Chapter 1

The Problem and Its Background

Introduction

The learning of nursing skills in a laboratory is an essential part of the

curriculum. It is here that students are introduced to skills, concept and procedures that

they then take into their clinical settings. Prior to caring for patients, students get to

practice in the lab first where they become familiar and safe with nursing care before

caring for patients in the hospital or community setting. Students come to the nursing

skills lab to practice basic advanced nursing skills during faculty supervised

classes/demonstrations and independent practice time.

The curriculum of nursing schools is characterized by exposing the

students, from the very early beginning of their attachment to the school, to patients

gradually through the different educational years. This is done in a suitable environment

which avoids the student nurse/patient contact being used for initial practice. This

suitable environment is the modern skills laboratory. The Clinical Skills Laboratories are

committed in delivering a first class service to students, providing a safe environment for

the teaching and learning of skills. Based in the nursing schools here in Rizal, the

laboratories consist of one child and midwifery laboratory, two general clinical skills

laboratories and two moving and handling laboratories. Nursing students develop their

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skills by using simulated environments and equipment. Props such as mannequins are

used to practice the different types of procedures and personal hygiene needs of the

would-be patient. Throughout their skills laboratory practice, students are also

shown how to wash their hands properly(hand washing), surgical hand washing

which is very important in the hospital area. All nursing students were able to practice

certain procedures like measuring blood pressure, intradermal intramuscular and

subcutaneous injection, Intravenous injection, rectal examination, vaginal examination

and IUD introduction, male and female genitalia examination, male catheterization,

female catheterization, nasal pack, attendance of normal labor, administering a BT/IVF,

proper gowning and gloving, and other different procedures characterized on each

different areas in the hospital. The researchers focused their study on the effects of

modern skill laboratories on nursing student’s clinical performance. The study will be

conducted on two nursing colleges school in Rizal. The scope of the study focused on

173 students, 90 girl and 83 boy, third year level.

Create a stress-free learning environment that incorporates practice and

reflective learning that will help the students, as well as to provide real world to

independent level of functioning. This is where the researchers would like to work on.

The modern skills laboratory creates and evaluate rich interactive learning

environment that are usable in classroom practice and that push forwards the envelope of

learning technologies including three dimensional visualization model manipulation,

multi sensory feedback and design based on learning this distal creatures will be

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presented so as to allow both interactive viewing and simulated physical and chemical

manipulation, anatomical models, electronic stimulator, modules for conducting

standardized patient encounter and will encourage students to go beyond traditional

learning methods and to apply the learning that they experience in the modern skills

laboratory to their clinical performance.

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Statement of the Problem

To determine the effects of modern skills laboratory to nursing students clinical

performance.

Sub – Problems

Based on the problem stated, the researchers attempted to answer the following questions.

1) How the respondents profile be described in terms of:

1.1 Age

1.2 Gender

1.3 Year level

1.4 Marital Status

2) How does modern skills laboratory affecting nursing students clinical performance be

describe, in terms of:

2.1 Anatomical Model

2.2 Electronic Stimulator

2.3 Modules for conducting standardized patient encounter

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3) How does modern skills laboratory affect the clinical performance of nursing students

in terms of:

3.1 Anatomical Model

3.2 Electronic Stimulator

3.3 Modules for conducting standardized patient encounter

4) Is there any significant relationship between Modern Skills Laboratory in the clinical

performance of Nursing Students in terms of:

4.1 Anatomical Model

4.2 Electronic Stimulator

4.3 Modules for conducting standardized patient encounter

5) To what extent does the modern skill laboratory affect the clinical performance of

nursing students, in terms of:

5.1 Anatomical Model

5.2 Electronic Stimulator

5.3 Modules for conducting standardized patient encoun

5
Purpose of the study

Create a stress-free learning environment that incorporates practice and

reflective learning that will help the students, as well as to provide real world to

independent level of functioning. This is where the researchers would like to work on.

Significance of the Study

Nursing Students: The result of this study could be beneficial to students and expand

their comprehension on how important Modern Skill Laboratories to their clinical

performance.

Instructors: The outcome of this study will be able to help the instructors to teach

more effectively and facilitates good transmission of knowledge with their students.

Patient: This would give the patient optimum level of wellness rendered by the

student’s nurses that are well trained on their modern skills laboratories.

Researchers: The study will give the researcher additional knowledge and

understanding about the effects of modern skill laboratories towards nursing students’

clinical performance. The result of this study might encourage others to conduct further

studies and can be used to advance research in the concept of the effects of modern skills

laboratory on nursing student clinical performance

Scope and Delimitations of the Study

6
 The researchers focused their study on the effects of modern skill laboratories on

nursing student’s clinical performance. The study will be conducted on two nursing

college’s school in Rizal. The scope of the study focused on 173 students, 90 female and

83 male and third year level.

7
THEORETICAL FRAMEWORK

This study is anchored on the theory of performance goal theory by Nicholls, the theory

of simulation by PennState Hersly, and the theory of evaluating clinical simulation for

learning procedural skills by Kneebone R.

According to Nicholls Performance Goal Theory, the central proposition of this theory

revolves around the manner in which individuals determine their goals in achievement

settings such as sport, PE, and the classroom.

According to this theory three factors interact to determine a persons

motivation:

• • Performance goals.
• • Perceived ability.
• • Achievement behavior.

This proposition indicates that individuals in Performance settings are typically oriented

to one of two goals when determining whether or not they have been successful in these

contexts.

• Someone may have a ‘task goal orientation’ where the focus is on improving

performance relative to past performance, not on comparison with others. They

have a stronger work ethic, are more persistent, and are better motivated because

the factors they focus on are internal and more controllable.

• Others may have an ‘outcome goal orientation’ where they constantly compare

themselves with others. Such factors are external and uncontrollable. They tend to

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 give up more easily, and select tasks that are easier to perform.

Individuals who determine success based on self-improvement and task mastery are

displaying a task orientation. For example, runners primarily concerned with improving

their technical form and race times are displaying a task orientation. Conversely,

individuals who determine success by comparing their own performances with those of

others are displaying an ego orientation. For example, runners who focus on beating their

competition regardless of time or technique are displaying an ego orientation.

(For a more complete understanding of achievement goal theory see Nicholls, 1984, 1989

and Dweck & Leggett, 1988.)

Although researchers continue to debate whether task orientation or ego orientation is

more desirable, the majority of the literature tends to support that a task orientation is

more conducive to positive behaviors in achievement settings. Moreover, researchers

have now begun to develop pedagogical practices that seem to influence the achievement

goal orientation of individuals. Therefore, the primary purpose of this paper is to describe

the methods that one can use to positively influence an individual to engage in

achievement settings with a task orientation.

Motivational Climates Ames (1992a, 1992b) has argued that individual goal orientations

may be influenced by the motivational climates that are created by what teachers and

significant others say and do. Moreover, Ames (1992a, 1992b) suggested that climates

focused on skill learning and self-improvement influence task orientation, while climates

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focused on comparisons of performance and ability with peers foster an ego orientation.

Climates that foster a task orientation are called task-involving while climates that foster

an ego orientation are called ego-involving.

Principles described by Ames (1992b) and Epstein (1988) concerning classroom structure

and resulting climates are used to design motivational climates that influence task or ego

orientation. These principles are based on the alterable elements of a lesson which are,

task, authority, rewards, grouping, evaluation, and time. These elements have been

referred to by using the acronym TARGET (Ames, 1992b; Epstein, 1988). The choices

teachers make about these elements determine the degree to which an instructional

climate is more task- or ego-involving

According to PennState Hersly’s Simulation Theory, Simulation training is

incorporated into a medical curriculum using a stepwise procedure (see diagram). First

task trainers are used to grasp the basic concepts of a technique and to practice the related

psychomotor skills.

Then a computer program or a more detailed anatomic model is incorporated to illustrate

the three dimensional anatomy of the procedure or to give a physical context into which

the basic tasks fit.

The next step is to incorporate multiple basic tasks into a complex task using the anatomy

to understand the order and necessity of each task. This step can be accomplished initially

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on a flat screen computer program, in order to establish the sequence of events, and then

moved to a virtual reality trainer to practice the steps of the task in sequence and to make

the environment more realistic.

The last training module would be to perform the entire operation from beginning to end

on a high fidelity simulator or instructor driven simulator. The additional challenge at this

stage is to incorporate the complex tasks into a realistic setting. Trainees are required to

perform multiple, unrelated complex tasks amid the usual distractions not only under

"ideal" conditions, but also to see how these tasks change when there is a problem. The

trainee must now sort relevant information from the environment and make real time

decisions on how to modify the complex tasks based on constantly changing conditions

as the patient responds to their interventions.

There only remains the fine tuning of skills and judgment on a real patient in the

operating room, under the supervision of a skilled health care provider.

Imagine you are a patient in a hospital in the 1890's. You have had trouble with upper

abdominal pain and your doctor says he has to remove your gall bladder. You are moved

from the ward into the operating room where several young men are standing around the

room, attentively watching the surgeon prepare his equipment. They are the residents, or

doctors in training. Another resident, obviously more advanced than the others, is

assisting the surgeon with preparations. As they begin putting you to sleep, you hear the

doctor giving instructions to the assistant regarding where to make the incision and what

11
to look for. The doctor is going to talk the resident through the operation. If the resident

(and you) are lucky, he has already observed several operations and has probably assisted

with a couple of them. Now it is his turn to be "in the driver's seat" for the first time, with

you on the other end of those instruments.

The following excerpt is from Dr. Floyd Burroughs. It chronicles one of his real life

experiences as he began his residency in June, 1897. (from "Reminiscences from the

Turn of the Century" by Floyd Burroughs, M.D. New York State Journal of Medicine, 66

(23), 1 Dec 1966, p 3072-5.)

"Later on, I revisited a forlorn, cheerless room in a sequestered corner of the second

floor, reserved as an arena for conducting surgical operations. My classmates and I were

required to attend surgical clinics in this room. Across its rear was a row of two or three

wooden benches on which we sat in patient misery.

During an operation we students were summoned in groups of three to approach the table

on which the unfortunate patient was stretched, and were permitted to peer over a

surgeon's shoulder at the field of action and this attempt to memorize with almost

photographic ability the technique displayed by a nimble surgeon. We were expected to

acquire enough information to qualify us to tackle a similar job someday..."

This method of teaching is called the apprenticeship model. "Learning on the job" has

been used for thousands of years to teach everything from the proper way to waterproof a

12
canoe to the best time of year to trim back a garden. Until recently, it was also the only

way to teach doctors how to practice medicine. Trial and error, with hopefully not too

many of the latter. Of course, many safeguards were developed over the years for the

patient's well-being, but the resident still had to start somewhere. Cadavers were used to

learn anatomy, but you cannot see inadvertent bleeding or understand the difference in

texture, consistency, and appearance between good and bad tissue if the tissue has been

preserved. Animal labs have been a necessary adjunct to medical training, but still do not

give a completely realistic experience.

When learning to drive, no one would suggest that a teenager read the driving manual,

then jump into a car for the first time and merge onto a 6 lane highway during rush hour.

Teenagers have already spent time observing others driving. When it is their turn to get

behind the wheel for the first time, they are taken to a parking lot or some other safe area,

and are allowed to get the feel of the car in a sheltered, protected environment. From

there, they will progress to side streets, then maybe a highway when there is little traffic.

Only after learning the basics are they ready to learn the advanced skills of handling their

own car while at the same time interacting with the other cars on a crowded road, or

dealing with dangerous conditions like icy roads or thick fog.

Today technology has enabled the medical community (and other professions as well) to

learn in a sheltered, protected environment. Simulated patients are replacing real ones in

the early parts of education. Beginning doctors can now make their most common, most

13
dangerous, and most preventable mistakes on a simulated patient, where the worst

possible outcome has to restart the program. A technique can be practiced over and over

until the trainee is comfortable with the steps and safeguards.

The proper handling of an emergency condition is very difficult to teach during the actual

emergency. Preparation is essential in the form of lectures and rehearsal. During an

emergency situation, however, there is no time to stop and think about what the next step

should be. The actions and protocols should come naturally; they should be second

nature. An instructor cannot withhold treatment during a code and allow the patient to

deteriorate while he waits for the resident to stop and think through the protocol on his

own, or allow the resident to administer inappropriate treatments just to make a teaching

point. Unless, the patient isn't real. The only way to practice a crisis without endangering

a patient is to learn in a simulated environment.

Another boon of the simulated environment is the ability to allow every student the

opportunity to see any disease they may encounter in their practice. In the example at the

beginning of this page, the doctor from the 1890's was required to recognize a limited

number of diseases and to know only a handful of operations commonly practiced in his

day. Today's doctor is expected to recognize and treat literally hundreds of conditions,

some of which are rare enough that he may not encounter them during his entire

residency. For those less common illnesses, residents can use simulation to gain

14
experience, and practicing physicians can use simulation to keep their knowledge and

skills current.

Instead of the old adage "see one, do one, teach one", medical education now has the

option of "see one, practice safely, do one, teach one". After learning from lectures and

observation, residents can practice on a realistic - but not real - patient. When they are

ready to perform the task for the first time on a real patient, they are merely fine tuning

their technique.

Nothing will completely replace learning by interacting with real patients, but the early

learning should take place in a controlled, safe way.

According to Kneebone R.’s Evaluating clinical simulations for learning

procedural skills: a theory-based approach.

Simulation-based learning is becoming widely established within medical education. It

offers obvious benefits to novices learning invasive procedural skills, especially in a

climate of decreasing clinical exposure. However, simulations are often accepted

uncritically, with undue emphasis being placed on technological sophistication at the

expense of theory-based design. The author proposes four key areas that underpin

simulation-based learning, and summarizes the theoretical grounding for each. These are

(1) gaining technical proficiency (psychomotor skills and learning theory, the importance

of repeated practice and regular reinforcement), (2) the place of expert assistance (a

15
Vygotskian interpretation of tutor support, where assistance is tailored to each learner's

needs), (3) learning within a professional context (situated learning and contemporary

apprenticeship theory), and (4) the affective component of learning (the effect of emotion

on learning). The author then offers four criteria for critically evaluating new or existing

simulations, based on the theoretical framework outlined above. These are: (1)

Simulations should allow for sustained, deliberate practice within a safe environment,

ensuring that recently-acquired skills are consolidated within a defined curriculum which

assures regular reinforcement; (2) simulations should provide access to expert tutors

when appropriate, ensuring that such support fades when no longer needed; (3)

simulations should map onto real-life clinical experience, ensuring that learning supports

the experience gained within communities of actual practice; and (4) simulation-based

learning environments should provide a supportive, motivational, and learner-centered

milieu which is conducive to learning.

16
Conceptual Paradigm
Figure 1

17
INPUT PROCESS/TROUGHPUT OUTPUT

Respondent’s Profile
• Age Data Bank Updated
• Gender
• Year level
Martial status

Modern skills Laboratory Describe the effects of modern skills Describe the effects of
affecting nursing students’ on nursing students clinical modern skills laboratory to
clinical performance describe, performance, in terms of: nursing students clinical
in terms of: performance.
• Anatomical Model • Anatomical Model
• Electronic stimulator • Electronic stimulator
• Modules for • Modules for conducting
conducting standardized patient en
standardized patient en counter
counter

Modern skills laboratory effects to Assess the effects of modern skills Identify the effects of
nursing students clinical laboratory to nursing students clinical modern skills laboratory to
performance in terms of: performance through: nursing students’ clinical
• Anatomical Model • Anatomical Model performance.
• Electronic stimulator • Electronic stimulator
• Modules for • Modules for conducting
conducting standardized patient en
standardized patient en counter
counter
Significant relationship between Assess the significant relationship of Determine the significant
modern skills laboratory to modern skills laboratory to nursing relationship of modern skills
nursing students clinical students clinical performance through: laboratory to nursing
performance in terms of: • Anatomical Model students’ clinical
• Anatomical Model • Electronic stimulator performance.
• Electronic stimulator • Modules for conducting
• Modules for standardized patient en
conducting counter
standardized patient en
counter
The extent of effects of modern Assess the extent of effects of modern To determine the extent of
skills laboratory on nursing skills laboratory on nursing students effects of modern skills
students clinical performance in clinical performance through: laboratory on nursing
terms of: • Anatomical Model students clinical
• Anatomical Model • Electronic stimulator performance.
• Electronic stimulator • Modules for conducting
• Modules for standardized patient en
conducting counter
standardized patient en
counter

18
 The Input-Process-Output (IPO) Model guides the readers and the researchers to

think systematically which means looking at outputs or key results, and from this

perspective to examine the required inputs and necessary process of through outputs, then

the systematic logic becomes easier logic becomes easier. (Franco) Input-Process-Output

model also known as the IPO Model is a functional model and conceptual schema of a

general system. An IPO chart identifies programs inputs, its output, and the processing

steps required to transform the inputs into the outputs. The IPO model has many

interdisciplinary applications, and is used to convey systems fundamentals in IT overview

education and as a brainstorming, preliminary investigation tool in systems development

processes such as the SDLC. It consists of at least three, and sometimes four, distinct

components. In contemporary Information Technology, it is almost always discussed as a

four component model in which the fourth is a named optional.

The components of the IPO model are defined as:

• I: Input - The information, ideas, and resources used

• P: Processing - Actions taken upon/using input or stored material

• O: Output - Results of the processing that then exit the system

19
Based on the data obtained and with the background of the study, the researchers made an

easy and more understandable means of studying the research. Profile of the respondent

in terms of age, gender, year level and marital status we gathered the questionnaires that

will serve as data base.

Modern skills laboratory affecting the nursing students’ clinical performance were

assessed through the use of anatomical models, electronic simulators and modules for

conducting standardized patient encounter the effects of modern skill laboratory to

nursing students’ clinical performance.

Modern skills laboratory effects to the nursing students’ clinical performance was

assessed through the use of anatomical models, electronic simulators and modules for

conducting standardized patient encounter the effects of modern skill laboratory to

nursing students’ clinical performance.

Determine the significant relationship of modern skills laboratory to nursing

students’ clinical performance was determined through the use of anatomical models,

electronic stimulators and modules for conducting standardized patient encounter and

identify the significant relationship of modern skill laboratory in nursing students’

clinical performance.

20
 The extent of the

effects of the modern skills laboratory to nursing student’s clinical performance will be

asses through the use of anatomical models, electronic stimulators and modules for

conducting standardized patient encounter and find out the extent of the effects of

modern skill laboratory in nursing student clinical performance.

21
Hypothesis

There is no significant relationship between modern skills laboratory to nursing student

clinical performance in terms of anatomical model, electronic stimulator, and modules for

conducting standardized patient encounter.

Definition of Terms

In order to facilitate better understanding of the problem and avoid ambiguous

meaning to items that can be otherwise interpreted in different ways, the following terms

are used in the study and operationally defined.

Modern Skills Laboratory: Environment for practicing and demonstrating nursing skills

electronic teaching aids such as computers, mannequins, models and other equipment

provide a non-threatening, hands-on learning environment for skill acquisition.

Clinical Performance: refers to the application of learned skills by nursing student in the

clinical area

Anatomical Model: comprehensive guide to anatomy and physiology of the human body

can be aided by practical experience examining histological preparations with practical

experience.

Electronic Stimulator: electronic devices use in hospital

22
Modules for conducting standardized patient en counter: methods of preparing

students for high-stakes standardized patient examinations . Purposes: The purpose is to

compare the impact of two formats of a formative SP examination (Web-based vs. in-

person) on scores on a subsequent high-stakes SP examination and to compare students'

satisfaction with each formative examination format.

23
 Chapter II

Review of Related Literature and Study

This chapter reviewed different literature and studies on the effects of modern

skills laboratory to nursing students’ clinical performance which were taken from local

and foreign sources. The literature and studies were reviewed to provide a clearest

perception of the problem in the study.

Foreign Literature

The Clinical Performance & Simulation Laboratory provides a supportive environment

for students to learn and master nursing skills. Our philosophy of auto-tutorial learning

fosters the development of critical thinking. The laboratory accommodates students by

providing unscheduled time for both skills practice and patient-specific preparation.

Scheduled time is available for physical assessment classes and clinical groups.

The laboratory is staffed with two full time, three part time, and supplemental preceptors.

All preceptors must have a BSN and clinical experience working as Registered Nurses.

The five current preceptors have over 100 cumulative years as RNs. The role of the

preceptor is to support student learning by assisting the students with skills practice and

developing critical thinking. Preceptors do not have responsibility for formal evaluation

of student performance. Behind the scenes the preceptors stay very busy maintaining

equipment and updating the skills modules.

24
Skills Modules have been developed for essential basic as well as advanced nursing

skills. They prepare students for practice in the lab by guiding them through each skill

using objectives and learning activities such as reading, videos, and Computer Assisted

Instruction. All modules are evidence based and are reviewed and updated biannually to

reflect changes in nursing practice and research.

The Clinical Performance and Simulation Laboratory have a wealth of resources and

equipment to enhance both student learning and student teaching projects. Equipment

includes items such as: simulators, life-size manikins, models, and site-specific I.V.

pumps and set-ups. Nursing texts, pamphlets, and posters, as well as policy and

procedure manuals for the major clinical sites are maintained within the laboratory.

Resources and equipment are available to use within the laboratory and also may be

checked out during regular academic year semesters. Materials are available to students

enrolled at all WSU campuses. Faculties are provided with resources to support clinical

and classroom instruction.

Clinical Learning Experience of nursing students, the Board of Registered Nursing is

statutorily authorized to interpret, implement, and enforce the

Nursing Practice Act and its regulations. Business and Professions Code § Section 2729

statutorily authorizes that nursing services may be rendered by a student nurse when

these services are incidental to the course of study when the nursing student is enrolled in

a board-approved nursing program.

25
BRN Position: Nursing faculty of a California board approved nursing program is

authorized by the above law to initiate and continue to allow nursing student’s clinical

education functions including administration of medication. The role of the nursing

faculty is to provide direct and indirect supervision of nursing students in all clinical

activities. The Board of Registered Nursing has relied on Business and Professions Code

Section 2729 and does not consider nursing students as unlicensed assistive personnel for

the purpose of clinical nursing education.

Faculty determines the amount of supervision to provide to any individual nursing

student. When

determining the appropriate level of supervision, faculty must consider the severity and

stability of the assigned patient, the patient’s condition, as well as the student’s

competency and ability to adapt to changing situations in the clinical setting. Faculty

should also consider the types of treatments, procedures, and medications to be

administered to the patient. When engaged in clinical learning experiences the nursing

student is under the supervision of the clinical faculty and the RN in the facility. Both the

clinical faculty and the RN in the clinical facility are responsible for the quality of care

delivered by students under their supervision.

Expanding clinical technology such as electronic medical records, medication distribution

systems, and bar-coding electronic medication administration processes require faculty

and nursing students to attend training sessions allowing them to gain the knowledge

necessary to use these systems. The board expects nursing faculty to ensure that the

26
learning experiences chosen provide the student with the opportunity to develop those

skills necessary to ensure that they will become safe, competent practitioners. Since these

technologies are here today and will be a future part of healthcare delivery, faculty and

nursing students must have hands on experiences with these systems while learning to

provide registered nursing care to patients.

Evaluating nursing clinical performance, the formative and summative evaluation.

When determining the types of information and forms used to complete student clinical

evaluations, it is important to differentiate between evaluative information that permit

additional student growth and evaluation at the end point when no further opportunities

for learning are available.

Clinical evaluation serves two purposes: formative and summative. Through evaluation

the teacher monitors student’s progress toward meeting the clinical objectives and

demonstrating competency in clinical practice. Formative evaluation provides

information about learning needs of students and where additional clinical instruction is

needed. Clinical evaluation that is formative is not intended for grading purposes; instead

it is designed to diagnose learning needs as a basis for further instruction.

Summative evaluation, in contrast, takes place at the end of the learning process to

ascertain if the objectives have been achieved and competencies developed. Summative

evaluation is the basis for determining grades in clinical practice. (Gaberson and

Oermann, 2006.)

27
You will provide formative evaluation both informally and formally. The reassuring

thumbs up after a student’s first injection communicating success is informal formative

evaluation. In the same manner if the student was unable to identify correct anatomical

landmarks, needed reminding to don gloves and not to recap the needle after injecting

medication, then a formal written formative evaluation is required. You will need to

determine the appropriate form used by your program to give written feedback. Some

programs use conference summaries or critical incidents forms.

In cases of clinical skills deficiency the most effective formative evaluation would

include feedback on the skill deficiency and a referral to the nursing skills lab to practice.

As part of the formative evaluation at a future clinical experience for the student

mentioned above you would want to verify that the student had improved the injection

skill by providing another opportunity for the student to demonstrate competency. This

would be particularly important in this example if using correct technique is a mandatory

aspect of safe medication administration that must be mastered by the time of the

summative evaluation to pass clinical.

Self directed learning, both faculty and student share responsibility in promoting clinical

growth. Holding students accountable for their own learning coupled with your providing

those opportunities to master skills, apply knowledge and use critical thinking will

enhance a respectful and trusting learning partnership. In addition students will develop

life long learning strategies, a career necessity,

28
Obermann and Gaberson (2005) identify that the ultimate goal is for students to progress

to a point at which they judge their own performance, identify resources for their learning

and use those resources to develop competency further.

Student aptitude for self directed learning progresses both through individual rotations

and throughout the entire program. As a new clinical faculty member initially you will

most likely feel more comfortable planning the learning environment especially in the

beginning semesters. Some programs have students record skills acquisitions, to share

with clinical faculty, to encourage assigning patients and learning skills to meet student

needs.

Feedback, students are much more accepting of feedback when they are given specific

criteria that must be improved, suggestions for making the improvement, and another

opportunity to show mastery. Give your feedback, as close to the incident as possible to

permit discussion while the event is fresh in both your and the student’s memory. Be

open to the student assessment and rationale of their behavior. A student that you are

identifying as needing time management skills for inability to complete her assignment

may self identify the need for assertiveness training in gaining patient or staff cooperation

to complete her assignment.

Fairness, students receiving your feedback will demand fairness. If you refer one student

with poor injection technique to the skills lab is sure to refer all students with similar

deficiencies. You’re being discreet and confidential when giving students negative

29
feedback will not prevent students from sharing every detail of their clinical

shortcomings with each other. Clinical failure is dreaded and causes students very high

anxiety. Students are very curious to know how other students performances compare to

their own, especially if a given students may be experiencing difficulty in mastering

skills. Student competition is frequently higher when clinical is evaluated with letter or

numerical grades.

In a discussion on competition in nursing school (Dunham, 2007) one student relates that

“there was competition over who had/has the easiest/hardest patient. Some were

extremely jealous if one person got to do a ton of skills in clinical while others didn’t.”

It is extremely important that you do not participate in student comparisons; you must

protect the confidentiality of students with clinical deficits and remind peers who are

inquisitive to focus on their own individual practice. Do not discuss, corroborate, or

correct any information about one student’s performance with another student. Focus on

fairness in making the assignments and the amount of supervision you provide. Even

when you have concerns about one student’s ability to provide safe care maintain a

balance of your time with all students. Providing more supervision of a weaker student is

differential treatment.

Norm-referenced and criterion-referenced evaluation, the discussion of comparison of

students lends itself to the mentioning at this point to two other types of evaluations;

30
norm-referenced evaluation and criterion-referenced evaluation. Norm referenced

evaluation compares and ranks a student’s performance with that of the others in the

group. This is not desired in the clinical setting as all students ideally could meet

outcomes. Criterion-referenced evaluation is based on performance standards that are

predetermined and shared with all students and evaluators; it minimizes comparisons

among students.

A further concern in using norm referenced evaluation beyond unfairness and

competition is that once a student starts demonstrating success in the clinical areas there

is a tendency to assign him/her the more challenging learning experiences than the

student showing less skill and judgment. This process can lend itself to your not

challenging the weaker students who need your vote of confidence and the opportunity to

grow. Furthermore when it’s time to complete the summative evaluation you may not

have enough information to clearly establish whether or not they have met outcomes for

the end of the rotation. The unfortunate outcome is that you will by default promote them

to a higher level of student practice, not having challenged them to prove their ability and

aptitude or to remediate their identified weaknesses. Students develop skills at different

rates so part of your responsibility is to keep abreast of each student’s progress and

provide opportunities for all students to continue on the learning trajectory.

31
Students do need to receive positive feedback on the behaviors that meet desired

outcomes so that they will continue to be developed and enhanced. Students with ability

and aptitude require challenges, just not all the challenges.

Failures, the need to fail a student who has not met outcomes can lead the instructor to

feelings of failure. As a new faculty member myself I had been working with a student

who was very unsuccessful in all aspects of clinical practice. She was consistently

disorganized, omitting care that compromised patient safety. She did not seek assistance

and was not honest about admitting her omissions. I felt that I just hadn’t found the right

patients for her to achieve; I struggled and continued to provide her new opportunities.

When I sought out my course leader for direction, she asked me if I would be

comfortable having this student provide care for my mother. I honestly had to say no. Her

answer was that it was my responsibility to remove the opportunity for her to

irresponsibly omit care for any one else’s mother. Only then did I put aside my feelings

of failure and addressed the student's performance in terms of patient safety and course

outcomes. From that perspective it was clearly evident that the failure belonged to the

student not me.

Clinical failure can be a less stressful process if there is a clear written record of your

providing feedback, suggesting remediation, providing new opportunities, and clarifying

that the student’s performance still does not meet the set standards. Failing nursing

students sometimes initiate grievance procedures, because many students want to blame

32
the instructor rather than accept responsibility for their shortcomings; in their perception

a career has been thwarted, a dream has been squelched. In the similar manner, students

who have had difficulty accepting responsibility for their actions in clinical practice,

continue to not accept the failure as a consequence of their behavior. Grievance proceeds

in the favor of the faculty when there is clear indication that due process has been

followed and the student has received notice of the unsatisfactory performance in a

timely manner. Review both the department and your college’s policies on student

grievances.

With this discussion on formative, summative, norm-referenced and criterion-referenced

evaluation, you can see why you need to get all the answers to your questions prior to the

start of the rotation. To recap, you need to know the level of performance and rating scale

and have frequent team caucus to be consistent with the team, use criterion-referenced

evaluation, and employ fairness. You need to know what evaluation tools are use to

insure that you give notice to deficient students, You need to know the student’s

familiarity with the evaluation and remediation process so that they can actively

participate in their learning And finally you need to know the evaluation intervals so you

can provide timely opportunities to remediate when possible.

The development of a clinical learning environment scale, within nursing, there is a

strong demand for high-quality, cost-effective clinical education experiences that

facilitate student learning in the clinical setting. The clinical learning environment (CLE)

33
is the interactive network of forces within the clinical setting that influence the students'

clinical learning outcomes. The identification of factors that characterize CLE could lead

to strategies that foster the factors most predictive of desirable student learning outcomes

and ameliorate those which may have a negative impact on student outcomes. The CLE

scale is a 23-item instrument with five subscales: staff-student relationships, nurse

manager commitment, patient relationships, interpersonal relationships, and student

satisfaction. These factors have strong substantive face validity and construct validity, as

determined by confirmatory factor analysis. Reliability coefficients range from high

(0.85) to marginal (0.63). The CLE scale provides the educator with a valid and reliable

instrument to evaluate affectively relevant factors in the CLE, direct resources to areas

where improvement may be required, and nurture those areas functioning well. It will

assist in the application of resources in a cost-effective, efficient, productive manner, and

will ensure that the clinical learning experience offers the nursing student the best

possible learning outcomes.

Assessing the Clinical Skills Performance of Nursing Students

This records the development of assessment criteria for the clinical skills performance by

pre-registration nursing students within a problem-based learning curriculum.

Questionnaires allowed informally established provisional criteria to be exposed to

students, practitioners and lecturers from all branches. Any opinions given and

suggestions made by the participants were taken into account and the improved set of

criteria was discussed in branch-specific focus groups, thus further enhancing them. A

34
pilot study with a group of children's nursing students and their supervisors was set up to

test the assessment criteria in practice. The students' skills performances were assessed by

their supervisors as well as by themselves. Interviews with all participants tested the

accuracy of the criteria, most of which were supported by the data. The improved criteria

are used as part of the summative assessment of practice within a problem-based nursing

curriculum.

Critical elements are the required and essential abilities that an individual must

effectively demonstrate as an Excelsior College Associate Degree nursing student taking

the Clinical Performance Nursing Examination (CPNE®).

Excelsior College School of Nursing is committed to providing educational opportunities

to students with disabilities and is in compliance with the Americans with Disabilities

Act of 1990 and Section 504 of the Rehabilitation Act of 1973. The College provides

reasonable accommodations based on the specifics of each case.

The CPNE tests a student's application of the nursing process and technical components

for nursing practice in the care of adults and children in the acute care setting. Therefore

the nursing student must be able to perform the following:

• Assess, perceive and understand the condition of assigned patients;

• See, hear, smell, touch and detect subtle changes in colors;

35
 • Communicate (both verbally and in writing) with English speaking patients and/or

family members/significant others as well as members of the health care team,

including nurses, physicians, support staff and faculty;

• Read and understand documents written in English;

• Perform diagnostic and therapeutic functions necessary for the provision of

general care and emergency treatment to the hospital patient

• Stand, sit, move and tolerate the required physical exertion necessary to meet the

demands of providing safe clinical care;

• Solve problems involving measurement, calculation, reasoning, analysis and

synthesis; and

Perform nursing skills in the face of stressful conditions, exposure to infectious agents

and blood-borne pathogens.

Critical elements are the required and essential abilities that an individual must

effectively demonstrate as an Excelsior College Associate Degree nursing student taking

the Clinical Performance Nursing Examination (CPNE®).

Excelsior College School of Nursing is committed to providing educational opportunities

to students with disabilities and is in compliance with the Americans with Disabilities

Act of 1990 and Section 504 of the Rehabilitation Act of 1973. The College provides

reasonable accommodations based on the specifics of each case.

36
The CPNE tests a student's application of the nursing process and technical components

for nursing practice in the care of adults and children in the acute care setting. Therefore

the nursing student must be able to perform the following:

• Assess, perceive and understand the condition of assigned patients;

• See, hear, smell, touch and detect subtle changes in colors;

• Communicate (both verbally and in writing) with English speaking patients and/or

family members/significant others as well as members of the health care team,

including nurses, physicians, support staff and faculty;

• Read and understand documents written in English;

• Perform diagnostic and therapeutic functions necessary for the provision of

general care and emergency treatment to the hospital patient

• Stand, sit, move and tolerate the required physical exertion necessary to meet the

demands of providing safe clinical care;

• Solve problems involving measurement, calculation, reasoning, analysis and

synthesis; and

Perform nursing skills in the face of stressful conditions, exposure to infectious agents

and blood-borne pathogens.

37
 According to VREL), published by East Carolina University Modern

equipments in the laboratories in the schools is a peer reviewed publication of the Virtual

Laboratory and Education Laboratory (VREL), published by East Carolina University.

Virtual Review in her schools addresses issues of incorporating virtual reality into the

education system of new modern equipments in the laboratories. It can be graphics based

(e.g., a walk through the building) or text based (e.g. a description of activity where

participants can interact with one another.

Modern Laboratories in the schools is published by the Education Laboratory

(VREL) in the College of Education at East Carolina University.. World wide web

provides the fastest dissemination of information which is necessary in the field of

Modern Equipments due to the subjects rapidly changing technology. The Virtual Reality

and Education Laboratory at East Carolina University is dedicated to finding ways to

study the implications of Virtual Reality and Education Lab. at East Carolina in 2006.

The current co-directors are Dr. Pantelids & Mr. David Vinciguerra.

According to College of Nursing at South University 2005 to graduate competent

nurses who are able to offer primary health care in the hospital, community as well as

secondary and tertiary care in any community all over the world. Since its establishment

in 2005, the school has been putting heavy emphasis on ethical considerations and

mastery of basic clinical skills which constitute an important component of clinical

competence. The basic clinical skills refer to those practical skills that are necessary in

38
encounters with patients; these skills are ranging from history taking to examining

different body systems and performing some procedures which should be mastered by

any physician.

Dr. Luanne Linnard-Palmer, chair of Dominican’s Department of Nursing. The

curriculum is characterized by exposing the students, from the very early beginning of

their attachment to the school, to patients gradually through the different educational

years. This is done in a suitable environment which avoids the doctor/patient contact

being used for initial practice. This suitable environment is the clinical skills lab.

The training in the clinical skills lab is not meant to be a substitute of clinical training

with real patients, but rather a preparatory step to it, so that the students become in a

much better shape as they start their training with patients.

The clinical skills lab started its activities in 2005; it was the first skills lab which has

been established in Egypt at that time. The objectives of lab are:

• Standardized training and evaluation of basic clinical skills; using the same tools

for all the students.

• Promotion of the humanistic attitudes in students approach to the patients.

The students are not allowed to examine any patient except after successful performance

of examinations on their peers and/or models.

39
 Integration of the clinical training into the curriculum Training in Integration of

the clinical training into the curriculum is to serve the two main educational strategies of

the College, which are the community-based education and the problem-based learning.

The link of the clinical skills with either strategy varies according to the educational

phase.

In phase I (pre-pathogenesis), the educational problems are organized into blocks which

address sequential phases of human development from pre-natal life to senescence. In

their community-based activities in the primary health care centers, students examine

patients of the same phase of life as in the problems in their blocks. They have to perform

certain clinical skills for each age group such as examination of visual acuity for school

children, measuring pulse and blood pressure of the aged subjects, etc. In the skills lab,

they are trained to perform these skills, using the standard checklists, before practicing on

real patients.

In phase II (pathogenesis), the educational problems are grouped around diseases of the

body systems and those problems form the core around which most other activities are

organized. During this phase, medical problems are utilized to motivate the students to

learn mainly basic medical sciences in addition to clinical sciences. At this level, students

are not requested to make diagnosis or to discuss management plans; instead, they are

supposed to be able to explain underlying basic mechanisms of the symptoms and signs

of various diseases. Thus, the skills on which students are trained, in the skills lab, are

intimately related to the problems they take in their small-group classes. For example,

40
they are trained on the clinical examination of the heart during the block of

cardiovascular problems.

In phase III (clerkship), students learn clinical interventional skills e.g. wound suturing,

urinary catheterization, in order to be more confident and less liable to commit accidental

mistakes as they practice such skills on the patients in the clerkship. The simulation lab,

will allow students to respond in real time to patient situations, said Dr. Luanne Linnard-

Palmer, chair of Dominican’s Department of Nursing.

“This simulation lab, with two programmable mannequins, will put Dominican in the

forefront of nursing education today by providing our students with the real-world

clinical experience they need to transition quickly into the role of an independently

functioning caregiver,” said Linnard-Palmer. “Simulation eliminates the serious risks

inherent in practicing health care skills on live patients and creates a stress-free learning

environment that incorporates practice and reflective learning.”

Two computer-controlled mannequins — an infant and an adult — are the main

simulation tools. The mannequins can be programmed to simulate common medical

conditions such as croup or asthma or more critical conditions like cardiac arrest or

grand mal seizure. If the mannequin is experiencing a grand mal seizure, for example,

the virtual patient will turn blue from lack of oxygen; the vital signs will change and can

show a stress response through impending cardiac arrest or septic shock. The student has

only minutes to respond to changes in heart rate, blood pressure, and breathing. A two-

way walkie-talkie in the mannequin enables the teacher — located in a nearby control

41
center—to serve as the voice of the mannequin so that the virtual patient can describe

symptoms and discomfort. These simulated scenarios will give nursing students the

opportunity to learn correct interventions in a risk-free environment. Errors can be

allowed to occur and play out, providing students with information and feedback about

their individual performance and work as a team. While the mannequins come with pre-

set scenarios, Dominican’s nursing faculty currently are working on creating specialized

scenarios, many of which incorporate psychological components. For example, Linnard-

Palmer, who still practices as a pediatric oncology nurse, has created a three-step

scenario for an infant with leukemia. In the first scenario, the nursing student not only

must recognize the symptoms of leukemia, but also must be able to provide emotional

support to the parents of the newly diagnosed patient the walkie-talkie in the pediatric

mannequin will be linked to a ‘parent.’ In the second scenario, the mannequin is

undergoing intensive chemotherapy and the student must recognize and treat the

complications of chemotherapy. In the third scenario, the child has ended a year-long

course of treatment and the nursing student is providing instructions to the parents while

discharging the patient.

Each mannequin will come equipped with a laptop computer for programming medical

scenarios, and monitors for tracking the results of the medical interventions undertaken

by the students. The lab will also include a video system for documenting classroom

42
 training, student testing, and for immediate feedback via group debriefing of cognitive,

behavioral, and affective skills.

The Skills Lab is equipped with numerous anatomical models. The models are accessible

to the students at all times and they are used extensively during individual and group

study sessions or tutorial sessions

Classes are taught in a safe, non-threatening and friendly environment. One of the

best ways to learn is by discussion and debate. The lab provides a comfortable

atmosphere for students to talk with peers and more experienced practitioners about

issues and dilemmas in patient care.

The Nursing Skills Lab houses a variety of equipment and supplies to assist

students in learning and mastering nursing skills and knowledge. Students are

encouraged to use instruments to practice physical examination (blood pressure cuffs,

stethoscopes, ophthalmoscopes, tuning forks etc), mannequins to practice psychomotor

skills examinations of the ear, eye, breast, prostate, pelvis; dressing changes, urinary

catheter insertions, enema administration, injection pads etc), videotapes, CD-ROMs and

other media, journals, reference materials. Sim Man and Vital Sim are computerized

mannequins used for various adult health.

Practice: The Nursing Skills Lab is a place for students to practice beginning and

advanced nursing skills while supervised by instructors and the skills lab staff or other

students. Although the lab is coordinated by an experienced registered nurse, the

Department hires student assistants to assist with instruction and skill validation.

43
Use multi-media: While at the lab, students can view videotapes, computerized clinical

simulation, and other multi-media that have been assigned or recommended by faculty.

This can be done alone or in small groups.

Competency verification of clinical skills: Students are required to have their competency

in performing certain skills validated. Students first receive instruction in the skill by

their instructor. Students can practice the skill at the lab. Appointment times are listed

on the bulletin board, Skills Lab windows and at the nursing office front desk. Students

are asked to call if they are unable to keep their scheduled appointment.

Supervised Tutoring: Many students take advantage of tutoring that is available by the

Project Manager: Nursing Skills Lab. Flyers are posted with dates and times of tutorial

sessions.

Camaraderie: One of the best ways to learn is by discussion and debate. The lab

provides a comfortable atmosphere for students to talk with peers and more experienced

students about issues and dilemmas in patient care.

The laboratory's centerpiece is a Human Patient Simulator (HPS) developed by

Medical Education Technologies, Inc. The simulator is life-sized and fully interactive.

Cardiovascular features of the HPS include palpable radial and carotid artery pulsations,

heart sounds (normal and abnormal), 5-lead electrocardiogram, noninvasive blood

pressure measurements, direct arterial blood pressure, central venous pressure, pulmonary

44
artery pressure, pulmonary artery occlusion (wedge) pressure, and thermo dilution

cardiac output. All measurements are made using standard monitoring instruments.

Other clinical features include breath sounds, and physiological and pharmacological

models which direct simulated patient responses to drugs, mechanical ventilation, and

other therapies. Virtually all simulator responses are automatic and dynamically

determined by sophisticated physiological and pharmacological models.

The HPS allows us to train students to manage emergencies in a safe, controlled, and

replicable environment. It can be used to expose students to circumstances which they

may see only rarely in the operating room, yet which require immediate and correct

intervention. The simulator is also currently being used to teach such varied subjects as

physiology, pathophysiology, pharmacology, and basic and advanced anesthesia

techniques. It is the first simulator in the United States which is owned by a School of

Nursing.

In addition to the Human Patient Simulator, the Simulation Laboratory contains a variety

of virtual reality and computer-assisted learning resources, as well as texts and journals

related to anesthesia practice.

The Nursing Multimedia Center (NMC) faculty and staff provide supportive

services to departmental faculties and students in the educational components of the

curriculum. The NMC faculty assists in providing limited guidance and instruction for

students as they progress with assignments in the NMC. In addition, the NMC faculty

45
serves as a resource for both faculties and students, and acts as a liaison between the

NMC and individual courses in the curriculum. With input from the School of Nursing

Curriculum Committee, the NMC faculty identifies resources appropriate to support and

enhance the curriculum, and meet specified outcomes for students.

Integral to the functioning of the center, staff provides assistance in locating and using

learning materials and equipment in the NMC. Staff assists in maintaining learning

equipment and supplies, and assembles needed resources in setting-up lab experiences. In

addition, staff also grades and posts tests, and maintains a test file record on each student.

Both faculty and staff provide a formal orientation to the use of the NMC for new

students in the School of Nursing.

The faculty and staff work collaboratively with departmental faculties and administration

to provide coordinated efforts in meeting learning needs of students in the NMC. New

technology and learning materials are identified and brought to the attention of all

faculties as a result of monitoring and previewing media. Faculties participate in the

selection process of learning materials for purchase and use in the NMC.

The Computer Support Staff assists students with the utilization and troubleshooting of

assigned computer based support instruction/software, as well as other resources

available to students on computers located in the NMC. She also works with the School

of Nursing Computer Support personnel on hardware troubleshooting and updates.

At the University of Hawaii at Manoa, students at the SONDH utilize a simulation

laboratory to learn basic patient care as well as gain exposure to critical care situations.

46
Through computerized simulation, a mannequin man and baby can reproduce health

situations and medical conditions such as: cardio arrest, respiratory disorders and internal

maladies. "SimMan" and "SimBaby" can simulate up to 2000 different medical

conditions as well as moans and cries. The use of clinical simulations as an active

learning strategy enhances the students' ability to engage in exploration, inquiry, critical

thinking, reasoning and decision making without jeopardizing client safety.

• Students' ability to engage in critical thinking is enhanced

• The students' ability to respond appropriately in an emergency situation is

improved

• Valuable clinical time is more efficiently utilized with the use of simulations as

teaching tool

• Simulations allow students to work through realistic patient problems and allow

them to make mistakes, learn and be evaluated without exposing a real patient to

risk

The nursing program had previously received a federal grant for the “Sim/Man”

mannequins but space for the virtual lab has been an issue. The college is now scrambling

to find an appropriate space to locate the lab. The equipment is mobile and can be moved

when the college is finally able to build its planned Allied Health and Sciences building.

47
, Nursing Director Kathy researcher and practitioners Wells said. The college is limited

to the number of students it can accept into the nursing program because CWC is “maxed

out” on its clinical hours at regional health care facilities. With the virtual lab, clinical

time in the hospitals can be reduced. Last year alone, CWC had to turn away 100

qualified applicants to the nursing program. Wells is most excited about giving students

the flexibility of dealing with particular illnesses or traumas at the time they are being

taught as the simulators will respond like a real patient and can be programmed to suffer

any medical malady.

If a student reacts properly to the signals of the simulated patient, its vital signs

improve. If the nursing student responds incorrectly, “it will go downhill,” Wells

explained. The program’s graduates will be much more marketable to hospitals and other

acute care facilities when employers know they have been trained to deal with trauma and

illnesses not normally seen at rural clinic sites, she added.

“We can expose students to things that typically would only be seen in large urban

hospitals,” said Vice President for Academic Services J.D. Rottweiler. “We can simulate

things rural nurses may not see during their entire career.”

The “Sim/Man” mannequins provide a sampling of various medical

48
emergencies in which our nurses need training. “The simulation lab will present these

symptoms and train our nurses to immediately recognize and provide needed assistance;

thus saving lives,” he said

The Virtual Medical Skills Lab in California (2008) can also be used by

practicing health care professionals for continuing education and refresher courses that

are required by law “Instead of sending doctors and nurses away for continuing medical

education, the lab will allow them to get it locally,” Rottweiler added.

The simulated mannequins can be programmed to produce any medical condition.

The nursing faculty will have the recipes for all bodily fluids so that students can learn to

test, for example, urine with high and low Ph levels. The new appropriation allows the

college to purchase simulated mannequins for different stages in life, from infants to

elderly. The dummies can even deliver babies in the breech position. Two nursing

faculty, as well as the nursing director, will attend training in Texas this summer to learn

moderate and advanced operational applications of the equipment. In an effort to give

nursing and medical students more hands-on experience in a safe setting, hospitals and

colleges throughout the country are increasingly training with high-tech mannequins

which can, among other things, bleed, sweat and have a pulse. (By CityTownInfo.com

Staff)

49
 According to Leo Manor the University of Phoenix unveiled its brand-new

immersive learning nursing center which features mannequins that cry, talk, cough and

breathe. The school invested more than $400,000 to renovate and equip the facility,

which will be used in its nursing degree programs.

University of Phoenix's immersive learning environment different is that our

nursing students are putting both their clinical and critical thinking skills to work," noted

Pam Fuller, dean of the school's College of Nursing, who was quoted by Reuters. "In

short, they are assessing a patient's condition, prioritizing their responsibilities and

actions, communicating what needs to be done, and then acting on the conclusions they

draw from the situation at hand."

Officials at the Brooklyn Hospital Center in New York, which recently opened a new

Simulation Center for its residency training program, said that the new technology allows

students to learn procedures such as inserting a central venous catheter line or performing

laparoscopic surgery.

"The technology used in the Simulation Center is changing the face of medical

education," said Dr. Benson Yeh, the hospital's chief academic officer, who was quoted

in the Brooklyn Daily Eagle. "Nearly all residency-level education used to take place in a

traditional hospital setting. By creating a 'virtual' patient in a virtual clinical setting, we

can provide residents and nurses with real-life scenarios and give them hands-on

experience with procedures, laparoscopic techniques and cardiac arrest."

50
Foreign Study

According to John L.P, 2003, this study compliments Health Resources Services Virtual

Medical Skills Lab and the use of sophisticated mannequins which can replicate any type

of illness or medical disorder that a student or practicing nurse in a rural setting may not

normally encounter.

While the virtual medical skills lab enhances a all the student’s clinical experience, it

may also make it possible to expand the number well qualified student nurses basic skills.

this study also give the students the flexibility of dealing with particular illnesses or

traumas at the time they are being taught as the simulators will respond like a real patient

and can be programmed to suffer any medical malady.

If a student reacts properly to the signals of the simulated patient, its vital signs improve.

If the nursing student responds incorrectly, “it will go downhill,”

“We can expose students to things that typically would only be seen in large urban

hospitals, “said John L. P.. “We can simulate things rural nurses may not see during their

entire career.”

The “Sim/Man” mannequins provide a sampling of various medical emergencies in

which our nurses need training. “The simulation lab will present these symptoms and

train our nurses to immediately recognize and provide needed assistance; thus saving

51
lives,” he said.

The Virtual Medical Skills Lab can also be used by practicing health care professionals

for continuing education and refresher courses that are required by law. “Instead of

sending doctors and nurses away for continuing medical education, the lab will allow

them to get it locally,”

The simulated mannequins can be programmed to produce any medical condition. The

nursing faculty will have the recipes for all bodily fluids so that students can learn to test,

for example, urine with high and low Ph levels.

The new appropriation allows the college to purchase simulated mannequins for different

stages in life, from infants to elderly. The dummies can even deliver babies in the breech

position.

According to Louie M, virtual lab simulation, 2005, simulation labs will provide almost

all nursing students with clinical experience in a risk-free virtual reality environment. The

simulation lab allows students the opportunity to respond in real time to patient

situations. It also promotes appropriate, timely decision-making in a safe, repeatable

environment. The goal is accuracy and competency of skills before the student enters the

clinical environment.

Each simulation lab has multiple programmable mannequins, including SimMan*, a

52
computer based programmable human patient simulator. This study has put forefront of

nursing education today by providing student nurses with the real-world clinical

experience they need to transition quickly into the role of an independently functioning

caregiver. By providing simulation, it eliminates the serious risks inherent in practicing

health care skills on live patients and creates a stress-free learning environment that

incorporates practice and reflective learning.

State-of-the-art clinical simulation equipment allows practice of nursing skills in a

realistic clinical environment. Having a full spectrum of simulation equipment from task

trainers to virtual skill simulators allows critical thinking practice for a wide range of

conditions. Scenarios can range anywhere from common medical conditions such as

croup or asthma to more critical conditions like cardiac arrest or grand mal seizure.

These simulated scenarios will give nursing students the opportunity to learn correct

interventions in a risk-free environment. Errors can be allowed to occur and play out,

providing students with information and feedback about their individual performance and

work as a team.

Each of the mannequins comes equipped with a laptop computer for programming

medical scenarios, and monitors for tracking the results of the medical interventions

undertaken by the students. The labs also include an IT system for documenting

classroom training, student testing, and for immediate feedback via group debriefing of

cognitive, behavioral, and affective skills.

53
This study may served as a model to all nursing schools to enhance the skills, knowledge

and experienced of their students in the most realistic way.

According to the Relevance of Nursing skills laboratory a study by Dominican

Laboratory, 2006 this study will served as a significant learning resource environment all

the students to practice independently, peer-to-peer, faculty-to-student, or with a skills lab

assistant. The Lab provides an atmosphere to learn and begin to transfer nursing skills to

the “real world” clinical setting.

The learning of nursing skills in a laboratory is an essential part of the curriculum. It is

here that students are introduced to skills, concepts and procedures that they then take

into their clinical settings. Prior to caring for patients, students get to practice in the lab

first where they become familiar and safe with nursing care before caring for patients in

the hospital or community setting. Students come to the Nursing Skills lab to practice

basic and advanced nursing skills during faculty supervised classes/demonstrations and

independent practice time. This study included the use 6 patient beds with functional

head walls units that are equipped with suction and “oxygen” which is actually just air for

manikins. Practice ranges from simple bed making to advanced skills that would be used

in an intensive care setting.

In addition to practicing Nursing Skills in the lab, students often come in to work on the

computers or to watch videos that augment the information in their text. The Nursing

Skills Lab is a Smart Classroom equipped with internet access to projected display.

54
Instructors and students alike can project their classroom materials via PowerPoint or

locate information on the internet to be projected and used in class. There must be always

a Nursing Skills instructor or a qualified and trained professors to help students with any

skills, math or general nursing knowledge. Nursing Students find the Nursing Skills Lab

a welcome place to gather and to study.

According to the study of Dr. Benjamin Dart,2009 a Medical Director for the Clinical

Skills and Simulation Center.

One of the unique elements of a medical field courses is a state-of-the-art Clinical Skills

and Simulation Center that houses both a surgical skills lab and a human patient

simulation lab. Both sections of this center provide an innovative and progressive facility

with stimulating educational experience in a multidisciplinary learning environment in

which residents, practicing physicians, and allied health professionals can train and learn

to provide better patient care

"It is good to have this vital educational element available to all students, residents, and

practicing staff at our institution," according to Dr. R. Phillip Burns, Professor and Chair

of the Department of Surgery and original Medical Director for the Medical Surgical

Skills Laboratory. "Skills training have become more and more frequently required by

credentialing agencies such as the Residency Review Committee as an important part of

medical education."

55
This study emphasized that all skills lab need a two state-of-the-art operating rooms (up

to 12 beds), micro-surgery rooms and anatomical study room, and a classroom. Residents

and practicing physicians are supervised in the acquisition of new skills and the practice

of new medical techniques, including those involved with orthopedic surgery and

arthroscopy, anatomical study, surgical skills practice, microsurgery, and vascular

procedures.

The Skills Lab facilities must enabled professors to teach new techniques and procedures

including specialized courses such as Advanced Trauma Life Support, Pediatric

Advanced Life Support, Laparoscopic Cholescystectomy, and GYN Laparoscopy Lasers.

The adjoining high-fidelity, human patient simulation lab is used to teach skills to all

health care professionals and students in a team environment. This study will help

medical students, residents, faculty, nurses, paramedics, physician assistants, and other

allied health personnel to work in an interdisciplinary patient environment to

improve patient care skills.

Further studies have shown that simulation can be used to reliably measure and

demonstrate resident competencies in acute care management. A simulation lab can take

the form of a trauma bay, operating room, intensive care unit, emergency department, or

a micro-surgery room. The accompanying classroom has audio visual equipment with

computer-controlled cameras, and state-of-the-art multimedia features.

56
The traditional method of bedside training does not give students as genuine an

experience as working with virtual, although tangible, patients. The Simulation Lab

utilizes a novel approach to education where not only medical care is taught, but an

environment is created where interpersonal, teamwork, and patient-safety skills can be

demonstrated and tested.

According to the study of Canterbury Christ Church University (2006) the

modern skills laboratory most practice related teaching was carried out in actual clinical

settings with patients used as the main teaching aids. This was not always appropriate,

especially for the learning of new skills, as it placed both students and patients potentially

at risk.

Canterbury Christ Church University has three well equipped Skills laboratories, located

on its Broadstairs, Canterbury and Chatham campuses, which provide an integral part of

the teaching component of programmes within the Faculty of Health and Social Care.

The first laboratory to be established was on the Canterbury campus in 2006, followed by

Broadstairs (nursing only) in 2008 and Chatham in 2009.

Each laboratory is well equipped with training aids such as simulators and replicates both

the hospital and community setting. The laboratory at Chatham is also equipped to a high

specification with radiography and occupational therapy suites.

57
The laboratories are divided into specialist practice areas for skills development in

nursing (adult, child and mental health), midwifery, operating department practice,

occupational therapy and radiography.

In addition, ward areas to replicate the hospital setting are complete with hospital beds,

lockers, nurse call system, hoists and patient monitoring equipment similar to the

facilities found in a hospital environment.

The Canterbury and Chatham laboratories each have community areas consisting of a

fully equipped bedroom, bathroom and kitchen to reflect the home setting. Dedicated

workshops for teaching the development of woodworking or creative skills and for

undertaking vocational and occupational assessment are integral.

Each laboratory has teaching and discussion areas (fitted with power point projectors)

where group debate can take place. In addition, the Canterbury and Chatham laboratories

have video cameras and microphones in situ so that audio visual recordings can be made.

This is of particular use for assessing students in relation to OSCEs.

Each skill laboratory houses a variety of computer assisted learning packages, and have

access to the World Wide Web and Clinic, in line with contemporary practice in learning

and teaching. Most recent acquisitions include two SimMan simulators (Housed in

Canterbury and Chatham) with ancillary modules and additional medical imaging

equipment to meet the needs of qualified practitioners.

58
Each site has excellent technician support by way of a dedicated Faculty of Health and

Social Care team of technicians. Faculty technicians co-ordinate skills laboratory

teaching by preparing the area and equipment and providing demonstration support. They

are also responsible for managing consumables and ensuring stock control.

The skills laboratories provide students and practitioners the opportunity to practice

clinical and other techniques, in order to gain competence and confidence in skill

acquisition from the start of training through to the development of advanced skills.

Learning new or 'brushing up' on infrequently used skills is more effectively

accomplished in a nonthreatening environment which is designed to be a 'real life'

representation.

As the skills laboratories also house computerized equipment and seminar rooms,

theoretical aspects of learning can be integrated with practice, thus providing the ideal

environment for the integration of theory and experiential learning, without fear of

harming a real patient or fear of failure.

Students or practitioners can learn under supervision and be assessed within the skills

laboratories. Learners can be taught and supervised either on a one to one basis or more

usually in small groups and they are able to develop a variety of perspectives including

that of being a patient, a care or a health professional.

59
 According International Nursing Assessment Consortium (INAC)8 The School

of Nursing provides you with the expert learning and support you need to make your

career in nursing a reality. Nursing can offer you an exciting, varied career with excellent

employment prospects and salaries of up to 100k at Nurse Consultant level.

Our nursing courses cover the core knowledge base that underpins nursing practice

including physiology, pathophysiology, psychology, sociology and clinical skills. You

will also study communication and interpersonal skills, social psychology, ethics and

professional accountability.

Our teaching staff are healthcare experts who are familiar with the care and treatment of

patients, and who understand the need to redefine and adapt knowledge and skills for

real-life scenarios.

We have well equipped laboratories where students can use clinical equipment and

practice on teaching models and mannequins.

Practice placements are an essential part of the nursing programme and enable

students to gain hands-on experience of working under supervision with real patients and

clients. Placements are provided in partnership with a variety of employers – for a list of

some of those employers see Partners and collaborations6.

60
An online directory of nursing placement providers is planned for 2009. In the meantime,

students wishing to find out more about their placements can contact the Nursing

Programme Office, listed on StudentSpace7

Students' work is regularly assessed through a combination of different methods

including essays, examinations, projects and presentations. All modules are individually

assessed to provide students with continuous feedback on their progress and to enable

them to move on to the next phase of the programme.

The Faculty is a member of the International Nursing Assessment Consortium (INAC)8,

through which we contribute to developing international standards in assessing nursing

competence.

Nursing is both academically and personally demanding and students are

supported through their studies to help them succeed. Support includes numeracy help for

those struggling with maths, supervision and mentorship on clinical placements, and help

and advice from other students.

The Nursing Clinical Skills Unit (NCSU) is a state-of-the-art practice laboratory

for nursing students. It is a simulated ward. The NCSU provides students a practice

environment that closely resembles the actual ward environment. For students, the

opportunity to practice within a simulated ward environment will assist them to develop

confidence and familiarity before they experience the actual ward environment. Clinical

61
Nursing Skills are taught in the SU. The NCSU Coordinator closely supervises the

students’ practice sessions. Students are expected to practice as much as possible all

nursing clinical skills that have been taught.

The main area of the NCSU consists of the simulated bed area for patients. With modern

equipment, DDA medication cupboard, blue linen, curtains for privacy, bed side tables,

patient cabinets, eight manual crank beds, two child cots and two basinets, this area is a

definite attraction for all nursing students.

Further simulation is offered by life-size comprehensive practice mannequins (Simon and

Suzie) and they can be found resting in their beds at opposite ends of the ward. Also, a

convincingly realistic ‘baby’ mannequin (Mindy) is often lying awake in the baby cot.

The students find great satisfaction interacting and practicing with Simon, Suzie, and

Mindy. In the future, these mannequins will be instrumental for the students to practice

the more invasive nursing clinical skills required of professional nurses today. Across

from the beds, one can find the dual nurses stations well equipped with tables, chairs, and

a medical case file for patient information. Definitely, learning nursing skills can be a

great challenge, however, the School of Nursing at UCSI University takes pride in how

the NCSU empowers the students to become confident and proficient with their clinical

skills, in their journey towards becoming a registered nurse.

62
 The Nursing Clinical Skills Unit (NCSU) is a state-of-the-art practice laboratory

for nursing students. It is a simulated ward. The NCSU provides students a practice

environment that closely resembles the actual ward environment. For students, the

opportunity to practice within a simulated ward environment will assist them to develop

confidence and familiarity before they experience the actual ward environment. Clinical

Nursing Skills are taught in the SU. The NCSU Coordinator closely supervises the

students’ practice sessions. Students are expected to practice as much as possible all

nursing clinical skills that have been taught.

The main area of the NCSU consists of the simulated bed area for patients. With modern

equipment, DDA medication cupboard, blue linen, curtains for privacy, bed side tables,

patient cabinets, eight manual crank beds, two child cots and two basinets, this area is a

definite attraction for all nursing students.

Further simulation is offered by life-size comprehensive practice mannequins (Simon and

Suzie) and they can be found resting in their beds at opposite ends of the ward. Also, a

convincingly realistic ‘baby’ mannequin (Mindy) is often lying awake in the baby cot.

The students find great satisfaction interacting and practicing with Simon, Suzie, and

Mindy. In the future, these mannequins will be instrumental for the students to practice

the more invasive nursing clinical skills required of professional nurses today. Across

63
from the beds, one can find the dual nurses stations well equipped with tables, chairs, and

a medical case file for patient information. Definitely, learning nursing skills can be a

great challenge, however, the School of Nursing at UCSI University takes pride in how

the NCSU empowers the students to become confident and proficient with their clinical

skills, in their journey towards becoming a registered nurse.

LOCAL LITERARTURES

According to Manila doctors Hospital and Manila doctors College ( MDC 2006 ).

The Top 3 Reasons To Use Anatomical Models And Charts in the Philippines Often

doctors need to explain certain medical concepts to their patients, which can be very

tough as the patients may not know about the details of the human body, medical terms,

etc. Also, in schools and medical colleges in Philippines teachers need to explain various

medical issues or the working of the human body in details. All this cannot be done

verbally. If the patients or students get to see what they are hearing, then understanding

that is easier for them. To make this job easier for doctors, teachers, students and

patients, anatomical charts and anatomical models are used. These models and charts

include brain models, heart models, skeleton models, spine models, torso models, etc.

Likewise, anatomical charts include detailed diagrams of the entire body or only a

particular part of the body. You may need the help of these anatomical charts and models

for many reasons; some of them are cited below:

64
By using anatomical charts and models, medical teachers can have the detailed anatomy

of the entire human body in front of them while they are explaining it to the students. In

schools, colleges, and medical institutes, it is easier for students to understand the human

body in a better way with the help of these anatomical models and charts. They are often

updated with new medical researches and discoveries so that any student going through

these charts or models can getup-to-date information.

Having a detailed description for all the small and big parts of the body is a great

help for the doctors and physicians. Anatomical models include all parts of the body, be it

ears, eyes, nose, legs or any other part. When a patient gets to understand properly what

and where a problem has occurred and how it can be removed or cured, then it becomes

easier for them to face any surgery or treatment. This not only makes the patients calm

before a surgery, rather they themselves can understand what limitations and restrictions

the doctor is facing.

Doctors can explain to their patients about the disease they are suffering from and

how it affects their body, using these anatomical models and charts. In certain cases,

especially after surgery, such models of the human body can be used to explain to

patients why they shouldn’t move a particular part of their body, for quick recovery.

Health Science Education (AHSE) 2005 introduces an advanced chart or model

of the human body is more suitable for senior students, doctors, and the like. But school

children may find them difficult to understand. So, the less complicated and larger than

65
life anatomical models are mainly used in junior schools. Different levels of anatomical

models and charts are available for students of different age groups. Anatomy models and

anatomy charts are also commonly used by fitness trainers, buying groups, chiropractors,

hospitals, physical therapists, and many other health care professionals. Veterinary clinics

also require animal anatomy models and charts.

Charts and diagram of human anatomy have been the cornerstone of the nursing

colleges in the Philippines (2004-2005) with a level III status since its inception.

Anatomical charts are essential teaching tools for understanding the man complex

elements of human anatomy and the effect of disease and trauma on those elements.

Elaborate illustrations provide a window into the human body that is clear and accessible

whether you are a medical professional, student or patient. More than just a tool of

medical education, anatomical charts also serve a valuable purpose as a practical

reference for both physician and patient. Complex and confusing medical procedures can

be more easily explained to the lay patient with the use of well made anatomical chart

allows nursing students to practice on make-believe patients to learn, sharpen and

improve skills. May nursing schools use high-tech mannequins to simulate real- life

patient situations.

The mannequins can be used to teach nurses simple techniques, such as how to

bathe patients and more complicated techniques, as well as how to react in emergency

situations.

66
The mannequins are programmed to act and react like humans they breathe, talk and

make other sound. Instructors can control interactions between the mannequin and the

nurses from central control room theses interactions are recorded and used as a teaching

tool.

The use of technology in nursing schools is viewed as a vital complement to hands – on

clinical experience. Along with patient simulations, the national league for nursing

believes nursing information technology should be a part all nursing schools curriculum.

Local Studies

According to FEU (2007) the Primus Interprets of first among equals in the

Philippines to have a real nursing Modern Laboratory uniquely designed as a stimulated

hospital proudly carries “Gold Standard” the yardstick by which all other nursing skills

are measured. The hospital set-up closely approximates the standards of the Joint

Commission, the leading health care accrediting body in the USA and other international

hospitals and infection standard in terms of bed-to-sink ratios, hospital door widths,

functionally and work and patient flow. In addition, AUSTCO, the leader in quality nurse

call system in the Philippines. With the nurse call system, students will learn to respond

to patient calls within two minute of the call enhancing the student’s customer service

and interpersonal relation skills.

67
 Competence, consistency and cognitive skills of nursing students by adapting

those kind of responses. And innovative spirit, FEU aims to bring the institute of nursing

to the forefront of nursing education in the Philippines, preparing its students to take on

the demands of a global tomorrow. Step into the FEU institute of nursing’s new state of

the art virtual laboratory which opened its doors in December 2006. The uniquely

designed simulated laboratory proudly carries the “Gold Standard”, the yardstick by

which all other nursing skills laboratories are measured. The hospital set up closely

approximates the standards of the Joint Commission. The leading health care accrediting

body in the USA and other international hospital and infection standards in terms of bed-

to-sink ratios, hospital door widths, functionality and work and point flow. In addition,

AUSTCO, the leader in quality nurse call systems , has partnered with FEU to house the

only advanced, cutting edge nurse call system has partnered with FEU to house the only

advanced, cutting edge nurse call system in the Philippines. With the nurse all system,

students will learn to respond to patient calls within two minutes of the call enhancing the

student’s customer service and interpersonal or relational skills. Dean of FEU IN

Anabelle Borromeo proudly announced “The Virtual Laboratory provides a learning

platform that allows our students to practice real life situations, training them to be nurses

of tomorrow.” Using third-operation computer-based simulations instead of the

traditional mannequins, the virtual laboratory at FEU_IN provides its realistic conditions

through the use of advance technology. Meet HAL, the human patient simulation who is

capable of taking breaths, talking having his pulses palpated and his blood pressure

68
obtained. The instructor controls HAL through a wireless computer, as such, HAL can be

programmed to experience realistic medical, which students can learn from. Besides

HAL, the FEU virtual laboratory likewise boasts or Noelle, the maternal interactive

birthing models with which nursing are able to assess pregnancies and births. FEU-IN’s

virtual laboratory aims the advantage nursing education in the Philippines by providing

its students with cutting edge training and equipment, creating the nurses of tomorrow.

On the top of the high-tech human patient simulators, the laboratory also boasts of an IV

insertion simulator. The device presents varying é of difficulty and complications in the

IV therapy procedure, simulating skin stretching, blood flashback, threading off of the

catheter and even provides the realistic pop of venipuncture, allowing the user to

experience the feel of realistic IV procedures. The Virtual Laboratory will also be

equipped with video conferencing terminals to capture master lectures and

demonstrations of nursing procedures. Captured video will be steamed live other

classrooms or computer laboratories where viewers are able to call the lecture and ask

questions. In some cases, the material will be saved for later viewing either in group

settings at classrooms or laboratories, or for download by students to their own portable

devices. Later, additional learning hospitals or schools so that students can, for example,

follow an actual operation taking place at a remote operating room via the video

conferncing technology.

According to Dean Borromeo, a nurse today, to be globally competitive,

must acquire basic skills in three areas while still in nursing school; these are technical,

69
relational and critical thinking skills. The virtual laboratory is an opportunity to fast track

the acquisition. Research on students show that those who have undergone stimulator

classes have exhibited improved preparedness and self-efficacy. The virtual laboratory is

FEU contribution to the development of nursing education in the PHILIPPINES by

providing quality education and advance training FEU creates globally competitive

nurses who are well-equiped for the demands of the tomorrow. For what sets these

graduates apart from the rest is that day are equipped with an in-depth nursing foundation

allowing them is function in any setting.” Dean Borromeo proudly commented by

supporting the advancement of quality nursing education and state of the art equipment,

FEU aims to be in the forefront of nursing education in the Philippines.

According to Manila Times (Sunday, March 25, 2008) FEU Institute of

Nursing transforms Philippine nursing education via its modern Virtual Laboratory.

Reflecting the rapid changes and developments in medical science and technology, Far

Eastern University’s Institute of Nursing to takes nursing education to the next level,

providing its students with the advantage of world class educations right here in the

Philippines through its traditional of excellence.

According to the Fatima News Team (Thursday, August 16, 2007) Modern Skills

Laboratory is the most extensive clinical simulation Laboratory in the country today,

features state of the art computer-model-driven-full sized human patient. Simulations

70
(HPS) that allow Fatima’s nursing students to experiences true to life clinical scenarios

that greatly augment their clinical treining. Will the nurse call system, students will learn

to respond to patient calls within two minutes of delivery.

71
 Chapter III

Research Methodology

This chapter presents the discussion on the research methodology of the study, the

subjects, population frame, and sample, research instrument, design, data gathering

procedure and statistical treatment used to analyze and interpret data.

Research Design:

The descriptive study, according to John W. Best (1999) is concerned with the

condition or relationship that exists practices that prevail, beliefs point of view or

attitudes that are held, processes that are going on; effect that are being felt; or trends

that are developing .

In view of this descriptive method used of research because this method has been

proven to be useful in the collection and organization of research data in order to arrive at

findings in conclusive form. The study extended to determine the relationship of nurses

clinical working strategy to patient level of satisfaction. Moreover the study would

determine the significant difference from one another of the three variables that affects

the patient level of satisfaction.

All of these justify the appropriateness of the descriptive method in the present

study

72
Research Settings

The study will be conducted in two Colleges of Nursing in Rizal.

Sampling Procedure

The researcher made use of stratified random sampling technique to assure that every

member of the population would have an equal chance to be chosen as respondents.

Respondents of the study

Respondents were chosen by the researchers to give questionnaire on specific

respondents that will supply us the needed information. Researchers will be giving

questionnaires to all third year nursing students who are presently with modern skill

laboratory.

Research Instrument

The instruments ]are the letter of approval and the questionnaires that will be

filled by the 3rd year Nursing Students in Colleges of Rizal. The letter of approval serves

as the permission in conducting research in one Nursing College in Rizal.

The use of self constructed questionnaire method as a research instrument to

gather data from the selected population. The researchers will distribute survey

questionnaires at the target population to be able to gathered data regarding their

attitudes, opinions and practices of effects of modern skills laboratories of nursing

73
student level competency. The questions are structured in which it requires straight

forward factual information without any unnecessary interaction in respondents and

presented in English dialect. The effect of modern skills laboratories the nursing students’

clinical survey will be answered on a Likert Scale of five point ranking system:

Strongly Agree (5), Agree (4), Uncertain (3), Disagree (2) and Strongly Disagree (1).

SUBJECT OF THE STUDY

The subjects of the study were composed of 173 nursing students 90 female and

83 male in two nursing colleges in Rizal.

Data Gathering Procedures

In the process of gathering data for this study, the researchers were accompanied

by the following phases:

Foremost, the researchers must obtain a formal letter of request that will be signed

by the research adviser to conduct a survey among 3rd year nursing students in two

nursing colleges in Rizal. Afterwards, they will identify the total number of their subjects

and make ready of the questionnaires that will going to distribute. Next, the researcher

will finalize the questionnaire. They will spread out the questionnaire out to their

74
respondents personally and secured them confidentiality of the resources and

information. When all questionnaires are returned, the researcher will allies the result of

the survey and employs the statistical treatment to the guide of their statistician.

Statistical Treatment of Data

Two forms of analysis is used in the study; namely, descriptive statistics such as

percent, F-test, mean and standard deviation to assess the relationship of nurses clinical

working strategies to the patient level of satisfaction. In addition, Pearson “r’ and

weighted mean was also used to determine the relationship between the variables.

A. The researchers made use of the percentage method to treat the data statically for

problem no.1 which respond to respondents’ profile, the formula used was:

Formula:

% = _ f__ x 100%

Where:

f --- Frequency

N --- Total Population

75
The results of the data gathered will be presented and analyzed with the use of tables

corresponding average in percent (%).

B. For problem no.2, the researchers used Weighted Mean as their statistical formula to

determine the effects of modern skills laboratory on the clinical performance of nursing

students. The formula used was weighted mean

Formula:

WX = ∑fx

______

Where:

WX --- Weighted Mean

fx --- Summation of Frequency

N --- Total Population

76
C. For problem no.3, which deals with the significant difference of the effects of modern

skills laboratory on the clinical performance of nursing students, data where subjected to

analysis of variance in which the F-test T-test were used.

Formula:

F = MSAG

MSWG

Where:

F --- The F – Test

MSAG --- Mean Squared Among Group

MSWG --- Mean Squared Within Group

Formula:

t= X1 – X2

Where:

77
 t = the t-test

X1 = the mean of Group 1

X2 = the mean of Group 2

SS1 = the Sum of Squares of Group 1

SS2 = the Sum of Squares of Group 2

n1 = the number of Observation in Group 1

n2 = the number of observation in Group 2

D. The researchers utilized the Pearson’s R formula to determine the significant

relationship between the independent and dependent variable to obtain the value of R

from ungroup data, the formula is as follows:

Formula:

r = (∑dx) (∑dy)

______________

√ (∑dx 2) (∑dy 2)

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 ∑dx 2 = ∑x2 - (∑x) 2

∑dy 2 = ∑y2 - (∑y) 2

(∑dx) (∑dy) = ∑dxy - (∑dx) (∑dy)

Where:

r --- Correlation between x and y

∑dx --- Sum of Test x

∑dy --- Sum of Test y

∑dx 2 --- Sum of Squared x Scores

∑dy 2 --- Sum of Squared y Scores

(∑dx) (∑dy) --- Product of the sum of x and y

79
E. The sample mean standard deviation were used to identify the extent of the effects of

modern skills laboratory of the clinical performance of nursing student and the mean

formula was used

Formula:

x = ∑x

Where:

x = sample mean

∑x = sum of the sample observation

n = sample size

Formula:

√ SD = ‌ i∑ fd2 - (∑ fd)2

n–1

Where:

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SD = Standard Deviation

∑ fd2 = Sum of the product between the frequency and fd.

n = Sample size

i = Interval

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 CHAPTER 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter deals with the presentation, analysis and interpretation of data

gathered regarding the effects of modern skills laboratory on nursing students’ clinical

performance.

Problem 1

The profile of the respondents in terms of Age, Gender and Civil Status.

Table 1 presents the frequency and percentage of the respondents in terms of

age, gender and civil status.

Table 1.1

Frequency distribution of the respondents in terms of age, gender and civil status.

Age Frequency Percentage

18-20 153 88.43%
21-23 6 9.24%
24-26 1 .6%
27-29 1 .6%
30-32 2 1.16%
Total 173 100%

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Table 1.1 shows the distribution of respondents according to age. The age group 18-20

years old among all the respondents got the 1st highest percentage which is 88.43%; the

age group of 21-23 years old among all respondents got the 2nd highest percentage which

is 9.24%, the age group of 30-32 years old among all respondents got the 3rd highest

percentage which is 1.16%; there is an equal distribution of respondents according to age.

It’s composed of the age group between 24-26 and 27-29 which is .6% of the student

respondents.

The age group of 18-20 got the highest percentage. This is maybe due to the

year level of the respondents. It can be inferred that college students’ age really falls on

that age bracket during this year level of studying.

Table 1.2

Frequency Distribution showing the gender of the respondents.

83
 Gender Frequency Percentage
Male 83 48%

Female 90 52%

Total 173 100%

As seen in the table 1.2 there are more female respondents which

comprised 52% that male respondents which comprises only 48%.

The trend about gender in the education ascertained the prevalent finding

that the female and males. It implies that both male and female are more persistent in

taking the nursing course.

Table 1.3

Frequency Distribution showing the civil status of the respondents.

Civil Status Frequency Percentage

Single 151 87%
Married 22 13%
Total 173 100%

Table 1.3 dearly shows the frequency and percentage distribution in terms

of civil status. As shown from the table there are 22 or 13% married and 151 or 87% of

them are single.

84
 Based on the age group, the respondents are expected to be single (18-20);

which comprised the highest percentage.

Problem 2

The descriptionof the modern skills laboratory affecting the nursing students’ clinical

performance..

Table 2
The computed weighted mean of anatomical model

Anatomical Model Wx Verbal Rank

Interpretation
1. Facilitates better knowledge transmission through 4.48 Strongly 1
demonstration on all the nursing procedure. Agree
2. Anatomical chart allows nursing students to practice 4.23 Strongly 3
on make believe patient to learn, sharpen and improved Agree
skills.
3. By using anatomical charts and model, teachers can 4.39 Strongly 2
have detailed anatomy of the entire human body. Agree
Average 4.37 Strongly
Agree

It was seen from the table that item number one got a mean of 4.48% which

is rank 1st with a verbal interpretation of “strongly agree”. item number three is second in

rank which got a mean of 4.39 and with a verbal interpretation of “strongly agree”. Third

in rank with a mean of 4.23 was item number 2 with a verbal interpretation of” strongly

85
agree”. Summing it up the average mean was 4.37 for the 3 given item with the verbal

interpretation of “Strongly Agree”.

It implies that students strongly agreed that anatomical models facilitates

better knowledge transmission through demonstration on all the nursing procedure, as the

most basic function of these anatomical model, because through the presence of

anatomical models, nursing procedures, and nursing actions are well practiced by the

students on a systematized and timely manner.

Table 2.2

Computed Weighted Mean of the Effects of Modern Skills Laboratory in Nursing

Students Clinical Performance in terms of Electronic Simulators.

Table 2.2 presents the computed weighted mean of the effects of modern skills laboratory

in nursing student’s clinical performance in terms of electronic simulator.

A. ELECTRONIC SIMULATORS Wx Verbal Rank

Interpretation
1. Nursing students have undergone simulators 4.14 MA 1
classes have exhibited and improved

86
 preparedness to clinical areas.
2. Simulators allow the students to practice 4.5 MA 2
basic skills such as recognizing cardiac sounds
(normal and pathologic), central and peripheral
vein access, pelvic exam and to use ECG,
cardiac monitor and defibrillator just prior to
entering the clinical setting.
3. Student nurses know how to interpret the 4.06 MA 3
results produced by the instrument they use and
aware of the limitations and possibilities of
errors uncritical reliance on values obtains by
the electronic simulators or machines use in
hospital.
Average 4.23 SA

As we can see in the table, the item “nursing students have undergone simulators

classes have exhibited and improved preparedness to clinical areas” ranked first with the

weighted mean of 4.14, the second rank belong to the item “simulators allow the students

to practice basic skills such as recognizing cardiac sounds (normal and pathologic),

central and peripheral vein access, pelvic exam and to use ECG, cardiac monitor and

defibrillator just prior to entering the clinical setting” with the weighted mean of 4.5, and

87
the third ranked with a weighted mean of 4.06 belongs to the item “student nurses know

how to interpret the results produced by the instrument they use and aware of the

limitations and possibilities of errors uncritical reliance on values obtains by the

electronic simulators or machines use in hospital”. All of the three items has a verbal

interpretation of “mostly agree”

It implies that students mostly agreed that nursing students who have undergone

simulator classes have exhibited and improved preparedness to clinical areas, because

through these simulation classes, the students are experiencing the natural act on hospital

area that prepared themselves on their first clinical visit, errors are known in advanced

that prevented it when real life are handled.

Table 2.3

Computed Weighted Mean of the Effects of Modern Skills Laboratory in Nursing

Students Clinical Performance in terms of Modules for conducting standardized patient

encounter.

88
 B. Modules for conducting standardized Wx Verbal Rank

patient encounter Interpretation

1. Standard and nursing skill procedures written in 4.19 MA 3

the module helps the student nurse in easy delivery

of services to patient.
2. Module helps the student nurse in easy access of 4.47 SA 1

things encountered in the clinical area.

3. Procedures done in the clinical areas are 4.23 SA 2

systematized through the guidelines on the

module.
Average 4.30 SA

The table 2.3 reveals that item “module helps the student nurse in easy access of

things encountered in the clinical area” ranked first with a weighted mean of 4.47, ranked

second was the item “procedures done in the clinical areas are systematized through the

guidelines on the module” with a weighted mean of 4.23, both the first and second rank

are verbally interpreted as strongly agree, while the third rank “standard and nursing skill

procedures written in the module helps the student nurse in easy delivery of services to

patient” verbally interpreted as mostly agree, with a weighted mean of 4.19.

It implies that modules play a great help to nursing students for giving easy access

of things encountered in the clinical areas

Table 2.4

89
Composite table on the Effects of Modern Skills Laboratory in Nursing Students Clinical

Performance

Table 2.4 presents the effects of modern skills laboratory in nursing student’s clinical

performance.

Wx Verbal Rank

Interpretation
ANATOMICAL MODEL 4.37 SA 1
ELECTRONIC SIMULATOR 4.23 SA 3
MODULES FOR CONDUCTING 4.30 SA 2

STANDARDIZE PATIENT ENCOUNTER

AVERAGE WX 4.3 MA

As shown in the table “anatomical model” ranked first with a weighted mean of

4.37, followed by “modules for conducting standardized patient encounter” with a

weighted mean of 4.30. Last in rank was “electronic simulator” with a weighted mean of

4.23 and all were verbally interpreted as strongly agree. The average sum of all the

weighted mean was 4.3 with a verbal interpretation of “mostly agree”.

The result implies that third year nursing students perceived that modern skills

laboratory affects their level of clinical performance as evident by high weighted mean.

Anatomical model has the highest mean among the three model skills laboratory

that affects the clinical performance of nursing students. This inferred that it may be

90
giving the great effect to the clinical performance of nursing students for most of the

students now are becoming more visuals than non-visuals.

Problem 3

Table 3.1

Variance Analysis in terms of sum of the variance on the Effect of Modern Skills

Laboratory on Nursing Students Clinical Performance

Sum of df Sum of Mean of S F. Value

Variance Square Square

Sum Among 2 0.02 0.01 0.31

Group
Sum Within 6 0.19 0.032 0.18

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 Group
Total 8 0.21 4.82 Critical Value: 5.143

Table 3.1 present the computed F-test on the effect of modern skills laboratory on

nursing student’s clinical performance in terms of anatomical model, electronic simulator

and modules for conducting standardized patient encounter.

The F-test of variance of the Effect of Modern Skills Laboratory on Nursing

Students Clinical Performance yielded a value of 0.31. Since the computed f value is

smaller than the critical value of 5.143 at 5% level of significance for the indicated

degree of freedom the null hypothesis was accepted. The result indicated that the

variables of Modern Skills Laboratory have an effect on Nursing Students Clinical

Performance but no significant difference with each other.

Problem No. 4

The Significant Relationship on the Effects of Modern Skills Laboratory on

Nursing Student’s Clinical Performance in terms of Anatomical model, Electronic

Simulator and Modules for conducting standardized patient encounter.

In order to determine the relationship between the effects of modern skills

laboratory on nursing student’s clinical performance, the researcher has measured the

degree of correlation using Pearson’s coefficient of correlation. The table 4.1 summarizes

the result of this test.

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 Table 4.1

Computed R-value on the relationship of the effects of modern skills laboratory on

nursing student’s clinical performance.

Variables R r² Interpretation Hypothesis

Anatomical model 0.8 0.76 Significant Reject Ho

7
Electronic simulator 0.8 0.76 Significant Reject Ho

7
Modules for conducting 0.8 0.76 Significant Reject Ho

standardized patient encounter 7

Critical Value: .829

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 The distribution could lead support to analysis of the correlation between the

effects of modern skills laboratory to nursing student’s clinical performance in terms of

anatomical model, electronic simulator and modules for conducting standardized patient

encounter.

The computed value of r between anatomical model, electronic simulator and

modules for conducting standardized patient encounter is 0.87 respectively.

It can be inferred that anatomical model, electronic simulator and modules for

conducting standardized patient encounter inflict effects to nursing students clinical

performance because all of them provides the essential hands-on learning, thorough

explanation on humjan body, ways of handling proper care and gives a guided

explorations on different nursing skills that enable the students to gain abilities to

rendered oiptimum level of c

Problem 5

To what extent does the modern skills laboratory to nursing student’s clinical

performance in terms of:

5.1 anatomical model

5.2 electronic simulator

5.3 modules for conducting standardized patient encounter

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 Table 5

Result of computed mean standard deviation

Variables X Standard Deviation Verbal

Interpretation
Anatomical model 13.1 8.47 Strongly Agree
Electronic simulator 12.7 8.75 Strongly Agree
Modules for conducting 12.89 8.59 Strongly Agree
standardized patient
encounter

The table 5 presents the result of computed mean and standard deviation.

Anatomical model with a weighted mean of 13.1 and a standard deviation of 8.47, the

item modules for conducting standardized patient encounter with a weighted mean of

12.89 and a standard deviation of 8.59, to electronic simulator with a weighted mean of

12.7 and a standard deviation of 8.75

. All of the items has a verbal interpretation of strongly agree.

It may be inferred that anatomical model has the greatest extent in effecting

nursing students clinical performance because it is the most reliable and easiest way on

transferring knowledge and demonstrating all nursing procedures. The basic of science

and such nursing skills can be summarized as a set of steps that helps the students

transmits skills and abilities through the use of anatomical models.

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 CHAPTER 5

SUMMARY, CONCLUSION AND RECOMMENDATION

This chapter presents the summary of findings, conclusion and

recommendations of the study and for further research and investigation. This piece of

work revealed the effect s of modern skills laboratory on nursing students’ clinical

performance such as anatomical model, electronic simulator and modules for conducting

standardized patient en counter.

SUMMARY OF THE STUDY

This study attempted to determine the Effects of Modern Skills Laboratory on

Nursing Students Clinical Performance.

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 The descriptive method of research was used with the assessment examination

as the main tool for gathering data.

The respondents of the study were 173 third year nursing students of two nursing

colleges in rizal.

The summaries of findings of the study are as follows:

Problem 1.

1. The profile of the respondents in terms of Age, Gender and Civil status.

1.1 In terms of age, ranked number one was the age bracket of 18-20 with a

frequency of 153 and 88 percentage.

1.2 In terms of gender, the female respondents outnumbered the male with a

frequency of 83 and a percentage of 48%.

1.3 In terms of civil status, single students outnumbered the married with a

frequency of 151 and a percentage of 87%.

97
2. description of modern skills laboratory affecting on nursing students’ clinical

performance in terms of anatomical model, electronic simulator and modules for

conducting standardized patient en counter.

2.1 In terms of Anatomical Model, the item “facilitates better knowledge

transmission through demonstration on all the nursing procedure” ranked

first with a weighted mean of 4.48 and verbally interpreted as “strongly

agree”.

2.2 In terms of Electronic simulator, the item “nursing students have

undergone simulator classes have exhibited and improved preparedness

to clinical areas” ranked first with a weighted mean of 4.14 and verbally

interpreted as mostly agree.

2.3 In terms of Modules for conducting standardized patient en counter, the

item “module helps the student nurse in easy access of things

encountered in the clinical area.

3. Effects of modern skills laboratory on nursing students clinical performance.

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 3.1 Nursing students clinical performance did not differ in terms of modern

skills laboratory.

4. The Significant Relationship of Modern skills laboratory to nursing students’

clinical performance in terms of anatomical model, electronic simulator and

modules for conducting standardized patient en counter.

4.1 Anatomical Model and electronic stimulator are significantly related to

nursing students’ clinical performance.

4.2 Electronic Simulator and modules for conducting standardized are

significantly related to nursing students’ clinical performance.

4.3 Modules for conducting standardize patient encounter and anatomical

model are significantly related to nursing students’ clinical performance.

5. The Extent of the Effects of Modern Skills Laboratory on Nursing Students

clinical performance.

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 5.1 .It may be inferred that anatomical model has the greatest extent in effecting

nursing students clinical performance because it is the most reliable and easiest way

on transferring knowledge and demonstrating all nursing procedures. The basic of

science and such nursing skills can be summarized as a set of steps that helps the

students transmits skills and abilities through the use of anatomical models.

CONCLUSION

On the basis of the findings of the study, the following conclusions were drawn:

100
 1. The respondents profile described in terms of age, gender and civil status. In

terms of age, ranked first was age 18-20 with 88.43% percentage, in terms of

gender the female and the male with a percentage of 52%, and in terms of civil

status the third year nursing students who are single ranked first with a percentage

of 87%.

2. Modern skills laboratory was described in terms of anatomical model, electronic

simulator and modules for conducting standardized patient en counter. There’s an

indication on that, there exist an effect on all the variables to the nursing students’

clinical performance.

3. Modern skills laboratory affects the nursing students’ clinical performance with

regards to anatomical model, electronic simulator and modules for conducting

standardized patient encounter, but are not significantly different with each other.

4. There is a significant relationship between modern skills laboratory to nursing

students clinical performance. The significant relationship exists between the

three variables and nursing students’ clinical performance.

5. The extent of the effects of modern skills laboratory to nursing students’ clinical

performance was greatly affected by the anatomical model.

RECOMMENDATIONS

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1. There should be a continuous search of knowledge and practice of skills with the

use of modern skills laboratory, on the part of the nursing students for them to

gain and develop the skills

2. All nursing students need to have improvement of their capabilities and the care

they will be brought and administer on the clinical area.

3. All nursing students should try their best on making used of the advantages the

modern skills laboratory could give to them.

4. The School of nursing should improve their Modern skills laboratory facilities to

attract and retain high quality nursing students, with a ultimate goal of improving

the nursing students abilities, potential and knowledge in terms of all the nursing

procedures that a nursing student should mastered to be able for them to give the

optimum level of care.

5. The administration of the college of nursing should try their best to come up with

the good and modern facilities to maintain the best knowledge transmission for

their students.

6. Other researchers in other setting may look into other variables and bigger

population may be linked in nursing students’ clinical performance to arrive at

more conclusive findings.

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 TOMAS CLAUDIO MEMORIAL COLLEGE

COLLEGE OF NURSING

MORONG, RIZAL

April 05, 2010

Dean College of Nursing

Dear Madam,

The undersigned is presently conducting a study entitled “the effect of modern

skills laboratory on the students clinical performance” Knowing your outmost interest in

the value of research as a tool for development. We would like to request a permission to

distribute questionnaires to 3rd year nursing student.

Thank you for your cooperation and immediate response.

Respectfully yours,

Verdillo, Princess D
Villaran, Mariel A.
Researchers
Noted by:
Liwayway M. Piedad RN, RM, MAeD, MAN, Ph.D

103
 TOMAS CLAUDIO MEMORIAL COLLEGE
College of Nursing
Morong, Rizal

_______________
April 5, 2010

Dear Sir/Madam:

Good day!
The undersigned nursing students of Tomas Claudio Memorial College, is
presently conducting a study entitled “The Effects of Modern skills Laboratory on the
Nursing student Clinical performance” which is undertaken in partial fulfillment of the
requirements of Nursing Research under the supervision of Dr. Liwayway M. Piedad
DEAN, College of Nursing, Tomas Claudio Memorial College.

The study aims to determine The effects of modern skills laboratory on nursing
students clinical performance. This could help to evaluate the quality of clinical
performance of Nursing Students.

In the line with the, may we request from your good office the permission to
distribute questionnaires to our respondents (3rd yr students of Our Lady of Fatima), as
our chosen respondents to collect data to this study.

This study will assure the confidentiality of the students.

Respectfully yours,

Princess D. Verdillo
Mariel A. Villaran

Approved by:
DR. LIWAYWAY PIEDAD
Dean College of Nursing

104
Survey Questionnaire

To the Respondents:

This study aims to assess the effects of modern skills laboratory in Level III

nursing students towards their human functioning. The result will help the researcher in

completing the material needed for the accuracy of the study. All the information will be

treated confidentially. Thank you.

I. Profile of the Respondents

( Please supply the necessary information.)

Name: (optional) _______________________ Gender: Male Female

Age: ______ Year Level:_______ Civil Status: Single Married

Effects of Modern Skills Laboratory on the Clinical Performance of Nursing Students

Questionnaire.
The following are statements about the effects of modern skills laboratory on the
clinical performance of nursing students.
Kindly put a [√] check mark on the corresponding statements that you think the most
applicable.
5 -- Strongly Agree
4 – Agree
3 – Uncertain
2 – Disagree
1 – Strongly Disagree

105
Questions 5 4 3 2 1

1.)Anatomical models

1.1. ) Facilitates better knowledge transmission

through demonstration on all the nursing

procedures.

This
1.2. include the average
) Anatomical chartgrades
allowsofnursing
nursingstudents
student, to
level III, enrolled in two of the

practice on make-believe patients to learn,

sharpen and improve skills.

1.3. ) By using anatomical charts and model,

teachers can have detailed anatomy of the

entire human body.

2.)Electronic Simulator

2.1) Nursing students have undergone stimulators

classes have exhibited and improved preparedness to

the clinical areas.

2.2) Simulators allows students to practice basic

skills such as recognizing cardiac sounds (normal and
pathologic), central and peripheral vein access, pelvic
exam, and to use ECG, cardiac monitor and
defibrillator just prior to entering the clinical setting.

2.3). student nurses know how to interpret the results

produced by the instruments they use and aware

of the limitations and possibilities of error

uncritical reliance on values obtained by the

electronic stimulators or machines use in the

hospital.

3.) Modules for conducting standardized patient

encounter

3.1) Standard and Nursing Skill procedures written 106

COLLEGE A.

RESPONDENTS BLOCK A BLOCK B

1 2.4 1.8
2 2.5 2.4
3 2.0 2.1
4 2.1 2.1
5 1.9 1.8
6 2.3 2.0
7 2.3 2.1
8 2.5 1.8
9 2.3 1.8
10 2.3 1.8
11 2.4 2.0
12 2.2 1.7
13 1.9 2.2
14 1.6 1.9
15 2.1 2.3
16 2.0 2.3
17 2.1 2.5
18 1.8 2.3
19 1.8 2.3
20 2.0 2.4
21 1.9 2.2
22 2.3 1.9
23 2.4 1.6
24 2.0 2.1
25 2.2 2.0
26 1.8 2.1
27 2.5 1.8
28 2.5 1.8
29 1.8 2.0
30 2.2 1.8
31 1.8 1.8
32 2.4 2.0
33 2.4 1.7
34 1.9 2.2
35 2.1 1.9
36 2.6 2.3
37 1.8 2.2
38 2.2 1.5
39 2.4 2.1
40 2.6 1.8

107
 41 2.0 1.7
42 2.2 2.5
43 1.8 2.3
44 2.4 1.9
45 2.1 2.4
46 2.1 2.5
47 1.8 2.0
48 2.0 2.1
49 2.1 1.9
50 1.8 2.3
51 1.8 2.3
52 1.8 2.5
53 2.0 2.3
54 1.7 2.3
55 2.2 2.4
56 1.9 2.2
57 2.3 1.9
58 2.2 1.6
59 1.5 2.1
60 2.1 2.0
61 1.8 2.1
62 1.7 1.8
63 2.5 1.8
64 2.3 1.9
65 1.9 2.3

College B.

RESPONDENTS BLOCK A. BLOCK B. BLOCK C. BLOCK D.

1 2.5 2 2.5 2
2 3 2 2.5 2
3 3 1.75 3 1.75
4 2 3 2.75 3
5 2.75 2 3 2
6 2 2.25 2.5 2.25
7 1.7 3 2.25 3
8 2.75 2.75 3 2.75
9 2 2.75 2.25 2.75

108
10 2 2.25 3 2.25
11 1.75 2.25 2.5 2.25
12 3 2.25 2 2.25
13 2 3 2.75 3
14 2.25 2.5 2.25 2.5
15 3 2 3 2
16 2.75 2.75 3 2.75
17 2.75 2.25 2.5 2.25
18 2.25 3 2.75 3
19 2.25 3 2 3
20 2.25 2.5 1.7 2.5
21 3 2 2.75 2
22 2.5 2 2 2
23 2 2.75 2 2.75
24 2.75 1.75 1.75 1.75
25 2.25 2 3 2
26 3 2.5 2 2.5
27 3 2.5 2.25 2.5
28 2.5 2.25 3 2.25
29 2 3 2 3
30 2 2.5 2.75 2.5
31 2.75 2 2 2
32 1.75 2.75 1.7 2.75
33 2 2.25 2.75 2.25
34 2.5 3 2 3
35 2.5 3 2 3
36 3 2.5 1.75 2.5
37 2.75 2.5 3 2.5
38 3 3 2 3
39 2.5 3 2.25 3
40 2.25 2 3 2
41 3 2.75 2.75 2.75
42 2.25 2 2.75 2
43 3 1.7 2.25 1.7
44 2.5 2.75 2.25 2.75
45 2 2 2.25 2
46 2.75 2.75
47 2.25 2
48 3 1.7
49 3 2.75
50 2.5 2
51 2
52 1.75
53 2.5

109
 54 3
55 3
56 2
57 2.75

CURICULLUM VITAE

Princess D. Verdillo
732 Sumulong St. Brgy. San Juan Morong Rizal
213-6002/ 09291226168
cessliam14@hotmail.com

Personal Information
Date of Birth: May 03, 1987
Place of Birth: Caloocan City
Citizenship: Filipino
Gender: Female
Civil Status: Single

110
Tertiary
Our Lady of Fatima University 2005 - 2006 Bachelor of
Valenzuela City. Science in Nursing
Tomas Claudio Memorial College 2007 up to present Bachelor of Science
Taghangin, Rizal in Nursing

Secondary
St Mary’s Academy of Caloocan City 2000-2004 1st – 4th yr
Caloocan City

Elementary
St Mary’s Academy of Caloocan City 1993- 2000 Kinder – Grade 6
Caloocan City

Awards and Accomplishment

• Bronze medalist in Caloocan Taekwondo Regional Schools Division
• Active member of Taekwondo club in High Schoo

CURICULLUM VITAE

PERSONAL DATA:
Name: Mariel A. Villaran
Address: 489 M. Alejandro St.
Jalajala, Rizal
Gender: Female
Civil Status: Single
Citizenship: Filipino
Age: 19
Date of Birth: May 22, 1991
Birth Place: Morong Rizal
Religion: UNACAED
Name of Father: Marcello F. Villaran
Name of Mother: Luzviminda A. Villaran

111
EDUCATIONAL BACKGROUND:
ELEMENTARY:
Sipsipin Elemantary School 1998-2003
SECONDARY:
Saint Michael Parochial School (SMPS) 2003-2005
Jiane Therese International School (JTIS) 2005-2007
TERTIARY:
Tomas Claudio Memorial College (TCMC) 2007-Present

AWARDS AND RECOGNITION

• Gold medalist in Chess girl school division in Rizal. 2002-2003
(Player of the year)
• Silver medalist Secondary division on Chess.
(Representative to REPRISA)
• Active member of Badminton, Drama and Chess club during High school.
• Received a 5th place academic award during third year high school.
• Graduate as First Honourable mention in High school.

112