Chapter 1

Introduction

Clinical learning experience is located at the center of nursing education and it is

the basis for the development of professional nursing. The empowerment of nursing

students occur during clinical learning in a complex and dynamic learning environment.

Student nurses have different clinical experiences, most especially when they are placed

in a private and public hospital setting. Moreover, it has been a fact that there is indeed a

huge difference in learning’s provided in terms of environmental factors. Clinical

exposure in the nursing field during the undergraduate years is an integral part of the

education. Student nurses are taught to prepare themselves to be able to do and know

certain aspects in providing and giving care to the patients. The clinical scope will help

stimulate the students to think critically to be able to solve problems in regards with the

needs of their patients.

As discussed in a concept analysis type of literature, there are four attributes that

affect the learning experience of the students. These in the form of physical space,

psychosocial and interaction factors, organizational structure and teaching and learning

components (Flott & Linden, 2015). With these characteristics provided and determined

an environment that has all the positive attributes of the four given characteristics will

likely lead to determining the positive learning outcome of the students, as well as their

self-confidence in their chosen field of expertise.

Although nursing education is a combination of theoretical and practical learning

experiences that enable nursing students to acquire the knowledge, skills, and attitudes

for providing nursing care globally, clinical training of nursing students is seen as the
10

basis of nursing practice. Nursing students need to be supported and guided so that they

can become responsible, accountable, and independent professionals who are able to

function within the scope of professional practice.

A Study conducted in Botswana revealed that nursing students failed to apply

theory into practice because they lack adequate supervision in the clinical area which

results to low performance in their clinical practices. It has been reported that clinical

instructors’ attitudes affect performance of nursing students in the clinical area. Positive

attitudes and supportive environment encourage students learning environment.

Constructive criticism improves practice in the clinical setting while negative criticism is

an obstacle for effective clinical performance. Limited chance for hands on practice in

training hospitals, shortage of nurse tutors, clinical instructors, and too many students in

the program can negatively affect performance of students in clinical practice. According

to Chun (2016), inappropriate clinical evaluation method, linguistic and intercultural

competence difficulties are some of the challenges. Lack of prior clinical experience,

unfamiliar areas, difficult patients, fear of making mistakes, and being evaluated by

faculty members were expressed by the students as anxiety-producing situations in their

initial clinical experience.

For higher education institutions that offer health-related courses, it is a relevant

and significant concern that they choose and support partnerships in clinical learning

environments that will provide quality clinical experience, to aid in providing the society

with future competent health care providers (Papastavrou, Dimitriadou, Tsangari &

Andreou, 2016). In context to the importance of clinical exposure to the nursing

education, the study by Jamshidi, Molazem, Sharif, Torabizadeh and Najafi Kalyani
11

(2016) discusses that “the clinical area of nursing education is of great importance for

nursing students in the selection or rejection of nursing as a profession.” With this, an

integration of both theory and practice with good clinical supervision could enable

student nurses expand their knowledge, increasing their confidence with their own

abilities and competence.

The purpose for this study is to reduce future errors and provide health consumers

with caregivers who are competent in their own craft. In this case, student nurses are

molded to become one of the first-line responders to emergencies and bedside care. Their

impact on the lives of their patient will show a nurtured community. Therefore, the goal

of this study is to examine the difference of clinical exposure of student nurses when they

are placed in the public and private hospital setting, providing insight to develop an

effective strategy and policy in nursing education.

Research Questions

This study was conducted to determine and compare the experiences of student

nurses in the public and private hospital setting. More so, the objective of the study aims

to answer the following questions:

1. What is the extent of clinical exposure of the respondents of private hospitals in

terms of:

a. skills,

b. environment and

c. patient?

2. What is the extent of clinical exposure of the respondents of public hospital in

terms of:
12

a. skills,

b. environment and

c. patient?

3. Is there a significant difference on the clinical exposure of the respondents

between private and public hospitals?

4. Is there a significant difference on the clinical exposure of the respondents

between private and public hospital when moderated by:

a. Age;

b. Gender and

c. Year Level?

Hypotheses

The following hypotheses were formulated based on the research questions listed

above:

1. There is no significant difference on the clinical exposure of the respondents

between public and private hospitals.

2. There is no significant difference on the clinical exposure of the respondents

when moderated by age, gender, and year level.

Significance of the Study

The findings of this study would benefit students not only in nursing but other

health-related profession. The greater demand of knowledge about this matter will reveal

whether a need for more effective, teaching approaches and exposures is needed to ensure

competent health professionals in the future. Moreover, specific groups will see this study

and its results as beneficial to:

13

School Administrators. The study will be a start for the initiating of innovation

within the academe, uncovering new methods in the development of the quality nursing

education under their nursing and health-related programs.

Colleges of Nursing. This will help administrators in the nursing programs

understand the everyday experiences of their students and will uncover new measures to

implement policies that will cater to the needs of the students as they achieve for greater

heights in their endeavour as giver of care.

Clinical Instructors. The study will help clinical instructors understand the

perception of their students towards their clinical exposure, which in turn, will serve as

basis for evaluation on the current teaching approaches and eventually address the needs

of their students.

Student Nurses. The study will promote confidence that could aid to control their

fear and anxiety, and choose to maximize learning and quality of service they will render

to their patients during their clinical duty.

Future Researchers. The pages of this study will provide additional information

leading them to contribute new knowledge for the current available data regarding this

topic and to conduct further studies.

Scope and Delimitation

The study was centered on the clinical exposure of student nurses within public and

private hospital settings. Samples were comprised of 77 students under the BS Nursing

program who were enrolled for Academic Year 2019-2020, in a private higher education

institution situated in Metro Manila, who had their clinical duty in both public and private
14

hospitals. However, the Level 1 nursing students were eliminated to participate due to not

having been exposed to clinical duties.

Theoretical Framework

The Experiential Learning Theory was used to anchor the primary objective of this

research study. The theoretical framework is authored by David Kolb in 1984.

Figure 1.

Kolb’s experiential learning theory (ELT). Adapted from Experiential Learning

Theory: A Dynamic, Holistic Approach to management Learning, Education and

Development, by A. Y. Kolb & D. A. Kolb, 2009.

Concrete
Experience (CE)

Accommodating Diverging
Active Reflective
Experimentation Observation
(AE) (RO)
Converging Assimilating

Abstract
Conceptualization
(AC)

According to Kolb, Boyatzis, and Mainemelis (1999) the theory suggests that a

certain experience is transformed into knowledge, creating a process which is called

“learning.” Additionally, this theory includes two modes of obtaining or grasping

experience which includes Concrete Experience (CE) and Abstract Conceptualization

(AC), and two modes that transform experience which are Reflective Observation (RO)

and Active Experimentation (AE). In this four-stage cycle, concrete experiences will lead

to observations and reflections. As they watch, abstract will be conceptualized, which

15

will lead to thinking and idealization. Once abstract is conceptualized, actual

experimentation will then occur.

Kolb, Boyatzis and Mainemelis (1999) further clarifies that the “watchers” tend to

favor reflective observation, while the “doers” favor active experimentation.

Research Paradigm

Independent Variable Dependent Variable

Public and Private Clinical Exposure

Hospital Skills
Environment
Patient

Moderating Variables

A. Age
B. Gender
C. Year level

Figure 2.

Research Paradigm on clinical exposure of student nurses in public and private

hospitals.
16

Definition of Terms

Environment. The setting of which the student nurses is exposed.

Clinical exposure. Field of experience and activities for student nurses which

includes being exposed in the actual healthcare setting.

Skills. Interventions performed by student nurses in the hospital duty.

Student nurse. Person who is studying or training to become a nurse.

Patient. Person who utilizes healthcare services which are handled by student

nurses during their clinical exposure.

Private hospital. A hospital owned by a company or organization and privately

funded through payment for medical services by patient consumers.

Public hospital. A hospital owned by the government, which provides medical

care free of charge.

 Chapter 2

Review of Related Literature

This chapter provides local and international related literatures and studies on the

clinical exposure of student nurses in public and private hospitals.

Nursing Education in the Philippines

A study by Masselink and Lee (2010) suggested through their results that nursing

schools in the Philippines have provided migration opportunities for undergraduate

student nurses for expanding student diversity within the nursing education. In context to

the result provided by Masselink and Lee, despite the increasing need for nurses in the

local setting, many are not swayed by this problem and are blindsided by the

opportunities that other countries can offer plus the negativity that may have been

contributed by early clinical exposure among student nurses, affecting their judgment and

insights on the health care delivery system in the country.

However, student nurses are taught and trained thoroughly, learning to respond first

hand on emergencies, provide care at the bedside, and most especially, the art and science

of caring is embedded within them in the course of four years (Usher et al., 2015). After

years of education, as discussed by the Bureau of Local Employment – Department of

Labor and Employment in an online article, (n. d.), the BSN degree qualifies them to

practice the nursing profession, however, another factor to become a full-fledged

registered nurse is that one must be able to pass the board examination to obtain official

license issued by the Professional Regulation Commission (PRC). In the Philippines,

approximately about more than 100,000 student nurses graduate each year (Labrague,

McEnroe-Petite, Gloe, Tsaras, Arteche, & Maldia, 2016).

18

In terms of clinical exposure, the BS Nursing curriculum in the Philippines includes

Related Learning Experience (RLE) as part of the requirements to be completed to be

able to be conferred with such degree. This is a teaching approach for the student nurses

to develop the competencies required in the field of nursing. In view of this, the RLE

approach is applicable in two areas, the guided practice in the skills laboratory and in the

actual clinical exposure. The clinical exposure should at least have 33.5 RLE units, or

1,708.5 hours for the 13 major subjects with RLE (Commission on Higher Education

[CHED] Memorandum Order No. 14, series of 2009).

Clinical Exposure

Nurses’ competence is based on the knowledge and skill taught to them (p. 1),” as

discussed by Jamshidi, Molazem, Sharif, Torabizadeh, and Najafi Kalyani (2016).

Learning skills on hand, and on a real patient will increase both confidence of the student

nurse to execute such intervention. Though classroom education has been a conventional

intervention for students to obtain knowledge, clinical training will provide opportunity

for students to convert classroom-obtain knowledge into practice.

According to the research authored by d’Souza, Karkada, Parahoo, and

Venkatesaperumal (2015) which focused on the clinical learning environment of nursing

students in Oman, through this exposure, students are able to develop “independence,

critical thinking, and clinical judgement, problem solving skills, ethics, safety practices,

and sense of responsibility (p. 833).”

Clinical experiences and the factors that come along will contribute to the learning

of student nurses. Every exposure can waste a great deal of time and energy, and over and

above that, nursing education and the clinical exposure impose burden financially for
19

both student and parents. Poor clinical exposure and supervision can cause and

compromise patient care. Furthermore, the same qualitative literature provides result with

two themes from the analysis of their data, and one of the two themes was unsupportive

learning environment as students’ clinical learning challenges (Baraz, Memarian, &

Vanaki, 2015). Further, a literature emphasizes that four aspects affect a student’s

exposure in the clinical area, and in the physical aspect, facilities, material equipment,

and learning tools were presented to have great contribution in one’s learning

(Haraldseid, Friberg, & Aase, 2015).

In terms of environment and supervision during clinical exposure, different medical

institutions have their own way of handling student nurses in their workplaces, creating

policies, objectives and guidelines to assist student nurses. A study by Moyimane,

Matlala, and Kekana (2017) discusses the objective of clinical practice for student nurses

mandated by the South African Nursing Council which provides the up and coming

registered nurses of meaningful learning opportunities in all ears of clinical placement to

ensure that, when the time of completion comes, these student nurses will be able to

provide quality nursing care to their patients on their own judgement.

Private Hospital

Healthcare institutions are learning environments for nursing students. Hospital

leadership styles, mentorship, supervision, communication, acquitting with the registered

and experienced nurses are factors that affect nursing students in one way or another.

Over and above that, it is a place where nursing students potentially develop their skills.

Thus, theories should be translated into practice so that students can experience working

in the real-life situation.

20

Ward et al. (2015) “For private patient, the centrality of choice meant that private

doctors were described as being required to ‘pick up their game’ in order to increase or

sustain their reputation, thus enhancing quality and trust. They made comparison with

doctors in public hospital who, apparently lacking in incentives around competition,

correspondingly were perceived to provide lower quality care.” .In this study they found

out that private hospital provide more quality and trustful patient care than government

hospital. And it showed that patients that stay in a private hospital feel safer and more

confident to get well.

Additionally, a study by Ward et al. (2015) presented through their results that the

quality and trust provided by the private hospital are better than of public hospitals. With

this information at hand, this is also a possibility that a better learning outcome can come

from private sectors for they provide quality care, which is ideally taught in the nursing

education as well.

Public Hospital

Many studies have already been conducted for the past few years to understand the

impact of Private hospital and Government hospital. According to (Mehran et al., 2016)

the health service of private hospital is higher than Government hospital. “Because the

issue of health services quality is important for customers, the importance of the findings

is that we can focus more on weaknesses and, by taking appropriate facilities and

equipment and paying more attention to amenities for customers, improve the public

sector. It’s suggested to improve the quality of public services by updating medical

equipment and paying more attention to amenities, competence, and experience of health

care workers especially in teaching hospital (because of the use of student)”.

21

The Philippine health care system consists of hospitals that are either publicly

owned by the government or privately own by non-government organizations (Picazo,

2015). And with this, this becomes a criteria for health consumers, for it has been

embedded among individuals that the public and private sectors provide services that are

not of the same level when it comes to promoting health services of quality (Alijanzadeh

et al., 2016). Moreover, among the perspective of the respondents, proper medical

equipment and appropriate facilities for patents were two of the qualities that showed

significant difference between the public and private sectors (p < 0.05). In contrast to a

study by Haraldseid, Friberg, and Aase (2015), it was revealed in the study that they have

conducted that four aspects affect a student’s exposure in the clinical area, and in the

physical aspect, facilities, material equipment, and learning tools were presented to have

great contribution in one’s learning. With these qualities lacking, clinical exposure

among these sectors can severely affect and impact the students’ confidence and

professional growth and development when they are not able to put their theoretical

knowledge into practice.

In contrast, another study has found that the public and private hospital setting

presents no significant differences. In terms of patients treated, the public sector tends to

cater slightly older individuals who may also have a lower socio-economic status, riskier

lifestyle and higher morbidity rate than of the private hospital setting. More so, the study

emphasizes that the quality provided by both sectors are the same, however, in similar

views with other literatures, the private sector tend to have the latest and a higher number

of equipment compared to the public sector, which usually obtains their funding from the

government (Tynkkynen & Vrangbæk, 2018).

22

Clinical Exposure and Skills

Clinical duties are the riskiest professional jobs ever, and a simple mistake can

cause one’s life unexpectedly. In order to execute certain skills and interventions

appropriate to their patients, clinical exposure is a very important factor to obtain enough

knowledge to save one’s life (Noviyanti, Handiyani, & Gayatri, 2018).

Research showed that nursing students still lack the appropriate skills toward

patient safety. The study by Solvik and Struksnes (2018) revealed several findings in

regard to skill development. Majority of nursing students reported that although exercise

in the clinical lab is one of many ways to prepare a student for practice, they were not

able to perceive the difference in resemblance of occurrences of exercises in the actual

hospital setting. Lastly, students with previous experience were less confident to master a

certain procedure in the clinical practice.

Similarly, another literature found that clinical practicum aids nursing students to

acquire practical knowledge rather than theoretically, for this allows the students to apply

what they have learned in the classroom setting towards the real-life situation, hence,

leading to the students to improve their skills, providing effective services. This somehow

places stress among students as well, affecting their academics the most, especially when

additional tasks are given to the student nurses. However, in summary, the student nurses

who responded on the study believed that clinical exposure improved their skills in the

nursing practice (Adjei, Sarpong, Attafuah, Amertil, & Akosah, 2018).

Clinical Exposure and Patient

It is well known that patients’ involvement in health care students’ learning is

essential and gives students opportunities to experience clinical reasoning and practice
23

clinical skills when interacting with patients. Students encounter patients in different

contexts throughout their education. Patients can provide opportunities for students to

practice clinical skills and to provide information as experts of their own illness or

disability. Patients may be real patients or actors who have been trained to simulate

illness and teach or instruct students. Looking across the research on patient involvement

in students’ clinical training reveals a lack of knowledge about the learning processes that

actually occur in encounters between health-care students’ and patients in clinical

settings.

Research has shown that patients’ experiences of their own involvement in

students’ learning are mainly positive and they are accustomed to the presence of

students. Patients may express feelings of empowerment and self-worth by sharing

experiences of illness and care and by letting students train practical skills. Helping

students to learn can also give patients satisfaction. However, not all experiences are

positive.

Suikkala and Leino-Kilpi (2005) found that the relationship between patients and

students has an impact on students’ learning. Students can focus on either just performing

tasks given by supervisors or performing care directed by the patients’ requirements and

expectations. Stockhausen (2009) emphasizes that learning occurs through the

relationships between patient and student. So research suggests that the nature of the

relationship between patient and student is important both for patients’ experiences and

for students’ learning. Manninen et al. (2013) found that a mutual relationship between

patient and student constitutes the basis of students’ learning. When this mutual

relationship exists, students experience external and/or internal authenticity in their

24

learning process. External authenticity is experienced by being at a real ward and taking

care of real patients. Internal authenticity refers to the experience of belonging by

creating a relationship with patient and making a contribution to their care.

The literature reports, despite feeling a moral obligation to act, most nursing

students lack the moral courage to intervene or speak up when faced with poor practice.

While students may subsequently report the behaviour, at the time of the event, they often

remain passive spectators and sometimes even active participants. The major themes

identified in the literature were: just a student, fear of consequences, mentor–student

relationship, and patient advocate identity. The literature also identified that nursing

students suffer ongoing moral distress when they do not have the courage to confront

poor practice.

The perspective of real patients focused on their role in students’ learning and

assessment processes. In general, patients appreciated the opportunity to contribute to a

student’s learning process and thus enhance the quality of patient care. However, the

patients’ approaches varied from active to passive participants, comprising active

participants contributing to students’ learning, followers of care and advice, and learning

platforms with whom students practiced their skills. Some patients perceived themselves

as active participants who facilitated students’ learning by sharing knowledge and

experience about their own care and wellbeing as well as assessed students’ performance

by providing encouraging feedback.

Previous research has shown that patients generally accept student involvement in

their care. A review including studies in general practice concludes that a majority of

patients, 83% to 98%, consent to a student’s presence or participation in consultations.

25

The patients’ acceptance of student participation has been related to the type of

examination, what kind of illness or problem is being addressed as well as to what degree

the student is working alone or with the professional. Patients have reported that the

situation is more delicate when students participate in physical exams and are more

comfortable when the focus is on gathering information and anamneses. However,

patients seem to be less comfortable with students when the consultations include

personal or intimate problems. More patients are willing to take part in the education

process when there is a professional present, especially in the case of more invasive and

technical procedures. Patients would be more positive towards students independently

performing the questioning or counselling if they also had the possibility to meet with the

doctor alone.

Patients’ previous experiences of student participation have been related to a more

positive attitude towards conceivable student involvement. Positive first-time experiences

of student participation contributed to the patient’s positive attitude towards continuing to

allow students to be involved in their care; 95% would let the same student participate,

and 90% would let any student participate. Among patients who were negative towards

student involvement, a majority had negative past experiences of student participation.

Good atmosphere and mutual relationships are of importance for patients’

participation in students’ learning process as active participants. In the present study, the

patients are engaged in students’ learning but differ in the extent to which they are active

participants or just letting the students practice on their bodies. Patients’ active

participation can develop into a learning relationship providing rich opportunities for
26

students to learn from and with the patients. Monrouxe et al. (2009) found that patients

usually participate passively as objects rather than as subjects in students’ learning.

Debyser et al. (2011) also stress the patients’ appreciation for students spending

time with them. This study shows that when the students are interested in patients as

individuals and subjects, not solely as objects on which to practice, they manage to create

a good atmosphere. Similarly, the patients become interested in the students and are

willing to help them to learn. This interaction between patients and students can result in

a mutual relationship.

When students and patients work together they also engage in a meaning-making

process that potentially results in transformative learning and knowledge construction.

When students assume a holistic approach to the patients’ situation, the encounters

become meaningful for both of them. By relating experiences with the patients to their

previous knowledge, the students enhance their understanding and readiness for future

encounters. They construct this new understanding based on the encounters with patients

as active participants. The patients gain knowledge and experience by contributing to

students’ learning. In Manninen et al. (2013) students expressed that they learned from,

through and with the patients. The present study shows that when students are patient-

centered the learning becomes a joint action where patients are active participants and the

mutual relationship develops into a learning relationship.

Clinical Exposure and Environment

Environment, when it comes to an attribute of the workplace, is one of the

inevitable factors that either brings positive or negative changes. This environment can be

affected by different factors. Leadership style, pedagogical atmosphere, nursing care on

27

the ward, and nurse teacher are some of components of environment that cause change in

the workplace. Victor, Ishtiaq, and Iqbal (2016) conducted a research on the perception of

clinical environment among nursing students of a private college of nursing in Pakistan.

Utilizing an analytical cross-sectional survey, this determined that out of the 195

respondents, 88 (45.13%) showed to some extent agreement on pedagogical atmosphere,

91 (46.67%) showed to some extent agreement on leadership style of ward manager,

nursing care on the ward and role of nurse teacher 21.54% (42) and supervisory

relationship 20% (39) respectively. Over all, the respondents exhibited high positive

perception, further concluding that “clinical learning is vital in nursing education as it

forms the basis of clinical practice and patient care, therefore, positive perceived

environment is imperative for the nursing students (p. 33).”

Clinical environment can be more appreciated when there are effective leadership,

supervision, and mentorship in the hospital setting. Clinical learning environment is so

important for student nurses because it aids the students to develop self-confidence and

improve their communication skill with the patients that they encounter. Study revealed

that the application of theories in to practice in the learning environment is very minimal

with reports from students that experienced nurses were not willing to show and share

their skills and knowledge with them (Adjei, Sarpong, Attafuah, Amertil, & Akosah,

2018).

Clinical Exposure among Student Nurses in terms of Age

The study authored by Solvik and Struksnes (2018) revealed in their findings that

age did not impact the students’ confidence in mastering certain interventions and

exercises in the clinical practice.

28

In contrary, a literature has provided evidence that mature aged nursing students

performed a significant higher level of success during their clinical exposure. However,

future researches are recommended to further advance the understanding of the complex

relationship between extrinsic and intrinsic factors of mature age students and their

academic success in higher education (Hayden, Jeong, & Norton, 2016).

Clinical Exposure among Student Nurses in terms of Gender and Year Level

In a descriptive cross-sectional study conducted to determine the nursing students’

perspective on clinical education, 150 nursing students were selected to take part. Results

revealed that the male and female students had different perceptions in several domains

of the clinical education (Heidari & Norouzadeh, 2015).

Given that male nursing students represent a small percentage of the student

population of the nursing program today, a study by Sedgwick and Kellett (2015)

revealed that male students demonstrated significantly lower scores on the efficacy

subscale (p = 0.02), suggesting that males have experienced more feelings of

marginalization and discrimination with the profession, and these can severely affect their

performance which creates more bias.

In contrast, another study has included that one of the variables that influences

clinical stress among nursing students is gender, however, in statistics, there is no

significant relationship between clinical practice stress and gender (p = 0.013).

Additionally, year level, conversely did show statistical significance, which is

suggestive that senior nursing students, or those on their fourth and final year has

reported that they have been experiencing clinical practice stress (p<0.001) (Lee, You, &

Park, 2015).
 Chapter 3

Methodology

This chapter presents the research design utilized, the locale of the study, sampling

technique used, the instrumentation used for data collection, and the statistical treatment

of data.

Research Design

The study utilized a descriptive-comparative design of quantitative research. This

type of research design is one of the most basic, focusing solely in seeking to describe

phenomenon that occurs, and how they vary (Esser & Vliegenthart, 2017). This study

examined the experiences of student nurses during their clinical exposure in both the

public and private hospitals. The study also objectifies the extent of clinical exposure of

the nursing students in terms of the environment, patient and skills.

Population and Sampling

The population of this study consisted of students enrolled under the BS Nursing

program for the first semester of the Academic Year 2019-2020 of a private higher

education institution in Metro Manila. A total of 77 respondents were chosen, using the

purposive convenience sampling technique. However, an inclusion criteria eliminates the

level one nursing students for they are not currently exposed in the clinical areas.

Respondents were coming from the sophomores (n = 32), juniors (n = 27), and senior

nursing students (n = 18) who had their clinical exposure to one private hospital and five

public hospital.
31

Age Group. Among the 77 respondents who took part in the study, 19 (25%)

were categorized under the 18 to 19 year old age group, while 36 (47%) were under the

20 to 21 year old age group. Moreover, 22 (29%) out of 77 respondents are 22 to 36 year

old age group.

45

36

27

18

0
18 to 19 years old 20 to 21 years old 22 to 36 years old

Figure 3

Demographical distribution of the Respondents according to Age Group

Gender. Figure 4 shows the percentage distribution of the respondents in which

there are 50 females and 27 males.

32 23%

42%
Female Male 2nd Year
3rd Year
4th Year

35%
35%

65%

Figure 4

Demographical distribution of the respondents according to Gender

Year Level. Figure 5 depicts three year levels, from second year, third year and

fourth year nursing students who took part in the research study. The most respondents

came from the sophomores with 42% (n = 32) of the total sample size while the least

number of respondents came from the senior class garnering only 23% (n = 18) out of the

total population.

Figure 5

Demographical distribution of the Respondents according to Year Level

33

23%

42% 2nd Year

3rd Year
4th Year

35%

Data Gathering Procedure

In obtaining the complete list of student nurses of the private higher education

institution, the researchers sought the approval of each appropriate corresponding

department with a written letter, with full disclosure of the purpose of the study, and an

assurance that data privacy was strictly implemented.

Statements or items, together with a demographic data checklist was handed and

distributed among the chosen respondents through a self-constructed survey-

questionnaire which focused on the clinical exposure of student nurses within public and

private hospitals.

Researchers begun the data gathering in which the respondents answered the

questionnaires on their own, to promote autonomy and provided explanation if asked to

do so. After gathering all the questionnaires from the respondents, the researchers

disclosed all information regarding the study and assured that confidentiality of data was

provided and that no other persons not related or connected within the research study

took hold of the accomplished questionnaires. The accomplished questionnaires are

placed in a safe box and were encoded for data analysis.

Instrumentation
34

The tool utilized to gather the needed data was through a self-constructed survey

questionnaire which measured the experiences of student nurses during their clinical

exposure in public and private hospitals. The questionnaire uses a 4-point Likert scale to

indicate and described whether the student nurse ‘never’, ‘seldom’, ‘frequently’, and

‘always’ experience certain intervention during their clinical exposure.

The survey questionnaire used to gather the data from the respondents undergone

validity and reliability testing. For the validity process, content validity was used and 4

research experts were chosen. Next, reliability testing was done through conducting a

pilot study which utilized 20 respondents. Items on public setting received a Cronbach

alpha score of .881 while items on private setting received a Cronbach alpha score

of .952, which both result scores deemed reliable.

Statistical Treatment

To be able to answer the objectives of this study, both descriptive and inferential

statistics was utilized. The extent of clinical exposure to both public and private hospitals

in terms of environment, patient and skill, descriptive statistics such as frequency

distribution, percentage and mean was used.

Further, inferential statistics such as independent t-test and MANOVA was used to

determine the difference between clinical exposure to public and private hospital when

the respondents are grouped according to their demographics, such as age, gender and

year level.

Table 1

Scoring interpretation to determine extent of clinical exposure

Mean Verbal Interpretation

35

1.00 — 1.75 Poor

1.76 — 2.50 Moderate
2.51 — 3.25 High
3.26 — 4.00 Very high

Ethical Considerations

This study considered all participation as voluntary and allowed chosen

respondents to withdraw their chanced to accomplish a questionnaire if they wish to do

so. They are also provided with a letter of invitation to participate and an informed

consent form filled with information regarding the study, adapted through the informed

consent forms template provided by the World Health Organization. This research study

has undergone the ethics review board of Manila Adventist College. To add, respondents

were given privileged to privacy and confidentiality and rest assured that all the articles

incorporated within the pages of this manuscript was acknowledged.