Vol 5, No.1

Republic of the Philippines Don Mariano Marcos Memorial State University Institute of Community Health and Allied Medical Sciences Agoo, La Union

HHEALTH CARE JOURNAL

2015

ICHAMS Health Care Journal

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2015

Print ISSN 2012-4015

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Online ISSN 2449-4607

EDITORIAL STAFF

Holly Lou M. Santos, PHD, RN Editor-in Chief

Janna M. Boado,MAN, RN,RM Associate Editor

Francis A. Uyaan,MAN, RN, Consultant

Dr.Inocencio D. Mangaoang Jr. Consultant

AnndraMargareth B. Dumo,MAN,RM,RN Associate Editor

Ofelia O. Valdehueza,MAN,RN,RM Consultant

Dr. Milagros R. Baldemor Consultant

Contributors: ICHAMS faculty and BSN IV Students


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Contents Page Glucose-6-Phosphate Dehydrogenase Deficiency: A Rocky Road Experience of Mothers ……………………………………………………………………

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Thrombocytotic Efficacy of Tawa-Tawa, Papaya and Malunggay Among Aspirin-Induced Laboratory Rabbits…………………………………………

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Effect Of Nurse – To - Patient Ratio On Nurse Satisfaction And Post Partum Patient Care Outcomes...........................................................

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Evaluation of the Philosophy, Vision, Mission, Goals and Program Outcomes of DMMMSU-ICHAMS………………………………………………………. Clinical Management Functions of DMMMSU ICHAMS Instructors: An Input to A Proposed Sustainability Program......................................................

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Glucose-6-Phosphate Dehydrogenase Deficiency: A Rocky Road Experience of Mothers Authors: Salvador P.Llavore, Rochelle B.Abenojar, Ina Stefanie M.Frijas, Jalyne Joy M.Olidan, Lourdes Rojas, Joel C. Estacio,MAN,RN,RM ABSTRACT ABSTRACT Indigenous people are the least contributors to climate change, yet they were the first to suffer from itsG6PD impacts; however, modification andinapplication of their traditional practicesthat minimized is the most prevalent illness children tested in Newborn Screening can leadthe to effects lifeof climate change to their life and culture.The study aimed to determine the knowledge and practices threatening hemolytic crisis and can have immense impact to mothers. This paper aimed to explore theon climate change ofofthe Bago with Tribe. The study, conducted from Novemberthe2013 to September 2014 lived experiences mothers G6PD-diagnosed children. Specifically, researchers explored thein Aringay, insight La Union, ethnography design the using a semi-structured interview anddisease observation. mothers’ on theutilized disorder, reaction towards diagnosis of their children, how the was Spradley’sand method usedstrategies. to analyzeThe datastudy fromisnine purposively chosendesign participants accepted their was coping a phenomenological using in-depth interview The participants that human works and modernization were mothers reasons residing of climate which was conducted frombelieved November,2013-September,2014. Participants were in change. Agoo, They perceived that climate changewith affected their food and water supply, caused method the emergence and La Union with toddlers diagnosed G6PD whohealth, were chosen purposively. Colaizzi’s was used aggravation of diseases, temperature changes and diversion of river location. They chose to lie between the to analyze the narratives and validation strategies were implemented to attain scientific rigor. traditional and modern way of life particularly with their practices in farming, home, health maintenance The study revealed that the mothers perceived that G6PD is caused by the lack of enzymes and and mitigation. hereditary aggravated by certain foods, drugs, and chemicals. This inquiry illustrated that the lived Keywords: Adaptation, Bago Tribe, climate change, knowledge, Aringay, La of Union experiences of the mothers is a complex life-changing reality that involvedpractice, a dynamic interplay several truths. The mothers felt fear, anxiety, shock, guilt and hurt initially. Later, they accepted G6PD wholeheartedly as it is a part of God’s plan, after determining their children’s positive future and with their trust to health care providers. The mothers sought for professional and God’s help and focused on rearing their children in order to cope with their situation. Keywords:Children, coping strategies, Glucose-6-Phosphate Dehydrogenase Deficiency, mothers INTRODUCTION Glucose-6-Phosphate Dehydrogenase Deficiency or G6PD is a common enzyme disorder of human beings, which is hereditary. This means that from the time a baby is born, there is already something wrong with how the child’s body makes and breaks important substances (Newborn Screening Reference Center, 2013). According to the World Health Organization (WHO) working group (2013), globally, G6PD is an important cause of neonatal jaundice, which can lead to kernicterus and death or spastic cerebral palsy. It can also lead to lifethreatening hemolytic crises in childhood and at later ages, by interacting with specific drugs and with fava beans in the diet. G6PD deficiency affects 400 million people worldwide. The highest prevalence rates (with gene frequencies from 5-25%) are found in tropical Africa, the Middle East, tropical and subtropical Asia, some areas of the Mediterranean, and Papua New Guinea (Virtual Medical Center, 2004).It is also common in Hong Kong with an incidence of 5.4% in male and 0.36% in female. The Neonatal Screening Unit of Clinical Genetic Service started its territory-wide neonatal screening program for G6PD deficiency and congenital hypothyroidism in 1984 (Lam, et al., 2011).

In the Philippines, around one (1) in 50 children are G6PD deficient and it is more common in boys than in girls. G6PD deficiency is the most prevalent illness tested in the newborn screening recorded by the Department of Health (DOH). It is a lifelong condition that cannot be outgrown. However, a child with G6PD deficiency can live an active, healthy and normal life as long as the child is able to avoid the substances that can trigger G6PD deficiency symptoms (Baby Center Medical Advisory, 2011). Babies with this deficiency may have hemolytic anemia resulting from exposure to oxidative substances found in drugs, foods and chemicals (Newborn Screening Reference Cente, 2013). Hemolytic anemia is the accelerated destruction of red blood cells, where a child may have pale skin, fatigue, shortness of breath, rapid heart rate (especially among newborns), and dark, tea-colored urine (Baby Center Medical Advisory, 2011). In Region 1, a total of 4,823 newborn screening results were reviewed and 300 cases were positive for G6PD deficiency in La Union. However, only 246 cases were deemed evaluable. Fifty-four cases were excluded because of incomplete data. The prevalence rate of G6PD deficiency in La Union is 6.2% which is comparable to the prevalence rate of


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the diseases in the Philippines. Central Pangasinan has the majority of cases with 74% cases. The prevalence among male infants is 3.59%, similar to the incidence among male Filipinos which is 3.9%. The female ratio of the disease in La Union is 2.4:1 (Department of Health, 2013). There are two G6PD variants in the Philippines, the first one originated in Palawan while the other one came from La Union particularly in Naguilian. A new G6PD variant with red cell enzyme deficiency and altered substrate specificity was found in a Filipino male and in his relatives. The ancestors of this cope came from the same town of Naguilian in the Province of La Union, but there was no known consanguinity. Other variants cause severe instability of the enzyme and are associated with chronic hemolytic disease even in the absence of exogenous agents. Some variants have altered substrate specificity in G6PD Palawan (Fernandez, 2010). The G6PD deficiency can be detected through newborn screening tests which check for rare but serious conditions in babies just after birth. All countries require certain screening tests to be performed on newborns, even if they appear healthy (Newborn Screening Reference Center, 2013).In the country particularly in Region 1,there are 111 active newborn screening facilities and 24 inactive newborn screenings facilities as of April 28, 2010. There are seventy three (73) newborn screening facilities in Pangasinan, 24 in Ilocos Sur, 21 in Ilocos Norte and 17 newborn screening facilities in La Union. Specifically, in Agoo, there are 3 newborn screening facilities located at Agoo Family Hospital, Agoo Maternity and Lying in Clinic and La Union Medical Center (Newborn Screening Reference Center 2013) .At Agoo Maternity and Lying in Clinic, the total number of babies who had G6PD as of the year December 2012-October 2013. With the complexity of the diseases, it may pose challenge to mothers and families who have children with G6PD. Mothers who have a child with G6PD may become depressed and will need interventions. It also clear that this study is relevant to nursing education and practice. It addressed the current void in the literature regarding the lived experiences of mothers with G6PD. It provides insights into these participant’s experiences as they underwent through the therapy in the hospitals. Through this phenomenological approach, the knowledge regarding the perceptions of the participants as they went through the therapy was eliminated, thus enriching the understanding of their peculiar experiences. Therefore, this a potential benefit to help workers particularly nurses- staff nurses, nurse educators, nurse administrators, and nurse leaders alike as they strive to improve the


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quality of nursing care through evidenced-based practice. The study aimed to determine the lived experiences of mothers with Glucose-6 Phosphate Dehydrogenase Deficient children in Agoo, La Union. Specifically, it sought to determine the insights of mothers with children diagnosed with G6PD regarding the disease, how did the mothers react towards the diagnosis of their children with G6PD, how was G6PD accepted by the mothers and the coping strategies of mothers with G6PD children. METHODOLOGY A qualitative study framed within phenomenology perspective was used to explore the lived experiences of the mothers with G6PDdiagnosed children. This means understanding or viewing the phenomenon through the eyes of those experiencing such phenomenon, as it is lived. The way to do this is to go to the source or the individuals who actually experienced the phenomenon and become immersed on the descriptions of what people experienced and how they experienced what they experienced. The study was conducted in November 2013 to September 2014 in Agoo, La Union. The participants of the study included seven mothers who were purposively selected based on their experienced and willingness to participate and who have a biological child aged 18 months to three years old, residing in Agoo, La Union and who were diagnosed with G6PD. The child should have experienced hospitalization due to G6PD or its complication. Participation in the study is voluntary. Information collected were coded and anonymity was assured through the use of pseudonyms.The researcher used Greek Roman Goddesses as pseudonym to symbolize or associate the participant’s strength in coping their situation. In-depth interview was utilized to gather data with the aid of a valid semi-structured interview guide. Interview sessions were conversational and interactive. The participants were asked to tell stories, knowledge and experiences regarding G6PD. The participants were interviewed separately. All the interviews were audio recorded. Also during the interview, the researchers took note of the non-verbal cues. In order to validate the study, several strategies were implemented. First, the credibility of the study was achieved using validation strategies of triangulation of data collection through observation and interview. The thick description would also contribute to its authenticity and vividness. Trustworthiness and rigor of research includes four aspects namely; credibility, dependability,


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transferability, conformability of the data which were demonstrated through attention and confirmation of discovered information. The goal was to accurately represent the experiences of the mothers, thus the prolonged engagement and the persistent observation of informants in the field. This necessitates developing a trusting relationship with the participants that facilitated a deeper understanding of the phenomenon under study. Also, peer debriefing or feed-backing was utilized through sharing data with colleagues and experts and openness to scrutiny. Furthermore, going back to the informants to see if the analysis interpretation made sense to them and reflected their experiences added to the trustworthiness of the data. The continuous selfreflection in the various stage of the research process, especially in the data collection and analysis stage will add onto the rigor of the study (Castro, 2010). RESULTS AND DISCUSSION The insight of the participants was categorized in different ways, which pertains to their knowledge of the participants to the disease. These experiences of the participants, when analyzed as a whole, and summarized by the paradigm case. In general, mothers were aware of the disease of their child. G6PD is a genetic disorder that mainly affects red blood cells, which carry oxygen from the lungs to tissues throughout the body. A defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely (hemolysis). This can cause hemolytic anemia, which can lead to symptoms of paleness, jaundice, dark urine, fatigue, shortness of breath, and a rapid heart rate (Frank, 2005). G6PD is critical to the normal function of red blood cells. Thus, G6PD deficiency can lead to a condition called hemolytic anemia when an affected individual is exposed to certain foods, infections or medications as triggers (Oppenheim, 2010). One of the participants, Phoebe, claimed, “It is lack the of enzyme or low RBC that leads to G6PD, for example she eats food that contain soya it will trigger his condition and develops red spots and fever”.Hesston (2013) also acknowledged the causes of G6PD deficiency in her child which is lack of enzyme and also hereditary in her family, she also knows what to do whenever her baby develops signs and symptoms of G6PD deficiency. G6PD is a lifelong condition. Mothers have no choice but to embrace the situation of their child wholeheartedly by all means whatever the reason. It’s not only their responsibility that pushes them to be strong but because of their love of their child.


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(Sunilap, 2012). IN this study, the participants had fair knowledge of G6PD deficiency. The majority has heard of G6PD deficiency and recognized it as blood disease and Hereditary. However, their knowledge about the pattern of inheritance seems to be lacking. The result is similar to the knowledge of other participants of G6PD. This can be attributed to be relatively mild clinical nature of G6PD deficiency in Agoo, La Union. Caring for someone with G6PD deficiency means monitoring their behavior, including what they eat and what they come in contact with. G6PD deficiency weakens red blood cells, meaning that certain foods, medicines, and other items that would be harmless to most people can cause the red blood cells of those with disorder to disintegrate rapidly. This was also acknowledged by Phoebe as she verbalized, “It is lack of enzyme or low RBC that leads to G6PD, for example she ate food that contain soya that will trigger his condition like red spots and fever”. Furthermore, the mothers felt various reactions toward the diagnosis of their children. Primarily, mothers did not expect their child to have the disease and they were shockedwith the newborn screening result presented to them. The mothers often cry to shout out their emotions. For instance, Venus said, “ I was worried I don’t know what kind of disease was that, of course it is my first baby that’s why I was worried (cried).” Moreover, G6PD have hurt so much the mothers. Running over the problem in their mind distracted them in their daily life habits .Hemera disclosed, “We feel so frustrated and it impels my compassion to my poor daughter. Before, I thought my daughter will grow up abnormal. But then with the consultations with her pediatrician. I was so happy when he told me not to worry that my baby will be able to grow normally like other children who don’t have this kind of deficiency.” Feeling like a nervous wreck, participants look at the world in ways that make it seem more dangerous than it really was, overestimating that things will turn out badly, jumping immediately to worst -case scenarios. Hera claimed, “I thought my child was going to die, of course I must be strong, I was praying to the Lord, It seemed like I lost my mind, I’m crying every night”. Fear is a normal reaction to the mothers. Most parents have little previous experience with G6PD deficiency; many are uncomfortable in the environment and concerned about their baby. They also fear the possibility of serious illness, disability, or even death. The disease also saps the mothers’ emotional energy, sending their anxiety levels to soar and interfere with their activities of daily living.


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In addition, the mothers felt guilty about their children’s condition. Hera honestly claimed, “Maybe it’s our fault as parents, my eldest even complains that it is always her sibling that we take care of, but I explain to her that her sister has a health problem." Despite their children’s condition, the mothers accepted their child’s situation and considered it as a grace of God. Furthermore, the participants devoted their time in caring their child and they still love them despite the fact that their children have G6PD. Hera verbalized, “I need to accept because she already has the disease and I know that God has a reason for giving this to me. Even if my child has a disease we still love her very much.” At first, one of the participants was miserable and always asking for a miracle for her child, but she was motivated and hope emerged when the participant was able to see in a television show that a child a with G6PD excelled. Because of that circumstance, she accepted the disease of her child and prepared for the future of their child. All parents set out with expectations, hopes and dreams for their child. While one parent hoped to see her child graduate from university, another is praying that they can live pain free. Furthermore, the mothers gave their trust to the health care providers as they know they are knowledgeable about the disease and its management. The mothers also closely monitored the condition of their child to prevent the complications. The participants religiously read food labels carefully before giving them to their child.


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CONCLUSIONS This phenomenology inquiry illustrated that the lived experiences of mothers with g6pd is a complex life changing reality that involved a dynamic interplay of several truths. The mothers with children diagnosed with G6PD are knowledgeable about the disease. The mothers experienced many trials and emotional crisis as with the diagnosis of their children.The mother’s acceptance was hard at first, but mothers learned to accept the situation of their child. The mothers have developed healthy coping strategies to alleviate their experiences and prevent the worsening of their child’s condition. RECOMMENDATIONS Based on the findings and conclusion the researchers offer the following recommendations. 1. Dissemination of information regarding G6PD house to house in order to spread the knowledge not only to mothers with G6PD children also to the future mothers. 2. Counseling should be done to mothers with children diagnosed with G6PD with the help of health care constituents and community social service. 3. The health care team should assist the mothers with children diagnosed with G6PD towards the acceptance of the disorders. 4. There should be strong support system from each family member of mothers with G6PD child which is essential to help them to cope up faster and easier to their crisis. 5. Further study may be conducted which focuses on the experiences of the family as a system which is affected by the health crisis of the family member.

REFERENCES Baby Center Philippines Medical Advisory Board (2012).Newborn Screening. Retrieved July 2011 from http://www.babycenter.com.ph/baby/ newborn/newborn screening/. Castro J. (2010). Lived Experiences of Filipino DOTS Treatment Partners. Lam et. al. (2011).Towards universal newborn screening in developing countries: obstacles and

the way forward. Retrieved December 2011 from http;//www.ncbi.nlm.nih.gov/ pub med/ 19904464. Newborn Screening Reference Center. (2011). Retrieved February 2013 from www.nbsrc.gov.ph Newborn Screening Reference Center. (2012). Retrieved February 2013 from www.nbsrc.gov.ph


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Thrombocytotic Efficacy of Tawa-Tawa, Papaya and MalunggayAmong Aspirin-Induced Laboratory Rabbits Authors: Alvin John L. Coloma, Ashly Sherein B. Casilla, Beth Honey Joy M. Estolero, Jeremiah C. Ulalan, Mary Grace E. De Leon, Gifford D. Veloso, MAN,RN ABSTRACT ABSTRACT This study aimed to explore the medicinal plants used by patients who suffered from Dengue Imprisonment of a husband who is the bread winner of the family may greatly affect the status of Fever and determine the thrombocytotic efficacy of the different treatments. The researchers used the family especially the wife. This paper aimed to deepen the understanding of the lived experiences of descriptive survey using a structured questionnaire to obtain initial data, then the researchers used the wives whose husbands are detained in BJMP Agoo District Jail. The study is a phenomenological design Controlled Randomized Design (CRD) to test the effectiveness of the different treatments. The study was using a semi-structured interview which was conducted from November,2013 to September, 2014. The composed of five treatments namely Tawa-tawa, Papaya and Malunggay expressed juice, (3 ml each), participants were the wives of detainees in BJMP Agoo District Jail who were chosen purposively. The Prednisone (0.5mg/ml/kg BW), Sterile Water (1 ml). Fifty (50) healthy 1kg male laboratory rabbits wives were interviewed during their visit at BJMP and in their homes. Ethical considerations were strictly (Oryctolaguscuniculus) which were at least 4-5 months old regardless of their breed were used. Data implemented in the conduct of the study.Moustakas' transcendental phenomenological model was used for were treated using Average Weighted Mean, One Way Analysis of Variance, and Scheffe’s Test. Papaya is data analysis and validation strategies were implemented to attain the scientific rigor of the study. the most effective followed by Tawa-tawa, and Malunggay.The three medicinal plants are more effective The wives had mixed emotions when their husbands were detained. They felt loneliness, hatred, fear and compared to the positive control (Prednisone) and negative control (Sterile Water). anxiety. The wives showed struggles in raising their children alone considering the negative speculation of others towards them. Despite the situation, their love remained which has been the greatest foundation of Keywords: Carica papaya Linn., Euphorbia hirta L., and Moringaoliefera Lam., platelets, the couple. The wives inclined themselves to work and rearing their children to cope with the situation. The thrombocytopenia. stories that they narrated suggested that they attempted to be strong for their children. These formed the themes which evolved which are: “The inevitable beginning”, “The weights of life”, “True love conquers INTRODUCTION Dengue Fever(DF)is a dreadful disease that can take life inalmostwithin four toten days when not treated. Globally, dengue viruscurrently is considered asone of the most fatalarthropod-borne viruses transmittedto humans, whether measured based onthe number of human infectionsandor the numbersof deaths. Dengue virusrangesofdisease in humans from undifferentiated fever, dengue fever syndrome, dengue hemorrhagicfever with and without shock (Focks et.al., 1995). Dengue’s impact to one’s health brings trouble to the physical and biologicalwell-being of a person. It is an acute illness of sudden onset that usually follows a benign cause with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rashes. The presence (the “dengue triad”) of fever, rash and headache (and other pains) is particularly characteristics of dengue (Cuncha, 2011). One of themost dangerous symptoms usually experienced by denguefever patients is the sudden decrease of platelet countwhich may lead to death. Moreover, the pathognomonic feature of severe dengue, which WHO classifies as dengue hemorrhagic fever (DHF) is a transient increase in vascular permeability resulting inplasma leakage. In severe cases, circulation is compromised and the patient can go intohypovolemic shock, and even die if not given

appropriate management.Patients withDHF can also have abnormal blood coagulation, but major hemorrhage is unusual except in association with profound or prolonged shock.Severe dengue can also be characterized by hepatic damage, cardiomyopathy, encephalopathy, and encephalitis 2although these manifestations are rareand the riskof death in such cases is high (Deen etal., 2006). Dengue may start with few, but it can extremely blow into an epidemic or anoutbreak. As long as there are lurking mosquitoes in homes behind curtains, sinks, laundry areas and drainage, threat against health ispresent. Study estimates that there are300 million dengue cases a year in the world, with India havingthehighest burden (BMJ,2013). While here in the Philippines,there were at least 42,207 dengue cases recorded from January to the first week of June 2013,and 193 of thecases werefatal (DOH,2013).According to the Department of Health,from the year 2010 to 2013,there are6,311 dengue cases with 44 deaths and has a 0.70case fatality ratio (CFR) in Region I in 2010.La Union has the highest record of 2,393 cases in the whole Region I with 5 deaths;in the province,City of San Fernando, La Union hasbeen reported with the highest dengue cases of 711 with 1 death,andsixth in line is Agoo, La Union forhaving132 dengue cases with no cases of death in the year 2010.


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In 2011, there were 14,203 dengue caseswith 71 deaths and 0.50 CFR reported in Region I. La Union was still onthe top list, having the highest record of dengue cases in Region I with a tremendous increase of 4,748 cases with 9 deaths, and still City of San Fernando is top on the list ofhaving the highest record of 1,304 with 1 death, andAgoo, La Union ranks on the eightplace having a 172 dengue cases, though there were no reported death. In 2012 there was a sudden increase of dengue cases in Region I having9,153cases with 36deaths and 0.39 CFR; however the province of Pangasinan spotted the highest record having 4, 545 dengue cases with 16 deathswhile La Union came to be the 3second in the list having 2,173 with 9 deaths. City of San Fernandowas still on the list having 586 dengue cases with 2 deathswhile Agoo, La Union was on the third spot having 261 dengue cases with 2 deaths. Also, in 2013 there was a tremendous increase of dengue cases in Region I having 16,307 with 46 deaths and 0.28CFR; on the other hand, Pangasinan still hadthe highest dengue cases with 8,927with 36 deaths, again came to be in the second spot was La Unionforhaving 3,470 with 3 deaths and 0.09 CFR;however,City of San Fernando has not beenremoved fromthe list of having the highest dengue cases in La Unionforhaving 943 dengue cases with no cases of death, and on the third spot was Agoo having 310 dengue cases with no cases of death. There arevarious clinical treatments of dengue;medical researchers continue to unfold through the science and technology of drugs. Additionally, conventional medicines are popular but expensive and that makes people getthe impression that famous, expensive synthetic chemical drug cures better and faster. Eventually, costlyadvertisement captures the mind of consumers with all its clinical evidences and the likes. Dengue fever treatment is not spared from this debate.True to all the infirmities, an individual does not only experience the illness itself but also the malady of financial demand and the stress that it brings along. One idea that contests the use of conventional medicine for dengue is the alternative healing that comes through the aid of herbal medicines.A good example of this are the Matigsalugbefore and now, living along the side of River Salug that runs fromArakan-Cotabato, Bukidnon and Davao mountain areas. Today, the tribe is very proud to use its indigenous knowledge systems


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in their everyday activities. They have strong sense of oneness in 4preserving their culture despite the influx of modern technology and knowledge(Gascon,2011). The information regarding the efficacy of the medicinal plants usually emanatesfrom the testimonies of elders who have tried and proven the medicinal plant’s “therapeutic” wonders. The curative effects of the herbs were tested by traditional healerson their patients on a try anderror basis. The knowledge and skills on the curativeapplication of any given herbal medicine has been handed down from generation to generation (DOH 2008). This study is highly recommended and pursued by the researchers because of thetimeliness of the effects of Dengue Fever to one’s health and the burden to the communitypeople who were classified as under thelow socio-economic status. Theresearchers also witnessed andobserved the expensiveness of the demand in treatingdengue fever. Poverty is the main reason why the researchers wantto discoverand prove the thrombocytotic efficacy of those medicinal plants that have been used locally. Medicinal plants do not only bring economic relief for the ill person but alsoacquire benefits from its substantially pure and natural potency. Meanwhile, the World Health Organization fact sheet dated December (2008),claimed that 80% of the population in some Asian and African countries depends on traditional medicine as their Primary Health Care (PHC) due to economic and geographical constraints. Philippines as a tropical country is gifted with thousands of medicinal plants which are virally patronized through folkloric experiences. One would think that such use is remotely traditional on time of advanced technology particularly in the aspect of biomedical field. While many dengue patients 5continue to believe and rely on manufactured drugs but on the extreme side almost equally proportional, many still seek the wonders and natural healing of herbs. An article of the Publications Committee of National League of the PhilippinesGovernment Incorporated (2007) expressed that “the use of herbal-based medicine and medicinal plants to treatmany diseases is growing worldwide as they havefew or noadverse effects, less toxic, more acceptable and less expensive than synthetic drugs. Here in the Philippines, the Department of Health is


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advocating the use of herbal medicines,which havebeen found to treat common ailments and has been a part of the PhilippineHealth Care. Republic Act No.8423, an act creating the Philippine Institute of Traditional and Alternative Health Care (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a traditional and alternative health care development fund and for other purposes, reiterated under this law is Sec. I. known as the “Traditional and Alternative Medicine Act (TAMA) of 1997. Consciously or unconsciously, the need to discover, rediscover and research the extent of efficacy of medicinal plants as aid for dengue to geographically and economically-deprived dengue patients must continue. On one hand, people’s views of medicines are strongly divided. On oneside, many of the elders would resort to old ways of lifein terms of diet and treatment; on the other side,younger generation viewsit as a form of medicine used by quack doctors. In addition to these, many herbs are unprocessed, unpacked, and locally available and bear its local name contribute to its unpopularity. Common people tend to be impressed bymore than ordinary or traditional cure. Nowadays, there are medicinal plants that have been found to have the potentialproperties to treat dengue fever, but it is not yet proven scientifically. Despite thesereasons, people prefer touse medicinal plants because they havecheaper cost, beneficial for low socio-economic people and accessible in grassland rural areas. Alternative healing manifests itself in many ways,but its profound effect is the relief that it brings. To some extent,manufactured drugs have the same potential effect as well. The researchers have observed that dengue patients have experienced conventional treatment and utilized the wonder of herbal medicines to either fight or eradicate dengue virus that has invaded and have caused susceptibility to breakdown. The researchers would like to dig into the efficacy of medicinal plants used fordengue treatment. It is along this premise that this study was undertaken. METHODOLOGY For the first part of the study, the researchers used a descriptive survey using a questionnaire in order to determine and identify the different medicinal plants used by patients


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who suffered from dengue fever in Agoo, La Union. Such medicinal plants as stated above are believed to increase the platelet count and cured the dengue disease. This was the basis in determining the treatments which, were used in the experiment. For the second part, the researchers used the Controlled Randomized Design (CRD), also known as Randomized Controlled/Clinical Trial (RCT), which has become the gold standard for assessing the effectiveness of therapeutic agent (Concato et al., 2006). The design significantly corresponds to the study and is used to determine the thrombocytotic efficacy of Tawa-tawa, Papaya and Malunggay expressed juice as treatments used in the test animal which are the laboratory rabbits. Actual treatments that were used are as follows: Treatment 1- Tawa-tawa leaf expressed juice (3 ml) Treatment 2- Papaya leaf expressed juice (3ml) Treatment 3- Malunggay leaf expressed juice (3 ml) Treatment 4- Prednisone (0.5ml/kg BW) Treatment 5- Sterile Water (1 ml)

Five phases were carried out by the researchers in order for them to work and gather data systematically. The first phase was the survey and gathering of data regarding the different medicinal plants used by patients diagnosed with dengue fever. Second was the identification and verification of the top three medicinal plants determined through the analysis and result of transcription of the data gathered. Next was the phytochemical analysis of the plants. The fourth phase was the preparation of the different treatments, equipment, materials, and test animals followed by the final phase which is the testing of efficacy of the said treatments to the test animals. Five Hundred (500) grams each of fresh and mature leaves of Tawa-tawa, Papaya and Malunggay were gathered from Brgy, Capas, Agoo, La Union. The leaves were washed thoroughly with tap water and rinsed separately with distilled water to ensure their cleanliness. Afterwards, they were air dried for an hour, and then the plant samples were placed on a clean and dry container and brought to the Natural Science Research Unit – Saint Louis University, Baguio City for the phytochemical analysis. A communication letter was sent to the Department of Agriculture at San Fernando, La Union asking permission before the conduct of the experiment. Also, the approval of the Ethical Committee was requested before the procedure.


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The 50 healthy, 4-5 month old healthy male laboratory rabbits with a body weight of 1kg, were purchased from a pet shop that is accredited by the Department of Agriculture in San Fernando City, La Union. Also, a certification was issued by the Regional Animal Disease Diagnostic Laboratory (RADDL) under the Department of Agriculture to conduct the experiment at the RADDL at Brgy. Tebag, Sta. Barbara, Pangasinan. Afterwards, the test animals were brought to the laboratory for a twoweek quarantine, acclimatization and conditioning process. Each test animal was kept on cube cage with 3 feet in width, 3 feet in length and 3 feet in height with a 1 foot stand of the cages divided separately for each treatment. They were treated fairly wherein the Laboratory rabbits were exposed with the same food, and the interval time of giving were also the same as noted (8am and 6pm).The test animals were exposed with the same ventilation, humidity, and at room temperature. The researchers used 5 treatments with 10 test animals each. The sampling technique that was used is simple random sampling through fish bowl method. The researchers used oral administration in giving their treatments in their test animals, thus it is easier and less risky. In the actual experiment, the researchers with the help of the veterinarian, administered the treatments to the test animals in order to determine the efficacy of the different treatments. After the 2-week acclimatization of the rabbits, on the 15th day, the researchers, with the supervision of the medical veterinarian, extracted 1 ml of blood specimen following the proper procedure and protocol on extracting blood specimen. If the platelet count of the laboratory rabbits range within normal platelet count (270480 x 103/mm3), they were then subjected for the inclusion in the administration of Aspirin to decrease the platelet count. On day 16, all of the gathered results in the initial platelet determination were in the normal range so a high-dose of Aspirin was given orally to the test animals using a gavage. The 200mg/kg tablet of Aspirin was pounded and diluted in 3ml of distilled water before administration. After 20 minutes of administration of Aspirin, the researchers again measured the platelet count following the same procedure in the proper extraction and protocol of blood extraction. When the platelet count of the laboratory rabbits decreased from the normal


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range (270-480 x 103/mm3), the test animals were prepared for treatment administration. On the 17th day, all of the treatments were administered orally using a syringe via gavage. After 24 hours of treatment administration, final analysis of platelet count was done. The researchers used frequency count and ranking to determine the top three medicinal plants used patients who suffered from dengue fever. Also, average weighted mean of was used to determine the efficacy of the treatments. One Way Analysis of Variance (ANOVA) was used to determine the significant differences in the efficacy of different treatments. Scheffe Test was subsequently applied in finding out where the difference lies among the treatments. RESULTS AND DISCUSSION As part of primary healthcare and because of increasing cost of drugs, the use of locally available medicinal plants has been advocated by the Department of Health. Many local plants and herbs in the Philippines backyard and field have been found to be effective in the treatment of common ailments as attested by the National Science Development Board, other government and private agencies/person engaged in research (Public Health Nursing in the Philippines, 2007). Indeed, the use of available medicinal plants could be an alternative medication, which is effective in the treatment of ailments (Rillera, et al, 2011). Table 1 shows the identified medicinal plants used by patient diagnosed with dengue fever patients in Agoo, La Union. Tawa-tawa was the most sought medicinal plants by patients who suffered from Dengue fever because it is usually accessible in the backyard and with the potential to increase platelet count. In the Philippines particularly in Davao, people use this plant to increase the platelet count of patients suffering from Dengue fever with low platelet count. Internal hemorrhaging will stop and Dengue fever will be cured after 24 hours. However, the mechanism of action is still unknown and the anti-viral properties and its ability to increase blood platelet is currently investigated (Kadir, 2013).


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Table 1.Medicinal Plants Used by Dengue Fever Patients in Agoo, La Union

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Table 2. Procedures Used in Preparing the Medicinal Plants

Plant

Frequency

Rank

Procedure

Frequency

Rank

Tawa-tawa Papaya Tawa-tawa + Papaya Malunggay TOTAL :33

19 4 4 6

1 3.5 3.5 2

Decoction Expressed Juice Total

19 12 31

1 2

Furthermore, a study in the University of Santo Tomas discovered that Tawa-tawa has a component that can help promote cell production and prevent cell destruction, which is responsible in the increase of platelet counts (Agron, 2012). Malunggay ranked as the second medicinal plant used by patient diagnosed with dengue fever in Agoo, La Union, and it is perceived to have thrombocytotic efficacy. MoringaoleiferaLam, locally known as Malunggay, a common backyard plant in Filipino homes, has achieved popularity in mainstream scientific journals describing its nutritional and medicinal properties Primarily because it is rich in compounds containing the simple sugar, rhamnose (Vera Besa, and Salibayb, 2013). Papaya (Carica papaya L.) is a tropical fruit that is widely cultivated and consumed both for its agreeable flavor as well as its many pharmacological properties (de Oliveira and Vitória, 2011). This specie is typical of tropical and subtropical regions, requires temperatures of between 21 and 33 °C and does not tolerate cold weather (less 23 than 15 °C) (Crane, 2005; Fuggate, Wongs-Aree, Noichinda, &Kanlayanarat, 2010; Rivera-Pastrana et al., 2010; Yadava, Burris, & McCrary, 1990). In this study, papaya, which is believed to have thrombocytotic efficacy, was used by the respondents. In India particularly in the State of Kerala, it has been reported that Papaya leaves can increase platelet count. Papaya leaf has been traditionally used in the treatment of Dengue fever. The aqueous extract of leaves of this plant exhibited potential activity against Dengue fever by increasing platelet count (Kadir, 2013). Table 2 shows the different procedures used in preparing the medicinal plants.

In the community, medicinal plants are prepared in several ways which vary based on how the plant was utilized, and sometimes, the kind of condition being treated. One of the methods is decoction (boiling), which is the most common method being used because it is the easiest and simplest way of preparing the medicinal plant. Another method is by expressed juice. Table 3 presents the medicinal plants used by all the participants in Agoo, La Union, which they perceived to have helped in the increase of platelet count after taking those identified medicinal plants when they were diagnosed to have dengue fever.These medicinal plants mainly increase the platelet count of patients with Dengue fever. Respondents verbalized that these medicinal plants really helped them to recover from Dengue fever. Some study revealed that these plants contain ingredients that will boost blood and cell production including platelet. Table 3.Perceived Effect of the Medicinal Plants Used by Dengue Fever Patients Effect

Frequency

Rank

Effective Not Effective Worsen Total

29 0 0 29

1 0 0

Table 4 contains the list of the different sources of information on how the participants came-up with the use of those identified medicinal plants in treating dengue fever.


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Table 4. Source of Information on the Use of Medicinal Plants Sources

Frequency

Rank

Hearsay Neighbor Health Care Provider Folkloric Experiences Significant Others Social Media Total

9 8 6 5 2 2 32

1 2 3 4 5.5 5.5

The study revealed that the respondents learned the use of the medicinal plants through hearsay that provides a framework for constructing knowledge-based expert systems. While hearsay makes no commitment to any particular application domain, it does supply a variety of generally applicable facilities. These include representation primitives and an interpreter for large-grained, flexibly schedulable production rules called knowledge sources (Erman et. al, 1981) because the sources of information were gathered from people who do not have authentic evidence to prove that the medicinal plants that they used have the potential to increase platelet count.The medicinal plants are useful for healing as well as for occurring of human disease because of the presence of phytochemical constituents (Wadood et al, 2013). Table 5 summarizes the results of phytochemical analysis of the three plant samples. Table 5.Phytochemical Substances Present in Tawa-tawa, Papaya and Malunggay Phytochemical Components

Alkaloids Carbohydrates Reducing Sugar Glycosides Saponins Phytosterol Phenolics Tannins Flavonoids Protein Diterpenes Triterpenes

Tawa -tawa

Results Papaya Malunggay

+ +

+ + +

+ + +

+ + + + -

+ + + + + +

+ + + + + -


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Results of the phytochemical screening of Tawa-tawa, Papaya and Malunggay, which was conducted in Saint Louis University, Natural Science Research, of Baguio City, show that the plants contain alkaloids, carbohydrates, glycosides, saponins, phytosterol, phenolic compounds, and flavonoids. The table shows that Papaya has the most chemical substances with thrombocytotic properties which are alkaloids, phenolic compounds, diterpenes and triterpenes, followed by Malunggay which have alkaloids, phenolic compounds and flavonoids. Last is the Tawatawa which has phenolic compounds and flavonoids. Phytochemical analysis shows that Alkaloids are detected in Papaya and Malunggay leaves but not in Tawa-tawa leaves. Alkaloids are group of naturally occurring chemical compounds that contain mostly basic nitrogen atom. Alkaloids are important chemical compounds that serve as rich reservoir for drug discovery (Jin, 2012).Alkaloids are known to have the characteristics to treat severe nonmalignant hematologic disorder such as refractory auto immune thrombocytopenia, hemolytic eremicsyndrome and thrombotic thrombocytopenia purpura (Mordi, et. al., 2013). Furthermore, alkaloids present include carpaine, pseudocarpaine and dehydrocarpaine I and II. These constituents can act on the bone marrow destruction and enhance its ability to produce platelets. Lastly, it can also prevent platelet destruction in the blood and thereby increase the life of the platelet in circulation (Pati., et. al, 2013). Moreover, both phenolics and tannins were detected in Malunggay leaves while the Tawa-tawa and Papaya only contain sphenolics. Apostol., et. al, (2012) claimed that“Although there were small amount of phenolic compound in Tawa-Tawa, this was sufficient to exert effect promoting quality and quantity of platelets. Phenolic compounds contain sufficient hydroxyls and other group (such as carboxyl) to form strong complexes-forming properties of tannins that contribute to the positive effects in the platelet count in blood (Tahir, 2014). Further study found out that phenolic compounds promote cell production and prevent cell destruction. (Lekamlage. et. al, 2012) The result also shows that flavonoids were detected in all plant samples. Flavonoids are water soluble polyphenolic molecules containing 15 carbon atoms. Furthermore,


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flavonoids were detected to have its antithrombocytopenia property, wherein it helps to increase the platelet count of induced thrombocytopenia rat models (Apostol., et. al, 2012).Also flavonoids have been shown to reduce platelet adhesion and aggregation, prevent thrombosis and thus improve microcirculation(Pati., et. al, 2013). Moreover, flavonoids are compounds known to stimulate and improve the megakaryotes to produce sufficient numbers of platelets to maintain a suitable platelet count in mammals in particular during chemotherapy. Furthermore, flavonoids are shown to have anabolic effect which is responsible for stimulant effect on blood cell production (Tahir, 2014). Additionally, diterpenes and triterpeneswere detected only in Papaya leaves which is synthesized by geraniol and geranylgeraniol that induce the acylation of proteins and the synthesis of vitamin E and K (Kim, 2013).The synthesis of vitamin K is important in the blood coagulation which response to vascular injury leading to the activation of platelets and coagulation factors with the ultimate formation of a fibrin plug. Several coagulation factors are zymogens of serine proteases that require vitamin K for normal biosynthesis (Stenflo, 1986). Table

6.Thrombocytotic Efficacy of the Treatments among Aspirin-Induced Laboratory Rabbits

Treatment Tawa-tawaa Papaya b Malunggayc Prednisone c Sterile Water c

Mean Platelet Efficacy Count 338.50 x 103/mm3 Effective 372.30 x 103/mm3 Effective 274.10 x 103/mm3 Effective 249.20 x 103/mm3 Not Effective 226.90 x 103/mm3 Not Effective


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has the most number of chemicals with Thrombocytotic properties which are diterpenes, triterpenes, flavonoids, alkaloids and phenolics. On the other hand, Tawa-tawa expressed juice (T1) is the second most effective treatment that increased platelet count of the test animals. The result of phytochemical analysis revealed that Tawa-tawa leaves have compounds such as phenolics and flavonoids, which are known to have the ability that contributes in producing platelets in the body. Other properties of Tawa-tawa are also known to have its ability to promote cell production and prevent cell destruction. Likewise, the improvement in the cell bleeding time and clotting time provided evidence that Tawa-tawa can preserve and promote the hemostatic function of platelets (Apostol.et,al., 2012). Malunggay turned out to be the third effective medicinal plant among treatments because it also has its properties that help to boost platelet count such as alkaloids, phenolics, tannins and flavonoids. Although there is no study that proves Moringaoleifera has its ability to promote platelet production, it also contains properties that are the same with Tawa-tawa and Papaya which stimulate production of platelet. Hence, the study verified the potential of Malunggay leaves for treating thrombocytopenia and can be an alternative to the established thrombocytotic drugs such as steroids and corticosteroids like prednisone. Prednisone which is the positive control of the study is a corticosteroid drug that reduces the body’s immune system. Because of this, it is useful for treating thrombocytopenia that is caused by an auto-immune disorder-- a disorder wherein the body’s immune system mistakenly attacks the body itself rather than foreign pathogens. However, the study revealed that prednisone is not effective.

Legend: 270--480 x 103/mm3 (Normal Platelet Count)

The study revealed that Papaya, Tawatawa and Malunggay were the effective treatments. Papaya (T2) is the most effective treatment for boosting platelet count. According to the study of Lekamlage (2013), they found out that papaya leaves extract can enhance haemopoiesis and thrombopoiesis in animals. In addition, Papaya leaves have been investigated for its potential properties against Dengue fever. Further studies proved that Papaya contains properties which are potent thrombocytoticeffects(Tahir, 2014).Moreover, based from the phytochemical analysis, Papaya

Furthermore, results should that there is a significant difference in the thrombocytotic efficacy of the treatments. Specifically, Papaya is more effective as compared to the other treatments. The result of the study is the same with the study of Arolloda, C. et. al., (2013) wherein Papaya (125.87%) has the highest percentage increase of mean platelet counts after reduction with anagrelide. Furthermore, Tawa-tawa is more effective than Malunggay. Administering Tawatawa decoction to animal models in previous studies helps improve their healing mechanism. Tawa-tawa was able to promote cell production,


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and prevents platelet destruction. Likewise, the improvement in the cell bleeding time and clotting time provided evidence that the indigenous plant can preserve and promote the hemostatic function of platelets. The phenolic compounds present in Tawa-tawa, are suspected to be responsible in the increased platelet counts of tested animals (Agron, 2012). Additionally,Malunggay has the same effectiveness with the controls of the study. According to the study of Ezejindu, et. al.(2015), Moringaoleifera leaf extract may have little effect on blood parameters with slight changes in white blood cells and this was seen in the study. Though Malunggay contains chemicals that may increase platelet count, the result is statistically the same with sterile water which has no thrombocytotic properties, This is in contrast in the study of Besa&Salibay (2013) wherein platelet counts of normal rats after the treatment period of Malunggay and tumor-induced rats before and after the treatment phase were observed to be much higher than normal. CONCLUSIONS Most patients diagnosed with dengue fever commonly used Tawa-tawa, Malunggay and Papaya which are usually prepared through decoction, perceived to be effective and were learned through hearsay; Papaya, Tawa-tawa and Malunggay contain chemicals with thrombocytotic properties; however, Papaya has the most number of phytochemicals. Moreover, and Papaya is the most effective treatment in increasing the platelet count and can be an alternative treatment for thrombocytopenia. RECOMMENDATIONS Based on the findings and conclusions, the researchers recommend the following: 1. The Local Government of Agoo should consider the results of this study for information dissemination so that the community will be aware of the best medicinal plant to be used in the treatment of dengue fever so that the people will be guided properly. 2. Papaya leaves can be used to increase platelet count due to its phytochemical properties. 3. Papaya leaf expressed juice can be an alternative treatment to dengue fever and can be used with the approval of health care providers.


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4. Studies in congruence to this may be conducted to further verify its results. Furthermore, the researchers recommend for deeper investigation to determine the thrombocytotic efficacy of Tawa-tawa, Papaya and Malunggay considering also other parts of the plants and the quantitative analysis and isolation of the phytochemicals. Researchers can aslo perform toxicity test and clinical trials. Researchers can also use 3ml for the negative control (Sterile Water) and increase the dosage of the positive control (Prednisone) and consider the weight of the test animals in the dosage of the treatments. REFERENCES Abdul Wadoodet. Al. (2013). Aphytochemical Analysis of Medicinal Plants Occuring in Local Area of Mardan. Retrieved from http://omicsonline.org/phytochemical-nalysisof-medicinal-plants-occcuring-in-local-areaof-mardan-21611009.1000144.php?aid=21624 Agron, E.B. (2012, September 10). Tawatawacontains active ingredients that may help dengue hemorrhagic fever (DHF) patientstudy. Retrieved from http://www.ehealth.ph/index.php/communityblog/tag/community-blog/Tawa-awa%20Plant Arolloda, C.E, et.al. (2013). Platelet Augmentation Activity of Seleceted Philippine Plants. International Journal of Pharmaceutical and Phytopharmacological Research (eIJPPP). Besa, J.J., and Salibayb, C., (2013). Synergistic Effects of Arthrospiraplatensis (Spirulina) and Moringaoleifera Lam. (Malunggay) on Tumorinduced Rattusnorvegicus (Sprague-Dawley Rat). Retrieved from http:’’j-amsa.amsainternational.org/index.php/main/article/view/ 33 Concato, J., et al (2006). Randomized, Controlled Trials, Observational Studies and the Hierarchy of Research Designs. Retrieved from http://wwwncbi.nlm.nih.gov/pubmed/0010861 325 Crane, 2005; Fuggate, Wongs-Aree, Noichinda, &Kanlayanarat, 2010; Rivere-Pastranaet.al., 2010; Yadava, Burris & McCrary, 1990. Papaya: Nutritional and Pharmacological characterization and quality loss due to physiolodical disorders. An overview. Retrieved fromhttp://ac.elscdn.com/S09639996911000068/1s2.s0963996911000068main.pdf?_tid=c9cd86


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e6-c536-11e4-bd7d00000aacb35e&acdnat=1425780163_1947f78 a0c2ac9b5286bb6cf7d104fb DOH (2013). DOH: 42,207 dengue cases, 193 deaths in January to 1st week of June.Retrieved fromhttp://www.gmanetwork.com/news/ story/312978/news/nation/doh-42-207-denguecases-193-deaths-from-january-to-1stweek-ofJune Pacheco (2013). Dengue Fever Retrieved from https//;//www.facebook.com/DrDavidPacheco GeneralMedicineClinic/posts/2257092542746 64 Ezejindu D.N. et. Al. (2015) Evaluation of Toxicity Effect of Graded Doses of Moringaoleifera Leaf Extract on Blood Indices Using 20 Adult Wistar Rats. Retrieved from http://www.ssjournals.com/index.php/ijbar/arti cle/view/1535 FP et.al R. (2007) Public Health Nursing in the Philippines (10th Edition) National League of Philippine Government Nurses, Incorporated. Book Gascon, M.G. (2011) Traditional Ecological Knowledge System of the Matigsalug Tribe in Mitigating the Effects of Dengue and Malaria Outbreak. Asian Journal of Health Ethno Medical Section, 1 (1), 161-162. Retrieved from http://www.eisrjc.com/documents. Traditional_Ecological_Knowledge_SYstem_ of the MAtigsalug Tribe-1325744609.pdf Guest et. Al. (2006) How many Interviews are enough? An Experiment with Data Saturation and Variablity. Retrieved from http:wwwrincondepaco.com.mx/Rincon/Inicio /Seminario/Documentos/Met-otros/Docs_draFleiz/Lecturas_sugeridas/Guest-datasaturation-interview.pdf


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Goncalves de Oliveria, J. and Vtoria, A.P. 92011). Papaya: Nutritional and pharmacological characterization, and quality loss due to physiological disorders. An overview. Retrieved from http://ac.els.cdn.com/ S0963996911000068/1s2.0S09639969 11000068main.pdf?_tid=c9cd86e6c536 11e4bd7d Jacqueline L. Deen, E.H. (2006). The WHO dengue classification and case definitions: time for Viewpoint. Retrieved from http://www.fimca.com.br/decifra_me/files/sab ermais/materials/dengue%204%5B1%5D.pdf Jin. J. (2012), Alkaloids Isolated from Natural Herbs as an Anti-Cacer Agents. Retrieved fromhttp://www.hindawi.com/journals/ ecam/201/485042 Lekamlageet, at al (2013) Does Carica Papaya Leay extract increase the platelet count? An experimental study in a murine model Asian Pacific Journal of Tropical Biomedicine, 720. Retrieved from http://wwww.ncbi.nlm.nih.gov/ pmc/articles/PMC3757281/pdf/apjtb0309720.pdf Pati, Shetty, Bhide and Narayanan. (2013). Evaluation of Platelet Augmentation act of Carica Papaya Leaf Aqueous Extract in Rats. Retrievd 2014. Journal of Pharmacognosy and Phytochemistry. Retrieved from http://www.phytojournal.com/vol1issue5/issue _jan_2013/11.1.pdf Rillera, et. Al. (2011) Community Organizing Participatory Action Research in BarangayDangdangla, San Juan, La Union Tahir, Z.K. (2014) Prevention of Fall in Platelet Count by Carica Papaya Leaf Juice.Retrieved from http\;//www.thebiomedicapk.com/articles/362. pdf


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Effect of Nurse –to-Patient Ratio on Nurse Satisfaction and Post Partum Patient Care Outcomes Author: Jennifer S. Ventura, Florelyn F. Estipular, Michelle Ann A. Barbachano, Karen Jane F. Gamboa, Mark Gil C. Lachica, Mr.Jovencio M. Milan, JR. RM, RN, MAN

ABSTRACT There are global issues on the staffing ratio effects on nurses’ satisfaction and patient care outcomes. The study aimed to determine the effect of nurse-to-patient ratio on nurses’ satisfaction and post partum patient care outcomes in selected hospitals in La Union conducted from March to September,2014. Sixty nurses and 63 post partum patients were chosen through purposive sampling. The study is descriptive-correlational design utilizing a questionnaire. Frequency count, percentage, Mean, ANOVA, Tukey’s Test and Pearson Chi-squarewere used. The nurse-to-patient ratio is above the maximum. Most nurses were satisfied in their working conditions and patients were mostly satisfied with the care they received, complications-free and admitted more than one day. Those with higher nurse-to-patient ratio have lesser patient satisfaction. An inverse relationship exists between the nurse-to-patient ratio and level of care satisfaction. The proposed enhancement strategy aims to improve the nurses’ working condition and patient care satisfaction. Keywords: Care outcomes, level of satisfaction, nurse-to-patient ratio, postpartum

INTRODUCTION Safe staffing level is an essential prerequisite to delivering quality patient care ( Royal College of Nursing, 2010). According to American Nurses Association(2008) there is a strong relationship between adequate nurse-to-patient ratios and safe patient outcomes. Ensuring adequate staffing levels has been shown to reduce medical and medication errors, decrease patient complications, decrease mortality, improve patient satisfaction, reduce nurse fatigue, decrease nurse burnout, and improves nurse retention and job satisfaction. Nurse to patient ratios were between 1:4 at best and 1:8 at worst. Patients on wards with the worst staffing ratios had a 31% greater mortality risk; however, according to the comprehensive study of Needleman J, et al (2002), there is no significant relationship between nurse staffing and mortality .Internationally, there are states who began to Therefore, the conclusion from the research determined that many of the studies actually provided conflicting evidences. Internationally, there are states who began to lobbied for mandatory safe staffing levels to protect patient’s safety. The California Nurses Association (CNA) is the first one that lobbied for mandatory nurse-to-patient ratio in 1992 due to concerns over poor or missed care, unstable nursing workforce and

increasing demand of services. They have formulated a mandatory nurse- to-patient ratio that provides a minimum number of nursing staff to patients that must be on duty. In the Philippines, there is no clear view about staffing ratio per patient; rather, an act providing for a more responsive nursing profession the R.A. 9173 otherwise known as “The Philippine Nursing Act of 2002” which states that the government and private hospital are hereby mandated to maintain the standard nurse-to-patient ratio set by the Department of Health (The Lawphil Project, 2013). The Philippines’ maternal mortality rate continues at an unacceptably high level. Approximately 4,100 to 4,900 women and girls die each year due to pregnancy-related complications. In Region 1, the mortality rate for post partum patients is 0.34 per one thousand live births ( National Epidemiology Center, Department of Health, 2007). OB ward is one of the busiest wards in the world with an average of 60 births a day but it can record as many as 100 in 24 hours (Daily Mail Reporter , 2011). The study aimed to determine the effect of nurse-to-patient ratio on nurse satisfaction and postpartum patient care outcome in selected hospitals in La Union. Specifically it sought to answer the nurseto-patient ratio of the area of assignment where the


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nurses are working, nurses’ level of satisfaction in terms of working condition, institutional policies, kind of supervision, interpersonal relations, salary and incentives, job security; post-partum patient care outcome in terms of level of care satisfaction, number of post-partum days and presence of complication. .Significant difference and significant relationship in the nurse satisfaction and patient care outcomes when grouped according to nurse-to-patient ratio. METHODOLOGY For the purpose of the study, the researchers used descriptive-correlational type of research design to determine and understand the relationship among the variables. The study was conducted from the month of March to September, 2014. The respondents were 60 staff nurses on duty in different hospitals in La Union who cater to confined post partum patients, chosen through purposive sampling. Another group of respondents were chosen through purposiveconvenience sampling. Another respondents were patients who delivered normally and who were in their post partum period regardless of number of admission days, and present complications if any and were willing to answer the questionnaire given to them. Patients who had just received medications with side effects that can alter the cognitive condition or consciousness were excluded to answer the questionnaire. Health care institutions in La Union with obstetric ward, and offers post partum care were selected, since the study focuses on the impact of nurse-to-patient ratio on nurse satisfaction and patient care outcome among post partum patients. Health care Institutions and the number of respondents of OB staff nurses and post partum patients gathered were as follows: 12 nurses and 6 patients from Rosario District Hospital gathered from May 5 to 10, 2014 ; 14 nurses and 28 patients from Ilocos Training and Regional Medical Center gathered from May 6 to 12, 2014 ; 11 nurses and 8 patients from Balaoan District Hospital gathered from May 30 and 31 to June 2-5 ,2014 ; 8 nurses and 6 patients from Naguilian District Hospital gathered from June 5 to 12, 2014 ; 9 nurses and 15 patients from Bacnotan District Hospital gathered from June 25- 27 and July 1 to 3, 2014 ; and 6 nurses and 0 patients from Caba Medicare Hospital gathered from July 8, 9, 21 to 24, 2014. The total number of respondents is 60 OB staff nurses and 63 post partum patients. Private Institutions and Maternal Lying-ins were excluded in the gathering of data. A private institution: Agoo Family Hospital was only used for the reliability testing of the instrument.

The researchers made use of the descriptive survey and they used a separate structured questionnaire to determine the impact of nurse-topatient ratio on the nurses’ level of satisfaction and post partum patient care outcomes. After the formulation of the questionnaire, validity of the questionnaires were checked five reliable experts. Validity test revealed a mean of 4.79 for the language level and suitability mean of 4.84 for the questionnaire on the level of nurses’ satisfaction. Also, all the items had a Content Validity Index (CVI) of 1. The adequacy result of the tool showed that it was adequate having a mean of 4.4 on a scale of 1 to 5. In terms of the patient’s questionnaire, the validity test showed a mean of 4.67 for the language level, suitability mean of 4.67 and all the items has a Content Validity Index (CVI) of 1. Furthermore, the result about the adequacy of the tool showed that it was adequate having a mean 4.6 of on a scale of 1 to 5. After the questionnaire was validated, reliability testing followed. The respondents for the reliability testing of the questionnaire were ten OB nurses who were employed in a private hospitalAgoo Family Hospital and attended post partum patients; and ten post partum patients who were admitted in the same institution. The CronbachAlpha formula was used for determining the reliability of the tool. Researchers computed and analysed the data gathered with the use of Statistical Package for Social Sciences (SPSS) trial version. The Cronbach’s alpha value for nurses’ level of satisfaction is 0.941 and 0.953 for post partum patient care outcomes, which showed that the tools used were reliable. Frequency and percentage, average weighted mean, One Way Analysis of Variance (ANOVA), Tukey’s Test and Pearson Chi-square as statistical tools. RESULTS AND DISCUSSION Based on table 1, the result indicates that the highest frequency of nurse-to-patient ratio is 1:111:20 (41.7%). On the other hand, the least nurse to patient ratio is 1:31 and above (5%).The selected health care institutions with obstetric ward, which offers post partum care has significant number of admissions and deliveries, but they have poor staffing level. In district hospitals there are only two staff nurses per shift who caters all the wards of the postpartum while in tertiary hospitals, there are only two staff nurses per ward. Government hospitals have always reason for lack of funds or profit to hire for more qualified registered nurses.


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Table 1. Nurse-To-Patient Ratio Selected Health Care Institutions in La Union Nurse-to-Patient Ratio

Frequency

%

1:10 and below

23

38.3

1:11 – 1:20

25

41.7

1:21 – 1:30

9

15.0

1:31 and above Total

3 60

5.0 100.0

Thus this implies that most nurses on different health care institutions in La Union were understaffed and caters patient above standard ratio. Furthermore, the staffing ratio set by the different government hospitals is not sufficient to monitor an increasing number of post-partum patients that may impact negatively on standards of care. According to Recto (2011), the ideal nurseto-patient ratio of 1:4 per shift has not yet realized in our country. Republic Act 9173 otherwise known as “Philippine Nursing Act of 2002” Article 6 Section 28, mandates that government and private hospitals must maintain the standard nurse-topatient ratio set by the Department of Health where in hospitals based on acuity and authorized bed capacity; in community based on need, population and geography; and in occupational and school settings based on relevant legal instruments. Table 2. Level of Satisfaction of Nurses Working in Selected Health Care Institutions in La Union Average Weighted Mean

Level of Satisfaction

Working Condition

2.87

Satisfied

Institutional Policies

3.07

Satisfied

Kind of Supervision

3.11

Satisfied

Interpersonal Relations

3.15

Satisfied

Salary & Incentives

2.70

Satisfied

Job Security

3.15

Satisfied

Total

3.01

Satisfied

Indicators

Table 2 presents the satisfaction of nurses in selected health care institution in La Union. As observed, all categorical ratings are satisfactory which means that the nurses are satisfied in all the indicators which are working condition, institutional policies, kind of supervision, interpersonal relations, salary and incentives and job security. The highest rated items that garnered a mean of 3.15 were interpersonal relations and job security. Based on the outcome of the study, it confirms that most of nurse respondents in the different health care institutions in La union were satisfied to their interpersonal interactions which exist between them and their colleague(s) and patient(s). On the other hand, with job security, the result of the study shows that most of the respondents are satisfied. The reasons are that they have confidence with their personal skills, they have good contract of employment that prevents arbitrary termination and they have assurance of continuity of gainful employment and permanence of job. The least to the result is salary and incentives. The staff nurses receives an average amount of P8, 000 as their monthly wage and a thirteenth month pay of P2, 500- P3, 000 and does not get overtime pay and or holiday pay. Thus this implies that Filipino nurses received a salary below expected amount of wage and rarely obtained any work incentives but were still satisfied despite of the fact. Table 3 presents the level of care satisfaction of post partum patients. The highest means that were gathered are 3.41 wherein patients are very satisfied in the professionalism of nurses such as proper uniform, gestures, way of speech and 3.38 that patients are very satisfied in the abilities of health professionals to anticipate their needs. This implies that Filipino nurses create a good impression and maintains a professional image by means of personal appearance; effective communication skills and a professional attitude. Moreover, health professionals have the ability to exhibit appropriate professional conduct and anticipate needs of patient while promoting the growth or development. On the other hand the least mean that was gathered is satisfaction with the environment. As observed by the researchers, the hospitals have lack of facilities and poor health care environment utilities which is less conducive for rendering quality care however patients were still satisfied.


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Table 3. Level of Care Satisfaction of Post Partum Patients in Selected Health Care Institutions in La Union Level of Care Satisfaction Mean Interpretation

Table 4. Patient Care Outcomes in Terms of Number Post Partum Days and Presence of Complication in Selected Health Care Institutions in La Union

Consent is informed clear Staff informed rights and obligation

3.33 3.08

Very Satisfied Satisfied

Treatment option is well explained

3.12

Satisfied

Privacy is assured

3.11

Satisfied

Abilities of health professionals

3.38

Very Satisfied

Services provided meet objectives

3.08

Satisfied

Nurses maintain safety and comfort

3.29

Very Satisfied

a.

Nurses ensure continuity of care

3.27

Very Satisfied

Staff helpfulness

3.13

Satisfied

Staff friendliness

3.19

Satisfied

Speed of service Availability of staff

3.00 3.13

Satisfied Satisfied

1 day or less 2 days 3 days 4 days Total b. Presence of Complication

Nurses answer questions promptly

3.32

Very Satisfied

Professionalism of the nurse is applied

3.41

Very Satisfied

Satisfaction with the environment/ward

2.60

Satisfied

Overall Mean

3.16

Satisfied

According to Herra and Roman (2010), some of the problems plaguing the Philippine health care system are inadequate budgets, insufficient equipment, declining involvement of the government at the national level, unclear systems of accountability and lack of hospital facilities in rural areas. Table 4 presents the patient care outcomes of post partum patients. Based on table 3, with regard to post partum days, the result shows that the highest number of post partum days is 2(42.9%) while the least is 4 days (9.5%). As the researchers observed, the delay of discharge was due to the delay of payment. Usually for Philippine government hospitals, poor patients are the ones with prolonged stay.

According to Davidas (2004), common practice of hospital or health care institutions owners detains their patients on the sole basis of the latter’s failure to fully settle its financial obligations. Detaining a patient to ensure payment would only add up patients bills because of extended stay. This happens usually to poor patients.World Health Organization recommendation on postnatal care Patient Care Outcome Frequency %

No. of Post Partum Days

Without With Hypertension) Total

(Dysuria,

22 27 8 6 63

34.9 42.9 12.7 9.5 100.0

61 2

96.8 3.2

63

100.0

(2013), for the provision of postnatal care to mothers and newborns in timing of discharge from a health facility after birth that after an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth. Table 5. Significant Difference in the Level of Nurse Satisfaction and Patient Care Outcomes as to Nurse-To- Patient Ratio

Level of Nurses Satisfaction Level of Care satisfaction Number of Post Partum Days Presence of Complication

p-value 0.672 0.000 0.546 0.894

Interpretation Not Significant Significant Not Significant Not Significant


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It is clear that the level of nurse satisfaction and patient care outcome in terms of the number of post partum days and presence of complication has no significant differences as to the nurse-to-patient ratio. This means that the nurses level of satisfaction, number of patients, post partum days and presence of complications do not differ as to the nurse-topatient ratio. It is also evident in table 5, that the level of care satisfaction of patients is the only one that has significant difference when grouped according to the nurse-to-patient ratio. This implies that the number of nurses who caters postpartum patients greatly affects patients care outcome in terms of level of care satisfaction Patient’s satisfaction is an important indicator to measure the quality of care rendered to the patients and healthcare facilities while in hospital (Sharma & Kamra, 2013). Table 6. Significant Differences in the Level of Care Satisfaction of Patients as to Nurse - toPatient Ratio (I)

(J)

1:10 and below

1:111:20

1:111:20

1:211:30

1:31 and above

1:211:30 1:31 and above 1-10 and below 1:211:30 1:31 and above 1-10 and below 1:111:20 1:31 and above 1-10 and below 1:111:20 1:211:30

(I-J) Mean Difference 0.249

p value 0.341

Interpretation Not Significant

0.979*

0.000

Significant

0.758*

0.022

Significant

-0.249

0.341

Not Significant

0.731*

0.004

Significant

0.509

0.178

Not Significant

-0.979*

0.000

Significant

-0.731*

0.004

Significant

-0.222

0.871

Not Significant

-0.757*

0.022

Significant

-0.509

0.178

Not Significant

0.222

0.871

Not Significant

The table shows that there is a significant difference in the level of care satisfaction of patients under a nurse-to-patient ratio of 1:10 and below and ratios of 1:21- 1:30 and 1:31 and above. Specifically, patients who were catered by nurses within the standard nurse-to-patient ratio have higher level of care satisfaction. When staffing levels are too low, RNs are frequently forced to compromise the care they give to their patients. Unsafe nurse staffing is a dangerous practice that leads to medical errors, poorer patient outcomes and nursing injuries as well as burnout. Table 7. Significant Relationship in the Nurse Satisfaction and Patient Care Outcomes as to the Nurse-To-Patient Ratio p value Level of Nurses Satisfaction Level of Care Satisfaction Number of Post Partum Days Presence of Complication

0.448 -0.009 0.886 0.277

As shown on table 7, the patient care outcome in terms of level of care satisfaction was the only one which has significant relationship with nurse-to-patient ratio. Specifically, a negative correlation exists between the level of care satisfaction and nurse-to-patient ratio. This means that as the nurse-to-patient ratio increases the post partum patient level of care satisfaction decreases. This may show that nurses who cater and monitor numerous number of patients above the standard ratio results to lesser satisfaction and poorer patient outcome. Nurses having high nurse-to-patient ratio are risk. This study agreed with Aiken, et al (2002) that low staffing levels are likely to lead to negative outcomes. As supported to studies which agree that the more patients a nurse is allocated, the worse the patient outcome is likely to be (Patterson, 2011). In response to the result of the study, an action proposal plan has been developed by the researchers. This action plan was based on salient findings of the study which was the effect of nurse-to-patient ratio on nurse satisfaction and post partum patient care outcome in selected health care institutions in La Union. The result showed that nurses on different health care institutions in La Union were mostly understaffed and caters to patients above the standard ratio. Salary and incentives of nurses is the least


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satisfaction. It is also presented that the level of care satisfaction of post partum patients significantly differs as to nurse-to-patient ratio and a negative correlation of patient care outcome in term of level of care satisfaction when grouped according to nurse-topatient ratio. The objectives of the enhancement strategy are after a year of implementation of the proposed program: Health care institutions will maintain the standard nurse-to-patient ratio set by the DOH; Nurses level of satisfaction will increase from satisfied to very satisfied; Patient’s care outcome from satisfied turns to very satisfied. CONCLUSIONS Based on the established findings of the study, the researchers conclusions are the following: Nurses on different health care institutions in La Union were mostly understaffed and caters to patients above the standard ratio. Most nurses are satisfied in terms of their working condition, institutional policies, kind of supervision, interpersonal relations, salary and incentives and job security. Most of the post partum patients are satisfied with their care outcomes, were free from complication and were admitted more than one day. Those with nurse-topatient ratio higher than the standard have lesser level of patient care satisfaction.As the number of nurseto-patient ratio increases the level of patient care satisfaction decreases.Enhancement strategy was then proposed to enhance the staffing ratio of health care institutions and promote higher satisfaction of nurses and patients. RECOMMENDATIONS The researchers recommend that health care institutions must improve their staffing level recognizing the standard nurse-topatient ratio in the country Hospitals should allot funds in hiring qualified nurses to promote a better working condition and render quality care to patients. Heads of hospitals may give rewards or promotions to nurses who exemplify excellence to their work; and respond to priority needs in physical environment. The action plan proposed by the researchers should

be taken into consideration by the persons and institutions to improve the level of satisfaction of nurses and patient care outcome. For future researchers, they can include the effects of nurse staffing on adverse outcomes, morbidity, mortality, and medical costs, medical errors, work environment for nurses in a bigger population particularly all hospitals in the province for better comparison. REFERENCES Aiken, et. a. (2011). Nursing Times. The Effects of Nurse Patient Ratio , 22-25. American Nurses Association. (2008, June 14). Nurse Staffing. ThePracticeofProfessionalNursing , 1. Daily Mail Reporter . (2011). One born every minute: The maternity unit where mothers are THREE to a bed. Philippines: Mail Online: updated June 9, 2011: www.dailymail.co.uk Davidas, R. D. (2004). Thirteenth congress 1st regular session. Quezon City: Republic of the Philippines House of Representatives. Herrera, M. E., & Roman, F. L. (2010). Overview of Health Sector Reform in the Philippines and Possible Opportunities For Public-Private Partnerships. Asian Institute of management , 1-54. National Epidemiology Center, Department of Health. (2007). Field Health Service Information System Annual. Philippines: www.doh.gov.ph Needleman J, B. P. (2002). Nurse-staffing levels and quality of care in hospitals. International Journal for Quality in Healthcare , 1415– 1422: oxfordjournals.org. Patterson, J. (2011). The effects of Nurse to Patient Ratios. Nursing Times , 107;2, 22-25 Recto, R. (2011). Philippine Nursing Practice Reform Act of 2011 (Senate Bill No. 2988)., (pp. 1-26). Manila Royal College of Nursing. (2010). Guidance on Safe nurse Staffing Levels in the UK, London:RCN. Sharma, S. K., & Kamra, P. K. (2013). Patient Satisfaction with Nursing Care in Public and Private. Nursing and Midwifery Research Journal Vol-9, No.3 , 1-14. The Lawphil Project. (2013, December 05). Retrieved 2013 2013, from www.lawphil.net: http://www.lawphil.net/statutes/repacts/ra2002/ra_ 9173_2002.html


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Evaluation of the Philosophy, Vision, Mission, Goals and Program Outcomes of DMMMSU-ICHAMS Authors: Jima J. Mamungay, RN, Janna M. Boado, MAN,RN,RM, Anndra Margareth B. Dumo, MAN,RN,RM, Holly Lou M. Santos, MAN,RN ABSTRACT Higher Educational Institutions (HEIs) are expected to create their aims, purpose and strategies in the form of Philosophy, Vision, Mission, Goals and program Outcomes (PVMGO) which must be assessed to measure its fulfillment. This paper aimed to evaluate the PVMGO of the DMMMSUICHAMSin Agoo, La Unionwhich was conducted from January to July,2015. The study is adescriptivecorrelational designutilizing a structured questionnaire. Respondents were 120 internal and external stakeholders who were chosen through quota sampling. ThePVMGO were highly accepted by the stakeholders. There is a significant difference in the stakeholders’ level of acceptability, perceived level of implementation, level of exposure and perceived effectiveness of the channels used for PVMGO dissemination.Amoderate correlation exists between the level of acceptability and extent of implementation of the PVMGO while a very high correlation exists between the level of exposure and level of effectiveness of the channels for PVMGO dissemination. Keywords: Acceptability, dissemination, goals, mission, vision

INTRODUCTION Organizations do not form accidentally or spontaneously; rather, they are goal oriented, have a specific purpose, and are created because one or more individuals perceive that the coordinated and concerted action of a number of people can accomplish something that individual action cannot (Schein, 2004). In large organizations, vision statements, mission statements and statements of values are often formalized to describe the company’s culture (Khan, 2005). Having both a vision and a mission statement will bring the values and expectations of the organization to the forefront, making strategic decisions easier and keeping the goals of the organization in mind (Coon, 2007). These statements may contribute to the characteristics of the culture of the organization. As described by Venzon (2006), a vision statement outlines the organization’s future role and function. This is what the institution is striving for and the reason of its existence. It represents the dream the organization would like to achieve (Sherren, 2012) and it sets forth the direction of the organization (Coon, 2007). The formalized statement of values as stated by Khan (2005) is the philosophy which describes the vision. The mission on the other hand, is the strategy on how

to achieve the vision of the organization. It is a statement of beliefs that directs the organization. It is the sense of purpose of the organization and the reason behind its structure and goals (Venzon, 2006) or why an organization exists and what it does to achieve its vision. Unfortunately, for many organizations, the mission is usually just a statement describing a desired working culture, and does not inspire focused behaviour (Sherren, 2012). The mission becomes the anchor for developing broad organizational goals and corresponding objectives and strategies. A major benefit of a clear and focused mission is how it can help the board and the staff make decisions about continuing or expanding existing programs and services, eliminating them, or creating new ones (N.C Center for NonProfits, 2007). Goals and objectives are summarized into mission or vision statement. Vision and mission have a direct bearing on the bottom line and the success of the organization. Thus, the institution’s Philosophy, Vision, Mission, Goals and Program Outcomes (PVMGO) inform an individual of the desired level of performance and how well the institute performs making its people a responsible citizen. Realization and fulfillment of PVMGO must be evaluated to measure the institution’s performance and the implementation of its programs which can greatly contribute to future strategic planning of the institution.


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The Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc. (AACCUP) (2014)stress the clear statements and regular visit of the institution’s vision, mission, goals and objectives. During accreditation, the State Universities and Colleges (SUCs) are evaluated in terms of the degree to which its vision, mission, goals and program outcomes are attained, not in comparison of others. Hence, the study was conducted. The study mainly aimed to evaluate the philosophy, vision, mission, goals and Bachelor of Science in Nursing (BSN) program outcomes (PVMGO) of DMMMSU ICHAMS. Specifically, the researchers sought to find the evaluation of the respondents on the PVMGO of DMMMSU-ICHAMS as to level of acceptability of the PVMGO, extent of the implementation of the PVMGO, level of exposure to channels for PVMGO dissemination and level of effectiveness of the channels for PVMGO dissemination. It also determined the significant difference between the evaluation of the respondents on the DMMMSU-ICHAMS PVMGO when grouped according to profile, the significant relationship between the level of acceptability and extent of implementation and the significant relationship between the level of exposure and level of effectiveness in the identified channels for PVMGO dissemination. METHODOLOGY The researchers used the descriptivecorrelational research design. The purpose of descriptive studies is to observe, describe, and document aspects of a situation as it naturally occurs and correlational research explores the interrelationships among variables of interest without researcher intervention (Polit & Beck, 2008). In this study, the researchers described the evaluation of stakeholders in the PVMGO of DMMMSU ICHAMS and determined the relationship of the different variables. The study was conducted in La Union covering the period from January 2015 to July 2015. The respondents of the study were the internal stakeholders of the DMMMSUICHAMS particularly the faculty, staff and students. Another set of respondents were the external stakeholders who are the alumni, parents, members of the partner industries of the institute. The researchers used quota sampling to determine the number of respondents of the study whereby the researches selected 120

stakeholders specifically 15 faculty, 15 staff, 15 members of partner industries, 15 parents and 60 students in various year levels .Polit and Beck (2008) describe quota sampling as a technique whereby the researcher identifies population strata or population characteristics and determines how many participants are needed for each stratum and in this study, the researchers employed the classification of the different stakeholders of the institute. The principal instrument of the study was a valid and reliable structured questionnaire which was adopted from the study of Giron, et.al (2011) with permission. The questionnaire were divided into four subcategories that measured the respondent’s evaluation of DMMMSUICHAMS PVMGO in terms of the level of acceptance, extent of implementation, level of exposure and level of effectiveness of the various channels dissemination using 5-pointLikert Scale. The respondents were solicited for their opinion on what were needed to be omitted, revised , and added. Average weighted mean, One-Way Analysis of Variance (ANOVA) Tukey’s test and Pearson Product Moment Correlation Coefficient was used as statistical tools. RESULTS AND DISCUSSION Table 1 presents the stakeholders’ level of acceptability of the stakeholders on the PVMGO of DMMMSU-ICHAMS.It is evident in that the PVMGO of DMMMMSU-ICHAMS were highly accepted by the stakeholders. This implies that the PVMGO were clearly stated and communicated, widely understood, and collectively shared. The goal of ICHAMS which is to produce quality graduates in the medical and health allied fields attained the highest mean (4.78) followed by the philosophy (4.74), ICHAMS’ second goal which is to offer course relevant to the health needs and situation of the times (4.74) and the first BSN Program outcome which is to apply knowledge of physical, social, natural and health sciences and humanities in the practice of nursing (4.74). Mission and vision statements have been overwhelmingly accepted as an indispensable part of the strategic management process for organizations of all types. Markos & Sridevi (2010) suggest that organizations should promote a strong work culture in which the goals and values of managers are aligned across all work sections.


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Table 1. Level of Acceptability of the Philosophy, Vision, Mission, Goals and BSN Program Outcomes of DMMMMSU-ICHAMS

PVMGO Philosophy: Total human development with appropriate competencies. Vision: A premier and globally competitive University. Mission: Provides relevant quality instruction, research and extension. Goal: To lead in transforming human resources into productive self- reliant citizens and responsible leaders. ICHAMS GOALS: 1. To produce quality graduates in the medical and health allied fields. 2. To provide effective community health care services in the field of medical and health allied courses. 3. To offer course relevant to the health needs and situation of the times. 4. To reach out to the less privileged but deserving high school graduates who cannot afford to enrol in private schools in the region. Mean BSN PROGRAM OUTCOMES: 1. Apply knowledge of physical, social, natural and health sciences and humanities in the practice of nursing. 2. Provide safe, appropriate and holistic care to individuals, families, population group and community utilizing the nursing process. 3. Apply guidelines and principles of evidencebased practice in the delivery of care. 4. Practice nursing in accordance with existing laws, legal, ethical and moral principles. 5. Communicate effectively in speaking, writing and presenting using culturally-appropriate language. 6. Document to include reporting up-to-date client care accurately and comprehensively. 7. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-cultural teams. 8. Practice beginning management and leadership skills in the delivery of client care using a systems approach. 9. Conduct research with an experienced researcher. 10. Engage in lifelong learning with a passion to keep current with national and global developments in general, and nursing and health developments in particular. 11. Demonstrate responsible citizenship and pride of being a Filipino. Mean Overall Mean

FAC

STA

STU

ALU

AFF

PAR

M

DER

4.80

4.80

4.93

4.67

4.67

4.60

4.74

HA

4.67

4.87

4.82

4.60

4.40

4.53

4.65

HA

4.80

4.93

4.90

4.60

4.27

4.67

4.69

HA

4.87

4.80

4.77

4.60

4.47

4.67

4.69

HA

4.87

5.00

4.83

4.80

4.40

4.80

4.78

HA

4.80

4.87

4.80

4.80

4.47

4.73

4.74

HA

4.80

4.80

4.85

4.80

4.40

4.60

4.71

HA

4.80

4.53

4.83

4.87

4.40

4.53

4.66

HA

4.82

4.80

4.83

4.82

4.42

4.67

4.72

HA

4.73

4.80

4.80

4.80

4.67

4.67

4.74

HA

4.80

4.60

4.65

4.53

4.33

4.33

4.54

HA

4.80

4.73

4.77

4.67

4.27

4.47

4.62

HA

4.87

4.87

4.75

4.60

4.67

4.27

4.67

HA

4.80

4.53

4.72

4.73

4.47

4.60

4.64

HA

4.87

4.60

4.75

4.73

4.27

4.40

4.60

HA

4.80

4.73

4.65

4.87

4.20

4.27

4.59

HA

4.80

4.67

4.65

4.67

4.33

4.20

4.55

HA

4.87

4.53

4.72

4.60

4.47

4.47

4.61

HA

4.80

4.60

4.75

4.67

4.47

4.47

4.63

HA

4.80

4.80

4.77

4.80

4.47

4.47

4.68

HA

4.81

4.68

4.72

4.70

4.42

4.42

4.62 4.66

HA HA


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Increasing the understanding of employees on organizational goals and attaining goal congruence across the members of the organization could greatly contribute to organizational success (Kronbreg&Gustafsson, 2012) since goals which are understood and accepted are more likely to succeed than those which are hardly accepted by stakeholders. Mullane (2002) argued and supported that mission and vision statements are useful for practical day-to-day operations, taking a contrary view to those who assert they are archaic documents that are typically exhibited as wall hangings. Moreover, according to Bartkus, Glassman and McAfee (2004),the mission statement communicate the strategics direction of the organization to stakeholders in order to guide strategic planning as well as motivates and inspires employees (Bartkus et al. 2004). Mission statements are then deemed relevant to the extent that they deliver high levels of motivation and inspiration to employees. In addition, Bart, Bontis and Tagger (2001)found that institutional goals and statements could positively affect employee behaviour which had a direct effect on firm

financial performance and this could only happen when the internal policies and programs are derived from the statement. These statements are also the foundations for the survival and growth of any organization (Analui and Karami, 2002). Table 2 presents the perceived extent of implementation of the PVMGO of DMMMSU ICHAMS. Results show that the PVMGO of DMMMMSU-ICHAMS were perceived by the stakeholders as fully implemented. This implies that the respondents were enthusiastic and fully involved in ways that promote the organization’s interests. Mission and vision statements are supposed to communicate both the organisation’s expectations of employees and as well as the organisation’s commitment to meeting the needs of this group of key stakeholders. When the components are conceptualized as measurable, it enhances the practical application of the mission and vision statements. According to Bart et al. (2001), when organizational recruitment, reward and information systems are aligned with the specific components in a mission statement, they serve to reinforce for employees the message in the mission

Table 2. Extent of Implementation of the Philosophy, Vision, Mission, Goals and BSN Program Outcomes of DMMMMSU-ICHAMS PVMGO Philosophy: Total human development with appropriate competencies. Vision: A premier and globally competitive University. Mission: Provides relevant quality instruction, research and extension. Goal: To lead in transforming human resources into productive self- reliant citizens and responsible leaders. ICHAMS GOALS: 1. To produce quality graduates in the medical and health allied fields. 2. To provide effective community health care services in the field of medical and health allied courses. 3. To offer course relevant to the health needs and situation of the times. 4. To reach out to the less privileged but deserving high school graduates who cannot afford to enrol in private schools in the region. Mean

FAC STA

STU

ALU AFF

PAR

M

DER

4.33 4.20

4.60 4.73

4.83 4.77

4.73 4.80

4.60 4.47

4.47 4.27

4.59 4.54

IFE IFE

4.47

4.73

4.82

4.60

4.53

4.40

4.59

IFE

4.33

4.67

4.78

4.60

4.40

4.67

4.58

IFE

4.33

4.93

4.83

4.73

4.40

4.67

4.65

IFE

4.27

4.80

4.80

4.80

4.47

4.67

4.63

IFE

4.33

4.73

4.85

4.80

4.53

4.53

4.63

IFE

4.40 4.33

4.40 4.72

4.80 4.82

4.93 4.82

4.20 4.40

4.47 4.58

4.53 4.61

IFE IFE


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BSN PROGRAM OUTCOMES: 1. Apply knowledge of physical, social, natural and health sciences and humanities in the practice of nursing. 2. Provide safe, appropriate and holistic care to individuals, families, population group and community utilizing the nursing process. 3. Apply guidelines and principles of evidencebased practice in the delivery of care. 4. Practice nursing in accordance with existing laws, legal, ethical and moral principles. 5. Communicate effectively in speaking, writing and presenting using culturally-appropriate language. 6. Document to include reporting up-to-date client care accurately and comprehensively. 7. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-cultural teams. 8. Practice beginning management and leadership skills in the delivery of client care using a systems approach. 9. Conduct research with an experienced researcher. 10. Engage in lifelong learning with a passion to keep current with national and global developments in general, and nursing and health developments in particular. 11. Demonstrate responsible citizenship and pride of being a Filipino. Mean Overall Mean

The result of the study also portray that the employees perform the roles and responsibilities in implementing the PVMGO of the institution. Getting employees motivated and committed towards the accomplishment of the organization’s vision may be a challenge to many institutions. Maduka&Okafor (2014) state that employee motivation will depend on the strengths of employees’ motives which are the needs, wants, desires, or impulses. Having a concern for these motives could result to employee satisfaction, which according to Harvard Business Review (2013) can in turn result to high quality support services and policies that enable employees to deliver quality services. Table 3 shows the level of exposure of the stakeholders to the various channels for PVMGO Dissemination. Results show that in general, the respondents were very much exposed to the various channels for PVMGO dissemination. This implies that the University utilized sufficient interventions to facilitate dissemination of PVMGO through various networks.

4.20

4.53

4.78

4.67

4.40

4.53

4.52

IFE

4.27

4.27

4.73

4.67

4.20

4.27

4.40

IFE

4.13

4.40

4.73

4.80

4.47

4.53

4.51

IFE

4.40

4.40

4.77

4.80

4.53

4.33

4.54

IFE

4.20

4.27

4.75

4.67

4.20

4.40

4.41

IFE

4.20

4.33

4.65

4.80

4.33

4.53

4.48

IFE

4.07

4.47

4.70

4.87

4.13

4.47

4.45

IFE

4.20 4.27

4.27 4.27

4.68 4.72

4.80 4.73

4.13 4.27

4.27 4.47

4.39 4.45

IFE IFE

4.20

4.33

4.65

4.73

4.47

4.53

4.49

IFE

4.27 4.22

4.53 4.37

4.77 4.72

4.80 4.76

4.20 4.30

4.60 4.45

4.53 4.47

IFE IFE

4.52

IFE

Table 3 likewise illustrate that the respondents were mostly exposed to the PVMGO through the orientation programs conducted by the institution (4.54). On the other hand, the stakeholders were least exposed to the DMMMSU-SLUC website (4.20). The implementation of the various channels is likewise widely observed in the institute. Orientation programs are conducted regularly among the various stakeholders of DMMMSU-ICHAMS which advocates the exposure of the stakeholders in the PVMGO of the institution. Introduction and orientation programs in an organization create an opportunity to inform people about the rules and standards in order to reduce the possibility of misunderstandings (Nekoranec&Nagyová, 2014).Aside from orientation programs, stakeholders who have access to the internet have the advantage of getting information from the institution’s website. However, since there are stakeholders who cannot easily access the website, the institute provided other channels to disseminate the organization’s PVMGO. Aligning policies and activities to the goals and values of the organization is also


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necessary in the promotion of a strong work culture (Markos&Sridevi, 2010).By disseminating the policies of the school, the stakeholders are informed of the institution’s PVMGO as well as the strategies, behaviors and values necessary which can lead to the attainment of these statements. If stakeholders understand these, it could greatly contribute to organizational success (Kronbreg&Gustafsson , 2012). Table 4 shows the perceived level of effectiveness of the various channels for PVMGO Dissemination. It is evident that the various channels used by the institute to disseminate the PVMGO were perceived to be very effective .This implies that the ways of informing the internal and external stakeholders about the institution’s PVMGO were executed successfully. The medium with the highest mean was checklist/manuals (4.56) followed by course

syllabi/curriculum (4.46) and office displays (4.46). As part of the services of the institution, the faculty and staff exert their effort in creating ways to effectively and efficiently disseminate the PVMGO of the organization. DMMMSU believes that it is an organization where productive citizens are developed (DMMMSU, 2013) which is indicative of people working to achieve the aims of the organization According to Ehtesham, Muhammad, & Muhammad (2011), a strong organization possesses a clear sense of purpose and direction that defines their goals and strategic objectives and expresses a vision of how the organization will look in the future. It also creates an intense sense of belongingness, which pilots organizational identity, better productivity, and job satisfaction (Lukić,Džamić, Knežević, Alčaković&Bošković(2014). The challenge then for the organization is to sustain the vision-driven behaviors of its members.

Table 3.Level of Exposure to the Various Channels for PVMGO Dissemination

PVMGO

Bulletin of Information (Brochures/ Leaflets) Course Catalogues Journals and Books Checklist/ Manuals Orientation Programs University/ College Events and Programs Tickler/RLE Record Course Syllabi/ Curriculum Office Displays Classroom Displays Newsletter/ Gazettes/ Campus Student Publication DMMMSU-SLUC Website ICHAMS’ Website Overall Mean .

FAC

STA

STU

ALU

AFF

PAR

M

DER

4.53 4.47 4.07 4.67 4.53

4.47 4.47 4.33 4.53 4.40

4.73 4.45 4.55 4.78 4.87

4.47 4.13 4.13 4.40 4.53

4.40 4.13 4.07 4.27 4.27

4.27 4.27 4.47 4.53 4.67

4.48 4.32 4.27 4.53 4.54

VME VME VME VME VME

4.40 4.73 4.73 4.60 4.60

4.33 4.13 4.13 4.13 4.20

4.85 4.87 4.75 4.62 4.48

4.60 4.53 4.60 4.33 4.33

3.93 4.00 4.27 4.40 4.53

4.47 4.40 4.53 4.20 4.13

4.43 4.44 4.50 4.38 4.38

VME VME VME VME VME

4.13 4.13 3.93

4.07 3.93 3.93

4.50 4.48 4.55

4.47 4.07 4.33

4.20 4.07 4.00

4.53 4.53 4.67

4.32 4.20 4.24

VME ME VME

4.43

4.24

4.65

4.38

4.19

4.44

4.39

VME

Table

4.

Level

of

Effectiveness

PVMGO

of

FAC

Bulletin of Information (Brochures/ Leaflets) Course Catalogues Journals and Books Checklist/ Manuals Orientation Programs University/ College Events and Programs Tickler/RLE Record Course Syllabi/ Curriculum Office Displays Classroom Displays Newsletter/ Gazettes/ Campus Student Publication DMMMSU-SLUC Website ICHAMS’ Website

the STA

DER

4.40 4.27 4.40 4.53 4.40

4.47 4.37 4.37 4.56 4.44

VEC VEC VEC VEC VEC

4.13 4.33 4.47 4.40 4.40

4.27 4.33 4.40 4.40 4.40

4.72 4.72 4.67 4.63 4.57

4.47 4.47 4.27 4.53 4.33

4.00 4.13 4.40 4.60 4.47

4.40 4.47 4.53 4.20 4.13

4.33 4.40 4.46 4.46 4.38

VEC VEC VEC VEC VEC

4.00 4.00 3.93

4.40 4.27 4.13

4.57 4.50 4.50

4.40 4.27 4.47

4.20 4.27 4.20

4.40 4.40 4.53

4.33 4.28 4.29

VEC VEC VEC

4.40

VEC

p-value

Interpretation

0.003

Significant

0.000

Significant

0.001

Significant

0.011

Significant

5.010

3.422

M

4.47 4.33 4.20 4.33 4.27

8.571

Level of Effectiveness of the Channels for PVMGO Dissemination

PAR

Dissemination

4.60 4.47 4.40 4.60 4.53

4.276

Level of Exposure to Channels for PVMGO Dissemination

AFF

PVMGO

4.68 4.50 4.67 4.82 4.78

Table 5. Significant Difference in the Evaluation of the Respondents on the DMMMSUICHAMS’ PVMGO

Extent of Implementation of the PVMGO

ALU

for

4.40 4.40 4.33 4.53 4.47

Table five presents the significant difference in respondents’ evaluation on the PVMGO of DMMMSU ICHAMS. It is evident that there is a significant difference in the level of acceptability, perceived level of implementation, exposure to the channels and perceived effectiveness of the channels for PVMGO dissemination since the p-values are all less than 0.05 level of significance.

Level of Acceptability of the PVMGO

STU

Channels

4.27 4.27 4.20 4.47 4.20

Overall Mean

F ratio

Various

Post-hoc test result revealed that in terms of the level of acceptability of the PVMGO, the internal stakeholders (faculty, staff and students) have higher evaluation than the members of the partner industries. This can be attributed to the participation of the various stakeholders in the formulation of the various statements. During the creation and modification of the PVMGO, the different stakeholders of the University were invited to participate; however, internal stakeholders were more active than the external stakeholders which could considerably contributed to the result of the study. As a State University, DMMMSU is governed by the Board of Regents which is composed of various stakeholders. Trakman (2008) described the stakeholder model of governance as one where governance is vested in a wide array of stakeholders including, among others, students, academic staff, alumni, corporate partners, government and the public at large. With this composition, the voice and unique perspectives of variety of stakeholder representatives is encouraged. In terms of the perceived level of implementation of the PVMGO, the students and alumni had higher evaluation than the faculty and members of the partner industries. As the main implementers, the faculty may have higher standards as compared to the recipients of the services (students and alumni). University faculty members are expected to integrate the concept of excellence in their internal quality systems and culture. In addition, the organization


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strongly believes that its members will be more effective if they pursue excellence in their programs, activities and outputs. This is one of the vital core values of the institution (DMMMSU, 2010) resulting for higher standards. Moving on, the students were more exposed to the various channels for PVMGO dissemination than the staff and members of the partner industries. Likewise, the students had higher evaluation than the faculty in terms of the perceived effectiveness of the identified channels for dissemination. This is due to the fact that the students are the main clienteles of the organization where most of the services are directed toward the achievement of their competencies and lifelong learning. As to the perspective of academic quality and standards, the capabilities of students and the level of student achievement are some of the indicators of excellence (Brusoni, et.al, 2014). Table 6 presents the relationship between the different variables in the study. Table 6.Relationship Between the Level of PVMGO Acceptability and Extent of Implementation; and Level of Exposure and Effectiveness of Channels for PVMGO Dissemination

Significant Relationship between Level of Acceptability and Extent of Implementati on

p-value

r-value Interpretation

0.000

0.564

Level of Exposure and Level of 0.000 Effectiveness of the Channels for PVMGO Dissemination

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Moderation Correlation

The study revealed that a moderate direct correlation exists between the level of acceptability and extent of implementation of the PVMGO. This means that the level of acceptability increases as the extent of implementation rises. This result challenges the institute to improve and sustain the efficient and effective implementation of the PVMGO. This also implies the need for continuous inculcation of service as a core value of the University more so that the institution believes that it is a home of committed public servants and leaders who aim to render quality service to their clientele, stakeholders and the community (DMMMSU, 2013). In addition, table six also revealed that a very high direct correlation exists between the level of exposure and level of effectiveness of the various channels for PVMGO dissemination. This result indicates that as the level of exposure increases, the perceived level of effectiveness of the different media for PVMGO dissemination also rises. The result points to the need for the sustained dissemination of the PVMGO utilizing various media to maintain the high exposure of the stakeholders. Nicolas (2014) claimed that stakeholder’s feedback is a part of quality assurance indicators of the academic unit. This move also indicates that the evaluation or feedbacks of the members of the organization are deemed to be important which promotes the feeling that the members are deeply valued in the organization. This in turn would lead to job satisfaction and organization commitment (Bakhshi, Kumar, & Rani, 2009).

CONCLUSIONS

0.819

Very High Correlation

The stakeholders of DMMMSUICHAMS highly accept the PVMGO. The evaluation of stakeholders on DMMMSU ICHAMS’ PVMGO varies. The level of acceptability of the PVMGO will increase as the extent of implementation is enhanced and vice versa. The level of effectiveness of the various channels for PVMGO dissemination will increase as the stakeholders become more exposed to the channels and vice versa


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RECOMMENDATIONS The researchers recommend that DMMMSU-ICHAMS should sustain the stakeholder’s participation during the formulation, revision, and update of the PVMGO. It should encourage the active participation of external stakeholders during PVMGO planning sessions and widen the dissemination of the various channels devised. Also, the institute should regularly evaluate the stakeholders’ acceptability of the PVMGO and its implementation .It should improve and update the various channels used for PVMGO implementation and strategically broaden the dissemination. For future studies, researchers may increase the population of stakeholders and utilize other sampling methods (ie. Stratifiedrandom sampling) in the selection of respondents. Researchers may also update the tool used based from the revisions made in the institutions PVMGO and conduct the study in other curricular programs and colleges or institutes. REFERENCES Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc. (AACCUP) . (2014). Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc. (AACCUP) . Retrieved January 25, 2015, from http://www.aaccupqa.org.ph/ConductOfAccred.ht ml Analui, F. and Karami, A. (2002).CEOs and the development of the meaningful mission statement, Corporate Governance.2(3), 13-20. Bakhshi,A., Kumar,K., & Rani,E. (2009).Organizational justice perceptions as predictor of job satisfaction and organization commitment. International Journal of Business and Management,4(9).doi: 10.5539/ijbm.v4n9p145 Bartkus, B. R., Glassman, M. and McAfee, R. B. (2004).A comparismof the quality of European, Japanese and US mission statements: A content analysis.European Management Journal, 22 (4), 393-401 Bart, C. K., Bontis N. and Tagger , S. (2001). A model of the impact of mission statements on firm performance.Management Decision, 39(1),9-18 Brusoni, M. et.al. (2014). The concept of excellence in higher education. Retrieved August 3, 2015 from http://www.enqa.eu/index.php/publications/ Coon,D. (2007). Creating a Vision and Mission Statement for your Organization. Retrieved January 25, 2015 fromhttp://www.cwu.edu/~cel/cms/uploads/Visio nMissionStatements.pdf

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Don Mariano Marcos Memorial State University. (2010). Annual Report 2009-2010 Don Mariano Marcos Memorial State University. (2013). Annual Report 2012-2013 Harvard Business Review. (2013). The impact of employee engagement on performance. Retrieved August 3, 2015 from https://hbr.org/resources/pdfs/comm/ achievers/hbr_achievers_report_sep13.pdf Ehtesham, U., Muhammad, T., &Muhammad,S. (2011). Relationship between organizational culture and performance management practices: A case of University in Pakistan. Journal of Competitiveness,4,78-86. Retrieved August 3, 2015 from http://www.cjournal.cz/files/77.pdf Khan, A. (2005). Matching People with Organizational Culture”. Retrieved January 25, 2015from http://www.themanager.org/hr/Matching_People_ with_Organizational_Culture.pdf Kronbreg,A. &Gustafsson, M. (2012). Goal congruence: The experience of a performance measurement system. Retrieved from https://gupea. ub.gu.se/bitstream/2077/30165/1/gupea_2077_3016 5_1.pdf Lukić,T., Džamić, V., Knežević,G., Alčaković,S. &Bošković,V. (2014). The influence of organizational culture on business creativity, innovation and satisfaction.Management Journal,47-58. doi: 10.7595/management.fon.2014.0027 Maduka,E. &Okafor,O. (2014). Effect of motivation on employee productivity: A study of manufacturing companies in Nnewi. International Journal of Managerial Studies and Research (IJMSR), 147-157. Retrieved August 3, 2015 from http://www.arcjournals.org/pdfs/ijmsr/v2-i7/14.pdf Markos,S. &Sridevi, S. (2010). Employee engagement: The key to improving performance. International Journal of Business and Management,89-96. Retrieved August 1, 2015 from http://www.myopinionatbesix.com/besixsurvey/med ia/besix-survey/pdf/4.-employee-engagement-thekey-to-improving-performance.pdf Mullane, J. V. (2002). The mission statement is a strategic tool: When used properly.Management Decision.40( 5), 448-455. Nekoranec,J.&Nagyová,L. (2014). Adaptation of employees in the organization and its importance in terms of human resource management.Retrieved August 3, 2015 from http://www.armyacademy.ro/reviste/rev1_2014/NE KORANEK.pdf N.C Center for NonProfits. (2007). Retrieved January 25, 2015 from http://www.handsonnwnc.org/express/nccenteron organizationaldevelopmentandstrategicplanning.p df Nicolas, M.(2014). ASEAN integration and quality assurance.University of Philippines.Retrieved August 3, 2015 from http://www.up.edu.ph/aseanintegration-and-quality-assurance/.


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Polit, D. E., & Beck, C. T. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philippines: Lippincott williams & Wilkins Schein, E. (2004). Organizational Culture and Leadership. California: Jossey-Bass. Sherren,J.,(2012) Phases of Organizational Development. Retrieved January 25, 2015 fromhttp://www.gatewayleadership.com/downloa ds-resources/downloads-resources-joe/phases-oforganizational-development

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Venzon, L. (2006). Nursing Leadership Towards Quality Care. C & E Publishing, Inc.: Quezon City. Williams, L.A. (2001). Imogene King’s Interacting Systems Theory: Application in Emergency and Rural Nursing. Online Journal of Nursing and Health Care, 2(1), 25–30

Clinical Management Functions of DMMMSU ICHAMS Instructors: An Input to A Proposed Sustainability Program Authors: Jovelyn C Higoy , Maricar B. Balisado, Jonathan C. Clata,, Zenith Grace B. Garcia, Joseph V. Reyes, Christine V. Tavas, RM, RN, MAN

ABSTRACT The study aimed to identify the extent of practice of managerial functions by clinical instructors employed at Don Mariano Marcos Memorial State University, Agoo, La Union. The study is descriptive survey and conducted in year 2012-2013. Purposive-quota sampling was used to select the nine clinical instructors, ninety students, and nine senior nurses who evaluated the clinical instructors. Data were treated using Weighted Mean, Pearson Product Moment Correlation Coefficient, and One Way Analysis of Variance. Most of the respondents are 25-29 years old, female with less than five years of hospital experience, and a master’s degree holder. The extent of practice of managerial functions as to planning, organizing, directing, controlling are highly practiced and are the strengths. There is no significant difference in the extent of practice of managerial functions along the perception of the three groups of respondents. The of age of the clinical instructors is significantly related to the extent of practice of controlling function of management. The sustainability program for clinical instructors was developed to maintain the practices necessary to improve students’ clinical learning.

Keywords: Clinical Instructors, DMMMSU-ICHAMS, management functions, nursing, sustainability program

INTRODUCTION During the last decade, the number of registered nurses and nursing students in the Philippines ballooned into an enormous number as a response to the increase in demand for nurses. In response to this, schools and colleges of nursing proliferated in the country. However, the rapid proliferation of nursing schools also resulted to a decline in the passing percentage in the Nurses Licensure Examination and point towards the symptom in the deteriorating quality of higher education institutions in the country (Rosales, et. al, 2011). In connection to this growing concern, the Institute of Community Health and Allied Medical Sciences (ICHAMS) of the Don Mariano Marcos Memorial State University (DMMMSU) has been constantly the number one nursing school in La Union based on its passing rate, and ranks second or third in Region 1, surpassing different schools offering the Bachelor of Science in Nursing Program for a longer time. However, inspite the honor and reputation it upholds, the Institute has not been able to achieve a hundred percent (100%) in its passing rate or come up with a constant line of nine percentages in the Nurse’s Licensure

Examination (NLE) which is also true to other nursing schools in La Union. Moreover, the poor program preparation of nursing schools is one of the factors which lead to unsuccessful candidates in the Nurses Licensure Examination (Rosales et. al, 2011). In addition, Henzi et. al., (2008), reported that certain faculty members who saw themselves as experts were likely to be seen as poor evaluators by students because the expert evaluator was out of touch with students’ actual capabilities, thus unrealistically expected expert level performance from the student. Although, the fact that the passing rate and the clinical competence of the nursing students cannot be solely blamed on the poor program of the institute and its instructors, but could also be attributed mainly on the students, identifying and removing various factors that may influence the achievement of an improved clinical management functions by the nurse instructors could be a great help in attaining and sustaining an excellent performance in the nurse’s board exams. The study aims to identify the extent of practice of managerial functions used by clinical instructors in the hospital setting, which can lead to loss of consistency and uniformity in


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managing typical behavior of nursing students. According to Tan and Beltran (2009), to be effective clinical instructor is both having managerial and administrative skills that are necessary in managing students of various personalities and different needs. In fact, what makes a great manager is her ability to look into the problems of an organization and making decisions which succinctly aims to solve these problems. In the clinical setting, nurse instructor must always see the consequences of her actions and decisions of how well she manages the group that may eventually lead to the performance of the students in the future. A student nurse who is guided with discipline and uplifted with substantial theories and skills as early as in their lower year level by their clinical instructors’ technique in managing challenging situations in the clinical area is more likely to be an excellent nurse in the future. Clinical instructors have an important role in the education and in the development of nursing students. In order to prepare students for the professional nursing role, nursing education programs must provide efficient clinical experience along with theoretical knowledge. The clinical instructor must act as a role model in leading and in managing the group to any situations in the clinical area. The Philippine nursing law of 2002, R.A. 9173 emphasizes these concerns of Filipinos. In addition, clinical instructors act as a transfer bridge for students between classroom theory and practice care situations. Furthermore, in order to effectively facilitate the transfer of theory into practice, as well as to evaluate students’ professional knowledge and skill development, clinical instructors need to be an integral part of the academic work environment (Wiens, 2013). Moreover, students work with a practicing clinician to develop the knowledge, skills, and attitudes necessary for entry into their profession. Identification of effective characteristics of nurse instructors provides useful information for students’ instruction in clinical setting and is crucial for improving the quality of clinical education (Declute and Ladychewsky, 2013). Clinical practice setting is a rich learning environment, it is also multifaceted place embedded with myriad of variables, many of which are beyond the control of nurse educators strategies to students managerial needs. Moreover, the effectiveness of clinical

34

teaching can be evaluated on the extent to which it produces intended outcomes (Phelps, 2009). In order to achieve excellence in the management process, variables such as the relationship of management behaviors to student learning must be thoroughly explored. According to Asperas (2009), in order to prepare students for the professional nursing role, nursing education programs must provide clinical experience along with theoretical knowledge. Student participation in clinical practice is often the most important portion of acquiring new nursing skills. Moreover, Manketelow (2013) stated that managerial development programs are very useful means of getting qualified facilitators. Instructor’s characteristics that have a positive effect on student’s outcomes must be identified and utilized. Exploration of effective characteristics of clinical instructors provides insight into improvement of educational programs for management practices of nurses. To deal with the challenges in the nursing management, nurse educator like clinical instructors has the responsibility to prepare the new generation nurses with advance leadership principles and management skills. Effective management of clinical instructors in the area reflects the students’ performance of their tasks and responsibilities. Say for example in the hospital or clinical setting, a nurse’s managerial skills and practices are as important as his or her leadership skills in influencing his or her coworkers in getting the work done. An instructor often times uses his or her management practices in the clinical area to come up with utmost and quality education for nursing students, in general. According to Saccomano (2008), an educator must be equipped with sufficient leadership and management techniques and experiences in order to meet the growing demand for healthcare situations and problems in relation to management. Nurse instructors’ management practices greatly affect student’s management skills and decision makings in delegating their tasks and also benefits them in their future performance as a registered nurse (Abdrbo, 2012). An excellent teacher increases performance of students whereas poor teacher lead in low performance of student. Furthermore, clinical teachers are regarded as one of the components in clinical teaching need to be assessed closely to make them understand the needs of effective management (Salem and Putri, 2012).


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The findings of the study served as basis for an improved clinical management program. This will serve as a point of reference to further assess and enhance the respondents’ managerial functions in the clinical setting. Moreover, the managerial functions of instructors in their clinical nursing practice can be a great help to other nurses in the way that it promotes guidance on how to deal with difficult situations in managing their subordinates typical behaviors and attitudes. This research can be used as a supplement regarding any research related to management. The researchers gained insights and better understand the importance of being a leader and a manager as they face the different challenging roles and circumstances in the clinical setting. METHODOLOGY The descriptive research design through survey with the use of a valid and reliable questionnaire was used in the study. It is descriptive because it provides and interprets descriptions regarding how a clinical instructor manages in the clinical setting specifically along planning, organizing, directing, and controlling functions. The research study focused on the extent of practice of managerial functions of DMMMSU-ICHAMS clinical instructors. A questionnaire is the main tool which was used in gathering the needed data. The respondents rated each item in the questionnaire using a four-point rating scale for the management functions as the evaluation tool for clinical instructors. This study was conducted in Ilocos Training and Regional Medical Center (ITRMC), Agoo Lying-in Clinic and Don Mariano Marcos Memorial State University – Institute of Community Health and Allied Medical Sciences (DMMMSU-ICHAMS). The respondents were nine clinical instructors and ten student nurses for every clinical instructor of DMMMSUICHAMS, and one senior nurse for every area in ITRMC where each clinical instructor had their duty. The clinical instructors of DMMMSUICHAMS are the persons evaluated in the study. Furthermore, clinical instructors of other nursing schools were excluded from the study. The purposive quota sampling technique was used. It is selected based on the knowledge of a population and the purpose of the study. The subjects were selected based on their characteristics which meets the criteria of

35

the study (Venzon, 2003). The floating of questionnaires was conducted on first semester of school year 2013-2014. The study was delimited to the truthfulness and interpretation of the respondents in answering the questionnaire which served as the main tool in gathering the data of the study. The clinical instructors were evaluated in two rotations, during the third and fifth rotation in August 29 to July 2 and from July 26 to 30. Its limitation included findings based on data which was gathered through the instrument. The researchers excluded themselves as respondents. Moreover, it was delimited to the areas or situations covered by the instrument. The research is quantitative type of research and focused on the assessment on the extent of practice of ICHAMS instructors’ managerial functions in the clinical setting. The respondents were grouped in to three, the clinical instructors of DMMMSU-ICHAMS (self), their students, and the senior nurse in their clinical area of duty. To provide the study with sufficient and relevant data, a questionnaire was prepared as the main tool in gathering data from the respondents. The questionnaire was designed to meet the objectives of the research endeavour. It was formulated by the researchers after a series of library and internet researches to establish the relevance of the content to the research objectives. The questionnaire for the clinical instructors themselves is not the same with the questionnaire for the students and senior nurses, eventually that the latter is constructed in the third person but they are still the same with the thought. The questionnaire was composed of three parts. Part I is composed of the cover letter to the respondents which explains the purpose of the research study. Part II deals with the profile which includes their age, sex, length of hospital experience, and highest educational attainment. Lastly, Part III is the evaluation tool for instructors to assess their extent of management practices in the clinical setting. The researchers utilized the content validity wherein the said instrument was reviewed by the 5 experts: Mr. Francis A. Uyaan, Chairman of the Nursing Department of ICHAMS, expert in teaching the subject, Nursing Leadership and Management; Mr. Norberto Prepose Jr., Assistant Chief Nurse for Training and Education at Ilocos Training and Regional Medical Center; Mrs. Flordeliza R. Bobiles, Officer in Charge Chief Nurse at Ilocos Training and Regional Medical Center; Dr. Adelina Ancheta, Dean of the College of


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Education of DMMMSU; and Prof. Marites B. Dagang, Chairman of Midwifery Department of DMMMSU-ICHAMS. The result of the validity test had a mean of 4.66 out of a perfect mean score of 5 which corresponds to a valid instrument. In terms of the adequacy of the items to measure the extent of management functions, the tool had a mean score of 4.6 out of 5. In terms of how suitable the items to measure the extent of management functions, the tool had a mean score of 4.6 out of 5. Moreover, the language level in the test items was rated with a mean score of 4.8 out of 5. Objective comments and suggestions of the experts were considered by the researchers. A certificate of approval for the reliability testing was signed by all the panel members. The researchers conducted the pre-test to five staff nurses of ITRMC, five clinical instructors of Union Christian College (UCC) together with their five student nurses. It was conducted in the first semester of the school year 2013-2014. The respondents of the pre-test were different from the respondents of the actual study. The researchers used the Cronbach’s Alpha to determine the internal consistency of the tool. The result was 0.96 which indicates that the instrument is accurate or consistent, or no more reconstruction of questionnaire is needed. A letter of approval was secured by the researchers from the dean of Union Christian College (UCC) and from the Chief of Hospital of Ilocos Training and Regional Medical Center (ITRMC). Before the distribution of the questionnaire, the researchers explained the direction and purpose of the study and facilitated the respondents in answering. After answering the questionnaire, the researchers collected and checked the answered questionnaire for the completeness per item and determined the reliability of the questionnaire. After testing the reliability and validity of the instrument, the researchers personally secured a letter of approval from the ITRMC Chief of Hospital and from the director of DMMMSU-ICHAMS prior to the actual

administration, distribution, and retrieval of the questionnaire from the respondents. To facilitate the answering of the questionnaires floated, the researchers rendered assistance to the respondents by explaining some of the concepts which the respondents found hard to understand. The researchers also assured confidentiality to the respondents. The researchers were the ones who distributed the questionnaires to senior nurses, student nurses, and clinical instructors. The floating of the questionnaires among senior nurses was done during the duty of clinical instructors in ITRMC while the floating of the questionnaires among student nurses and clinical instructors was done during their lecture days in ICHAMS. The answered questionnaires were retrieved and were checked for the completeness of the answers and the data were organized and subjected for analysis and interpretation by the researchers. The researchers were guided to approach and assess the extent of practice of management functions of ICHAMS clinical instructors. When the variables were identified, the significant relationship in the extent of practice of management functions of clinical instructors when grouped according to respondents’ profile was determined. The data gathered was tabulated and analyzed. The outcome of the study in relation to the data gathered served as a basis for a proposed sustainability program for clinical instructors. frequency count, percentage, average weighted mean, Pearson Product Moment Correlation Coefficient and One Way Analysis of Variance (ANOVA) . RESULTS AND DISCUSSION The clinical instructors from Don Mariano Marcos Memorial State University (DMMMSU) in the school year 2013-2014 were the persons evaluated in the study. They were evaluated by the senior nurses, students, and by themselves. They were grouped according to their age, gender, length of hospital experience, and highest educational attainment.

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Table 1. Profile of the Clinical Instructors of DMMMSU-ICHAMS Factors Age 25 - 29 years old 30 - 34 years old 35 - 39 years old 40 years old and above Total Sex Male Female Total Length of Hospital Experience Below 5 years 5 years and above Total Highest Educational Attainment Masters Graduate With Master’s Degree Units Total Table 1 shows that almost one half of the respondents (44.44%) are 25 to 29 years old. Meanwhile, the age ranging from 30 – 34 years old and 35 to 39 years old comprise the same percentages (22.22%). However, the age ranging from 40 and above have the least population (11.11%). The age bracket of 25 to 29 years old which was the highest insinuates the emergence of young clinical instructors in the profession. This also suggests that nursing institutions are pre dominated by younger clinical instructors in their ages of twenties. Furthermore, old clinical instructors with ages 40 and above are not typical in the profession. This is due to the fact that the highly skilled nurses left the country for a greener pasture and for permanent emigration. As a result of this, there were fewer nurses left in the country to complete in the job market, and more importantly, to perform tasks required by a developing country. Added by Alburo and Abella (2012), those persons who left for abroad included those already working and in the labor force or those who had sufficiently gained experience in the discipline. Young clinical instructors outweighed the number of clinical instructors who are most likely to be familiar in the field of clinical teaching. It can be inferred here that instructors who are already expert or proficient in the field of clinical teaching were most likely to be in

Frequency

Percentage (%)

4 2 2 1 9

44.44 22.22 22.22 11.11 100.00

3 6 9

33.33 66.67 100.00

7 2 9

77.77 22.23 100.00

5 4

55.56 44.44

9

100.00

their lowest numbers and in the field of clinical teaching. Furthermore, Auerbach (2008) also supported that the number of people entering the profession remains at its lowest point in forty years, however large numbers of people are entering the profession in their late twenties and early thirties. Table 1 shows that more than half of the respondents (66.66%) are female. The findings are correlated to what Evans and Frank (2007) stated that nursing is a feminine profession which constitutes to a significant barrier to men choosing to enter nursing, and in part accounts for the low numbers of men in the profession. Men who choose non-traditional occupations such as nursing are at greater risk than their women counterparts of being unsupported and devalued. Moreover, viewed from a gender perspective, women in the nursing profession are generally socialized to be more concerned with interpersonal aspects of relationships than are men (Valentine, 2011). They are the one who places more emphasis on how well they can relate to others. This is also true in the statement of Neighbours (2013) that nursing is seen as a feminine occupation and is thus devalued in male dominated patriarchal society. Male nurses

20

separate themselves and the masculine sex role from their female colleagues. This implies that more nursing instructors are female because it is perceived to be a female related job. As a profession predominated by females, it is stereotyped as having the traits of nurturing, caring, dependence, and submission in contrast with the perceived male traits of strength, dominance, and aggression. The role of nurses as caregivers is viewed by men as a function very suitable for female personalities that is why lesser men are in the nursing profession. More females in the academe can also help students in the fact that there are also more female students than men. Students especially females can relate well to their clinical instructors and there will be more cooperation and harmony in the group. This is the reason the said course is typically predominated by females. Table 1 also shows that majority of the respondents have less than 5 years of hospital experience (77.77%). However, the length of hospital experience categorized from 5 years and above have only 22.23% of the total population. This implies that registered nurses having a long or extensive hospital experience are rare to apply as a clinical instructor in an institution. Experienced nurses commonly goes abroad to seek for a greener pasture (Tan and Beltran, 2009). This also proves that the length of hospital experience is not the primary factor in the hiring of a clinical instructor in the nursing institution, instead considering on their personal intellects and skills. In relation to this, Gandhi (2012) concluded that fresh graduates are easily hired. He added that they bring new ideas and apply current trends in the nursing profession. Recruiting graduates can also increase diversity within the work team. Moreover, more than half of the respondents (55.55%) have already earned their

Master’s degree while the remaining 44.44% of the respondents are still having their Master’s Degree Units. This study presents data which proves that clinical instructors recognize the value of continuing education. It can also be implied that nursing institutions are strictly complying with the new memorandum order of the Commission on Higher Education (CHED) that instructors teaching in the tertiary level must earn at least master’s degree. The CHED Memorandum Order (CMO) No. 40, s. 2008, requires that all higher education institutions (HEIs) faculty to have at least master’s degree shall be fully implemented by AY 2011-2012. In addition, more than 50% or 70,000 higher education institutions (HEIs) faculty need to upgrade their qualifications and competencies in order to improve the quality of teaching in our HEIs. The vast majority of students in higher education are being taught by faculty who possess no more than the level of qualification for which they are studying. This implies that clinical teaching to students can be enhanced as the instructors are continuously enrolled in educational activities. Not only clinical instructors are benefitted through this memorandum order imposed by the CHED but also students are also benefitted this way by means of providing better learning experience and more advanced quality of education provided (CHED Memorandum, 2008). Table 2 presents the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by the self along planning. It measures on how well the clinical instructor takes his or her initiative to do or plan something related to the clinical duty that should be worked-out in advance. It can be viewed that clinical instructors perceived themselves as highly practiced in their extent of practice in the planning function in the area

20

Table 2. Extent of Practice of Managerial Functions of ICHAMS Clinical Instructors along Planning as Evaluated by Themselves (CI), Senior Nurses (SN), and Students (S) Managerial Functions 1. The clinical instructor creates and documents a welldeveloped plan of care. 2. The clinical instructor states clear objectives. 3. The clinical instructor considers policies, rules, and regulations of the institution on making plans. 4. The clinical instructor involves every group member in planning and in goal setting. 5. The clinical instructor respects students’ opinions and suggestions. 6. The clinical instructor includes the most practical methods for achieving each objective. 7. The clinical instructor collaborates with the staff and other health care professionals in formulating the plan of care to improve the quality of patient care in the area. 8. The clinical instructor anticipates future problems and plan alternatives to prevent or cope with potential problems. 9. The clinical instructor develops strategies and sets realistic time frame. 10. The clinical instructor prioritizes activities in the area. 11. The clinical instructor involves principles that guide towards achievement of both ethical and legal principles. 12. The clinical instructor uses critical thinking, problem solving, and decision making in every process of planning. 13. The clinical instructor modifies plan of care as needed depending on the needs and problems of students and patients. 14. The clinical instructor identifies appropriate methods for faster delegation of tasks. Average Weighted Mean

As perceived by the self, 6 out of 14 items got the highest weighted mean, the item no. 3, 5, 6, 7, 9, and 13. Item no. 3 with an average of 4.00 talks about the function of the clinical instructor to consider policies, rules, and regulations of the institution in making plans. This implies that the clinical instructors adhere to the policies set by the schools. This also indicates that clinical instructors establish uniformity of decision makings regarding policies that must be applied especially in controlling typical behaviors of students in the clinical area.

WM (CI) 3.67

DER

DER

HP

WM (SN) 3.44

DER

HP

WM (S) 3.48

3.67

HP

4.00

AWM

HP

3.53

HP

3.39

HP

3.49

HP

3.52

HP

HP

3.44

HP

3.68

HP

3.71

HP

3.89

HP

3.50

HP

3.65

HP

3.68

HP

4.00

HP

3.61

HP

3.66

HP

3.76

HP

4.00

HP

3.33

HP

3.59

HP

3.64

HP

4.00

HP

3.50

HP

3.62

HP

3.89

HP

3.44

HP

3.53

HP

4.00

HP

3.22

MP

3.54

HP

3.59

HP

3.89

HP

3.61

HP

3.62

HP

3.71

HP

3.44

HP

3.50

HP

3.73

HP

3.56

HP

3.89

HP

3.56

HP

3.60

HP

3.68

HP

4.00

HP

3.50

HP

3.70

HP

3.71

3.62

DER

HP

HP

HP 3.73

3.89

HP

3.67

HP

3.73

HP

3.76

HP

3.87

HP

3.48

HP

3.62

HP

3.66

HP

Moreover, clinical faculty are the one who fosters professional development of students. It is one of their important functions to control the attitudes and behaviours of students in order to maintain discipline and coordination of tasks (Swick, et. al, 2007). Also, the item no. 5 gained the highest weighted mean of 4.00 which indicates that clinical instructors respect students’ opinions and suggestions. This implies that the clinical instructors are approachable in every query of their students. They are willing to accept any suggestions without belittling the rights and

20

opinions of others that will contribute to the improvement of plans. Likewise, as stated by Dahlke et.al, (2012), it is a function of a clinical instructor to facilitate the learning needs of students in the area. They must communicate clearly, set objectives and expectations, must be approachable, and should correct students without belittling them. The item no. 6 which also gained the highest weighted mean states that clinical instructor considers the most practical methods of achieving the plan objectives. This denotes that clinical instructors plan activities in the area that is achievable and are realistic to implement. They take importance to some alternatives that can improve their plan of care to provide immediate care response to patients. According to Levy, et.al, (2009), this will rebuild the nursing workforce, implement new models of care and bring health and wellbeing to an exhausted and stretched nursing workforce. Through this, students can apply the knowledge they have learned in theoretical course to real environment to where a lot of uncontrolled variables that might interfere the intervention. The item no. 7 also gained the highest weighted mean of 4.00 which states that the clinical instructors collaborates with the staff and other health care professionals in formulating plan of care. This implies that clinical instructors are developing plan by not only involving themselves but also considering the suggestions of the health care team members. They apply the principle of teamwork and collaboration for the improvement of the health status of the patient. According to Levy et. al, (2009), working as a team work would be helpful in professional behaviours consisted of confidencebuilding actions like positive reinforcement and support, with the opposite types of feelings of humiliation creating hindering behaviours. Supervision and supervisory relationships are dynamic and that the relationships need to keep pace with the educational process. Additionally, helpful clinical instructor characteristics promote learning by engaging the student management were perceived as most important by others followed by interpersonal behaviours. Item no. 13 gained the highest weighted mean stating that clinical instructors modify the plan of care as needed depending on the needs

and problems of students and patients. This implies that they gives urgent attention to the most critical patient and develops an individualized plan of care for them. Management is not just important because it helps ensure the survival and longevity of profession; it is an essential aspect of providing quality healthcare. Management behaviour has been reported to improve clinical outcomes and patient satisfaction. Therefore, the benefit of management transcends both preparing students and young professionals for involvement in an association, organizational roles or political action and preparing clinician for management responsibilities (Fang, 2006). Moreover, there are also items which got the lowest weighted mean but it still falls under highly practiced, the item no. 1 and item no. 2. The item no. 1 has an average weighted mean of 3.67 stating that clinical instructors create a well-developed plan of care. This implies that clinical instructors are well competent in making plans. They are capable of doing an accurate and appropriate plan specific to the patient. Moreover, according to the statement of Mache Dereli (2008), clinical instructors must maintain autonomy of the group in establishing the plan of care. He or she delegates responsibility to the group and implement plans after every decisions being made. Also, the item no. 2 has an average weighted mean of 3.67 stating that clinical instructors state clear objectives in order for students know the specific actions needed for the achievement of their desired goals. This implies that clinical instructors apply good communication techniques in the area in order to deliver clear objectives regarding the individualized care of patients. Furthermore, as stated by to Mache Dereli (2008), instructors should address the needs of the group to state a clear understanding to their objectives. In addition, Cole and Wesle (2006), found out that students were able to value their clinical instructors most if they are able to demonstrate professional behaviour related to communication, respect students input, and models professional behaviour. The overall average weighted mean along the planning function of clinical instructors is 3.87 that fall under highly practiced. This implies that they are capable and knowledgeable

21

enough in making plans before doing any task which can lead to the improvement of patient’s health status. Table 2 presents the evaluation of senior nurses regarding the planning functions of clinical instructors. It shows on how well clinical instructors plan properly and accurately before the start of the duty. The extent of practice of managerial functions of ICHAMS instructors are highly practiced regarding their planning function as perceived by senior nurses. As gleaned on the table, only one item got the highest weighted mean. The item no. 14 has the highest weighted mean of 3.67 stating that the clinical instructors identify appropriate methods for faster delegation of tasks. This implies that clinical instructors are competent enough in performing their responsibility as a leader and supervisor of students in the area. They are able to identify systematic actions which are highly needed for fast and accurate interventions. Moreover, there is also one item which got the least weighted mean. Item no 9 with a weighted mean of 3.22, falls under the descriptive equivalent rating of moderately practiced. This is about the function of the clinical instructor to develop strategies and set realistic time frame. This proves that clinical instructors are able to identify specific methods that can lead to the achievement of their goals. This also indicates that clinical instructors are knowledgeable in time management in the way that they are able to give time allotment to every specific action in the area. The overall average weighted mean in the planning function of clinical instructors is 3.48 but it still categorized under highly practiced. In conclusion, head nurses perceived the clinical instructors as highly efficient in their planning function. As a good leader of the group in the clinical area, they are able to show initiative in the formulation of plans, and able to identify specific actions needed to work-out in advance. Furthermore, according to Wiens (2013), head nurses perceived the clinical instructors as experts in the field of planning. They have high confidence to clinical instructors’ abilities in decision makings and to their knowledge in the clinical area. However, the study of Zabat et. al, (2009), found out that most clinical instructors do not have solid foundation in their clinical teaching skills that’s

why some head nurses want to collaborate more often with them. Table 2 presents the extent of practices of managerial functions of ICHAMS clinical instructors as evaluated by students along planning. It can be viewed here that students evaluated their clinical instructors as “highly practiced” in their extent of practice in their planning functions. The study revealed that along the planning function, 2 out of 14 questions got the highest weighted mean of 3.73 and classified as highly practiced, the item no. 14 and item no. 11. Item no 11 states that clinical instructors involve principles that guide towards achievement of both ethical and legal practices. This implies that clinical instructors recognize the rights of every patient. They don’t just consider the needs of every patient and perform interventions alone but also includes ethical principles in doing specific interventions. Furthermore, it is supported in the statement of Koerber, et. al, (2007) that clinical instructors are role models by providing students of ethical values through discussion of their clinical experiences in the area which further provides profound impact on students learning. Item no 14 has a weighted mean of 3.73 which states that clinical instructors identify appropriate methods for faster delegation of task. This denotes that clinical instructors are able to distinguish alternatives in cases that problems may arise that can contribute to a delay of work. However, there is one item which got the least weighted mean. The item no. 1 gained the lowest weighted mean of 3.48 but still falls under highly practiced stating that clinical instructors create and document a welldeveloped plan of care. This implies that clinical instructors are very specific and accurate in the making of plans. They develop plans applicable to the health needs of the patient and ensure to be correct to avoid certain errors that can arise. It could be gleaned from the table that student nurses rated the clinical instructors as “highly practiced” along the fourteen planning functions included from the questionnaire. This is derived from the overall mean of 3.62. This implies that students have high trust to their clinical instructors in their planning function. They recognize their clinical instructors as efficient and effective in formulating plans. This is also true in the statement of Alkahtani et. al (2011) that in order for a manager to get the

22

loyalty of his/her followers and for them to meet their defined objectives, he/she must include all the students and other health care staff in the development of plans and activities. The clinical instructor must acknowledge their decisions and suggestions and in the prioritization of activities in order to accomplish their desired target. Table 3 illustrates the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by self along organizing. It talks about the ability of the clinical instructor to oversee and coordinate activities in the clinical area. It can be viewed here that clinical instructors are “highly practiced” in their extent of practice in the organizing function in the clinical area. As stated on the table, the respondents have a highest weighted mean of 4.00 in 4 items, the item no. 4, 6, 10, and 12. These items signifies that DMMMSU clinical

instructors are highly practiced in conducting orientation to the clinical area before the start of duty, demonstrates competency in organizing students in the clinical area, able to keep an open mind and hear on-going concerns of students without judgment, and encourages students to approach her whenever the assigned tasks is unclear. This means that clinical instructors promotes familiarization of students in the area in order achieve faster delegation of tasks. Clinical instructors are approachable to the students to stimulate cooperation and collaboration within the group. It is also supported by Tan and Beltran (2009), that clinical instructors must apply the concepts or steps in staffing. He or she must induct and orient personnels in order to facilitate good working environment and be able to understand the organizational culture

Table 3 Extent of Practice of Managerial Functions of ICHAMS Clinical Instructors along Organizing as Evaluated by Themselves (CI), Senior Nurses (SN), and Students (S) Managerial Functions

M (CI)

DER

M (SN)

DER

M (S)

AM

DER

1. The clinical instructor uses time wisely.

3.89

HP

3.61

HP

3.66

3.72

HP

2. The clinical instructor conducts orientation to the clinical unit before the start of duty. 3. The clinical instructor conducts pre-conference before assigning each student to their respective patients. 4. The clinical instructor conducts post-conference to know the students comments regarding their assigned responsibility. 5. The clinical instructor is able to deal with uncertainty, inconsistency, and complex issues on the area. 6. The clinical instructor demonstrates competency in organizing students in the clinical area. 7. The clinical instructor promotes an atmosphere conducive to learning. 8. The clinical instructor is accessible to students and applies theoretical discussion to practical situation. 9. The clinical instructor constantly informs students of their responsibilities to carry them out correctly. 10. The clinical instructor is able to keep an open-mind and hear on-going concerns of students without judgment. 11. The clinical instructor allows each student to concentrate to his or her specific role and responsibility. 12. The clinical instructor encourages students to approach him/her whenever the assigned task is unclear. 13. The clinical instructor assigns tasks depending on the severity of cases assigned to each member. 14. The clinical instructor reduces the chance of doubts of confusion concerning assignments by constantly informing students of their tasks. Average Weighted Mean

4.00

HP

3.72

HP

3.73

3.82

HP

3.89

HP

3.61

HP

3.70

3.73

HP

3.89

HP

3.50

HP

3.66

3.68

HP

3.89

HP

3.56

HP

3.56

3.67

HP

4.00

HP

3.50

HP

3.65

3.72

HP

3.89

HP

3.56

HP

3.60

3.68

HP

3.56

HP

3.56

HP

3.57

3.56

HP

3.89

HP

3.67

HP

3.70

3.75

HP

4.00

HP

3.67

HP

3.66

3.78

HP

3.89

HP

3.61

HP

3.64

3.71

HP

4.00

HP

3.61

HP

3.59

3.73

HP

3.89

HP

3.56

HP

3.65

3.70

HP

3.89

HP

3.39

HP

3.73

3.67

HP

3.90

HP

3.58

HP

3.65

3.71

HP

of the setting. It is also a role of a manager in the clinical area to facilitate the learning needs of the members of the group in order to achieve the success of their goals. In another view, the respondents gained 3.56 as the least weighted mean, but still falls on the descriptive equivalent rating of highly practiced. This means that clinical instructors is accessible to students and applies theories to practical situations in the area. To sum up, the respondents gained an average weighted mean of 3.90 (highly practiced). This implies that clinical instructors are effective in their organizing strategies in the area. Clinical instructor influences the students to build good relationships to other members of the group by means of professional approach. Table 3 indicates the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by senior nurses along organizing. It shows here that the clinical instructors have a highly practiced function in the organizing process as viewed by the senior nurses. There is only one item which got the highest weighted mean. The item no. 2 has an average weighted mean of 3.72 that falls under highly practiced. It states that clinical instructors conduct orientation to the clinical unit before the start of duty. This implies that clinical instructors promote familiarization of the students in the clinical area. They want students to easily adapt and learn more to the new environment and as much as possible to avoid errors that may arise within their duty. Moreover, according to Tomey (2007), orientation of the manager to his or students is an important in the management process. Clinical instructors know that in order for the students to avoid committing serious mistakes, he or she must give time to the students have orientation in the clinical area before the start of duty. He also added that one’s security usually increases when someone is considerate enough to help one adjust to a new situation. In addition, there are 2 items which got the least weighted mean, the item no. 4 and 5. The item no. 4 gained the lowest weighted mean of 3.50 but still falls under highly practiced. This states that the clinical instructor conducts post conference to know the comments of the students regarding their assigned responsibility. This implies that clinical instructors carefully assess the students’ experiences after the duty. They are

open-minded to feedbacks of students regarding their tasks in order for them learn more from their mistakes and to prevent it from happening again. In connection with this, Alkahtani et. al, (2011) stated that a good leader and a manager must be those who can guide his/her people through the uncertainty and confusion, which periods of rapid change entail. Also, the item no. 6 falls under highly practiced. It states that the clinical instructor demonstrates competency in organizing students in the clinical area. With this result, clinical instructors are capable in motivating students to work together in achieving their common goal which is to provide holistic care to individuals. This implies that they give an equal distribution of task to students to ensure close monitoring of every patient. This is also true in the study of Salem and Putri (2012) that clinical instructors positively affect students learning process through their motivation, extra effort, and satisfaction in guiding students in the area. It could be gleaned from the table that senior nurses gave high evaluations to clinical instructors regarding their organizing functions. It has an average weighted mean of 3.58 that falls under highly practiced. This implies that they are reliable in terms of organizing the actions and distributing task fairly to every student. In accordance with this, Toelke (2012) states that clinical instructors need to spend time orienting to the clinical facility, development of clinical rotations and assignments. Clinical instructor must orient students to the facility, conducts pre and post-conference to the students understanding and further development. Table 3 indicates the extent of practices of managerial functions of ICHAMS clinical instructors as evaluated by students along organizing. It shows here that clinical instructors have highly practiced organizing skills are viewed by the students. As shown on the table, 2 out of 14 items got the highest weighted mean, the item no.2 and item no. 14. The item no. 2 talks about the function of the clinical instructor to conduct orientation to the clinical unit before the start of duty. This implies that clinical instructors recognize the importance of providing briefings to students before the start of duty. They perform their role as an educator by providing basic information to students before doing

20

interventions on order to gain a more accurate result. Further orientation must be conducted overtime as a role of a clinical instructor in order to instill clarity of the objectives and responsibilities of the students (Tomey, 2007). Moreover, item no. 14 has an average of 3.73 states that they reduce chance of doubts of confusion concerning assignments by constantly informing students of their tasks. This implies that clinical instructors are perfectionist in their work in the clinical area. It proves that they do not want any errors that can arise in the clinical area, so as an initial action to prevent mistakes or problems, they constantly inform students of their assigned tasks and closely monitor students in their actions. However, there is one item which got the lowest weighted mean. The item no. 5 gained the lowest weighted mean of 3.56 but still falls under highly practiced. This states that clinical instructors are able to deal with uncertainty inconsistency, and complex issues in the area. This implies that instructors are able to handle problems in the clinical area. As a role of being a manager of the students, the clinical

instructor must learn how to control the environment to which his or her students are being involved. He or she must learn how to deal with the uncertainties in the clinical area and must anticipate problems that may arise in order to prepare for possible solutions (Marquis and Huston, 2007). It is clearly understood that student nurses perceived their clinical instructor’s management as highly capable or competent in the organization of his or her students in the area. This is evidenced by the overall weighted mean of 3.59 as highly practiced in the descriptive equivalent rating. This implies that clinical instructors involve every students and part of the health care team for the attainment of a common purpose and objectives. In relation to this, a good clinical instructor have been identified as one who involves his/her self to their students, one who is being clear and organized, emphasizes problem solving, and delivers positive feedback with good communication to students (Laurent and Weidnert, 2010)

Table 4: Extent of Practice of Managerial Functions of ICHAMS Instructors in the Clinical Setting along Directing as Evaluated by Themselves (CI), Senior Nurses (SN), and Students (S) M (CI) 1. The clinical instructor maintains discipline in the area. 4.00 2. The clinical instructor guides students in doing their tasks. 4.00 3. The clinical instructor demonstrates proficiency and 3.78 intellectual competence in the area. 4. The clinical instructor exhibits updated knowledge regarding 3.89 the area and discussion to actual situations and experiences. 5. The clinical instructor helps students manage their problems in 3.89 the area. 6. The clinical instructor gives clear directions. 3.78

DER

DER

AM

DER

HP HP HP

M (S) 3.67 3.73 3.68

HP HP HP

3.78 3.80 3.67

HP HP HP

3.44

HP

3.67

HP

3.67

HP

HP

3.56

HP

3.63

HP

3.69

HP

7. The clinical instructor uses problem solving strategies like case scenarios and brainstorming. 8. The clinical instructor delegates authority and assigns responsibility for the accomplishment of tasks. 9. The clinical instructor gives directions that are clear and concise. 10. The clinical instructor supervises the performance of procedures by the students and provides assistance when necessary. 11. The clinical instructor warns of consequences of misbehavior and improper conduct. 12. The clinical instructor allows questions after giving directions to students. 13. The clinical instructor directs students to see things as a whole in the area and sensing relationships and connections. 14. The clinical instructor is always ready to help students with specific needs. Average Weighted Mean

3.78

HP

3.44

HP

3.56

HP

3.59

HP

HP

3.61

HP

3.58

HP

3.66

HP

3.78

HP

3.67

HP

3.66

HP

3.70

HP

3.78

HP

3.44

HP

3.55

HP

3.59

HP

3.89

HP

3.56

HP

3.69

HP

3.71

HP

3.89

HP

3.61

HP

3.62

HP

3.71

HP

3.89

HP

3.67

HP

3.7

HP

3.75

HP

3.89

HP

3.67

HP

3.68

HP

3.75

HP

3.89

HP

3.67

HP

3.74

HP

3.77

HP

3.87

HP

3.58

HP

3.65

HP

3.70

HP

Managerial Functions

DER

HP HP HP

M (SN) 3.67 3.67 3.56

HP

Table 4 illustrates the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by self along directing. It measures the skills of clinical instructors in the supervision and coordination of the group in performing their responsibilities in the clinical area. As stated on the table, the respondents have a highest weighted mean of 4.00 in two out of fourteen items. These are the items no. 1 and 2. It signifies that ICHAMS clinical instructors are highly practiced in maintaining discipline in the area. He or she guides students in doing their task. Furthermore, in the study of Wiens (2013), clinical instructors perceived their selves as effective in managing students in the clinical area. He added that clinical instructors have high confidence in their abilities and autonomy in decision making which promotes impact in the organization of the group’s identified goals. In another view, there are 5 items out of fourteen which got the least weighted mean, the items no. 3, 6, 7, 8, and 9. The respondents gained 3.78 as the least weighted mean, but still falls on the descriptive equivalent rating of highly practiced. This means that clinical instructors demonstrate proficiency and gives clear direction in the area. He or she uses problem solving strategies concerning on learning process. The clinical instructor delegates authority and assigns responsibility for the accomplishment of tasks and allows questions after giving directions. Moreover, clinical instructors are responsible for the student professional development through effective clinical mentoring in addition to management characteristics and teaching clinical skills (Levy et. al, (2009), To sum up, the respondents gained an average weighted mean of 3.87 (highly practiced). This means that the clinical instructor influences the students to build good relationships to other members of the group by means of professional approach. Moreover, to be a good leader, instructors must provide full support to their subordinates. He or she must identify their needs and respond to their concerns through listening and empathy, and encouraging their subordinate’s opinion to facilitate completion of task that can lead to the achievement of goals (Cummings et. al, 2009).

As reflected on the table, the average weighted mean of 3.67 found on item no 1, 2, 8, 12, 13, 14 receive the highest rate along directing. This talks about how the clinical instructors maintain discipline in the area and guide students in doing their tasks. This implies that clinical instructors delegate authority and assigns responsibility for the accomplishment of tasks and allows questions after giving directions to students. He or she directs students to see things as a whole in the area and sensing relationships and connections. They are effective clinical instructors and ready to help students with specific needs. Furthermore, the study made by De Guzman et. al, (2008) about understanding the persona of clinical instructors, they made identify the characteristics of an effective clinical instructor. He or she must be able to facilitate the learning needs of the students as well as being able to establish a harmonious learning atmosphere for and with the students. He must be a leader or a manager of students in the clinical area which promotes enlightening, engaging, and embracing. .It can also be inferred that there are also 3 items that got the lowest weighted mean. As shown on the table items no. 4, 6, 9, having a weighted mean of 3.44, modified as highly practiced, and states that clinical instructors exhibit updated knowledge regarding in the area and discusses the actual situations and experiences. Clinical instructors give clear and concise directions. This would help students to understand further on how to cope up with the certain situations. From the above findings, it can be viewed that senior nurses considers the management practices of clinical instructors along directing as highly practiced having an average weighted mean of 3.48. In addition, being rated as highly practiced, head nurses acknowledges the directing capabilities of the clinical instructors. This is also true to the study of Masoumi (2008) that senior nurses have high perceptions to clinical instructors directing capabilities in the clinical area. He added that senior nurses possess the skill to teach the quality of good caring for the improvement of the students learning.

20

Table 5 illustrates the extent of practice of functions of ICHAMS clinical instructors as evaluated by the student nurses along directing. Clinical instructors are highly practiced in their directing function as evaluated by their students. In the table, only one item got the highest weighted mean. The item no. 14 got the highest weighted mean of 3.74 which indicates

that clinical instructors are highly capable in providing student’s specific needs. He or she supervises the performance of students, warns consequence of misbehaviour, and allows questions after giving directions to students. This implies that clinical instructors are helpful to student’s problems in the clinical area.

Table 5: Extent of Practice of Managerial Functions of ICHAMS Clinical Instructors along Controlling as Evaluated by Themselves (CI), Senior Nurses (SN), and Students (S) Managerial Functions 1. The clinical instructor considers discipline as a part of the controlling process. 2. The clinical instructor observes punctuality in the area. 3. The clinical instructor reprimands students who fail to wear the prescribed uniform in reporting for duty. 4. The clinical instructor gives demerits for students who commit error. 5. The clinical instructor reprimands students with incomplete paraphernalia. 6. The clinical instructor compares results of students’ performance with standards and objectives. 7. The clinical instructor relays to the students on their strengths or weakness in the area. 8. The clinical instructor asks students to share what they have learned in every rotation. 9. The clinical instructor encourages students to be responsible for their actions. 10. The clinical instructor influences and stimulates students’ motivation to do their tasks. 11. The clinical instructor praises or recognizes students for their positive behavior. 12. The clinical instructor allows further independence as students master their clinical skills. 13. The clinical instructor provides suggestions for the improvement of their goals. 14. The clinical instructor provides progressive constructive feedback to students concerning performance. Average Weighted Mean

M (CI) 3.67

DER

DER

HP

M (SN) 3.72

3.89

HP

3.89

AM

DER

DER

HP

M (S) 3.68

HP

3.69

HP

3.83

HP

3.70

HP

3.81

HP

HP

3.78

HP

3.63

HP

3.77

HP

3.67

HP

3.61

HP

3.53

HP

3.60

HP

3.89

HP

3.78

HP

3.69

HP

3.79

HP

3.44

HP

3.67

HP

3.59

HP

3.57

HP

3.78

HP

3.67

HP

3.60

HP

3.68

HP

3.56

HP

3.61

HP

3.65

HP

3.61

HP

4.00

HP

3.78

HP

3.68

HP

3.82

HP

3.89

HP

3.72

HP

3.70

HP

3.77

HP

3.89

HP

3.78

HP

3.62

HP

3.76

HP

3.89

HP

3.61

HP

3.62

HP

3.71

HP

3.78

HP

3.67

HP

3.70

HP

3.72

HP

3.78

HP

3.67

HP

3.67

HP

3.71

HP

3.79

HP

3.71

HP

3.65

HP

3.72

HP

20

Moreover, the item 9 got the least weighted mean of 3.55 which talks about the function of the clinical instructors to provide clear and concise directions to students. This implies that clinical instructors do not want doubts, confusion, and errors to arise during their duties, so as an initial action to prevent this, they initially provide clear directions to gain clear understandings. It is supported by Roussel (2007) that clinical instructors are effective in giving directions and in delegating tasks to their students. They recognize their own function as an important role in order to facilitate cooperation and unity of direction. To sum up, the respondents gained an average weighted mean of 3.65 (highly practiced). This implies that student nurses projects their clinical instructors as highly competent in providing directions to student nurses which are beneficial to the management As shown on the table, only one item got the highest weighted mean. The item number 9 got the highest weighted mean as 4.00 which lies on the scale of highly practiced in terms of controlling. It pertains to the ability of the clinical instructor to encourage students to be responsible in their tasks. This implies that clinical instructors act as a leader in the clinical area. As a leader they motivate students and influence them towards the specific goal of the group. Moreover, a clinical instructor can be a nurse manager and a leader of the group by persuading the group to work to achieve organizational objectives (Roussel, 2007). On the other hand, there is also one item which got the least weighted mean. This is the item no. 14, which got a 3.44 weighted mean but still categorized to highly practice. This pertains to the function of the clinical instructor to compare results of students learning with standards and objectives. This implies that clinical instructors perform good assessment of students’ capabilities by means of determining their level of excellence in performing their tasks. They follow the schools’ set standards in evaluating their students to avoid biases. Moreover, according to Roussel (2007), as a manager of students, the clinical instructor must evaluate them with the set standards of the institution with regards to the performance of the students. In addition, the respondents along controlling process gained 3.79 as an average weighted mean categorized as highly practiced.

and control of their behaviors and actions in the clinical area. According to Levy et. al (2009), it is a role of a clinical instructor to promote positive clinical learning environment which can develop students learning capabilities. He added that firm supervision to students with regards to their actions and behaviours in the clinical area is important as well as interpersonal teaching and good interpersonal skills. Table 5 indicates extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by self along controlling. This talks about the function of the clinical instructors to exercise his or her authoritative power in order to achieve coordination of tasks and to control student’s action. It can be viewed in the table that clinical instructors rated their selves as “highly practiced” in their extent of practice in the controlling function. The clinical instructors have high self-ratings in their function as a controller. This proves that clinical instructors have a high self-confidence in exercising their authoritative power for the benefits of students to gain discipline and orderliness of actions in the area. Moreover, Alkahtani et. al, (2011) specified that a good leader and manager must include policy issues in order to develop potential solutions to problems that will arise within the group. In order to implement policy in organizations, managers must learn how to communicate the need for change, and how to make a change appealing to gain support from the members. Table 5 represents the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by senior nurses along controlling. Senior nurses rated the clinical instructors as highly practiced in their function of controlling. As shown from the above findings, only one item got the highest weighted mean. The item no 2 with a weighted mean of 3.83, modified as highly practiced demonstrates on how clinical instructors observe punctuality of the students in the area. It can also be viewed that there are some items which got the lowest weighted mean on the item no 4, having a weighted mean of 3.61 that still falls under highly practiced, states that clinical instructors give demerits for students who commit errors in the area. This means that clinical instructors want students to learn more through their

20

mistakes so that it will not happen again during different circumstances. Moreover, there are also items whish got the least weighted mean, these are the items, 4, 8, and 12. The item no 8, having a weighted mean of 3.61 and modified as highly practiced states on how clinical instructors asks students to share what they have learned in every rotation. This is to evaluate the student’s learning capabilities during rotations in the different area. Moreover, the item no 12 having an average of 3.61, talks on how they allow their students to be independent in order for them to master their clinical skills. This would help students to be more competent and efficient in the health care delivery. From the above findings, it can be viewed that senior nurses considers the management practices of clinical instructors along controlling as highly practiced, having an average weighted mean of 3.71 which signifies their effectiveness in controlling the students in the clinical area. Moreover, senior nurses perceived clinical instructors controlling of their students as an important skill in the improvement of students learning (Winglinsky, 2008). In addition, according to Sharif and Masoumi (2008), the inability to control and supervise students in order to prevent mistakes could reflect a bad image on the side of the clinical instructor. Table 5 indicates the extent of practice of managerial functions of ICHAMS clinical instructors as evaluated by student along controlling. Students rated their clinical instructors as “highly practiced” in their extent of practice in the controlling function. The study revealed that along the controlling process two items out of 14 has the highest weighted mean of 3.70, which classified as highly practiced. These are the items, 2, 10, and 14. This indicates that clinical instructors are highly effective in observing punctuality in the area and in providing suggestions for the achievement of their desired goals. This means that clinical instructor collaborates to student’s goal attainment through giving recommendations for further improvement. This would also imply that discipline has been observed in the area. In addition, the study of Nehring (2006) identifies the qualities of best clinical teachers. She enumerates the qualities as being good role models to students, was able to enjoy nursing

and teaching, and demonstrates clinical skills and judgement to students actions for their further improvement of skills. On the other hand, there is one item which got the lowest weighted mean of 3.53 but still categorized to highly practice. This indicates that clinical instructors give demerits for students who commit error. We therefore conclude that students do not prefer on demerits that they received whenever they commit errors. In addition, the respondents along controlling process gained 3.65 as an average weighted mean. From the above findings, it can be inferred that students have qualified their clinical instructors to be very effective in controlling students by means showing power and authority. Moreover, the study of Phelps et. al (2009), found out that students mostly respects their clinical instructors if they have the ability to control their temper, treats their students sincerely, having patience and empathy, and possesses an enthusiastic attitude in clinical teaching. Table 6 presents the significant relationship between the extent of practice of managerial functions of ICHAMS clinical instructors along their profile as perceived by self, senior nurses, and students. As gleaned on the table, only the controlling function of the clinical instructors has a significant relationship on the age with a p-value of .024 and an r-value of -.734 and all the rest of the profile can be stated as significantly related to the extent of practice of managerial functions of the clinical instructors. This means that older clinical instructors compared with young clinical instructors have less proficiency with regards to their extent of practice of controlling function. Older clinical instructors tend to demonstrate kindness instead of having close monitoring and supervision in the area. As shown in table, the p-values are all higher than 0.05. Moreover, the profiles are not significant factors in the extent of practice of managerial functions as to planning, organizing, and directing, since the p-value are greater than 0.05. This means whether or not they are young or old, experienced or just young in the profession, master’s graduate or not, these are not considered criteria in determining the planning, organizing, and directing function of the clinical instructors.

21

Table Table 6. Significant Relationship between the Extent of Practice of Managerial Functions of ICHAMS Instructors in the Clinical Setting as Evaluated by Themselves (CI), Senior Nurses, and Students

This implies that the ability of the clinical instructor to manage his or her students depends greatly on her own personal techniques and skills necessary to provide better organization of his or her subordinates and their tasks. Although sometimes it is evident that the profile of the respondents affect his or her delivery of work and management of tasks, still it is more apparent that the ability to practice more extensively the role of the being a manager is an innate personality to the persons own style of management (Tan and Beltran, 2009). Moreover, the study of Kelly (2007) found out that the criteria in determining the extent of managerial skills of the clinical instructor include their own nature of knowledge followed by their communication skills in in the clinical setting. She emphasizes that knowledge will appear in four areas as it pertains to the clinical setting, the curriculum, the learner, and teaching/learning theory. Table 7 shows the significant difference between the perceptions of the three groups of respondents on the extent of practice of managerial functions of the clinical instructors. As gleaned on the table, all the p-values are all higher than 0.05. This means that the three groups of respondents do not significantly differ in their evaluation on the extent of practice of managerial functions of the clinical instructors.

Table 7 Significant Difference between the Extent of Practice of Managerial Functions of Clinical Instructors and the Evaluation of Self, Senior Nurses, and Students Management Functions Planning Organizing Directing Controlling

p-Value

Interpretation

0.384 0.874 0.447 0.427

Not significant Not significant Not significant Not significant

The study found out that the perceptions of clinical instructors to their managerial function was likely the same as the perceptions of the senior nurses and student nurses. This can be due to the fact that the clinical instructor applies his or her responsibility to collaborate managerial functions to the all the members of the health care team and also to his or her students. This implies that senior nurses and student nurses are aware on the development of plans by the clinical instructor and the students understand the objectives in the area stated by the clinical instructor. There is no difference on the perception of the three groups of respondents as the result of collaboration between the students, clinical instructor, and other health care professionals in formulating the plan of care. This result was similar to the study of Salem and Putri (2012) that in terms of leadership and management in the area, the perception score of the clinical instructors to their skills are almost the same as compared to the perceptions of students.

Table 8: Summary on the Extent of Practice of Managerial Functions of ICHAMS Clinical Instructors as Evaluated by Themselves (CI), Senior Nurses (SN), and Students (S) Managerial Functions

M (CI)

M (SN)

M (S)

Overall M

DER

Strength or weakness

Planning Organizing Directing Controlling AM

3.87 3.90 3.87 3.79 3.86

3.48 3.58 3.58 3.71 3.59

3.62 3.65 3.65 3.65 3.64

3.66 3.71 3.7 3.72 3.70

Highly Practiced Highly Practiced Highly Practiced Highly Practiced Highly Practiced

Strength Strength Strength Strength Strength

Furthermore, Alkahtani et. al (2011) found out that in order for the manager to totally control his or her people and to meet the defined objectives of the group, all members and persons related in the development of plans must be involved. Health team members and students in the area should not be aloof to the activities set by the clinical instructor. Table 8 presents the computed average weighted mean of the clinical instructors evaluated by self as to planning, organizing, directing, and controlling and its verbal descriptions with respect to the statistical procedures being used. It shows here that the extent of practice of managerial functions of clinical instructors is highly practiced in terms of their own perceptions. The clinical instructors gained an average weighted mean of 3.86 in their self-evaluation as to their extent of practice of managerial functions. The strengths of the instructors as to managerial practices involve all the aspects of management included in the study: planning, organizing, directing and controlling. The respondents did not have any weakness in terms of their managerial functions. The clinical instructors gave high self-ratings as to what they perceived on their own managerial functions in the clinical setting. This implies that clinical instructors produced favourable impression to themselves in terms of their managerial functions in the area. In addition, clinical instructor portrays competency in their field of practice. They excel in the different areas of management. In relation to this, clinical nurse educators should be well prepared and trained in order for them to produce competent nurses who will carry out safe patient care and for them to be equipped with clinical teaching skills to

maximize clinical teaching time (Jackson et. al, 2008). Table 8 presents the computed average weighted mean of the clinical instructors evaluated by senior nurses as to planning, organizing, directing, and controlling and its verbal descriptions with respect to the statistical procedures being used. It shows here that senior nurses have highly practiced evaluation on the extent of practice of managerial functions of the clinical instructors with an average weighted mean of 3.59. The study determined that the extent of practice of managerial functions of clinical instructors is highly practiced in the evaluation of senior nurses. The strengths of the instructors as to managerial functions involve all the aspects of management included in the study: planning, organizing, directing and controlling. The respondents did not have any weakness in terms of the managerial functions. This implies that the clinical instructors of DMMMSU-ICHAMS are already equipped with enough management skills and practices that make them being effective in the clinical management. In addition, the study made by Wiens (2013) found out that most of the clinical instructors developed their role confidence as a result of their several years of considerable efforts of addressing challenges in the clinical area and has learned their academic role expectations. He added that almost clinical instructors felt that they have been prepared better for the role to promote consistency in facilitating expectations. Table 8 presents the computed average weighted mean of the clinical instructors perceived by the students as to planning, organizing, directing, and controlling and its

20 verbal descriptions with respect to the statistical procedures being used. It shows here that students gave high ratings (highly practiced) to their clinical instructors with regards to their extent of practice of managerial functions. The average weighted mean was 3.64. The study determined that the extent of practice of managerial functions of ICHAMS clinical instructors as perceived by the students is highly practiced. The strengths of the instructors as to managerial functions involve all the aspects of management included in the study: planning, organizing, directing and controlling. The clinical instructor does not show any weakness regarding the areas mentioned. Students observed their clinical instructor’s performance on their managerial functions as highly practiced. This implies that clinical instructors are already effective in terms of their management practices in the clinical setting. Students observed their clinical instructor’s capabilities as useful influence in their management functions which can lead to their better learning of clinical skills. It also implies that students admires their clinical instructors and recognizes their position, authority, and power as a leader and a manager in the clinical area. Moreover, the findings are also similar form the study of Kelly (2007), that students rated their teachers’ knowledge in clinical management as an important one followed by their communication skills. How well students perceived that they were being motivated, directed, and being supported by their clinical instructor appeared to have greater impact to student views of effective clinical teaching. In response to the results of this study, the researchers developed sustainability program. Primarily, this was based on the findings which include the determination of the extent of practice of managerial functions of DMMMSUICHAMS clinical instructors. Results revealed that the extent of practice of managerial functions of the clinical instructors as to planning, organizing, directing, and controlling was categorized as highly practiced evaluated by the clinical instructors themselves, head nurses, and students. Furthermore, the aim of the program is to maintain and uphold the clinical instructors’ extent of practice on their management functions in the clinical setting by providing an opportunity for them to assess their own managerial functions on a range of personal dimensions, develop a plan for improvement,

and receive feedback to sustain their progress in their development. The main goal of this program is to explore and identify qualities of ideal management in the nursing profession. The program also aims to identify the clinical instructors’ personal learning goals and objectives for the program and develop plans as a means to help them maintain competency in the area of clinical management. In order to attain its goals and objectives, different plans are developed. During the program, participants who are leaders in their own way will develop cooperative peer relationships with other nurse managers to sharing ideas, brain-storming, providing support, and feedback while applying new concepts and approaches. The program will be interactive, using a range of creative learning techniques, including cases, role plays, exercises, scenarios, storytelling, and the expressive arts to express their own point of view. The environment will be conducive to learning that will promote participants relaxation and comfort yet stimulating and challenging. It will be designed to build rapport and trust as a first step for cooperative and active learning. Participants will learn management process which can help them maintain and uphold managerial functions that they will be used indifferent situations. The program will utilize Mc Gregor’s Motivational Theory, and Fayol’s Management Theory. To further reinforce the strategy, the researchers will use pamphlets and posters to disseminate information regarding managerial functions of a nurse. In addition, participants will receive a certificate of completion on conclusion of the program. To make this possible, the researchers proposed a sustainability program. However, this will be done through the participation of the clinical instructors of DMMMSU-ICHAMS, the research and extension unit, as well as the DMMMSU administration to serve on the coordination of the program. With them, there will be a greater possibility to implement it successfully. With the above mentioned strategies, chances are high that the extent of practice for managerial functions by the clinical instructors will be sustained CONCLUSIONS Clinical instructors of DMMMSUICHAMS are young adults, female with few hospital experience but are Master’s Degree

21 holder. They demonstrate proficiency in practicing the managerial functions. As the age of clinical instructors increases, the extent of practice of managerial functions on controlling also increases. The clinical instructors, senior nurses, and students had the same perception on the extent of practice of managerial functions of the clinical instructors.The clinical instructors of DMMMSU-ICHAMS have no weakness in terms of their extent of practice of managerial functions. The sustainability program for clinical instructors was developed to maintain their practice of managerial functions necessary to improve students’ learning in the clinical area. RECOMMENDATIONS The school administration is encouraged to give further assistance and support to their clinical instructors for them to boost their confidence, improve their performance, and motivate them to finish and continue their continuing education activities. They should also encourage attending trainings and seminars regarding nursing management in the clinical area. Senior nurses and evaluation of the self must also involve in evaluating the performance of the clinical instructors which is done every semester of the school-year. Older clinical instructors must strengthen their controlling functions through attending management seminars. Clinical instructors must maintain their effectiveness in collaborating their management plans and functions in the clinical area. The clinical instructors must capitalize with the strengths in the area. The sustainability program is proposed to maintain the extent of practice of managerial functions of the clinical instructors necessary to improve students learning in the clinical area. For future researchers who are willing to adopt the study, they are encouraged to do the same study in a larger population or area in order to determine more the extent of managerial practices of clinical instructors. REFERENCES Abdrbo, A. A. (2012). Self Assessment of Leadership Behaviors among Baccalaureate. International Conference on Management and Education Innovation, 106-111. Abelos, A. V., Aguinalde, L. R., dela Cruz, R. B., & Dalusong, M. M. (2006). Organization and Management. Manila: Giuani Prints House.

Alburo, F. A., & Abela, D. I. (2012). Skilled Labour Migration from Developing Countries: Study on the Philippines. Manila: International Migration Papaers. Asperas, C. M., Bautista, M. L., & Galang, D. R. (2005). Leadership and Management in Nursing; Theories, Concepts, Principles, and Practices. Manila: Educational Publishing House. Auerbach, D. L., Buerbaus, P. I., & Staiger, D. O. (2008). Better Late Than Never:Workforce Supply. Health Affairs, 3241-3249. Cawaon, F. C. (1998). Introduction to Nursing Management Functions. Manila: Educational Publishing House. CHED. (2010). Faculty Development. Retrieved August 18, 2013, from Commision on Higher Education: www.ched.gov.ph Dahlke, S., Baumbusch, J., Affleck, F., & Kwon, J.-Y. (2012). The Clinical Instructor Role in Nursing. Journal of Nursing Education, 1-5. De Guzman, A., Lewis, A. P., Joseph Prietoa, R., Purificaciona, V. N., Jamilla Quea, J., & Quiaa, P. (2008). Understanding the Persona of Clinical Instructors: The Use of Students’ Doodles in Nursing Research. Nurse Education Today, 48-54. DeClute, J., & Ladychewsky, R. (2013). Enhancing Clinical Competence Using A Collaborative Clinical Education Model. Journal of American Physical Therapy Association, 683-697. Dereli, M. (2008). A Survey Rsearch of Leadership Styles of Elementary School Pricipals. Evans, J., & Frank, B. (2007). Contraindications and Tension:Exploring Relations of Masculinities in the Numerically Female dominated nursing profession. The Journal of Men Studies, 277-292. Fang, B. Y. (2006). A Study of Leadership Styles and Foreigh English Teacher's Job Satisfaction in Adult Englsh Cram Schools of Taipei and Kaoshiung Cities in Taiwan. Ghandi, B. (2012, May 14). Retrieved August 9, 2013, from B. Ghandi Corporation Website: http://bhavingandhi.com/2012/05/14/whyshould-you-hire-fresh-graduates-instead-ofexperienced-professionals-part-1/ Henzi, D., Davis, E., Jasinevicius, R., & Hendricson, W. (2006). North American Students' Perspectives about their Clinical Education. New York: Journal of Dental Education.

22 Jackson, B. S., Napier, D., Newman, B., Odom, S., Ressler, J., Ridgeway, S., et al. (2008). Nursing Faculty Qualifications and Roles. NCSBN Leading in Nursing Regulation, 1-11. Kelly, C. (2007). Student's Perceptions of Effective Clinical Teaching Revisited. Nurse Education Today, 885-892. Koerber, A. D., Botto, R. W., Pendleton, D. D., Abazzaz, M. D., Doshi, S. J., & Rinando, V. A. (2007). Enhancing Ethical Behavior; Views of Students, Administrators, and Faculty. Journal of Dental Education, 213224. Laurent, T., & Weidnert, T. G. (2009). Clinical Instructors and Student Athletic Trainers Perceptions of Helpful clinical Instructor Characteristics. Journal Of Athletic Training, 58-61. Levy, L. S., Sexton, P., Willeford, S. K., Barnum, M. G., Guyer, S. M., Gardner, G., et al. (2009). Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review. Athletic Training Education Journal, 8-13. Manktelow, J., Thompson, R., Evison, A., & Podmoroff, D. (2013). How Good are your Management Skills. Retrieved from www.mindtools.com: file:///C:/Users/User/Desktop/new%20thesis %20journals/How%20Good%20Are%20You r%20Management%20Skills%20%20%20Te am%20Management%20Training%20from% 20MindTools.com.htm Marquis, B. L., & Huston, C. J. (2007). Leadership Roles and Management Functions in Nusing. New York: Jones and Bartlett Publishers. Nehring, V. (2006). Nursing Clinical Teacher Effectiveness Inventory: a replication study of the characteristics of ‘best’ and ‘worst’ clinical teachers as perceived by nursing faculty and students. Journal of Advanced Nursing, 934-940. Neighbours, C. (2013). Male Nurses, Men in a Female Dominated Profession: The Perceived Need for Masculinity Maintenance. American Journal of Nursing, 50-62. Phelps, L. L. (2009). Effective Characteristics of Clinical Instructor.

Rosales, A. B., Arugay, Y. C., Divinagracia, C. D., Palaganas, E. C., & Santos, J. A. (2011). An Analytical Study of the Performance of Graduates of Philippine Colleges of Nursing in the Licensure Examination. Professional Regulation Commission, 1-30. Roussel, L. (2007). Nursing Management and Leadership. Sudburg Massachusetts: Jones and Bartlett Publishers. Saccomano, S. J. (2008). Registered Nurse Leadership Style, Confidence Level, and Delegation Practices to Unliscenced Assistive Personnel: An Exploration of Confidence. Sharif, F., & Masoumi, S. (2008). A Qualitative Study of Nursing Students' Experiences of Clinical Practice. European Journal of Medical Research, 4-6. Tan, C. B., & Beltran, E. I. (2009). Leadership and Management in Nursing; A Transformaive and Reflective Patient Care Text and Workbook. Manila: Educational Publishing House, Inc. Toelke, L. D. (2012). The Clinical Nurse Instructor: Best Practices in Orienting Newly Hired Clinical Faculty. Washington. Tomey, A. M. (2007). Guide to Nursing Management and Leadership. Singapore: Mosby An Imprint of Lisevier. Valentine, P. E. (2011). A Gender Perspective on Conflict Management Strategies on Nurses. Journal of Nursing Scholarship, 69-74. Vector Study Corporation. (n.d.). Retrieved 2013, from Vector Study Website: http://www.vectorstudy.com Venzon, L. M. (2003). Nursing Management Towards Quality Care. Quezon: C & E Publishing, Inc. Wenglinsky, H. (2007). Teacher Classroom Practices and Student Performance: How Schools can Make a Difference. Educational Testing Service, 1-19. Wiens, S. E. (2013). linical Instructors' Perceptions of Structural and Psychological Empowerment in Academic Nursing Environments. London. Zabat, E. K., & Haas, S. S. (2009). Fast Facts for the Clinical Nursig Instructor. New York: Springer Publishing Company.

20

GUIDELINES FOR PUBLICATION IN THE ICHAMS HEALTH CARE JOURNAL

and clarity of agreements must be observed. The accuracy of statements rests with the authors.

1. Accepted papers for publication a. Previously unpublished and original research papers including thesis/COPAR, full-length articles or research notes advancing the knowledge in education and the practice of Nursing and Midwifery. b. Papers presented by faculty members invited as speakers for symposium, conferences and workshops. 2. Instruction to Contributors Manuscripts be typed in Microsoft Word, Times New Roman (font style) and font 10. should not exceed 10 pages, including tables and must be written in two columns (Except for the title, author and abstract) which are 2.75 inches in width and 0.5 inch space in between the columns. Typing must be single spaced with 1.5 margin on the left and 1 inch on the other sides. Pages should be numbered on the upper right.Format for all length of research papers: Title – This should be brief as possible Authors – Placed under the title. For student researches, name of co-authors/advisers should also be written. Abstract – This is asummary of the main finding of the work. It should not exceed 250 words . Introduction – This should include a brief statement of the problem and its importance, a short survey of the literature and the objectives of the work to be described in the paper. Methodology – This section will include detailed and with a broad outline of the procedure or methodology of the study/paper. Results and Discussion - Thispart presents and discussed the findings of the study which are arranged depending upon the nature and objectives of the study. Breaking up a section is encouraged to facilitate reading. Special attention should be given to the preparation of the discussion. Brevity

Conclusions–Conclusions should be drawn from the findings supported by the collected data. Recommendations- It should be brief and relevant and based from the findings of the study. Authors should also include recommendations due to the limitations of the study. Acknowledgment – This should be brief and direct to the point.This is an optional part of the paper. References – References should be confined to papers cited by the authors and listed alphabetically. Follow APA Format 6th Edition. About the Authors- Brief description of the authors. This is an optional part of the paper. 3. Papers for publications (soft copy saved in rewritable CD with label) shall be accepted at the ICHAMS Research Unit. 3.1. The Editorial Staff shall examine and evaluate the manuscript submitted for publication within a period of one month. When revisions are needed, the paper shall be returned to the author for appropriate modifications. 3.2. Authors whose papers are accepted for publication shall be notified of the action taken by the Editorial Staff. 3.3. Authors of the articles or any materials of interest published in the Health Care Journal are solely responsible for any fraction of the Laws on Intellectual Creation. 3.4. The Editorial Staff reserves the right to refuse articles submitted for publication in the ICHAMS Health Care Journal not conforming to the guidelines for publication.

21

DMMMSU Philosophy Total human development with appropriate competencies. DMMMSU Vision A premier and globally competitive university. DMMMSU Mission Provides relevant quality research and extension.

instruction,

DMMMSU Goal To lead in transforming human resources into productive self-reliant citizens and responsible leaders. ICHAMS Goals 1.To produce quality graduates in the medical and health allied fields. 2.To provide effective community health care services in the field of medical and health allied courses. 3. To offer course relevant to the health needs and situation of the times. 4. To reach out to the less privileged but deserving high school graduates who cannot afford to enrol in the private schools in the region. BSN Program Outcomes 1. Apply knowledge of physical, social, natural and health sciences and humanities in the practice of nursing. 2. Provide safe, appropriate and holistic care to individuals, families, population group and community utilizing the nursing process. 3. Apply guidelines and principles of evidence-based practice in the delivery of care. 4. Practice nursing in accordance with existing laws, legal, ethical and moral principles. 5. Communicate effectively in speaking, writing and presenting using culturallyappropriate language. 6. Document to include reporting up-to-date client care accurately and comprehensively. 7. Work effectively in collaboration with inter, intra- and multi-disciplinary and multi-cultural teams. 8. Practice beginning management and

leadership skills in the delivery of client care using a systems approach. 9. Conduct research with an experienced researcher. 10. Engage in lifelong learning with a passion to keep current with national and global developments in general, and nursing and health developments in particular. 11. Demonstrate responsible citizenship and pride of being a Filipino. Midwifery Program Outcomes 1. Apply knowledge of physical, social, natural, and health sciences in the practice of midwifery in various settings in health promotion and disease prevention. 2. Provide safe, appropriate and holistic care to pregnant women, newborn, their families, and community utilizing health care process. 3. Adhere to the existing laws, legal, ethical and moral principles of the midwifery practice in rendering clientele- focused health care services. 4. Practice collaborative and effective communication both written and verbal in English and culturally appropriate language with inter, intra, multi-disciplinary and multi-cultural teams to address communication barriers to effectively respond to clients and teammates. 5. Lead a team of health and non-health members to effectively deliver health care services in the community. 6. Evaluate, utilize, interpret and participate in the conduct of research aligned to local and national development agenda/ goals to address current issues and concerns of midwifery practice. 7. Actively engage in lifelong learning for professional and personal growth to ensure responsiveness to the latest developments and evidence-based practice in midwifery. 8. Recognize and promote local, regional and national diversities that reflect the nature of Filipino society while providing holistic care to clients.

22

Research Vision:

ICHAMS Research and Extension Objective

To be a leading University in technology innovation in Region 1 along Agriculture, Fisheries and related sciences,

To generate and disseminate appropriate technologies and information in response to the needs of its clientele and contribute to the welfare and development of communities in the province in particular, and to the nation in general.

Mission: To conduct multi-disciplinary and collaborative researches in agriculture, food technology, fisheries and other related sciences to attain food sufficiency and to generate employment in the region. Objectives of the University Research Unit 1. To generate relevant technologies in education, agriculture, agroforestry, fisheries, trade and industry, health and nutrition, local government administration, energy and socioeconomic and related sciences; 2. To disseminate research outputs through the scientific fora, publish in refereed journals, increase the application for patents and commercialize research products and technologies; 3. To mentor budding researchers and to increase the percentage of faculty conducting research from 32% to 90%.; 4. To empower researchers through capability building; 5. To upgrade laboratory facilities and equipment for the conduct of basic, applied and action researches; 6. To sustain existing linkages and further establish linkages with local and international funding agencies; 7. To apply for CHED Accredited Research Journal; and 8. To sustain the two national centers (SRDI and NARTDI), one regional center (PCC) and establish the technology innovation center in food and machines/facilities/equipment.

Strategies: 1.

2.

3.

4. 5.

Establish linkages with other agencies (international, national and local) for possible research and extension project and program collaboration and for funding. Develop and strengthen research and extension income generating programs and project. Adopt interdisciplinary approach in research and extension program development and implementation. Maximize possible resources for the development of the unit. Develop the unit’s work force through continuous capability building and reinforcements.