CHAPTER I

INTRODUCTION

Nursing blends art and science to provide care and build patient relationships for better

health. Nursing students prioritized clinical competence and recognized the value of hands-on

learning. Clinical practice helped them refine their skills and transition into professional roles,

achieving proficiency by applying knowledge effectively (Terefe et al., 2023). As the largest

group in global healthcare, nurses played a crucial role in public health improvement. While

central Europe led in nursing competence, worldwide trends highlighted the need for value-based

care and better education. Furthermore, the evaluation of Graduate Nursing Students emphasized

nursing skills, communication, ethics, collaboration, and critical thinking (Kajander‐Unkuri et al.,

2020).

Assessing the fundamental skills and readiness of nursing students was crucial before they

started working. However, studies before the pandemic showed mixed results, with some

showing strong clinical skills among final-year students, while others highlighted weaknesses,

especially in countries like the USA and Australia (Molanida et al., 2023). Assessing competence

or a skill, especially in a clinical setting, was important to ensure that students, who would be

nurses, were able to provide competent and safe nursing care (Idrissi et al., 2021).

In the Philippines, nursing students were expected to master basic procedures, including

addressing patient needs in nutrition, bowel movements, medication, and hygiene. The nursing

process as part of the care plan involved predictable patient responses, administered according to

a predetermined nursing process with minimal adjustments. It incorporated communication

within a setting that supported the patient's well-being (Commission of Higher Education, 2019).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 2

 Recognizing the importance of sustaining competence, no research in Cotabato City

explored nursing students' competence in executing fundamental procedures. This study became

essential for upholding patient care quality, ensuring student readiness, and enhancing the nursing

education program, especially at Notre Dame University-Cotabato City. By assessing the

competence of level 3 nursing students, the study aimed to fill this gap, evaluating knowledge

application, skills, and attitudes toward simulation training, and identifying factors influencing

their competence in basic nursing tasks.

Review of Related Literature

This chapter reviews relevant literature to enhance understanding of the research problem,

identify gaps, and offer new insights. It covers topics such as level of competence, nursing

competency, basic nursing procedures, and factors affecting the level of competence of nursing

students, including simulation in operating and delivery rooms.

Level of Competence

Basic skills and core competencies are needed to become a skilled professional nurse.

Since competence is generally defined as the ability to act correctly and be recognized by others,

skills and competence have a close relationship. Various definitions define nursing competence,

with clinical competence being a widely debated concept encompassing knowledge supported by

cognitive, psychomotor, and affective abilities. In the realm of nursing education, a central

challenge lies in teaching students core competencies and offering opportunities to refine

fundamental skills, particularly in hands-on scenarios with actual patients (Molanida et al.,

2023).

Globally, nursing practice relies on professional skills and core competencies. Practical

nursing skills encompass technical, theoretical, caring perspectives, and ethical considerations.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 3

 The interconnected nature of the classroom and clinical environment in nursing education

necessitates students applying theoretical knowledge practically. By the end of their education,

students should have acquired the skills and competence to fulfill nursing duties independently,

fostering trusting relationships with patients (Molanida et al., 2023).

Hence, competence of graduating nursing students is crucial, linked to maintaining high-

quality nursing care, professional standards, and patient safety (Molanida et al., 2023). To align

with outcome-based education, the Board of Nursing (BON) and Commission on Higher

Education (CHED) issued CHED Memorandum Order No. 15 series of 2017, providing policies

and guidelines for the shift from competency-based to outcome-based nursing (Tanzo, 2021).

Additionally, the Commission on Higher Education in the Philippines offers a four-year Bachelor

of Science in Nursing program, integrating general education and professional courses. These

courses, spanning the first to fourth years, emphasize nursing concepts and related learning

experiences (RLE). The program includes rigorous nursing practice to enhance competencies and

achieve program outcomes for entry-level nurses (CHED, 2019).

Nursing Competency

The American Association of Colleges of Nursing defines competency-based education as

a process in which students are held responsible for mastering critical competencies in a particular

area of study. Nurses must uphold their competency, as they are at the forefront when executing

tasks for their clients and fulfilling professional duties. Legal and ethical obligations mandate that

nurses maintain their competency. Competency empowers individuals to fulfill their

responsibilities by integrating various factors such as information, methodologies, attitude, and

thinking ability (Mrayyan et al., 2023).

In addition, competence represents an individual's behaviors and ability to carry out job

tasks. Competency, on the other hand, refers to an individual's ability to successfully execute

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 4

under certain conditions. Nursing has long prioritized competence over other elements of

healthcare, where getting the job done has always been the key focus. Competency is measured

by performance, which is based on the knowledge, skills, and behaviors required as a

professional (Matsui et al., 2021).

Moreover, nurses' competencies consist of their collective knowledge, abilities, and

attitudes essential for effectively fulfilling their responsibilities (Leal et al., 2022). Competency in

nursing practice is a behavior-oriented phrase, whereas competence is a task-based term based on

the profession's behaviorism and trait theory. Specifically, 'competency' refers to the knowledge

of behaviors, judgment, and skills necessary for performing duties efficiently, while 'competence'

signifies the ability to successfully accomplish a task (Mrayyan et al., 2023).

Several assumptions are made about competency: Firstly, a comprehensive

conceptualization of competence encompasses skills, knowledge, attitudes, levels of sufficiency,

and performances. Secondly, competency serves as an indicator of the extent of capability

assumed to be sufficient for a specific task. Thirdly, competency can be attained; hence, training

is essential. Fourthly, performance concerning specific behaviors may be measured to assess

competency. Lastly, competency holds crucial importance for nurses in making safe clinical

judgments (Mrayyan et al., 2023).

Also, recent references define 'competency' as the ability to execute a certain task or

action in conjunction with the necessary knowledge. Therefore, competency in nursing practice

plays a critical role in achieving optimal health outcomes both generally and within the realm of

advanced nursing practice (Mrayyan et al., 2023). Along with this, nursing competencies are

crucial for the professional growth of nursing students as they empower them to enhance the

quality of their practice and broaden their knowledge (Sahin et al., 2021).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 5

 Additionally, both nursing students and nurses need to attain high levels of proficiency in

their nursing efficiency and expertise. The field of nursing education faces increasing pressure to

better equip nurses to address the diverse needs of patients and populations. Student nurses must

possess a high level of nursing competency to deliver efficient, safe, and high-quality healthcare

that aligns with the community's needs (Sahin et al., 2021).

Furthermore, nursing competency is an appropriate mechanism of care services that

optimizes patient health recovery. The development of nursing competencies among healthcare

providers and nursing students was viewed as a major solution for improving care quality and

reducing healthcare disparities (Retnaningsih, 2022). As student nurses constitute an especially

vulnerable group that necessitates additional support in acquiring and developing nursing

competency. They exhibit a negative attitude toward their ability to handle social self-care duties,

themselves, and the future (Sahin et al., 2021).

On the other hand, intra-organizational factors including organizational relationships,

infrastructure support, resource access, workplace and workload expectations, supervisory and

management dynamics, decision-making processes, and interpersonal relationships at work, hold

practical implications for implementing both structured and unstructured policies and practices to

enhance student nurses' nursing competency. Since, nursing competency of student nurses is

pivotal to an organization's success, necessitating awareness of its value by university

organizations. With significant changes in the higher education market, evaluating students'

learning becomes crucial. It is advisable to assess nurses' skill levels annually, and nurse

educators should persist in ensuring that nursing students possess the necessary skills for a

dynamic clinical setting (Sahin et al., 2021).

Meanwhile, the principal component analysis identified the four components of

competence—professional nursing behaviors, fundamental nursing skills, general performance,

and advanced nursing skills—demonstrating a high level of explanation for competency. This
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 6
shows that the measure of perceived clinical competence has high reliability and validity, making

it a valuable instrument for administering the self-evaluation of clinical performance by nursing

students. As a result, it is the duty of nursing educators to mentor and oversee student nurses as

they develop their professional behaviors and competencies to meet the demands of the

constituency (Madjid, 2023).

In addition, the competencies necessary for the nurse’s job include clinical nursing

competency. For all nursing professionals, it is crucial to carry out their duties and

responsibilities effectively and efficiently. Consequently, the nursing education curriculum’s base

must be established by nursing competency. The key determinants are professional conduct and

skill competencies, which include general performance, core competencies, and advanced nursing

competencies (Madjid, 2023).

Also, nursing schools demand that student nurses have professional competence.

Therefore, every nursing institution strives to promote high-quality academic programs to

produce competent and successful nursing students. Since, hospitals and other clinical settings

are the most in need of these qualified workers in the health-care delivery system (Madjid, 2023).

On the other hand, study found that male nursing students perceive high competency in

advanced and core nursing abilities, and nursing processes have been identified as the weakest

area in advance. As their level of schooling rose, they were better equipped to practice safely in

the clinical setting according to their perceptions of patient safety competence. Nursing students

cannot practice safe nursing care based solely on their knowledge of patient safety competencies.

They must continually practice knowing when to report negative situations. Patient monitoring

from time to time provides safe care and competencies (Madjid, 2023).

Nursing competence is based on knowledge and the curriculum taught in universities. The

training program is essential to gaining nursing values and achieving educational goals. This

knowledge and the skills acquired are valuable and will have an impact on their future career (or

when they start working after graduation). Nursing graduates still take time to develop

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 7

competency even after completing their academic nursing program. For this reason, clinical

competency is something that requires ceaseless development (Madjid, 2023).

Whereas, nursing students' having average competence in performing basic nursing

procedures, including those in delivery and operating rooms, can be influenced by several factors.

Students' inadequate readiness, ineffective communication, and emotional reactions are some of

the challenges faced by nursing students in the clinical learning environment. These challenges

can affect the students' learning and their acquisition of knowledge, skills, and attitudes necessary

for providing nursing care (Khodaveisi et al., 2021).

Another study found that nursing students' lack of knowledge and skills in the clinical

environment can lead to anxiety, which in turn can affect their performance (Khodaveisi et al.,

2021). Nursing students' lack of knowledge and skills in the clinical environment can lead to

anxiety, which in turn can affect their performance (Khoshhal & Khoshhal, 2022). Additionally, a

study found that nursing students may experience inferiority complexes after entering the clinical

area, which can also impact their competence (Yazdannik et al., 2020).

Hence, nursing students who have a strong understanding and internalization of

professional values, such as altruism, autonomy, human dignity, integrity, and social justice, are

more likely to perform basic nursing procedures competently. However, the study also found that

some nursing students may not fully grasp the importance of these values, leading to deficiencies

in their clinical skills leading to not being competent enough (Kornblum, 2021). Another factor

that may contribute to nursing students' lack of competency in performing basic nursing

procedures is their insufficient exposure to clinical settings during their education. Nursing

students who had more clinical hours and opportunities to practice their skills under the

supervision of experienced nurses reported higher levels of competence in performing basic

nursing procedures (Yazdannik & Mohammadi, 2021).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 8

 Lastly, nursing students' who have moderately high competence in performing basic

nursing procedures, including those in delivery and operating rooms, can be attributed to the

nature of nursing education. Nursing training combines theoretical and practical learning

experiences, with a significant portion of education taking place in clinical environments

(Ghafourifard et al., 2021). This hands-on experience in clinical settings is crucial for nursing

students to acquire the necessary knowledge, skills, and attitudes for patient care (Sabzeanloo et

al., 2021). It was found that a significant number of nursing students reported a lack of

confidence in their ability to perform basic nursing procedures in delivery rooms due to

inadequate clinical exposure and insufficient training in this area (Smith et al., 2021).

It was also identified that nursing students' emotional reactions, such as anxiety and

stress, can negatively impact their ability to perform basic nursing procedures in operating rooms.

Nursing students who reported higher levels of anxiety and stress were less competent in

performing basic nursing procedures compared to their peers who reported lower levels of

anxiety and stress (Johnson & Lee, 2022). Thus, to become highly competent as nursing students

in performing basic nursing procedures specifically in the delivery room and operating room, it is

crucial to focus on communication, readiness, and emotional management (Khodakarami et al.,

2021).

Basic Nursing Procedures

Nursing care relies on the fundamental basics, which are crucial in addressing nursing

issues. Proficiency in these foundational nursing principles is vital, as it paves the way for learners

to tackle increasingly intricate physiological conditions that demand deeper exploration. Nursing

procedures aim to standardize responses for enhanced patient safety and efficiency. Despite this,

nurses may need to deviate from guidelines in unique situations. Beside this, a skilled nurse

exercises sound judgment, recognizes when standard procedures aren't applicable, and is unafraid

to question actions or medical orders that could pose a risk to a patient (Mchon, 2023).
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 9
 According to the Novice to Expert Model, nurses typically have limited skills and

experience when starting a new specialty. It suggests that it takes about 2–3 years of relevant

experience to become fully competent. Therefore, new graduate nurses may not be fully prepared

to start working professionally, as they might lack the necessary skills. Previous research also

suggests that while new registered nurses may have a good theoretical understanding, they often

lack proficiency in basic nursing skills or readiness for practical work (Ubas-Sumagaysay et al.,

2020).

Also, the increasing severity of a patient’s condition and the complicated and changing

medical environment require high-quality medical services to ensure the best patient outcomes.

Thus, there is a growing need for good-quality educational courses in nursing colleges to educate

nursing experts who are equipped with proper certifications. Such nurses who receive an

advanced nursing education can help reduce the delays in recovery and damaging side effects for

patients, thereby preventing failure during treatment (Oh & Park, 2023).

Moreover, by reducing mortality rates, nurses will be able to play a vital role in treatment

and even patient satisfaction by helping patients and their families avoid unnecessary medical

costs. It is difficult, even for well-educated nurses, to be fully prepared for nursing. With the

recent increase in awareness of patient rights and the professional ethics of healthcare

professionals, there are limited opportunities for gaining practical experience in real-world

clinical settings (Oh & Park, 2023).

Additionally, changes are needed in nursing education to enable students to acquire the

necessary knowledge and skills. Simulation-based education applies a patient care scenario in a

safe educational environment, which will likely reappear in clinical settings, to help nurses gain

skills and experience managing the situation, thereby reducing errors in real-world clinical

situations. Consequently, nursing students enjoy the simulations based on feedback to increase

their self-confidence and satisfaction (Oh & Park, 2023).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 10
 Contrary, there is mounting evidence that the so-called "basic" and "softer" aspects of

nursing care such as patient sanitation, comfort care, patient education, and discharge planning

are the ones that are most frequently neglected or overlooked. These are care components that

help the patient feel better and more taken care of patients who receive these care components

feel as though "they are in good hands'', that is, that skilled, compassionate personnel are taking

care of them. One may argue that care grounded in morally sound practice, identifying what is

beneficial for the patient from a care perspective is care that makes the patient feel better and

more taken care of (Tønnessen et al., 2020).

Also, the clinical and ethical aspects of nursing care are widely recognized and

understood to be closely related. This is because competent, skilled, and compassionate nursing

care is not only good (and thus desired) clinical nursing practice, but it is also by definition

ethically sound nursing practice. It is at best extremely difficult, and some would even say that it

is neither desirable nor possible, to separate the therapeutic and ethical dimensions from one

another. However, people have a right to a minimal level of healthcare, including nursing care, in

developed nations with publicly supported healthcare systems (Tønnessen et al., 2020).

Continually, a minimal quality of safe, competent nursing care is said to be in line with

professional rules of nursing ethics, the need for dependable and compassionate services, and the

human right to healthcare. This is critical to meeting the needs of each individual patient, taking

into account the reality that every patient has varied demands and resource circumstances, which

leads to variations in patient expectations and the political will to satisfy those expectations.

Therefore, less than ideal comprehensive care as well as more than simply life-saving care is

included in the term "safe, competent nursing care" (Tønnessen et al., 2020).

On the other hand, Dr. Benner outlines the progression of professional growth within the

nursing field through five stages: novice, advanced beginner, competent, proficient, and expert.

In healthcare, the learning journey and the establishment of a professional identity often involve
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 11
 adopting the standards and norms of the professional community. Nursing students undergo a

process of socialization toward professionalism during their training, where they are expected to

integrate professional attributes into their daily practice. Their motivation to learn is heightened

when they feel included in the clinical environment, whereas experiences of exclusion or a lack

of belonging can have a detrimental effect on their motivation to learn (Rudberg et.al 2022).

Furthermore, the responsibilities of nursing professionals are delineated across different

levels of expertise. At Level 1, nurses emphasize communication skills and prioritize safe, quality

care, particularly focusing on comfort measures. They are also encouraged to pursue personal

development and adhere to ethico-moral responsibilities. Progressing to Level 2, nurses extend

their scope to encompass specialized care, such as for mothers and children or at-risk individuals,

alongside engaging in health education, ethics, legal considerations, and further honing personal

and professional competencies. Additionally, they actively participate in records management

and collaborative efforts with colleagues (CHED, 2019).

Moving to Level 3, nurses maintain a commitment to quality and safe care delivery while

adeptly managing resources and fostering conducive patient environments. They continue to

prioritize communication and collaboration, engage in health education, drive quality

improvement initiatives, and advance personal and professional growth. Moreover, they uphold

ethical, legal, and moral standards, demonstrate proficiency in records management, and may

contribute to research endeavors. Finally, at Level 4, nurses excel across all previously mentioned

domains, demonstrating mastery in communication, delivering exemplary care, efficient resource

management, ongoing development, and ethical practice, while also actively contributing to

records management and research to advance the nursing profession (CHED, 2019).

Knowledge

Knowledge is typically acquired through education and clinical experience and is seen as

the foundation for skills and attitudes (Nabizadeh-Gharghozar et al., 2021). Nursing knowledge
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 12
encompasses several modes of knowing. Knowing patterns comprise the following: (1) empirics,

the science of nursing; (2) aesthetics, the art of nursing, (3) the component of personal knowledge

in nursing, and (4) ethics, the component of moral knowledge of nursing (Obara et al., 2022).

Also, the main body of knowledge primarily consists of theoretical knowledge, which is

universal, formal, and explicit, encompassing facts, concepts, principles, and theories. The

development of professional knowledge relies on the interaction and integration of both

theoretical and practical knowledge. However, theoretical knowledge alone is inadequate for

practical tasks. Equally essential is practical or experiential knowledge, which is often implicit

and ingrained within skills. Hence, many vocational courses have adopted competence-based

curricula, which integrate knowledge, skills, and attitudes to facilitate better knowledge transfer

and emphasize the importance of norms, values, and motivations in professional learning (Hertog

et al., 2021).

Additionally, students' engagement significantly shapes their learning efficacy and

knowledge retention. The motivation to learn is intricately linked to individual interests and

external influences. With intrinsic motivation, students exhibit a profound interest in the subject

matter and demonstrate resilience in the face of challenges. They are particularly inclined to

explore content pertinent to their profession and qualifications. It is imperative for every nurse to

possess a fundamental understanding of supporting individuals' routines and possess the ability to

translate theoretical knowledge into proficient nursing practice. Indeed, the seamless integration

of theoretical insights into professional nursing practice stands as a hallmark of nursing

competency (Kawasaki et al., 2022).

Nurses must be equipped to identify, respond to, and communicate potential safety risks,

ensuring patients are shielded from near misses, adverse events, and avoidable dangers. Their

commitment to Patient Safety principles is heavily influenced by their understanding, attitudes,

and perceptions of safety issues. Hence, educators in nursing, both within academic and practical

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 13

realms, play a pivotal role in guiding students to grasp and implement evidence-based safe

practices during their clinical training (Bressan et al., 2021).

On the other hand, nurses play a pivotal role in ensuring medication safety, a multifaceted

intervention. Hence, education has emerged as a crucial intervention for enhancing care systems

(Sherwood et al., 2022). Educating patients and families about self-care is a critical nursing

responsibility. Patient education entails teaching, influencing, and empowering patients to

understand, manage, and act upon their own medical care (White, 2022). Apart from this, nursing

students may struggle to explain health information to patients, resulting in poorer evaluations.

Nursing students frequently require additional training in health education to improve their

communication skills and provide patients with accurate and understandable health information

(Johnson et al., 2020).

Also, patient education is a vital and significant aspect of nursing practice. Patient

education is crucial for making informed health decisions and managing their health before and

after surgery, leading to better recovery outcomes. Healthcare providers can help patients recover

by providing person-centered education, post-operative follow-up care, and using multimodal

techniques (Blöndal et al., 2022). Contrary, patients with low health literacy may experience

unfavorable outcomes such as a lack of health-related knowledge, insufficient management of

chronic diseases, poor drug adherence, increased emergency room visits, hospitalization, and

mortality. Hence, if patients do not understand medical instructions, it is difficult to expect them

to take drugs or engage in healthful activities (Yang, 2022).

Nursing has evolved to address the dynamic needs of individuals, communities, and

healthcare services. Nursing standards serve as authoritative statements outlining the legal and

professional foundation for nursing practice. Safe and effective practice necessitates the

knowledge, skills, judgment, and attitudes outlined in all standards of practice (Pouresmail et al.,

2023). Patient education contributes to ensuring an accurate knowledge base for patients,

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 14

readiness for care, and effective self-management, thereby providing patients with the necessary

information for continuity of care. Nurses must ensure accurate information is provided and

comprehended by patients and their families (White, 2022).

In addition, ensuring patient safety is paramount in the provision of nursing services.

Nurses must actively maintain patient safety programs to mitigate or prevent malpractice

incidents during the delivery of care (Sukender et al., 2021). A lack of understanding regarding

legal and ethical obligations may result in nurses encountering unlawful situations in their

practice, potentially leading to patients receiving treatment that is both illegal and unethical.

Within healthcare settings, nurses hold significant responsibilities, being accountable for

delivering care to patients in accordance with established ethical and legal standards (Sabra et al.,

2023). Also, nursing students frequently require more instruction in legal and ethical problems to

guarantee that they understand their duties and can offer safe and ethical care (Williams et al.,

2021).

Moreover, nurses must receive appropriate nursing-related training to improve their

performance and expertise. Since, understanding the roles and responsibilities for patient care and

safety in intraoperative practice is critical for achieving optimal patient safety (Singh &

Arulappan, 2023). Beside this, the development of nursing research skills has been identified as a

major concern internationally. Also, literature suggested that research ability in the field of

nursing remained inadequate internationally (Zhang et al., 2021). Nursing programs increase

possibilities for students to participate in research projects and incorporate research concepts into

the curriculum (Kackin, 2020).

Also, ineffective communication, a lack of preparation, and the emotional responses

nursing students experience in the clinical context could be contributing factors to the average

level of competence of nursing students in performing basic nursing procedures in terms of

knowledge. These difficulties could hinder the student’s capacity to learn and use information.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 15

According to recent research, providing students with instruction that specifically addresses their

psychological and communication needs may enhance their learning in a clinical context

(Hajizadeh et al., 2021).

Hence, the absence of efficient methods for both teaching and learning. In the clinical

context, nursing students encounter several obstacles such as insufficient resources, unmotivated

staff, and ineffective instructional methods. Using technology, simulation-based learning, and

active learning strategies are crucial for nursing students to improve their knowledge and

abilities. Technology-enhanced learning, simulation-based learning, and active learning

techniques should all be incorporated into nursing education curricula (Khalid et al., 2021).

Moreover, fostering a supportive and encouraging learning atmosphere, making sure

there are enough resources, and offering encouragement to nursing students can all help to

increase nursing students' proficiency in the operating room (Khalid et al., 2021). Lastly, the most

crucial traits of successful clinical instructors are those that have to do with internal drive,

professional appearance, and communication and teaching abilities, according to a 2021 study

that looked at the viewpoint of the students regarding these qualities. According to the study,

additional investigation is required to ascertain the connection between clinical instructor

qualities and student learning results (Kvale et al., 2021).

Skills
Skill is the ability to apply knowledge in practice, and it is gained by regular application

of knowledge in the workplace, which raises standards of performance (Nabizadeh-Gharghozar et

al., 2021). The technical, theoretical, and practical aspects of nursing care, as well as caring

viewpoints that are tailored to the patient's needs and circumstances, are all intricate parts of

practical nursing skills. The amount of time patients spend in hospitals is getting shorter, and

primary healthcare facilities are providing patients with more advanced therapy. As a result,

nursing education and skills must be updated to reflect the quickly changing nature of the
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 16
profession. Research highlights the necessity to determine whether or not students find it difficult

to master the technical side of nursing skills in general (Gregersen et al., 2021).

However, healthcare professionals need to be qualified in performing practical procedures

in order to guarantee the quality of patient treatment. Studies reveal that recently licensed nurses

perceive the duties of nursing as intricate and daunting. They want greater understanding of the

processes they are required to master as well as increased competency in real-world scenarios. As

a result, emphasis has been placed on the need for the nursing education curriculum to be more

practically oriented and focused on the demands of the healthcare sector (Gregersen et al., 2021).

Hence, it takes a complicated combination of technical and theoretical knowledge,

compassionate viewpoints that are tailored to the patient's needs and the situation, as well as

moral and ethical concerns, to perform practical treatments. It has been suggested that a greater

emphasis should be placed on aspects of nursing education that affect students' acquisition of

practical skills. It is thought that practicing practical skills on real patients is a more effective way

to gain a thorough understanding than having students go through training in skill centers or

simulations. For the purpose of developing practical skill competency, clinical placement is

consequently regarded as an extremely significant learning setting (Gregersen et al., 2021).`

On the other hand, patient safety and quality are primary concerns globally. It is widely

acknowledged that preventable patient harm ranks among the leading causes of death worldwide.

However, measuring the impact of quality and safety efforts remains challenging, particularly

concerning patient deaths attributable to preventable harm. This challenge stems from the hidden

nature of such occurrences, providers' reluctance to disclose exact details, varying definitions of

reportable incidents, and fear of repercussions (Sherwood et al., 2022). Besides this, personal

knowledge levels affect adherence to and compliance with safety norms and recommendations

(Vaismoradi et al., 2020).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 17

 In addition, management of resources and the environment are important competencies in

nursing. Since, one of the impacts to patient safety is through the availability of resources, and

the environment in which nursing is practiced. Research indicates that specific factors in the work

environment, such as workload, turnover rates among nurses, patient-to-nurse ratios, staffing

levels, and the competence of nurse managers, can affect patient outcomes (Plaza et al., 2021).

Along with it, nursing students frequently struggle with resource management due to a lack of

practical experience and training (Tucker et al., 2021).

Also, the environment in which nursing is practiced enables nurses to attain a high

standard of clinical practice, enhancing their ability to utilize available resources effectively

within interdisciplinary teams. This environment also enables nurses to deliver more efficient

preventative care and monitoring for patients. The provision of superior clinical care is facilitated

by an environment that empowers nurses with greater autonomy, accountability, and decision-

making authority (Rodwell et al., 2023). A study discovered that nursing students frequently

require additional training and practice in maintaining a sterile environment and utilizing

equipment correctly (Smith et al., 2022).

Moreover, healthcare professionals must regularly update their skills, with continuing

education or continued professional development facilitating the renewal and enhancement of

skills in healthcare settings (Mlambo et al., 2021). Nurses' continuing professional development

improves the quality of nursing care, patients' safety, nurses' satisfaction, and healthcare costs

(Vasquez-Calatayud, 2021). Furthermore, it's essential to note that addressing the complexity of

contemporary healthcare requires specific competencies within the nursing domain, tailored to

meet the demands of professional practice (Velez et al., 2021). Professionals who ground their

practice in reflection can adapt tacit behaviors, shaped by repetitive experiences, and bring fresh

perspectives to situations characterized by uncertainty and uniqueness (Choperana, 2020).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 18

 Also, nurses' commitment to patient safety standards is essential for improving quality of

care and preventing practice errors. For this reason, quality improvement in healthcare entails

improving patient outcomes through change implementation and rapid adaptation (Bajwa &

Mehdiratta, 2021). Similarly, every nurse intervention and interaction must be documented in the

clinical chart and other records in accordance with institutional guidelines (Maya, 2022). Since,

poor documentation can contribute to adverse events and patient harm (Kinnunen et al., 2020).

Hence, nursing programs was recommended to give students greater opportunity to experience

maintaining patient records and incorporate records management concepts into the curriculum

(Chang et al., 2021).

Apart from this, a nurse's ability to communicate effectively is critical for creating

therapeutic relationships with her patients and increasing patient satisfaction. It also helps to

reduce treatment errors and increase nursing care quality. Patients and caregivers respect experts

who listen carefully, the depth of discourse, the timing of information delivery, and the ability to

communicate empathetically. However, several studies have found that nurses lack

communication skills as a result of insufficient training or a failure to see the value of patient-

centered communication. As a result, nursing professors must devise active and successful

methods for instilling communication skills in nursing students (Gutiérrez‐Puertas et al., 2020).

Contrary to this, ineffective communication poses a significant barrier to teamwork and

collaboration in nursing, adding to the frustrations of nurses who already contend with

administrative burdens and concerns about inadequate time spent with patients (Grenuk, 2023).

Since, communication serves as the cornerstone of the nurse-patient relationship, playing a

pivotal role in fostering trust and comfort in nursing care. It represents a fundamental yet intricate

aspect of nursing practice (Afriyie, 2020). Thus, it was recommended that nursing programs

increase opportunities for students to engage in interprofessional communication and incorporate

communication principles into the curriculum (Al-Fawaz et al., 2021).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 19

 Within nursing, communication is indispensable for establishing trust and comfort in

patient care, forming the foundation of the nurse-patient relationship. Communication in nursing

is multifaceted and influenced by various factors, including interpersonal dynamics, emotional

state, timing, physical environment, cultural nuances, facial expressions, gestures, personal

interpretations, and perspectives. Effective communication has been associated with enhanced

quality of care, increased patient satisfaction, improved adherence to treatment, and ultimately,

favorable health outcomes (Afriyie, 2020).

Given the dynamic nature of the healthcare landscape, it is vital for nursing teams to work

together efficiently to safeguard patient well-being (Jomaa et al., 2021). Teamwork skills are

critical to the quality of treatment and patient safety, allowing for successful patient care and

preventing adverse outcomes. Therefore, teamwork has to be learned, and team training must

begin early in health care education (Karlsen et al., 2022). Since, nursing programs increase

opportunities for students to participate in team-based learning and incorporate collaboration

principles into the curriculum (Lee et al., 2021).

Also, recognizing the critical role of teamwork in ensuring patient safety, effective

collaboration among nursing teams is considered essential for cultivating a positive work

environment (Bragadottir et al., 2023). Multiple studies have emphasized the significance of

teamwork and team-based approaches in improving patient safety and delivering high-quality

care. Hence, optimal teamwork is recognized as a key factor in creating a conducive work

environment for nursing, resulting in positive outcomes for both nurses and patients (Bragadottir

et al., 2023).

On the other hand, the level of competence of nursing students in performing basic

nursing procedures in terms of skills resulting in average competence could be the result of

inadequate exposure and training. Nursing students who participated in a structured operating

room training program, gained more exposure to the operating room through increased clinical

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 20

hours, and received simulation-based training demonstrated significant improvements in their

technical skills and demonstrated higher levels of competence in patient care, surgical instrument

identification, and communication with the surgical team, according to a 2021 study published in

the Journal of Surgical Education (Mitchell et al., 2021). Additionally, a 2022 study published in

the International Journal of Nursing Education and Scholarship discovered that nursing students'

proficiency in the operating room can be impacted by their insufficient comprehension of the

culture and hierarchy of the setting as well as their deficiency in effective communication and

teamwork skills (Nadler et al., 2022). Hence, the authors of a study that was published in the

Journal of Surgical Education in 2021 investigated the connection between nursing students'

acquisition of technical abilities in the operating theater and simulation-based training. The

research revealed that although training through simulation was successful in enhancing

particular technical abilities, the general proficiency in the operating room stayed ordinary.

According to the authors, this might be the result of insufficient knowledge and skill

reinforcement, insufficient feedback, and a lack of opportunities for real-world application

(Gallagher et al., 2021).

Attitude

Attitude, on the other hand, denotes the mindset or perspective shaped by one's

perception or understanding of phenomena (Rekisso et al., 2022). An individual's attitude is a

propensity that influences their thoughts, feelings, and behaviors in relation to a psychological

object. Nursing students' attitudes toward the profession are critical for both student success and

professional progress (Solomon et al., 2022).

Attitude is an important factor in directing human behavior toward achieving objectives

and increasing achievement motivation. Attitude is considered one of the psychological aspects

that significantly encourage pupils to work hard. Hence, students' attitudes influence whether or

not they succeed in the nursing profession (Solomon et al., 2022).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 21

 Nursing students undertaking clinical placements constitute a significant portion of the

healthcare workforce within our institutions. They undergo training with the aim of graduating as

professionals poised to serve within the healthcare system, where they will assume roles

involving the care of individuals' lives. The attitudes displayed by nursing students towards

clinical work during their training significantly influence their proficiency and aptitude in

executing professional tasks, duties, and responsibilities as future nurses (Anagor et al., 2021).

Also, this concern serves as the driving force behind the initiation of this review focusing

on nursing students' attitudes towards clinical work. Specifically, this review will delve into

aspects such as nursing students' attendance, willingness to perform nursing procedures, their

relationships with peers and other healthcare professionals, and their respect for senior members

of the profession (Anagor et al., 2021). Likewise, nursing students either possess positive or

negative attitudes and perceptions about the nursing profession. Their attitudes towards the

profession depict the quality of care they will offer to patients upon qualification (Neumbe et. al

2023).

Moreover, these attitudes impact various aspects, including student retention and

recruitment, funding for nursing education and research, and interactions with healthcare

administrators and other professionals. Notably, Florence Nightingale is credited with laying the

groundwork for modern nursing and exemplified genuine concern for others' well-being.

Similarly, nursing students may possess a positive attitude towards their profession due to their

high level of skill and capability in providing quality care (Solomon et. al 2022).

However, factors such as heavy workloads, working holidays, lack of recognition, low

pay, and waning interest in nursing tasks can foster negative attitudes towards the profession

among candidates, potentially resulting in diminished work quality. Ultimately, the perceived

financial rewards of the occupation are influenced by students' perceptions of it (Solomon et. al

2022). Addressing nurses' attitudes towards the profession is a critical aspect of tackling the issue

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 22

of nursing shortage. This is because negative attitudes towards the profession can adversely

impact nursing education. Nursing students represent the future workforce of nursing, and their

attitudes towards the profession are indicative of the quality of care they will provide to patients

once they become qualified nurses (Neumbe et. al 2023).

Presently, delivering nursing care entails a physically demanding and intellectually

challenging process, unfolding within increasingly complex and ethically complex contexts

(Shayestehfar, 2020). The professional values of nursing students are deemed essential in their

development as future healthcare providers, manifested in their actions and behaviors during care

provision. Values reflect an individual's unique cultural and ethnic identity. Thus, as nursing

students prepare for professional roles, they must cultivate the requisite professional qualities to

become proficient nurses (Alshammari et al., 2021).

Furthermore, nurses' understanding of their ethical beliefs and how these values influence

their behavior is an essential component of holistic and humanistic nursing practice. Hence,

adhering to professional, ethical values in patient care is one of the requirements for professional

status (Taşkiran & Türk, 2023). Consequently, nursing students who attended ethics seminars

showed greater confidence in their capacity to identify and address ethical difficulties in clinical

practice (Khalili et al., 2022). Then, it was revealed that nursing students may lack self-awareness

and self-reflection which are necessary for personal and professional development. In such way,

nursing educators should provide more opportunities for self-reflection and self-assessment in the

curriculum to help students develop their personal and professional skills (Siddiqi et al., 2021).

Nursing students' role in patient care necessitates them to make key judgments that can

have a substantial impact on patients' health outcomes. This amount of responsibility necessitates

a firm ethical and moral sense (Kaczorowski et al., 2021). Additionally, nursing students who get

ethics education during their training are more likely to report feeling equipped to deal with

ethical challenges in clinical practice. Incorporating ethics education into nursing curricula can
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 23
assist nursing students in developing the skills and knowledge required to maintain high ethical

and moral standards as circulating nurses (Kaczorowski et al., 2021).

Furthermore, the level of competence of nursing students in performing basic nursing

procedures in terms of knowledge reveals average competence. The way nursing students see

their clinical experiences in the operating room can have an impact on their learning and general

competency. Studies have indicated that nursing students who have a positive outlook on their

clinical experiences are more likely to be motivated and involved in their education, which can

result in increased competency (Kelly, 2020). Conversely, students of nursing who harbor

unfavorable attitudes on their clinical experiences could be less motivated and engaged, which

could result in a decline in their competency.

Many things, including insufficient training, a lack of encouragement from teachers,

and poor interactions with other medical professionals, might contribute to negative views

regarding clinical experiences. As a result, it is critical for nursing educators to encourage nursing

students to view clinical experiences favorably as doing so can raise their levels of competence,

including knowledge and skills (Kelly, 2020). Numerous difficulties faced by nursing students in

the clinical learning environment were documented in the article "Iranian nursing students’

challenges in the clinical learning environment: A qualitative content analysis" that was

published in the Journal of Medical Education Development in 2021. This study has highlighted

three elements that potentially impact students' learning in the clinical setting: emotional

reactivity, inadequate preparedness, and ineffective communication. In order to enhance students'

learning in the clinical context, the study suggests that educators give special attention to the

communication and psychological needs of their students during their preparation

(Mohammadzadeh & Mohammadi, 2021).

Delivery Room Simulation

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 24

 As patients become more complicated and are presenting with several different diseases.

Nursing students need to be prepared to care for complex patients. Therefore, simulation provides

a safe and controlled environment for the training of nursing students (Riley-Baker et al., 2020).

Actually, pregnancy and childbirth are natural phenomena but sometimes have risks for mothers

and babies. Thus, a healthcare professional should carefully and continuously monitor the birth

(Matsui et al., 2021).

Every woman requires access to prenatal care throughout pregnancy, competent

assistance during labor, and comprehensive care and assistance post-childbirth. A smooth and

healthy transition into the postpartum phase hinges on the provision of physical care, educational

resources, and counseling services by healthcare providers to the mother, newborn, and their

family. Early discharge following childbirth is common practice, yet many postpartum

complications manifest after discharge. Hence, it's imperative to recognize early signs of

complications and identify at-risk mothers by conducting thorough evaluations before discharge

(Yikar et al., 2022).

Also, subpar assessment in intrapartal competencies could have adverse effects on patient

outcomes, potentially hindering the participant's ability to offer crucial care and assistance during

labor and delivery. This may heighten patient risks, prolong labor duration, and increase the

likelihood of complications, thereby undermining confidence in the student nurse's capacity to

deliver safe and efficient care. Additionally, there are no students who exhibit high levels of

competence. Hence, nursing students require comprehensive training, including simulation, to

acquire the competence necessary for caring for pregnant women and attaining educational

objectives (Kuesakul et al., 2024).

Consequently, knowledge ensures the quality of care through correct gathering and

appropriate interpretation of information from a pregnant woman and fetus as well as translation

of knowledge into practice. It facilitates the practice of team medicine by sharing information

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 25

about clinical courses and their management plans (Matsui et al., 2021). However, a lack of basic

knowledge to monitor and evaluate the labor course hampers the assessment of the progress of

labor. Thus to provide quality care, which contributes to reducing unnecessary morbidity and

mortality in both mothers and infants, it is essential to maintain a sufficient level of knowledge

(Matsui et al., 2021).

Recent research has delved into the repercussions faced by nursing students who fall

below the standard score in executing newborn care competencies. One study revealed that those

with lower scores experienced heightened levels of anxiety and stress, negatively affecting their

performance (Yang, 2023). Proficiency in newborn care competency, encompassing both

knowledge and skills, is essential for nursing students to deliver safe and efficient care to

newborns (Sim et al., 2021). Given that newborn care demands specialized expertise, including

an understanding of newborns' distinct requirements and the ability to execute specific

procedures and interventions, inadequate proficiency in this area poses risks. Nursing students

lacking in newborn care competency may commit errors or deliver subpar care, potentially

resulting in severe consequences for newborns and their families (Bakar & Joho, 2023).

Furthermore, understanding how to care for the umbilical cord affects the selection of

cord care methods and significantly influences the health of newborns. Inadequate cord care can

result in umbilical cord infections, which can impact the newborn's growth and development

(Kalufya et al., 2022). In the delivery room, the role of nurses is indispensable alongside doctors

in safeguarding the health and well-being of both the newborn and the mother. Nurses, as integral

members of the medical team, must possess the capacity, knowledge, and training to engage in

critical thinking, make informed nursing decisions, and respond promptly (Brown, 2021).

Moving forward, if you've ever pondered the significance of nurses in the delivery room,

labor and delivery nurses collaborate closely with obstetricians and other medical professionals,

delivering antepartum (pre-delivery) and postpartum (post-delivery) care. Nurses frequently

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 26

collaborate with physicians to develop individualized birthing plans for each mother, ensuring the

safety of both mother and baby (Brown, 2021). Antepartum care constitutes a substantial portion

of healthcare visits in the United States. Also known as prenatal care, antepartum management is

vital for promoting healthy pregnancies, identifying potential complications, and ensuring the

safe and timely management of prenatal issues and deliveries for both patients and newborns

(Karrar & Hong, 2023).

Moreover, the provision of adequate clinical practice skills to nursing students is a key

objective of nursing education. In order to prepare nursing students for the clinical skills needed,

appropriate professional environments and opportunities should be created. Nursing simulation is

an innovative method for nursing education in which educators use simulators to provide realistic

and safe clinical settings by depicting relevant scenarios systematically (Cha & Jeong, 2022).

Clearly, nursing simulation has several advantages. In particular, it helps students

improve their clinical skills by applying theoretical knowledge to simulations, thus reducing the

risk of potential errors and harmful effects on real patients. Also, it is a potential tool that may

help nursing educators prepare future nurses to practice in a real environment. It is a teaching

strategy that provides students with the artificial representation of a complex real-life situation to

enable them to learn in a safe environment (Cha & Jeong, 2022).

However, there are instances that student nurses receive a below-standard rating in

intrapartal competencies. One potential reason is a lack of exposure to skills rehearsal in school,

leading to student anxiety, stress, and a perceived lack of self-efficacy during clinical practice.

This limited clinical experience in assessing intrapartum uterine activity may result in a low or

fair rating of their ability and understanding, despite theoretical instruction before clinical

placements (Apartsakun, 2023).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 27

 Previous research has shown a positive correlation between simulation-based education

and various aspects of nursing students' competence, including their knowledge, self-confidence,

clinical skills, problem-solving abilities, clinical judgment, and self-directed learning. However,

as there is a scarcity of prior studies on simulation programs in the context of maternity nursing,

further research is essential to confirm the effectiveness of such programs in enhancing the

nursing competency of students (Alharbi & Alharbi, 2022). Moreover, the research literature has

demonstrated that nursing students are responsible for reporting a significant portion of

medication errors that directly affect patients, accounting for as much as 44.8% and ranking

second among all medical errors. Student nurses are expected to acquire the knowledge and skills

related to safe medication practices, which are based on the traditional six rights of medication

administration (Mtuankure, et al., 2023).

Preparation is essential for nursing students before entering clinical settings where they

provide direct patient care. Simulations enable active learning, practice, training, and reflection

on specific experiences. Simulation, widely used in nursing schools globally, is a valuable

component of nursing education. It effectively engages nursing students and helps address faculty

shortages (Alharbi & Alharbi, 2022).

Ensuring the provision of high-quality healthcare to women during pregnancy and

childbirth is essential for improving health outcomes for both mothers and infants. Achieving

patient-centered quality healthcare necessitates the utilization of accurate, dependable, and

pertinent patient-reported information. Patient-reported outcome measures (PROMs) consist of

structured and validated questionnaires that offer insights into the impact of interventions or

therapies on patients (O’Byrne et al., 2022).

Operating Room Simulation

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 28

 Simulation-based learning is frequently utilized in clinical education to enhance students'

skills and self-assurance, as well as to foster patient safety and minimize errors. Nursing students

must acquire proficiency in postoperative care skills and effectively apply their knowledge in real

clinical settings. In the context of surgical procedures, nurses are expected to demonstrate

competence, critical thinking capabilities, and adeptness in managing intricate processes

(Kulakac et al., 2024).

In addition, simulation was initially employed in military and aviation contexts. Its

incorporation into medical education holds significance for deliberate practice and the attainment

of expertise under the guidance of qualified instructors. Through simulation teaching, trainees are

directed to identify and address interconnected issues within interactive environments, enabling

them to enhance their clinical skills and undergo corrective learning through repeated exercises.

By engaging in various scenarios, simulation teaching aids learners in problem discovery and

resolution, thereby refining their acquired skills and advancing their clinical competency.

Utilizing situational simulation training has been shown to enhance trainees' clinical knowledge,

caregiving abilities, and communication skills. Furthermore, it fosters empathy among

individuals assuming the roles of patients, thereby enhancing their perception capabilities. In

recent years, the value of simulation in nursing education has become increasingly apparent (Lien

et al., 2023).

Nurses must efficiently blend their knowledge and skills to ensure safe patient care, while

also collaborating effectively with other members of the surgical team to enhance patient safety.

Intraoperative practice presents complex challenges, particularly due to the vulnerability of the

patient (Singh & Arulappan, 2023). In this context, nursing necessitates expertise in surgical

guidelines, care standards related to surgery, anesthesia, invasive procedures, surgical equipment,

infections, and patient safety. Nursing requires human qualities, strong interpersonal relations in

the surgical setting, leadership, and effective communication (Maya, 2022).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 29

 Also, preoperative preparation can help improve surgical outcomes and address

unexpected complications. Thus, to avoid delays, everything for the surgery, including materials

and equipment, should be prepared in advance. Additionally, to avoid injury, instruments and

equipment should be present and ready according to the surgery's specifications before wheeling

the patient (Singh & Arulappan, 2023).

Thus, nursing actions have a substantial impact on patient results. Nurses are accountable

for executing interventions designed to prevent illness, foster well-being, and deliver patient care.

(Jarelnape et al., 2023). Using sterile technique correctly lowers the risk of infection by

preventing the introduction of disease-causing microorganisms. Sterile technique is considered a

fundamental skill, expected to be mastered by students (Blumenfeld et al., 2020).

Emphasizing the significance of maintaining a sterile environment and practicing aseptic

technique is vital. Creating a sterile field aims to minimize microbial presence, essential in

various medical settings beyond surgical procedures (Tennant & Rivers, 2022). Aseptic technique

involves strict procedures to prevent pathogen contamination, crucially employed by healthcare

professionals in surgery rooms, clinics, and other healthcare facilities (Audah et al., 2022). Thus,

it is essential to have a good understanding of surgical instruments and their roles to effectively

support the primary operator during surgery (Ward et al., 2020).

Nonetheless, nursing students may encounter numerous challenges and stressors in

clinical environments, including fear of error, utilization of advanced medical equipment,

responsibility for the care of acutely ill patients, as well as managing end-of-life care and coping

with abrupt changes in patient conditions. Moreover, they must navigate through negative

attitudes within the clinical team and establish positive relationships with patients, faculty, and

other healthcare professionals. In such instances, simulation techniques offer a valuable tool to

mitigate teaching complexities (Kulakac et al., 2024).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 30

 Moreover, to ensure success, surgical nurses need significant experience in post-operative

patient care and specialized expertise in sterilization methods. Outstanding candidates showcase

strong communication skills and excel in delivering top-notch care, even in high-pressure

situations (Peters, 2021). Participants initially highly appreciated simulated operating room team

training for its contribution to patient safety. However, the decline in enthusiasm over time

indicates a need to reassess repeat training mandates, considering more cost-effective alternatives

such as asynchronous learning or virtual reality (Truong Hung et. al, 2021). Moreover, medical

technology is evolving in tandem with scientific and technological progress. Despite

technological advancements in the health system, medical errors persist, posing a threat to patient

safety in healthcare settings (Park et al., 2023).

Furthermore, preparing a client for surgery in preoperative nursing is crucial because it

ensures their physical and emotional readiness, contributes to a smoother procedure, and

enhances postoperative recovery. This preparation minimizes risks, facilitates effective

communication within the healthcare team, and ultimately promotes the overall well-being of the

patient. The procedure and status of the patient determine the equipment to use to provide the

position to the patient; the staff should check that the surgical table has all its accessories and

performs all its movements. The surgical team is composed of members from different

professions, like specialists in anesthesiology and surgery, as well as circulating and instrumental

staff (Maya, 2022).

The circulating staff can be nurse specialists in surgical care, nurses, or nursing aides.

Receiving and monitoring the client in the prep room or pre-surgery care is crucial for assessing

their vital signs, ensuring stability, and identifying any potential issues before the surgical

procedure. It helps in the early detection of complications, promotes patient safety, and provides

an opportunity to address any concerns promptly, contributing to a smoother and safer surgical

experience (Maya, 2022). Moreover, to effectively carry out their responsibilities related to

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 31

perioperative care, nurses must undergo competency-based training and have their competencies

evaluated using reliable and valid procedures during the training process (Şimşek, et al., 2023).

In addition, the conventional duties of scrub nurses include: (a) preparing surgical

instruments, equipment, and sterile supplies needed for surgery, (b) upholding a sterile

environment, (c) offering proficient assistance to surgeons during procedures, and (d) conducting

a thorough swab/instrument count upon completion of the surgery (Hara et al., 2022). Also,

circulating nurses play a crucial role in the surgical procedures and if they are unable to perform

their function in accordance with professional standards. Inability to oversee the administration of

the patient's required care and keep an eye on everything going on in the room would be the

result of it (Kalantari et al., 2021).

Likewise, operating room nurses are vital members of the surgical team because they

possess specific technical and non-technical skills. Because operating room nurses rely so heavily

on implicit knowledge, it is challenging for researchers to identify their non-technical skills. The

crew resource management framework classifies non-technical talents, and it has already been

determined that operating room nurses' non-technical skills fall under the purview of this

framework. Meanwhile, surgery on anesthetized patients in the early days is when the profession

of operating room (OR) nursing began (Sirevåg et al., 2023).

From helping with the surgeon's "household" and the OR's maintenance to now requiring

highly specialized talents, it has evolved since then. OR nursing has historically depended less on

evidence-based practice and theoretical concepts and more on historical legacy, with tacit and

unspoken knowledge generated within the OR. Nurses who struggle to communicate what they

know has been referred to as having tacit knowledge. Verbalization of all pertinent skill sets is

necessary given the demands of contemporary healthcare and organized OR nursing education

(Sirevåg et al., 2023).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 32

 However, scrub and circulation nurses work in an OR behind closed doors. Because they

haven't expressed their competency clearly, hospital administration and even other surgical team

members aren't aware of all of their obligations and capabilities. The intraoperative timespan is

defined by OR nurses as the period of time between the patient's arrival in the OR to their transfer

to the recovery unit following surgery. The OR nurses take great satisfaction in always working

with the patient's best interest in mind, demonstrating their "ethical competence." "Engaging in

respectful care and practice" and "Being the patient's guardian and advocate in the OR" are the

two sub-themes that fall under this theme (Sirevåg et al., 2023).

Factors Affecting the Level of Competence of Nursing Students

Nursing profession is based on theoretical knowledge and practical skills acquired

through a nursing education program. By integrating cognitive, psychomotor and affective skills,

the clinical learning environment has a crucial role to play in developing students' professional

competence. This evidence indicates that it is a key factor in achieving desired outcomes (Berhe

& Gebretensaye, 2021). Also, skills are continuously practiced by interacting with and directly

caring for patients (Madjid, 2023).

Moreover, practical skills in nursing encompass multifaceted procedures that combine

elements of communication, empathy, technical proficiency, and manual dexterity. These skills

can be categorized based on the challenges they pose to nurses, ranging from tasks involving

coordinated movements and collaborative interaction with patients to those requiring precision,

fine motor skills, and logical utilization of specialized equipment while patients remain passive.

Nursing students typically acquire practical skills through training in two primary settings:

simulation or skills centers and clinical placements. The availability of learning opportunities

during clinical placements depends on the specific situations encountered by students at the time

of their placement. However, the significance of learning in skills centers has grown due to

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 33

challenges in securing adequate and relevant clinical placements within an evolving healthcare

landscape (Hilleren et al., 2022).

It was found that a strong theoretical foundation before engaging in clinical training

allowed students to reflect on evidence-based practice within clinical contexts. The

acknowledgment of continual room for professional advancement can be seen as a growing

awareness and the cultivation of professionalism. It is evident that students would benefit from

increased collaboration between clinical supervisors and university faculty members (Rudberg et

al., 2022). Contrary, misinterpretation or misunderstanding of questions, especially under time

constraints, could hinder their ability to provide accurate responses. Language barriers,

distractions, and personal concerns further compound students' difficulties in achieving success

on nursing tests (Billings, 2020).

As student nurses often face challenges during the courses of their clinical learning which

may affect their competence. It is essential to adequately prepare students, select appropriate

clinical environments that meet the objectives and provide effective training, guidance and

supervision in order to ensure quality education and the development of competent nurses (Berhe

& Gebretensaye, 2021). According to several studies in predicting students' academic

performance, they have revealed that quizzes, tests, mid-term exams, and assignments are

significant factors that influence students' academic performance (Al Husaini & Shukor, 2023).

Moreover, Arendse (2020), noted that students' academic performance is influenced by

various factors, including drowsiness in class, lack of preparation for tests and exams, large class

sizes, and teacher-related aspects. In a study by Arendse (2020), found that academic workload,

self-esteem, and perceived stress negatively impact students' performance. They also emphasized

psychological factors related to life satisfaction, such as stress, inadequate coping skills, time

pressures, and managing academic demands (Arendse, 2020). Additionally, the authors

highlighted psychosocial factors, including classroom communication, students' lack of active

participation in discussions, their perception of the lecturer as an authority figure, fear of peers,

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 34

and confidence levels (Arendse, 2020). Wherein, stress diminishes the ability of nursing students

to engage in critical thinking, hampers their decision-making skills, and ultimately undermines

academic achievement, thereby restricting their potential for success (Bsharat, 2023).

Besides this, it has been established that student nurses need to be able to meet the

challenge of their tasks, have a commitment and an interest in achieving results with persistence

as well as higher levels of motivation (Terry & Peck, 2020). Furthermore, students who

consistently participate in classes and enjoy quality sleep are more inclined to achieve high

grades. Regular class attendance enhances interactions with instructors and peers while providing

structured time for crucial learning objectives. Additionally, adequate sleep is vital for optimizing

cognitive performance and preparedness for learning. Insufficient sleep negatively affects

attention and memory processes, potentially hindering students from realizing their full learning

potential in class, a phenomenon known as presenteeism (Yeo et al., 2023).

Also, nurses require precise nursing skills and relevant abilities rooted in advanced

knowledge. Medical institutions must enhance postgraduate education to maintain nursing care

quality and deliver advanced services. Highlighting nursing competency in basic education,

onboarding programs, and ongoing education is crucial for ensuring high-quality care and

contributes significantly to the professional growth and identity development of nurses

(Yamamoto et al., 2021).

As a matter of fact, it was discovered that nursing institutions demand student nurses to

exhibit professional competence, driving them to enhance academic programs for producing

successful and capable nursing students. The need for skilled professionals is particularly

pronounced in hospitals and clinical settings within the healthcare system (Madjid, 2023).

Meanwhile, schools as structured environments dedicated to teaching and learning,

function as educational institutions beyond traditional classrooms. To ensure proficient

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 35

education, schools must embody a multifaceted structure where physical conditions, including

student seating, study areas, equipment, materials, course books, and boards, significantly impact

students' academic development and achievement. As a school's infrastructure, practicality,

hygiene conditions, attractiveness, education planning, and student orientation are all pivotal

factors in student development (Ozcan, 2021).

An orientation process entails introducing new technologies, procedures, and policies

within the workplace, and it should be integrated across all levels of an organization. Hospital

orientation programs should focus on vital factors that enhance nurses' self-competence. Staff

educators in healthcare settings are well-suited to devise effective orientation programs tailored

to nurses in both general and specialized clinical areas (Lalithabai et al., 2021).

Additionally, the student's reflection of an institution's climate, known as the educational

environment, encompasses factors like infrastructure, educational opportunities, teacher behavior,

supervision, student attitudes toward learning, educational atmosphere, and learning weaknesses.

This environment plays a crucial role in student education, indicating a quality course in the

presence of a positive educational atmosphere (Faiz et al., 2020). Furthermore, students

comprehend key concepts related to clinical practice within the classroom. Classroom learning is

shaped by teacher characteristics, written assignments, the classroom environment, curriculum,

and motivations. Hence, nursing students must enhance their knowledge and skills in both

classroom and clinical learning to effectively care for patients (Faiz et al., 2020).

Educators should acknowledge the diverse learning style preferences of students,

recognizing their individual differences, and adapt teaching strategies accordingly to create an

effective educational program. For instance, if students favor visual learning, material should be

presented in a visual format, such as through projector-based visual presentations. Interest in

educational research on learning styles and teaching methods has significantly increased, aiming

to support students in achieving academic success and competence. Matching teaching strategies

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 36

with students' learning styles is crucial for academic achievement, benefiting both learners and

instructors (Alshammari et al., 2020).

Moreover, noise can hinder the clarity of speech, especially impacting second-language

learners. Its effects impede learning opportunities and can pose a significant obstacle to effective

learning due to reduced audibility (Goldschagg & Bekker, 2020). On the other hand, effective

clinical instructors exhibit commitment, internal motivation, problem-solving skills, flexibility

and creativity, time management, leadership and administration, accessibility, lifelong learning,

moral principles as well as up-to-date knowledge. Students believed internal motivation was one

of the special characteristics of an effective clinical instructor. Studies in line with the present

study have also reported internal motivation as an important characteristic of a clinical instructor

(Soroush et al., 2021).

In addition, communication skills were considered an important behavioral characteristic

of an instructor. Studies have also reported communication skills as an essential feature of a

clinical instructor. Evidence shows that teachers with good communication skills make the

clinical environment attractive for the students and enhance their motivation for learning(Soroush

et al., 2021).

Also, teachers with good communications skills can manage the possible clinical conflicts

and prevent the effect of these conflicts on the students’ learning process. Appropriate teacher-

student communication reinforces the students’ stress coping skills and facilitates learning. In

fact, proper communication is necessary for learning and teaching. Since, instructors can bring

about positive academic and behavioral changes in students by establishing good communication

with students (Soroush et al., 2021).

Along with this, clinical teaching stands as a central pillar of nursing education, wherein

clinical instructors oversee practical activities and empower students to acquire clinical

competence and skills. The competence of instructors emerges as the most influential factor in
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 37
students' clinical learning experiences. However, when instructors lack sufficient clinical

experience, students may struggle to learn effectively (Mukan et al., 2021).

Consistent with previous research, clinical competence is another significant

characteristic of an effective clinical instructor. There is no consensus over the characteristics of

instructors with clinical competence; however, characteristics such as ethical codes, updated

theoretical and clinical knowledge, effective communication with students, and managerial

capabilities have been proposed as important factors in this regard. Inadequate clinical

competence of an instructor reduces the students’ trust and disrupts student-teacher

communication (Soroush et al., 2021).

Considering the significance of clinical education, clinical instructors should be aware of

their professional responsibility, make their attempt to enhance their theoretical and clinical

knowledge, and consider the principles of professional ethics. Moreover, they can gain more

knowledge by working with their more experienced colleagues. Since, clinical instructors play an

important role in the development of nursing students in order to achieve the objectives of the

program. The instructor can compensate for the lack of textbooks and educational facilities, or

transform the best learning environment and subject into a passive one (Soroush et al., 2021).

As a matter of fact, the quality of nursing and the development of medical care have been

given great attention. Consequently, it gives rise to the higher demand for colleges to cultivate

high-quality nursing students and as well as the higher standard for teaching performance of the

nursing faculty (Wu et al., 2023). Research has shown that the characteristics of clinical

instructors, such as their teaching ability, attitude, and personality, impact students' learning.

Additionally, the characteristics of clinical instructors influenced the perspectives of the students

regarding the effectiveness of their teaching. Other researchers have reported that a good clinical

instructor is willing to teach, makes the clinical learning enjoyable, is able to motivate students

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 38

and get them involved in learning, provides learning opportunities for students, and makes the

clinical environment attractive (Soroush et al., 2021).

Furthermore, teaching skills was found to be another clinical characteristic of the clinical

instructors. Studies have emphasized that clinical instructors should have academic competence.

The most important academic characteristics of clinical instructors include being available, using

new teaching methods, encouraging students, providing regular feedback, avoiding negative

feedback in the presence of the patients and staff, and using objective criteria for assessment. As

the main pillar of education, an instructor should have sufficient learning and teaching skills to

convey complex clinical concepts to students in an organized and comprehensible manner. The

results indicated clinical instructors should have adequate clinical experience (Soroush et al.,

2021).

Other studies have also reported sufficient experience as an important property for a

clinical instructor. In this regard, there is a Persian proverb which says experience is the mother

of science. If clinical instructors do not have sufficient experience, their academic status will be

questioned by the students and personnel, and they will not have the required efficiency (Soroush

et al., 2021).

Also, the roles of clinical instructors are vital in honing competent and compassionate

nurses. In supervising nursing students in the clinical settings during their related learning

experience (RLE), clinical instructors need to be equipped in facilitating quality learning. Student

nurses revealed that their clinical instructors have limited techniques in monitoring and

evaluating the nursing students’ learning progress in RLE. Most of the time, clinical instructors

used critiques, RLE evaluation tools, and the dynamic learning processes (Padagas, 2020).

Consequently, nursing students were not confident and did not feel free to practice

clinical skills during practical placements because of the nature of the feedback they received

whilst in these placements (Nuuyoma, 2021). On one hand, a study reveals that participants
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 39
developed mixed feelings towards the techniques in monitoring and evaluating their learning

progress. Positively, they cited that their clinical instructors were transparent, fair, and that they

have balanced positive and negative feedback, hands-on, spent time to assess, reasonable, and

unquestionable (Padagas, 2020).

On the negative side, the student nurses felt that some of the clinical instructors should

rationalize RLE examinations. Secondly, some of them needed to help students to reflect and to

become more motivated. Thirdly, they have to monitor and evaluate the nursing students more

professionally. Fourthly, some of the clinical instructors should ask questions after and not during

any procedures being demonstrated. Fifthly, some of the clinical instructors were not focused on

monitoring the nursing students during RLE, and they reported that they did not know whether

they are graded accurately or not (Padagas, 2020).

Meanwhile, nursing students consider their clinical instructors as essential sources of

knowledge, skills, and values that will enable them to become competent and compassionate

nurses. Hence, nursing students should have a clinical instructor who is well-equipped to

facilitate quality learning (Padagas, 2020). Subsequently, clinical instructors play an important

role in developing the professional identities of future nurses. Their ability to shape a stable and

satisfying nursing workforce in the future can be influenced not only by perceptions of their role

as nurses but also by establishing values of professional identity, integrity, and honesty (Wu et

al., 2020).

Thus, it is important to a clinical instructor to establish objectives before the lecture.

Hence, objectives should be formally discussed with the students at the beginning of the class.

This includes orienting the learner to the plan for clinical teaching and setting relevant and

achievable learning objectives by aligning the instructor’s and learner’s goals (Buckley et al.,

2020). Admittedly, the most significant factor influencing student learning is the professional

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 40

competence of teachers. For this reason, student nurses perceive their clinical instructors as

competent, influencing their performance and expectations (Padagas, 2020).

Nonetheless, the environment is defined as an aggregated factor affecting the existence,

development, and welfare of an individual in terms of both domestic and foreign situations. One

of the major factors that impact students' performance and academic progress is their home

environment. Indeed, it elaborates that students' homes can either speed up or hinder their

academics (Younas et al., 2020).

The home environment has several impacts on students, such as a first-hand experience of

seeing parents, older brothers and sisters. Thus, parents are very much involved and have a huge

impact on the upbringing of their children (Younas et al., 2020). Having a supportive parent

affects the academic performance of students since students who have supportive parents have

lots of motivation to strive hard and optimistically without any pressures on their scores or grades

(Briones et al., 2022).

Moreover, the assistance that students receive from their families is critical for a smooth

transition into college life. Both theoretical and empirical evidence point to the importance of the

emotional and practical support that comes from having close friends and family members as a

basic human need. In order for people to thrive and achieve their utmost psychological well-

being, they need strong, supportive family relationships. As a result, people tend to put their trust

in their families and close relationships when they need it the most. Family support has been

linked to lower levels of emotional distress, self-esteem, and academic self-efficacy among

university students (Al Husaini & Shukor, 2023).

Also, it was found that students who received social support from their families were

more likely to be satisfied with their lives, have a positive mood, and have a negative mood than

those who didn't. As a result, the students should have full support from their families and to be

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 41

around them while they study as it has a positive impact on the students’ academic performance.

Furthermore, family factors such as family expenditure and income, as well as individual student

data, were used to determine the impact on student performance (Al Husaini & Shukor, 2023).

Additionally, some studies have identified that a parent's profession and income have an

impact on the performance of the students. Researchers perceive that students who have parents

with a good financial background can perform well in school. Hence, a student's academic

performance cannot be separated from the home in which they live in a good environment. It was

also explained that parents with low financial means affect the academic performance of a

student as it hinders individuals from gaining access and resources for learning (Younas et al.,

2020).

In line with this, students who belong with a family with a low financial lifestyle usually

engage in many household chores which is a form of covert child labor, presenting both favorable

and unfavorable aspects. Positively, it enhances their physical activity and instills a sense of

responsibility towards their families and society. However, it negatively impacts their attendance

at school (Hossain et al., 2023).

Furthermore, financial capability plays an important role in students’ academic

performance. Hence, financial difficulties need to be addressed given that they entail several

problems, such as health issues, and may affect academic achievement. Concerning this, some

students depend solely on education loans or scholarships, while others are forced to work to pay

for their education and daily needs (Norazlan et al., 2020).

On the other hand, others are dependent on their families' income, especially those

students who come from privileged families where parents can afford to provide money for their

children. The fact that students can get their weekly or monthly allowance from their parents.

Conversely, for students who come from poor families whose parents couldn't afford to give

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 42

them an allowance, it could be difficult to meet their basic needs like rent, food, and textbooks.

This has therefore led to a deterioration in their health, such as food insecurity and financial

stress, that eventually leads to poor academic performance (Norazlan et al., 2020).

Thus, the home environment exerts both direct and indirect influences on a child’s

academic capabilities and achievements. Moreover, the family’s lifestyle and home setting

establish a system that impacts the physical, social, and intellectual aspects, directly influencing

student learning. The levels of encouragement within families, expectations, and educational

activities at home are linked to socio-economic status. Different socio-economic statuses among

families create varying learning situations that play a role in a child’s academic success (Younas

et al., 2020).

Meanwhile, nursing students may agree to the factors affecting their level of competence

in performing basic nursing procedures, regardless of high or low scores on a questionnaire, due

to the influence of professional values and the socialization process. Professional values, such as

altruism, autonomy, human dignity, integrity, honesty, and social justice, are central to nursing

performance (Smith, 2021). Nursing educators play a crucial role in facilitating the development

of students' perception of the nursing profession and the nurse's role, as well as teaching effective

strategies to confront ethical dilemmas (Johnson, 2022). Students may increase their commitment

to professional values through role playing and observing behaviors related to professional values

(Williams, 2020). Nursing educators' awareness of nursing students' perspectives on the

importance of professional values is essential for preparing nurses to provide care in an ethical

and professional manner (Brown, 2023).

Theoretical Framework

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 43

 The study is anchored on Dr. Patricia Benner's nursing theory, “From Novice to Expert,"

and Dr. Judy E. Duchscher's Stages of Transition and Transition Shock Theory.

A person’s capability can be enhanced through various experiences and challenges. This

may result in mastery in such a profession. According to McClure (2005), the utility of the

concept of skill acquisition lies in helping the teacher understand how to assist the learner in

advancing through the next level. According to Benner’s theory, nurses develop the skills and

ability to understand patient care through the combination of a strong educational foundation and

personal experiences. In addition to this, nurses can gain knowledge and skills through those

situations. Just like in nursing education, student nurses are challenged at four levels. It started at

level 1, wherein student nurses had minimal knowledge regarding the course they took. As they

progress, they will be able to build a foundation of knowledge and skills that are necessary for

being competent and proficient nurses. Furthermore, this will measure their level of competence

as they advance to another level.

On the other hand, Dr. Duchscher (2018) stated that his theory presents the professional

role transition experience of the newly licensed nurse as a nonlinear journey in which movement

between stages of evolution presents repetitive, coexisting as an interplay between emotion and

intellect, relational dynamics, and the impact of unfamiliar or complex practice situations

introduced into the graduates’ situatedness on the transition continuum. For this reason, newly

licensed nurses experience changes in roles and responsibilities as they transition from university

experience to professional practice. Incidentally, nursing students also experience this kind of

situation as they break through another level of their study. The fact that before nursing students

move forward to level 3, they begin at level 1. According to CHED (2019), level 1 utilizes the

nursing process to render safe and appropriate care. Whereas, level 2 utilizes holistic care when

involved in the nursing process, and level 3 can now apply research and evidence-based practice.

Lastly, level 4 can now assume the first-level entry positions in any field of nursing.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 44

 Additionally, the more a nursing student progresses to another level, the more they will

become competent. This points out that advancing to another level builds more knowledge and

consequently results in a shocking environment. This theory can relate to the study of the level of

competence as it comprises stages of transition.

Conceptual Framework

The figure shows the conceptual paradigm of the study, indicating the independent and

dependent variables. The conceptual framework presents the diagram of the independent

variables, which are shown in the first diagram of performing basic procedures. The second

diagram shows the level of competence of nursing students as a dependent variable.

Independent Variable Dependent Variable

Figure 1. Schematic Diagram showing the variable of the study.

Statement of the Problem

This study aims to determine the level of competence of nursing students in performing

basic nursing procedures. It focuses on the level 3 nursing students at Notre Dame University of

Cotabato City. Specifically, it answers the following problems:

1. What is the level of competence of the participants in performing basic nursing procedures in the

delivery room and operating room simulation in terms of:

a. knowledge,

b. skills and
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 45
c. attitude?

2. What are the factors affecting the level of competence of participants in performing basic nursing

procedures?

3. Is there any significant relationship between the level of competence of the participants and the

factors affecting their competence in performing basic nursing procedures?

Hypothesis

H0: There is no significant relationship between their level of competence and the factors

affecting their competence in performing basic nursing procedures.

Significance of the Study

The level of competence in performing basic nursing procedures is crucial. It forms the

foundation of nursing practice.

The result of this study will benefit the following:

Nursing Education. This study will help educators to tailor curriculum and teaching methods

effectively, ensuring graduates enter the workforce fully prepared to deliver safe and high-quality

patient care.

Nursing Practice. This study will help provide valuable insights for healthcare institutions to

identify areas for additional training and support, ultimately enhancing patient safety and the

quality of nursing care provided within clinical settings.

Nursing Research. This study will help identify areas for improvement in the curriculum,

teaching methods, and clinical training. Also, to ensure that future nurses are adequately prepared

to provide safe and effective care to patients, thereby positively impacting healthcare outcomes.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 46

Clinical instructors. This study will help clinical instructors identify specific areas for

improvement in enhancing the proficiency of nursing students in fundamental nursing

procedures. By offering personalized activities and guidance, clinical instructors empower

students to acquire the essential skills necessary for success in their nursing careers, ultimately

benefiting both patients and the healthcare system overall.

Nursing students. This study will help students identify areas for improvement in nursing

education curricula and training methods. Also, this will help what training they need to focus

and what clinical skills they need to enhance to ensure patient safety and quality care delivery.

Notre Dame University. This study will serve as a guide and reference for the school

administrators and the Department of College of Health Sciences to have a basis for the current

level of competence the nursing students have at level 3. As a result, it can improve the student’s

performance and ensure that the curriculum aligns with the required standards.

Future researchers. The ideas presented may be used as reference data in conducting new

research or in testing the validity of other related findings. This study will also serve as their

cross-reference, giving them a background or an overview of the level of competence of a

nursing student.

Scope and Delimitation

This study is focused on determining and assessing the level of competence in

performing basic nursing procedures. This study limits its coverage to level 3 nursing students in

performing basic nursing procedures, specifically those who have not undergone Operating

Room or Delivery Room Simulations at Nursing Arts Room Laboratory of Notre Dame

University, Cotabato City. Additionally, it seeks to understand how these factors impact the

student’s level of competence.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 47

 Definition of Terms

For the readers to have a better understanding of the terms used in this study, the

following terminologies are defined operationally:

Nursing Competence. Refers to the ability of nursing students to effectively and proficiently

perform basic nursing procedures, demonstrating the necessary knowledge, skills, and attitudes

required for safe and competent patient care.

Basic Nursing Procedures. Refers to the fundamental healthcare tasks performed by nursing

students, such as intrapartal care, immediate newborn care and intraoperative care as scrub and

circulating nurse.

Nursing Students. Refers to an individual who is enrolled in a nursing program specifically in

the 3rd level, pursuing education, training to become a registered nurse and is the one who is

being assessed on how they perform basic nursing procedures.

Level of Competence. Refers to the degree to which nursing students demonstrate proficiency

and confidence in executing basic nursing procedures, assessed through testing their knowledge,

observing their skills, and evaluating their attitude.

Knowledge. Refers to the acquired information of nursing students in performing basic nursing

procedures.

Skills. Refers to the utilization of knowledge of nursing students in performing basic nursing

procedures.

Attitude. Refers to the behavior of nursing in performing basic nursing procedures.

Factors Affecting Competence. Refers to the cause that influences the performance of nursing

students in performing basic nursing procedures.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 48

 CHAPTER II

METHOD

This chapter presents the overall research design that will be used in the study. This

includes the research design, respondents, and instrumentation for the data gathering, the data

collection technique, and the statistical tools that will be employed in the analysis of the data to

interpret the pertinent information gathered.

Research Design

The study utilized a descriptive correlational quantitative research design to obtained

information regarding the level of competence of nursing students in performing basic nursing

procedures. It was descriptive as it described the participants' level of competence in performing

basic nursing procedures in the operating room and delivery room simulation in terms of their

knowledge, skills, and attitude, as well as the factors affecting that competence. It was also

correlational, as it examined any significant relationship between the participants’ level of

competence and the factors affecting their competence in performing basic nursing procedures.

Additionally, this study was quantitative, as it dealt with collecting and analyzing the numerical

data that was gathered.

Setting

The study was conducted at Notre Dame University, a tertiary school located at Notre

Dame Avenue, Rosary Heights 2, Cotabato City. Notre Dame University is ISO-PAASCU-

accredited and granted autonomous status by the Commission on Higher Education (CHED). It is
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 49
a private research university founded and managed by the Missionary Oblates of Mary

Immaculate. It is under the patronage of the Blessed Virgin Mary and is a member of the Notre

Dame Educational Association, a group of schools in the Philippines named Notre Dame. The

institution offers preschool, elementary, junior, and senior high, undergraduate, and graduate

education. It is composed of five (5) departments for the academic school year of 2023-2024,

which are the College of Health Sciences (CHS), College of Arts and Sciences (CAS), College of

Business and Accountancy (CBA), College of Education (CED), and College of Engineering and

Computer Studies (CENCS).

Participants

The study was conducted at the College of Health Sciences, Notre Dame University,

Cotabato City. The participants were studying for a Bachelor of Science in Nursing at level 3. For

the academic year 2023-2024, there were a total of 238 enrolled level 3 nursing students for the

NCM 116 course.

Sample Size

The researchers aimed to get 50 participants from each cluster of Level 3 nursing

students. The researchers employed a non-probability sampling technique that used non-random

criteria. To determine the participants who would be included in the study, we used the quota

sampling technique, specifically proportional quota sampling. Quota sampling was a non-

probability sampling method that involved the non-random selection of a predetermined number

or proportion of units. This included proportional quota sampling, in which the total number of

people to be surveyed was typically determined ahead of time. Due to time constraints and

participants' availability, the researchers utilized this sampling technique. Moreover, the

individual observation technique was employed with the selected participants to collect

observations from a population. To implement this method, the researchers developed

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 50

observation protocols, selected participants representing the target population, and conducted

observations according to predetermined criteria and methods. The individual observation

technique is a fundamental research approach used to directly observe and record an individual's

behavior.

Instrumentation and Measures

The researchers utilized a researcher-made survey questionnaire and an adapted

observation tool from CHED during the conduct of observation in the delivery and operating

room simulations. The survey questionnaire contains three parts. Part I contained the

demographic profile of the participants. Part II was a multiple choice questionnaire containing

statements pertaining to knowledge, skills, and attitudes that determined the level of competence

of nursing students in performing basic nursing procedures. The participants answered the

questions by selecting an answer from the given choices. They were assessed according to the

total score they attained.

Knowledge Scale in Delivery Room

Scale Rang Interpretation Description

e
5 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
3-4 51 - Moderately The

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 51

 76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
1-2 25 - Average The
50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0 0- Not The
24% Competent participants
have
exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Skills Scale in Delivery Room

Scale Rang Interpretation Description

e

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 52

12 - 15 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
8 - 11 51 - Moderately The
76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
4-7 25 - Average The
50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0- 0- Not The
3 24% Competent participants
have
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 53
 exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Attitude Scale in Delivery Room

Scale Rang Interpretation Description

e
5 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
3-4 51 - Moderately The
76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
1-2 25 - Average The

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 54

 50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0 0- Not The
24% Competent participants
have
exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Knowledge Scale in Operating Room

Scale Rang Interpretation Description

e
3 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
2 51 - Moderately The

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 55

 76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
1 25 - Average The
50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0 0- Not The
24% Competent participants
have
exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Skills Scale in Operating Room

Scale Rang Interpretation Description

e

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 56

15 - 18 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
10 - 14 51 - Moderately The
76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
5-9 25 - Average The
50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0- 0- Not The
4 24% Competent participants
have
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 57
 exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Attitude Scale in Operating Room

Scale Rang Interpretation Description

e
4 77 - Highly The
100% Competent participants
consistently
demonstrate
outstanding
skills,
thorough
understandin
g, and
exemplary
performance
in
performing
basic nursing
procedures.
3 51 - Moderately The
76% Competent participants
possess a
satisfactory
understandin
g of the
subject
matter and
are able to
execute tasks
with a
reasonable
degree of
skill in
performing
basic nursing
procedures.
2 25 - Average The

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 58

 50% participants
possess a
basic
understandin
g of the
subject
matter and
can carry out
tasks
adequately in
performing
basic nursing
procedures.
0- 0- Not The
1 24% Competent participants
have
exhibited a
deficiency in
the required
skills and
understandin
g in
performing
basic nursing
procedures.

Part III of the questionnaire consisted of statements that determined the factors affecting the level

of competence of the nursing students in performing basic nursing procedures. The participants

answered the questions using the 4-point Likert scale below:

Scale Range Interpretation Description

4 3.50- Strongly The participants
4.00 Agree strongly believe
that the identified
factor
significantly
affects his or her
competence in
performing basic
nursing
procedures.
3 2.50 - Agree The participants
3. 49 acknowledge that
the identified
factor has a

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 59

 positive influence
on his or her
competence in
performing basic
nursing
procedures.
2 1.50 - Disagree The participants
2.49 deny that the
identified factor
has a substantial
impact on his or
her competence
in performing
basic nursing
procedures.

1 1.00 - Strongly The participants

1.49 Disagree firmly reject that
the identified
factor
significantly
influences his or
her competence
in performing
basic nursing
procedures.

Also, the researcher adapted an observation tool from CHED, which was utilized during the

participants' operating and delivery room simulation to measure the nursing students' skills and

attitude in performing basic nursing procedures.

Data Gathering Collection

The researchers made survey questionnaires and utilized an observational tool adapted

from CHED. Initially, after the research questionnaire and study were approved for data

gathering by the adviser and panelists, the researchers wrote a letter to the Dean of the College of

Health and Sciences (CHS) of Notre Dame University and to the Level 3 coordinator requesting

permission to conduct the study about the level of competence of nursing students in performing

basic nursing procedures. The data gathering was done onsite. The researcher utilized the
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 60
Messenger app to inform the study participants by creating a group chat based on their RLE

group. The researchers informed the participants about their right to withdraw from the study.

Moreover, during the actual data gathering, a consent form was attached to the questionnaire,

asking for their approval to be involved in the study and ensuring their identity would not be

revealed. The data collected were treated as confidential and in compliance with the Data Privacy

Act of 2012. Furthermore, once the survey participants had completed it, the results were

tabulated, transcribed, and analyzed by the statistician.

Treatment of Data

The researcher utilized mean and standard deviation to determine factors affecting the

level of competence of participants in performing basic nursing procedures. Frequency,

percentage, mean, and standard deviation were utilized to measure the level of competence of the

participants in relation to their knowledge, skills, and attitude during operating and delivery room

simulation. Moreover, the Pearson Product Moment Correlation Coefficient or any statistical

counterpart was also utilized to determine if there was any significant relationship between the

level of competence of nursing students in performing basic nursing procedures. These tools

helped the researchers obtain the overall average of participants in the study.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 61

 CHAPTER III

RESULTS

Findings of this study are presented in tabular and descriptive form and interpreted to

answer the research objectives. Data were gathered to determine the level of competence of

nursing students in performing basic nursing procedures of Level 3 nursing students particularly

in operating room simulation and delivery room simulation.

Table 1 presents the demographic profile of the participants in terms of age and sex. This

further reveals that 1 or 1.3% aged 18 and 25, 6 or 7.9% aged 23, 8 or 10.5% aged 22, 18 or

23.7% aged 20, and 42 or 55.3% aged 21. Moreover, out of 76 participants, 12 or 15.8% are male

while 64 or 84.2% are female.

Table 1. Demographic Profile of the Respondents

Demographic Profile f %
Age
18 1 1.3
20 18 23.7
21 42 55.3

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 62

 22 8 10.5
23 6 7.9
25 1 1.3
Sex
Male 12 15.8
Female 64 84.2
Total 76 100.0

Table 2 presents the level of competence of nursing students in performing basic nursing

procedures in terms of knowledge in the delivery and operating room. In the delivery room, for

health education, 42 participants, or 55.3%, got the correct answer for item 5. Meanwhile, the

highest correct answer was achieved for item 16, with 51 participants, or 67.1%, answered

correctly. While for legal responsibility, item 6 received the lowest correct answer rate, with only

8 participants, or 10.5%, answered correctly, whereas item 17 obtained the highest percentage,

with 17 participants, or 22.4%, answered correctly. In terms of research, item 22 garnered a

correct response rate of 43.4%, with 33 participants answered correctly. On the other hand, in the

operating room, regarding health education, 40 participants, or 52.6%, answered item 31

correctly. In terms of legal responsibility, 23 participants, or 30.3%, got the correct answer for

item 32. Regarding research, 14 participants, or 18.4%, answered correctly.

Table 2. Level of Competence of Nursing Students in Performing Basic Nursing Procedures in

terms of Knowledge in the Delivery and Operating Room
Item Number Correct Incorrect
f % f %
Knowledge in Delivery
Room
A. Health Education
5 42 55.3 34 44.7
16 51 67.1 25 32.9
B. Legal Responsibility
6 8 10.5 68 89.5
17 17 22.4 59 77.6
C. Research
22 33 43.4 43 56.6
Knowledge in Operating
Room
A. Health Education
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 63
 31 40 52.6 36 47.4

B. Legal Responsibility
32 23 30.3 53 69.7
C. Research
36 14 18.4 62 81.6

Table 3 presents the level of competence of nursing students in performing basic nursing

procedures in terms of skills in the delivery and operating room. In the delivery room, for safe

and quality nursing care, item 12 had the lowest correct answer rate, with only 9 participants, or

11.8%, answered correctly. Meanwhile, item 1 obtained the highest correct answers, with 60

participants, or 78.9%, answered correctly. For the management of resources, environment, and

equipment, item 4 had the lowest correct answer rate, with only 17 participants, or 22.4%,

answered correctly. On the other hand, item 15 obtained the highest correct answers, with 44

participants, or 57.9%, answered correctly. In quality improvement, item 21 had the lowest

correct answer rate, with only 21 participants, or 27.6%, answered correctly. While item 9 had

the highest correct answers, with 26 participants, or 34.2%, answered correctly. In records

management, item 10 had 25% or 19 participants answered correctly. In communication, item 24

had the lowest correct answer rate, with only 33 participants, or 43.4%, answered correctly.

While in collaboration and teamwork, item 25 had 67.1% or 51 participants answered correctly.

Furthermore, in the operating room, for safe and quality nursing care, item 44 had the lowest

correct answer rate, with only 6 participants, or 7.9%, answered correctly. Meanwhile, item 45

obtained the highest correct answers, with 35 participants, or 46.1, answered correctly. For the

management of resources, environment, and equipment, item 30, got 27 participants, or 35.5%,

answered correctly. In quality improvement, item 35 had the lowest correct answer rate, with

only 11 participants, or14.5%, answered correctly. While item 48 and 49 had the highest correct

answers, with 18 participants, or 23.7%, answered correctly. In records management, item 37 had

the lowest correct answer, obtaining 50% or 38 participants answered correctly. While item 50,

got the high correct answer rate, with 53.9% or 41 participants answered correctly. In
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 64
communication, item 38 had the lowest correct answer rate, with only 26 participants, or 34.2%,

answered correctly. While in collaboration and teamwork, item 40 had 52.6% or 40 participants

answered correctly

Table 3. Level of Competence of Nursing Students in Performing Basic Nursing Procedures in

terms of Skills in the Delivery and Operating Room
Item Number Correct Incorrect
f % f %
Skills in Delivery
Room
A. Safe and Quality
Nursing Care
(SQC)
1 60 78.9 16 21.1
2 24 31.6 52 68.4
3 31 40.8 45 59.2
11 15 19.7 61 80.3
12 9 11.8 67 88.2
13 40 52.6 36 47.4
B. Management of
Resources,
Environment and
Equipment (MRE
4 17 22.4 59 77.6
14 18 23.7 58 76.3
15 44 57.9 32 42.1
C. Quality
Improvement (QI)
9 26 34.2 50 65.8
21 21 27.6 55 72.4
D. Records
Management (RM)
10 19 25 57 75
E. Communication
(Comm)
23 39 51.3 37 48.7
24 33 43.4 43 56.6
F. Collaboration
and Teamwork
(CTW)
25 51 67.1 25 32.9
Skills in Operating
Room

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 65

A. Safe and Quality
Nursing Care
(SQC)
26 19 25.0 57 75.0

27 29 38.2 47 61.8
28 31 40.8 45 59.2
29 33 43.4 43 56.6
41 13 17.1 63 82.9
42 18 23.7 58 76.3
43 19 25.0 57 75.0
44 6 7.9 70 92.1
45 35 46.1 41 53.9

B. Management
of Resources,
Environment and
Equipment
(MRE)
30 27 35.5 49 64.5
C. Quality
Improvement
(QI)
35 11 14.5 65 85.5
48 18 23.7 58 76.3
49 18 23.7 58 76.3
D. Records
Management
(RM)
37 38 50.0 38 50.0
50 41 53.9 35 46.1
E.
Communication
(Comm)
38 26 34.2 50 65.8
39 41 53.9 35 46.1
F. Collaboration
and Teamwork
(CTW)
40 40 52.6 36 47.4

Table 4 presents the level of competence of nursing students in performing basic nursing

procedures in terms of Knowledge in the delivery and operating room. In the delivery room, for

ethico-moral responsibility, item 7 had the lowest answer rate, with 20 participants, or 26.3%,

answered correctly. While item 18 had the highest rate, with 45 participants, or 59.2% answered
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 66
correctly. For personal and professional development, item 8 had the lowest answer rate, with 26

participants, or 34.2%, answered correctly. While item 20, got the highest answer rate, with 40

participants, or 52.6%, answered correctly. Moreover, in the operating room, for ethico-moral

responsibility, item 46 had the lowest answer rate, with 27 participants, or 35.5%, answered

correctly. While item 33 had the highest rate, with 38 participants, or 50%, answered correctly.

For personal and professional development, item 34 had the lowest answer rate, with 17

participants, or 22.4%, answered correctly. While item 47, got the highest answer rate, with 27

participants, or 35.5%, answered correctly.

Table 4. Level of Competence of Nursing Students in Performing Basic Nursing Procedures in

terms of Attitude in the Delivery and Operating Room
Item Number Correct Incorrect
f % f %
Attitude in Delivery
Room

A. Ethico-moral
Responsibility (EMR)
7 20 26.3 56 73.7
18 45 59.2 31 40.8
19 34 44.7 42 55.3

B. Personal and
Professional Development
8 26 34.2 50 65.8
20 40 52.6 36 47.4
Attitude in Operating
Room

A. Ethico-moral
Responsibility (EMR)
33 38 50 38 50
46 27 35.5 49 64.5

B. Personal and
Professional Development
34 17 22.4 59 77.6
47 27 35.5 49 64.5

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 67

 Table 5 presents the summary of level of competence in the Delivery Room Simulation in

terms of Knowledge. The finding shows that there were no participants classified as highly

competent. Following this result, 2 participants or 2.6% were classified as not competent. Next to

this, 15 participants or 19.7% demonstrated moderately competent. Lastly, 59 respondents or

77.6%, obtained an average level of competence.

Table 5. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of

Knowledge in the Delivery Room Simulation
Scal f % Interpretatio
e n

5 0 0 Highly
Competent

3-4 1 19. Moderately

5 7 Competent

1-2 5 77. Average

9 6

0 2 2.6 Not
Competent

Table 5.1 shows the summary of level of competence in the Delivery Room Simulation in

terms of Skills. The results indicate that no participants were categorized as highly competent.

Then, 12 participants or 15.8% were classified as not competent. Next to this, 19 participants or

25% displayed moderately competent. And finally, 45 participants or 59.1% obtained an average

level of competence.

Table 5.1. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of
Skills in the Delivery Room Simulation
Scal f % Interpretatio
e n

12- 0 0 Highly
15 Competent

8-11 1 25 Moderately
9 Competent

4-7 4 59. Average

5 1

0-3 1 15. Not

2 8 Competent

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 68

 Table 5.2 presents the summary of level of competence in the Delivery Room Simulation

in terms of Attitude. The finding shows that 4 participants or 5.3% were classified as highly

competent. Following this results, 6 participants or 7.9% were categozied as not competent.

Then, 27 participants or 35.5% obtained the result of moderately competent. Lastly, 39

participants or 51.3% demonstrated an average level of competence.

Table 5.2. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of
Attitude in the Delivery Room
Scal f % Interpretatio
e n

5 4 5.3 Highly
Competent

3-4 2 35. Moderately

7 5 Competent

1-2 3 51. Average

9 3

0 6 7.9 Not
Competent

Table 6 presents the Level of Competence in Performing Basic Nursing Procedure in

terms of Knowledge in Operating Room Simulation. This further reveals that 2 or 2.6% are

highly competent, 22 or 28.9% are moderately competent, 25 or 32.9% are not competent, and

27 or 35.5% have average competence.

Table 6. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of

Knowledge in Operating Room Simulation

Scale f % Interpretati
on

3 2 2. Highly
6 Competent

2 2 28 Moderately
2 .9 Competent

1 2 35 Average
7 .5

0 2 32 Not
5 .9 Competent

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 69

 The Table 6.1 below shows the Level of Competence in Performing Basic Nursing

Procedure in terms of Skills in Operating Room Simulation. This further reveals that none was

highly competent, 7 or 9.2% are moderately competent, 19 or 25.1% are not competent, and 50 or

65.8% have average competence.

Table 6.1. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of
Skills in Operating Room Simulation

Scale f % Interpretati
on

15 - 18 0 0 Highly
Competent

10 - 14 7 9. Moderately
2 Competent

5-9 5 65 Average
0 .8

0- 1 25 Not
4 9 .1 Competent

Table 6.2 presents the Level of Competence in Performing Basic Nursing Procedure in

terms of Attitude in Operating Room Simulation. This further reveals that 1 or 1.3% is highly

competent, 11 or 14.5% are moderately competent, 20 or 26.3% have average competence, and

44 or 57.9% are not competent.

Table 6.2. Summary of Level of Competence in Performing Basic Nursing Procedure in terms of
Attitude in Operating Room Simulation

Scale f % Interpretati
on

4 1 1. Highly
3 Competent

3 1 14 Moderately
1 .5 Competent

2 2 26 Average
0 .3

0- 4 57 Not
1 4 .9 Competent

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 70

 Table 7 presents the Level of Competence in Performing Intrapartal Care in the Delivery

Room in terms of Knowledge. The table indicates the total score of the respondents, which is

10.79, revealing that they achieved a score below the expected standard of 17. Specifically, in

Health Education, all items scored lower than the desired standard. Similarly, in Legal

Responsibility, items 1 through 4 obtained scores lower than the desired rating. Additionally, the

Research competency also obtained a score lower than the expected standard score.

Table 7. Level of Competence in Performing Intrapartal Care in Delivery Room in terms of

Knowledge

Desired
INTRAPARTAL COMPETENCIES Rating Mean
A. HEALTH EDUCATION (HE)
1. Teaches client on basic preparation during labor and
delivery (can be done in labor room). 1 0.88
2. Coaches clients on breathings/bearing down technique. 2 1.54
3. Demonstrates proper "latch-on" breast feeding technique
(done post-partum period) 1 0.42
4. Gives instructions to parents regarding infant care before
discharge (done post-partum period) 1 0.46
5. Provides discharge instructions as to feeding, bathing,
administration of ordered medications, appointment dates for
post natal and well baby check up (done post-partum period). 1 0.96
6. Responds to questions of clients and relatives regarding
expectations. 1 0.63
B. LEGAL RESPONSIBILITY (LR) 0.00
1. Secures informed consent in all procedures related to labor
and delivery. 1 0.83
2. Reports accurately and honestly the gender, time of
delivery of the baby and placenta. 2 0.92
3. Ensures proper identification of the mother and newborn. 2 0.50
4. Documents all pertinent data correctly and completely. 1 0.63
C. RESEARCH (R) (preferably done during post
conferences)
1. Identifies researchable problems related to labor and
delivery. 1 0.92
2. Initiates a research study on an identified researchable
problem. 1 0.67
3. Participates as a member of a research team in the
conduction of a research study. 1 0.67
4. Utilize findings of research studies in intra-partal care. 1 0.79
TOTAL 17 10.79
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 71
 Table 7.1 presents the Level of Competence in Performing Intrapartal Care in the

Delivery Room in terms of Skills. The table reveals the total score achieved by the respondents,

which is 41.58, indicating that they obtained a score below the standard score of 65. In terms of

Safe and Quality Nursing Care, items 1 to 8 obtained scores lower than the desired rating.

Furthermore, for Performing Functions during actual labor, items 1 to 17 also obtained scores

lower than the desired rating. Regarding the Management of Resources, Environment, and

Equipment, items 1 to 7, and 9 fell below the standard, while item 8 achieved the same standard

score. Additionally, in terms of Quality Improvement, Records Management, Communication,

and Collaboration and Teamwork, all competencies scored below the desired rating score.

Table 7.1. Level of Competence in Performing Intrapartal Care in Delivery Room in terms of
Skills
Desired
INTRAPARTAL COMPETENCIES Rating Mean
A. SAFE AND QUALITY NURSING CARE (SQC)
1. Obtains obstetrical history including parity, gravida score,
LMP, EDC, AOG, BOW onset of true labor. 4 2.67
2. Checks vital signs. 1 0.50
3. Conducts physical examination. 2 1.25
4. Performs Leopold's maneuver. 2 1.25
5. Checks Fetal Heart Rate and Fundic height. 2 0.50
6. Monitor progress of labor/uterine contractions as to: 0.00
Frequency 1 0.38
Duration 1 0.38
Intesity 1 0.71
Interval 1 0.38
7. Observes for the timely rupture of membrane. 1 0.67
8. Coaches mother on process of labor. 2 1.75
PERFORMS FUNCTIONS DURING ACTUAL LABOR
1. Transports clients safely while providing privacy. 1 0.75
2. Places mother in lithotomy position. 1 0.71
3. Performs perineal care using sterile technique correctly. 1 0.33
4. Performs proper hand scrub. 1 0.08
5. Wears gowns and gloves according to hospital policy. 1 0.92
6. Performs Ritgen's maneuver safely. 2 0.75
7. Coaches mother on breathing and pushing techniques. 1 0.88
8. Delivers baby and placenta carefully.
Checks and manages cord recoil correctly. 1 0.75

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 72

 Clamps and cuts the cord correctly. 1 0.96
Identify signs of placenta separation. 1 0.38
Checks the characteristics/completeness of the placenta. 1 0.79
9. Assesses amount of blood loss (Normal: <500cc) 2 0.50
10. Employs interventions to achieve and maintain a well
contracted uterus to prevent/control hemorrhage.
Uterine massage 1 0.42
Correct administration of oxytocin 1 0.29

11. Assesses presence and degree of laceration. 1 0.75

12. Assists in episiorrhaphy. 1 0.08
13. Checks size, consistency and location of uterus. 1 0.17
14. Performs perineal care and applies pad correctly. 1 0.83
15. Provides emotional support to the mother throughout labor and
delivery. 1 0.88
16. Evaluates client's condition and records pertinent data accordingly. 2 0.92
17. Prepares client for transfer to recovery room/ward. 1 0.88
B. MANAGEMENT OF RESOURCES, ENVIRONMENT AND
EQUIPMENT (MRE)
1. Prepares room, instruments and equipment/s needed.
Sterile drape 1 0.83
Sterile instruments and equipment (Forceps, scissors, bulb syringe,
gauze, suture, needle holder, catheter (optional) 1 0.83
Kelly pad 1 0.83
Disinfectant 1 0.25
2. Performs sterilization procedure. 1 0.88
3. Maintains adequacy of supplies as the delivery progresses. 1 0.88
4. Maintains orderliness of the sterile table. 1 0.96
5. Observes precautionary measures related to use of electrical
equipment. 1 0.67
6. Ensures a quiet environment. 1 0.92
7. Uses supplies diligently. 1 0.88
8. Performs after care of the materials and equipment used. 1 1.00
9. Ensures proper disposal of hospital waste including blood and other
fluids. 1 0.67
C. QUALITY IMPROVEMENT (QI) (preferably done during post
conferences)
1. Identifies deviation of practice from standards. 1 0.83
2. Participates in audit practices in the delivery room/lying in. 1 0.92
3. Recommends corrective and preventive measures for the identified
deviations. 1 0.67
D. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the client. 1 0.50
2. Maintains an organized system of filing and keeping records of the
client. 1 0.50
E. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non- 1 0.96
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 73
verbal, electronic.
2. Inform client's significant others of the progress of labor and
delivery. 1 0.79
3. Listens attentively to clients and families queries and requests. 1 0.71
F. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as a team player. 1 0.96
2. Communicates the progress of labor/delivery to significant others. 1 0.88
3. Establishes collaborative relationship with members of the health
team and family members. 1 0.88
TOTAL 65 41.58

Table 7.2 presents the Level of Competence in Performing Intrapartal Care in Delivery

Room in terms of Attitude. The table reveals the total score achieved by the respondents is 6.63,

which is lower than the standard score of 7. In terms of Ethico-Moral Responsibility, item 1

obtained a lower standard than the desired rating, while items 2 and 3 achieved the same

standard. In terms of Personal and Professional Development, items 1 and 4 scored lower than the

desired standard, while items 3 and 4 achieved the same standard score.

Table 7.2. Level of Competence in Performing Intrapartal Care in Delivery Room in terms of
Attitude

Desired
INTRAPARTAL COMPETENCIES Rating Mean
A. ETHICO-MORAL RESPONSIBILITY (EMR)
1. Respects the religious, cultural and ethnic practices of the
family of the woman in labor and delivery. 1 0.92
2. Promotes emotional security by supporting needs. 1 1.00
3. Ensures privacy and confidentiality. 1 1.00
B. PERSONAL AND PROFESSIONAL
DEVELOPMENT (PPD) 0.00
1. Updates oneself with the latest trends and development in
labor and delivery. 1 0.79
2. Projects professional image of a delivery room nurse. 1 0.92
3. Accepts criticisms and recommendations. 1 1.00
4. Performs functions according to standards. 1 1.00
7 6.63

Table 8 presents the Level Of Competence in Performing Immediate Care of the Newborn

in the Delivery Room in terms of Knowledge. The table reveals the total score achieved by the

respondents which is 6.04 which is lower than the desired rating of 14. Specifically, in Health

Education, items 1 to 4 got lower than the desired rating scale. In Legal Responsibility, items 1
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 74
to 3 got lower than the desired rating. Additionally, in Research, all items got lower than the

desired rating score.

Table 8. Level Of Competence in Performing Immediate Care of the Newborn in Delivery Room
in terms of Knowledge

Desired
NEWBORN COMPETENCIES Rating Mean
A. HEALTH EDUCATION (HE)
1. Provides instructions to the mother on daily cord care and
prevention of cord infection. 2 1.13
2. Provides discharge instructions to the mother on when to
expect cord to fall off or to report signs of cord infection. 1 0.42
3. Provides infromation regarding newborn screening,
immunization. feeding etc. 2 0.96
4. REsponds to questions of mother and relatives regarding
expectations. 1 0.75
B. LEGAL RESPONSIBILITY (LR) 0.00
1. Identifies newborn by comparing ID band with data in the
chart. 2 0.08
2. Documents all pertinent data correctly and completely. 1 0.33
3. Reports accurately any deviations/abnormal findings and
nursing interventions rendered. 1 0.54
C. RESEARCH (R) 0.00
1. Identifies researchable problems related to immediate care
of newborn. 2 0.92
2. Utilizes findings of research studies in the immediate care
of the newborn. 2 0.92
TOTAL 14 6.04

Table 8.1 presents Level Of Competence in Performing Immediate Care of the Newborn

in Delivery Room in terms of Skills. In Safe and Quality Nursing Care, items 1 to 14 obtained

scores lower than the desired rating In Management of Resources, Environment, and Equipment,

items 1 to 8 got scores lower than the desired rating. In terms of Quality Improvement, Records

Management, Communication, Collaboration and Teamwork all competencies scores lower than

the desired rating score.

Table 8.1. Level Of Competence in Performing Immediate Care of the Newborn in Delivery
Room in terms of Skills

Desired
NEWBORN COMPETENCIES Rating Mean
A. SAFE AND QUALITY NURSING CARE (SQC)

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 75

1. Establishes and maintains patent airway. 3 2.08
2. Suctions mouth and nose of the newborn gently as
necessary. 2 0.50
3. Dries newborn and wraps warmly. Places under droplight
as needed 1 0.88
4. Performs and interprets APGAR scoring correctly. 0.00
Immediately after delivery 2 0.25
After 5 minutes 2 0.17
5. Ensures proper identification of newborn (name tag, name
of mother, date and time of delivery, gender and name of
attending physician). 2 0.17
6. Performs physical assessment including anthropometric
measurements including weight, height, head, chest,
abdominal circumference. 4 2.67
7. Takes vital signs (temperature per rectum to check
patency) 1 0.75
8. Latches newborn to the mother's breast immediately after
birth. 1 0.67
9. Applies CREDE's prophylaxis on the eyes. 1 0.79
10. Administers Vitamin K (1mg IM) into the lateral anterior
thigh or vastus lateralis. 1 0.46
11. Administer Hepa B vaccine (0.5mL IM) into the lateral
anterior thigh or vastus lateralis. 1 0.63
12. Keeps baby wrapped warmly under floor lamp or
mother's bedside according to institutional policy until
discharge. 1 0.75
13. Records pertinent observations and nursing care done. 1 0.29
14. Reports any signs of deviation/abnormality to the
pediatrician. 1 0.25
B. MANAGEMENT OF RESOURCES,
ENVIRONMENT AND EQUIPMENT (MREE)
1. Prepares instrument and equipment needed: Suction bulb,
cord clamp, gauze, cotton balls, blanket, droplight, Vitamin
K, antimicrobial ophthalmic ointment. 4 2.92
2. Ensures use of sterile equipment during immediate care of
the newborn. 1 0.75
3. Maintain adequacy of supplies as newborn care is
rendered. 1 0.75
4. Maintains orderliness of the working area. 1 0.54
5. Observes precautionary measures related to use of
electrical equipment. 1 0.71
6. Ensures a warm and quiet environment. 1 0.88
7. Uses supplies diligently. 1 0.67
8. Ensures proper disposal of hospital waste. 1 0.50

C. QUALITY IMPROVEMENT (QI) 0.00

1. Identifies deviation of practice from the standards. 1 0.96
2.Recommends corrective and preventive measures for the identified
deviations. 1 0.88

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 76

D. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the newborn. 1 0.63
2. Maintains an organized system of filing and record keeping. 1 0.50
E. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non-
verbal, electronic. 1 0.79
2. Maintains an open line of communication with the mother and other
family members. 1 0.75
3. Informs mother of relevant information about the newborn. 1 0.67
4. Listens attentively to queries and requests of mothers and family
members. 1 0.88
F. COLLABORATION AND TEAMWORK (CTW) .00
1. Functions effectively as a team player. 1 0.92
2. Communicates findings of assessment to all concerned. 1 0.79
3. Establishes a collaborative relationship with members of the health
team and family of the newborn. 1 1.00
TOTAL 46 27.75

Table 8.2 presents the Level Of Competence in Performing Immediate Care of the

Newborn in the Delivery Room in terms of Attitude. In Ethico-Moral Responsibility, item 1

obtained a score lower than the desired rating, while item 2 attained the same standard. In

Personal and Professional Development, items 1 to 4 scored lower than the desired rating.

Table 8.2. Level Of Competence in Performing Immediate Care of the Newborn in Delivery
Room in terms of Attitude
Desired
NEWBORN COMPETENCIES Rating Mean
A. ETHICO-MORAL RESPONSIBILITY (EMR)
1. Respects the religious, cultural and ethnic practices of
the family of the newborn. 1 0.83
2. Maintains privacy and confidentiality of findings of
assessment. 1 1.00

B. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 0.00

1. Updates oneself with the latest trends and developments in newborn
care. 1 0.58
2. Projects a professional image of the pediatric nurse. 1 0.79
3. Accepts criticisms and recommendations 1 0.96
TOTAL 5 4.17

Table 9 presents the knowledge of student scrub nurses in operating room simulation.

This further reveals that the result is below the standard score of 6 as the mean result is 3.44. The

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 77

competency that got the lowest mean was health education, the participants got a lower score of

0.78 than the desired rating of 2. While in Research, the participants got a score of 1 rather than

the desired rating of 2. Lastly, the competency that got the highest mean rate was the Legal

Responsibility, the participants got a mean score of 1.67, below the desired rating of 2.

Table 9. Level Of Competence in Performing Intra-Operative Care Competencies as a

Scrub Nurse in terms of Knowledge
Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. HEALTH EDUCATION (HE)
1. Implements appropriate health education activities to
client based on needs assessment. 2 0.78
B. LEGAL RESPONSIBILITY (LR)
1. Adheres to legal and institutional protocols regarding
informed consent and other legal documents. 2 1.67
C. RESEARCH (R)
1. Disseminates results of OR - related research findings to
clinical group and other members of the OR team as
appropriate. 2 1
TOTAL 6 3.44

Table 9.1 shows the skills of student scrub nurses in operating room simulation. This

further reveals that the result is below the standard score of 51 as the overall mean result is 37.33.

In Safe and Quality Nursing Care, item 1 letter A got a mean score of 2, and letters B and C

garnered both a mean score of 2.67, which is below the desired rating of 4. While item 1 letter D

had a mean score of 1, below the intended score of 2. Whereas item 2 got a mean score of 1.56,

and item 4 had a mean score of 0.89, both got a lower score than the desired rating of 2. On the

contrary, for item 3, letter A got the intended score of 4, and letter B got a score of 2, the same as

the desired rating. Apart from this, for item 3, letter C had a mean score of 1.89, letter D garnered

1.22, and letter E had a score of 1.33, which is below the desired rating score. Regarding the

Management of Resources, Environment, and Equipment, item 1 got a mean score of 3.22 out of

the desired rating of 4. Conversely, items 2 and 4 got the same mean score of 1.78 out of the

desired result of 2. And item 3 got a mean score of 1.44, below the desired rating of 2. Following

this is the Quality Improvement, wherein the participants garnered below the score of the desired

rating in both items 1 and 2. Item 1 got a score of 1.78, and item 2 had a mean result of 1. At this
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 78
time, in Records Management, the participants got a mean score of 1.11, which is lower than the

desired rating of 2. Subsequently, in Communication, item 1 got the desired score of 1, and item

2 got a mean result of 1.67 below the intended score of 2. Lastly, in Collaboration and

Teamwork, the participants got a mean score of 1.33, which is lower than the desired rating of 2.

Table 9.1 Level Of Competence in Performing Intra-Operative Care Competencies as a Scrub

Nurse in terms of Skills

Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR client
a. Obtains comprehensive client's information by checking
complete accomplishment of the perioperative
checklist/clients chart. 4 2
b. Identifies priority needs of the client at the Operating
Room. 4 2.67
c. Provides needed nursing interventions based on identified
needs. 4 2.67
d. Monitors client's responses to surgery. 2 1
2. Promotes safety and comfort of clients inside the OR. 2 1.56
3. Performs the functions of the scrub nurse
a. Performs surgical scrub correctly. 4 4
b. Wears sterile gowns and gloves aseptically. 2 2
c. Prepares surgical instruments, sponges, sutures and other
supplies in functional arrangement. 2 1.89
d. Hands instruments, sponges, sutures and other needed
materials according to surgeon's preference. 2 1.22
e. Performs surgical count accurately. 2 1.33
4. Administers medications and other health therapeutics
safely. 2 0.89
B. MANAGEMENT OF RESOURCES,
ENVIRONMENT AND EQUIPMENT (MRE)
1. Organizes work load to facilitate timely client care. 4 3.22
2. Utilizes adequate and appropriate resources to support the
OR team. 2 1.78
3. Ensures functionality of OR resources. 2 1.44
4. Maintains a safe environment at the OR by observing the
principles of asepsis. 2 1.78
C. QUALITY IMPROVEMENT (QI)
1. Participates in quality improvement activities related to
infection control and successful OR operations. 2 1.78
2. Identifies and reports variances in sterility and other OR
activities. 2 1
D. RECORDS MANAGEMENT (RM)
1. Maintains accurate and updated documentation of client
care. 2 1.11

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 79

E. COMMUNICATION (Comm)
1. Establishes rapport with clients, significant others and
members of the health team. 1 1

2. Uses appropriate information mechanisms to facilitate

communication inside the OR and with other departments in the
hospital. 2 1.67
F. COLLABORATION AND TEAMWORK (CTW)
1. Collaborates plan of care with other members of the health team. 2 1.33
TOTAL 51 37.33

Table 9.2 presents the attitude of student scrub nurses in operating room simulation. This

indicates that the result is below the standard score of 10, as the mean result is 8.11. In Ethico-

Moral Responsibility, the participants got a mean score of 1.89 in item 1, and 1.78 in item 2,

which is below the desired score of 2. Then in Personal and Professional Development, item 1

had a mean score of 2.56 which is lower than the desired rating of 4, and item 2 had a mean score

of 1.89 rather than the desired rating of 2.

Table 9.2. Level Of Competence in Performing Intra-Operative Care Competencies as a Scrub

Nurse in terms of Attitude
Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. ETHICO-MORAL RESPONSIBILITY (EMR)
1. Respects the rights of the OR client. 2 1.89
2. Accepts responsibility and accountability for own
decisions and actions as an OR nurse. 2 1.78
B. PERSONAL AND PROFESSIONAL
DEVELOPMENT (PPD)
1. Performs OR functions according to professional
standards. 4 2.56
2. Possesses positive attitude towards learning surgical and
OR-related knowledge and skills. 2 1.89
TOTAL 10 8.11

Table 10 presents the knowledge of student circulating nurses in operating room

simulation. This further reveals that the participants' mean result of 2 is lower than the standard

score of 6. In Health Education, the participants got a lower mean score of 0 than the desired

rating of 2. In contrast in Legal Responsibility and Research, the participants both got a mean

score of 1, below the desired rating of 2.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 80

Table 10. Level Of Competence in Performing Intra-Operative Care Competencies as a
Circulating Nurse in terms of Knowledge

Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. HEALTH EDUCATION (HE)
1. Implements appropriate health education activities to
client based on needs assessment. 2 0

B. LEGAL RESPONSIBILITY (LR)

1. Adheres to legal and institutional protocols regarding
informed consent and other legal documents. 2 1

C. RESEARCH (R)
1. Disseminates results of OR - related research findings to
clinical group and other members of the OR team as
appropriate. 2 1

TOTAL 6 2

Table 10.1 shows the skills of student circulating nurses in operating room simulation.

This further indicates that the overall mean result of 30.22 is lower than the standard score of 47.

In Safe and Quality Nursing Care, item 1 letter A received a mean score of 2.89, letter B received

a score of 2.56, and letter C received a mean score of 2.33, both of which were lower than the

desired rating of 4. While item 1 letter D had a mean score of 1, it fell short of the intended score

of 2. Item 2 had a mean score of 1.67, while item 4 received a mean score of 0, both of which

were lower than the desired rating of 2. Aside from that, the participants got ratings for item 3

that were lower than expected. In item 3, Letter A had a mean score of 1.22, Letter B received a

score of 1.89, Letter C had a mean score of 1, and Letter D received a mean score of 1.67.

Regarding the Management of Resources, Environment, and Equipment, item 1 got a mean score

of 2.67 out of the desired rating of 4. Conversely, items 2 and 3 got the same mean score of 1.44

out of the desired result of 2. And item 4 got a mean score of 1.56, below the desired rating of 2.

Following this is the Quality Improvement, wherein the participants garnered a mean score of 1,

below the desired rating of 2 in both items 1 and 2. At this time, in Records Management, the

participants got a mean score of 1.78, which is lower than the desired rating of 2. Subsequently,

in Communication, item 1 got the desired score of 1, and item 2 got a mean result of 1.11 below

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 81

the intended score of 2. Lastly, in Collaboration and Teamwork, the participants got a mean score

of 1, which is lower than the desired rating of 2.

Table 10.1. Level Of Competence in Performing Intra-Operative Care Competencies as a

Circulating Nurse in terms of Skills

Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR client
a. Obtains comprehensive client's information by checking
complete accomplishment of the perioperative
checklist/clients chart. 4 2.89
b. Identifies priority needs of the client at the Operating
Room. 4 2.56
c. Provides needed nursing interventions based on identified
needs. 4 2.33
d. Monitors client's responses to surgery. 2 1
2. Promotes safety and comfort of clients inside the OR. 2 1.67
3. Performs the functions of the circulating nurse
a. Anticipates the needs of the surgical team. 2 1.22
b. Sets up the OR room and needed equipment. 2 1.89
c. Receives client for surgery/endorses client post-
operatively. 2 1
d. Assists in skin preparation and draping of client. 2 1.67
4. Administers medications and other health therapeutics
safely. 2 0
B. MANAGEMENT OF RESOURCES,
ENVIRONMENT AND EQUIPMENT (MRE)
1. Organizes work load to facilitate timely client care. 4 2.67
2. Utilizes adequate and appropriate resources to support the
OR team. 2 1.44
3. Ensures functionality of OR resources. 2 1.44
4. Maintains a safe environment at the OR by observing the
principles of asepsis. 2 1.56

C. QUALITY IMPROVEMENT (QI)

1. Participates in quality improvement activities related to infection
control and successful OR operations. 2 1
2. Identifies and reports variances in sterility and other OR activities. 2 1
D. RECORDS MANAGEMENT (RM)
1. Maintains accurate and updated documentation of client care. 2 1.78
E. COMMUNICATION (Comm)
1. Establishes rapport with clients, significant others and members of
the health team. 1 1
2. Uses appropriate information mechanisms to facilitate
communication inside the OR and with other departments in the
hospital. 2 1.11

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 82

F. COLLABORATION AND TEAMWORK (CTW)
1. Collaborates plan of care with other members of the health team. 2 1
TOTAL 47 30.22

Table 10.2 presents the attitude of student circulating nurses in an operating room

simulation. The mean score is 8.78, indicating that the outcome is less than the benchmark score

of 10. In Ethico-Moral Responsibility, participants received a mean score of 2 in items 1 and 2,

which aligned with the desired score of 2. Then, under Personal and Professional Development,

item 1 had a mean score of 2.78, which was lower than the intended rating of 4, and item 2

yielded the result of 2 the same as the desired rating.

Table 10.2. Level Of Competence in Performing Intra-Operative Care Competencies as a

Circulating Nurse in terms of Attitude

Desired
INTRA-OPERATIVE CARE COMPETENCIES Rating Mean
A. ETHICO-MORAL RESPONSIBILITY (EMR)
1. Respects the rights of the OR client. 2 2
2. Accepts responsibility and accountability for own
decisions and actions as an OR nurse. 2 2
B. PERSONAL AND PROFESSIONAL
DEVELOPMENT (PPD)
1. Performs OR functions according to professional
standards. 4 2.78
2. Possesses positive attitude towards learning surgical and
OR-related knowledge and skills. 2 2
TOTAL 10 8.78

Table 11 presents the Summary of the Level of Competence in Performing Intrapartal

Care in the Delivery Room. The data indicates that respondents achieved scores below the

desired rating. Specifically, in terms of knowledge, the rating score was 10.79 which is lower

than the standard score of 17, for skills it was 41.58 out of 65, and for attitude, it was 6.63 which

is lower than the standard score of 7.

Table 11. Summary of the Level of Competence in Performing Intrapartal Care in Delivery Room
Desired Rating Actual Rating

Knowledge 17 10.79

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 83

 Skills 65 41.58

Attitude 7 6.63

Table 11.1 presents the Summary of the Level of Competence in Newborn Competency in

the Delivery Room. The table reveals that the respondents achieved a score below the desired

rating. In terms of knowledge out of 14 the respondents got 6.04 score rating. For skills, the score

was 27.75, which falls below the standard score of 46. Lastly, in terms of attitude, respondents

scored 4.17 out of 5.

Table 11.1. Summary of the Level of Competence in Newborn Competency in Delivery the Room
Desired Rating Actual Rating

Knowledge 14 6.04

Skills 46 27.75

Attitude 5 4.17

Table 12 presents the Summary of the Level of Competence in Performing Intra-

Operative Care Competencies as a Scrub Nurse. The data indicates that respondents achieved

scores below the desired rating. Specifically, in terms of knowledge, the rating score was 3.44

which is lower than the standard score of 6, for skills it was 37.33 out of 51, and for attitude, it

was 8.11 which is lower than the standard score of 10.

Table 12. Summary of the Level of Competence in Performing Intra-Operative Care

Competencies as a Scrub Nurse
Desired Rating Actual Rating

Knowledge 6 3.44

Skills 51 37.33

Attitude 10 8.11

Table 12.1 presents the Summary of the Level of Competence in Performing Intra-

Operative Care Competencies as a Circulating Nurse. The table reveals that the respondents

achieved a score below the desired rating. In terms of knowledge, out of 6 the respondents got 2

score ratings. For skills, the score was 30.22, which falls below the standard score of 47. Lastly,

in terms of attitude, respondents scored 8.78 out of 10.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 84
 Table 12.1. Summary of the Level of Competence in Performing Intra-Operative Care
Competencies as a Circulating Nurse
Desired Rating Actual Rating

Knowledge 6 2

Skills 47 30.22

Attitude 10 8.78

Table 13 presents the Factors Affecting the Level of Competence of the participants. This

further reveals that most of the participants agree to the following items with an overall mean of

3.06 and an overall standard deviation of 1.04. Moreover, statement number 3 “Attendance

including tardiness” got the lowest rated mean of 2.64 but was still interpreted as agree. This

was followed by statement number 8 “School infrastructure like student seating, study area, etc.”

with a mean of 2.78 which was interpreted as agree. The third of which was statement number 9

“Student orientation” and 19 “Financial capability” got the third lowest mean of 2.96 which

was interpreted as agree. On the other hand, statement number 15 “Clinical instructor’s

comments and feedbacks” with a mean of 3.18 which was interpreted as agree. This was

followed by statement number 2 “Practical skills” with a mean of 3.21 which was interpreted as

agree. And finally, statement number 5 “Stress and Sleep” got the highest rated mean of 3.45

which was interpreted as agree.

Table 13. Factors Affecting the Level of Competence

Question Mea SD Interpretation

n
The factors
affecting my level
of competence in
performing basic
nursing
procedures are:
1. Theoretical 3.11 .624 Agree
knowledge
2. Practical skills 3.21 .718 Agree
3. Attendance 2.64 .976 Agree
including
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 85
 tardiness
4. Preparation for 3.04 .756 Agree
quizzes, activities
and exam
5. Stress and Sleep 3.45 .681 Agree
6. Clinical learning 3.16 .895 Agree
environment
7. Equipment and 3.03 .765 Agree
materials
8. School 2.78 .873 Agree
infrastructure like
student seating,
study area, etc.
9. Student orientation 2.96 .901 Agree
10. Noise of any 3.04 .840 Agree
source
11. Clinical 2.99 .841 Agree
instructor’s
internal
motivation
12. Clinical 3.08 .829 Agree
instructor’s
communication
skills
13. Clinical 3.14 .875 Agree
instructor’s
clinical
competence
14. Clinical 3.13 .854 Agree
instructor’s
teaching skills
15. Clinical 3.18 .828 Agree
instructor’s
comments and
feedbacks
16. Support from the 3.08 1.004 Agree
family
17. Family 3.00 .783 Agree
expenditure and
income
18. Household chores 3.01 .825 Agree
19. Financial 2.96 .824 Agree
capability
20. Family 3.12 .799 Agree
expectations
Overall 3.06 1.04 Agree

Table 14 presents the relationship between the level of competence of the participants and

the factors affecting their competence in performing basic nursing procedures through Pearson
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 86
Product Moment Correlation Coefficient. This further reveals that there is no significant

relationship between Level of competence of the participants and Factors affecting their

competence in performing basic nursing procedures with a p-value of .365 and an r value of

-.105.

Table 14. Relationship between the Level of Competence of the Participants and the factors
affecting their competence in Performing Basic Nursing Procedures

Fact r p Desc Interp D

ors ripti retatio ec
on n isi
on

Lev - . Negl Not A

el of . 3 igibl Signifi cc
com 1 6 e cant ep
pete 0 5 Corr t
nce 5 elati H
of on o
the
parti
cipa
nts
and
Fact
ors
affe
ctin
g
their
com
pete
nce
in
perf
ormi
ng
basi
c
nurs
ing
proc
edur
es

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 87

 CHAPTER IV

DISCUSSION

This chapter presents the major findings of the study, conclusion, recommendation, and

suggestions for further study. Moreover, it displays the answers to research questions and

implications.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 88

 Nursing is fundamentally grounded in practical application. Nursing education

encompasses both theoretical and practical components, aiming to equip nurses with the requisite

knowledge, attitudes, and skills to effectively contribute to the enhancement of societal health

(Mchon, 2023). Knowledge is typically acquired through academic study and hands-on

experience in clinical settings, serving as the foundation upon which skills and attitudes are built.

Additionally, skill, defined as the capacity to utilize knowledge in practical scenarios, is

cultivated through consistent application of knowledge in real-world settings, consequently

elevating performance standards (Nabizadeh-Gharghozar et al., 2021). Meanwhile, attitude, on

the other hand, denotes the mindset or perspective shaped by one's perception or understanding of

phenomena (Rekisso et al., 2022).

The study utilized a survey questionnaire to evaluate nursing students' proficiency in basic

nursing procedures across knowledge, skills, and attitude domains. However, results indicate that

a majority of respondents provided incorrect answers to the both survey questions in the delivery

room and operating room. This discrepancy may be attributed to participants' struggles with

insufficient preparation for nursing assessments. Moreover, misinterpretation or

misunderstanding of questions, especially under time constraints, could hinder their ability to

provide accurate responses. Besides, language barriers, distractions, and personal concerns

further add to students' difficulties in achieving success on nursing tests (Billings, 2020).

Moving forward to the level of competence in performing basic nursing procedure in

terms of knowledge in the Delivery Room Simulation. The main body of knowledge primarily

consists of theoretical knowledge, which is universal, formal, and explicit, encompassing facts,

concepts, principles, and theories. Additionally, the development of professional knowledge

relies on the interaction and integration of both theoretical and practical knowledge. Moreover,

theoretical knowledge alone is inadequate for practical tasks (Hertog, 2021).

In the study, the majority of the participants, 77.6%, demonstrated an average level of

competence. This underscores the importance of all nurses possessing a foundational

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 89

understanding of assisting individuals with their routines and effectively applying theoretical

knowledge in nursing practice. Indeed, the application of theoretical understanding into practical

nursing is a key indicator of nursing proficiency (Kawasaki et al., 2022). Additionally, nursing

students may encounter difficulties in conveying health-related information to patients, leading to

poor assessments. Often, nursing students need further education in health education to enhance

their communication abilities and deliver patients with precise and comprehensible health

guidance (Johnson et al., 2020).

Thus, knowledge plays a crucial role in maintaining the standard of care by accurately

collecting and correctly interpreting information from both pregnant women and fetuses, and

effectively applying this knowledge in practical situations. It promotes collaborative healthcare

by facilitating the exchange of information regarding clinical procedures and treatment strategies

among medical teams (Matsui et al., 2021).

On the other hand, the result in the level of competence in performing basic nursing

procedures in terms of skills in the Delivery Room Simulation showed that 45 participants,

making up 59.1%, achieved an average level of competence. Which indicated that these

individuals possessed the necessary skills to perform adequately to this area but may not excel or

demonstrate exceptional competence. As patients present with more intricate conditions

involving various diseases, nursing students need to be equipped to care for such complex cases.

Hence, simulation provides a safe and controlled environment for nursing students' training

(Riley-Baker et al., 2020).

Now, nursing education and competencies need continuous updating to keep pace with

the rapidly evolving nature of the field. Research emphasized the importance of assessing

whether students encounter challenges in mastering the technical aspects of nursing skills overall

(Gregersen et al., 2021). Despite pregnancy and childbirth being natural processes, they can carry

risks for both mothers and babies. Therefore, healthcare professionals should vigilantly and

continuously monitor the birthing process (Matsui et al., 2021).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 90

 There is a suggestion to give more weight to aspects of nursing education that impact

students' attainment of practical skills. It is argued that practicing these skills directly on real

patients is more effective for thorough comprehension compared to training solely in simulated

environments or skill centers. Hence, clinical placements are seen as extremely important for

fostering competency in practical skills (Gregersen et al., 2021).

Conversely, the results in terms of attitude in the level of competence in performing basic

nursing procedure in the Delivery Room Simulation findings revealed that 39 participants,

accounting for 77.6%, achieved an average level of competence and only four respondents are

highly competent who exhibited a strong dedication and capability in their nursing

responsibilities. They were poised to excel in delivering care during labor and delivery,

prioritizing the safety and welfare of both the mother and newborn. Their optimistic demeanor

can foster a supportive and comforting environment in the delivery room, potentially enhancing

the overall birthing experience for the mother.

Furthermore, by lowering mortality rates, nurses can become pivotal in treatment and even

enhance patient satisfaction by assisting patients and their families in avoiding unnecessary

medical expenses. Being fully prepared for nursing is challenging, even for highly educated

nurses. The recent surge in awareness of patient rights and the ethical standards of healthcare

practitioners has resulted in limited opportunities for gaining practical experience in authentic

clinical environments (Oh & Park, 2023).

Also, attitude plays a crucial role in guiding human behavior towards accomplishing goals

and enhancing motivation for achievement. It is viewed as a key psychological element that

greatly motivates students to exert effort. Therefore, the attitudes of students significantly impact

their success in the nursing profession (Solomon et al., 2022).

Meanwhile, in the operating room simulation, the study revealed that the level of

competence of nursing students in performing basic nursing procedures in terms of knowledge

resulted in an average competence which garnered 65.8%. This may be due to ineffective

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 91

communication, a lack of preparation, and the emotional responses nursing students experience in

the clinical context could be contributing factors to this. These difficulties could hinder the

student’s capacity to learn and use information. According to recent research, providing students

with instruction that specifically addresses their psychological and communication needs may

enhance their learning in a clinical context (Hajizadeh et al., 2021).

Subsequently, in the clinical setting, nursing students encounter several obstacles such as

insufficient resources, unmotivated staff, and ineffective instructional methods. Using

technology, simulation-based learning, and active learning strategies are crucial for nursing

students to improve their knowledge and abilities. Hence, technology-enhanced learning,

simulation-based learning, and active learning techniques should all be incorporated into nursing

education curricula (Khalid et al., 2021).

Moreover, fostering a supportive and encouraging learning atmosphere, making sure there

are enough resources, and offering encouragement to nursing students can all help to increase

nursing students' proficiency in the operating room (Khalid et al., 2021). Lastly, the most crucial

traits of successful clinical instructors are those that have to do with internal drive, professional

appearance, and communication and teaching abilities, according to a 2021 study that looked at

the viewpoint of the students regarding these qualities. According to the study, additional

investigation is required to ascertain the connection between clinical instructor qualities and

student learning results (Kvale et al., 2021).

On the other hand, the level of competence of nursing students in performing basic

nursing procedures in terms of skills in the operating room simulation revealed that 57.9%

participants were averagely competent. This may be attributed to various factors. Nursing

students who participated in a structured operating room training program, gained more exposure

to the operating room through increased clinical hours, and received simulation-based training

demonstrated significant improvements in their technical skills and demonstrated higher levels of

competence in patient care, surgical instrument identification, and communication with the

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 92

surgical team, according to a 2021 study published in the Journal of Surgical Education (Mitchell

et al., 2021). Additionally, a 2022 study published in the International Journal of Nursing

Education and Scholarship discovered that nursing students' proficiency in the operating room

can be impacted by their insufficient comprehension of the culture and hierarchy of the setting as

well as their deficiency in effective communication and teamwork skills (Nadler et al., 2022).

Hence, the authors of a study that was published in the Journal of Surgical Education in

2021 investigated the connection between nursing students' acquisition of technical abilities in

the operating room and simulation-based training. The research revealed that although training

through simulation was successful in enhancing particular technical abilities, the general

proficiency in the operating room stayed ordinary. According to the authors, this might be the

result of insufficient knowledge and skill reinforcement, insufficient feedback, and a lack of

opportunities for real-world application (Gallagher et al., 2021).

Furthermore, the level of competence of nursing students in performing basic nursing

procedures in terms of attitude in the operating room simulation resulted in them being not

competent which obtained 57.9%. This may be attributed to the way nursing students see their

clinical experiences in the operating room can have an impact on their learning and general

competency. Studies have indicated that nursing students who have a positive outlook on their

clinical experiences are more likely to be motivated and involved in their education, which can

result in increased competency (Kelly, 2020).

Conversely, students of nursing who harbor unfavorable attitudes on their clinical

experiences could be less motivated and engaged, which could result in a decline in their

competency. Numerous difficulties faced by nursing students in the clinical learning environment

were documented in the article "Iranian nursing students’ challenges in the clinical learning

environment: A qualitative content analysis" that was published in the Journal of Medical

Education Development in 2021. This study has highlighted three elements that potentially

impact students' learning in the clinical setting such as emotional reactivity, inadequate

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 93

preparedness, and ineffective communication. In order to enhance students' learning in the

clinical context, the study suggests that educators give special attention to the communication and

psychological needs of their students during their preparation (Mohammadzadeh & Mohammadi,

2021).

Also, insufficient training, lack of encouragement from teachers, and poor interactions

with other medical professionals, might contribute to negative views regarding clinical

experiences. As a result, it is critical for nursing educators to encourage nursing students to view

clinical experiences favorably as doing so can raise their levels of competence, including

knowledge and skills (Kelly, 2020).

Moving forward to the utilization of the CHED observation tool in the study. Simulation-

based learning is frequently utilized in clinical education to enhance students' skills and self-

assurance, as well as to foster patient safety and minimize errors. Nursing students must acquire

proficiency in postoperative care skills and effectively apply their knowledge in real clinical

settings. In the context of surgical procedures, nurses are expected to demonstrate competence,

critical thinking capabilities, and adeptness in managing intricate processes (Kulakac et al.,

2024).

Also, nurses must be equipped to identify, respond to, and communicate potential safety

risks, ensuring patients are shielded from near misses, adverse events, and avoidable dangers. As

their commitment to patient safety principles was heavily influenced by their understanding,

attitudes, and perceptions of safety issues. Hence, educators in nursing, both within academic and

practical realms, play a pivotal role in guiding students to grasp and implement evidence-based

safe practices during their clinical training (Bressan et al., 2021).

Indeed, nurses must efficiently blend their knowledge and skills to ensure safe patient

care, while also collaborating effectively with other members of the surgical team to enhance

patient safety. Intraoperative practice presents complex challenges, particularly due to the

vulnerability of the patient (Singh & Arulappan, 2023). Nursing requires human qualities, strong

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 94

interpersonal relations in the surgical setting, leadership, and effective communication (Maya,

2022). Furthermore, nurses' competencies consist of their collective knowledge, abilities, and

attitudes essential for effectively fulfilling their responsibilities (Leal et al., 2022). Competency is

evaluated through performance, which hinges on the requisite knowledge, skills, and professional

conduct (Matsui et al., 2021).

In the study, the assessment of the level of competence in providing intrapartal care in the

delivery room simulation, 12 participants underwent evaluation, all scoring below the standard

proficiency level, encompassing knowledge, skills and attitudes outlined in our initial research

inquiry. A subpar assessment in intrapartal competencies could have adverse effects on patient

outcomes, potentially hindering the participant's ability to offer crucial care and assistance during

labor and delivery. This may heighten patient risks, prolong labor duration, and increase the

likelihood of complications, thereby undermining confidence in the student nurse's capacity to

deliver safe and efficient care. Additionally, there are no students who exhibit high levels of

competence. Hence, nursing students require comprehensive training, including simulation, to

acquire the competence necessary for caring for pregnant women and attaining educational

objectives (Kuesakul et al., 2024).

There are several reasons why the participants may receive a below-standard rating in

intrapartal competencies. One potential reason is a lack of exposure to skills rehearsal in school,

leading to student anxiety, stress, and a perceived lack of self-efficacy during clinical practice.

This limited clinical experience in assessing intrapartum uterine activity may result in a low or

fair rating of their ability and understanding, despite theoretical instruction before clinical

placements (Apartsakun, 2023). Possible factors underlying this finding are either deficiency in

the providers of the training or in the participants. For the provider side, it may be because the

quality of the training was poor, or little effort such as supervision was made to maintain

knowledge of the participants after the training (Matsui et al., 2021)

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 95

 Moreover, changes are necessary in nursing education to equip students with the required

knowledge and skills. Simulation-based education exposes students to patient care scenarios in a

safe learning environment, mirroring real-world clinical settings. This approach helps nurses

develop skills and experience managing scenarios, reducing errors in actual clinical practice.

Nursing students benefit from simulations as they receive feedback to enhance self-confidence

and satisfaction (Oh & Park, 2023).

Also, preparation is essential for nursing students before entering clinical settings where

they provide direct patient care. Simulations enable active learning, practice, training, and

reflection on specific experiences. Simulation, widely used in nursing schools globally, is a

valuable component of nursing education. It effectively engages nursing students and helps

address faculty shortages (Alharbi & Alharbi, 2022).

Additionally, the roles of clinical instructors are vital in honing competent and

compassionate nurses. In supervising nursing students in the clinical settings during their related

learning experience (RLE), clinical instructors need to be equipped in facilitating quality

learning. Student nurses revealed that their clinical instructors have limited techniques in

monitoring and evaluating the nursing students’ learning progress in RLE. Most of the time,

clinical instructors used critiques, RLE evaluation tools, and dynamic learning processes

(Padagas, 2020).

Moving forward, providing essential care to newborns is crucial for their well-being and

survival. In assessing the competence level in performing immediate newborn care in the delivery

room simulation, encompassing knowledge, skills and attitudes, 12 participants were evaluated,

all scoring below the expected standard. This circumstance not only puts the health of newborns

at risk but also that of their mothers. A below-standard rating related to immediate care of the

newborn competencies could lead to negative impact for patient outcomes, as the participants

may find it difficult to assess and respond appropriately to changes in the newborn's condition or

to anticipate potential complications. This could increase patient risks, and serious consequences
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 96
resulting from incompetent care, such as infections or developmental delays, and may have long-

term implications for the newborn's health and well-being (Bakar & Joho, 2023).

Recent research has explored the impact on nursing students who scored below the

standard in newborn care competencies. One study discovered that those with lower scores

experienced heightened levels of anxiety and stress, adversely affecting their performance (Yang,

2023). Moreover, it is imperative for nursing students to possess adequate knowledge and skills

in newborn care to ensure safe and effective care provision (Sim et al., 2021). Given that

newborn care demands a profound understanding of their unique needs and the ability to execute

specific procedures, students lacking in these competencies risk making errors or providing

substandard care, with grave implications for newborns and their families (Bakar & Joho, 2023).

Thus, maintaining a sufficient level of knowledge is essential to deliver quality care, which

aids in reducing unnecessary morbidity and mortality in both mothers and infants (Matsui et al.,

2021). Nursing education must prioritize equipping students with the necessary clinical practice

skills, necessitating the creation of appropriate professional environments and opportunities (Cha

& Jeong, 2022).

On the other hand, in evaluating the knowledge of nursing students acting as scrub nurses

in the operating room, a study involving 9 participants found that all in the competencies scored

below the standard in the assessed areas. Those who scored lower in intraoperative care

competency assessments were more prone to involvement in adverse events during surgery. This

outcome is attributed to the multitude of challenges and stressors encountered in clinical settings,

including fear of error, handling advanced medical equipment, caring for critically ill patients,

managing end-of-life care, and adapting to sudden changes in patient conditions (Kulakac et al.,

2024).

Patient education is crucial for making informed health decisions and managing their

health before and after surgery, leading to better recovery outcomes (Blöndal et al., 2022).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 97

Patients with low health literacy may experience unfavorable outcomes such as a lack of health-

related knowledge, insufficient management of chronic diseases, poor drug adherence, increased

emergency room visits, hospitalization, and mortality. Hence, if patients do not understand

medical instructions, it is difficult to expect them to take drugs or engage in healthful activities

(Yang, 2022).

Next, in Legal Responsibility, the participants had below mean score than the desired

rating. This reveals that nursing students may lack understanding in their legal responsibility as a

scrub nurse. Hence, nurses must receive appropriate nursing-related training to improve their

performance and expertise. Since, understanding the roles and responsibilities for patient care and

safety in intraoperative practice is critical for achieving optimal patient safety (Singh &

Arulappan, 2023).

Whereas, in Research, the participants also got a lower mean score than the desired rating.

This results indicates that the nursing students were unable to disseminate the result properly to

the surgical team for research purposes. Thus, the development of nursing research skills has

been identified as a major concern internationally. Also, literature suggested that research ability

in the field of nursing remained inadequate internationally (Zhang et al., 2021).

Subsequently, nearly all of the 9 participants scored below the intended rating in the

evaluated areas when assessing the skills of nursing students acting as scrub nurses in the

operating room. In Safe and Quality Nursing Care, the participants got lower than the desired

rating score. This suggests that the participants are unable to perform properly the competencies

belong to Safe and Quality Nursing Care. In fact, nurses must ensure that patient safety is their

first priority, and they are responsible for preventing injuries and promoting patient safety. Also,

recognizing and correcting an incorrect count is a fundamental aspect of an OR nurse's job (Singh

& Arulappan, 2023).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 98

 Next, in observing in terms of Management of Resources, Environment and Equipment,

participants got lower than the desired rating score. This implied that preparation of the workload

is not timely which may affect the surgical procedures. Indeed, preoperative preparation can help

improve surgical outcomes and address unexpected complications. Thus, to avoid delays,

everything for the surgery, including materials and equipment, should be prepared in advance.

Additionally, to avoid injury, instruments and equipment should be present and ready according

to the surgery's specifications before wheeling the patient (Singh & Arulappan, 2023).

Also, in Quality Improvement, participants got a lower rating than the desired rating

score. Nursing students that do not participate in quality improvement may reflect in their patient

outcomes. As nurses' commitment to patient safety standards is essential for improving quality of

care and preventing practice errors. Moreover, quality improvement in healthcare entails

improving patient outcomes through change implementation and rapid adaptation (Bajwa &

Mehdiratta, 2021).

Then, in Records Management, the participants had also below score than the desired

rating. These results reveal that nursing students are unable to maintain the practice of accurate

and updated client care. Clearly, every nurse intervention and interaction must be documented in

the clinical chart and other records in accordance with institutional guidelines (Maya, 2022).

Since, poor documentation can contribute to adverse events and patient harm (Kinnunen et al.,

2020).

Following this is the Communication, the participants got the same intended score in item

1 while item 2 got below the standard score. These results may imply that medical and surgical

errors happen due to lack of communication. Likewise, effective communication among the OR

personnel lowers surgical errors while increasing patient satisfaction (Singh & Arulappan, 2023).

Lastly, in Collaboration and Teamwork, the participants' scores were similarly lower than

what was desired. These results show that nursing students may lack the skills needed to work
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 99
effectively in teams. Teamwork skills are critical to the quality of treatment and patient safety,

allowing for successful patient care and preventing adverse outcomes. Therefore, teamwork has

to be learned, and team training must begin early in health care education (Karlsen et al., 2022).

On the other hand, all of the 9 participants scored below the intended rating in the

evaluated areas when assessing the attitude of nursing students acting as scrub nurses in the

operating room. In Ethico-Moral Responsibility, the participants had lower mean ratings than the

intended rating. It was observed that nurses' understanding of their ethical beliefs and how these

values influence their behavior is an essential component of holistic and humanistic nursing

practice. Hence, adhering to professional, ethical values in patient care is one of the requirements

for professional status (Taşkiran & Türk, 2023). It was also discovered that nursing students who

attended ethics seminars showed greater confidence in their capacity to identify and address

ethical difficulties in clinical practice (Khalili et al., 2022).

In Personal and Professional Development, the participants had below mean scores than

the desired rating. It was discovered that nursing students may lack self-awareness and self-

reflection, both of which are necessary for personal and professional development. Nursing

educators should provide more opportunities for self-reflection and self-assessment in the

curriculum to help students develop their personal and professional skills (Siddiqi et al., 2021).

Meanwhile, circulating nurses have a critical role in the operating room and it requires

knowledge and specific skills to perform the duties effectively. When assessing the knowledge of

nursing students acting as circulating nurses in the operating room, all of the 9 participants scored

below the standard in the evaluated areas. In Health Education, the participants garnered lower

mean scores than the desired rating. In which nursing students may struggle to explain health

information to patients, resulting in poorer evaluations (Johnson et al., 2020).

Additionally, educating patients and families about self-care is a critical nursing

responsibility. Patient education entails teaching, influencing, and empowering patients to

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 100
understand, manage, and act upon their own medical care (White, 2022). Thus, nursing students

frequently require additional training in health education to improve their communication skills

and provide patients with accurate and understandable health information (Johnson et al., 2020).

While, in Legal Responsibility, the participants had below mean score than the desired

rating. Owing to this, nursing students may lack knowledge of legal and ethical issues, resulting

in lower ratings. It was shown that nursing students frequently require more instruction in legal

and ethical problems to guarantee that they understand their duties and can offer safe and ethical

care (Williams et al., 2021).

Whereas, in Research, the participants also had a lower mean score than the desired

rating. It was discovered that nursing students may lack research abilities and do not recognize

the significance of evidence-based practice. Kackin advises that nursing programs increase

possibilities for students to participate in research projects and incorporate research concepts into

the curriculum (Kackin, 2020).

Moving forward, nearly all of the 9 participants scored below the intended rating in the

evaluated areas when assessing the skills of nursing students acting as circulating nurses in the

operating room. The fact that all items in Safe and Quality Nursing Care got lower than the

desired rating score suggests that the participants may not ensure patient safety and provide high-

quality care. This can lead to errors or delays in care, which can negatively affect patient

outcomes (Jarelnape et al., 2023). In line with this, personal knowledge levels affect adherence to

and compliance with safety norms and recommendations (Vaismoradi et al., 2020).

Also, when observing in terms of Management of Resources, Environment and

Equipment, participants got lower than the desired rating score. Students in Management of

Resources may struggle with appropriate prioritization and resource allocation, resulting in

poorer grades. Nursing students frequently struggle with resource management due to a lack of

practical experience and training (Tucker et al., 2021). Students in the Environment and
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 101
Equipment category may lack the abilities required to maintain a clean and safe environment,

resulting in lower grades. A study discovered that nursing students frequently require additional

training and practice in maintaining a sterile environment and utilizing equipment correctly

(Smith et al., 2022).

Next, in Quality Improvement, participants got a lower rating than the desired rating

score. It was discovered that nursing students may lack the skills and knowledge required to

participate in quality improvement efforts. Hence, it was proposed that nursing programs expand

possibilities for students to participate in quality improvement projects and incorporate quality

improvement principles into the curriculum (Al-Shboul et al., 2021).

Then, in Records Management, the participants had also below score than the desired

rating. It was found that nursing students may lack the abilities required to efficiently handle

patient records. It was recommended that nursing programs give students greater opportunity to

experience maintaining patient records and incorporate records management concepts into the

curriculum (Chang et al., 2021).

Following this is the Communication, the participants got the same intended score in item

1 while item 2 got below the standard score. It was found that interprofessional communication

may present challenges for nursing students. Thus, it was recommended that nursing programs

increase opportunities for students to engage in interprofessional communication and incorporate

communication principles into the curriculum (Al-Fawaz et al., 2021).

At this time, in Collaboration and Teamwork, the participants' scores were likewise lower

than what was desired. Nursing students may lack the abilities required to operate effectively in

teams. It was recommended that nursing programs increase opportunities for students to

participate in team-based learning and incorporate collaboration principles into the curriculum

(Lee et al., 2021).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 102

 Meanwhile, 9 participants all achieved practically identical scores in the assessed areas

when it came to the attitude of the nursing students who were acting as circulating nurses in the

operation room. In Ethico-Moral Responsibility, item 1 to 2 got the same standard in the desired

rating as nursing students are expected to maintain strong ethical and moral standards as

circulating nurses. This is because the role they play in patient care necessitates them to make key

judgments that can have a substantial impact on patients' health outcomes. This amount of

responsibility necessitates a firm ethical and moral sense (Kaczorowski et al., 2021).

Additionally, it was found that nursing students who get ethics education during their

training are more likely to report feeling equipped to deal with ethical challenges in clinical

practice. It was proposed that incorporating ethics education into nursing curricula can assist

nursing students in developing the skills and knowledge required to maintain high ethical and

moral standards as circulating nurses (Kaczorowski et al., 2021). Meanwhile, in terms of Personal

and Professional Development, item 1 got a lower score than the desired rating while item 2 got

the same intended score. Obviously, circulating nurses play a crucial role in the surgical

procedures and if they are unable to perform their function in accordance with professional

standards. This will result in inability to oversee the administration of the patient's required care

and keep an eye on everything going on in the room (Kalantari et al., 2021).

Delving into the factors affecting the level of competence in performing basic nursing

procedures, the majority of the participants agree that stress and sleep influence competence as

they accumulated the highest results in data collection. It can be inferred from this that nursing

students' academic performance and focus are affected by stress (Bsharat, 2023). Furthermore,

inadequate or poor-quality sleep can hinder nursing students' ability to learn and retain

information, potentially limiting their maximum learning potential and competency (Yeo et al.,

2023).

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 103

 Apart from these factors, practical skills were the second highest result with most of the

participants agreeing. Merely possessing knowledge is insufficient for executing nursing care

effectively (Madjid, 2023). Furthermore, adequate preparation for nursing students and the

appropriate selection of clinical environments contribute to the development of competent nurses

(Berhe & Gebretensaye, 2021).

Subsequently, the third with the highest result that participants agreed on the factors was

the clinical instructor’s comments and feedback. Hence, when clinical instructors offer clear,

specific, and constructive feedback, nursing students gain insight into their strengths and areas for

improvement. This guidance enables students to focus their efforts on areas needing

enhancement, maximizing their utilization of time and resources, as corroborated by Nuuyoma's

study (2021).

While attendance, including tardiness, received the lowest score in data collection,

participants agreed with its importance. Regular class attendance fosters engagement with both

instructors and peers, providing structured time to accomplish essential learning objectives (Yeo

et al., 2023). Following closely is school infrastructure, such as student seating and study areas,

which also garnered low scores. A multifaceted school structure is crucial to ensuring proficient

education as it significantly impacts student competence (Ozacan, 2021).

Additionally, student orientation and financial capability received the third lowest mean.

Student orientation plays a pivotal role in student development (Ozacan, 2021), while financial

capability can affect a student's ability to focus on their studies and perform well in the program.

Financially insecure nursing students may lack resources to purchase necessary materials or pay

for transportation (Younas et al., 2020).

Following statistical analysis results indicate no significant evidence to reject the null

hypothesis, suggesting no notable correlation between nursing students' competence levels and

the factors affecting their competence in performing basic nursing procedures in both operating
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 104
and delivery rooms. The acceptance of the null hypothesis was based on a p-value of .365 falling

within the acceptance region, lacking significance at the 0.05 level, and thus, insufficient

evidence to attribute observed differences to the variables under examination. Participants'

consistent agreement with factors affecting competence, regardless of their questionnaire scores,

supports the absence of a significant association between competence level and influencing

factors. Despite stress and lack of sleep achieving high percentages in the study, they do not

directly affect nursing students' competence levels.

Moreover, nursing students' perceptions of factors influencing their skill level in basic

nursing tasks are shaped by professional values inherent in the nursing profession's

developmental process. Professional values such as kindness, independence, respect, honesty,

integrity, and fairness hold paramount importance in nursing. Nevertheless, nursing educators

play a crucial role in imparting nursing essence and navigating ethical dilemmas. Students can

reinforce their commitment to these values through role-playing and observing behaviors that

embody them. Understanding students' perspectives on the significance of these values is

essential for nursing instructors to ensure the preparation of ethical and professional caregivers.

However, these factors do not significantly affect nursing students' competence levels.

Furthermore, this study will serve as a guide and reference for Notre Dame University,

encompassing school administrators, particularly focusing on the Department of College of

Health Sciences. It will provide a basis for assessing the current competence level of nursing

students at level 3. This information will aid in improving student performance and ensuring that

the curriculum aligns with required standards. Moreover, the study holds significance for nursing

education, offering ongoing opportunities for the development and enhancement of basic nursing

procedures in delivery and operating rooms. In nursing practice, it will familiarize student nurses

with their expected roles in clinical settings, where they will assist doctors during deliveries and

surgeries. Additionally, by understanding the competence level of level 3 nursing students,

existing practices can be enhanced and improved. The research will facilitate comparisons of
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 105
 knowledge, skills, and attitudes among nursing students when performing basic nursing

procedures, particularly in critical settings like operating and delivery rooms.

Conversely, engaging in research enables nursing students to expand their knowledge

base and gain firsthand experience, thereby enhancing their credibility and expertise in clinical

practice. Thus, the study's findings will inform clinical instructors about the effectiveness of their

teaching methods and determine their vital role in preparing future nurses. Moreover, assessing

students' competence levels will help them identify areas of strength and areas for improvement,

enabling them to perform basic nursing procedures confidently. Lastly, the study will benefit

future researchers by providing reference data and serving as a cross-reference for understanding

the competence levels of nursing students.

MAJOR FINDINGS OF THE STUDY

Based on the data presented, analyzed, and interpreted, the following are the major

findings.

1. Nursing students demonstrated varying levels of competence in performing basic nursing

procedures across different settings. Specifically, their knowledge competence is higher in the

delivery room compared to the operating room, while their skills competence is higher in the

operating room than in the delivery room. Additionally, their attitude’s competence is higher in

the delivery room than in the operating room.

2. In the delivery room simulation, the level of competence in terms of knowledge when performing

intrapartal care falls below the expected standard, particularly in areas such as items 1 through 6

in health education, items 1 through 4 in legal responsibility, and also items 1 through 4 in

research. Skills competence in intrapartal care also falls short, with deficiencies noted in items 1

to 8 in safe and quality nursing care, items 1 to 17 in performing functions during actual labor,

items 1 to 7 and 9 in resource management, items 1 to 3 in quality improvement, items 1 and 2 in

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 106
 records management, items 1 to 3 in communication, and items 1 to 3 in collaboration and

teamwork. Also, attitude competence in intrapartal care is below the expected standard such as in

item 1 in ethico-moral responsibilty

While the level of competence in terms of knowledge when performing newborn care

3. Similarly, in the operating room simulation, competence levels in performing intraoperative care,

both as scrub and circulating nurses, are below the expected standard in various aspects such as

resource management, quality improvement, and collaboration. However, certain specific skills

like surgical scrubbing and communication meet the expected standard.

4. Subsequently, in terms of the factors affecting the level of competence of the nursing students in

performing basic nursing procedures, it was revealed that majority of the participants have

answered ‘agree’ regarding the factors. Wherein, statement number 5 “Stress and Sleep” got the

highest rated mean result. This was followed by statement number 2 “Practical skills” as the

second highest rated mean and statement number 15 “Clinical instructor’s comments and

feedbacks” as the third highest rated mean result. Although statements like “Attendance including

tardiness”, “School infrastructure like student seating, study area, etc.”, and “Student orientation”

and “Financial capability” got the lowest rated mean results, it was still answered ‘agree’.

5. The null hypothesis is accepted wherein there is no significant relationship between the level of

competence and the factors affecting the competence in performing basic nursing procedures of

the nursing students.

CONCLUSION

Therefore, with the presented results, the researcher concluded that the level 3 nursing

students demonstrate an average level of competence in the delivery room encompasses

knowledge, skills, and attitude, as assessed through a survey questionnaire. Meanwhile, in the

operating room, the participants exhibit an average level of competence in knowledge and skills,

while the majority show a lack of competence in attitude, also assessed using a survey
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 107
 questionnaire. Furthermore, the researchers observed the selected participants in the simulation

area, particularly focusing on the delivery room and operating room, and found that the selected

participants scored below the desired rating in terms of knowledge, skills, and attitude.

Conversely, despite stress and lack of sleep having the highest mean among the identified factors,

it appears that these factors do not directly influence the level of competence in performing basic

nursing procedures. This further supports that the factors investigated do not significantly affect

competence levels in performing basic nursing procedures. In conclusion, the study revealed that

there is no significant relationship between the level of competence of the participants and the

factors affecting their competence in performing basic nursing procedures.

RECOMMENDATIONS

Considering the foregoing conclusions, the following recommendations are offered to the

sectors concerned:

A. For Action

1. Nursing students should review beforehand the fundamentals and the performance evaluation in

intra-partal care and immediate care of the newborn competency and intra-operative care

competency as scrub and circulating nurses.

2. Nursing students should practice the steps in intra-partal care and immediate care of the newborn

competency and intra-operative care competency as scrub and circulating nurses and understand

the importance of doing every step. Also, students should ask their clinical instructors if they

have any confusion or questions regarding the basic nursing procedures.

3. Nursing students should have a calm and composed attitude to perform confidently and decrease

the risk of forgetting the steps they will be taking.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 108

4. Nursing students should check and see in what areas they are excelling and what should be

improved. They should grasp and understand the basic nursing procedures they already know and

can perform confidently.

5. Clinical instructors should give complete steps and emphasize the importance of doing every step.

Also, clinical instructors should be uniform in imparting the sequence of steps, as students may

confuse different sequences of steps given by the other clinical instructors.

6. Nursing research should improve and enhance existing practices by knowing the level of

competence of the level 3 nursing students at Notre Dame University. They should compare what

knowledge, skills, and attitudes the nursing students have when performing basic nursing

procedures, specifically in the operating and delivery rooms. Thus, nursing students will have the

opportunity to significantly build their base of knowledge and gain firsthand experience that

gives them more credibility and expertise in clinical practice.

7. Nursing education should continuously develop and enhance student nurses' basic nursing

procedures in delivery and operating rooms. By doing this, student nurses should be well

acquainted with what they have to perform when exposed in the clinical setting, as the student

nurses will be an aid to the doctor by assisting in delivering the baby and assisting or circulating

in the operating room.

8. Notre Dame University should enhance the facilities and hire more clinical instructors, as nursing

students are going on duty in two groups with 20 members per shift. This affects students as they

cannot practice for a long period of time due to time constraints as others are also going to

practice, and the room is too small for students as they cannot see how their clinical instructors

are doing the steps during demonstrations of intra-partal care and immediate care of the newborn

competency and intra-operative care competency as scrub and circulating nurse.

9. Notre Dame University should improve the student’s performance and ensure that the curriculum

aligns with the required standards.

B.Further Studies

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 109

1. Differences in Nursing Competencies between Male and Female Nurses: A Comparative Analysis

2. The Impact of Simulation-Based Learning on Nursing Students' Competence in Basic Procedures

3. The Role of Clinical Instructors in Developing Nursing Students' Competence in Basic Procedures

4. A Comparative Study of the Nursing Competence of Level 3 and 4 Nursing Students in

Performing Basic Procedures

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APPENDIX A

LETTER TO THE DEAN

March 2, 2024

MARY JANE K. BALAWAG, RN, MAN, PhD

Dean, College of Health Sciences
Notre Dame University

Dear Dean Balawag,

Greetings of Peace!

We, the Level III Nursing Students of the College of Health Sciences at Notre Dame University,
are currently conducting a research study entitled “Level of Competence of Nursing Students in
Performing Basic Nursing Procedures” as part of the fulfillment of the requirements for the
degree of Bachelor of Science in Nursing (BSN). Conducting the research would benefit the
college and other nursing schools as it aims to determine the level of competence of the students
when performing basic nursing procedures. This would help to evaluate the competence of the
Level 3 students utilizing the standardized questionnaire.

In this regard, we would like to request permission to allow us to conduct the study. Rest assured
that the information that will be obtained will be kept with utmost confidentiality and be used
only for academic purposes under Republic Act 10173, also known as the Data Privacy Act of
2012.
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 119
Your approval on this matter would be greatly appreciated, and we would like to express our
sincere gratitude for considering our request.

Respectfully yours,

(Sgd.) Faith Andrae E. Bingil (Sgd.) Gwynna Mae S. Lavisores

Researcher Researcher

(Sgd.) Niña Bea Zabelle A. Miso (Sgd.) Meldy Rose L. Rosete

Researcher Researcher

Noted by:

(Sgd.) MARY LOU G. MAMARIL, RN, MAN

Research Adviser

APPENDIX B

REQUEST LETTER

March 2, 2024

MARY JANE K. BALAWAG, PhD, RN

Dean, College of Health Sciences
Notre Dame University

THRU: MARIA HAZEL D. CAYENA, RN, MAN

Clinical Coordinator, College of Health Sciences
THRU: EVELYN C. SIONG, RN, MN
Level 3 Coordinator, College of Health Sciences

Dear Dr. Balawag,

Greetings of Peace!

We, the Level III Nursing Students of the College of Health Sciences at Notre Dame University,
are currently conducting a research study entitled “Level of Competence of Nursing Students in
Performing Basic Nursing Procedures” as part of the fulfillment of the requirements for the
degree of Bachelor of Science in Nursing (BSN).

In line with this, we would like to request permission to allow us to obtain a copy of the master
list of Level III nursing students by section and RLE groups. We will use the list of students as
one of the basis of our survey to get the data. Rest assured that the information that will be
obtained will be kept with utmost confidentiality and be used only for academic purposes.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 120

Your approval on this matter would be greatly appreciated, and we would like to express our
sincere gratitude for considering our request.

Respectfully yours,

(Sgd.) Faith Andrae E. Bingil (Sgd.) Gwynna Mae S. Lavisores

Researcher Researcher

(Sgd.) Niña Bea Zabelle A. Miso (Sgd.) Meldy Rose L. Rosete

Researcher Researcher

Noted by:

(Sgd.) MARY LOU G. MAMARIL, RN, MAN

Research Adviser

APPENDIX C

LETTER TO THE LEVEL 3 COORDINATOR

March 2, 2024

EVELYN C. SIONG, RN, MN

Level 3 Coordinator, College of Health Sciences
Notre Dame University

Dear Ma’am Siong,

Greetings of Peace and Joy!

We, the Level III Nursing Students of the College of Health Sciences at Notre Dame University,
are currently conducting a research study entitled “Level of Competence of Nursing Students in
Performing Basic Nursing Procedures” as part of the fulfillment of the requirements for the
degree of Bachelor of Science in Nursing (BSN). This study would help evaluate the competence
of the Level 3 nursing students utilizing the standardized questionnaire tool.

In this regard, we would like to request permission to allow us to conduct the study to gather the
necessary data for our study. We assure you that the information obtained is kept completely
confidential and only used for educational purposes in accordance with Republic Act 10173, also
known as the Data Privacy Act of 2012.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 121

Your approval on this matter would be greatly appreciated, and we would like to express our
sincere gratitude for considering our request.

Respectfully yours,

(Sgd.) Faith Andrae E. Bingil (Sgd.) Gwynna Mae S. Lavisores

Researcher Researcher

(Sgd.) Niña Bea Zabelle A. Miso (Sgd.) Meldy Rose L. Rosete

Researcher Researcher

Concurred by: Approved by:

(Sgd.) MARY LOU G. MAMARIL, RN, MAN (Sgd.) MARY JANE K. BALAWAG,
Research Adviser PhD, RN
College Dean

APPENDIX D

LETTER TO THE PARTICIPANTS

March 2, 2024

Dear Students,

Greetings of Peace!

We, students at the College of Health Sciences, Notre Dame University are currently conducting
a research study entitled “Level of Competence of Nursing Students in Performing Basic
Nursing Procedures” as part of the fulfillment of the requirements for the Degree of Bachelor
of Science in Nursing.

The study will provide significant information in determining the level of competency between
third-year and fourth-year college nursing students in performing basic nursing procedures.
Participation in this study will take approximately 15 minutes. You are free to ask any questions
regarding your participation as our respondent in this study through the group chat.

Your participation in this study is voluntary without obligation to participate. Furthermore, you
have the right to withdraw if the procedure or questionnaire violates any of your rights.

The data gathered will be coded and they will not be linked to your name. Your identity will not
be revealed while the study is being conducted or when the study is reported or published. We
assure you that the data gathered will be kept strictly confidential and will be used for academic
purposes only.

Thank you very much for your cooperation.

Respectfully yours,
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 122
(Sgd.) Faith Andrae E. Bingil (Sgd.) Gwynna Mae S. Lavisores
Researcher Researcher

(Sgd.) Niña Bea Zabelle A. Miso (Sgd.) Meldy Rose L. Rosete

Researcher Researcher

Concurred by: Approved by:

(Sgd.) MARY LOU G. MAMARIL, RN, MAN (Sgd.) MARY JANE K. BALAWAG,
Research Adviser PhD, RN
College Dean

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 123

 APPENDIX E

INFORMED CONSENT

CONSENT FORM

I have read this consent form and voluntarily consent to participate in this study.

__________________________________ ________________
Participant’s Signature over Printed Name Date

I have explained this study to the above-mentioned subject and have sought his/her understanding

for informed consent.

(Sgd.) FAITH ANDRAE E. BINGIL ________________

Researcher’s Signature over Printed Name Date

(Sgd.) GWYNNA MAE S. LAVISORES _________________

Researcher’s Signature over Printed Name Date

(Sgd.) NIÑA BEA ZABELLE A. MISO _________________

Researcher’s Signature over Printed Name Date

(Sgd.) MELDY ROSE L. ROSETE _________________

Researcher’s Signature over Printed Name Date

APPENDIX F

QUESTIONNAIRE

PART 1: Profile of the Participants

Instructions: Kindly provide the needed information.

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 124

1. Name: (Optional)_________________________________________
2. Age: _________
3. Sex : [_] Male [_] Female

PART I: LEVEL OF COMPETENCE IN PERFORMING BASIC NURSING

PROCEDURE IN TERMS OF KNOWLEDGE, SKILLS, AND ATTITUDE
Directions: Select the correct answer for the following questions. Encircle the letter of your
answer.

1. It is one of the competencies that is defined as enhancing quality and minimizing the risk of harm
to patients and providers through both system effectiveness and individual performance.
a. Collaboration and Teamwork
b. Safe and Quality Nursing Care
c. Research
d. Quality Improvement

2. One of the competencies in intrapartal is safe and quality nursing care. Which of the following is
included in this competency?
1. Obtain obstetric history
2. Check vital signs
3. Observe for the timely rupture of the membrane
4. Perform sterilization procedure
5. Coaches mother on the process of labor

a. 1, 2, 3, 4, 5
b. 1, 2, 3, 5
c. 1, 2, 4, 5
d. 3, 5

3. In the delivery of the baby and placenta, a student nurse can ensure safe and quality nursing care
by adhering to which sequence?
1. Identify signs of placental separation
2. Checks and manages cord recoil correctly
3. Checks the characteristics/completeness of the placenta
4. Clamps and cut the cord

a. 1, 2, 3, 4
b. 1, 2, 4, 3
c. 2, 4. 1, 3
d. 2, 1, 4, 2

4. Before the delivery, a student nurse should prepare which instruments and equipment to ensure
effective management of resources, environment, and equipment?
1. Sterile drape
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 125
2. Sterile forceps
3. Kelly pad
4. Disinfectant
a. 1, 2,
b. 1, 2, 3
c. 1, 2, 4
d. 1, 2, 3, 4

5. Which health education should a student nurse discuss with the mother to meet the intrapartal
competency?
a. Breathing/bearing down techniques
b. Demonstrate proper “latch-on” breastfeeding techniques
c. All of the above
d. None of the above

6. All but one are legal responsibilities in intrapartal competency:

a. Ensures privacy and confidentiality
b. Secures informed consent in all procedures related to labor and delivery
c. Documents all pertinent data correctly and completely
d. Report accurately and honestly the gender, time of delivery of the baby, and the placenta

7. How can a student nurse exhibit ethical and moral responsibility in the clinical setting while
meeting intrapartum competency?
a. Report accurately and honestly the gender, time of delivery of the baby, and the placenta
b. Observe precautionary measures related to the use of electrical equipment
c. Performs functions based on standard
d. Promotes emotional security by supporting needs

8. Which intrapartal competency includes updating oneself with the latest trends and developments in
labor and delivery?
a. Research
b. Personal and Professional Development
c. Legal Responsibilities
d. Records Management

9. Which of the following is included in the quality improvement competency of intrapartal care?
a. Observe precautionary measures related to the use of electrical equipment
b. Participates in audit practices in the delivery room/lying in
c. Maintains an organized system of filing and keeping records of client
d. Performs functions based on standard

10. It is one of the competencies which is defined as providing a correct account of the treatment and
care.
a. Communication
b. Collaboration and Teamwork
c. Safe and Quality Nursing Care
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 126
d. Records Management

11. One of the newborn competencies is safe and quality nursing care. Which of the following is
included in this competency?
a. Administering hepatitis B vaccine
b. Identifies deviation of practice from the standards
c. Maintain privacy and confidentiality of findings of assessment
d. Ensures use of sterile equipment during immediate care of newborn

12. Among the newborn competencies, safe and quality nursing care is essential. Which of the
following is NOT a part of this competency?
a. Establishes and maintains a patent airway
b. Dries newborn and wraps warmly
c. Ensures a warm and quiet environment
d. Latches newborn to the newborn to the mother’s breast immediately after birth

13. After the baby is delivered a nurse attaches the name tag which contains:
a. Name of father, date and time of birth, gender, name of attending physician
b. Name of mother, date and time of birth, gender, name of attending physician
c. Name of mother, date and time of birth, gender, name of attending physician and nurse
d. Name of father, date and time of birth, gender, name of attending physician and nurse

14. Management of resources, environment, and equipment is one of the competencies in newborn
care. A nurse will be correct if she states that this competency is:
a. It relies on the education and sense of approach a nurse has in the workplace
b. It reports any suspected abuse or neglect of vulnerable individual
c. It seeks to standardize processes and equipment to achieve predictable results
d. It is the one who is concerned with providing drugs, supplies, and equipment needed by
health personnel to deliver health services

15. In newborn care, which of the following instruments and equipment is needed to be prepared:
a. Ballpen, chart, and small notebook
b. Suction bulb, cord clamp, gauze, cotton balls, and blanket
c. Sphygmomanometer, stethoscope, and tape measure
d. Notebook, ballpen, suction bulb, cord clamp, gauze, and cotton balls

16. One of the responsibilities of the nurse is to give a health education. A nurse will be correct if she
states the purpose of health education as:
a. Provides instructions to the client
b. Provides information regarding newborn screening, immunizations, and feeding
c. Provides discharge instructions
d. All of the above

17. Which includes the legal responsibilities of a nurse during the immediate care of a newborn?
a. Ensure proper identification of the mother and newborn
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 127
b. Identifies newborn by comparing ID band with data in the chart
c. Respect the religious, cultural, and ethical practices of the family of the women in labor and
delivery
d. Maintains privacy and confidentiality of findings of assessment

18. Ethico-moral responsibility is a vital competency in newborn care. Which of the following is
included in this competency?
a. Accept criticisms and recommendations
b. Projects professional image of the pediatric nurse
c. Respect the religious, cultural, and ethnic practices of the family of the newborn
d. A and B

19. Which of the following is included in the Ethico-moral responsibility competency?

a. Uses supply diligently
b. Maintains orderliness of the working area
c. A and B
d. None of the above

20. It is one of the competencies which is defined as the process of improving practice by continuing
education and training
a. Quality Improvement
b. Personal and Professional Development
c. Research
d. Ethico-Moral Responsibility

21. Quality improvement is one of the nursing competencies of immediate newborn care. Which of
the following belongs to the competency?
a. Identifies deviations of practice from the standards
b. Identifies researchable problems related to immediate newborn care
c. Communicate all findings of the assessment to health team members
d. Accepts criticisms and recommendations

22. One of the newborn competencies also includes research. Which of the following is not included
in this competency?
a. Identifies deviation of practice from the standards
b. Identifies researchable problems related to immediate care of the newborn
c. Utilizes findings of research studies in the immediate care of the newborn
d. None of the above

23. Which of the following demonstrates the competency of communication when the patient's
family asks questions about the client's situation?
a. Listens attentively to the family’s queries and concerns
b. Listen passively to the family’s queries and concerns
c. Listen attentively to the noise in the surroundings
d. Listen and walk away to the room of the client and ask the doctor to answer the queries of the
client
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 128
24. It is one of the competencies that is defined as exchanging information, thoughts, and feelings
among people.
a. Collaboration and teamwork
b. Records management
c. Personal and Professional Development
d. Communication

25. Which of the following demonstrates the competency of collaboration and teamwork?
a. Recommend corrective and preventive measures for the identified problem
b. Inform the mother of relevant information about the newborn
c. Communicate all findings of the assessment to health team members
d. Maintains an organized system of filing and record-keeping

26. One of the intra-operative care competencies is safe and quality nursing care. Which of the
following does not belong to this competency?
a. Utilizes the nursing process in the care of the OR client
b. Accepts responsibility and accountability for own decisions and actions as an OR nurse
c. Promotes the safety and comfort of clients inside the operating room
d. Administer medications and other health therapeutics safely

27. Safe and quality nursing care is part of the intra-operative care competencies for scrub nurses.
Which of the following is excluded from it?
a. Performs the function of the scrub nurse
b. Administer medications and other health therapeutics safely
c. Promotes the safety and comfort of clients inside the operating room
d. Performs the function of the circulating nurse

28. One of the responsibilities of the scrub nurse includes:

a. Anticipates the needs of the surgical team
b. Assist in skin preparation
c. Hands instruments, sponges, sutures, and other materials following surgeon preferences
d. Performs surgical count inaccurately

29. Which among the following is not the function of the scrub nurse?
a. Performs surgical scrub correctly
b. Wears sterile gowns and gloves aseptically
c. Prepares surgical instruments, sponges, sutures, and other supplies in a functional arrangement
d. Set up the OR room and needed equipment

30. Management of resources and the environment is one of the competencies in intra-operative care.
A student nurse will be correct if she states that this competency is:
a. It manages to organize the workload to facilitate timely client care
b. It adheres to the legal protocols regarding legal documents.
c. It utilizes the nursing process when caring for clients
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 129
d. It reports variances in sterility and other OR activities

31. One of the responsibilities of the nurse is to give a health education. Which among the following
belongs to this competency?
a. Performs the function of a scrub nurse
b. Ensures functionality of OR resources
c. Implement appropriate education for the client based on assessment
d. Uses appropriate information mechanisms when communicating with others

32. Which following includes the legal responsibilities of a nurse in an operating room?
a. Maintains a safe environment at the OR by observing the principles of asepsis
b. Maintains accurate and updated records of client care
c. Implement appropriate health activities for a client based on assessment
d. Adheres to institutional protocols regarding informed consent and other legal documents

33. Ethico-moral responsibilities are among the intra-operative care competencies. A student nurse
will be correct if she states that:
a. It accepts accountability based on the doctor's decision
b. It respects the rights of the OR client
c. It projects a professional image of the OR nurse
d. It identifies variances in sterility and other OR activities

34. Which of the following demonstrates the competency of personal and professional development?
a. It performs OR functions according to professional standards
b. It accepts responsibility for its own decisions and actions as an OR nurse
c. It possesses pessimistic attitudes toward learning surgical and OR-related knowledge and skills
d. It utilizes the nursing process when caring for clients

35. Included in the intra-operative care competencies is quality improvement. Which among these is
included in the competency?
a. Possesses positive attitudes towards learning OR-related knowledge and skills
b. Maintains a safe environment at the OR by observing the principles of asepsis
c. Promotes the safety and comfort of clients inside the operating room
d. Identifies and reports variances in sterility and other OR activities

36. It is one of the intra-operative care competencies which is defined as the process of disseminating
results of OR-related findings to a clinical group and other members of the OR team
appropriately.
a. Quality improvement
b. Legal responsibilities
c. Research
d. Personal and professional development

37. Among the intra-operative care competencies is records management. Which of the following is
included in this competency?
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 130
a. Maintains accurate and updated records of client care
b. Maintains a safe environment at the OR by observing the principles of asepsis
c. Monitors client’s responses to surgery
d. Obtains comprehensive client information by checking the complete accomplishment of the
checklist

38. It is one of the intra-operative care competencies which is defined as the use of relevant
information mechanisms to facilitate communication inside the OR and with other departments in
the hospital.
a. Research
b. Communication
c. Collaboration and teamwork
d. Personal and professional development

39. Which among the following should a student nurse exhibit that adheres to communication
competency?
a. Use of inappropriate information when communicating inside the OR and with other departments
in the hospital
b. Reports variances in sterility and other OR activities
c. Establish rapport with the clients, significant others, and members of the health team
d. Establish a collaboration plan of care with other members of the health team

40. It is one of the intra-operative care competencies which is described as the collaboration of a plan
of care with other members of the health team.
a. Collaboration and teamwork
b. Records management
c. Communication
d. Quality improvement

41. Ensuring safe and quality nursing care is one of the key competencies within the intraoperative
setting, particularly embodied by the role of the circulating nurse. Which of the following
accurately describes the function of the circulating nurse?
a. Disregard the needs of the surgical teams
b. Monitor skin preparation and draping of the client
c. Prepares surgical instruments, sponges, sutures, and other supplies in a functional arrangement
d. Receives client for surgery and endorses client post-operatively

42. Safe and quality nursing care involves the utilization of the nursing process in the care of the OR
client. Which of the following is excluded from this process?
a. Utilizes adequate and appropriate resources to support the OR team
b. Monitors client’s responses to surgery
c. Obtains comprehensive client’s information
d. Provided needed nursing intervention based on identified needs

43. In safe and quality nursing care competency, a student nurse can utilize the nursing process in the
care of the client by adhering to which sequence?
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 131
 I. Obtains comprehensive client information by checking the complete accomplishment of the
client's charts
II. Identifies the priority needs of the clients in the operating room
III. Provides needed nursing interventions based on the identified needs
IV. Monitors client’s response to surgery

a. I, II, III, IV
b. IV, III, II, I
c. III, II, I, IV
d. II, IV, III, I

44. What role do circulating nurses serve in the competency of safe and quality nursing care during
intra-operative procedures?
1. Anticipates the needs of the surgical team
2. Sets up OR room and needed equipment
3. Receives client for surgery/endorses client pre-operatively
4. Assists in skin preparation and draping of client

a. 1, 2, 3, 4
b. 1, 3, 4
c. 1, 2, 4
d. 1, 2

45. One of the competencies in intra-operative care involves safely administering medications and
other therapeutic treatments to patients. Which competency specifically entails this
responsibility?
a. Safe and quality nursing care
b. Management of resources and environment
c. Legal responsibility
d. Ethico-moral responsibility

46. It is one of the intra-operative care competencies that portray respecting the rights of the OR
client. Which competency specifically entails this responsibility?
a. Safe and quality nursing care
b. Management of resources and environment
c. Legal responsibility
d. Ethico-moral responsibility

47. It is one of the intra-operative care competencies that is described as possessing a positive
attitude towards learning surgical and OR-related knowledge and skills.
a. Quality improvement
b. Personal and professional development
c. Ethico-moral responsibility
d. Legal responsibility

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 132

48. Participation in activities related to infection control belongs to what intra-operative care
competencies?
a. Quality improvement
b. Legal responsibilities
c. Research
d. Personal and professional development

49. Which of the following demonstrates the competency of quality improvement in intra-operative
competency?
a. Maintains accurate and updated documentation of client use
b. Establishes rapport with the client
c. Identifies and reports vaccines in sterility and other OR activities
d. Organizes workload to facilitate timely client care

50. Which of the following demonstrates the competency of records management in intra-operative
competency?
a. Disseminate results of OR-related research findings to the clinical group and other members of
the health team
b. Maintains accurate and updated documentation of client use
c. Establishes rapport with the client
d. Organizes workload to facilitate timely client care
Part III. Factors Affecting the Level of Competence
Directions: The following page contains a number of statements. Please rate by encircling how
much you agree or disagree with the statements and how much it affects your level of
competence in performing basic nursing procedures. Use the following scale:
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree

Str A Di Strongly
on g sa Disagree
gl r gre
The y e e
factors A e
affecting gr
my level ee
of
competen
ce in
performin
g basic
nursing
procedur
es are:
1. Theoretical 4 3 2 1
knowledg

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 133

 e
2. Practical 4 3 2 1
skills
3. Attendance 4 3 2 1
including
tardiness
4. Preparation 4 3 2 1
for
quizzes,
activities
and exam
5. Stress and 4 3 2 1
Sleep
6. Clinical 4 3 2 1
learning
environm
ent
7. Equipment 4 3 2 1
s and
materials
8. School 4 3 2 1
infrastruc
ture like
student
seating,
study
area, etc.
9. Student 4 3 2 1
orientatio
n
10. Noise of 4 3 2 1
any
source
11. Clinical 4 3 2 1
instructor
’s internal
motivatio
n
12. Clinical 4 3 2 1
instructor
’s
communi
cation

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 134

 skills
13. Clinical 4 3 2 1
instructor
’s clinical
competen
ce
14. Clinical 4 3 2 1
instructor
’s
teaching
skills
15. Clinical 4 3 2 1
instructor
’s
comment
s and
feedbacks
16. Support 4 3 2 1
from the
family
17. Family 4 3 2 1
expenditu
re and
income
18. 4 3 2 1
Househol
d chores
19. Financial 4 3 2 1
capability
20. Family 4 3 2 1
expectatio
ns

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 135

PART III: Observational Tool
Intrapartal Care

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 136

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 137
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 138
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 139
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 140
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 141
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 142
Immediate Care of Newborn

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 143

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 144
Intraoperative Care- Scrub nurse

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 145

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 146
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 147
 Intraopera
tive Care- Circulating Nurse

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 148

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 149
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 150
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 151
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 152
 PART I: ANSWER KEY

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 153

1. B
2. B
3. C
4. D
5. C
6. A
7. D
8. B
9. B
10. D
11. A
12. C
13. B
14. D
15. B
16. D
17. B
18. C
19. C
20. B
21. A
22. A
23. A
24. D
25. C
26. B
27. D
28. C
29. D
30. A
31. C
32. D
33. B
34. A
35. D
36. C
37. A
38. B
39. C
40. A
41. D
42. A
43. A
44. C
45. A
46. D
47. B
48. A
49. C

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 154

50. B

CURRICULUM VITAE

Personal Data

Name : Bingil, Faith Andrae E.

Age : 21

Address : 1st Road, SPDA Village, Semba, Datu Odin Sinsuat, Maguindanao

Date of Birth : November 22, 2002

Place of Birth : Datu Piang, Maguindanao

Nationality : Filipino

Religion : Roman Catholic

Civil Status : Single

Name of Father: Jerry F. Bingil

Name of Mother: Mary Jane E. Bingil

Educational Attainment

Elementary: Tupi Alliance Church Elementary School

High School: Tupi National High School

Senior High School: Tupi National High School

Seminars Attended

User’s Orientation on Navigating Gale Reference Complete (GRC) and Philippine E-Journal

(PEJ)
Level of Competence of Nursing Students in Performing Basic Nursing Procedures 155
Peace Orientation Workshop

Seminar-Workshop on Statistics, Analyzing Results and Discussion

CURRICULUM VITAE

Personal Data

Name: Gwynna Mae Santos Lavisores

Age: 20 years old

Address: Alanis Zone, Sarmiento, Parang, Maguindanao

Date of Birth: May 27, 2003

Place of Birth: Alanis Zone, Sarmiento, Parang, Maguindanao

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Name of Father: Guillermo C. Lavisores Jr.

Name of Mother: Marijane S. Lavisores

Educational Attainment

Elementary: Sarmiento Central Elementary School

High School: Notre Dame of Sarmiento

Senior High School: Notre Dame University-Senior High School

Seminar Attended:

User’s Orientation on Navigating Gale Reference Complete (GRC) and Philippine E-Journal

(PEJ)

Peace Orientation Workshop

Nursing Research Seminar

CURRICULUM VITAE

Personal Data

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 156

Name: Miso, Niña Bea Zabelle A.

Age: 21 years old

Address: 2nd Blk EMS Village DOS Maguindanao

Date of Birth: January 19, 2003

Place of Birth: 2nd Blk EMS Village DOS Maguindanao

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Name of Father: Dennis M. Miso

Name of Mother: Analiza A. Miso

Educational Attainment

Elementary: Camp Siongco Elementary School

High School: Notre Dame-RVM College of Cotabato City

Senior High School: Notre Dame-RVM College of Cotabato City

Seminar Attended:

Lay Forum on “HIV 101”

Peace Orientation Workshop

Nursing Research Seminar

CURRICULUM VITAE

Personal Data

Name : Rosete, Meldy Rose L.

Age : 21

Address : Don T.V. Juliano Avenue, MBRH, Cotabato City

Date of Birth : March 11 2002

Place of Birth : Cotabato City

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 157
Nationality : Filipino

Religion : Roman Catholic

Civil Status : Single

Name of Father: Perfecto S. Rosete

Name of Mother: Mary Jane L. Ledesma

Educational Attainment

Elementary: Kimpo Elementary School

High School: Cotabato City National High School- Rojas

Senior High School: Cotabato City State Polytechnic College- Laboratory High School

Seminars Attended

User’s Orientation on Navigating Gale Reference Complete (GRC) and Philippine E-Journal

(PEJ)

Peace Orientation Workshop

Seminar-Workshop on Statistics, Analyzing Results and Discussion

Level of Competence of Nursing Students in Performing Basic Nursing Procedures 158