Chapter 1

INTRODUCTION

Background of the Study

Caring has been attributed to the nursing discipline and became the foundation,

and core concept of the nursing practice. Theoretical frameworks and developments

regarding the aspect of caring in nursing have arisen and gave advancement to the

discipline of nursing. Locsin (2005) has grounded his concept from the advancement of

technology in the present era. He describes nursing as technological competency as

caring that present the coexistence of technology and caring in nursing. Furthermore, he

emphasized that being technologically competent is being caring and proficient to the

nursing practice (Kato, Miyagawa, Yasuhara, Osaka, Kataoka, Ito, Tanioka, Locsin,

Kongswan, 2017).

Being proficient in the profession, the nurse must embody the expertise in the

nursing practice, not just in providing holistic care but also in ensuring the safety of the

patient. In present times, healthcare systems have become more complex and

specialized. Along with this, the health problems of the patient had even more become

diverse. In a news article from Sunstar Philippines (2018), there have been incidents

where patient safety has been compromised and most of these incidents happening

inside Intensive Care Units. Such incidents include infected medical devices -- ventilators,

central lines, and urinary catheters. Professional nurses must be well-equipped with

patient safety skills to minimize the occurrence of medical errors (Jang & Lee, 2017).

According to Cronenwett, Sherwood & Gelmo (2009), future work of nursing

professionals will be directed when technological competency is involved in the

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development of the proficiency of nurses. With this, it will enhance patient care safety, as

well as reducing the instances of committing an error. Furthermore, technological

competency will benefit the nursing discipline as it makes through the advancement of

professional nursing knowledge, as well as the nursing practice.

The nursing practice in the Philippines has always been centered on providing

holistic care to the patient. In addition, professional nurses in the Philippines face

complexity and challenges upon entering the workforce and the need and demand for

patient care in hospitals have escalated due to dynamic and advancement of technology.

Health care professionals, especially nurses need to be at the top of their game in order

to render quality and holistic care and to ensure safety to their patients, especially with

the fast-changing and development in the scope of technology. This study aims to know

if there is a gap between technological competency in caring for nurses assigned in

operating rooms and intensive care units and if they are well equipped with such

proficiency to be able to deliver care to their patients. Technological competency as an

instrument in caring in the nursing practice will enhance not only the proficiency of the

nursing students in providing holistic care but also their patient safety competency in the

clinical area (Edwards & O’Connor, 2011).

Theoretical Framework

This research study is anchored from Dr. Rozzano Locsin's middle range theory:

Technological Competency as Caring in Nursing. Dr. Rozanno Locsin is a registered

nurse from Dumaguete City who practices as a Professor of Nursing at Florida Atlantic

University and Tokushima University. He is also a visiting professor in several countries

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in Asia, such as Thailand and the Philippines. He earned his Bachelor and Master’s

Degree in Nursing at Silliman University and obtained his Doctor of Philosophy in Nursing

at the University of the Philippines. His theory explicated the co-existence between

technology and caring in the nursing practice. According to Locsin (2005), technological

competency is more than the entirety of technology, proficiency, caring, and compassion.

This notion was supported by underlying assumptions of the theory which are: (a) a

person is caring by his or her humanness, (b) a person is complete at the moment, (c)

knowing a person is a continuous process to appreciate the person, (d) technology is

used to perceive a person as a whole, and (e) nursing is a professional discipline.

Furthermore, this theory directly focuses on the process of technological knowing

which is the efficient use of the advanced technology along with enhancing the essence

of nursing care within the context of a person's health experience (Locsin, 2009). The

theory also stated that in order to attain holistic and quality care, the nurse and the patient

must establish mutual respect and trust. The patient must participate and allow the

technology to be involved in the process of technological knowing. Thus, both the nurses

and the patient including the technology should be congruent to one another in order to

attain the goal - quality and holistic care.

Applying this theory into practice would aid BSN Alumni of University Z to focus and

to see the patient as the subject of care rather as an object at the moment. Through this,

patient safety will be actively and efficiently performed, and the competency with regards

to the patient safety of these professional nurses will be developed. Furthermore, applying

the Technological Competency as Caring in Nursing theory to the study would help the

researchers in illustrating the correlation of the level of technological competency as

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caring and the patient safety competency of the BSN Alumni of University Z in the

specialized area such as Intensive Care Unit and Operating Room where they are

currently working. It will determine how the BSN Alumni of University Z render care and

ensure safety to the patients in spite of the dynamic advances in the environment of the

clinical setting.

Conceptual Framework

INDEPENDENT VARIABLE (X) DEPENDENT VARIABLE (Y)

Level of Technological Competency Patient Safety Competency among

BSN Alumni of University Z

Age
Sex
Years in nursing experience
Area of Specialization

INTERVENING VARIABLE (Z)

Fig. 1. Conceptual Paradigm of the Study

Figure 1. Describes the conceptual model of the study where the relationship of

independent variable, the level of technological competency as caring in nursing, affects

the dependent variable, which is the patient safety competency among BSN Alumni of
 5

University Z. The intervening variables of this research study are the age, sex, years in

nursing experience, and the area of specialization of the target respondents.

Statement of the Problem

This study aims to determine the relationship between the technological

competency as caring in nursing and patient safety competency among BSN Alumni of

University Z.

Specifically, it attempts to answer the following questions:

1. What is the profile of the professional nurses in terms of:

a. Age

b. Sex

c. Years in nursing experience

d. Area of Specialization

2. What is the level of technological competency as caring in nursing of the BSN Alumni of

University Z?

3. What is the level of patient safety competency of BSN Alumni of University Z?

4. Is there a significant difference between the level of technological competency as caring

in nursing when grouped according to profile?

5. Is there a significant difference between the level patient safety competency of the BSN

Alumni of University Z when analyzed according to profile?

6. Is there a significant relationship between technological competency as caring in nursing

and patient safety competency among the BSN Alumni of University Z?

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Hypothesis

For research questions number one, two and three is hypothesis free. For

research inquiries numbers four, five and six, the following hypotheses have been

derived:

Ho4: There is no significant difference between the levels of technological

competency as caring in nursing when grouped according to profile.

Ho5: There is no significant difference between the levels of patient safety

competency of the BSN Alumni of University Z when analyzed according to profile.

Ho6: There is a significant relationship between technological competency as

caring in nursing and patient safety competency of BSN Alumni of University Z.

Scope and Limitation

This research study will cover only the perception of the BSN Alumni of University

Z on their level of technological competency as caring, as well as their level in patient

safety competency in the clinical area. Respondents of this study are the BSN Alumni of

University Z, both male and female and are currently working in a specialized area such

as Intensive Care Unit and Operating Room in a tertiary hospital. This study will be

conducted in one of the establishments of University Z during a scheduled meeting with

the approval of the Dean of the School of Nursing. The duration of this research study is

5 months, from the month of June 2019 until October 2019.

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Significance of the Study

The research aims to highlight the significance of the study to the following

beneficiaries:

Administrators and Faculty of University Z - School of Nursing. Through this study,

the administrators and faculty will be able to evaluate the technological competency as

caring and patient safety competency of the nursing graduates in University Z. It will aid

them to identify certain matters that need to be modified in order to provide quality

education to the current student nurses of University Z. Thus, producing more competent

nursing graduates in the future.

BSN Alumni of University Z. This study will benefit the BSN Alumni of University Z

in a way that they will determine their level of technological competency as caring towards

patient safety competency in the clinical area they are currently working. Also, the results

of this study will be utilized as a guide to improve their competency in the nursing practice

in terms of technological competency as caring and patient safety competency.

Nursing Practice. This research study will benefit the nurses in a way that they will

use this as a tool in enhancing their skills with regards to technological competency as

caring in correlation with patient safety, since the study enables nurses to assess their

own competency levels for self-improvement and can also be used for staff development.

This will render holistic and quality nursing care to the patient.

Nursing Education. This study will serve as a guide to the school of nursing

administrators, clinical instructors and BSN Alumni of University Z in developing and

sustaining technological competency to improve the nursing healthcare quality.

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Nursing Research. This research study will serve as a blueprint for conducting

future nursing research that is relevant to the concept of technological competency as

caring and patient safety competency.

Future Researchers. This research study will serve as a guide to the researchers

who will conduct a similar study in the near future. This will aid them in expanding their

knowledge regarding technological competency as caring in nursing and its relationship

with being competent in patient safety.

Definition of Terms

For better understanding of the terms used in this study, the following were

defined conceptually and operationally:

Competency. This refers to the combination of observable and measurable

knowledge, skills, abilities and personal attributes that contribute to enhanced employee

performance and ultimately result in organizational success (Axley, 2008). In this study,

it is the ability of a professional nurse to carry out skills effectively and the ability to perform

them properly such as executing tasks and being creative in problem-solving to meet the

needs and requests of patients.

BSN Alumni of University Z. The study will focus on the technological competency

as caring and patient safety competency of BSN Alumni of University Z who have had

clinical exposure in the operating rooms and intensive care units at any tertiary level

hospital.
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Patient Safety. According to the the World Health Organization (2019), this refers

to the absence of preventable harm to a patient during the process of health care and

reduction of risk of unnecessary harm associated with health care to an acceptable

minimum. In this study, it refers to the patient’s well being under the care of the

professional nurse.

Technological Competency as Caring. It refers to the caring in nursing that involves

the coexistence of technology and nursing and is use to know and perceive a person

holistically and as a recipient of care rather than an object (Locsin, 2016). In this study, it

refers to the competent use of technology within a caring point of view by the BSN Alumni

of University Z to know their patient holistically in the moment. This is patterned from Dr.

Locsin’s definition of technological competency as caring.

University Z. The code name that will be used for locale of the study. The said

university where the researchers will conduct their study.

 Chapter 2

REVIEW OF RELATED LITERATURE AND RELATED STUDIES

This chapter presents a review of literature that is related to the study. The various

information presented will supplement the discussion on the Technological Competency

as Caring of Nurses and their Patient Safety Competency.

Technological Competency as Caring

In the study of Pepito and Locsin (2018), it was discussed that technological

breakthroughs had revolutionized human health and wellness care thereby also changing

the concepts, organization, and structure of the nursing practice. Innovation and

advances in technology have allowed health care professionals, especially nurses to

perform their jobs and render care to their patients efficiently and effectively. It will also

aid nurses to have coordination and proper communication with other healthcare

professionals in order to deliver appropriate care to their patients. Thus, nurses, as well

as other healthcare workers should engage themselves in expanding their knowledge

regarding advances in technology as they will be the one who decides which aspects of

their roles should be delegated to technology.

Locsin (2016) added that the sophisticated forms of technology have now been

part of the integral and contemporary life of the human and their nature. People need to

adapt to the complexity and dynamic demands of technology in order to reside with the

fast-changing social norms. In the healthcare system, technology has also been

embedded in order to give quality care and treatment to the patient. With this, healthcare
 11

providers must be competent in order to provide continuous holistic care to the patients

regardless of the fast innovation of technology.

According to Locsin and Purnell (2015), nursing - one of the subsidiaries of the

health care system dwells with changes along with the progression and demands of

society and technology. Technological competency as caring in nursing fosters the

coexistence of caring and technology towards future human-environment demands on

human caring. Ergo, technology immersed with the grounds of nursing practice to

accentuate and transpire nursing as human caring.

An article by Trossman (2013) involves a healthcare institution in Texas that makes

way through the advancement of technology in order to provide patient safety. According

to Helen Currier, a Texas Nurses Association member, "Our ability to use technology

always lead to safer care" (2013). In line with the complexities of the health care these

days, technological competency - when done right - can aid nurses in providing quality

and safe care to their patients. From administration of medication alone and

communicating with the other health care providers, nurses must be at the top of their

game in order to prevent mistakes. Thus, appropriate technology allows nurses to

improve patient outcome, as well as avoid possible errors.

On the other hand, another article by Huston (2013) pointed out various impacts

of the emerging innovations of technology in the nursing practice. Aside from patient

safety, advances in technology have also more significant implications for

communication, nursing leadership, and acquisition and distribution of nursing knowledge

and expertise. Hence, nurses must establish a foundation regarding the fast-changing
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technologies that will proactively modify the nursing practice to enhance their competency

that is needed to address certain innovations in the discipline.

According to Locsin, Barnard, Tanioka, and Campling (2006), Technological

competency as caring in nursing is a three-part illustration of a nursing practice model

that focuses on preserving the essence of nursing care as the technologic environment

continuously progresses. The first part of the model addresses the interrelationship of

both caring and technology. Part two stresses and describes the practical issues relevant

to the model. And lastly, section three presents the practical application of the model in

the nursing practice. Being technologically competent plays a significant role for nurses

in a variety of ways and situations - it becomes a vehicle for enhancing nursing care.

Furthermore, Simpson (2005) concluded that enhancing nursing care is one of the

significant focus of every nursing professional. Strengthening the competency of each

nurse includes prevention of medical or nursing errors. These errors are more likely to be

caused by a weak system such as weak safety cultures, communication, protocols, and

training. Various solutions have been done and discussed and fortunately - technology

weighs a lot better in providing safety for the patient, as well as the prevention of medical

errors. However, nurses as being technologically competent should manage the three

P's: People, processes, and programs. Technology may help in eliminating errors,

howbeit, it is still the nurses who manipulate the system, as well as their other colleagues

who are still in the process of learning the system.

Studies shown above suggest that technology plays a significant role in nursing

practice. The concept of advancement in technology mainly focuses on delivering

appropriate and holistic care to the patients. It also dwells more on the professional
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competency of nurses towards the dynamic changes in the organization and structures

of their discipline due to the fast-changing concept of technology. Given the observation

and result of the studies, it is essential for the nurses to be technologically competent.

Being able to adapt to changes easily enhances their competency in the practice of

nursing. Ergo, nurses should expand their knowledge regarding technology in order to

conform to any modification in the aspect of the nursing discipline.

Patient safety competency of Intensive Care Unit Nurses

One of the goals of patient safety is to prevent the occurrence or acquisition of

hospital-acquired infections. The most common infection acquired by patients in the ICU

is the Ventilator-Associated Pneumonia (VAP). A set of practices have been implemented

in order to prevent patients in acquiring this infection and improve patient outcomes.

According to the study of Shahnaz, Bhardwaj, Tamang, and Dwivedi (2018), the bundle

or the set of practices performed by the ICU nurses had help in preventing the acquisition

of VAP. In their study, they covered 30 ICU nurses in selected hospitals both public and

private. With that, the result of the study revealed that critical unit nurses from both

hospitals have a knowledge gap to prevent the incidence of VAP among patients attached

to a mechanical ventilator in the unit. Furthermore, the study concluded that ICU nurses

in the private hospital have good performance in delivering the implemented set of

practices in preventing VAP, whereas ICU nurses in government hospitals had an

average performance in the use of VAP bundle. However, critical unit nurses from both

hospitals need to undergo continuous training to be equipped with such knowledge and

skills to prevent the incidence of VAP and also to develop their competency in patient

safety (Shahnaz et al., 2018).

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According to Sharour, Suleiman and Al-Ghabeesh (2018), many factors increase

the risk for medical errors in the critical unit. These are the workload of the nurses, time

pressure and high technology. With that, they have intensively studied the safety culture

in the critical unit both in government and private healthcare institutions. The findings of

the study show that critical unit nurses from different settings such as medical, surgical,

and pediatric ICU - both public and private hospital had a low safety culture in the area.

ICU nurses had highlighted some factors that contribute to the results of the study.

According to the ICU nurses, increase workload, and inappropriate nurse-patient ratio

had given an impact on the safety climate on the critical unit. ICU nurses who are

assigned with different tasks became a bedside nurse due to unsuitable nurse-patient

ratio. Also, with the advance technology surrounding the clinical area, ICU have a hard

time showcasing their competency in caring through technology due to increase

workload. Thus, hospital managers should pay attention to these factors as it could affect

the patient in the ICU and it can provide an optimal improvement in the clinical area

(Sharour et al., 2018).

A study by Phyllis Kanjakaya (2014) focused on the perception of ICU nurses with

regards to the effects of the use of technological equipment. According to Kanjakaya,

Intensive Care Unit is an extreme environment where different types of technological

equipment and devices that are intended for the care of the critical patients are found.

These technology found in ICU played a significant role in reducing morbidity, mortality,

and the length of hospital stay of the ICU patients. In this study, it revealed that most of

the ICU nurses identified the positive effect of utilizing technology in the ICU area.

However, some ICU nurses identified some negative impacts of using technology.
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According to the respondents of the study, the use of technology increases the risk of the

patient due to misinterpretation of data. Also, it increases the nurses' psychological stress

because of the complicated aspects of the technological equipment or devices used for

the patient. Moreover, this study also displays a significant finding, which is the number

of ICU nurses who are unaware of the negative effects of technology. This instance will

lead critically ill patients to unnecessary risk. Ergo, ICU nurses must be given an

opportunity to practice several technological devices through training and seminars. This

will enable them to promote patient safety through their competency in using devices and

equipment in the clinical area.

On the other hand, a study by Samaher Laila, Nadia Ahmed, and Mohammad

Mogahed (2011) assessed the perception of ICU nurses with regards to the use of

technological equipment in the critical care unit. According to this study, intensive care

unit or critical care unit is the specialized area in the hospital where the challenge of

technology in nursing is extreme. In a clinical setting where most patients are critical,

technological equipment and devices are vital for patient care management as they

provide life supports to those with life-threatening health problems. With this, technology

has been part of the ICU nurses' daily patient care management. In this study, it shows a

positive perception from the respondents as they perceived positive effects of technology

towards patient safety and care. According to the ICU nurses, technology improved

patient care and made an easy and faster completion of nursing duties, as well as it

improved their skills and enhanced their knowledge. Hence, the contemporary aspect of

technology must be included in the continuing education of the nurses to continue in

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developing their competency in patient care and safety through technology (Laila, Ahmed

& Mohammad, 2011).

Findings of these studies show that technological developments have been

incorporated with the nursing practice, especially in the Intensive Care Unit. Despite the

negative effects perceived by the ICU nurses, the positive impact of using technological

equipment and devices has been the main reason why ICU nurses continue to dwell with

technology in providing care to the critically ill patients. Efficient use of technology does

not only promote patient safety and quality care but also it aids in enhancing the nursing

skills and knowledge of ICU nurses. With this, technological competency of nurses should

be developed through various training and seminars to maintain a safe environment in

the clinical area (Aguas et al., 2017).

Patient safety competency of Operating Room Nurses

Operating room represents one of the most complex areas in the hospital. The

surgical procedures done in the setting are dynamic and needs cooperation with all the

surgical team to ensure a positive outcome. The World Health Organization emphasized

that lack of surgical care quality and safety can lead to adverse events that can

compromise the overall well-being of the patient. In the study of Mallouli, Tlili, Aouicha,

Rejeb, Zedini, Salwa, Mtiraoui, Dhiab, and Ajmi (2017), patient safety culture in Tunisian

operation rooms were assessed through a Survey Questionnaire. The results of the study

demonstrate the lack of development of patient safety culture in the operating room.

Three dimensions exhibited low rating among all aspect included in the survey. These

are the teamwork across the unit, the frequency of adverse events reported, and staffing.

A low score in the aspect of teamwork should be given attention as it highlights the
 17

problem in cooperation and communication within the surgical team. This matter is crucial

as it may compromise the safety of the patient on the operating table. Collaboration within

the team must be done to ensure and promote a safety climate during the surgical

procedure. Surgical equipment and devices must be used efficiently in order to provide

quality care to the patient. The efficient use of operating room devices does not only fall

under the responsibility of the OR nurse but also it includes other healthcare professional

in the surgical team. Another dimension who had a low rating is the frequency of the

adverse events that were reported. The results explain the lack of reporting culture in the

clinical area where nurses and other healthcare professional consider errors as a lack of

skill rather than a way for learning opportunity. Another dimension with a low rating was

the staffing in the operating room. The findings of the study described the poor staffing

condition in the setting as there is not enough staff to handle such workload. With such

conditions, staff work in a crisis mode where all healthcare professionals are working too

much and too quickly without securing a safety climate in the area. It includes the

inefficient use of surgical equipment and devices that may lead to unnecessary patient

risk and medical errors. The results of the study indicate that the Tunisian operating

rooms need to improve the quality and safety care through implementing a quality

management system in order to establish a strong patient safety culture in the setting

(Mallouli et al., 2017).

According to Erestram, Haglind, Bock, Erichsen, Andersson, and Angenete

(2017), to reduce complications in the operating room during the surgical procedure, both

technical and non-technical skills must be done. The most important skill is effective

communication. The surgical team consists of many healthcare professionals. Thus,

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collaboration during the procedure is essential to prevent complications related to the

well-being of the patient. With this, the World Health Organization (2007) had created a

modified checklist to improve intraoperative team communication and consistency of

care. In this study, it has been found out that there is a discrepancy in good

communication between the healthcare professionals as other healthcare providers

perceive the teamwork of the surgical team differently. Furthermore, it shows that there

were no significant changes in the teamwork climate of healthcare professionals after

using the revised WHO checklist.

On the other hand, the study of Ongun and Intepeler (2017) describe the operating

room as a complex area where it is marked by the presence of different healthcare

professionals and by an increased used of technology. Various factors were perceived as

an underlying cause of the medical error, and one of them is the inefficacy of

interprofessional communication. The inefficacy of interprofessional communication may

lead to disruption of the effective use of equipment and devices needed for surgical

procedure. This instance will lead to medical error that can compromise the overall well -

being of the patient. However, the result of this study shows that healthcare professionals

in the operating room show a moderate level of patient safety attitudes due to the

effectivity of their interprofessional teamwork. The healthcare professionals perceived

good and effective communication towards each other. Thus, unit supervisors should

provide more opportunity to the healthcare professional in the operating room to improve

rather than to maintain the positive relationship towards each other that leads to effective

teamwork (Ongun and Intepeler, 2017). With this, the positive and safe climate in the area

will be maintained, and it will ensure the safety of the patients in the operating room.
 19

Another study by Hinde, Gale, Anderson, Roberts, and Sice (2016) focused on the

influence of the in situ simulation or the interprofessional point of care to the nurses in the

operating room. The in situ simulation has been used to improve patient safety

competency of not just nurses but also other healthcare professionals. The findings of

this study reveal that through the in situ simulation, there was a significant improvement

in both safety and teamwork climate in the operating room being studied. Moreover,

there is an improved awareness and confidence by the nurses in terms of dealing with

the critical situation after the implementation of the in situ simulation in the clinical area.

Ergo, other healthcare institutions might adapt the interprofessional point of care

simulation training to develop the safety climate in their clinical environment to ensure the

safety of the patient in the area.

Most studies show that ineffective communication and lack of teamwork is one of

the underlying cause of medical errors in the operating room. Collaboration and teamwork

is essential especially in utilizing technology in the clinical setting. Equipment and devices

are use in the clinical area not only by the physicians but also by the nurses. Hence, when

utilizing technology in promoting the well-being of the patient in the operating room,

effective communication within the surgical team must be present. According to Hinde et

al., (2016), a simulation training such as the in situ simulation would aid in the

improvement of the patient safety culture of the operating room professionals. Through

this, medical errors that are deemed to be preventable can be further avoided and thus

promoting a secure and quality care to the patient in the operating room.
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Review of Related Studies

Intensive care unit nurses are known to have high professional consciousness and

seek profound knowledge regarding technology. The advances of technology have

modified the environment that they worked in. With this, ICU nurses should transcend the

appropriate delivery of care to their patients with the dynamic nature of technology.

The study of Kato et al. (2017) about the recognition and practice of Intensive Care

Unit nurses with regards to Technological Competency as Caring focuses on the

proficiency of these nurses in the nursing practice based on the theory developed by Dr.

Rozzano Locsin. This includes 17 hospitals that agreed to become part of this research

studies. The ICU nurses of these hospitals answered a survey questionnaire that consists

of the concept of recognition of the Technological Competency as Caring in Nursing

(TCCN) and the viewpoint of ICU nurses on the practical situation of TCCN.

There are four factors used in order to compare the recognition and practice

situation of TCCN. These are the gender, years in clinical nursing, years in ICU nursing,

experience receiving education on caring, and educational level. With all of these four

factors, the score for recognition was significantly higher compared to the practice

situations. It also shows that the score for recognition is higher in the cluster who had

received education on caring than those group who did not have any experience.

Moreover, the score was also found to be higher from those nurses who have ten years

of experience in the nursing practice and the ICU practice.

Comparing the results of the study, the scores reflect that the ICU nurses who have

been educated on caring acquired the recognition of the concept of TCCN practically in

the ICU setting. Although they have recognized the necessity of TCCN in their practice,
 21

they perceived that they don't have much opportunity to practice the theory or the concept

of TCCN enough to execute TCCN in a practical situation.

Synthesis of the Review of Related Literature and Studies

In this chapter, the researchers included literature and studies that have been all

published from the year 2006 to 2018. These studies expressed various concepts relating

to technological competency as caring and competency in patient safety of the

professional nurses working in a specialized area such as the Intensive Care Unit and

Operating Room. Many researchers have shared their observations and thoughts through

their studies regarding the innovations of the healthcare system due to technology and

the strategies that would enhance the competency of the professional nurses on patient

safety. With that, it has been found out that the uprising advancement of technology

affects the overall structure and organization of the nursing practice. The nursing

discipline should adhere to the dynamic changes of the healthcare system to continue to

provide holistic and quality care, as well as to ensure safety to the patients. In order to

conform to the modifications, continuous education and training should be provided to the

professional nurses for them to develop their clinical skills, as well as maintain and

enhance their patient safety competency.

 Chapter 3

RESEARCH METHODOLOGY

This chapter presents the procedures to be conducted in the research study

namely: research design, research locale, sampling technique, research instrument,

research procedure, statistical treatment, and ethical consideration.

Research Design

This study will utilize the correlational research design. Correlational research is a

type of nonexperimental research in which the researcher measures two variables and

assesses the statistical relationship between them with little or no effort to control

extraneous variables (Price, Jhangiani, Chiang, 2015). Furthermore, it shows how one

entity impacts the other and, what are the observed changes in the relationship of those

entities. A correlational method as one of the quantitative research method uses

mathematical analysis in order to correlate two or more variables. The patterns and

relationship between the studied variables are concluded as they reside in their natural

pace and set up.

Research Locale

This research study will be conducted at University Z in Davao City with the

respondents coming from the BSN Alumni of this institution. University Z showcases its

excellence as one of the top performing school in Davao City.

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Respondents of the Study

The respondents of the study are the 30 BSN Alumni of University Z that have

been working as an Intensive Care Unit Nurse and Operating Room Nurse in a tertiary

hospital.

Tertiary Healthcare Institution n %

Private Healthcare Institution 15 50

Government Healthcare Institution 15 50

Total 30 100%

Table 1. Distribution of the Respondents

Sampling Technique

A purposive sampling technique, a type of non-probability sampling technique, will

be used to choose the respondents of this study. This sampling technique will focus on

the particular characteristics of the chosen respondents which in this study is the BSN

Alumni of University Z who are currently working in a specialized area - Intensive Care

Unit and Operating Room, in a tertiary hospital. Thus, purposive sampling technique is

suitable for this study.

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Research Instrument

The instrument that will be used in gathering data for the research study is a survey

questionnaire adapted from the study of Development and Psychometric Testing of the

Technological Competency as Caring in Nursing Instrument by Dr. Rozzano Locsin

(2011) and Self-Assessment of Patient Safety Competence: A Questionnaire Survey

Final Year British and Finnish Pre-Registration Nursing Students by Hannele, Langari,

Tella & Smith (2017). The questionnaire has two parts. The first part of the survey

questionnaire includes the demographic data of the respondents which are the Age, Sex,

Years in Nursing Experience and Healthcare Institution currently working. The second

part comprises of two Likert Scale questionnaires about Technological Competency as

Caring and Patient Safety Competency. The Technological Competency as Caring survey

questionnaire is composed of 25 questions and the Patient Safety Competency of 14

questions. Both survey questionnaires are answerable by a rating scale ranges from 1 to

5 which corresponds to the following: 1 – Strongly Disagree, 2 – Disagree, 3 – Neutral,

4 – Agree, and 5 – Strongly Agree. Moreover, the questionnaires will be interpreted by

the following measures of the variables both for Technological Competency and Patient

Safety Competency:

Technological Competency As Caring

Range Level Interpretation

of Mean

5 4.51 – 5.00 Excellent The technological competency as caring strongly

affects the respondents’ capacity to render quality care.

 25

4 3.51 – 4.50 Very Good The technological competency as caring affects the

respondents’ capacity to render quality care.

3 2.51 – 3.50 Good The technological competency as caring moderately

affects the respondents’ capacity to render quality care.

2 1.51 – 2.50 Fair The technological competency as caring does not affect

the respondents’ capacity to render quality care.

1 1.0 – 1.50 Poor The technological competency as caring does not

strongly affect the respondents’ capacity to render

quality care.

Patient Safety Competency

Range Level Interpretation

of Mean

5 4.51 – 5.00 Excellent The respondent strongly agree that they are competent

with regards to patient safety.

4 3.51 – 4.50 Very Good The respondent agree that they are competent with

regards to patient safety.

3 2.51 – 3.50 Good The respondent believe that they have a neutral

competency with regards to patient safety.

2 1.51 – 2.50 Fair The respondent disagree that they are competent with

regards to patient safety.

1 1.0 – 1.50 Poor The respondent strongly disagree that they are

competent with regards to patient safety.

 26

Research Procedure

The researchers will ask permission to the Dean of the School of Nursing, Dr.

Patria V. Manalaysay, RN, MAN, Ph.D., DNS, to conduct the study. After given the

permission, the researcher will secure an informed consent from the respondents through

conducting an orientation. The orientation will include the purpose of the study, the rights

of the respondents, and the instructions on how the questionnaire should be answered.

Also, objectives of the study will be explained before the distribution of the questionnaire.

The researchers will be the ones to distribute the survey questionnaire and collect it after

10-15 minutes. Respondents of this study will be assured of the confidentiality of the

gathered data. Lastly, tabulation of the gathered data will be done after all of the

respondents have answered the questionnaire and all the data will be analyze using the

computer software.

Statistical Treatment

The researchers will utilize both parametric and non-parametric measures in the

analyzation of the data based on the statement of the problem.

The frequency distribution and percentage will be utilized to tabulate on the

demographic profile of the target respondents which is to answer the research query

number 1.

Mean and standard deviation will measure the level of technological competency as

caring and patient safety competency of BSN Alumni of University Z which are the

research inquiries number two and three.

 27

The ANOVA will be utilize to determine the significant difference between level of

technological competency as caring and patient safety competency of the BSN Alumni of

University Z when analyzed according to their profile.

The Pearson R moment correlation test will measure the relationship between the

level of technological competency as caring and patient safety competency of BSN

Alumni of University Z.

Ethical Consideration

Research Ethics that comprises appropriate research guidelines is essential to

complete the research study. A letter of request for the ethical approval to will be

personally given to Patria V. Manalaysay, RN, MAN, Ph.D., DNS, dean of School of

Nursing, to conduct a study. In addition, a letter of request was sent to Dr Rozzano Locsin

and Dr. Sussana Tella, to utilized their standardized questionnaires which will be use as

a research instrument in this study. Once approved, a letter and informed consent will be

discussed and given to the respondents of this study. The informed consent will consist

of the purpose, objectives, procedure of the study, and the benefits of the respondents

from the study. Respondents will be informed that their participation is entirely voluntary

and they have the discretion to withdraw from the research study. The respondents will

also be assured that the confidentiality of the data from the survey questionnaire will be

strictly maintained. The researchers will assure that the respondents have read and

understood the terms and condition of the research study before signing the informed
 28

consent. Furthermore, the data gathered by the researchers will be immediately disposed

of by shredding after the duration of the study.

REFERENCES
 30

REFERENCES

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Questionnaire–Intensive Care Unit Version: adaptation and validation for

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108.

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P.,

& Warren, J. (2007). Quality and safety education for nurses. Nursing

outlook, 55(3), 122-131.

Edwards, J., & O'Connor, P. A. (2011). Improving Technological Competency in

Nursing Students: The Passport Project. Journal of Educators Online, 8(2), n2.

Hinde, T., Gale, T., Anderson, I., Roberts, M., & Sice, P. (2016). A study to assess

the influence of interprofessional point of care simulation training on safety

culture in the operating theatre environment of a university teaching

hospital. Journal of interprofessional care, 30(2), 251-253.

Jang, H., & Lee, N. J. (2017). Patient safety competency and educational needs

of nursing educators in South Korea. PloS one, 12(9), e0183536.

Kanjakaya, P. K. (2014). Nurses perceptions regarding the use of technological

equipment in the intensive care unit setting of a public sector hospital in

Johannesburg (Doctoral dissertation).

 31

Kato, K., Miyagawa, M., Yasuhara, Y., Osaka, K., Kataoka, M., Ito, H., ... &

Kongswan, W. (2017). Recognition and Status of Practicing Technological

Competency as Caring in Nursing by Nurses in ICU. International Journal of

Nursing & Clinical Practices, 2017.

Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (2000). To err is human: Building a

safer health system. Washington DC: National Academy Press.

Laila, S. A., Ahmed, N. T. M., & Mogahed, M. M. A. (2011). Nurses’ perception

regarding the use of technological equipment in the critical care units.

Journal of American Science, 7(10), 545-52.

Locsin, R. C. (2007). Rapture and suffering with technology in

nursing. International Journal of Human Caring, 11(1), 38-43.

Locsin, R. C. (2016). Technological Competency as Caring in Nursing: Co-

Creating Moments in Nursing Occurring within the Universal Technological

Domain. Journal of Theory Construction & Testing, 10(1).

Locsin, R. C., & Purnell, M. J. (205). Advancing the theory of Technological

Competency as Caring in Nursing: The Universal Technological Domain.

International Journal for Human Caring.

 32

Manley, B. (2015). Advancing the theory of technological competency as caring in

nursing: The universal technological domain. International Journal of

Human Caring, 19(2), 50-54.

Mallouli, M., Tlili, M. A., Aouicha, W., Ben Rejeb, M., Zedini, C., Salwa, A., ... &

Ajmi, T. (2017). Assessing patient safety culture in Tunisian operating

rooms: a multicenter study. International Journal for Quality in Health

Care, 29(2), 176-182.

Ongun, P., & Intepeler, S. S. (2017). Operating room professionals’ attitudes

towards patient safety and the influencing factors. Pakistan journal of

medical sciences, 33(5), 1210.

Parcells, D. A., & Locsin, R. C. (2011). Development and psychometric testing of

the technological competency as caring in nursing Instrument. International

Journal of Human Caring, 15(4), 8-13

Pepito, J. A., & Locsin, R. (2019). Can nurses remain relevant in a technologically

advanced future?. International journal of nursing sciences, 6(1), 106-110.

Price, P. C., Jhangiani, R. S., & Chiang, A. (2015, October 13). Retrieved from

https://opentextbc.ca/researchmethods/chapter/correlational-research/
 33

Shahnaz, A., Bhardwaj, U., Tamang, E. K., & Dwivedi, S. (2018). A comparative

study to assess the competency among ICU nurses in using ventilator

associated pneumonia bundle to prevent ventilator associated

pneumonia in selected government and private hospitals of New

Delhi. International Journal of Nursing Education, 10(3).

Sharour, L. A., Suleiman, K., & Al-Ghabeesh, S. (2018). Toward having safe

environment in critical care units: a multisite study. Critical Care & /

Shock, 21(4).

Simpson, R. L. (2005). Patient and nurse safety: how information technology

makes a difference. Nursing administration quarterly, 29(1), 97-101.

Tella, S., Smith, N. J., Partanen, P., & Turunen, H. (2015). Learning patient safety

in academic settings: a comparative study of Finnish and British nursing students’

perceptions. Worldviews on Evidence-Based Nursing, 12(3), 154-164.

The Joint Commission. (2013). Sentinel event date - Root causes by event type.

Retrieved from http://www.jointcom-mission.org/Sentinel_Event_Statistics/

Trossman, S. (2013). Texas hospital approaches technology with eye toward

patient safety, nursing practice. The American nurse, 45(5), 11.

 34

World Health Organization. Implementation manual, Surgical Safety Checklist.

Secondary Implementation manual, Surgical Safety Checklist 2008.

http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_

Manual_finalJun08.pdf?ua=1.
35
APPENDICES
 APPENDIX A

Ateneo de Davao University

School of Nursing
Jacinto Street, Davao City

July ___, 2019

Patria V. Manalaysay, RN,MAN,PhD,DNS

Dean
School of Nursing
Ateneo de Davao University

Dear Dr. Manalaysay,

We, the group 3 of BSN 4A, will be conducting a research study that is a part of

our academic requirements entitled “Technological Competency as Caring in Nursing

towards Patient Safety Competency among BSN Alumni of University Z”.

In line with this, may we humbly ask permission from your good office to allow the

researchers to conduct the study to the Bachelor of Science in Nursing - Alumni of Ateneo

de Davao University.

We are hoping for your kind consideration. Thank you, and more power!

Sincerely,

Trissha I. Junasa
Group Leader

Liza Floresca, RN, MAN, PhD

Group Mentor/ Adviser
Approved by:

Patria V. Manalaysay, RN, MAN, PhD, DNS

Dean, School of Nursing
 APPENDIX B

Ateneo de Davao University

School of Nursing
Jacinto Street, Davao City

February 6, 2019

Rozzano Locsin,, RN, PhD, FAAN

Tokushima University

Dear Dr. Locsin,

Greetings!

We, the undersigned are BSN 3 student nurses from Ateneo de Davao

University School of Nursing under the mentorship of Prof. Liza G. Floresca, RN,

MAN, Ph.D. We are currently in the process of developing our research study with

a working title “Technological Competency as Caring in Nursing towards Patient

Safety Competency among BSN Alumni of University Z”. In line with this, we

humbly ask for your permission if we may use your questionnaire on technological

competency for our research. Thank you and we look forward to hearing back from

you in this matter. God Speed.

Sincerely,
Trissha I. Junasa
Alexandra S. Balao
Aubrey Unique M. Evangelista
Zainah A. Esmael
Stephen Josh V. Lim
 APPENDIX C

Ateneo de Davao University

School of Nursing
Jacinto Street, Davao City

March 14, 2019

Sussana Tella, RN, MNSc, Ph.D

Department of Nursing Science
University of Eastern Finland

Dear Dr. Tella,

Greetings!

We, the undersigned are BSN 3 student nurses from Ateneo de Davao
University - School of Nursing from the Philippines. We are currently in the
process of developing our research study with a working title “Technological
Competency as Caring in Nursing towards Patient Safety Competency among
BSN Alumni of University Z”. In line with this, we humbly ask for your permission
if we may use your questionnaire on Self-Assessment of Patient Safety
Competency for our research. Thank you and we look forward to hearing back
from you in this matter. God Speed.

Sincerely,
Trissha I. Junasa
Alexandra S. Balao
Aubrey Unique M. Evangelista
Zainah A. Esmael
Stephen Josh V. Lim

BS Nursing
Ateneo de Davao University
Davao City, Philippines
 APPENDIX D

Ateneo de Davao University

School of Nursing
Jacinto Street, Davao City

Informed Consent
(Universal Format from WHO)
Purpose:
You are invited to participate in this research study. The purpose of this study is to
study the technological competency as caring and patient safety competency of the BSN
Alumni of University Z. The findings of this study will be reported to the Ateneo de Davao
University – School of Nursing.

Procedures:
In this research study, you will be asked to answer a survey questionnaire that will
take about 5 minutes to answer. The survey questionnaire will be provided and collected
by the researchers. The researchers will explain a brief background of the study and
instructions on how to answer the survey questionnaire. If you don’t wish to answer any
item included in the survey questionnaire, you may skip it and move on to the next item.
The data that will be gathered will be kept with outmost confidentiality and only the
researchers will have access to your given information.

Participation:
Your participation on this research will be entirely voluntary. You have the
discretion to participate or withdraw from the study without negative consequences of any
kind. Also your withdrawal from the study will not bear any negative impact on the results
and findings of the research study.
Benefits:
This study will have no direct benefit to you. However, your participation is likely to
be a great help to determine the technological competency as caring and patient safety
competency of the of University Z.

Confidentiality:
The information/data gathered for this research study will be treated with outmost
confidentiality will be used for research purposes only.

Consent:

Your signature on this form indicates that you have read and understood the

foregoing information, and your rights and responsibilities as a respondent. Your printed

name and signature below indicates your consent to participate in this research study,

according to the terms and condition above.

_________________________________

Participant’s Signature over Printed name

_________________________________

Date and Time

 APPENDIX E

Ateneo de Davao University

School of Nursing
Jacinto Street, Davao City

Letter of Permission to the Respondents

Good day!

We, the 4th year Bachelor of Science in Nursing students of Ateneo de Davao University,
who are currently proposing a study entitled TECHNOLOGICAL COMPETENCY AS
CARING IN NURSING TOWARDS PATIENT SAFETY COMPETENCY AMONG BSN
ALUMNI OF UNIVERSITY Z.

The goal of the study is to determine the relationship between the technological
competency as caring and patient safety competency among BSN Alumni of University
Z. In line with this, we humbly ask for your participation on our study. However,
participation on our study is voluntary. Respondents have the right to withdraw at any
time without giving any negative impact on our research study. If you decide to participate
on our study, you will be asked to answer a survey questionnaire that will take about 5
minutes to answer. Rest assured that the data gathered will be strictly kept with outmost
confidentiality and will be use for research purposes only.

Thank you very much and God bless!

 APPENDIX F
Questionnaire: Technological Competency as Caring and Patient Safety Competency
among BSN Alumni of University Z

Gender:
o Female
o Male

Area of Specialization:
o Intensive Care Unit
o Operating Room

Age:_________
Years in Nursing Experience: ____________________
Instructions: Below are the list of statements in relation with Technological Competency
and Patient Safety Competency. Please indicate how strongly you agree or disagree with
each statement by putting a check (✓)

Technological Competency as Caring in Strongly Disagree Neutral Agree Strongly

Nursing Disagree Agree

1 2 3 4 5
1. Nursing, an important part of
healthcare, focuses on human caring.

2. Technology assists nurses in knowing

the “who” and “what” of persons.

3. The outcome of nursing is healing –

saving lives and increasing a sense of
self.

4. Nurses use unique techniques to care

for patients.

5. Caring us engaging in compassion,

physical presence, comforting, and
respecting the whole person.
6. Technology and caring help to build
patient self-worth when used without
bias.
7. Knowing the “what” and who about a
patient means to appreciate the patient
as more than his/her physical parts.

8. Nursing is a unique field of knowledge,

skills, and caring abilities.

9. Caring in nursing is listening to, doing

with, and being with the patient.

10. Nurses need to balance the demands of

using machine technologies
competently with caring in nursing.

11. Caring means knowing the person’s

physical self and his/her emotional
conditions in a particular moment.
12. Nurses must include patients in
designing care plans to ensure
accuracy and completeness of their
care.

13. Technological competence is the

proficient use of machines within a
caring point of view.
14. Nurses must respect patients’ personal
hopes and dreams, which may change
from one moment to the next.
15. Nurses need to practice nursing within
a caring perspective in their
assessment and interpretation of
healthcare data.

16. Nurses need to value patients as

knowledgeable about their own selves
and their care.
17. Nurses relate with their patients to
create a shared sense of safety and
security.
18. Competent nurses execute and follow
up on tasks and emotions, and use
creativity in meeting/exceeding patient
needs.

19. Knowing patients involves respecting

the person as whole and complete in
each moment.

20. the competent nurse anticipates patient

needs while respecting all belief
systems and focusing on patient
healing.

21. Caring in nursing occurs in shared

situations of teaching and learning
between nurses, patients, and family
members.

22. Caring in nursing serves to reduce

vulnerability and other stresses/anxiety
inherent in nurse-patient relationships.

23. Selfless commitment to patient’s

needs, hopes, and dreams is caring.

24. As an expression of caring in nursing,

technological competence is using
many ways of knowing o that the nurse
and the patient can know each other.

25. Nurses use technology and human

touch together in order to relate to their
patients with true presence and caring
intentions.
 Strongly Strongly
Patient Safety Competency Disagree Disagree Neutral Disagree Agree

1 2 3 4 5
1. My competence in patient safety has
continuously improved during my
nursing education
2. I understand the central concepts
related to patient safety (e.g. patient
safety incidents, near miss adverse
event and barriers)
3. I am satisfied with my patient safety
competence
4. My competence regarding patient safety
is good
5. If I notice an adverse event (patient
suffer or harm), I respond immediately
as the situation requires
6. If I notice a patient safety incident (an
adverse event or near miss event), I
know how to make the patient safety
report

7. If another health care professional

behaves in a manner that puts the
patient at risk, I intervene without delay
8. After a report of patient safety incident is
made, I know how the analyses should
proceed
9. I plan to continue to develop my patient
safety competency
10. I understand the role of effective
teamwork to ensure patient safety
11. I communicate clearly to ensure patient
safety (using such as repeat back)
12. I work systematically to ensure patient
safety
13. I can identify possible patient safety
incidents
14. I can prevent possible patient safety
incidents in nursing care situations
 APPENDIX G
Sample Table of Data

I. Frequency Distribution according to the profile of the respondents

Respondent Characteristic Number (n) Percentage (%)

Male 15 50%

Female 15 50%

Age

- 21-30years old 15 50%

50%
- 31-40years old 15

Years in Nursing Experience

- 1-5years 15 50%
50%
- 6-10years 15

Healthcare Institution Currently Working

- Private Institution 15 50%

50%
- Government Institution 15
II. Level of Technological Competency as Caring and Patient Safety
Competency of the BSN Alumni of University Z.

Respondent Characteristic Number Minimum Maximum Mean Std.

(n) Deviatio

Male 9 61.32 71.72 66.1883 3.53144

Female 9 61.32 71.72 66.1883 3.53144

Age 60.49 84.41 70.6990 5.00595

- 21-30years old 189

- 31-40years old 189

Years in Nursing Experience 55.00 77.33 65.7105 4.49654

- 1-5years 210

- 6-10years 210

Healthcare Institution 55.00 77.33 65.7105 4.49654

Currently Working

- Private Institution 210

- Government 210

Institution
III. Significant difference between level of technological competency as caring
and patient safety competency of the BSN Alumni of University Z.

Respondent Characteristic Mean Std. One Way ANOVA

Deviation

Male 66.1883 3.53144 >1

Female 66.1883 3.53144 >!

Age 70.6990 5.00595 <1

- 21-30years old

- 31-40years old

Years in Nursing Experience 65.7105 4.49654 >1

- 1-5years

- 6-10years

Healthcare Institution Currently 65.7105 4.49654 >1

Working

- Private Institution

- Government Institution
IV. Relationship between the level of technological competency as caring and
patient safety competency of BSN Alumni of University Z.

Respondent Characteristic Correlation Direct and strength of

Coefficient Correlation

Value (r)

Male -1 Perfectly Negative

Female -0.8 Strongly Negative

Age -0.5 Moderately Negative

- 21-30years old -0.2 Weakly Negative

- 31-40years old

Years in Nursing Experience 0 No association

- 1-5years 0.2 Weakly Positive

- 6-10years

Healthcare Institution Currently 0.5 Moderately Positive

Working 0.8 Strongly Positive

- Private Institution 1 Perfectly Positive

- Government Institution