstanding, they expect to receive the best possible healthcare. One of the

requisites of quality care is the competency of the emergency room nurses in the

discharge of her functions, especially in trauma cases.

Hence, this study is deemed significant to the following beneficiaries and the

reason for their consideration:

Clients. As the primary recipients of nursing care, this study will broaden their

understanding of what lies ahead while in the ER. More and more patients are

demanding to be informed partners in decisions regarding their health and their

concerns are now directed at the whole spectrum of their healthcare while in a

healthcare institution.

Patients’ family and friends. Through this study, they will be empowered to

serve as co-partners in the delivery of quality healthcare. More than the patient, they are

interested to be assured that the patients’ stay in the ER is worth the time, effort and the

monetary cost of therapy, rehabilitation and recovery. They are the ones who will ask

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questions concerning the health well-being of the patients … questions many of which

will be answered by this study.

Nursing staff. Both the staff nurses and their superiors are put to task whenever

a prospective client steps into the ER. Nurses interact with patients more often than any

other health care personnel in a hospital. The nurse is the one who translates

information imparted by physicians technically and professionally with a humane touch.

Patient’s perception of nursing care can be influenced by their pre-service expectations

of the service provider that are in turn influenced by number of factors such as, cultural

background, socioeconomic status, etc. and most especially their manifested

proficiency in performing their functions. This study will serve as a reminder and

guidelines they can refer to achieve the provision of quality nursing care.

Hospital Administrators. This study will inform them of how the staff nurses and

their superiors perceived the level of competence of the former with the end in view of

having a basis for policy reformulation especially when the results are adverse to what

the health community expects. Moreover, after receiving a service, the patient compares

the perceived service with the expected one. If the perceived service matches or

exceeds their expectations they opt to come to the hospital again and recommend it to

the needy persons, not necessarily for emergency cases only.

The hospital administrators as well as all health care workers have to be clever

enough to know what the patient actually wants. By getting to know the patient a little

more and to get their views on the care one ought to come closer to what the patient

considers as good care.

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 Current Researcher. This study represents his modest contribution to the

continuing discussion about the level of competency of emergency nurses as a critical

component in the delivery of quality nursing care which is beyond the standard.

Future Researchers. This study may be used by them as a resource material in

the event that their study topic is related to the current topic. Or they may continue from

where the current researcher leaves off, updating and upgrading information based on

the circumstances obtaining during their time.

Definition of Terms

Some terms may have different meanings when used in other contexts. Some

terms may have double meaning, too. For the enlightenment and greater understanding

of the reader, the following significant terms were defined operationally according to

their usage in this study:

Level of competency. In the delivery of care to trauma patients, this will be

measured using competency checklist (ENA, 2007).

Immediate Supervisor. He or she is a nurse exercising direct supervision over

emergency staff nurses. In this study, he or she is a head nurse.

Quality Nursing Care. In this study, it is the measure of excellence or a state of

being free from defects and deficiencies of emergency room nurses in meeting the

needs of the clients through caring, empathy and respect.

Staff Nurses. They are nurses assigned at the Emergency Room without

specific supervisory or managerial functions.