Research Manuscript Group 1 1
Research Manuscript Group 1 1
________________________________
A Thesis
Presented to
the Faculty of the College of Nursing
University of Northern Philippines
Tamag, Vigan City
__________________________________
by:
Batch 2022
Chapter 1
THE PROBLEM
Introduction
In today’s society showing your emotions and feelings is often seen as a 'weakness'
for both women and men. Men are often conditioned to believe that they must be the provider
and must not show their vulnerability. Women are often seen as 'too sensitive' when they
speak about their feelings and what they care for. We are told that if we don't care we will
never get hurt, or if we hold no expectations for people we will never experience
disappointment. However, to be vulnerable and to speak out for what we truly believe in
takes the utmost strength and courage and should be celebrated not denied. Caring is
displaying kindness and concern to others, this action and emotional force don't just show
love and affection to others, but it is also widely utilized to give that support and courage to
fight for once dear life. In the context of the health care profession, caring is a dynamic
essence, the most central and unifying focus for nursing practice and that's why caring plays
Through caring, nurses provide efforts and responsibilities to strengthen the trust,
well-being of the patient and to promote development in health processes, but because of the
increasing complex care for patients and lack of time, there is a risk that nursing practice will
become more technical without a caring element. Caring requires nurses who focus on the
relationship with the human being by seeing, understanding and taking responsibility. Nurses
deal with different patients every day and that means they constantly need to reach their
patient needs and expectation. They ensure that patient receive the necessary management un
order for them to regain the normal live that they had. Therefore, nurse make nurse caring
behaviors transparent to the patient to achieve patient health outcome and provide an optimal
level of care to patients. Caring is central in nursing practice which promotes healing and
improved health which nurses’ attributes. Caring helps the nurses create openness,
attentiveness, and respect for the patient as they create a nurse-patient relationship. Through
caring, nurses provide efforts and responsibilities to strengthen the trust, well-being of the
patient and to promotes development in health processes. By caring, a patient can find safety
environment and the person as a human being is required. Students who enrolled in a nursing
program must have a caring ability to interact with the patient to provide quality patient care
which greatly affects the health outcome or recovery of the patient. To safeguard the patient,
student nurses need to be aware of themselves as a human being and become aware of values
which require own knowledge and be aware how to approach patient. By that, nurses can
easily view and understand the patient and be responsible for giving care based on patients'
needs. Also, it can contribute to more positive patient recovery and improve the physical and
mental quality of the life in a patient with serious illness. According to Noddings (2013), the
ethic of caring can be enacted through a connection built between the “one-caring” and the
“cared-for. As student progress through a nursing program, one’ become more aware of the
professional levels of caring. Papathanassiou, Tsaras, and Sarafis (2014), also emphasizes
that clinical learning environment in particular is essential for the acquirement of and
attribute. In the beginning of students in nursing brings some caring behavior such as
compassion and humanity with her/him on entering nursing. Over the duration of clinical
exposure, they develop and add to their personal caring attributes. Throughout the course the
students are taught and experience ways of actualizing caring behaviors through relationships
within a nursing context. Individual differences in student nurses can also provide additional
dimension to caring. By that, student nurses can easily view and understand the patient and
be responsible for giving care based on patients' needs. Also, it can contribute to more
positive patient recovery and improve the physical and mental quality of the life in a patient
with serious illness. Nurses offer in-kind and heartfelt acts to provide therapeutic nursing care
and to build trust with their patients. A nurse who possesses caring behavior and by actively
engaging in caring can improve her patient’s ability to heal from within. This reflects that
nurses’ caring behavior is always directly proportional to patient satisfaction. Nurses play an
important role to achieve patient’s satisfaction by serving and caring for the patients because
it is the basis when providing care to patients. Nursing caring behavior may automatically
provide quality nursing care to patients. This is also emphasized in Li, Yu, Yang, and Liu
(2016), that caring behavior of nursing student takes into account the essential elements that
The researchers’ purpose in this qualitative study is to assess and investigate the
caring behavior of the BSN III students in terms of patient’s recovery. It makes use of the
main research question: “What are the caring behavior of a student nurse in relation to
With this aim, this research study would help nursing students imbibe the importance
of possessing caring behavior in the nursing practice. This could also help the improvement
of rendering care for patient recovery and satisfaction, and how student nurses view caring in
delivering health services to the patient. For them to manage and understand the importance
of learning caring skills that might potentially enhance patient-centered care and increase
This study aims the caring behavior of level III student nurses in the University
of Northern Philippines towards patient’s recovery during the first semester of academic year
2020-2021.
This section shows the sources that have been used by the researchers
According to the 1971 book “On Caring” by American philosopher Milton Mayeroff
(1925-1979) as cited in Gazmen and Jainar (2018), Caring is the antithesis or the opposite of
simply using the other person to satisfy one's own demands. The meaning of caring is not to
be confused with such meanings as wishing well, liking, comforting, and maintaining, or
simply having an interest in what happens to another. Also, it's not an isolated feeling or a
momentary relationship, neither is it simply a matter of eager to look after some person.
Caring, as helping another grow and actualize himself, is a process, a way of correlating to
someone who involves development, in the same way that friendship can only emerge in time
through mutual reliance and a deepening and qualitative transformation of the relationship.
Whatever the important differences are among a parent caring for his child, a teacher caring
for his student, a physician caring for his patient, or a spouse caring for his partner, it’s shows
that they all exhibit a common pattern. But besides caring for people, during this sense,
People may look after many other things also. An individual may care, for instance, for a
regardless of the important differences between caring for an individual, and caring for a
thought, it shows that there's a standard pattern of helping others to grow. It is this general
pattern of caring that people may be able to describe and explore. It would now like to
examine the role of caring in a man's life and the nature of a life that has been integrated
through inclusive caring. Caring features a way of ordering activities and values around itself;
it becomes primary, and other activities and values come to be secondary. When a person
who has been unable to worry or have anybody or nothing to worry about involves look after
another, many matters previously felt to be important fade in significance and people
associated with caring combat new importance. For example, if others work to care as
compare favorably with others which previously seemed very important, become
community having to do with the welfare and growth of a children which one did not notice
before. As far as an individual can, he must promote and safeguard conditions that make
caring possible, exclude what is in compact· be with caring and its conditions, and
subordinate what is merely irrelevant. Such ordering is not felt as an Imposition from outside
which denies and closes oneself to life; rather, it is unforced and as a natural unfolding,
emerges from within life. It is liberating in that it opens up more fully to life and brings more
in touch with a single identity and others, just as organizing time around what must be find as
genuinely interesting helps to live more significantly. People who value caring by the people,
and to tend to encourage and further it in others. The caring person is drawn toward other
caring people, just as the interesting person (the man genuinely interested in something) is
attracted to other interesting people. Sokola (2017) viewed caring as a developmental process
the other in a caring manner. Knowledge of another is gained through sensibility and
comprehension to another's point of view, but contended that one can only understand in
another person what is understood in self. Therefore, self-awareness is essential to grow and
care. To care for another person, in the most significant sense, is to help him grow and
actualize himself. Consider, for example, a parent caring for its child. A parent gains
admiration to the child as existing in his right and as striving to grow and develop. If a caring
is comprehensive enough, they involve genuinely and fruitfully order all areas of life. Caring
then gives a center around which an individual activities and experiences are integrated.
Human caring as the moral ideal of nursing is the central focus of professional
practice. “In the context of nursing practice, a nurse being with patient is the pattern or form
of the nurse’s care.” (Jarrin, 2012). It involves concern and empathy, and a commitment to
the client’s lived experience of human health and the relationship among wellness, illness and
disease. The nurse, as a person, is engaged as an active partner in the human care transactions
with clients across the life span. Human care ang human care transactions seek protect,
enhance and preserve human worth and dignity. Nursing care involves values, a will and a
care is an epistemic endeavor that defines reflection and action. Caring is contextual, specific
and individual and involves organized, specific practice that is related to caring for and about
others. Caring is nursing’s source of power. According to the Department of Health (2012),
nurse caring as a whole has long been regarded a critical core professional value of
compassion and an ability to respond with humanity and kindness to others’ pain, distress,
anxiety or needs. It is also, the possession of knowledge of assessed needs and related
scientific principles to identify ways in which to give comfort and relieve suffering. Hence,
dualistic caring concept remains difficult to measure and quantify. Eriksson’s (2018) ethical
caring mantra; “I was there, I saw, I witnessed and I became responsible” (pp. 15) can be
helpful when reflecting on nursing the patient. Nurses who are present in the caring situation
see and observe the person’s suffering and understand that they are responsible for acting in
the person’s best interest. To look in the patient’s face can be a way to meet the patients’
vulnerability and suffering (Sæterstrand & Rudolfsson, 2019). According to Watson (1979)
as cited in Oluma and Abadiga (2020), Caring is a principal and unique concept in nursing
which is described as human acts of doing something with people, to people and as people. It
can be effectively demonstrated and practiced interpersonally that result in the satisfaction of
involvement with the others. Nursing care behavior and nurse’s perception of care behavior is
an act and trait enacted by professional nurses that provide concern, protection and attention
to the patient.
clinical caritas processes emerge from Watson’s own caritas factors that involved
the promotion of faith, trust, love, hope, caring, selflessness, spirituality, energy, andundersta
nding. She uses the Greek word ‘caritas’ to mean something that is very fine and indeed
precious, (invoking) love”. She calls for these clinical caritas processes to be a guide used to
practice this theory. These are: Practice of loving kindness and equanimity within context of
caring consciousness. Being authentically present, and enabling and sustaining the deep
belief system and subjective life world of self and one being cared for. Cultivation of one’s
own spiritual practices and transpersonal self, going beyond ego self and opening to others
caring relationship. Being present to, and supportive of, the expression of positive and
negative feelings as a connection with deeper spirit of self and the one being cared for.
Creative use of self and all ways of knowing as part of the caring process; to engage in the
attends to unity of being and meaning, attempting to stay within others’ frames of reference.
Creating a healing environment at all levels (physical as well as non-physical), a subtle
environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and
peace are potentiated. Assisting with gratification of human needs, with an intentional caring
body-spirit, wholeness, and unity of being in all aspects of care; tending to both the embodied
spirit and evolving spiritual emergence. Opening and attending to spiritual-mysterious and
existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for.
This guide is supposed to help a nurse toward implementing caring behaviors into their own
nursing practice. It is also emphasized by Caruso, Cisar and Pipe (2008) that applying
Watson’s theory not only allows for nurses to better care for patients as a whole, but is also
allows for nurses to better care for themselves as whole being as well.
According to McMillan (2017), the core of the Theory of Caring is that “humans
cannot be treated as objects and that humans cannot be separated from self, other, nature, and
the larger workforce.” Her theory includes the whole field of nursing; with the emphasis on
the interpersonal process between the care recipient and caregiver. It is focused on “the
centrality of human caring and on the caring-to-caring transpersonal relationship and its
healing potential for both the one who is caring and the one who is being cared for”, Caring
as the essence of nursing is the core professional value recognized by many nursing oriented
professional and regulatory bodies (Nurse and Midwifery Council, 2010; Canadian Nurses
can’t be separated, namely attention, responsibility, and performed with sincerity Wafika
(2009). Caring behaviors are also an attitude of caring, respect for self and respect for others,
it means to give one's attention and learning preferences and how a person thinks and acts.
Providing care is not that simple, not just an emotional feeling or behavior are being
utilized, because caring behavior is a concern to achieve better care, so that patients were
satisfied with the services provided at an organization of health services such as hospitals.
The caring occasion/caring moment is the space and time where the nurse and patient
come together in a manner for caring to occur. These moments build on the element of
forming a trusting nurse-patient relationship. This time could be established when involving
the patient and family in the plan of care, implementing hourly rounding, patient education
moments, etc. Healing and caring occur in caring moments shared between the patient and
nurse. These moments allow for the nurse and patient to connect on a spiritual level while
creating the potential to change or alter an individual’s life forever (Williams II, McDowell,
& Kautz, 2011). According to Combras (2011), the relationship that nurses develop with
patients during hospital shift in the wards are the most impactful factors that varies caring
behavior and affect satisfaction. Among the caring behaviors assessed, comforting care
behavior had the highest among the nurses, this shows that nurses value comfort when it
comes to caring for their patients. This was supported by Pedrazza, Trifiletti, Berlanda,
Minuzzo, & Motteran, (2015), which stated that comforting takes a huge part in gaining and
technologically advanced and complex care, her/his needs as a human being must be
illuminated. To fully view the patient as a unique individual and invite her/him to a caring
relationship, nurses need to be aware of themselves as a human being and their internal
values (ethos). Becoming aware of one’s inner core values requires self‐knowledge, and
awareness of one’s approach to the patient. Tutton (2005) emphasized the importance of
developing a connection between nurse and patient and the significance of understanding the
patient as well as gaining and retaining an emotional connection. If nurses are aware of the
internal values of nursing, it may be easier for them to see and understand the patient as a
human being in her/his context and be responsible for nursing based on patient needs. In this
way, patients can be the person they want and wish to be. Otherwise, there is a risk that as
with Maya’s Veil, the increasingly advanced and complex care will prevent nurses from
seeing the reality of the situation. By being conscious of their internal values, nurses can
create a setting where they are caring and take responsibility for the patient. Openness,
attentiveness to and respect for the patient as a person can create personal meaning for both
nurses and patients in the caring relationship in nursing practice. Nurses can use self‐
reflection to create an awareness of nursing and caring, as well as ethical inner values in
caring. The advantages are that nurses can thus gaining a deeper understanding of caring in
nursing practice.
According to Longtin (2010), when patient was given a humanistic care, they are
more likely to adhere to orders and active participates of care resulting to better outcome.
Furthermore, Quiting (2013) wrote that nurse are the ones who keep patients’ company for
the longest time. The duty of nurse is not only to deal the ill but to warm the chill. Therefore,
humanistic caring matters more for them in the practices of loving, kindness, the instillation
communication. Even though nursing theories lay emphasis on participation and studies have
explored patient participation in different circumstances and situations, there have not been
congruence on the topic of definition, elements, and processes. The lack of clarity is
collaboration, partnership, and influence. Nevertheless, when the focus is on the patient
viewpoint, the idea of patient participation is commonly used. A nurse needs to use plans
including building close co-operation and rapport with the patient, getting to know the
patient, and reinforcing self-care capacity. It was found that a nurse can lack theoretical or
practical knowledge required as well as an insight that patient involvement needs deliberate
and planned interaction between nurse and patient together through adjusted actions within
known to increase motivation and adherence to prescriptions, give better management results,
create countless satisfaction with received care, and reduce stress and anxiety”. The
participation of the patient is a significant basis for nursing care and medical treatment and it
is also a legal right in various Western countries. Studies have established that the patients
consider participation to be both clear and important, but some of the findings shows the
opposite and patients may desire a passive recipient role. The knowledge that may influence
the patients’ participation is thus of great importance when it comes to meeting their
expectations and demands. Patient participation has been explored in different situations, one
of the examples is discharge planning and bedside reporting in emergency care and was
for the involvement of a patient perception: facing own inability, meeting lack of empathy,
meeting a paternalistic attitude, and sensing structural barriers. Wellard (2003) stresses that
some reasons restricting participation were identified by limited communication among the
nurses and patients, task-oriented nursing labor, and environmental constraints limiting
patients’ privacy.
Clearly, nursing’s body of knowledge points to caring as its essence of focus. Caring
behaviors originated from a strong interest in something or someone that contributes to the
good, worth, dignity or comfort of others. Those descriptive studies presented on nurses’
caring behavior provides a starting point for further research in the effects of caring behaviors
Methodology
This section presents a discussion of the research design, population, data
Research Design
This study is a qualitative research where in the researchers will be using formulated
questions as a guide to gather the relevant data needed for the study. The collected data will
Participants
The participants of the study will be the Level III nursing students of College of
Nursing in the University of Northern Philippines who are already exposed in their clinical
duties at various hospital in Ilocos Sur. 18 participants will be chosen through purposive
sampling to gather relevant and in-depth data. Exclusion criteria for the participants will be
the members of the group researchers and students unexposed or once exposed at OB/Pedia ward.
Students that will participate must have at least 2 ward exposures at OB/pedia areas.
The data gathering instrument will be the formulated guide questions made by the
researcher it will be coupled with observation and interview via phone call/ video call
through FB messenger to gather needed data and to improve the depth of understanding of
the context of caring behavior of the BSN III students and to verify the data gathered through
interview. The interview will be recorded by using a messenger call or a telephone call. After
recording, the content interviews will be transcribed in exactly the same words for analysis.
Specifically, it answered the following questions: What are the caring behaviors of student
nurses that affect patient’s recovery? How effective are these caring behavior of student
nurses to the fast recovery of patient? And What are the problems encountered by the student
Prior to the conduct of the study, the researcher will forward a research proposal to
the Ethics Review and Committee of the University of the Philippines be reviewed, to ensure
that prospective participants will be free from harm. After it has been reviewed and approved,
the researcher will secure an informed consent that is patterned to the template of the World
Health Organization. Included in the consent form is a statement that participants may
withdraw at any time, ask questions, and refuse to answer questions. The consent states that
the participation of the participants will be voluntary and they can withdraw anytime.
Prospective participants will be given adequate information on both the possible risks and the
potential benefits of their involvement to allow them to make informed decisions about
whether or not to participate in the research. Participants interview will last until data
saturation. The participants’ rights, as depicted in the consent, will be reiterated at the
Ethical Consideration
The consideration of ethics in research, and in general business for that matter, is of
growing importance. It is, therefore, critical that the researcher understand the basics of
ethical research and how this might affect their research project. This is especially important
if the research involves interaction with businesses or members of the general community
who serve as participants (i.e., respondents) in the research. There are a range of interactions
in the research that might occur, including in-depth interviews, focus groups, surveys, or even
observing people’s behavior. Though all researchers (student, professional, or academic) are
well intentioned, there is the possibility that interaction with participants may inadvertently
unintentionally disclose a person’s sexual orientation when that person wanted to keep this
confidential.
Informed consent
Informed consent means that the person participating in the evaluation is fully
informed about the evaluation being conducted. Participants need to be made aware of the
purpose of the project, who or what group is funding it, how the findings will be used, if there
are any potential adverse impacts of their participation and who will have access to the
findings. The main purpose of informed consent is that the participant is able to make an
informed decision as to whether they will participate in the evaluation or not. Additional
information should also be provided in the event that the participant becomes distressed in
Voluntary participation
Voluntary participation means that people participate in the evaluation free from
coercion. The researcher explained the importance and made the participants aware about
their participation in the study. The participants on this study are free to withdraw their
participation at any time without negatively impacting on their involvement in the current
study and without any unfavorable consequences and they are not harmed as a result of their
participation. It is the right of participants to leave in the study at any time, therefore no
Do no harm
Harm can be both physical and/or psychological and therefore can be in the form of
the evaluation process does not in any way harm (unintended or otherwise) participants.
Confidentiality
Confidentiality means that any identifying information is not made available to, or
accessed by anyone but the program coordinator. Confidentiality also ensures such
identifying information is excluded from any reports or published documents. Given that
there are often small numbers in peer-based programs, it is very important to consider how
reports are worded to ensure that there is no opportunity for people to be identified even
though names are not used. The researchers removed any identifying information after
analyzing the data and all study results were reported without identifying information so that
no one viewing the results was able to match anyone with the responses. Data from this study
was saved on a password-protected computer and in a secured file folder for one year. Only
principal investigator and study staff will have access to the information
Anonymity
Anonymity is a stricter form of privacy than confidentiality, as the identity of the
participants remains unknown to the research team. This is more difficult to achieve than
confidentiality as participants in the context of social research are usually known to the
program coordinator. To maintain the anonymity of the participants, the researcher ensured
data by assigning code names for participants to keep their identities confidential. Foremost,
their records secure through the use of protected files and keeping survey form in a locked
file. Any of the information will be removed after analyzing and interpreting the data so that
Establishing Trustworthiness
the demonstration that the evidence for the results reported is sound and when the argument
made based on the results is strong. The trustworthiness of a qualitative study can be
increased by maintaining high credibility and objectivity. These criteria include credibility,
the results of qualitative research are credible or believable from the perspective of the
participant in the research. Since from this perspective, the purpose of qualitative research is
to describe or understand the phenomena of interest from the participant’s eyes, the
participants are the only ones who can legitimately judge the credibility of the results
Trochim (2006). The participants will be given a copy of the transcript file to check if they
The idea of dependability emphasizes the need for the researcher to account for the
ever-changing context within which research occurs. The research is responsible for
describing the changes that occur in the setting and how these changes affected the way the
research approached the study (Trochim, 2006). In this study, the researcher’s adviser, critic,
and a panel of examiners will serve as the auditors to examine whether or not the findings,
interpretations, and conclusions are supported by the data. Qualitative research tends to
assume that each researcher brings a unique perspective to the study. Confirmability refers to
the degree to which the results could be confirmed or corroborated by others. There are
several strategies for enhancing confirmability. The researcher can document the procedures
for checking and rechecking the data throughout the study Trochim (2006). The researcher
will return to some participants for verification of the findings to ensure that confirmability
was addressed. Transferability refers to the degree to which the results of qualitative research
transferability is primarily the responsibility of the one doing the generalizing. The
qualitative researcher can enhance transferability by doing a thorough job of describing the
research context and the assumptions that were central to the research. The person who
wishes to the results to a different context is then responsible for making the judgment of how
Risks
The researchers ensured that there are no risks for the participants in their
researchers guaranteed that participants have their rights to be protected against any illegal
invasions for the preservation of their dignity by only collecting personal information that is
essential to the research activity. Collected personal data are securely stored so that only the
researcher may access it and never be released without the express consent of the subject.
Benefits
The research study benefited the health care provider in dealing with their patient and
for them to know the level of caring behavior applied during giving care. The research study
helps to improves services in developing an additional nursing intervention for the patient’s
fast recovery and to gain a richer understanding of how to improve their performance to
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