DAVAO DOCTORS COLLEGE, INC.

Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

CHAPTER 1

INTRODUCTION

Background of the study

The Students' entry to a higher education brings out a series of

development for personal, cognitive, professional, affective and social

development, as an outcome in progression of expectations of the chosen

undergraduate course. These expectations are often reach of fear and anxiety

also doubt about the academic performances and the professional trainings. At

the end of the day, the undergraduate course will be the students' new existent

learning environment, which can be positively or negatively affect in the growth to

their academics, performances and future selected profession.

In Brazilian literature, there is a lack of research on the matter, whereas in

foreign literature it is possible to find studies that investigated this variable in the

context of undergraduate nursing students. Therefore, the starting point of this

study is the lack of information about satisfaction with the academic experience

among undergraduate nursing students at a public university in Southern Brazil.

The authors considered that the investigation on academic satisfaction is

essential for planning and for the consequent improvement of institutional

 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

services and programs oriented toward students, which qualify the educational

process, thus justifying this study (Florianopolis, 2015).

Hence, the acknowledgment of possible degrees of students' satisfaction

or dissatisfaction can contribute to the establishment of strategies with the aim to

qualify students' learning and development by identifying their needs, bringing

improvements to professors and the coordination staff, making efforts to obtain

students' satisfaction so as to reduce a possible discrepancy between their

expectations and what the institution actually delivers. Academic institutions have

proved to be important for the intellectual and vocational development of

students, as they offer the opportunity to share ideas and experiences at

theoretical and practical levels, to interact with other students, professors,

employees and the community as a whole, and they also encourage students to

better understand the process of interaction between undergraduate course and

scholars, as well as changes resulting from this interaction. In this sense, we

should point out that one of the results obtained from the interaction between the

student and the undergraduate course is related to academic satisfaction

(Florianopolis, 2015).

In field of Nursing, it is important to understand how the students

experienced their undergraduate course. Students must also have opportunity to

give feedback or evaluation based on experiences during their trainings in the

hospital setting, also the level of satisfaction on the working environment

including the facilities, services, and with the personnel. Students who are not

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

convinced nor satisfied with facilities rendered affects their academics, their

future performances, also their working environment relationships towards their

subordinates, as well as to the people whom are involved towards the care

services that they will give.

Review of Related Literatures

This section presents different readings from various authorities on the

subject of the research which provides the researchers the important concepts

and principles. Those were included in this chapter. It helps in familiarizing

information that is relevant to the study.

Nursing student’s satisfaction towards personnel

Providing education for registered nurses to enable them to lead student

education in the clinical setting communicates the organizational value of the

role. Registered nurses identified being supported in having the time-to-teach

were considered important in facilitation of the clinical teaching role.

Professional nurses are essential for the appropriate training and

adaptation of the students. They teach, guide and monitor, as well as facilitate

integration of trainees into the clinical setting

Clinical placements provide opportunities for professional socialization by

allowing nursing students to experience how staff nurses interact, feel, and think,

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

as well as what they value. The degree of learning, skill development and

confidence of students is influenced by their relation with nurses. In clinical

practice, the nurse is said to assume different roles in order to facilitate students’

learning, such as a stranger, a resource person, a teacher and a leader. Previous

studies show how nurses’ attitudes and behaviour towards students can vary,

influencing their integration into the clinical practice environment.

A study by Parvin (2016), Clinical experience plays a pivotal role in proper

clinical-based nursing education, which affects the quality of learning in nursing

students. Clinical learning experiences require the interaction of nursing students

and their presence in clinical settings. Such interactions could simplify or inhibit

the learning process in nursing students and impact on their transition to clinical

practice. In a clinical environment, nursing students gain new experiences in

terms of professional interactions, communication skills and socialization.

Considering the constant interactions of nursing students with nurses, developing

a supportive clinical environment is crucial to promoting a sense of belonging in

these students. A supportive, interpersonal relationship between nursing students

and nurses in clinical environments is essential to fostering a beneficial learning

environment for nursing students. In addition, a positive, constructive relationship

between nurses and nursing students could be largely effective in increasing

learning efficiency. Positive attitude of nurses toward nursing students is

significantly involved in the socialization of these students. Furthermore, proper

communication of nurses and nursing students could improve the interactions

between healthcare centers and universities. On the other hand, negative

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

attitude of nurses toward nursing students could adversely affect their education

and lead to nursing staff shortage.

The most common way in which students develop their own professional

behaviours in relation to the delivery of care is through role modelling. The

nursing student uses role modelling to create her or his own understanding of the

patient’s world and the part that she or he has to play in it (Woodward, 2003).

Erikson et al (1983) define role modelling as ‘the facilitation and

nurturance of the individual in attaining and maintaining and/or promoting health

through purposeful interventions’. The role of nurses who adopt teaching

responsibilities is to facilitate this process for the student through the

development of their professional behaviours and identity.

Valentine (1997) describes the outcomes of role modelling as being both

positive and negative. Positive behaviours are those that are considered

desirable for the professional development of the student. Negative behaviours

include unprofessional, unethical or inappropriate behaviours. As role modelling

relies heavily on imitation and observation, both positive and negative behaviours

can easily be adopted by the student.

In Spain, nursing programs follow the European guidelines of the

European Higher Education Area (EHEA). The EHEA aims to increase

compatibility among national higher education systems (university level courses).

The curriculum of nursing studies comprises two basic components: a)

theoretical content; and b) training in competencies, abilities and technical skills.

These components are covered both at the university as well as within clinical

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

settings, such as hospitals. The bachelor’s degree in nursing includes 32.5% of

credits intended for training provided in clinical settings. In Spain, universities

develop nursing curricula, however, nursing students acquire their main skills

during clinical placements. University nursing departments are in charge of

selecting hospital professionals responsible for monitoring students. These

professionals, referred to as associate professors, are the key communication

link between clinical settings and the university. During their clinical placements,

students are welcomed by the nursing unit team, and each student is assigned a

reference nurse. (Lapeña-Moñux et al, 2016)

Clinical placements provide opportunities for professional socialization by

allowing nursing students to experience how staff nurses interact, feel, and think,

as well as what they value. The degree of learning, skill development and

confidence of students is influenced by their relation with nurses. In clinical

practice, the nurse is said to assume different roles in order to facilitate students’

learning, such as a stranger, a resource person, a teacher and a leader. Previous

studies show how nurses’ attitudes and behaviour towards students can vary,

influencing their integration into the clinical practice environment. (Lapeña-

Moñux et al, 2016)

Nursing student’s satisfaction towards services

A conducive and supportive learning environment for student nurses

depends on the availability of placement support systems, such as supervision,

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

mentorship, preceptorship and relationships between the faculty, student nurses

and clinical staff. Learning in practice placement requires an environment which

is conducive to learning, and provides the appropriate support from skilled

practitioners and educators. A clinical setting rich in learning experiences, but

lacking a supportive environment, discourages the learners in seeking

experience and results in the loss of learning and growth opportunities. On the

other hand, a setting with limited experiences but rich in support, may provide

opportunities for student nurses to examine new health needs and ways of

addressing them. Thus, regardless of where clinical practice is taking place, the

learning climate influences student nurses’ achievement and satisfaction with the

learning experience.

Since nursing is a performance-based profession, clinical learning

environments play an important role in the acquisition of professional abilities and

train the nursing students to enter the nursing profession and become a

registered nurse. Moreover, the clinical area of nursing education is of great

importance for nursing students in the selection or rejection of nursing as a

profession.

Unlike classroom education, clinical training in nursing occurs in a

complex clinical learning environment which is influenced by many factors. This

environment provides an opportunity for nursing students to learn experimentally

and to convert theoretical knowledge to a variety of mental, psychological, and

psychomotor skills which are of significance for patient care. Students’ exposure

and preparation to enter the clinical setting are one of the important factors

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

affecting the quality of clinical education

Nursing student’s satisfaction towards facilities

According to Papastavrou, et al (2016),The acquisition of quality clinical

experience within a supportive and pedagogically adjusted clinical learning

environment is a significant concern for educational institutions. The quality of

clinical learning usually reflects the quality of the curriculum structure. The

assessment of the clinical settings as learning environment is a significant

concern within the contemporary nursing education. The nursing students’

satisfaction is considered as an important factor of such assessment, contributing

to any potential reforms in order to optimize the learning activities and

achievements within clinical settings. Student’s acceptance within the nursing

team and a well-documented individual nursing care is also related with students’

satisfaction. The pedagogical atmosphere is considered pivotal, with reference to

students’ learning activities and competent development within the clinical

setting. Therefore, satisfaction could be used as an important contributing factor

towards the development of clinical learning environments in order to satisfy the

needs and expectations of students.

Clinical learning environment is a complex social entity. This environment

is effective on the learning process of nursing students in the clinical area.

However, learning in clinical environment has several benefits, but it can be

challenging, unpredictable, stressful, and constantly changing. In attention to

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

clinical experiences and factors contributing to the learning of these experiences

can waste a great deal of time and energy, impose heavy financial burden on

educational systems, cause mental, familial and educational problems for

students, and compromise the quality of patient care.

According to Nahid Jamshidi, Zahra Molazem, Farkhondeh Sharif,

Camellia Torabizadeh, and Majid Najafi Kalyani, nurses’ competence is based on

the knowledge and skill taught to them. Nursing training is a combination of

theoretical and practical learning experiences that enable nursing students to

acquire the knowledge, skills, and attitudes for providing nursing care. Nursing

education is composed of two complementary parts: theoretical training and

practical training. A large part of nursing education is carried out in clinical

environments. In Iran and many other countries, clinical education forms more

than half of the formal educational courses in nursing. Therefore, clinical

education is considered to be an essential and integral part of the nursing

education program. Since nursing is a performance-based profession, clinical

learning environments play an important role in the acquisition of professional

abilities and train the nursing students to enter the nursing profession and

become a registered nurse. Moreover, the clinical area of nursing education is of

great importance for nursing students in the selection or rejection of nursing as a

profession.

Unlike classroom education, clinical training in nursing occurs in a

complex clinical learning environment which is influenced by many factors. This

environment provides an opportunity for nursing students to learn experimentally

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

and to convert theoretical knowledge to a variety of mental, psychological, and

psychomotor skills which are of significance for patient care. Students’ exposure

and preparation to enter the clinical setting are one of the important factors

affecting the quality of clinical education. (Jamshidi et al, 2016)

Since an optimal clinical learning environment has a positive impact on the

students’ professional development, a poor learning environment can have

adverse effects on their professional development process. The unpredictable

nature of the clinical training environment can create some problems for nursing

students. (Jamshidi et al, 2016)

Theoretical Framework

This study was anchored in the social learning theory of Albert Bandura

(2015) and Jean Lave (1988). Albert Bandura developed the Social Cognitive

Theory in 1986 and posits that people learn through observing others’ behavior,

attitudes, and outcomes of those behaviors. “Most human behavior is learned

observationally through modeling: from observing others, one forms an idea of

how new behaviors are performed, and on later occasions this coded information

serves as a guide for action.” (Bandura). Social learning theory explains human

behavior in terms of continuous reciprocal interaction between cognitive,

behavioral, and environmental influences. Social learning theory is increasingly

cited as an essential component of sustainable natural resource management

and the promotion of desirable behavioural change.

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

In Situated Learning Theory of Lave (1988), it posits that in contrast with

most classroom learning activities that involve abstract knowledge which is and

out of context, Lave argues that learning is situated; that is, as it normally occurs,

learning is embedded within activity, context and culture. It is also usually

unintentional rather than deliberate. Lave and Wenger call this a process of

“legitimate peripheral participation”.

Knowledge needs to be presented in authentic contexts, settings and

situations that would normally involve that knowledge. Social interaction and

collaboration are essential components of situated learning, learners become

involved in a “community of practice” which embodies certain beliefs and

behaviors to be acquired. As the beginner or novice moves from the periphery of

a community to its center, he or she becomes more active and engaged within

the culture and eventually assumes the role of an expert.

This theories where related to this study because it refers on how the

students are affected based on their environment and the people around them.

This theories explains the factors that can affect the students learning abilities by

observing others, having an experience and how the students become

acquainted with the tasks.

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

Conceptual Framework

INPUT PROCESS OUTPUT

Linkage Linkage Policy

Satisfaction  Survey Development
Question
Program
1. Personnel  Data
2. Services Analysis
3. Facilities

Figure 1. Research Paradigm

The Figure 1 represents the research paradigm of this study, depicting an

input-process-output (IPO) model. The input shows the Linkage Satisfaction

among the Nursing Students of a Private Higher Education Institution in Davao

City in terms of Personnel, Services, and Facilities. For the process, a survey

questionnaire formulated by the group was used to collect the data. Data

analysis was made after the result was tallied as the next step of the process.

Based on the findings gathered, a Linkage policy development program was

proposed.

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

Statement of the Problem

The researchers aimed to assess the Linkage Satisfaction among the

Nursing Students of a Private Higher Education Institution in Davao City

Specifically, the researchers would like to answer the following questions:

1. What is the demographic profile of the participants in terms of?

1.1 Batch; and

1.2 Sex?

2. What is the linkage satisfaction of the students on the following affiliation

center?

2.1 DDH;

2.2 MDMRC; and

2.3 SPMC?

3. Based on the findings, what Linkage Policy Development Program may be

proposed?

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

Definition of Terms

Linkage Satisfaction. This refers to the satisfaction of the nursing students to

the Private Higher Education Institution in regards to the three parameters which

is the personnel, services, and facilities.

Nursing Students. This refers to the respondents of this study who evaluated

their level of satisfaction to the linkages of a Private Higher Education Institution

in Davao City.

Private Higher Education Institution. This pertains to the Institution located at

General Malvar St., Poblacion District, Davao City which offers various programs

including Bachelor of Science in Nursing.

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 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

Significance of the Study
This study is deemed beneficial to the following:

Nursing Students. This study will help the nursing students express their

satisfaction to the affiliation centers as well as identify the available services

offered by these affiliation centers in terms of promoting professional

development and fostering knowledge-based nursing care practice. In that way,

nursing students will be able to learn in the different clinical settings offered by

the affiliation centers that would develop their skills, knowledge and attitude in

the practice of nursing.

Affiliation Center. The study will help the affiliation center to know what

parameters that may need improvement or enhancement and to know the

satisfaction level of the students in their rendered services.

Nursing Administration. The study will help the Nursing administration to

know if the affiliation centers were capable enough to meet the student’s

satisfaction and needs that will help the nursing students enhance their learnings

and skills.

Future Researchers. The findings of the study will serve as a reference

material and a guide for future researchers who wish to conduct the same study

related to Linkage Satisfaction of Nursing Students.

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